eHealth Exchange Transition
Update
October 2, 2012
Mariann Yeager
Interim Executive Director
Healtheway, Inc.
703-623-1924
myeager@healthewayinc.org
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Discussion Topics
• Context
• eHealth Exchange
• eHealth Exchange Strategic Road Map
• State engagement
• Transition Strategy
• Healtheway
• eHealth Exchange Anchor Participants
• Healtheway Members
• Cross-industry Collaborative Initiatives
• Harmonized testing program with HER HIE Interoperability
Workgroup
• Q&A
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Context
• Nationwide Health Information Network (NwHIN): A set of
standards, services and policies deemed by ONC as NwHIN.
• eHealth Exchange: A community of exchange partners who, via
a contractual relationship, share information using NwHIN or
other standards, services and policies.
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Started as an NwHIN program initiative in 2007
Transitioning to public-private partnership in 2012
Rebranded as eHealth Exchange
Healtheway assuming operational support, starting Oct 2012
• Healtheway: non-profit organization chartered to support the
eHealth Exchange
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eHealth Exchange Strategic Road Map
Phase 1
Phase 2
Mature,
Grow, Scale
Initial Rollout
(2009 – 2011)
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Early adopters
Federal business cases
Shared infrastructure
Early lessons learned
Success / viability
ONC program pilot
concludes
Production ramps up
Phase 3
Sustainability
2014
2012-2013
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Transition to publicprivate model
Grow participation
and transactions
Refine and scale
Expand value cases
Align with NwHIN
governance
Implement
sustainability model
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Continued growth in
participant and
transactions
Revenue model
sustains operations
Nationwide
deployment
Interoperable
exchange among
private entities
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eHealth Exchange Vision / Mission
• Vision
• To serve as a critical element of the nationwide health
information infrastructure; and
• To improve the health and welfare of all Americans through
health information exchange that is trusted, that scales, and
enhances quality of care and health outcomes by supporting
comprehensive longitudinal health records.
• Mission
• To expand trusted, secure and interoperable exchange of health
information across the nation by providing shared governance
and necessary shared service to public and private organizations
who wish to interconnect as a network of networks.
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eHealth Exchange Participants and
Technology Partners
• eHealth Exchange Participants:
• Rapidly growing community of exchange partners
• Facilitate and govern exchange, meet eligibility criteria and
successfully complete production readiness testing of ExchangeReady system
• 34 organizations in production, representing hundreds of hospitals,
thousands of providers and millions of patients
• Another two dozen organizations in the pipeline
• Dramatic growth, primarily in private sector
• Technology Partners
• Provide Exchange-Ready technology solutions to eHealth Exchange
Participants
• Approximately 20 solutions support participants, with rapid growth
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eHealth Exchange Participants*
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Alabama One Health Record
Centers for Medicare and Medicaid Services
(CMS)
Childrens’ Hospital of Dallas
Community Health Information Collaborative
(CHIC)
Conemaugh Health System
Department of Defense (DOD)
Department of Veterans Affairs
Dignity Health
Douglas County Individual Practice Association
(DCIPA)
Eastern Tennessee Health Information
Network (etHIN)
EHR Doctors
HealthBridge
HEALTHeLINK (Western New York)
Idaho Health Data Exchange
Inland Northwest Health Services (INHS)
Kaiser Permanente
Lancaster General Health
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Marshfield Clinic
Medical University of South Carolina (MUSC)
MedVirginia
MultiCare Health System
National Renal Administrators Association (NRAA)
New Mexico Health Information Collaborative
(NMHIC)
North Carolina Healthcare Information and
Communications Alliance, Inc. (NCHICA)
OCHIN
Quality Health Network
Regenstrief Institute
Social Security Administration (SSA)
South Carolina Health Information Exchange
(SCHIEx)
South East Michigan Health Information Exchange
(SEMHIE)
Strategic Health Intelligence
University of California, San Diego
Utah Health Information Network (UHIN)
Wright State University
* 6 others in activation stage
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State Engagement in eHealth Exchange
• Current status
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4 in production
1 in activation
2 engaging in pilot of new testing program
11 others in the pipeline
• Approaches
• Coordinated with state:
• States connect to eHealth Exchange as a participant (e.g. SC)
• States refer regional HIEs to join eHealth Exchange (e.g. NY)
• Complimentary
• Regional HIO joins Exchange since states focus on other types of exchange
modalities (TN)
• Bridge
• Health System joins Exchange until state is in production (e.g. HI)
• Independent
• Health systems or regional HIOs join Exchange independent of state effort
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Technology Solution Providers*
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ApeniMED
Aurion
Axolotl
CareEvolution
CGI
Cogon
CONNECT
CSC
Epic
Harris
K Force
MEDecision
MedFX
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Medicity
Mirth
MobileMD
Northrop Grumman
OneHealthPort
Orion Health
SAIC
Talis
Thompson
Vangent
Wright State Research
Institute
* Plus other vendors engaged EHR HIE Interoperability Workgroup
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National Return on Investment
• Efficiencies and cost savings realized to date through multi-party
trust agreement, shared infrastructure and governance
• Significant potential savings by lessening the burden of testing
prior to exchanging with a new partner
• Expands coverage throughout the US, reaching hundreds of
hospitals, thousands of providers and millions of patients
• Incremental costs per participant decrease as participation
grows, lowering the costs to HIE, while enabling HIE to scale
nationwide
• Value to clinical decision making and cost savings increase
exponentially with utilization
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eHealth Exchange Benefits
Implement
once,
exchange with
many
Functional
and scalable
shared
services
Recognition as
part of trusted
community
Value
Proposition
Enforced
compliance
and
accountability
Expanded
connectivity
Cost effective
and efficient
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TRANSITION STRATEGY
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Transition Goals and Objectives
• Remain aligned with the national strategy
• Facilitate a smooth transition from ONC to a non-profit publicprivate endeavor, while assuring continued growth and
continuity of eHealth Exchange operational support
• Double participation in the eHealth Exchange and increase
utilization by 50%, with ability to support a full rollout in 2013
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Current – Future State
Current
• ONC NwHIN initiative NwHIN Exchange
• Coordinating Committee*
• DURSA*
• Onboarding & testing
facilitated by ONC
• Operations supported /
funded by ONC
• Services provided to
participants for free
Future
• Public-private initiative eHealth Exchange
• Coordinating Committee*
• DURSA*
• Testing facilitated by testing
body designated by CC
• Operations supported/ funded
by Healtheway
• Participants begin paying for
services in future
* Unchanged
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Exchange Trust Framework Unchanged
• DURSA remains in full force and effect
• Coordinating Committee retains all authorities as specified in
the DURSA
• Healtheway board does not have any oversight responsibilities
with respect to eHealth Exchange, but will operate under an
agreement with the Coordinating Committee
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Exchange – Healtheway Interactions
eHealth
Exchange
Federal
Participants
May wish to join
as members
Industry
eHealth Exchange
Participation Fees
State
Participants
Healtheway
Join
Private
Participants
Eligible for CC
Representation
Exchange
Coordinating
Committee
Select Healtheway to
run Exchange / CC
operations
Exchange / CC
Operations
Support Program
Healtheway
Community
Collaboration
Program
Contract
Select
Exchange Testing Body
Certificates
Staff, legal
support
Service
Registry
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Exchange CC – Healtheway Board Functions
eHealth Exchange
Coordinating Committee
Federal
Participants
State
Participants
Healtheway Board
Appoint
3 CC
Reps
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Oversee eHealth Exchange
participation
Approve specs, test guides, policies
Enforce DURSA
Handle disputes / breaches
Approve changes to DURSA
Designate Healtheway to support
eHealth Exchange operations
Governm
ental
Liaisons
Exec
Director
• Any organization that wishes to be a
part of Healtheway community
collaboration (e.g. HIE, vendor, payer,
non-profit, academic institution, etc.)
Private
Participants
•
Up to 9
Elected
Members
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Assure corporation is effectively supporting
and providing value to its customers (e.g.
Exchange, etc.)
Make financial decisions (e.g. annual budget,
membership program, funding, etc.)
Engage & oversee Executive Director / staff
Guide business strategy and oversee business
(e.g. programs, marketing, partnerships, etc.)
Set strategic direction
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HEALTHEWAY
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Healtheway Mission
• To provide the infrastructure to support the safe and secure
exchange of data which eHealth Exchange Participants use to
further their respective missions to:
• Improve clinical decision making and coordination, quality and
affordability of care;
• Support meaningful use;
• Enhance disease surveillance, support preparedness and routine
public health missions to improve public health; and
• Realize efficiencies and expedite provision of funding and services
to individuals to support their care and well-being.
• To provide services and programs to Healtheway Members to
advance implementation of HIE.
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eHealth Exchange Participation Fees &
Deliverables
• Annual Participation Fees: subscription fees that Participants,
as defined in the Data Use and Reciprocal Support Agreement
(DURSA), pay an annual basis to:
• Continue use of shared eHealth Exchange infrastructure – use of
digital certificate and service registry to discover exchange
partners
• Reliance on shared testing process
• The right to exchange with other Participants
• Reliance on Coordinating Committee (CC) oversight mechanisms
established in the DURSA (e.g. breach notification, dispute
resolution, etc.)
• Eligible for representation on the Coordinating Committee
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eHealth Exchange Anchor Participant
Program
• eHealth Exchange Participants who pay subscription fees for
the first two years (FY 2012 and FY 2013) will qualify for the
program.
• eHealth Exchange will begin charging all Participants
subscription fees, starting in FY 2014.
• Anchor program benefits
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Significantly discounted fees
Recognition and added visibility and promotion
Priority for pilots
Featured in profiles, webinars, etc.
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Exchange: Anchor Participant Fee Schedule
Non-Federal
Participant
Anchor Participant
Other Participant
Tier
2012
2013
2014
2015
2016
2017
2018
2019
2020
< $1M
$
4,750 $ 4,750 $ 3,300 $ 3,300 $3,300 $3,300 $3,300 $ 3,300 $ 3,300
$1 - $10 M
More than
$10 M
$ 9,950 $ 9,950 $ 7,000 $ 7,000 $7,000 $ 7,000 $7,000 $ 7,000 $ 7,000
$ 19,000 $ 19,000 $ 14,500 $14,500 $14,500 $14,500 $14,500 $14,500 $14,500
< $1M
$ -
$ 4,750 $ 4,750 $ 4,750 $4,750 $ 4,750 $4,750 $ 4,750 $4,750
$1 - $10 M
More than
$10 M
$
-
$ 9,950 $ 9,950 $ 9,950 $ 9,950 $ 9,950 $ 9,950 $ 9,950 $ 9,950
$
-
$ 19,900 $ 19,900 $19,900 $19,900 $19,900 $19,900 $19,900 $ 19,900
Fiscal Year: May 1st of current year through April 30th of following year
* Average annual savings to Anchor Participants, starting FY 2014 – 30%
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Healtheway Member Benefits
• Eligible for voting seat on Healtheway board of directors, with
ability to help shape the future of Healtheway and HIE
implementation
• Right to select up to 9 members to serve on board
• Voting rights at annual member meetings
• Input on strategic direction
• Input on strategy and joint work products with other initiatives
• Voice in cross-industry collaborative efforts, with unique
opportunity to foster the future of the largest public and
private exchange community of its kind in the US
• Promotion in member list, web site, communications and
annual report
• Recognition of organizational commitment to cross-industry
collaboration to unify industry
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Founding Members
• Members who join by December 31, 2012 and commit to twoyears of membership
• Founding Member status, with a unique logo
• Priority consideration for participating in Exchange pilots
• Members who join by early September
• Visible role in launch of Healtheway
• Eligible for board representation at its formation (September
2012)
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Healtheway Membership Dues
Annual Revenue*
Annual
Membership Fee
>$50 Million
$50,000
$25-$50 Million
$30,000
$10–$25 Million
$18,000
$5–$10 Million
$8,000
<$5 Million
$5,000
* NOTES
• Annual revenue shall be based upon annual healthcare revenue when organizations operate in different industry
sectors.
• For governmental agencies, professional associations and academic institutions, the tiers are based upon annual
budget in lieu of annual revenue.
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For more information
Mariann Yeager
Interim Executive Director
O: 703-519-0012
C: 703-623-1924
myeager@healthewayinc.org
www.healthewayinc.org
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