Health Information Exchange (2012-2014)

Focus Area: Health Information Technology
Project Title: Jefferson Health Information Exchange

Leadership Oversight 2012 into 2013:

Accountability Leaders and Structure:

2012: JRHA and JHIE Advisory group;

2013: Transition Board of JHIE (see appendix); AIM Consultants; Jefferson IT; Jefferson Regional Health Alliance (JRHA)

Staff: 2012: none;

2013: Paula Weldon, Program Manager and Sophia Jones, Implementation Specialist

Project Champion: 2012: Mark Hetz, Asante;

2013: JHIE Transition Board: Chair, Rich Bodager, CEO of SO Cardiology

Fiscal Agent: 2012: JRHA acts as fiscal agent with funds oversight; 2013 JHIE forms own nonprofit and acts as own fiduciary agent and Board structure

Key Stakeholders: Past Advisory Group has evolved into Full Board and Committees and Workgroups


March 2013 as above and including >150 early adopter physicians in 15 clinics participating in the Phase 1 implementation.

July 2013: Adoption >300 physicians in 27 clinics

Financial Support:

Funders for 2012: Asante, Providence, Sky Lakes Hospital, MRIPA/AllCare, PrimeCare.

Funders for 2013: Implementation Phase: Asante, Sky Lakes, MRIPA/AllCare, Providence. Subsequent Funders for 2013: Providence, Primary Health CCO, Jackson Care Connect CCO, Cascade Comprehensive Care CCO, PrimeCare IPA

Regional Scope: Jackson, Josephine, and Klamath County hospitals and medical clinics.

  • Potential Scope to include additional medical clinics in southern Oregon, and include addiction and mental health, dental, long term care and other providers.
  • Connection to state and national HIEs is a priority.


Project Goals:

  1. Support appropriate patient utilization:
  • Decrease redundant and costly medical test/technology
  • Improve throughput with decreased costs of Emergency Departments
  • Medication reconciliation with Community Record creation
  1. Support Coordination of Care:
  • Augment chronic care management and patient medical home initiatives with closed loop referrals
  • Support alignment of stakeholders as new models of accountable care emerge and provide the backbone for emerging care teams/coordinated care
  1. Decrease Administrative Costs:
  • Support change in workflow with closed loop referrals
  • Support the health plans audit process
  1. Data Aggregation:
  • Focus on population health using data for public metal and physical health initiatives to improve the entire community’s health outcomes and ensure outcomes that align with best practices
  • Connect to multiple health registries

Project Success Defined As: (Desired Outcomes)
a robust Health Information Exchange is created with key stakeholders’ support for data exchange, use of the system, and financial contribution. An effective HIE is connected to both regional health and healthcare providers and state and national Health Information Exchanges, thus improving clinical care of patients by having essential patient information available at the point of care in order to reduce errors and redundancies and improve efficiencies.

Milestones: 2012

  1. Held quarterly Advisory Group Meetings (wide stakeholder engagement and informational meetings)
  2. JRHA facilitation and guidance in the JHIE formation throughout 2012 and into 2013 engaging key stakeholders to support aligned movement toward HIE vision
  3. Completion of preliminary environmental assessment
  4. Creation of strategic plan for HIE formation in southern Oregon
  5. Establishment of a governance structure with the formation of the JHIE Transition Board with weekly and monthly meetings. Executive Team: Rich Bodager, CEO, SO Cardiology, Chair; Byron Reed, CEO, Jefferson IT, Vice Chair; Gina Bianco, President AIM Consultants, Interim Director
  6. Contracted with Gina Bianco, AIM Consultants, for support with above work.
  7. Over 54 participants with 552 in-kind contribution hours

Milestones: October 2012 through Feb 2013

  1. Creation of JHIE logo
  2. Contracted with AIM for interim staffing - Gina Bianco, President of AIM, as interim Director for JHIE for operational and strategic support:
  • Gina Bianco as interim Director
  • Created the Technical committee ( Asante, Providence Sky Lakes, JRHA, Aim Consulting, Jefferson IT) which formed and executed the contract for a 3 hospital, shared vendor agreement allowing for the use of Medicity as a vendor platform for a community-wide HIE.
  • Finance committee created the 3 year business plan for a sustainable phased rollout of Jefferson HIE beginning in January 2013Estabilshed Phase 1 implementation scope of work, policies and procedures
  • Began Phase 1 rollout with Jefferson IT
  1. Contracted with Jefferson IT for staffing and technical support:
  • Vetted, hired, trained, and housed Paula Weldon, Program Manager and Sophia Jones Implementation Specialist for JHIE implementation phase.
  1. With Gina Bianco created an implementation plan and process to install JHIE phase I into the early adopter clinics
  2. Began implementation phase in January 2013 into 15 different clinics with >150 clinicians. 

Milestones: March 2013 through July 2013:

  1. Continued Phase 1 Implementation with >300 physicians and >27 clinics onboard.
  2. Developed User groups for peer support and implementation follow up.
  3. Began partnership meetings with proposed new funders of JHIE to engage both financial and user support.
  4. Formed Full Board with 3 county representation, CCO representation, providers, and Behavioral Health representation
  5. Secured funding for phase 2 implementation
  6. Met with OHA and State HIT staff to discuss alignment with and support of State in JHIE
  7. Shifted from 3 Hospital based contracts with Medicity (HIE vendor) to one JHIE contract, creating a truly neutral community based HIE


Next Steps and Timeline:

  • Phase 1: Point to point sharing of information: Closed loop referrals, results inbox, secure messaging - Jan 2013-Mar 2014
  • Phase 2: Community Health Record: ability to store data from multiple sources and query for patient information across all databases - June 2013—2015 (development in 2013 and early 2014 and implementation late 2014 into 2015)
  • JHIE becomes its own nonprofit organization; application in for IRS nonprofit status. - Jan 2013
  • Establishment of the full JHIE Board - Jan 2013—July 2013 Done
  • Shift of JRHA role from HIE formation to support for funding engagement and consensus building for a community health record (Phase 2) as well as integration of HIE into healthcare reform projects (see below) - Jan 2013-Dec 2013
  • Funding acquisition for early 2014 Phase 2 - Jan 2013—June 2013 Done
  • Implementation of Phase 1 - Jan 2013—Mar 2014 Ongoing
  • Development of Phase 2
    • Committees: Consumer, Provider, Behavioral Health Task Force; Privacy Ongoing
    • Addictions and Mental Health Integration Ongoing development with Vista Logic
      June 2013—June 2014
  • Integration with healthcare reform projects: CCOs work with development of pilots to show proof of concept for care coordination support for projects such as Community Care Project (High Utilization project) and Opioid Prescribers Group work, transitions of care, Emergency Department diversion programs - Ongoing
  • Phase 3—Data aggregation and population health - 2015


Key Learnings:

  • Health Information Exchange is most valuable when the participation is broad and deep
  • Creating this depth of participation requires going slow to go fast
  • Building trust and creating a step by step way for people to stay engaged is essential

Current Obstacles/Opportunities:

  • Changing National and State priorities for Health Information Exchange
  • Multiple vendors and electronic health records developing “HIE” confusing to the providers
  • Multiple organizations with different decision making processes and priorities for HIE slow the process
  • Implementation and adoption of HIE may be slow if JHIE staffing not adequate
  • Financing beyond phase 2 is still being developed.
  • Development of policies and procedures for data storage and exchange will take time
  • HIE as a support to Behavioral Health integration is being addressed with the newly forming JHIE BH Taskforce
  • Integration of HIE as a supportive technology to care transformation is slowly catching on (e.g.: using referrals capability for outreach workers; using ADT (admission, Discharge and Transfers) phase 1 capabilities for f/u on case managed patients, etc.)

Appendix: Participants

Transition Board, through June 2013:

  • Rich Bodager, Chair; CEO, SO Cardiology
  • David Chabner, Director IT, SkyLakes
  • Doug Flow, CEO, MRIPA
  • Steve Hayter, System Director, Providence Health & Services
  • Mark Hetz, CIO, Asante
  • Matt Hough, MD, Southern Oregon Pediatrics
  • Paul Matz, MD, Medford Medical Clinic, Chair PrimeCare
  • Byron Reed, CEO, Jefferson IT

Board Members, from July 2013 onward:

  • Rich Bodager, Chair; CEO, SO Cardiology
  • David Chabner, Director IT, Sky Lakes Hospital
  • Doug Flow, CEO, MRIPA, AllCare CCO
  • Steve Hayter, System Director, Providence Health & Services
  • Mark Hetz, CIO, Asante
  • Paul Matz, MD, Medford Medical Clinic; Chair, PrimeCare IPA
  • Ed Smith Burns, Director, Addictions and Recovery Center
  • Sarah Lamanuzzi, MD, Director, Klamath Health Partnership
  • Richard Williams, MD, Mountain View Family Practice
  • Bill Guest, CEO, Cascade Comprehensive Care CCO
  • Open Seat: Consumer from Consumer Committee
  • Open Seat

Acting Director:

  • Gina Bianco, President, AIM Consultants


  • Anne Alftine, MD, Jefferson Regional Health Alliance

Transition Board Guests/Proxies

  • Kate Amidei, Asante
  • Robert Mayfield, Providence Medford
  • Scott Rucker, MRIPA
  • Shauna Spees, Providence Medford
  • Kevin Whitley, MRIPA

Advisory Group: through March 2013:

  • Mike Bond, PrimeCare
  • Neal Boren, Cascade Comprehensive Care
  • Stacy Brubaker, Jackson Co MH
  • Don Bruland
  • Kathy Bryon, Gordon Elwood Foundation
  • Larry Cohen
  • Joshua Cott
  • Peg Crowley, Community Health Center
  • Brad Cummings
  • Mark Decker, Jackson Co HHS
  • David Donnelly, MD, Veterans Affairs
  • Allen Douma, MD, JRHA
  • Carol Flinn, Providence Medical Group South
  • John Forsyth, MD, JRHA
  • Bill Guest, Cascade Comprehensive Care
  • Dick Gibson, Providence
  • Carol Grant, Community Health Center
  • James Grebosky, MD, Asante
  • Tom Hanenburg, Providence Medford
  • Lisa Hendricks, Community Health Center
  • Laurie Henning
  • Brian Herwig, Providence Medford
  • Kurt Higuera, Siskiyou Community Health
  • Diane Hoover, Josephine CO HHS
  • John Jackson, MD, Providence Medical Group South
  • Len Jacobsen
  • Brenda Johnson, La Clinica
  • John Kleeman
  • Chuck LaBuwi
  • Jennifer Lind, Jackson Care Connect
  • Chris Mason, Addiction Recovery Center
  • Mark Marchetti, Ashland Community Hospital
  • Stephanie Mendenhall, JaCo HHS
  • Mark Orndoff, JaCo HHS
  • Simon Parker-Shames, La Clinica
  • David Passonian
  • Maggie Polson
  • Lance Reyes, Regence
  • Ken Rhee, La Clinica
  • Kelly Roberston
  • Maggie Rollins, Primary Health
  • Randy Romanoff
  • Ida Saito, La Clinica
  • Ginger Scott, Community Health Center
  • Belle Shepherd, JaCo Public Health
  • Jim Shames, MD, JaCo Medical Director
  • Bill Sloan, Rogue Valley Physicians
  • Karla Stephens
  • James Stubbs
  • Tricia Sullivan
  • Danni Swafford
  • Bill Thorndike, Medford Fabrication, JRHA
  • Dave Toler, RVCOG, Seniors and Disability
  • Shelly Uhrig
  • Roy Vinyard, Asante
  • Sarah Walker, Addiction Recovery Center
  • John Wilson
  • Rick Zwarverwer

Report Respectfully Submitted by Anne Alftine MD

JRHA Consulting Project Director