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					IndianaCTSI   ACCELERATING CLINICAL AND
              TRANSLATIONAL RESEARCH                              Indiana Clinical and Translational Sciences Institute
                                                                                                  www.indianactsi.org




                                    David L. Johnson
                            BioCrossroads President and CEO

                                      CTSI Annual Meeting
                                              April 19, 2010

                                          www.biocrossroads.com
IndianaCTSI       ACCELERATING CLINICAL AND
                  TRANSLATIONAL RESEARCH                      Indiana Clinical and Translational Sciences Institute
                                                                                              www.indianactsi.org



             CLINICAL INFORMATION DRIVES INNOVATION
     The Indiana CTSI spans and strengthens health information technology
      (HIT) as a national research center and an Indiana signature strength


 At the national level, the CTSI Program is premised on the importance of
 electronic communication of clinical information to advance outcomes and drive
 research
 •    “Bioinformatics is the cornerstone of communication within the [CTSIs] and with all
      collaborating organizations… To facilitate the conduct of research in health care
      settings and to transfer research findings into routine care, clinical and translational
      research must employ applicable standards adopted by the HHS for use in U.S. health
      care and public health operations.” (U.S. Department of Health and Human Services,
      RFA for Institutional Clinical and Translational Science Award, March 22, 2007, p. 8)


 HIT research is inherently translational anyway
 •    Constantly seeks to produce, transmit, aggregate and analyze more and higher quality
      clinical data for better and higher quality health care delivery and health outcomes
IndianaCTSI      ACCELERATING CLINICAL AND
                 TRANSLATIONAL RESEARCH                      Indiana Clinical and Translational Sciences Institute
                                                                                             www.indianactsi.org



           CLINICAL INFORMATION DRIVES INNOVATION
 The IUSM-led consortium won Indiana’s CTSI based, in significant
 measure, on Indiana’s unique strengths in developing HIT assets and
 applications
 •   The Regenstrief Institute (and the Indiana Health Information Exchange)
 •   The Regenstrief Center for Healthcare Engineering
 •   The IU School of Informatics
 •   Specific proposed HIT-driven collaborations with Eli Lilly and Company (disease
     modeling/personalized medicine) and WellPoint (drug safety and health outcomes)

 The CTSI is now perfectly positioned to provide and sponsor the
 continuing, collaborative research components essential to advance the
 “meaningful use” of HIT throughout the Indiana healthcare system and
 across the United States
 •   Tailored research on HIT standards, interoperability and quality measures
 •   Focal point for receiving federal grant funds and coordinating significant programs in
     comparative effectiveness and clinical effectiveness research (CER)
IndianaCTSI      ACCELERATING CLINICAL AND
                 TRANSLATIONAL RESEARCH                  Indiana Clinical and Translational Sciences Institute
                                                                                         www.indianactsi.org



  BioCrossroads: WE’RE REALLY IN THIS FOR THE DATA
         From the beginning, BioCrossroads has promoted strong
     collaborations that bring the promise of better data to healthcare
                          delivery – and discovery
 •    BioCrossroads is Indiana’s initiative to build on our healthcare and life
      sciences strengths. HIT is one of our very best Indiana assets.

 •    BioCrossroads drove the structuring and formation of the Indiana Health
      Information Exchange in 2004, drawing upon the research strengths of the
      Regenstrief Institute to aggregate and analyze and transmit privacy
      protected patient information through the development of one of the nation’s
      largest and most successful regional health information networks.

 •    BioCrossroads coordinated the structuring and formation of the Fairbanks
      Institute for Healthy Communities in 2006, developing a multi-therapeutic
      platform for longitudinal studies pairing rich clinical information with clinical
      samples to achieve better health outcomes for communities like Indianapolis.
IndianaCTSI     ACCELERATING CLINICAL AND
                TRANSLATIONAL RESEARCH                Indiana Clinical and Translational Sciences Institute
                                                                                      www.indianactsi.org



BioCrossroads: WE’RE REALLY IN THIS FOR THE DATA

 •   BioCrosroads worked closely with the IU School of Medicine, the Regenstrief
     Institute, Indiana University and Purdue University in pursuing the CTSI
     award in 2008 and in promoting the specific CTSI health outcomes
     collaborations with our members, Lilly and WellPoint.

 •   BioCrossroads continues to work closely today with the State of Indiana, our
     statewide regional health information organizations (including IHIE), IU,
     Purdue, the Regenstrief Institute and the Regenstrief Center for Healthcare
     Engineering and Ivy Tech in assisting with the structuring, formation and
     submission of grant proposals for ARRA funding that have so far brought
     over $33 million to Indiana and our HIT sector.

 •   Better data will benefit all of our stakeholders (e.g., Lilly, Cook, Roche,
     Clarian, Covance, Medco, WellPoint) as well as our start ups.
IndianaCTSI   ACCELERATING CLINICAL AND
              TRANSLATIONAL RESEARCH            Indiana Clinical and Translational Sciences Institute
                                                                                www.indianactsi.org


             Indiana is truly a national leader in HIT
  State’s Robust and Advanced Network Preceded Federal Reform Efforts

• 5 Health Information Exchange Organizations (HIOs) in Indiana
   – IHIE (Central), MedWeb/MIE (Northeast), MHIN (North Central),
      HealthLINC (Southwest), HealthBridge (Southeast)
   – Different but complementary structures, markets and models
   – Together, these HIOs cover and connect 45 hospitals, 40 outreach
      laboratories,12,000 physicians and 12 million patient records and
      generate over 6.3 million monthly results.
• These HIOs are innovative enterprises on the frontier of HIT service and
  software development
• The network is powered by Indiana’s premier research institutions
   – The Regenstrief Institute is the largest and most comprehensive
      medical informatics laboratory in the world
IndianaCTSI        ACCELERATING CLINICAL AND
                   TRANSLATIONAL RESEARCH                           Indiana Clinical and Translational Sciences Institute
                                                                                                    www.indianactsi.org


            The Indiana landscape is conducive to
 achieving necessary, early success as we move to a national
system flowing health information securely from coast to coast
 •   Indianapolis-based hospital systems are already freely exchanging data
     among one another (currently expanding across other communities
     throughout the state)
      –   Indiana’s medical malpractice environment allows hospitals and physicians to securely share
          data more readily than most states
 •   The Indiana network has also achieved effective interstate exchange of
     data.
      –   HIOs in Indiana are now exchanging messages with Kentucky, Michigan and Ohio
 •   Indiana’s privately funded collaborative model has enabled market
     driven advancement toward adoption and interoperability
 •   Regenstrief’s INPC repository holds promise for the types of data that
     can be aggregated and analyzed to generate better health outcomes
      –   The demographics of central Indiana’s population can provide valuable insight into therapies
          for cardiovascular disease and metabolic disorders, as demonstrated by the work of
          Regenstrief and the Indiana Health Study of the Fairbanks Institute for Healthy Communities
IndianaCTSI               ACCELERATING CLINICAL AND
                          TRANSLATIONAL RESEARCH                               Indiana Clinical and Translational Sciences Institute
                                                                                                               www.indianactsi.org


       Indiana has already built workable, regional HIE capabilities
                       with home-grown resources

 Indiana HIE has received only 3% of federal
 funding awards for HIT
                 $33.50
                                   $84.30


                                          $24.00
                                                                   •    Indiana HIE was opportunistically
                                             $38.90                    created, privately funded, AND IS
                                                                       OPERATIONAL
                                              $101.20


      $638.15                                                      •     Prior to any federal funding, Indiana’s
                                                                       5 HIOs have collectively invested over
                                              $42.20
                                                                       $52 million in innovation and
                                                                       implementation of HIE infrastructure and
                                                                       services.
      Indiana                New York              Massachusetts

      Illinois               California            Texas

      All Others
 IndianaCTSI                                    ACCELERATING CLINICAL AND
                                                TRANSLATIONAL RESEARCH                                                      Indiana Clinical and Translational Sciences Institute
                                                                                                                                                            www.indianactsi.org


                                                                      IHIT Board                                     The result is a rapidly growing – and
Governance
                                                                                          Advisory Committees          highly promising -- Indiana HIE
                                                                                                                                    network
                                                  HHS/ONC                    Indiana Health Information Technology, Inc. (IHIT)
Implementation Funding                                                                (CEO/ State HIT Coordinator)
                                                  Philanthropy
                                                                 $
                                                                                                        Adm & Contracting
Coordination, Contracting,
Policy, & Certification
                                                    1. Build-out of required          $
                                                       HIE capabilities and                           Policy & Standards
                                                                                                                                                        FSSA
                                                       services as needed                                 Committee
                                                                                                                                            Medicaid
                                                    2. Regional HIE                                                                                      Loan Program
                                                                                                        Audit, Cert., &
                                                       interconnectivity                             Licensing Committee
HIE Operations                                         forming the Indiana
                                                       Health Information
                                                                                             MHIN
                                                       Network
                                Public Health       3. Expansion to
                                                                                                  Med Web          $
                                                       underserved areas
                                  Hospital
         meaningful use (TBD)




                                                                                              IHIE
                                  Clinical
           As needed for




                                                                          Reporting        HealthLinc
                                                                                                                     Regional Center
                                    ADT                                                                              Program
                                                                                                  Healthbridge
                                    Labs                                                                           Tech. Assist.

                                 Radiology                                                        Indiana
                                                                                                   Health
                                                                                                                     Provider Desktop
                                                                                                                                               $               $
                                                                                                                   Office Applications
                                                                                                Information
                                 Pharmacy                                                                          EHR
                                                                                                  Network
                                                                                                                   ePrescribing
                                  Claims
                                                                                      $                            Clinical Summary (CCD)


Patient Care                                                 Payers              State               Hospitals and Physicians
IndianaCTSI         ACCELERATING CLINICAL AND
                    TRANSLATIONAL RESEARCH                          Indiana Clinical and Translational Sciences Institute
                                                                                                    www.indianactsi.org

     Even before the national healthcare debate began, the Federal
    Government had already secured HIT-enabled “healthcare reform”
                   through ARRA stimulus funding
•   ARRA is funding $35 billion in new programs advancing the development, adoption and
    use of health information technology to deliver better healthcare for hospitals, doctors and
    patients across the United States.
•   The Health Information Technology for Economic and Clinical Health (HITECH) Act, enacted
    as part of the ARRA, promotes the adoption and meaningful use of health information
    technology to:
      – Develop electronic patient records, report test results, prescribe medicines, record
         doctor visits, and
      – Exchange clinical information among each provider of care for every patient.
•   Currently fewer than 20% of physicians and fewer than 10% of hospitals employ even
    basic electronic health records for their practices and patients, but this will change…
      – Incentives, and ultimately penalties, have been put in place to drive adoption and
         meaningful use of electronic health records (EHRs)
          • Eligible professionals will receive up to $44,000 over 5 years from Medicare or up to $63,750
            over 6 years from Medicaid
          • Hospitals are eligible for incentive payments from both Medicare and Medicaid
          • Failure to achieve meaningful use brings reimbursement penalties, starting 2015
IndianaCTSI                           ACCELERATING CLINICAL AND
                                      TRANSLATIONAL RESEARCH                               Indiana Clinical and Translational Sciences Institute
                                                                                                                           www.indianactsi.org


                HIT enabled healthcare reform will improve healthcare quality, safety and efficiency
                                   driving toward Meaningful Use* (MU) of HIT



                           2009                     2011                      2013                            2015

                                                     HIT Enabled Health Reform
 Meaningful Use Criteria




                           HITECH
                           Policies          2011 MU Criteria
                                             Electronically capture
                                             health information in a    2013 MU Criteria
                                             coded format; using that   Encourage the use of
                                             information to track key                                    2015 MU Criteria
                                                                        health IT for continuous         Promote improvement in
                                             clinical conditions and    quality improvement at the
                                             communicating that                                          quality, safety and efficiency,
                                                                        point of care and the            focusing on decision support for
                                             information for care       exchange of information in
                                             coordination purposes                                       national high priority conditions,
                                                                        the most structured format       patient access to self
                                                                        possible                         management tools, access to
                                                                                                         comprehensive patient data
                                                                                                         and improving population health

                                                                                                         11
IndianaCTSI             ACCELERATING CLINICAL AND
                        TRANSLATIONAL RESEARCH                      Indiana Clinical and Translational Sciences Institute
                                                                                                    www.indianactsi.org


    Achieving “meaningful use” will require significant public and private resources
    Current HITECH funding is the federal down payment for HIT & HIE infrastructure
  Funding for Health Information Exchange                    Incentives for Adoption
 $564 million for Statewide HIE Development                  New Medicare & Medicaid payment incentives
  •    States receive between $4 and $40 million             for HIT adoption
  •    Indiana received $10.3 million on 3/15/10               •    $23 billion in expected payments from
                                                               Medicare
 $220 million for Beacon Community Program                          to hospitals & practitioners thru 2016
  •    15 HIEs to receive between $10 and $20 million          •    $21 billion in expected payments from
  •    IHIE and Memorial Hospital (MHIN) each applied          Medicaid
  from Indiana                                                      through 2021
  •    300 applications were submitted nationwide              •    ~$44 billion expected outlays
  •    IHIE awaiting announcement
                                                             Community Health Centers
  Funding for Health Information Technology
                                                             $1.5 billion in grants through HRSA for
$1.2 billion for loans, grants & technical assistance for:   construction, renovation and equipment,
 •     Regional Extension Centers ($640M)                    including acquisition of HIT systems
   •           Purdue awarded $12M
 •     Workforce Training ($80M)                              Broadband and Telehealth
   •           Ivy Tech awarded $5M (HIT training)
   •           IPIC awarded $4.8M (Healthcare training)       $4.3 billion for broadband & $2.5 billion
 •     University Based Workforce Training Programs           For distance learning / telehealth grants
   •           Indiana University awarded $1.4M
 •     Research
   •           Regenstrief awaiting announcement
 •     HER State Loan Fund (pending)

                                                                                  12
IndianaCTSI   ACCELERATING CLINICAL AND
              TRANSLATIONAL RESEARCH                              Indiana Clinical and Translational Sciences Institute
                                                                                                  www.indianactsi.org



Indiana’s HIT strengths give us a head start in achieving meaningful use
                  U.S. HIT Implementation Readiness: Landscape as of December 2008




                                                                                       Source: www.slhie.org
IndianaCTSI        ACCELERATING CLINICAL AND
                   TRANSLATIONAL RESEARCH                        Indiana Clinical and Translational Sciences Institute
                                                                                                 www.indianactsi.org


   Indiana’s opening advantages in competing for federal funds
Indiana has:
• meaningful data exchange across health provider networks with minimal investment (e.g.
    IHIE and HealthBridge)
• a medical malpractice environment (tort reform) that is physician-favorable and allows
    hospitals to share data
• a cooperative environment among exchanges working collaboratively to meet meaningful use
• invested millions of private and philanthropic dollars toward a workable, revenue sustained
    system already utilized by providers and physicians

                                         VS. Other National Models
California has:
• multiple parties competing to lead the state’s program to implement federal grant funding
• not achieved meaningful data exchange across networks
• invested billions of dollars in systems that are not self-sustaining
Massachusetts (and Boston) have:
• robust electronic health records in siloed systems that to date have been neither
   interoperable nor accessible among hospital systems
• competition for patients and substantial privacy concerns that have inhibited data sharing
   between hospital systems
IndianaCTSI         ACCELERATING CLINICAL AND
                    TRANSLATIONAL RESEARCH                  Indiana Clinical and Translational Sciences Institute
                                                                                            www.indianactsi.org


        Indiana’s HITECH Funding for HIT and HIE Efforts
                      to date = $33.5 million
 Funding for Health Information Exchange
 State Health Information Exchange Cooperative Agreement Program
 •    Indiana Health Information Technology Inc. has been established by the Governor to
      serve as a governance and contracting structure for extending health information
      technology exchange capabilities to every corner of the state
 •    Indiana Health Information Technology Inc. awarded $10.3 million on March 15.
  Funding for Health Information Technology

 Beacon Community Program
 •    Indiana Health Information Exchange (IHIE) awaiting award
 Regional extension center for health information technology
 •    $12 million awarded to Purdue
 Job training and educational/university grants
 •    $5 million awarded to Ivy Tech
 •    $4.8 million awarded to Indianapolis Private Industry Council
 •    $1.4 million awarded to Indiana University
IndianaCTSI    ACCELERATING CLINICAL AND
               TRANSLATIONAL RESEARCH                 Indiana Clinical and Translational Sciences Institute
                                                                                      www.indianactsi.org



  Expansion projects have been identified and coordinated among Indiana’s
        stakeholders to further interoperability and meaningful use


          Foundational Projects               Infrastructure Proj. & Use Cases
 1.   Statewide Provider Directory         1. Central Repository
 2.   Nomenclature Normalization           2. Quality Reporting
 3.   Clinical Message Routing             3. Public Health Reporting
 4.   Electronic Results Delivery          4. Clinical Summary Capability
 5.   Computerized Order Entry             5. Providing a Medicine List
 6.   Patient Health Record Integration
                                           6. Patient Identity Matching
 7.   Data Source Connectivity
                                           7. ePrescribing Application Provision
                                           8. Results Discovery/Query
                                           9. ePrescribing Transaction Hub




                                                                    16
IndianaCTSI      ACCELERATING CLINICAL AND
                 TRANSLATIONAL RESEARCH                    Indiana Clinical and Translational Sciences Institute
                                                                                           www.indianactsi.org


                       THE OPPORTUNITY
     Models achieving early success will be positioned to attract
                  significant additional resources
 •    ARRA and the healthcare reform act have demonstrated the federal
      government’s resolve for rapid implementation of systematic change
       – The prior market driven models of opportunistic (and occasional) HIT and HIE
         development have been surmounted by the ARRA mandate to create a national
         health information framework that must be deeply adopted, widely interoperable,
         and eventually self-sustained
 •    Initial funding has been directed broadly to develop “a level playing field” for
      HIT and HIE capabilities over 50 state “laboratories”

 •    But state and regional models that are replicable and scalable will be
      rewarded with increased opportunity and funding

 •    Ultimately, widespread adoption, interoperability and meaningful use will
      likely be achieved by the selective scaling and deployment of the best and
      most successful models in multiple markets
IndianaCTSI                     ACCELERATING CLINICAL AND
                                TRANSLATIONAL RESEARCH                                                     Indiana Clinical and Translational Sciences Institute
                                                                                                                                           www.indianactsi.org


 Electronic HIE Services                                     THE VISION FOR OUR MODEL
• Clinical Summary Exchange for Care
   Coordination & Patient Engagement                Indiana’s Proposed HIE Network Service Structure
• Discrete Data Provision for CDS & PM
• Clinical Lab Ordering/Results Delivery
• ePrescribing and Refill Requests                                          Data Services Users
• Rx Fill Status/Medication Fill History
• Eligibility and Claims Transactions                                      Health Care Providers
• Quality Reporting
• Public Health Reporting
                                                                           Health Information
                                                                           Exchange Organizations

                                                             Future?                   Central
                                                                                                              HealthBridge
                                                                                      Repository*
                                       Others                                                                                                       Others
                                                                                                                                   Physicians
                 Pharma
                               Community
                               Health                MHIN                             Message/
                                                                                                                      HealthLINC                      Patients
                               Centers                                               Data Routing

               CROs                                                    Provider                        Patient
                                                                       Directory                       Directory                      Hospitals

                 Health Plans-     Clinical                                            Patient
                                                                                       Directory                                                    Payers
                 Case              Laboratories
                                                                                                                                 Pharmacy
                 Management
                                                                  Med Web                                  IHIE
                                                 Radiology                                                                                Medicare
                                 Government-
                                 Public Health
*For:                                                                                                                 Medicaid-
CDS- Clinical Decision Support                                                                                        Case Management
                                                   CTSI – Research                                                                                Secure Health
PM- Population Management                                                          Government-
                                                   Universities                                                                                   Information
                                                                                   Quality Reporting
                                                                                                                                                  “Pipeline”

                                                                                                                             18
IndianaCTSI    ACCELERATING CLINICAL AND
               TRANSLATIONAL RESEARCH               Indiana Clinical and Translational Sciences Institute
                                                                                    www.indianactsi.org


                     THE CHALLENGES
 Our opportunities to succeed and remain a leader in HIT are
            tremendous, but challenges remain
 Historic challenge:
 •   Although we have a group of the nation’s largest and longest-running HIOs,
     optimal connections among the HIOs have been limited and exchanges were
     not progressing toward interoperability until recently



 Over the past year, Indiana’s collaborative
  efforts have identified solutions to solve this
  problem, but adoption and implementation
  challenges remain on the horizon…
IndianaCTSI        ACCELERATING CLINICAL AND
                   TRANSLATIONAL RESEARCH                            Indiana Clinical and Translational Sciences Institute
                                                                                                     www.indianactsi.org




              Adoption and Implementation Challenges
 •   Physician resistance to adoption
      –   Real and perceived costs of implementation may not outweigh the incentives for
          adoption


 •   Questions abound on the credibility of threatened reductions in Medicare
     reimbursement rates

 •   Privacy concerns may inhibit access to repository data that will unlock the
     true potential of better information for reducing costs and increasing quality of
     healthcare

 •   Are personal EHRs the future of healthcare or a distraction?
      –   Data ownership at the patient level or system level could enable -- or inhibit -- true meaningful
          use of data
IndianaCTSI      ACCELERATING CLINICAL AND
                 TRANSLATIONAL RESEARCH                      Indiana Clinical and Translational Sciences Institute
                                                                                             www.indianactsi.org


 Despite challenges, recent business developments show
   the early promise of HIT application in new settings
 Drug-safety monitoring
 •   Pfizer’s recently announced Aster (adverse drug event spontaneous triggered event
     reporting) project aimed at making reporting easier and obtaining better data more
     likely


 Product registries
 •   The Kaiser Permanente National Total Joint Replacement Registry (TJRR) is a national
     level database designed as a post-market surveillance system for elective total hip and
     knee replacement. It has resulted in a successful identification, monitoring, and
     notification of a hip implant recall as well as identification of patient risk factors for
     postoperative complications and hospital readmissions, leading to significant changes
     in surgical indications and preoperative care


 Public Health Alerts
 •   The Indiana Public Health Emergency Surveillance System now pushes electronic
     public health alerts to providers in its network during health crises such as H1N1
IndianaCTSI   ACCELERATING CLINICAL AND
              TRANSLATIONAL RESEARCH            Indiana Clinical and Translational Sciences Institute
                                                                                www.indianactsi.org


BETTER HEALTH INFORMATION = BETTER LIFE SCIENCES
  Success for Indiana HIT and HIE can put all of Indiana’s life
     science stakeholders at a competitive advantage
 • A centralized repository to study health outcomes
   and collect post-market data holds tremendous
   potential to:
     – Increase the efficiency of clinical development
     – Increase the safety of products reaching patients
     – Track clinical outcomes
     – Conduct post-market evaluation of new therapies
     – Provide quality reporting to payers and providers
     – Enhance translational research capabilities
     – Reward innovation

				
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