We examined foundational interoperability and the value of actionable longitudinal patient records – the cornerstone of a successful population health strategy. We took an inside look at how North Dakota HIN (NDHIN), a leading healthcare institution paramount in the fight on some of population health’s biggest challenges, has succeeded in building a flexible and scalable technical foundation for the population health initiatives of its participating providers. North Dakota HIN Information Technology Director, Sheldon Wolf, and Orion Health’s Vice President of Healthier Populations, Suzanne Cogan, presented on new deep data and the technology foundation in place to deploy pop health applications and services. Discover DNHIN strategy for care management, coordination and transition of care, and how upcoming integrated real-time analytics will quickly replace cumbersome reporting spreadsheets, home-grown tools and mix-match of siloed applications. The North Dakota Health Information Network (NDHIN), is dedicated to improving healthcare by creating a secure, medical record sharing network for providers and consumers. NDHIN Health Information Technology Office is responsible for implementing this information network, developing efficient health record systems, and implement value-added services for population health initiatives. The NDHIN manages 880,000 patients records and has 42 participating hospitals, 186 provider organizations, and two major payers. In this presentation, you can see: o The interoperability strategy used by NDHIN to build the foundation for its participants’ population health initiatives (Sheldon) o How NDHIN has created a solid data foundation and their data strategy (Sheldon) o The benefits of value-added services running on top of the critical data foundation (Sheldon on data today and strategy + services offering today and strategy) The importance of a real-time analytics engine capable of creating a payer registry, a real-time patient registry, and a managed database

1. NO POP HEALTH
WITHOUT THE RIGHT
FOUNDATION
HEALTH DATA MANAGEMENT WEBINAR | 11/03/2016

2. AGENDA
• Introduction to Orion Health
• Introduction to North Dakota HIN
• Goals for today
• North Dakota HIN presentation
• Use Cases
• Industry trends
• New foundational platform and pop health
applications requirements
• Q&A
SHELDON H. WOLF
North Dakota Health Information
Technology Director
SUZANNE COGAN
Vice President
Healthier Populations

3. Page 3 • 2016 © Orion Health™ group of companies
Orion Health | Interoperability and PHM Customers Around the World
55 PHM
communities
worldwide
102 million
patient
records
viewed
Over 60 US
health
departments
30+ large CINs
and ACOs, and
HIEs in the US

4. Page 4 • 2016 © Orion Health™ group of companies
Our People | Global Footprint
1
Mexico
243
United States
16
Canada
5
Spain
2
Italy
1
Greece
1
Turkey
1
Kuwait
34
UK
4
Ireland
4
Belgium
2
Netherlands
3
Denmark
1
Norway
2
Austria
1
Germany
1
Sweden
1
Finland
1
Saudi Arabia
2
Qatar
1
UAE
1
India
1
Thailand
1
Hong Kong
1
Malaysia
1
Singapore
14
Australia
20
New Zealand
73
China
2
Korea
4
Japan
1
Russia
1
Argentina
1
South Africa
4
France
Orion Health | Global Clients & Offices

5. Page 5 • 2016 © Orion Health™ group of companies
Orion Health | Unique Qualifications in the New Era of Healthcare
FUTURE PROOF
ARCHITECTURE
FOCUS
EXPERIENCE
POPULATION
& PRECISION
HEALTH
END TO END
SOLUTION

6. BUILDING CAPACITY,
USAGE, AND VALUE
FOR POP HEALTH
INITIATIVES
Sheldon H. Wolf
North Dakota Health Information Network
Technology Director

7. North Dakota HIN Facts
42
Hospitals
186
Provider
Organizations
2
Major Payers:
Blue Cross & Sanford Health
880,000
Patients in eMPI
19th
Largest State
36
Critical Access Hospitals

8. North Dakota Critical Access Hospitals
& Referral Centers

9. NDHIN Innovative Services Today
Communicate Hub
DIRECT secure messaging
(over 800 messages per week)
Alerts and
notifications
Clinical portal with
claims and clinical data
(500 record look-ups per week)
Prescription
drug-monitoring
program
Longitudinal medical
record with
image viewing
Real-time public health
reporting

10. NDHIN Current State
• NDHIN Public/Private Partnership
• Orion Health Technology Platform
• eMPI, patient matching
• Provider Directory
• Longitudinal Clinical Record
• Image Exchange
• ADT Alerting
• Single Sign-on (SSO)
• PDMP access w/SSO
• Immunization Registry
• Electronic Reportable Labs
• Syndromic Surveillance
• Access to 25-30 out State HIE’s

12. NDHIN Future State Additions
Infrastructure
• Orion Health Amadeus
Platform Upgrade
• Provider Directory Upgrade
• Medications
• Additional Single Sign-on
• C-CDA Discrete Data
• Genomic Data
State Systems
• Cancer Registry
• Enhanced Immunization System
• Behavioral Health EHR
• Developmental Disabilities EHR
• Corrections EHR
• State Vets Home EHR
• University Health systems EHR
Federal Systems
• VA, IHS, DOD
• South Dakota
• Snow Bird aStates
• 40 additional States
& HIEs

13. NDHIN Future State Additions
Payer
§ Access
§ Data contribution
§ All Plans
• Medicaid
• Medicare
• Commercial
• Large Employer
• Workman’s Comp
Patient
§ Global Personal Health Record
§ Patient Reportable Data,
Telehealth, Wearables
MU Providers
§ Hospitals
§ Clinics
• Traditional
• Urgent Care
• Pharmacies
§ Large Reference Labs
§ Chiropractors
§ Optometrists
§ Dentists

14. NDHIN Future State Additions
Non MU Providers
§ Long Term Care
• Assisted Living
• Basic care
§ Behavioral Health
§ Residential Treatment Centers
§ Home Health Care
§ Hospice, Palliative Care
§ EMS
§ Pharmacies
§ DME
§ Audiology
§ Podiatry
§ Prosthetics
§ New Born Screening
§ Local Health Departments
• K-12 Schools

15. NDHIN Future State Additions
Strategic Statewide Applications
Care Coordination
Coordinate integrates with Engage - Social Services Referrals - Risk Scores
Gaps in care - Clinical & Claims Data
Analytics, Population Health
Statewide Credentialing
Advance Directives, POLST/MOLST Registry

16. NDHIN- Tools
Patient-centered
care
Shared care
plans
Collaborative
worklists
Referral
management
Risk
calculators
Patient
engagement
Medication
management
Assessments
Hospitals Clinics
Behavioral Health
Long Term Care
Local Public Health
Ø K-12 school nurses
ND Developmental
Disabilities
VA
Home Health
ND University
System
IHS
Medicaid
ACOs
NDPERS/ state
employees health plan
Commercial
SNAP
Foster care Child care
assistance
TANF
Autism services
Special-needs
adoption
LIHEAP
Transportation
Job programs
Housing Assistance
Department of
Corrections
ND Veteran’s
Home
Care Coordination
Partners
Future State: New Data types Integration and Care Coordination
Clinical Care – Behavioral Health – Social Services
Key
Providers
Payers
Human Services
Community Services
Medicare
Self-insured Employers
VA
DOD
SSA
Chiropractors
Optometrists Hospice
EMS
Labs
Pharmacies
University Health
DMS
Audiology
Podiatry
New Born Screening
Prosthetics

18. USE CASES

19. NDHIN Use Cases
Local Public Health Units Care Coordinators
Medical Records
Information
Prescription Drug
Monitoring Requirement
Referrals
Hypertension/
Vital Records
Meaningful Use
Claims Payment
(Medicaid)
MU

20. POPULATION HEALTH
FOUNDATION &APPLICATIONS

21. Page 21 • 2016 © Orion Health™ group of companies
Industry Trends | Precision Medicine: The Right Treatment at the Right Time
FUTURE PROOF
ARCHITECTURE
A vast amount of untapped data could have a great impact on our health
Source: Health Aff (Millwood). 2002 Mar-Apr;21(2):78-93. The case for more active policy attention to health promotion.
McGinnis JM, Williams-Russo P, Knickman JR.

22. Page 22 • 2016 © Orion Health™ group of companies
Industry Trends | Healthcare Data Explosion
2012
500 Petabytes
=
10 billion
Four drawer
cabinets
2020
25,000 Petabytes
=
500 billion
Four drawer
cabinets
The amount of
healthcare data worldwide is expected to grow
by 50 times in 8 years

23. Page 23 • 2016 © Orion Health™ group of companies
New Platform Requirements | Handling Data Complexity
Healthcare is changing from a closed community into an ecosystem centered around
the patient and their record which will include many elements not traditionally captured.

24. Page 24 • 2016 © Orion Health™ group of companies
Orion Health | Market Evolution

25. Page 25 • 2016 © Orion Health™ group of companies
Population Health Management | Maturity Model

26. Page 26 • 2016 © Orion Health™ group of companies
Orion Health | Key Pop Health Needs to Address
Quality and Compliance
Reporting
Managing Revenue and
Costs
Coordinating Care
‣ Monitor and manage key
performance metrics under value
based contracts:
‣ Pay for Performance
‣ Shared Savings
‣ Bundled Payments
‣ Give practices and providers the
tools required to identify and close
care gaps.
‣ Population exploration tools for
care coordination staff
‣ Patient risk stratification tools
‣ High risk discharge and medication
adherence analysis
‣ Tools to identify key
contributors to costs:
‣ Readmissions
‣ Utilization
‣ PMPM
‣ Manage network leakage and
referrals.

27. Page 27 • 2016 © Orion Health™ group of companies

28. Page 28 • 2016 © Orion Health™ group of companies
Amadeus | With Integrated Analytics Engine
Open APIs
3rd Party AppsEngage Coordinate
Data Processing Pipeline
Cleansing
SequencingRouting
Mapping
Replay Enriching
Analytics App Suite (Pop Health, MSSP)
Analytics EngineData Engine
Rhapsody
3rd Party Analytics
Patient
Registries
Streaming &
Computation
Pipeline
In Memory Massively
Parallel Processing
Raw Data
Store
Privacy Service
Clinical Portal EMR Connect Bulk DownloadDocument Exchange
C-CDA Services
Terminology
Services
EMPIConsent
Consumer
EMR / PMS
Lab
Payer
HIE
Data Spaces
Clinical
Payer
Consumer
Custom

29. Page 29 • 2016 © Orion Health™ group of companies
Orion Health Amadeus| Population Level

30. Page 30 • 2016 © Orion Health™ group of companies
Orion Health Amadeus | Integration of Analytics & Care Coordination

31. Page 31 • 2016 © Orion Health™ group of companies
Orion Health Amadeus | Drill down to Patient-Centric Longitudinal Health Record
+ Gaps in Care

32. Page 32 • 2016 © Orion Health™ group of companies
Orion Health Amadeus | Drill down to Patient-Centric Longitudinal Health Record
+ Gaps in Care

33. Q&A