BLACK BOOK MARKET RESEARCH 2015 USER SURVEY ......Black Book Rankings, the health care division of Black Book Market Research LLC annually evaluates leading health care /medical software,

State of the Enterprise/Private Health Information Exchange Industry Published February 2015

© Black Book Market Research. This report is a licensed product. Page 1

■ Aggregate Black Book Survey 2015 HIE Findings

■ Top Enterprise HIE Vendors

- Ambulatory Physician EHR System HIE Vendors

- Hospital Network/System HIT System HIE Vendors

- Core Enterprise HIE Vendors

- Complex Data Systems HIE Vendors

- Payer/Insurer Centric HIE Vendors

BLACK BOOK MARKET RESEARCH 2015 USER SURVEY

State of the Enterprise Health Information Exchange Industry



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2015 Enterprise HIE Survey

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TABLE OF CONTENTS

PART ONE: 2015 BLACK BOOK HIE USERS SURVEY RESULTS 6

STATE OF THE ENTEPRISE HIE INDUSTRY

AGGREGATED RESPONSE FINDINGS: EHR/EMR & HIE SURVEY RESULTS

KEY FINDINGS 7-30

SURVEY OVERVIEW 31

BLACK BOOK METHODOLOGY 32

HOW THE DATA SETS ARE COLLECTED 32-33

WHO PARTICIPATES IN THE BLACK BOOK RANKING PROCESS

PART TWO: PRIVATE HEALTH INFORMATION EXCHANGE VENDOR ANALYSIS 34

TOP HEALTH INFORMATION EXCHANGE VENDORS, EXECUTIVE SUMMARY 35-37

STOP LIGHT SCORING KEY 38

OVERALL KPI LEADERS 43

SUMMARY OF CRITERIA OUTCOMES

TOP SCORE PER INDIVIDUAL CRITERIA

INDIVIDUAL KEY PERFORMANCE 45-63

APPENDIX I - Brown-Wilson Group Consulting 64

APPENDIX II - HIE Glossary 65-68

APPENDIX III - Directory of Public HIEs 76

APPENDIX IV - Supplemental Survey Statistics 77

TABLE OF FIGURES

Figure 1: Comprehensive HIE vendors defined 39

Figure 2: Key to raw scores 40

Figure 3: Raw score compilation and scale of reference 41

Figure 4: Scoring key 42


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TABLE OF AGGREGATED HIE/EHR SURVEY FINDINGS

FINDING 1: OPERATIONAL HIES PAGE 19

FINDING 2: IMPLEMENTATIONS OF BASIC EMR AND FULLY FUNCTIONAL PAGE 20 EHR 2009 - 2014

FINDING 3: SURVEY RESPONSE RATES BY ORGANIZATION TYPE PAGE 20

FINDING 4: HIE READINESS, EMR ADOPTION RATE BY PRACTICE SIZE PAGE 21

FINDING 5A & 5B: CHANGES IN IT ORGANIZATION HIE SPEND ANTICIPATED PAGES 21-22 IN NEXT 24 MONTHS

FINDING 6: ANTICIPATED LARGEST BUDGET IT PROJECT INCREASES PAGE 22 IN NEXT 24 MONTHS

FINDING 7: HIE READINESS, FULLY FUNCTIONAL EMR-EHR PAGE 23 IMPLEMENTATION RATE BY STATE

FINDING 8: AWARENESS OF DIFFERENT HIE VENDORS IN MARKETPLACE PAGE 24

FINDING 9: VENDOR SELECTION CRITERA PAGE 24

FINDING 10: HIE READINESS, EMR ADOPTION / IMPLEMENTATION PAGE 25 RATE BY SPECIALITY

FINDING 11: HIE READINESS, MODULE ADOPTION RATES BY PRACTICE PAGE 26 SIZE, LOCATION, REGION

TABLES OF HIE & EHR USER RESPONSES

BLACK BOOK™ SURVEYS Q2 – Q4, 2014, Q1 2015 PAGES 27-32


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TABLE OF TABLES

TABLE 1: TOP HIES – HOSPITAL HIT EHR-BASED HIE PAGE 36

TABLE 2: TOP HIES – AMBULATORY EHR-BASED HIE PAGE 36

TABLE 3: TOP HIES – CORE HIE SYSTEM PAGE 37

TABLE 4: TOP HIES – COMPLEX DATA ORGANIZATIONS/TECHNOLOGY INTEGRATORS HIE PAGE 38

TABLE 5: TOP HIES – PAYER SYSTEMS HIE PAGE 38

TABLE 6: TOP SCORE PER INDIVIDUAL CRITERIA PAGE 44

TABLES OF INDIVIDUAL KEY PERFORMANCE INDICATOR, TOP 10 HIGHEST MEAN BY KPI PAGES 44-61

TABLE 7: HIE STAKEHOLDER ALIGNMENT PAGE 44

TABLE 8: BRAND IDENTITY PAGE 45

TABLE 9: DATA USE - NEUTRALITY PAGE 46

TABLE 10: DATA USE – RELIABILITY, ACCURACY, CONTINUITY PAGE 47

TABLE 11: DATA INTEGRITY, SYSTEM TRUST PAGE 48

TABLE 12: DATA TRANSMITTAL & EXCHANGE PAGE 49

TABLE 13: SECURITY/PRIVACY PAGE 50

TABLE 14: CLINICAL WORKFLOW PRODUCTIVITIES PAGE 51

TABLE 15: SUSTAINABILITY, VIABILITY & FINANICAL MANAGEMENT PAGE 52

TABLE 16: BEST OF BREED INNOVATION PAGE 53

TABLE 17: WIDESPREAD INTEROPERABILITY, SCALABILITY & FLEXIBILITY PAGE 54

TABLE 18: ACCOUNTABLE CARE SUPPORT PAGE 55

TABLE 19: COST & LABOR IMPROVEMENTS/EFFICIENCIES PAGE 56

TABLE 20: DATA ANALYTICS & BUSINESS INTELLIGENCE PAGE 57

TABLE 21: QUALITY REPORTING SERVICES PAGE 58

TABLE 22: PATIENT-CENTRIC PROCESSES & ACCESSIBILITY PAGE 59

TABLE 23: CUSTOMER SERVICE, CARE, SUPPORT PAGE 60

TABLE 24: CONFIGURATION, INTERFACES, INTEGRATION WITH HIT EHR/EMR HIS PAGE 61


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PART ONE: STATE OF THE ENTERPRISE HIE INDUSTRY

In the United States, each state has a designated entity responsible for developing an operational plan for health

information exchange (HIE). In many countries, the government is mandating a national health network that enables

electronic health records (EHR). Regardless of location, the HIE architecture must support the needs of a variety of

participants for interstate and intrastate/country information sharing including hospitals, providers, human services

agencies, federal registries and payers.

While technology has had a massive impact on many aspects of society, most health care providers still use paper

charts to document their patients’ medical records.

The ability to electronically exchange health information is a basic and critical need in improving health care in the United

States. Through electronic exchanges, health care providers can provide better services to their patients in a more

efficient manner that results in both parties saving money.

While more efficient and effective health care is the ultimate goal, sharing a patient’s health information in a secure and

private manner is of utmost importance. In order to ensure that privacy and security are maintained, health organizations

will need to be under the umbrella of a HIE.

The crucial role of HIEs in accomplishing a health care organization’s move to

patient-centric accountable care is undeniable. However by the end of Q4 2014, 83%

of private physician practices and 70% of non-system hospitals remain

meaningfully unconnected.

The definition of a HIE has two forms: the verb and the noun. HIE as a verb is the electronic movement of health-related

information among health organizations according to nationally recognized standards. HIE as a noun is a health

information organization (HIO) or network (HIN) that brings together health care stakeholders within a defined geographic

area and governs HIE among them for the purpose of improving health care in that community.

A private HIE, or enterprise HIE, is sponsored or managed by hospitals or health systems, payers/insurers, or IDNs for

the benefit of patients, physicians, providers and caregivers in their community. A private/enterprise HIE provides the

capability to electronically exchange clinical information among different health care information systems and electronic

medical record systems. Private HIEs are concentrated in a single community and its surrounding area, often within a

25-mile radius of the main/largest hospital or city center. Private HIEs typically raise capital from participants to

implement a narrow set of services in a short time frame.

Public HIEs are chartered with covering a large region or state involving many stakeholders. They obtain most funding

from government resources. Several states such as Utah and Maine are examples of fully public HIEs. Nebraska’s HIE

began as a private HIE and evolved into a state-wide public HIE. Public HIEs serve a vital role in bringing data exchange

to rural communities and driving the adoption of the nationwide health information network (NHIN) standards and

services. Statewide HIEs in areas of high rural populations and access to government funds are poised to concurrently

pursue these goals.

Among the most functional and operational state-sponsored HIEs include: Colorado, Indiana, Kansas, and New York,

according to survey participants from 2012 to 2014.

The uncertain sustainability of private HIEs has caused some health care organizations to delay the implementation of a

HIE infrastructure, despite the strategic importance to ACO development. In 2011, nearly one fifth of the previous year’s


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80 operational HIEs had merged or ceased operations, suggesting that HIE leadership is failing to attract sustainable

investment.

HIE sustainability and the future of such networks generally depends on their ability to create a useful and meaningful

user value proposition for healthcare providers and payers. In turn, this value proposition is dependent on the needs of a

provider community and its payers, which must see the HIE as a helpful and effective tool that supports the delivery of

high quality healthcare at exceptional costs. More providers than ever are participating in health information exchanges.

Meanwhile, a majority of HIE organizations are struggling to find sustainable business models.

More than $548 million in the HITECH Act was devoted to offering startup funding to HIEs, which have greatly filled gaps

in EHR interoperability. That money has run out, and many HIEs have not determined how to fund themselves past the

immediate horizon. Grants are the largest funding source for 6 of every 10 of this nation’s operational HIEs.

Payers have participated in fewer than 40% of the efforts to sustain public HIEs to date, and even fewer (22%) pay to

participate in them for ongoing data. Payers, however, are seen as the primary beneficiary of HIEs as sharing health data

reduces testing, redundant procedures, readmissions, and catches medical errors before they occur. HIEs enable the

study of population health trends, and serve an ultimate benefit to the payers.

EARLY ADOPTERS

Aggregate Survey Responses: HIE Vendors by Most Clients (Public and Private)

MOST STAKEHOLDERS CONNECTED AS REPORTED BY PRIVATE VENDORS (2014)

EPIC SYSTEMS

CERNER

DBMOTION/ALLSCRIPTS

AETNA MEDICITY

MCKESON RELAYHEALTH

MOST REPORTED GOVERNMENT/AGENCY CLIENTS CONNECTED BY PUBLIC HIE VENDORS (2014)

ORION

INTERSYSTEMS

OPTUM

ICA


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Aggregate Survey Responses: HIE Vendors recognized by Brand Name (survey participants select top 3)

MOST RECOGNIZED BRAND NAMES BY ENTERPRISE PROSPECTS (SELECT 3 HIE BRANDS YOU RECOGNIZE)

CERNER DBMOTION ALLSCRIPTS

MCKESSON ICA

AETNA MEDICITY OPTUM

ORION INTERSYSTEMS

EPIC SYSTEMS COVISINT

Source: Black Book Rankings

The ability to exchange health information electronically is a basic and critical capability that is the foundation of efforts to

improve health care in the United States. HIEs make all relevant patient information available where it’s needed, when

it’s needed, and for whom it’s needed. It is expected to improve the quality of care and patient safety while reducing

health care costs. Below is a list describing some of the ways HIEs will develop health care:

• Give access to a patient’s complete clinical information, assisting care providers in giving high quality care

• Provide a mechanism in reducing duplication of services and health care costs

• Facilitate operational and administrative efficiencies resulting in reduced operational costs

• Enable integration of sick (illness care) with well care

• Link first-responder teams with trauma care teams

• Send patients reminders about scheduled appointments, tests, and results viewings. In doing so, a better profile

of his or her health is established

• Stimulate consumer education and involvement in their health care processes

• Promote transparency of service and cost

There are multiple types of organizations involved in an HIE, as well as a variety of governance models. These include

state-led HIE efforts, state-sponsored public-private initiatives, health plan, and hospital system-wide initiatives.

The two distinct models of HIE continue to complicate HIE strategic development by provider health care organizations.

The two alternatives are (1) start or invest in a finitely regional or local community, privately funded HIE, or (2) delay until

a larger regional or statewide, publicly funded government HIE is implemented.


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98% Health care organization decision makers believe private, community-based

HIEs are the preferred choice to achieve Accountable Care Organization

deliverables. Only 3% of ACO Managers find operational public HIEs capable of

meeting their data requirements as currently configured and funded.

In recent years, new government programs like The American Recovery and Reinvestment Act of 2009 are helping

health care providers make the switch to electronic health records.

The Reinvestment Act provides resources to help health care providers across the country use electronic health records

to increase the quality, safety and efficiency of health care. The act assists states in creating HIEs for the secure and

efficient exchange of patients’ electronic health records among health care providers.

Under the Reinvestment Act there is also the Health Information Technology for Economic and Clinical Health Act, or the

HITECH Act, which establishes programs to accelerate the adoption and use of electronic health records and other types

of health IT. The HITECH Act provides more than $20 billion to promote the use of health IT among health care providers

nationwide and to train thousands of people for careers in health IT to help health care providers implement electronic

health records.

In March 2010, the Office of the National Coordinator (ONC) completed the announcement of State Health Information

Exchange (State HIE) Cooperative Agreement Program. In total, 56 states, eligible territories, and qualified State

Designated Entities (SDE) received awards. This program funds states’ efforts to rapidly build capacity for health

information across the health care system both within and across states. Awardees are responsible for increasing

connectivity and enabling patient-centric information flow to improve the quality and efficiency of care. Key to this is the

continual evolution and advancement of necessary governance, policies, technical services, business operations, and

financing mechanisms for HIEs over each state, territory, and SDE’s four-year performance period. This program is

building on existing efforts to advance regional and state-level HIE while moving toward nationwide interoperability.

In January 2011, an additional $16 million was made available to states through the ONC’s new Challenge Grants

Program. This program provides funding to states, aiming to encourage breakthrough innovations for health information

exchange that can be leveraged widely in support of nationwide HIE and interoperability. The HIE Challenge Grant

Program provides 10 awards between $1 and $2 million to State HIE Cooperative Agreement Program grantees to

develop innovative and scalable solutions in five key areas.

Health information exchanges (HIEs) continue to play an important role in healthcare, allowing the quick, easy exchange

of patient information between physicians, providers, hospitals, pharmacies, payers, and other healthcare professionals,

while working to reduce the cost of healthcare.

Because these partnerships involve the transfer of protected health information (PHI), HIEs are under increased

pressure to ensure that their networks are complying with HIPAA, and are safe from breaches.

HIE provides the capability to electronically move clinical information among disparate health care information systems

while maintaining the meaning of the information being exchanged. The goal of HIE is to facilitate access to, and retrieval

of, clinical data to provide safer and more timely, efficient, effective, and equitable patient-centered care. HIE is also

useful to public health authorities to assist in analyses of the health of the population.

HIE systems facilitate the efforts of physicians and clinicians to meet high standards of patient care through electronic

participation in a patient's continuity of care with multiple providers. Secondary health care provider benefits include

reduced expenses associated with:

- The manual printing, scanning and faxing of documents including paper and ink costs, as well as the maintenance

of associated office machinery


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- The physical mailing of patient charts and records, as well as phone communication to verify delivery of traditional

communications, referrals, and test results

- The time and effort involved in recovering missing patient information, including any duplicate tests required to

recover such information

Formal organizations are now emerging to provide both form and function for health information exchange efforts, both

on independent and governmental/regional levels. These organizations are, in many cases, enabled and financially

supported by statewide health information exchange grants from the Office of the National Coordinator for Health

Information Technology. These grants were legislated into the HITECH components of the American Reinvestment and

Recovery Act in 2009. The latter organizations (often called Regional Health Information Organizations or RHIOs) are

ordinarily defined geographically as entities which develop and manage a set of contractual conventions and terms,

arrange for the means of electronic exchange of information, and develop and maintain HIE standards.

In the United States, federal and state regulations regarding HIEs and HIT (health information technology) are still being

defined. In addition to fluctuating health care regulations among the states, federal regulations such as "Meaningful Use"

legislation and some state governments’ implementation of state-sponsored HIEs (such as the North Carolina HIE) are

rapidly changing the face of this relatively new industry. HIEs and RHIOs continue to struggle to achieve self-

sustainability and the vast majority remain tied to federal, state, or independent grant funding in order to remain

operational; with some exceptions such as the Indiana HIE.


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TRENDING IN Q1 2015

90% of Physicians feel more effective and capable of delivering higher quality diagnoses and care with trusted patient data sets, but

69% don’t trust the exchanged records as complete or technically accurate that they currently receive from HIEs (down from 97% in 2013)

82% of hospitals that adopted an EHR participated in exchanging patient data with siloed HIE providers, but over ¾ did so via limited direct messaging functionality.

67% of physicians agree that the lack of provider interoperability is responsible for repressing innovations in patient care (down from 87% in 2013).

Source: Black Book HIE Users Survey. 2015

91% of Payers and

88% of Providers

Anticipate the HIE Vendor

Marketplace to pare down to

Less than 10 Major

Operative HIE Vendors or

fewer prominent vendors by

2017.

VE

ND

OR

CO

NS

OL

IDA

TIO

N

31% of Hospitals and

12% of Physician Practices/Groups

Participate in a Public or Private

HIE, actively using the HIE system

for exchanging data, primarily lab

reports, Q4 2014

P

RO

VID

ER

HIE

PA

RT

ICIP

AT

ION


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Aggregate Survey Responses: Sustainable, Viable HIES Self-Funded (Vendor reported)

Aggregate Survey Responses: Qualities of a Sustainable HIE (User perspective)

QUALITIES OF A SUSTAINABLE HIE (RANKED TOP BY 2014 SURVEY RESPONDENTS, SELECT 5)

Advanced state of operations 100%

Completed pilot stages 100%

Transmitting data via stakeholders 98%

Data analytics 45%

Quality reporting 42%

Not dependent on federal or government funding 41%

Revenue-based model 40%

Subsequent fees paid by subscribing providers 21%

Patient access to health records and data 10%


YEAR SUSTAINABLE PRIVATE

HIES

2014 152

2013 75

2012 30

2011 24

2010 18


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Types of Exchange Technical Models for HIEs

State-of-the-art systems are used to secure records to the greatest degree and prevent access by unauthorized sources.

All systems must comply with the security rule of the federal Health Insurance Portability and Accountability Act (HIPAA).

HIPAA is only a minimum requirement as state laws and regulations are often stricter.

There are three main forms of technology used for HIEs:

CENTRALIZED

- All data is “housed” in a shared central repository and updated based on defined policies and procedures that span

interoperable requirements to privacy and security policy and procedures

o Pros

Provides uniform data format supporting a high degree of data interoperability

Requires a cohesive, centralized system with defined methods, procedures and policies for

access, maintenance and management/control

o Cons

Requires strong political and governance oversight and management of data ownership and

control

More complex and challenging implementations ranging from technical scalability to support of

privacy and security policies

Cost

FEDERATED (Record Locator Service)

- Data stays at the source, maintaining custodianship and control over the data. When requested, the data is queried

from the data source organization

o Pros

Easiest and quickest way to achieve exchange

Limits conflict over data ownership

o Cons

Management of authorized and legitimate access to third party systems

Data control and availability not guaranteed

Management of data standards and profiles for exchanges – which ones to use

HYBRID

- Combination of centralized and federated models specific to each HIE entity setup, socioeconomic, political and

geographic environments, size, etc.

- Most flexible model


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Black Book Industry Research Minimum Standards/Requirements for selecting a

sustainable HIE (Early Adopter Feedback on Vendor Selection)

MINIMUM REQUIREMENTS OF A SUCCESSFUL, SUSTAINABLE HEALTH

INFORMATION EXCHANGE

(COMPILED BY BLACK BOOK RESEARCH, Q4 2013 & Q4 2014)

At least one to two years’ experience running an operational HIE

Can connect more than 350 physicians

Can perform 75,000 clinical transactions per month

Has an Enterprise Master Patient Index (EMPI) that integrates data from many sources

Contain at least 400,000 patient records

Can move data between at least two disparate, non-related EHR/EMR systems

Capable of sorting out duplicates and merge records

Vendor can connect and communicate between EMR systems and non-system IDN members

Capable of e-prescribing

Capable of e-lab

Capable of secure messaging

Capable of referral management

Capable of inputting clinical data from portal

Capable of clinical email alerts

Advanced reporting and analytics modules

Has high adoption success track record among physicians, hospitals, and ancillary providers

Has high opt-in rate from patients, exceeding 50%

Can sustain with non-grant related and other government resources

System model that positions the HIE to meet the needs of Accountable Care

Steady flow of funds for development and operations obtained from stakeholders in the private sector



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Expansion of Enterprise/Private HIE and Future Uses:

One of the biggest reasons HIEs are attractive is drawn from their ability to cut costs. The use of HIEs prevents

duplication of procedures and test results. Many hospitals and health systems are eager for the introduction of sharing

imaging results so the ordering of multiple tests can be avoided, which in turn saves a substantial amount of money for

both the caregiver and patient.

Hospitals are also using HIEs to coordinate transitions of care through connected health care solutions, enabling

caregivers to share important clinical information when their patient transitions across sites of care. This usage once

again helps reduce costs and improve the quality of care by reducing avoidable and expensive hospital readmissions.

HIE can help hospitals manage population health by analyzing data from multiple sources. The expansion of HIE

throughout regions and states can increase the amount of data available to hospitals, aiding providers in clinical decision

making.

Overall these trends aim to drive more sharing of health information in attempts to coordinate better patient care.

HIEs AND PENDING DATA REQUIREMENT SURGE OF ACOs

The opportunity is ripe for HIEs to assist ACOs with tracking down rich episodes of care and diagnostic data, developing

patient profiles and assembling continuity of care records to assist ACOs. By helping ACOs streamline data collection,

and patient profiling and grouping, HIEs will prove to be indispensable to the success of an ACO as they will be central to

its physicians achieving the necessary degree of patient-centered care coordination.

In addition to patient profiling, ACO physicians will use HIEs to connect with other providers who are rendering care to

ACO assigned patients. ACO physicians will depend on the HIE to assure that the information available is valid,

complete and useful. ACO physicians will rely on the HIE to enable communications with other ACO participants,

manage patient identities, provide record locating services, establish registries and be a gateway to external networks.

An HIE, as a conduit for ePrescribing and repository of clinical registries, is well positioned to assist ACOs in aggregating

reportable data, such as percentage of ePrescribing and registry use.

Beyond care coordination, HIEs will prove essential in ACOs addressing the other performance measurement domains

as well. Through connectivity with personal health records managed by ACO patients, HIEs will provide communication

between patient and ACO physicians so that the patient can receive timely care, schedule appropriate follow up

appointments, receive alerts and other information, such as health promotion and education. HIE patient-physician

linkages will also enable shared decision making.

With respect to the metrics regarding patient safety, the HIE can obtain and aggregate data pertinent to identifying the

frequency of health care acquired conditions to assist ACO physicians in managing their patient population and reduce

preventable conditions such as pressure ulcers, falls, poor glycemic control, and post-operate sepsis.

The HIE will also enable compliance with preventative health measures and appropriate treatment of at risk populations.

An HIE can provide tracking to allow for management of immunizations, breast and colorectal cancer screening. Direct

communication with patients allow ACO physicians to monitor and manage weight gain, tobacco usage, and diabetic

testing as well as make certain that appropriate drug therapies are applied to patients with chronic conditions, such as

diagnosed heart failure.

By connecting ACOs and their physicians with disparate clinical systems, providing interoperability of clinical information,

and enabling patient-centered care, HIEs are key to an ACO’s success. The relevance of HIEs to ACOs will help assure

the sustainability of HIEs. HIEs should study the final regulations carefully to understand their implications for

functionality and to better position themselves to play the integral role in ACO development.

Though HIE is still in its infancy, and ideal use case is years away, there is great potential for it to be a significant factor

in improving the quality, accessibility, and cost effectiveness of healthcare. Properly implemented and adopted, HIE will

revolutionize the practices of transitions of care and connected health, which have long been difficult to manage. The


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benefits of extending access to a more comprehensive view of the electronic health record (EHR) lay the foundation for

the creation of a longitudinal patient record and more complete, effective, and personalized care for the patient and their

treatment process. It has long been held that healthcare is local; it no doubt remains personal, both to the patient and

their loved ones. Of necessity, modern medicine involves many care providers, procedures and services from a variety of

delivery settings. HIE enables the patient to regain the local, personal experience while enriching physicians’ ability to

verse a comprehensive plan of care. The infusion of Meaningful Use and HITECH incentives combined with new

healthcare payment models that reward value over volume represents the needed impetus that will propel the healthcare

system to the next level of care.

HIE is the next phase in EHRs. The benefits of HIE include better care coordination, the assurance that patients and

providers have the right information available when needed, simultaneously improved efficiency and quality, cost

savings, fewer errors, avoidance of duplicate tests or procedures, improved population health, and more effective

consumer and patient engagement. Truly, key facets of healthcare such as chronic disease management, case

management for patients undergoing lengthy procedures, rehabilitation, and homecare will reap significant benefits from

HIE. However, given the rapid market and policy changes and technology innovations currently transpiring, there is

confusion among healthcare stakeholders in regards to how best to proceed with implementing HIE. Leading HIE

organizations are indeed charting new ground. Emerging HIE efforts can and should learn from those who are further

along in order to avoid reinventing the wheel and to leapfrog toward success. Great progress is being made to make

successful widespread HIE and all of its benefits to patients a reality. Challenges and barriers remain – most notably

funding and sustainability, variations in how interoperability standards are implemented, provider adoption, disparate

electronic medical records (EMRs), and privacy and security – but they are being tackled and overcome. HIE will be a

vital foundation for new healthcare payment and delivery models such as accountable care and patient centered medical

homes.

BLACK BOOK CLASSIFICATION AND RANKING OF PRIVATE HIE VENDORS

PROVIDER-CENTRIC HIE VENDORS

AMBULATORY EHR COMPANIES (Physician organization centric)

Includes those vendors with systems that cooperate with open vendor data sharing & garden-walled EHRs

PROVIDER-CENTRIC HIE VENDORS

INPATIENT EHR COMPANIES (Hospital and health care system/IDN centric)

Includes those vendors with systems that cooperate with open vendor data sharing & garden-walled EHRs

CORE HIE VENDORS ‘

(Smaller and niche software companies, acquisition likely due to expertise and market share)

Interoperability dedicated functionality, public and private exchanges included

COMPLEX DATA HIE VENDORS

(Large multi-industry/multi-product software and advisory companies,

typical recognized outsources of IT infrastructure and application services)

PAYER-CENTRIC HIE VENDORS

(Insurers)


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INDUSTRY SECTORS SEEKING POSSIBLE ACQUISITIONS TO

ENTER & NARROW HIE VENDOR MARKET

Key: Increasing Acquisition & Merger Activity

++

LARGE MULTISTATE HEALTH

CARE & PURCHASING

GROUPS/ORGANIZATIONS

eg. Tenet, HCA, Premier, VHA,

MedAssets, CHS

LARGE EHR COMPANIES

INPATIENT & AMBULATORY

eg, Cerner, QSI NextGen,

GE Healthcare , Epic, McKesson,

eClinicalWorks, Allscripts,

athenahealth

CORE HIE VENDORS

eg, Orion, Mirth, RelayHealth,

Kryptiq, dbMotion, Alere, Covisint,

ICA, InterSystems. Sandlot

PHARMACY BENEFIT

MANAGERS & e-RX &

PHARMACEUTICAL

COMPANIES

eg, Express Scripts, Surescripts,

Merck, and Bayer

LARGE MULTISTATE PAYERS

eg, United, Cigna, Humana,

WellPoint, WellCare, Molina,

Amerigroup, BCBS, Aetna

LARGE IT SERVICE FIRMS &

OUTSOURCERS

eg, Infor/Lawson, CSC, Dell,

Deloitte, Hewlett Packard, INFOR, Oracle,

IBM, Accenture, Infosys, Wipro, TCS

HIE VENDOR ANTICIPATED

MARKETPLACE

CONSOLIDATION

2015-2017

QUALITY INITIATIVE

ORGANIZATIONS

MALPRACTICE &

LIABILITY INSURERS


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Industry Consolidation

As the health care industry braces for a surplus of technologies that capture, store, secure and exchange patient data,

many small health care information technology providers will be gobbled up by larger competitors in the next 18 months.

Many health-IT vendors are small- to-medium-sized, privately held companies and could be prime acquisition targets for

larger companies seeking HIE solutions.

The HIE market will dramatically change during the next two years as providers seek electronic health records systems

that support data exchange to qualify for meaningful use incentives. Insiders expect HIE technologies to become a

commodity by 2014, and larger, well-funded, dominant market vendors will acquire their way on top of a crowded market

currently made up of many small, privately held vendors.

As HIEs consolidate, it is vital that they keep and cultivate the confidence of their original stakeholders by involving them

in the operational progression. The key challenge for consolidating HIEs will be to maintain the stakeholder trust that has

taken extraordinary efforts to develop.

Ninety percent of HIE industry participants now overwhelmingly predict the marketplace will pare down to six major HIE

operator sectors after 2014-2015 in the enterprise market: Large/Sustainable Core HIE Vendors, Large IT Service and

Outsourcing Firms, Large Multi-state Hospital and Health care Provider Organization, Large EHR EMR Firms,

Pharmaceutical Companies and PBMs, and Multi-state Payers/Insurers.

2015: Payers Continue to Reject Public HIEs and Pony Up to Fund and Lea Private Enterprise Interoperability

Commercial payers are investing in private connectivity solutions and snubbing the bureaucracies, fees and complex

architecture of government sponsored health information exchanges compounding the sustainability problems of public

HIEs. Black Book’s annual satisfaction survey of all HIE users and stakeholders discovered 86 percent of the nation’s

224 operating public HIEs are failing despite the recent announcement of limited federal grants to rescue some networks.

Most public HIEs are struggling with flawed business models and are failing to provide meaningful connectivity according

to 97 percent of payers, 86 percent of hospitals, and 73 percent of physicians HIEs as reported in a recently released

Black Book survey. Black Book surveyed 1,813 provider organizations utilizing health information exchanges, and 1,290

payers and insurers over the last six months of 2014. Eighty vendors were represented by the poll responses ranking the

performance of HIE developers.

Stakeholders forecast the number of public HIEs to significantly decrease by 2017. 72 percent of HIE stakeholders

conclude as few as 10 currently functioning public exchanges can sustain operations without more effective processes,

participation schemes, revenue or funding streams, and effective business models.

In Q1 2014, six in 10 operational HIEs were funded by $546M in HITECH funds but 95 percent of payers do not see the

value proposition in public HIEs. Without federal grants, HIEs are forced to assess high fees for stakeholders while

developing alternative revenue generating prototypes. At the same time, public HIEs are struggling to exchange trusted

patient data sets between payers and providers.

Health insurers participate in fewer than 20 percent of public HIEs. 89 percent of payer respondents overwhelming reject

paying the annual fees of public exchanges, despite the fact that payers are seen as the primary beneficiaries of

interoperability, realizing significant saving by reducing redundant testing, experiencing fewer repeated procedures,

decreasing readmissions, and identifying population health trends.

Payers are determining how they can best manage the HIE ecosystem by gaining access to the clinical data of covered

members. With the majority of hospitals and medical practices fully functional with EHR, reciprocal data flow with payers

has been the tipping point to provoke insurers to initiate leadership roles in private HIEs.


Black Book Rankings



Additionally, 90 percent of clinicians (up from 88% last year) and 96 percent of payers agree that payers will fill an

information gap for clinicians at the point of eligibility and will allow them to administer better care via access to

aggregated data on members.

Providers are not benefiting financially yet and without proven worth or certain return, the shift to payer investment in

private HIEs was inevitable with value-based care emerging. The stakeholders that benefit the most from HIE are the

ones that will pay to support it and pilot the exchange initiatives forward.

HIE is a field in relative infancy but its measures for success are clearly mapped. Black Book polled users of operational

exchanges, both public and private to determine the top performing vendors on eighteen HIE-specific gages.

Current users ranked four HIE vendors as top performers in their specialty theatres of engagement. Ranking first in their

respective categories in the Private/Enterprise and Public HIE marketplace for 2015 are:

ORION HEALTH– Government Payer and Commercial Insurer-Centric HIEs

AETNA MEDICITY– Core Private HIEs

CERNER – EHR-Centric HIEs

INTERSYSTEMS–Core Public HIEs

Other vendors receiving top honors in specific key performance indicators were: UUUUU

Additional significant findings from the 2015 Black Book HIE user survey include:

58 percent of multi-provider networks and hospital systems are considering private HIEs for more standardized sharing

of patient data (up from 33% in 2013).

98 percent of healthcare organizations believe that private, community/regional HIEs are the preferred choice to

comprehensively achieve accountable care organization deliverables.

Although HIE use has increased 69 percent from 2012 to 2014, there’s still a need for financial drivers and regulatory

demands to increase interoperability between payers and providers, according to 93 percent of survey participants.

Nearly 100 percent of providers agree that payers need to reward providers for HIE utilization that leads to tangible

reduction in readmissions, elimination of duplicate diagnostic testing and decreasing episodes of care.

Private exchanges will continue to outpace public HIEs as organizations are exploring how they will effectively aggregate

data to support their ACO efforts. Eventually, given meaningful use, the industry can expect to see connections between

private and public exchanges emerging for the purpose of sharing public health data and to support the portability of

medical records. But there is an obvious challenge of whether public, regional and state exchanges will still be around to

connect to when that happens, or if these private exchanges and EHR vendors will instead connect stakeholders directly

to a national exchange.

Given the surge of payers investing in private networks, and EHR vendors working collaboratively to establish standards

for interoperability, it would appear that public HIEs may only have a subordinate position in successful stakeholder

connectivity as the industry progresses.


Black Book Rankings



AGGREGATED RESULTS FROM HIE AND EHR/EMR USER

SURVEY QUESTIONS 2015

FINDING 1A: OPERATIONAL HEALTH INFORMATION EXCHANGES

Survey Year Public and Private Operative

Data Exchanges

Operational Exchanges Using

Commercial Technology

to Share Data

2014 336 278

2013 322 220

2012 259 89

2011 224 76


FINDING 2: IMPLEMENTATIONS OF BASIC EMR AND FULLY FUNCTIONAL EHR 2006 -2014

IMPLEMENTED

EHR

2006 BASIC

EMR

2009 BASIC

EMR

2009 FULLY

FUNCTIONAL

EHR

2011

BASIC

EMR

2011 FULLY

FUNCTIONAL

EMR

2014

BASIC

EHR

2014 FULLY

FUNCTIONAL

EMR

National Office-

based Practices 29.0% 44.5% 6.3% 60.3% 11.2%

‘

82.84%

47.5%

National Hospital,

Academic and

Institutional

Based Practices

42.8% 66.0% 32.1% 87.6% 38.5%

97.0%

69.0.%



Black Book Rankings



FINDING 3: SURVEY RESPONSE RATES BY ORGANIZATION TYPE

SURVEY RESPONDENT IDENTIFICATION PERCENT OF TOTAL RESPONSE

Solo and Small Physician/Clinician 8.1%

Clinics/ Large Groups 9.7%

Academic Hospitals and Medical Centers over 250 Beds 15.5%

Community Hospitals IDNs & Chains/Systems 28.2%

Small Hospitals, Rural/CAC under 100 Beds 5.5%

Payers/Insurers/Others 33.0%

FINDING 4: HIE READINESS BY INDICATED BY EMR ADOPTION RATE BY PRACTICE SIZE

PRACTICE SIZE ADOPTION/IMPLEMENTATION RATE

50+ PHYSICIAN GROUPS 95.8%

20-49 89.4%

10-19 73.2%

2-9 56.2%

1 (SOLO & SMALL PRACTICES) 39.1%

OVERALL 68.0%

FINDING 5: CHANGES IN IT ORGANIZATION HIE SPEND ANTICIPATED IN NEXT 24 MONTHS (DROPPING)

HEALTH CARE DELIVERY

ORGANIZATIONS SPEND FOR

HIE

2014 2015 PROJECTING 2016

SPEND INCREASING 10+% FOR

HIE

77% 98% 65%

NO SPEND OR DECREASING

10+% FOR HIE

4% 1% 20%


Black Book Rankings



ORGANIZATIONS INCREASING 2015 HIE SPEND ANTICIPATED IN NEXT 36 MONTHS BY POTENTIAL BUYER/USER

HEALTH CARE DELIVERY

ORGANIZATIONS SPEND FOR HIE 2015 PROJECTING 2016

PROJECTING 2017

IDNS, HEALTH SYSTEMS 99% 83% 35%

ACADEMIC MEDICAL CENTERS 90% 100% 67%

PAYERS 45% 99% 100%

LARGE/MULTISPECIALTY

GROUPS 89% 100% 92%


FINDING 6: ANTICIPATED LARGEST BUDGET IT PROJECT INCREASES NEXT 24 MONTHS

INDICATE BIGGEST INCREAES INS

FOR IT SPENDING IN 2015-2016 CIO/CMO SELECTING IN FOUR (5) TOP PROJECTS

SECURITY PROGRAMS 100%

REVENUE CYCLE MANAGEMENT 88%

ANALYTICS 80%

CLINICAL DECISION SUPPORT & POPULATION HEALTH 74%

ELECTRONIC HEALTH RECORDS 35%

NETWORKING 33%

WEB STORAGE & DIGITAL IMAGING 20%

HIE 17%

CPOE, E-PRESCRIBING & ANCILLARY REPORTING 13%

HARDWARE & INFRASTRUCTURE 3%

OTHER 7%


Black Book Rankings: HIE User Survey 2015



FINDING 7: HIE READINESS: INDICATED BY

FULLY FUNCTIONAL EMR-EHR

IMPLEMENTATION RATE BY STATE

STATE PERCENT UTILIZING COMPLEX OR

FULLY FUNCTIONAL EMR-EHR

IOWA 36.3%

MASSACHUSSETTS 34.2%

RHODE ISLAND 32.1%

OREGON 30.9%

MINNESOTA 30.8%

DELAWARE 30.8%

MICHIGAN 30.4%

KANSAS 30.3%

INDIANA 30.0%

COLORADO 29.6%

MISSOURI 28.2%

VERMONT 26.4%

IDAHO 24.5%

PENNSYLVANIA 24.5%

MAINE 24.4%

NEW JERSEY 24.4%

WISCONSIN 24.3%

SOUTH DAKOTA 24.3%

TEXAS 24.3%

NEVADA 24.0%

NORTH CAROLINA 23.8%

ILLINOIS 23.6%

MISSISSIPPI 23.5%

WASHINGTON 21.6%

MONTANA 21.3%

OKLAHOMA 21.0%

FLORIDA 20.9%

HAWAII 20.5%

TENNESSEE 20.5%

ARIZONA 20.4%

ALABAMA 18.9%

GEORGIA 16.7%

OHIO 16.7%

KENTUCKY 15.3%

CALIFORNIA 15.1%

NEW YORK 15.0%

LOUISIANA 14.3%

VIRGINIA 14.2%

CONNECTICUT 14.0%

ALASKA 13.3%

WYOMING 12.5%

NEW HAMPSHIRE 12.4%

MARYLAND 12.0%

NEBRASKA 11.9%

UTAH 11.6%

SOUTH CAROLNA 10.3%

NEW MEXICO 10.2%

WEST VIRGINIA 9.6%

NORTH DAKOTA 9.1%

AVERAGE 24.5%





FINDING 8: AWARENESS OF DIFFERENT HIE VENDORS/BRANDS IN MARKETPLACE

PROVIDER CIO AWARENESS/KNOWLEDGE OF HIE

VENDORS BEFORE SELECTION PROCESS PERCENT AWARE OF VENDORS

KNEW OF NO VENDORS 27.2%

KNEW OF AT LEAST ONE VENDOR

32.5%

KNEW MORE THAN ONE VENDOR 31.3%


FINDING 9: VENDOR SELECTION CRITERIA FOR 2015 HIE

USERS’ TWO MOST CRUCIUAL CRITERIA

FOR HIE VENDOR SELECTION (LAST 12 MONTHS)

PERCENT SELECTED THIS CRITERIA

PAYER/INSURER NETWORK INCLUSION 70.4%

HIE DISOUNTED BY EHR VENDOR/OR INCLUDED IN EHR 69.3%

INDUSTRY, PEER OR COMMUNITY RECOMMENDATION 33.4%

AFFORDABILITY 22.9%

INTERGRATION EXPERIENCE 15.5%

USABILITY/ANALYTICS 14.0%

EXISTING RELATIONSHIP WITH VENDOR (DISCOUNTS) 10.2%





FINDING 9: HIE READINESS: INDICATED BY EMR ADOPTION/IMPLEMENTATION RATE BY SPECIALTY

SPECIALTY TOTAL ACTIVE

PHYSICIANS

(NON-RESEARCH/

NON-TEACHING)

PATIENT CARE

PHYSICIANS

EST IMPLEMENTING

BASIC EMR

PERCENT OF

SAMPLE

IMPLEMENTING

EMR

Radiology 27562 25002 20977 84%

Emergency Medicine 30742 27981 23308 83%

Pediatrics 54061 48111 38393 80%

Neurology 12630 10597 8202 77%

Family Medicine/General Practice

103315 95627 67130 70%

Plastic Surgery 6671 6307 4314 68%

Gastroenterology 12086 10998 7446 68%

Obstetrics & Gynecology 39689 36827 24858 68%

Ophthalmology 17846 16616 10883 66%

Urology 9916 9308 5818 63%

Otolaryngology 9220 8711 5227 60%

Physical Medicine & Rehab 8084 7168 4279 60%

Psychiatry 39371 33955 19864 59%

Neurosurgery 4921 4480 2527 56%

Internal Medicine 104904 91457 50850 56%

Allergy & Immunology 4222 3594 1955 54%

Infectious Disease 6424 4567 2297 50%

Geriatric Medicine 3769 2995 1396 47%

General Surgery 26769 22852 10398 46%

Hematology & Oncology 11802 9584 4198 44%

Dermatology 10390 9799 3714 38%

Nephrology 7550 6359 2308 36%

Cardiovascular Disease 21511 19476 6135 32%

Rheumatology 4568 3763 1095 29%

Orthopedic Surgery 20323 18912 5447 29%

Child Adolescent Psychiatry

7312 6318 1542 24%

Vascular Surgery 2610 2393 584 24%

Endocrinology 5448 4112 901 22%

Pulmonary Medicine 11567 9829 2044 21%

Thoracic Surgery 4820 4388 908 21%

ALL PHYSICIANS 765788 678336 345952 51%

Source: Black Book Rankings, 2012-2014




FINDING 10: HIE READINESS, MODULE ADOPTION RATES BY PRACTICE SIZE, LOCATION, REGION

2008

Basic EHR

2014

Basic EHR

2008

EHR+PM+ERX

2014

EHR+PM+ERX

2008

No EMR

2014

No EMR

Primary Care 15% 82% 6% 45% 80% 7%

SIZE

Solo Practice 8% 38% 2% 19% 85% 17%

2-5 Physicians 11% 73% 4% 40% 84% 4%

6-25 Physicians 17% 95% 6% 59% 77% 2%

26-99 Physicians 22% 97% 8% 86% 69% 0%

100+ Physicians 35% 98% 18% 93% 52% 0%

SETTING

Hospital and

Academic Med

Center Practices

16% 92% 6% 84% 82% 1%

Office Practices 12% 64% 5% 20% 85% 18%

LOCATION

Urban 13% 92% 4% 45% 80% 6%

Rural 6% 23% 2% 22% 89% 19%

REGION

Northeast 11% 84% 4% 61% 86% 15%

Midwest 13% 82% 4% 56% 83% 7%

South 12% 78% 5% 44% 84% 12%

West 16% 74% 6% 43% 76% 10%





CLIENT/USER FOCUS RESPONSES, Q4 2014

WHAT IS THE FUTURE OF HIE PLATFORMS (INDICATE WHAT PLATFORM YOU PREDICT WILL BE MOST VIABLE)

STAKEHOLDER CLOUD ENABLED HIE

PLATFORM STANDALONE HIE

PLATFORM PLAFORM VARIATIONS AND COMBINATIONS

PAYER/INSURER 94% 47% 24%

SILOED EHR 9% 41% 12%

STATE/REGIONAL/ LARGE AGENCY

10% 12% 3%

HOSPITAL SYSTEMS IDN

33% 24% 20%

SMALL HOSPITALS/CLINICS

13% 5% 2%

PHYSICIAN PRACTICES

18% 7% 10%


TOP PRIORITIES FOR CLOUD PLATFORM HIE VENDOR RISK ASSESSMENTS (SELECT 4)

CIO/IT PRIORITY ONE OF FOUR TOP PRIORITIES

AUDITTING DATA USE

12%

DIGITAL ASSET MANAGEMENT

29%

AUDITTING STORAGE

34%

SECURITY

37%

HIPAA LIABILITY

40%

OWNERSHIP/CONTROL OF OFFSITE DATA

92%

ACCESS TO OFFSITE DATA

93%


PROVIDER HIE PERCEPTIONS: INDICATE WHETHER THE TYPE OF HIE VENDOR CORPORATE BASE (INSURER,

EHR/SOFTWARE, PHARMA) CONCERNS YOUR LEADERSHIP TEAM MOST ON ONE OR MORE ISSUES (DATA INTEGRITY,

SUSTAINABILITY, SECURITY, REPUTATION)

PROVIDERS

HIE VENDOR/OWNER STAKEHOLDER:

LABS/ANCILLARY PROVIDERS

STAKEHOLDER: HOSPITALS, IDNS & HEALTH SYSTEMS

STAKEHOLDER: PHYSICIANS & CLINCS

PAYERS/INSURERS

87% 69% 20%

EHR VENDORS

14% 19% 10%

PHARMACEUTICAL COMPANIES

7% 24% 79%





EXPECTATIONS OF NATIONAL CODING STANDARDS: INTEROPERABILITY REALITIES

LABS/ANCILLARY

PROVIDERS

HOSPITALS

PHYSICIANS

PAYERS

ONLY WANT TO

VIEW DATA

91%

46%

34%

1%

WANT TO IMPORT

DATA

9%

50%

15%

99%


EXPECTATIONS OF FULLY FUNCTIONAL REGIONAL INTEROPERABILITY HIEs BEYOND RECORD EXCHANGE &

MEANINGFUL USE COMPLIANCE (SELECT TOP 3)

PAYERS/INSURERS

HOSPITALS

PHYSICIANS

CONNECT MULTIPLE EHR

SYSTEMS & VENDORS

95%

88%

23%

INCREASE EFFECTIVENESS

OF PRIMARY CARE

95%

22%

20%

AUTOMATE PUBLIC HEALTH

REPORTTING 2% 10% 39%

STREAMLINE MULTIPAYER

TRANSACTIONS 83% 70% 60%


HIE DATA HOARDING AND PAY-FOR-DATA PROFITEERING

HIE USERS/PROSPECTIVE USERS

FEEL DATA HOARDING &

PROFITEERING

BY

PAYERS/INSURERS

BY

SILOED

EHR

COMPANIES

BY

PROVIDER GROUPS & IDNS

MAJOR CONCERN

75%

95%

40%

CONCERNING

20%

4%

29%

NO CONCERN 2% 0% 13%

DON’T KNOW 2% 1% 10%





COMPETEING EHRS WITH HIE FUNCTIONALITY ARE ROADBLOCKS TO DEVELOPING & HARMONIZING DATA STANDARDS

RESPONSE HOSPITALS PHYSICIANS PAYORS

YES

48%

91%

34%

NO

22%

1% 10%

MAYBE 28% 4% 54%

DON’T KNOW 2% 4% 2%


HIE RETURN ON INVESTMENT (SELECT YOUR FOUR TOP ROI GOALS)

HOSPITALS PHYSICIANS PAYERS ANCILLARIES

COLLABORATING WITH ACOs & PATIENT CENTERED

MEDICAL HOMES 64% 14% 90% 15%

TURNAROUND OF ANCILLARY RESULTS

39% 35% 82% 82%

ACHIEVEMENT OF MEANINGFUL USE

37% 90% 5% 7%

CONTROL OF ADMISSIONS/READMISSIONS

70% 11% 79% 2%

IMPROVED ELIGIBILITY & DISABILITY DETERMINATION

18% 22% 84% 26%

IMPROVED PERFORMANCE ON RISK CONTRACTS

58% 23% 18% 6%

IMPROVING HEALTH OF PATIENT POPULATION

10% 11% 89% 2%





BARRIERS TO SUCCESSFUL HIE IMPLEMENTATIONS (SELECT THREE MOST DIFFICULT BARRIERS YOU ARE

ENCOUNTERING)

EFFICIENT ELECTRONIC AND ACCURATE DATA

EXCHANGE BETWEEN PROVIDERS, PAYERS AND AGENCIES

72%

GARDENWALLED EHR SYSTEMS & DATA

OWNERSHIP/HAORDING

80%

LACK OF CORE NATIONAL STANDARDS

19%

PATIENT AUTHORIZATION AND CONSENT

12%

COMPETITION BETWEEN HIE VENDORS

8%

VARIETY AND NUMBER OF SOFTWARE

APPLICATIONS PER PROVIDER

12%

COMPETENT MANAGEMENT & STAFF

53%

COSTS/FEES

39%

GOVERNANCE ISSUES

30%

COMPETITIVE HOSPITAL SYSTEMS & NETWORKS

13%

NOT PARTICIPATING IN PAYER CONNECTIVITY

9%





SUMMARY

SURVEY OVERVIEW

In Q2 2014 through Q4 2014, the Black Book Rankings’ Health Information Exchange client/user/prospective customer survey

investigated 67 HIE self-stated vendors utilized by 1,813 validated HIE users nationwide for rankings and an additional 2,240

respondents in pre-use, implementation, system decision making or purchased but not yet installed status. Over 4,000 prospective HIE

stakeholders participated in ballots that did not evaluate vendor performance.

Additionally, in an adjunct survey, Black Book received completed ballots from 1,290 healthcare payers, insurers, and related

organizations on key performance indicators and trend development questions relating to payer involvement in HIE sustainability.

KEY SATISFACTION FINDINGS

Key finding: most important HIE satisfaction KPIs

Stakeholder engagement (92%), and Funding/Sustainability (95%) are the most important attributes influencing HIE client companies’

satisfaction with their HIE vendors. Brand reputation (83%) and successful/operational clients (82%) followed.

Key finding: HIE vendor satisfaction is highest among hospital systems/IDNs and larger physician groups

Clients with more than 25 physicians in a single setting and multihospital systems are significantly more satisfied with their HIE than are

single and small group practice (2-5, 6-25 physician group) client. Strong satisfaction in the larger practice segment declined from 88%

to 36% in 2014 for EHRs also, indicating a high level of technology expertise in these organizations was being frustrated by fees, siloed

patient data, and failures to interface.




BLACK BOOK METHODOLOGY

HOW THE DATA SETS ARE COLLECTED

Black Book collects ballot results on 18 performance areas of operational excellence to rank vendors by health information exchange

product lines. The gathered data are subjected immediately to an internal and external audit to verify completeness and accuracy and to

make sure the respondent is valid while ensuring that the anonymity of the client company is maintained. During the audit, each data set

is reviewed by a Black Book executive and at least one external auditor. In this way, Black Book's clients are able to clearly see how a

vendor is truly performing. The 18 criteria on operational excellence are subdivided by the client type and further analyzed by HIE base,

market size, geography and HIE functions reportedly used.

Situational and market studies are conducted on areas of high interest such as e-Prescribing, Health Information Exchange,

Accountable Care Organization, hospital software, services providers, educational providers in e-health, bench markers and advisors.

These specific survey areas range from four to 20 questions of criteria each.

UNDERSTANDING THE STATISTICAL CONFIDENCE OF BLACK BOOK HIE SURVEY DATA

Statistical confidence for each performance rating is based upon the number of organizations scoring the health information exchange.

Black Book identifies data confidence by one of several means:

Top-5-ranked vendors must have a minimum of ten ballots from at least three unique clients represented. Broader categories may

require a minimum of 20 client ballots to qualify and validated respondents. Data that is asterisked (*) represent a sample size below

required limits and are intended to be used for tracking purposes only, not ranking purposes. Performance data for an asterisked

vendor's services can vary widely until a larger sample size is achieved. The margin of error can be very large, and the reader is

responsible for considering the possible current and future variation (margin of error) in the Black Book performance score reported.

Vendors with over ten unique client votes are eligible for top five rankings and are assured to have highest confidence and lowest

variation. Confidence increases as more organizations report on their outsourcing vendor. Data reported in this form is shown with a

95% confidence level (within a margin of 0.25, 0.20 or 0.15, respectively).

Raw numbers include the quantity of completed surveys and the number of unique organizations contributing the data for the survey

pool of interest. Six subsets of stakeholders were used to isolate scores by organization type as identified by the survey participant.

WHO PARTICIPATES IN THE BLACK BOOK RANKING PROCESS

More than 400,000 practice management and physician leaders and other users ranking from hospital executives, clinicians, IT

specialists and front-line implementation veterans are invited to participate in the 2015 annual Black Book EMR EHR e-Health initiatives,

e-Rx, HIE and ACO satisfaction surveys. Non-invitation participants must complete a verifiable profile and utilize a valid corporate email

address to be included. Several data sets from the EHR/EMR polling was included in this HIE report. Further, 1,813 HIE users of

operational HIEs and 2,240 individuals implementing nonoperational HIEs completed verifiable surveys, as did ,290 payer

representatives in the CIO, CMO, CFO or CEO ranks, or their assigned representative.

The Black Book HIE survey web instrument is open to respondents and new participants from provider/user organizations from

September 1, 2014 to December 15, 2014 at http://blackbookrankings.com and http://blackbookpolls.com Only one ballot per corporate

email address is permitted and changes of ballots during the open polling period require a formal email request process to ensure

integrity. Payers participated from November 1, 2014 to January 7, 2015.

http://blackbookrankings.com/

http://blackbookpolls.com/




HIE VENDOR RANKINGS AND RESULTS – 2015

Nearly five thousand current and implementing providers HIE users, and 1,300 payer users, and 4,000 prospective users evaluated

trends and HIE systems with validated corporate email addresses. Current users ultimately ranked 80 HIE suppliers offering individual

or bundled arrangements as part of the Black Book annual survey, conducted via web survey instruments. Additionally the current or

prospective HIE users answered questions about budgeting, vendor familiarity and vendor selection processes, but current non-user

ballots are not counted in the vendor ranking process of client satisfaction. Only current users’ ballots ranked vendors on the satisfaction

and experience Key Performance Indicators. The six most highly utilized systems of HIE and EMR systems are included as subsets,

as they represented the largest groups of respondents in 2014-2015.

HIE VENDORS WITH >100

SURVEY RESPONSES 2015

OPTUM (AXOLOTL/INGENIX/UNITED HEALTH CARE )

MEDICITY (AETNA)

CERNER

DB MOTION/ALLSCRIPTS

EPIC

RELAYHEALTH (MCKESSON)

ORION

AVAILITY

INTERSYSTEMS

MEDECISION

2015 BLACK BOOK ENTERPRISE HIE SURVEY

67 HEALTH INFORMATION EXCHANGE VENDORS

1,813 RESPONDENTS CURRENTLY USE HIE (INSTALLED/OPERATIONAL)

2,240 RESPONDENTS IN PARTIAL USE, IMPLEMENTATION UNDERWAY (NOT OPERATIONAL)

1,776 RESPONDENTS CONSIDERING PURCHASE, PARTICIPATION, (NOT INSTALLED)

1,290 PAYER/INSURER HIE USER RESPONSES




PART TWO: 2015 COMPARATIVE RESULTS

ENTERPRISE HEALTH INFORMATION EXCHANGES

SUMMARY OF TOP PERFORMING ENTERPRISE HIE VENDORS

TOP GOVERNMENT PAYER/COMMERCIAL INSURER-CENTRIC HIE

HEALTH INFORMATION EXCHANGE VENDOR

► ORION HEALTH

www.orionhealth.com

TOP ELECTRONIC HEALTH RECORD-CENTRIC HIE


►CERNER

www.cerner.com

TOP CORE SYSTEM GOVERNMENT/PUBLIC HIE


► INTERSYSTEMS

www.intersystems.com

TOP CORE SYSTEM PRIVATE ENTERPRISE HIE


► AETNA MEDICITY

www.medicity.com




2015 TOP PRIVATE HIE VENDORS GOVERNMENT AND COMMERICAL PAYER-CENTRIC SYSTEMS

Table 1: Top 5 PAYER-CENTRIC HIEs

2015 Rank HIE Vendor – Payer Systems

1 ORION HEALTH

2 OPTUM

3 AETNA MEDICITY

4 AVAILITY

5 MEDECISION

6 NAVINET LUMERIS

7 COVISINT

8 CERITFY/HUMANA





2015 TOP PRIVATE HIE VENDORS PHYSICIAN PRACTICE EHR

Table 2: Top 10 MEDICAL PRACTICE ELECTRIONIC MEDICAL RECORD FIRM HIEs

2015 Rank HIE Vendor – Ambulatory EHR Only

1 DBMOTION ALLSCRIPTS

2 CERNER

3 GREENWAY/VITERA

4 ATHENAHEALTH

5 EPIC

6 SIEMENS

7 MCKESSON RELAYHEALTH

8 QSI NEXTGEN

9 OPTUM

10 ECLINICALWORKS

2015 TOP PUBLIC/PRIVATE HIE VENDORS - CORE HIE SYSTEMS

Table 1: Top 20 CORE SYSTEM HIEs

2015 Rank HIE Vendor – Core HIE Systems (NON EHR SYSTEMS)

1 INTERSYSTEMS

2 ORION

3 ICA

4 DBMOTION

5 MEDICITY

6 RELAYHEALTH

7 ALERE WELLOGIC

8 SANDLOT

9 HARRIS

10 HEALTHUNITY

11 TRUVEN HEALTH

12 QSI MIRTH

13 CARE EVOLUTION

14 IATRIC SYSTEMS

15 AX SYS HEALTH

16 INTEHEALTH

17 4MEDICA

18 PATIENTKEEPER

19 MEDSEEK

20 ECLNICALWORKS




2015 TOP PRIVATE HIE VENDORS - COMPLEX DATA ORGANIZATIONS AND TECHNOLOGY OUTSOURCERS

Table 1: Top 10 COMPLEX DATA TECH FIRMS HIEs

2015 Rank HIE Vendor – Complex Data Organizations and Outsourcers

1 INFOR (FORMERLY LAWSON)

2 CTG

3 DELL

4 AT&T

5 ORACLE

6 VERIZON

7 CSC

8 COVISINT

9 HEWLETT PACKARD

10 IBM




2015 TOP PRIVATE HIE VENDORS – ELECTRONIC HEALTH RECORD CENTRIC (INPATIENT & AMBULATORY NETWORKS)

Table 1: Top 10 EHR-CENTRIC HIEs

2015 Rank HIE Vendor – ALL EHR SYSTEMS

1 CERNER

2 DBMOTION ALLSCRIPTS

3 MCKESSON RELAYHEALTH

4 QSI NEXTGEN

5 EPIC SYSTEMS

6 SIEMENS

7 GE HEALTHCARE

8 QUADRAMED

9 CPSI

10 MEDITECH


Top HIE Vendor Scoring

Top Enterprise Health Information Exchange Vendors Published January 2015

© Black Book Rankings. This report is a licensed product. Page 39

STOP LIGHT SCORING KEY

Figure 1: Comprehensive end-to-end HIE vendors are defined as being comprised of six survey stakeholders

PAYERS INSURERS &

PAYER AGENCIES

HOSPITAL SYSTEMS,

CORPORATIONS & IDNS

COMMUNITY HOSPITALS &

ACADEMIC MEDICAL CENTERS

CLINICS, IPAS & LARGE

PHYSICIAN GROUPS

SOLO & SMALL PHYSICIAN PRACTICES

ANCILLARY PROVIDERS

LAB/PHARM/MH





Figure 2: Key to raw scores


Figure 3: Color-coded stoplight dashboard scoring key

Green (top 10%) scores better than 90% of HIE vendors. Green coded vendors have received constantly highest client satisfaction scores.

8.71 +

Clear (top 33%) scores better than 67% of HIE vendors. Well-scored vendor which have middle of the pack results.

7.33 to 8.70

Yellow scores better than half of HIE vendors. Cautionary performance scores, areas of improvement required.

5.80 to 7.32

Red scores worse than 66% of HIE vendors. Poor performances reported potential cause for service and contractual cancellations.

Less than 5.79


0.00–5.79 ►

◄ 5.80–7.32 ►

◄ 7.33–8.70 ►

◄ 8.71–10.00

Deal breaking dissatisfaction

Does not meet expectations

Cannot recommend vendor

Neutral

Meets/does not meet expectations

consistently

Would not likely recommend vendor

Satisfactory performance

Meets expectations

Recommends

vendor

Overwhelming satisfaction

Exceeds expectations

Highly recommended vendor




Figure 4: Raw score compilation and scale of reference

Black Book raw score scales

0 = Deal breaking dissatisfaction ◄ ___ ► 10 = Exceeds all expectations


Individual vendors can be examined by specific indicators on each of the main functions of HIE vendors as well as grouped and summarized subsets. Details of each subset are contained so that

each vendor may be analyzed by function and end-to-end HIE services collectively.




Figure 5: Scoring Key

Q6 CRITERIA RANK COMPANY PAYERS

INSURERS AGENCIES

HOSPITAL SYSTEMS

CORPS, IDNS


MED CTRS


PHYSICIAN PRACTICES

SOLO & SMALL

PRACTICES

ANCILLARY PROVIDERS

MEAN

1 Nationwide HIE 8.49 8.63 9.02 9.19 8.50 8.01 8.66

Source; Black Book Rankings

Criteria rank – refers to the number of the question or criteria surveyed. This is the sixth question of the 18 criteria of which this vendor ranked first of the 20 vendors analyzed positioned only on

this particular criteria or question. Each vendor required ten unique client ballots validated to be included in the top ten ranks.

Company – name of the HIE vendor.

Subsections – each subset comprises one-fourth of the total HIE vendor mean at the end of this row, and includes all buyers and users who indicate that they contract each respective HIE

functional subsection with the supplier, specific to their enterprise.

Mean – congruent with the criteria rank, the mean is a calculation of all three subsets of HIE functions surveyed. As a final ranking reference, it includes all market sizes, specialties, delivery sites

and geographies.


Published February 2015

© Black Book Rankings. This report is a licensed product.

Page 43

2015 COMPARATIVE RESULTS

ENTERPRISE HEALTH INFORMATION EXCHANGES

2015 INDIVIDUAL KEY PERFORMANCE: ENTERPRISE HEALTH INFORMATION EXCHANGES



© Black Book Rankings. This report is a licensed product.

Page 44

TOP SCORE PER INDIVIDUAL CRITERIA

Key Performance Indicator

2015 Top HIE Vendor

HIE STAKEHOLDER ALIGNMENT ORION HEALTH

BRAND IDENTITY & MARKET IMAGE ORION HEALTH

DATA USABILTY TRUST/NEUTALITY INTERSYSTEMS

DATA USE RELIABILITY/ACCURACY/CONTINUITY ORION HEALTH

DATA INTEGRITY ORION HEALTH

EASE OF DATA TRANSMITTAL AND EXCHANGE CERNER

SECURITY AND PRIVACY ORION HEALTH

CLINICAL SYSTEMS WORKFLOW/PRODUCTIVITY CERNER

SUSTAINABILITY/FUNDING/FINANCIAL MANAGEMENT/VIABILITY AETNA MEDICITY

BEST OF BREED TECHNOLOGY/INNOVATION RESEARCH AND DEVELOPMENT AETNA MEDICITY

WIDESPREAD INTEROPERABILITY AND FLEXIBILITY INTERSYSTEMS

ACCOUNTABLE CARE SUPPORT ORION HEALTH

COST & LABOR IMPROVEMENTS/EFFICIENCIES MCKESSON/RELAYHEALTH

DATA ANALYTICS/BUSINESS INTELLIGENCE INTERSYSTEMS

QUALITY REPORTING SERVICES AND COMMUNICATIONS CERNER

PATIENT ACCESSIBILITY ORION HEALTH

CUSTOMER SERVICE AND SUPPORT DBMOTION ALLSCRIPTS

CONFIGURATION AND INTERFACES ORION HEALTH

VENDOR AGNOSTIC CULTURE & PRACTICE ORION HEALTH

FINANCIAL SYSTEMS WORKFLOW/PRODUCTIVITY AETNA MEDICITY


© Black Book Market Research. This report is a licensed product.

Page 45

Q1/Table 7: HIE STAKEHOLDER ALIGNMENT

Q1 CRITERIA

RANK COMPANY

PAYERS INSURERS & AGENCIES

HOSPITAL SYSTEMS,

CORPORATIONS & IDNS


MEDICAL CENTERS


PHYSICIAN PRACTICES

SOLO & SMALL PRACTICES

ANCILLARY PROVIDERS LAB/RX/MH

MEAN

1 ORION HEALTH 9.60 9.95 9.68 9.60 9.88 9.81 9.75

2 CERNER 9.41 9.82 9.77 9.34 9.15 9.55 9.51

3 INTERSYSTEMS 9.16 9.53 9.37 9.24 9.38 9.27 9.33

4 DBMOTION/ALLSCRIPTS 9.07 9.59 9.25 9.28 9.13 8.89 9.20

5 OPTUM 9.35 8.57 9.09 9.42 9.27 8.76 9.08

6 GREENWAY 9.34 9.00 8.73 8.95 8.50 9.34 8.98

7 ATHENAHEALTH 8.78 9.66 9.01 8.54 8.67 8.86 8.92

8 AVAILITY 9.07 8.87 9.38 8.34 8.28 8.43 8.73

9 MCKESSON/RELAYHEALTH 8.36 8.67 8.85 9.08 8.83 8.18 8.66

10 ICA 8.43 9.21 8.58 8.54 7.98 8.85 8.60



Page 46

Q2/Table 8: BRAND IDENTITY & MARKET IMAGE

Q2 CRITERIA

RANK COMPANY


HOSPITAL SYSTEMS,

CORPORATIONS & IDNS


MEDICAL CENTERS


PHYSICIAN PRACTICES



MEAN

1 ORION HEALTH 9.94 9.90 9.68 9.90 9.85 9.77 9.84

2 INTERSYSTEMS 9.26 9.71 9.86 9.77 9.69 9.93 9.70


4 OPTUM 9.65 9.55 9.29 9.22 9.01 9.49 9.37


6 GREENWAY 9.41 9.35 8.90 8.89 8.83 9.19 9.10

7 MEDECISION 8.83 9.19 9.42 8.58 9.20 8.65 8.98

8 CERNER 8.56 9.18 9.20 8.16 8.51 7.99 8.60

9 EPIC SYSTEMS 9.10 8.20 7.87 8.22 9.08 9.07 8.59

10 AVAILITY 8.16 8.51 7.24 8.12 8.93 9.08 8.34




Page 47

Q3/Table 9: DATA USE TRUST/NEUTRALITY

Q3 CRITERIA

RANK COMPANY


HOSPITAL SYSTEMS,

CORPORATIONS & IDNS


MEDICAL CENTERS


PHYSICIAN PRACTICES



MEAN

1 INTERSYSTEMS 9.31 9.62 9.60 9.46 9.77 9.04 9.47

2 OPTUM 9.57 9.68 9.67 9.12 9.08 9.63 9.46


4 AVAILITY 8.77 9.24 9.43 9.28 9.03 9.21 9.16

5 ORION HEALTH 8.56 9.36 8.45 9.57 9.17 9.54 9.11

6 DBMOTION ALLSCRIPTS 8.99 9.09 9.05 9.47 9.08 8.93 9.10

7 SIEMENS 8.92 8.55 8.20 8.58 9.54 9.32 8.85

8 QSI NEXTGEN MIRTH 9.11 9.09 9.27 8.30 8.65 8.53 8.83

9 ATHENAHEALTH 8.95 8.96 8.48 9.21 8.39 8.60 8.77

10 GREENWAY 9.25 8.16 8.45 8.75 8.66 8.97 8.71




Page 48

Q4/Table 10: DATA USE RELIABILITY/ACCURACY/CONTINUITY

Q4 CRITERIA

RANK COMPANY


HOSPITAL SYSTEMS,

CORPORATIONS & IDNS


MEDICAL CENTERS


PHYSICIAN PRACTICES



MEAN

1 ORION HEALTH 9.54 9.97 10.00 9.69 9.65 9.92 9.80


3 OPTUM 9.52 9.27 9.56 9.53 9.38 9.31 9.43

4 GREENWAY 9.65 8.92 9.27 9.39 9.22 9.16 9.27

5 ICA 8.49 8.97 9.31 9.27 9.20 9.11 9.06

6 INTERSYSTEMS 8.26 8.70 9.09 9.62 9.05 9.00 8.95

7 ATHENAHEALTH 8.65 8.82 8.47 9.27 8.76 8.96 8.82

8 SIEMENS 7.66 7.51 9.06 7.71 9.58 8.63 8.36

9 MEDECISION 7.36 7.42 8.53 9.21 8.44 8.68 8.27

10 CERNER 8.42 8.61 8.08 7.71 8.26 7.80 8.15




Page 49

Q5/Table 11: DATA INTEGRITY

Q5 CRITERIA

RANK COMPANY


HOSPITAL SYSTEMS,

CORPORATIONS & IDNS


MEDICAL CENTERS


PHYSICIAN PRACTICES



MEAN

1 ORION HEALTH 9.49 9.70 9.85 9.85 9.84 9.73 9.74

2 INTERSYSTEMS 9.59 9.35 9.39 9.23 8.79 9.75 9.35


4 OPTUM 9.18 9.38 9.22 8.68 9.39 9.17 9.17

5 GREENWAY 9.07 9.08 8.74 9.05 9.06 8.52 8.92

6 MEDECISION 8.65 8.99 8.67 9.66 8.53 8.66 8.86


8 ALERE WELLOGIC 8.83 8.47 7.99 8.88 7.69 9.36 8.54

9 CERNER 8.94 8.68 8.88 8.04 7.80 8.37 8.45




Page 50

Q6/Table 12: EASE OF DATA TRANSMITTAL AND EXCHANGE

Q6 CRITERIA

RANK COMPANY


HOSPITAL SYSTEMS,

CORPORATIONS & IDNS


MEDICAL CENTERS


PHYSICIAN PRACTICES



MEAN

1 CERNER 9.74 9.80 9.89 9.68 9.23 9.78 9.69

2 ORION HEALTH 9.87 9.55 9.67 9.58 9.67 9.71 9.68

3 INTERSYSTEMS 9.20 9.51 9.54 9.42 9.29 9.23 9.37



6 GREENWAY 8.94 9.65 8.73 8.71 8.77 9.74 9.09

7 ICA 8.63 9.15 9.32 8.96 8.25 8.91 8.87

8 AVAILITY 8.02 9.16 9.08 8.55 8.20 9.06 8.68

9 OPTUM 8.67 8.69 8.70 8.76 8.45 8.30 8.60

10 SIEMENS 8.28 8.85 8.49 8.80 8.31 7.95 8.45




Page 51

Q7/Table 13: SECURITY/PRIVACY

Q7 CRITERIA

RANK COMPANY


HOSPITAL SYSTEMS,

CORPORATIONS & IDNS


MEDICAL CENTERS


PHYSICIAN PRACTICES



MEAN

1 ORION HEALTH 9.77 9.75 9.89 9.58 9.33 9.61 9.66


3 GREENWAY 9.14 9.51 9.35 9.22 8.87 9.16 9.21

4 SIEMENS 9.05 9.57 9.23 9.26 8.76 9.07 9.16

5 INTERSYSTEMS 9.33 8.55 9.07 9.40 8.66 8.77 8.96

6 CERNER 8.71 8.98 9.32 8.93 8.61 8.81 8.89

7 AVAILITY 8.76 9.64 8.99 8.52 8.63 8.33 8.81

8 OPTUM 9.05 8.85 8.16 8.32 8.89 9.52 8.80

9 ATHENAHEALTH 8.34 8.65 9.28 9.06 8.44 8.65 8.74





Page 52

Q8/Table 14: CLINICAL SYSTEMS WORKFLOW PRODUCTIVITY

Q8 CRITERIA

RANK COMPANY


HOSPITAL SYSTEMS,

CORPORATIONS & IDNS


MEDICAL CENTERS


PHYSICIAN PRACTICES



MEAN

1 CERNER 9.74 9.97 9.83 9.66 9.64 9.69 9.75


3 ORION HEALTH 8.90 9.40 9.92 9.62 9.73 9.61 9.53

4 OPTUM 8.60 9.30 8.78 8.69 8.81 9.58 8.96

5 GREENWAY 9.39 9.26 9.17 8.64 8.55 8.50 8.92

6 AVAILITY 7.92 9.22 8.32 9.03 8.53 9.34 8.73

7 INFOR 8.73 9.11 8.79 8.19 7.51 9.22 8.59


9 INTERSYSTEMS 7.88 8.43 7.96 8.18 8.77 8.19 8.24

10 ICA 7.71 8.73 7.19 8.00 8.19 9.41 8.21




Page 53

Q9/Table 15: SUSTAINABILITY/FUNDING/FINANCIAL MANAGEMENT/VENDOR VIABILITY

Q9 CRITERIA

RANK COMPANY


HOSPITAL SYSTEMS,

CORPORATIONS & IDNS


MEDICAL CENTERS


PHYSICIAN PRACTICES



MEAN

1 AETNA/MEDICITY 9.53 9.70 9.39 9.53 9.71 9.82 9.62

2 ORION HEALTH 8.73 9.39 9.16 9.35 9.46 9.24 9.22

3 GREENWAY 8.81 9.24 8.85 9.25 8.89 8.58 8.94

4 SIEMENS 8.67 8.64 8.90 9.48 8.92 8.55 8.86

5 CERNER 8.27 9.41 9.12 8.51 8.38 8.13 8.64

6 INTERSYSTEMS 8.94 8.06 8.27 9.20 8.30 8.65 8.57

7 OPTUM 9.09 8.75 8.20 8.44 8.01 8.76 8.54

8 ICA 8.66 8.34 8.83 8.42 8.47 7.65 8.40

9 ATHENAHEALTH 8.99 7.55 8.56 8.65 7.99 8.38 8.35

10 HEALTHUNITY 7.91 8.79 7.71 8.17 7.85 8.34 8.13




Page 54

Q10/Table 16: BEST OF BREED TECHNOLOGY/INNOVATION/RESEARCH & DEVELOPMENT

Q10 CRITERIA

RANK COMPANY


HOSPITAL SYSTEMS,

CORPORATIONS & IDNS


MEDICAL CENTERS


PHYSICIAN PRACTICES



MEAN

1 AETNA/MEDICITY 9.59 9.44 9.74 9.31 9.86 9.79 9.62

2 INTERSYSTEMS 9.33 9.59 9.29 9.38 9.38 9.59 9.43

3 ORION HEALTH 9.50 9.42 9.92 9.37 9.00 9.09 9.38

4 ALERE WELLOGIC 8.63 9.48 9.58 9.10 8.71 8.92 9.07



7 CERNER 7.90 9.04 9.03 9.06 8.14 8.04 8.54

8 OPTUM 8.40 8.51 7.18 8.64 8.70 8.38 8.30

9 ICA 8.66 7.82 8.62 7.61 7.87 8.64 8.20

10 ATHENAHEALTH 7.68 8.20 8.61 8.02 7.95 8.50 8.16




Page 55

Q11/Table 17: WIDESPREAD INTEROPERABILITY AND FLEXIBILITY

Q11 CRITERIA

RANK COMPANY


HOSPITAL SYSTEMS,

CORPORATIONS & IDNS


MEDICAL CENTERS


PHYSICIAN PRACTICES



MEAN

1 INTERSYSTEMS 9.49 9.84 9.40 9.91 9.79 9.91 9.72

2 CERNER 9.60 9.84 9.59 9.63 9.28 9.51 9.58

3 GREENWAY 9.50 9.49 9.39 9.02 9.20 9.27 9.31

4 ICA 9.01 9.63 9.03 9.51 8.77 9.57 9.25

5 OPTUM 9.10 9.22 9.20 9.59 8.79 8.64 9.09

6 ORION HEALTH 9.12 9.02 9.01 9.20 8.36 9.29 9.00


8 SIEMENS 8.56 8.73 9.39 9.11 8.37 8.51 8.78

9 AETNA MEDICITY 9.08 8.29 8.97 8.98 8.65 8.35 8.72

10 AVAILITY 8.44 8.27 9.19 9.13 8.32 8.12 8.58




Page 56

Q12/Table 18: ACCOUNTABLE CARE SUPPORT/ANALYTICS

Q12 CRITERIA

RANK COMPANY


HOSPITAL SYSTEMS,

CORPORATIONS & IDNS


MEDICAL CENTERS


PHYSICIAN PRACTICES



MEAN

1 ORION HEALTH 9.66 9.85 9.92 9.85 9.80 9.92 9.82

2 INTERSYSTEMS 9.61 9.52 9.44 9.65 9.29 9.85 9.56


4 OPTUM 9.02 9.64 8.77 8.98 8.78 9.58 9.13


6 AVAILITY 9.13 9.03 9.04 8.95 8.37 9.30 8.97

7 GREENWAY 8.99 8.86 9.09 9.10 8.51 8.54 8.85

8 CERNER 7.57 9.74 9.76 8.44 8.93 7.52 8.66

9 HEALTHUNITY 8.23 8.30 8.90 8.70 8.66 8.36 8.53

10 SIEMENS 8.45 8.28 8.01 8.56 8.33 9.27 8.48




Page 57

Q13/Table 19: COST & LABOR PROCESS IMPROVEMENTS/EFFICIENCIES

Q13 CRITERIA

RANK COMPANY


HOSPITAL SYSTEMS,

CORPORATIONS & IDNS


MEDICAL CENTERS


PHYSICIAN PRACTICES



MEAN


2 ORION HEALTH 9.57 9.61 9.68 9.07 9.53 9.31 9.46

3 AVAILITY 9.37 9.00 8.82 9.54 8.96 8.65 9.06

4 INTERSYSTEMS 9.01 9.49 8.52 9.22 8.99 8.62 8.98

5 HEALTHUNITY 9.18 9.57 9.31 9.13 8.45 8.20 8.97

6 GREENWAY 8.99 9.18 7.84 9.14 9.10 8.72 8.83


8 ICA 9.37 9.09 8.73 9.19 8.54 7.72 8.77

9 CERNER 8.95 8.96 9.06 8.35 7.80 8.45 8.60





Page 58

Q14/Table 20: DATA ANALYTICS/BUSINESS INTELLIGENCE

Q14 CRITERIA

RANK COMPANY


HOSPITAL SYSTEMS,

CORPORATIONS & IDNS


MEDICAL CENTERS


PHYSICIAN PRACTICES



MEAN

1 INTERSYSTEMS 9.74 9.63 9.51 9.79 9.73 9.90 9.72

2 CERNER 9.23 9.55 9.87 9.56 8.93 9.59 9.46

3 EPIC SYSTEMS 9.20 9.51 9.05 9.34 9.01 9.44 9.26

4 ATHENAHEALTH 9.83 8.67 9.94 9.25 8.87 8.84 9.23

5 QSI NEXTGEN

MIRTH 9.54 9.28 8.84 8.95 9.61 8.47 9.12

6 ORION HEALTH 8.94 9.65 8.79 8.99 9.14 8.75 9.04

7 GREENWAY 8.63 9.15 9.72 8.51 9.29 8.95 9.04

8 DBMOTION

ALLSCRIPTS 8.02 9.16 9.07 9.70 8.86 8.54 8.89

9 INFOR 8.67 8.69 8.62 8.83 9.19 7.75 8.63

10 ICA 8.28 8.85 8.09 8.97 8.11 8.99 8.55




Page 59

Q15/Table 21: QUALITY REPORTING SERVICES & COMMUNICATIONS

Q15 CRITERIA RANK

COMPANY PAYERS

INSURERS & AGENCIES

HOSPITAL SYSTEMS,

CORPORATIONS & IDNS


MEDICAL CENTERS


PHYSICIAN PRACTICES



MEAN

1 CERNER 9.46 9.89 9.67 9.43 9.53 9.54 9.59

2 ORION HEALTH 9.50 9.48 9.72 9.77 9.30 9.49 9.54

3 INTERSYSTEMS 9.44 9.19 8.92 9.90 8.99 9.39 9.31

4 MEDECISION 9.57 8.84 9.41 9.19 9.04 9.62 9.28

5 SANDLOT 8.41 8.89 9.08 8.54 9.26 8.65 8.81

6 EPIC SYSTEMS 9.62 8.27 8.58 8.61 8.30 9.30 8.78

7 ICA 8.18 8.62 8.55 8.68 8.41 9.34 8.63

8 INFOR 8.41 7.94 8.68 9.21 8.57 8.55 8.56

9 GREENWAY 8.57 8.74 8.07 8.57 8.34 8.58 8.48

10 CTG 8.14 8.57 8.35 8.19 8.22 8.92 8.40

Source: Black Book Ranking6

Q16/Table 22: PATIENT ACCESSIBILITY



Page 60

Q16 CRITERIA

RANK COMPANY


HOSPITAL SYSTEMS,

CORPORATIONS & IDNS


MEDICAL CENTERS


PHYSICIAN PRACTICES



MEAN

1 ORION HEALTH 9.92 9.81 9.94 9.69 9.52 9.76 9.77

2 DBMOTION

ALLSCRIPTS 9.57 9.53 9.64 9.48 9.40 9.33 9.49

3 GREENWAY 8.93 8.99 9.54 9.22 9.15 9.52 9.23

4 INTERSYSTEMS 9.06 8.73 9.20 9.20 9.06 9.58 9.14

5 OPTUM 9.31 8.52 9.62 8.97 9.34 8.56 9.05

6 AVAILITY 9.04 8.95 9.05 8.68 9.33 8.99 9.01

7 CERNER 8.79 8.88 9.65 9.07 8.77 8.51 8.95

8 HEALTHUNITY 8.00 9.07 9.05 9.11 9.06 8.86 8.86

9 ALERE WELLOGIC 8.34 8.91 8.92 9.04 8.35 8.66 8.70

10 MCKESSON

RELAYHEALTH 8.37 8.53 9.12 8.46 8.42 9.20 8.68




Page 61

Q17/Table 23: CUSTOMER SERVICE, CARE & SUPPORT

Q17 CRITERIA

RANK COMPANY


HOSPITAL SYSTEMS,

CORPORATIONS & IDNS


MEDICAL CENTERS


PHYSICIAN PRACTICES



MEAN


2 ORION HEALTH 9.85 9.90 9.90 9.48 9.69 9.93 9.79

3 OPTUM 9.45 9.32 9.23 9.79 9.54 9.87 9.53

4 INTERSYSTEMS 9.33 9.36 9.72 9.50 9.01 9.49 9.40

5 GREENWAY 9.17 9.50 9.05 8.87 9.44 8.94 9.16

6 EPIC SYSTEMS 8.81 9.03 8.71 8.72 9.29 9.19 8.96

7 CERNER 9.09 9.20 9.42 8.58 8.62 8.65 8.93

8 SIEMENS 9.46 8.42 8.95 8.94 8.51 9.18 8.91

9 AVAILITY 9.38 9.16 8.22 8.75 8.47 9.07 8.84

10 MCKESSON/

RELAYHEALTH 8.66 8.52 9.00 8.05 9.24 9.08 8.76




Page 62

Q18/Table 24: CONFIGURATION & MULTIPLE EHR-EMR/HIT INTERFACES

Q18 CRITERIA

RANK COMPANY


HOSPITAL SYSTEMS,

CORPORATIONS & IDNS


MEDICAL CENTERS


PHYSICIAN PRACTICES



MEAN

1 ORION HEALTH 9.51 9.78 9.89 9.49 9.47 9.59 9.62

2 CERNER 9.12 9.52 9.55 9.24 9.48 9.39 9.38

3 INTERSYSTEMS 9.35 9.24 8.53 9.60 9.35 9.23 9.22



6 GREENWAY 8.47 9.31 9.10 9.01 9.07 8.52 8.91

7 ATHENAHEALTH 9.25 8.83 8.73 8.30 9.13 8.77 8.84

8 OPTUM 8.25 8.40 9.07 9.23 8.89 8.36 8.70

9 SIEMENS 8.80 8.15 8.21 8.75 8.51 8.57 8.50

10 AVAILITY 7.95 8.82 7.92 9.00 8.30 8.61 8.43




Page 63

Q19/Table 25: VENDOR AGNOSTIC CULTURE & PRACTICE/SHARES WELL WITH OTHERS

Q17 CRITERIA

RANK COMPANY


HOSPITAL SYSTEMS,

CORPORATIONS & IDNS


MEDICAL CENTERS


PHYSICIAN PRACTICES



MEAN

1 ORION HEALTH 9.84 9.68 9.82 9.61 9.59 9.67 9.70

2 INTERSYSTEMS 9.29 9.92 9.73 9.82 9.42 8.47 9.44

3 GREENWAY 9.36 9.74 9.63 9.00 9.30 9.55 9.43

4 ORION HEALTH 9.86 9.64 9.29 8.98 9.50 9.21 9.41

5 CERNER 9.23 9.95 9.22 9.58 9.39 9.13 9.40

6 QSI MIRTH 8.78 9.51 9.49 9.20 8.67 9.34 9.17

7 EPIC SYSTEMS 9.34 9.04 9.14 9.11 9.46 8.85 9.16

8 MEDECISION 8.89 9.23 9.04 9.47 8.93 8.88 9.07


10 ALERE WELLOGIC 8.99 8.69 8.92 9.06 8.27 9.20 8.86




Page 64

Q20/Table 26: FINANCIAL/CLAIMS SYSTEMS WORKFLOW & PRODUCTIVITY

Q18 CRITERIA

RANK COMPANY


HOSPITAL SYSTEMS,

CORPORATIONS & IDNS


MEDICAL CENTERS


PHYSICIAN PRACTICES



MEAN

1 MEDICITY AETNA 9.88 9.79 9.85 9.71 9.80 9.85 9.81

2 AVAILITY 9.26 9.52 9.70 9.31 9.50 9.42 9.45

3 INTERSYSTEMS 9.17 9.83 9.47 9.30 9.38 9.35 9.42

4 DBMOTION

ALLSCRIPTS 9.58 9.21 9.23 9.05 8.72 9.51 9.22

5 MCKESSON

RELAYHEALTH 8.58 9.16 9.41 9.34 9.27 9.20 9.16

6 ORION HEALTH 9.15 9.09 9.31 8.77 9.04 9.28 9.11

7 ATHENAHEALTH 9.47 8.88 9.05 8.85 8.40 9.91 9.09

8 OPTUM 8.95 9.25 8.87 9.08 9.94 8.15 9.04

9 ICA 9.80 9.18 8.55 8.57 8.40 9.24 8.96

10 GREENWAY 9.06 9.26 8.58 8.85 9.10 8.77 8.94




Page 65

Appendix

Top Enterprise HIE Vendors Published February 2015


APPENDIX I

BROWN-WILSON GROUP CONSULTING

We hope that the data and analysis in this report will help you make informed and imaginative HIE, ACO and EMR/EHR business

decisions. If you have further requirements, the Brown-Wilson Group consulting team may be able to help you. For more information

about BWG and Black Book’s consulting capabilities, please contact us directly at; [email protected]

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The facts of this report are believed to be correct at the time of publication but cannot be guaranteed. Please note that the findings,

conclusions and recommendations that Black Book Rankings delivers will be based on information gathered in good faith from both

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accept no liability whatever for actions taken based on any information that may subsequently prove to be incorrect.

Appendix



APPENDIX II: HIE GLOSSARY

Accountable Care Organization: An accountable

care organization (ACO) is a type of payment and

delivery reform model that seeks to tie provider

reimbursements to quality metrics and reductions

in the total cost of care for an assigned population

of patients. A group of coordinated health care

providers form an ACO, which then provides care

to a group of patients. The ACO may use a range

of payment models (capitation, fee-for-service with

asymmetric or symmetric shared savings, etc.).

The ACO is accountable to the patients and the

third-party payer for the quality, appropriateness,

and efficiency of the health care provided.

According to the Centers for Medicare and

Medicaid Services(CMS), an ACO is “an

organization of health care providers that agrees to

be accountable for the quality, cost, and overall

care of Medicare beneficiaries who are enrolled in

the traditional fee-for-service program who are

assigned to it.”

Beacon Community: A grant program sponsored

by the Office of the National Coordinator for Health

IT (ONC) for communities to build and strengthen

their existing health information technology

infrastructure and exchange capabilities. These

communities demonstrate the vision of a future

where hospitals, clinicians, and patients are

meaningful users of health IT and together the

community achieves measurable improvements in

health care quality, safety, efficiency, and

population health.

Bundled payments: Payments are referred to as

bundled when the unit of payment includes multiple

individual services

Certification criteria: Certification of Health IT

products will provide assurance to purchasers and

other users that an HER system, or other relevant

technology, offers the necessary technological

capability, functionality, and security to help them

meet the meaningful use criteria established for a

given phase. Providers and patients must be

confident that the electronic health IT products and

systems they use are secure, can maintain data

confidentiality and can work with other systems to

share information. Confidence in health IT systems

are an important part of advancing health IT

system adoption and allowing for the realization of

the benefits of improved patient care. Certification

criteria are determined by regulations led by ONC.

Data Use and Reciprocal Support Agreement

(DURSA): The DURSA is the legal multi-party trust

agreement that is entered into voluntarily by all

entities, organizations and Federal agencies that

desire to engage in electronic health information

exchange with other members of the Nationwide

Health Information Network Exchange.

Electronic medical record (EMR): An electronic

record of health-related information on an

individual that can be created, gathered, managed,

and consulted by authorized clinicians and staff

within one health care organization.

Electronic order entry: Computerized physician

order entry (CPOE) (also sometimes referred to as

computerized provider order entry or electronic

order entry) is a process of electronic entry of

medical practitioner instructions for the treatment of

patients under his or her care. These orders are

communicated over a computer network to the

medical staff or to the departments (pharmacy,

laboratory, or radiology) responsible for fulfilling the

order. CPOE decreases delay in order completion,

reduces errors related to handwriting or

transcription, allows order entry at the point of care

or off site, provides error checking for duplicate or

incorrect doses or tests, and simplifies inventory

and posting of charges

Federal Health Architecture: The Federal Health

Architecture (FHA) is an E-Government Line of

Business initiative managed by the Office of the

National Coordinator for Health IT (ONC). FHA was

formed to coordinate health IT activities among the

more than 20 federal agencies that provide health

and healthcare services to citizens. FHA and its

federal partners are helping build a federal health

information technology environment that is

interoperable with private sector systems and

supports the President’s plan to enable better

point-of-service care, increased efficiency and

improved overall health in the U.S. population. FHA

is responsible for supporting federal efforts to

deploy health IT standards and ensuring that

federal agencies can seamlessly exchange health

data among themselves, with state, local and tribal

governments, and with the private sector.

Fee-for-service payments: Fee-for-service is a

payment model where services are unbundled and

paid for separately. In the health insurance and the

healthcare industries, fee-for-service occurs when

doctors and other healthcare providers receive a

fee for each service, such as an office visit, test,

Appendix



Procedure or other healthcare service. Payments

are issued retrospectively, after the services are

provided. Fee-for-service is the dominant physician

payment method in the United States. This is the

opposite structure to accountable care payment

models.

Formulary: A formulary is a list of prescription

drugs covered by a particular drug benefit plan.

Health information exchange (HIE): An

organization that oversees and governs the

exchange of health-related information among

organizations according to nationally recognized

standards.

Health information organization (HIO): An

organization that oversees and governs the

exchange of health-related information among

organizations according to nationally recognized

standards.

Health Information Service Provider (HISP): A

Health Information Service Provider, or HISP, is a

logical concept that encompasses certain services

that are required for Direct Project exchange, such

as the management of trust between senders and

receivers. It may be a separate business or

technical entity from the sender or receiver,

depending on the deployment option chosen by the

implementation.

Health Information Technology for Economic

and Clinical Health (HITECH) Act: The Health

Information Technology for Economic and Clinical

Health (HITECH) Act seeks to improve American

health care delivery and patient care through an

unprecedented investment in health information

technology. The provisions of the HITECH Act are

specifically designed to work together to provide

the necessary assistance and technical support to

providers enable coordination and alignment within

and among states, establish connectivity to the

public health community in case of emergencies,

and assure the workforce is properly trained and

equipped to be meaningful users of EHRs.

Combined, these programs build the foundation for

every American to benefit from an electronic health

record, as part of a modernized, interconnected,

and vastly improved system of care delivery.

Implementation guides: Publications listing

electronic data interchange messages that are in

use in a particular industry or application. It

indicates how the information in those messages

should be presented on a segment-by-segment,

and data-element-by-data-element basis, including

which segments and data elements are needed,

which are not and what code values will be

expected in the application of that particular

message.

Master patient index: Healthcare organizations or

groups of them will implement a master patient

index (MPI) to identify, match, merge, de-duplicate,

and cleanse patient records to create a master

index that may be used to obtain a complete and

single view of a patient. The MPI will create a

unique identifier for each patient and maintain a

mapping to the identifiers used in each record’s

respective system.

Meaningful Use criteria: The American Recovery

and Reinvestment Act of 2009 specifies three main

components of Meaningful Use: 1) The use of a

certified EHR in a meaningful manner, such as e-

prescribing; 2) The use of certified EHR technology

for electronic exchange of health information

to improve quality of healthcare; 3) The use of

certified EHR technology to submit clinical quality

and other measures. The criteria for meaningful

use will be staged in three steps over the course of

the next five years: Stage 1 (2011 and 2012) sets

the baseline for electronic data capture and

information sharing; Stage 2 (expected to be

implemented in 2014-2015) and Stage 3 will

continue to expand on this baseline and be

developed through future rulemaking.

National eHealth Collaborative: National

eHealth Collaborative (NeHC) is a public-private

partnership focused on accelerating progress

toward widespread, secure and interoperable

nationwide health information exchange to improve

health and healthcare. NeHC’s neutrality and

diverse multi-stakeholder participation provides a

unique platform for collaboration. NeHC educates,

connects, and encourages healthcare stakeholders

to advance health information technology and

health information exchange nationwide through its

NeHC University web-based education program, its

Consumer Consortium on eHealth, its support of

the Nationwide Health Information Network

Exchange, its collaborative online community and

its ongoing study of leading health information

exchanges. National eHealth Collaborative is a

cooperative agreement partner of the Office of the

National Coordinator for Health IT within the U.S.

Department of Health and Human Services.

Nationwide Health Information Network: The

nationwide health information network is the

portfolio of nationally recognized services,

standards and policies that enable secure health

information exchange over the Internet. Often also

used as an umbrella term to describe the result

Appendix



of standards harmonization and pilot testing

activities led by the ONC Office of Standards and

Interoperability.

Nationwide Health Information Network

Exchange: The Nationwide Health Information

Network Exchange (“Exchange”) is a group of

federal agencies and non-federal organizations

that came together under a common mission and

purpose to improve patient care, streamline

disability benefit claims, and improve public health

reporting through secure, trusted, and

interoperable health information exchange.

The Office of the National Coordinator for

Health Information Technology (ONC) is the

principal Federal entity charged with coordination

of nationwide efforts to implement and use the

most advanced health information technology and

the electronic exchange of health information. The

position of National Coordinator was created in

2004, through an Executive Order, and legislatively

mandated in the Health Information Technology for

Economic and Clinical Health Act (HITECH Act) of

2009.

Patient centered medical home: A patient

centered medical home integrates patients as

active participants in their own health and

wellbeing. Patients are cared for by a physician

who leads the medical team that coordinates all

aspects of preventive, acute and chronic needs of

patients using the best available evidence and

appropriate technology. These relationships offer

patients comfort, convenience, and optimal health

throughout their lifetimes.

Patient consent: There are five generally

accepted models for defining patient consent to

participate in an HIE. The no consent model does

not require any agreement on the part of the

patient to participate in an HIE. The opt-out model

allows for a predetermined set of data to be

automatically included in an HIE but a patient may

still deny access to information in the exchange.

The opt-out with exceptions exchange enables the

patient to selectively exclude data from an HIE,

limit information to specific providers, or limit

exchange of information to exchange only for

specific purposes. The opt-in model requires

patients to specifically affirm their desire to have

their data made available for exchange within an

HIE. The opt-in with restrictions model allows

patients to make all or some defined amount of

their data available for electronic exchange.

Patient Protection and Affordable Care Act: The

federal Patient Protection and Affordable Care Act

(P.L. 111-148), signed March 23, 2010, as

amended by the Health Care and Education

Reconciliation Act, signed March 31, 2010, is also

referred to as the Affordable Care Act (ACA), or

simply as “federal health reform.” The 900+ page

act contains many provisions, with various effective

dates. Provisions included in the ACA are intended

to expand access to insurance, increase consumer

protections, emphasize prevention and wellness,

improve quality and system performance, expand

the health workforce, and curb rising health care

costs.

Personal health record (PHR): An electronic

record of health-related information on an

individual that conforms to nationally recognized

interoperability standards and that can be drawn

from multiple sources while being managed,

shared, and controlled by the individual.

Private HIE (or Enterprise HIE): The term

“private” HIE generally refers to HIEs which

operate under the governance of an integrated

delivery network (IDN) or a single healthcare

system. The term “enterprise HIE” is often

substituted in this context.

Public HIE: The term “public” HIE is generally

used to describe HIEs which are community-based

and are open to, and governed by, participants

from multiple organizations. Public HIEs often rely

on grants to help them get established and then

require a solid revenue stream to become

sustainable. Note, however, that public HIEs are

not in fact always totally funded with public or

government funds.

Record locator service: In an HIE, a record

locator service is the part of the system that

determines what records exist for a member and

where the source data is located. The record

locator service includes these distinct functions:

manage participating provider identities; maintain

and publish a patient index; match patients using

an algorithm; look up patient record locations (but

not the records themselves); communicate

securely and maintain an audit log; and manage

patient consent to record sharing (under state laws

and ARRA).

Regional Health Information Organization

(RHIO): A health information organization that

brings together health care stakeholders within a

defined geographic area and governs health

information exchange among them for the purpose

of improving health and care in that community.

Standards & Interoperability Framework: The

Standards and Interoperability (S&I) Framework is

a set of integrated functions, processes, and tools

Appendix



being guided by the healthcare and technology

industry to achieve harmonized interoperability for

healthcare information exchange.

State Designated Entities (SDEs): Organizations

appointed by each state that received

ARRA/HITECH funding through the HIE

Cooperative Agreement Program to establish or

expand statewide exchange.

State HIE: The state HIE provides alignment of

architecture, technology and policy throughout an

individual state. Currently there are fifty-six states

and territories planning and coordinating state level

exchanges through a State Designated Entity. The

state HIE typically manages funding provided by

the Office of the National Coordinator (ONC) and

assists specific HIEs within the state.

Virtual Lifetime Electronic Record (VLER): The

VLER initiative launched following President

Obama’s April 9, 2009 direction to the Department

of Defense (DoD) and the Department of Veterans

Affairs (VA) to create a unified lifetime electronic

health record for members of the U.S. Armed

Services. VLER will contain both administrative

(i.e. personnel and benefits) and medical

information for Service members and Veterans.

VLER will provide access to information from day

one of a Service member’s military career through

transition to Veteran status and beyond.

Appendix



APPENDIX III: PUBLIC HIE DIRECTORY ALABAMA One Health Record State designated www.onehealthrecord.alabama.gov Kim Davis-Allen [email protected] 334-252-5011 ALASKA Alaska eHealth Network (AeHN) State designated www.ak-ehealth.org Doris Yanas-House [email protected] 866-966-9030 Alaska Federal Healthcare Access (AFHCP) www.afhcp.org 907-729-1900 ARIZONA Health Information Network of Arizona (HINAz) State designated www.hinaz.org Kalyanraman Bharatha [email protected] 520-309-2943 Arizona Health-e Connection (AZHEC) www.azhec.org [email protected] 602-688-7200 Arizona HealthQuery (AzHQ) www.slhi.org/ahf_projects/mhip [email protected] 602-385-6500 ARKANSAS State Health Alliance for Records Exchange (SHARE) State designated www.sharearkansas.com 501-410-1999 CALIFORNIA California Health eQuality (CHeQ) State designated http://www.ucdmc.ucdavis.edu/iphi/Programs/cheq/index.html [email protected] 916-734-4754 Central Valley California HIE (CVCA HIE) www.ekcita.org [email protected] 213-261-0700 Coast eClinical Hub

www.civerex.com [email protected] 800-529-5355 Health Access El Dorado (ACCEL) www.acceledc.org Christine Sison [email protected] Health-e-LA www.healthela.org Michelle Mondia [email protected] 562-522-0646 HealthShare Bay Area www.healthsharebayarea.org [email protected] Inland Empire HIE www.iehie.org Richard Swafford [email protected] 951-686-1326 John Muir Health Data Exchange www.johnmuirhealth.com David Minch [email protected] 925-260-1522 Orange County Professional RHIO (OCPRHIO) www.ocprhio.org [email protected] 714-919-4429 Redwood MedNet www.redwoodmednet.org [email protected] Santa Cruz County Health Information Exchange (SCHIE) www.santacruzhie.org Bill Beighe 831-465-7874 Western Health Information Network (WHIN) Laura Landry [email protected] 562-436-2923 COLORADO Colorado Regional Health Information Organization (CORHIO) State designated www.corhio.org 720-285-3200

mailto:[email protected]



Appendix



Quality Health Network (QHN) www.qualityhealthnetwork.org [email protected] 970-248-0033 CONNECTICUT Eastern Connecticut Health Network (ECHN) www.echn.org [email protected] 860.533.3414 eHealth Connecticut www.ehealthconnecticut.org 860-240-5617 Health Information Technology Exchange of Connecticut (HITE-CT) State designated www.ct.gov/hitect John DeStafano [email protected] 860-383-6648 DELAWARE Delaware Health Information Network (DHIN) State designated www.dhin.org DISTRICT OF COLUMBIA DC Direct Secure Messaging (DC DSM) State designated www.dhcf.dc.gov [email protected] 202-442-5988 Metro DC Health Information Exchange FLORIDA Big Bend RHIO www.bigbendhealth.com Zach Finn [email protected] Central Floria RHIO (CFRHIO) www.cfrhio.org Stephanie Howell [email protected] 407-212-2081 Escambia HIN/Access Escambia Florida Agency for Healthcare Administration State designated www.ahca.myflorida.com 888-419-3456 Florida Health Data Network (FHDN) www.hienetworks.com [email protected] 850-702-0365

Florida Health Information Exchange (FHIE) www.florida-hie.net [email protected] Health Network of the Palm Beaches (HNPB) www.pbccha.org Alan Sivek [email protected] Healthy Ocala www.healthyocala.org Northeast Florida RHO (NEFRHO) www.nefrho.org Polk County Health Information Exchange Chris Pittman [email protected] South Florida Health Information Initiative (SFHII) Alex Romillo [email protected] SunCoast RHIO Lou Galterio [email protected] Tampa Bay RHIO www.mytampabayhealth.org Stephanie Blay [email protected] GEORGIA Chatham County Safety Net Planning Council (CCSNPC) www.chathamsafetynet.org 912-644-5219 Georgia Health Information Exchange (GHIE) State designated www.georgia-hie.org Georgia Regional Academic Community HIE (GRACHIE) www.grachie.org T. Cramer [email protected] 706-496-4170 GUAM Guam HIE State designated www.hie.guam.gov Ed Cruz [email protected] 671-475-1229 HAWAII Hawai'i Health Information Exchange State designated www.hawaiihie.org Beth Eaton [email protected]

http://www.dhin.org/




http://www.healthyocala.org/

http://www.nefrho.org/





http://www.georgia-hie.org/

Appendix



IDAHO Idaho Health Data Exchange (IHDE) State designated www.idahohde.org Scott Carrell [email protected] 208-332-7253 North Idaho Rural Health Consortium (NIRHC) www.nirhc.org Carol Wilson [email protected] 208-666-3863 ILLINOIS Central Illinois HIE (CIHIE) www.cihie.org Joy Duling [email protected] 800-691-6597 Health Information Exchange of Southern Illinois (HIESI) www.connectsi.us/healthcare_hie.htm Kathy Lively [email protected] 618-998-0970 Illinois Health Information Exchange (IHIE) State designated hie.illinois.gov [email protected] 312-814-1600 Lincoln Land Health Information Exchange (LLHIE) www.llhie.com Steve Lawrence 618-332-0694 MetroChicago Health Information Exchange (MCHIE) www.mchc.com Terri Jacobsen [email protected] 312-906-6037 INDIANA HealthLINC HIE www.healthlinc.org Todd Rowland [email protected] 812-353-4025 Indiana Health Information Exchange (IHIE) www.ihie.org John Kansky [email protected] 317-644-1723 Indiana Health Information Technology, Inc. (IHIT) State designated www.indianahealthit.com 317-232-1165

Michiana Health Information Network (MHIN) www.mhin.com 800-814-6446 IOWA Iowa e-Health State designated www.iowaehealth.org 866-924-4636 KANSAS Kansas Health Information Exchange (KHIE) State designated www.khie.org Bill Wallace [email protected] Kansas Health Information Network (KHIN) www.khinonline.org 785-861-7490 Lewis and Clark Information Exchange (LACIE) www.lewisandclarkinformationexchange.org [email protected] Wichita Health Information Exchange (WHIE) www.whie.net KENTUCKY Kentucky Health Information Exchange (KHIE) State designated www.khie.ky.gov Louisville Health Information Exchange (LOUHIE) www.louhie.org Northeast Kentucky RHIO (NeKY RHIO) www.nekyrhio.org 606-743-4005 LOUISIANA Louisiana Health Information Exchange (LaHIE) State designated www.lhcqf.org/lahie-about [email protected] 225-334-9299 Louisiana Rural Health Information Exchange (LaRHIX) www.larhix.org Donald Hines [email protected] 225-933-5006 MAINE HealthInfoNet State designated www.hinfonet.org [email protected] 207-541-9250


http://www.whie.net/

http://www.khie.ky.gov/

http://www.louhie.org/

Appendix



MARYLAND Chesapeak Regional Information System for Our Patients (CRISP) State designated www.crisphealth.org [email protected] 877-952-7477 MASSACHUSETTS Massachusetts eHealth Collaborative (MAEHC) www.maehc.org [email protected] 781-434-7905 Massachusetts eHealth Institute (MeHI) State designated www.mehi.masstech.org [email protected] 617-371-3999 New England Healthcare Exchange Network (NEHEN) www.nehen.net Sira Cormier 781-290-1300 Secure Architecture for Exchanging Health Information (SAFEHealth) www.safehealth.org Larry Garber [email protected] 1-800-635-1221 MICHIGAN Ann Arbor Area Health Information Exchange (A3HIE) www.a3hie.org Great Lakes Health Information Exchange www.glhie.org [email protected] 517-347-3373 Jackson Community Medical Record (JCMR) www.jcmr.org 517-841-7434 Michigan Health Connect www.michiganhealthconnect.org Doug Dietzman [email protected] 877-269-7860 Michigan Health Information Alliance www.mihia.org Kim Morley [email protected] Michigan Health Information Network (MiHIN) State designated www.michigan.gov/mihin Beth Nagel [email protected]

Michigan Health Information Network Shared Services (MiHINSS) www.mihinss.net Timothy Pletcher [email protected] My1HIE www.my1hie.com 877-869-1443 Northern Michigan Health Information Exchange Southeast Michigan Health Information Exchange www.semhie.org Mick Talley [email protected] Southwest Michigan Health Information Exchange www.mihealthelink.org [email protected] Upper Peninsula Health Care Network (UPHIE) www.uphcn.org Peggy Peterson 906-225-3146 West Michigan Health Information Exchange MINNESOTA Community Health Information Collaborative/HIEBridge (CHIC-RHIO) www.hiebridge.org Cheryl Stephens [email protected] 218-625-5515 Minnesota Health Information Exchange State designated www.health.state.mn.us/e-health/hie.html [email protected] MISSISSIPPI Mississippi Coastal Health Information Exchange (MS-HIN) State designated www.ms-hin.ms.gov [email protected] 866-439-3446 MISSOURI Lewis and Clark Information Exchange (LACIE) www.lewisandclarkinformationexchange.org [email protected] Missouri Health Information Exchange State designated www.dss.mo.gov/hie [email protected] 573-751-6961








Appendix



MONTANA Health Information Exchange of Montana www.hiemontana.org HealthShare Montana State designated www.healthsharemontana.org Marcy Johnson [email protected] 406-794-0170 NEBRASKA Nebraska Health Information Initiative (NeHII) State designated www.nehii.org Deb Bass [email protected] 402-981-7664 NEVADA HealtHIE Nevada www.healthienevada.org [email protected] 855-484-3443 Nevada Health Information Exchange State designated www.dhhs.nv.gov/HIT.htm Lynn O'Mara [email protected] 775-684-7593 NEW HAMPSHIRE New Hampshire Health Information Organization (NHHIO) State designated www.nhhio.org Jeff Loughlin [email protected] 603-219-0184 NEW JERSEY Camden Health Information Exchange http://www.camdenhealth.org/programs/health-information-exchange/ 856-365-9520 Central Jersey Health Information Exchange Project (CJHIEP) www.cjhiep.org [email protected] Electronic Medical Records Exchange of South Jersey (EMRX-SJ) www.emrx-sj.org [email protected] 609-272-6388 Health-e-cITi-NJ www.healthecitinj.org [email protected] 973-485-6242

Jersey Health Connect www.jerseyhealthconnect.org Kris Iorio [email protected] 908-343-6105 Trenton Health Team Health Information Exchange www.trentonhealthteam.org 609-989-3242 ] NEW MEXICO New Mexico Health Information Collaborative (NMHIC) State designated www.nmhic.org Jeff Blair [email protected] 505-938-9904 NEW YORK Adirondak Regional Community Health Information Exchange (ARCHIE) www.archiehealthexchange.org Brooklyn Health Information Exchange (BHIX) www.bhix.org info@bhix@org 718-283-5650 e-Health Network of Long Island www.ehealthnetworkli.net [email protected] 631-638-4000 Health Advancement Collaborative of Central New York (HAC-CNY) www.hac-cny.org Nancy Smith [email protected] 315-952-1166 HealtheConnections RHIO of Central New York www.healtheconnections.org [email protected] 315-472-8099 HealtheLink www.wnyhealthelink.com Karen Kinley [email protected] 716-206-0993 Healthcare Information Exchange of New York (HIXNY) www.hixny.org Scott Momrow [email protected] 518-357-3689 Taconic Health Information Network Community (THINC) www.thinc.org Meghann Hardesty

http://www.hiemontana.org/


http://www.archiehealthexchange.org/

Appendix



[email protected] 845-896-4726 Interboro RHIO www.interbororhio.org [email protected] 718-334-5844 LIPIX www.lipix.org Danielle Craighead [email protected] 877-695-4749 New York Clinical Information Exchange (NYCLIX) www.nyclix.org [email protected] 212-263-4633 New York eHealth Collaborative State designated David Whitlinger [email protected] 646-619-6403 Rochester RHIO www.rochesterrhio.org Jill Eisenstein [email protected] 585-256-4653 Southern Tier Health Link (STHL) www.sthlny.com Christina Galanis [email protected] 607-651-9150 The Bronx RHIO www.bronxrhio.org Charles Scaglione [email protected] 718-708-6633 NORTH CAROLINA North Carolina Healthcare Exchange (NCHEX) www.nchex.net Mark Bell [email protected] 919-677-4141 North Carolina Healthcare Information and Communications Alliance (NCHICA) www.nchica.org Holt Anderson [email protected] 919-558-9258 North Carolina Health Information Exchange State designated www,nchie.org Jeffrey Miller

[email protected] 919-981-5245 Sandhills Community Care Network www.communitycare-sandhills.org 910-246-9806 Southern Piedmont Parnership for Public Health (SOPHIE) www.sph.unc.edu/nciph John Graham [email protected] 919-966-8450 West North Carolina Health Network (WNCHN) www.wnchn.org 828-667-8220 NORTH DAKOTA North Dakota Health Information Network (NDHIN) State designated www.ndhin.org 701-328-1983 OHIO Appalachian Health Information Exchange (AHIE) www.rhiohio.org Brian Phillips [email protected] 740-593-2524 Clinisync/Ohio Health Information Partners State designated www.ohiponline.org Dottie Howe [email protected] 614-664-2650 Collaborating Communities Health Information Exchange (CCHIE) www.cchie.org Marty Larson [email protected] 937-271-2343 Community HIO Mike Seiser [email protected] Wright State Health Link www.wright.edu Katherine Cauley [email protected] 937-258-5546 OKLAHOMA Health Alliance for the Uninsured (HAU) www.hauonline.org Pam Cross 405-286-3343

Appendix



Heartland Health/LACIE www.lacie-hie.com [email protected] MyHealth Access Network www.csctulsa.org [email protected] 918-585-5551 Norman Physician Hospital Organization www.normanpho.com Gary Clinton [email protected] 405-307-2155 Oklahoma Health Information Exchange State designated www.okhca.org 800-522-0114 Oklahoma State Medical Association (OSMA) www.osmaonline.org 405-601-9571 Secure Medical Records Transfer Network (SMRTNET) www.smrtnet.org Cynthia Hilterbrand [email protected] 405-802-3489 SoonerVerse/Oklahoma Primary Care Association www.okpca.publishpath.com 405-424-2282 OREGON Care Accord State designated www.careaccord.org [email protected] Gorge Health Connect www.gorgehealthconnect.org [email protected] 541-296-2266 OCHIN www.ochin.org [email protected] 503-943-2500 PENNSYLVANIA Keystone Health Information Exchange (KeyHIE) www.keyhie.org James Younkin [email protected] 570-214-9348 Northeast Pennsylvania Health Information Exchange (NEPA HIE) www.nepahie.org 570-504-9693

Pennsylvania eHealth Initiative (PAeHI) www.pahie.org 717-561-5338 Pennsylvania Health Information Exchange (PHIX) State designated www.paehealthcollab.com [email protected] PUERTO RICO Puerto Rico Health Information Network (PRHIN) www.prhin.net RHODE ISLAND CurrentCare State designated www.currentcareri.com Laura Adams [email protected] 401-276-9141 SOUTH CAROLINA Eletronic Health Network (EHN) www.healthstik.com 843-735-5044 Lakelands Rural Health Netowrk (LRHN) www.lhrn.org [email protected] 864-330-8221 South Carolina Health Information Exchange (SCHIEx) State designated www.schiex.org Adriane Able [email protected] 803-898-7883 SOUTH DAKOTA South Dakota Health Link State designated www.sdhealthlink.org [email protected] TENNESEE Health Information Partnership for Tennessee (HIPTN) www.hiptn.org Vicky Estrin [email protected] 615-948-0493 Middle Tennessee eHealth Connect (MTeHC) www.midtnehealth.com MidSouth eHealth Alliance (MSeHA) State designated www.mseha.org Rodney Holmes 901-866-1640




http://www.prhin.net/


http://www.midtnehealth.com/

Appendix



Shared Health www.sharedhealth.com Emily Bagley [email protected] 423-535-2977 TEXAS Critical Connection www.criticalconnection.com Marlene Smitherman [email protected] 512-236-1887 Galveston County Health Information Exchange www.utmbhpla.org [email protected] 409-747-2789 Greater Houston HealthConnect www.ghhconnect.org [email protected] 832-564-2599 Harris County Health Alliance www.hchalliance.org 713-368-3285 Health Information Network of South Texas (HINSTX) www.hin-southtexas.com [email protected] 361-694-6432 HIE Texas State designated www.hietexas.org Eric Heflin 512-814-0321 Integrated Care Collaboration (iCare) www.icc-centex.org [email protected] 512-804-2090 SandlotConnect www.sandlotsolutions.com Jerry Malone [email protected] 817-529-8269 Texas Public Health Information Network (TxPHIN) www.txphin.org [email protected] UTAH Utah Health Information Network State designated www.uhin.org [email protected] 877-693-3071 VERMONT

Vermont Health Information Exchange State designated www.vitl.net 802-223-4100 VIRGINIA MedVirginia State designated www.medvirginia.net Carol Duckworth [email protected] 804-359-0671 Northern Virginia RHIO (NOVARHIO) www.novarhio.org Virginia Health Exchange Network (VHEN) www.hits.virginia.gov/vhen.html Kim Barnes [email protected] WASHINGTON Community Choice Health Record Bank www.communitychoice.us 509-782-5030 Franciscan Health Information Exchange www.fs.axolotl.com Mary Kasal [email protected] 253-552-4186 Medical Information Network - North Sound (MIN-NS) www.min-ns.org Duncan West [email protected] 206-618-2391 OneHealthPort State designated www.onehealthport.com [email protected] 206-624-3128 South Sound Health Communication Network www.southsoundnetwork.org Whatcom Health Info Network (HInet) www.hinet.org Lori Nichols [email protected] 360-671-6800 WEST VIRGINIA eHealth West Virginia www.ehealthwv.org Patricia Ruddick [email protected] 304-346-9864


http://www.novarhio.org/


http://www.southsoundnetwork.org/

Appendix



West Virginia Health Information Network (WVHIN) State designated www.wvhin.org [email protected] 304-558-4503 WISCONSIN Wisconsin Health Information Exchange (WHIE) www.whie.org 262-240-0198

Wisconsin Statewide Health Information Network (WISHIN) State designated www.wishin.org Joseph Kachelski [email protected] 608-274-1820 WYOMING Wyoming Health Information Organization (WYHIO) State designated www.wyhio.org [email protected] 307-432-4025

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BLACK BOOK MARKET RESEARCH 2015 USER SURVEY ......Black Book Rankings, the health care division of Black Book Market Research LLC annually evaluates leading health care /medical software,