North Carolina Health Information Exchange Board Meeting Developing an Operational Plan for Statewide HIE in North Carolina May 14, 2010

North Carolina Health Information ExchangeBoard Meeting

Developing an Operational Plan for Statewide HIE in North Carolina

May 14, 2010

Discussion Document – Not for Distribution2

Project TeamWorkgroup Facilitation and Coordination

BernsteinBernstein

PawlakPawlak

DuttonDutton

Governance

BernsteinBernstein

OlbergOlberg

Clinical & Tech Operations

du Pontdu Pont

KwanKwan

Legal & Policy

BelfortBelfort

PawlakPawlak

Project Management

Finance

RayRay

Apodaca Apodaca

GarcimondeGarcimonde


Planning Approach Project Deliverables

Coordinating with...• Medicaid Meaningful Use Plan• Regional Extension Center

Leveraging Other Assets...• Beacon Community (Southern Piedmont Community Care Plan)• CHIPRA Quality Demonstration Grant• NHIN activities• Operational and planned HIEs• Regional and local quality efforts

Key Work Product...

• Statewide HIE Operational Plan


Planning ApproachThree Steps...Assess, Engage, and Guide

1. Assess HIE and HIT Resources• Review inventories of existing resources• Identify needs, requirements, planning horizons• Conduct informational interviews with key stakeholders

2. Engage Stakeholders• Facilitate an inclusive, collaborative process• Provide structured, thorough analysis of all options• Update stakeholders on meaningful use incentives, standards and technology trends,

federal policies and regulations, and leading practices in other states• Support public review and participation

3. Guide Stakeholders to Clear, Actionable Recommendations• Guide participants through threshold questions to drive recommendations and

development of detailed plans


Planning ApproachStakeholder Engagement and Workflow

Governance Board/Steering CommitteeGovernance Board/Steering Committee

Governance Work GroupGovernance Work Group

Clinical & Tech Operations Work

Group

Clinical & Tech Operations Work

Group

Legal & Policy

Work Group

Legal & Policy

Work Group

Compile Drafts, Feedback, and Public InputCompile Drafts, Feedback, and Public Input

Components of Strategic and Operational PlanComponents of Strategic and Operational Plan

Dra

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Fin

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Manatt facilitates analysis and track & document decisionsManatt facilitates analysis and track & document decisions

Engagement is transparent & inclusive...“stakeholders support what they create”

Finance Work Group

Finance Work Group


Planning ApproachGuide Stakeholders...Sample

Methodology based on planning and operational experiences in nine (9) states

Threshold Question• What financing mechanisms should be used to sustain

statewide HIE services?Identify

Threshold Questions

Assess Options, Pros, Cons, Risks

Resolve

Options•Exchange fees (transaction, subscription) •Assessments•Gain sharing

Resolution

• Key consideration...Fed funding insufficient to build/operate statewide HIE

• Reaching a decision...Authority to execute, practical considerations


Work Group MethodologyIntegration of Key Deliverables

Clinical & Tech Operations Work Group

Clinical & Tech Operations Work Group

Legal &Policy

Work Group

Legal &Policy

Work Group

Finance Work Group

Finance Work Group

•Identify clinical/business objectives

•Define architecture•Identify services•Detail functions, options•Develop high-level costs

•Identify privacy issues•Define options•Identify policy/tech requirements

•Collect relevant environment data

•Define revenue sources •Identify funding constraints and timing considerations

Implementation Requirements

•Technical specifications•Implementation sequencing

•Detailed cost estimates•Detailed, 4 yr budget•Evaluation strategy

Governance Work GroupGovernance Work Group

•Define roles, decision making authority

•Identify goals•Define measures


Work Group Activities

Work Group Deliverables

May June

IdentifyKey

Issues

Assess Options

Refine Plan

Membership

Charters• Clinical/business

priorities

• Use cases

• Tech architecture

Clinical/business priorities

Use cases

Technical architecture

Implementation req’ments

Sustainability model

Budget

Operational Plan 1st Draft

FinalizePlan

Planning ApproachWorkgroup Facilitation

July Aug

Completed Operational Plan


Purpose To develop working cost and business models for sustainable HIE services in North Carolina.

Operational Plan Requirements

1. Project Schedule (2010 - 2013)

2. Staffing Plans

3. Cost Estimates

4. Budget for Sustainable Business Model

5. Issues and Risk Mitigation Strategies

6. Controls and Reporting

Other Deliverables

Short Term

• Business model, foundational assumptions• Inventory of cost drivers and revenue sources• Estimated costs for statewide HIE

Medium Term

•Identify possible revenue sources, including tax and subscription models and possible loan funds•Detailed plan to build sustainable business model to support HIE services, including budget, available funding sources, and recommendations

Long Term

•Sustainable business model for statewide HIE services

Work Group Charters/DeliverablesSample

Discussion Document – Not for Distribution10 10

Example: Strategic Plan Workgroup Deliverables

Workgroup Deliverables

Governance • Description of governance entity, including membership, authority and governance model • Description of how state will address HIE accountability and transparency• Description of coordination with Medicaid, federally-funded state programs, and other ARRA programs (e.g.

broadband)

Finance • Business plan that enables financial sustainability of HIE governance and operations by 2014 • Develop and update project budget

Technical Infrastructure

• Description of how infrastructure will facilitate interoperability • Description of technical approach and architecture to be used including HIE services to be offered ( if

applicable)• Review and augment environmental scan of HIE

Business & Technical Operations

• Implementation strategy to address how the state will meet meaningful use requirements • Description of incremental approach for HIE services to reach all geographies and providers • Identify plan and timeline for NHIN participation

Legal/Policy • Describe NC and interstate privacy and security issues related to HIE • Describe plans to analyze and/or modify state laws• Describe development of policies and procedures to foster secure HIE • Describe the use of trust agreements (e.g. data sharing and use agreements)• Describe how the state will address noncompliance with HIE policies

Consumer Engagement

• Consumer engagement and outreach plan• Develop communications and educational materials for consumers, general public, and press

Discussion Document – Not for Distribution11 11

Example: Operational Plan Workgroup Deliverables

Workgroup Deliverables

Governance • Description of coordination and interdependencies with relevant ARRA programs (e.g. REC, broadband, and workforce development)

• Description of governance and policy structures, including their ongoing development

Finance • Detailed cost estimate for the implementation of the Strategic Plan • Detailed schedule describing the tasks and sub-tasks to be completed, including resources, dependencies, and specific

timeframes • Description of proposed resolution and mitigation methods for identified issues and risks • Staffing plans for the project, including project managers and description of key roles• Description of activities to implement financial policies, procedures, and controls to ensure compliance with GAAP and OMB

Circulars

Technical Infrastructure

• Description of efforts to become consistent with HHS adopted interoperability standards and certification requirements as part of the planned implementation

• Description of the technical architecture and how its requirements will ensure statewide availability of HIE among healthcare providers, including plans for protection of health data

• Description of how the technical architecture will align with NHIN core services and specifications • Description of technical solutions to develop HIE capacity and enable meaningful use

Business & Technical Operations

• Project schedule describing tasks and sub-tasks to be completed to enable statewide HIE• Identification and description of issues, risks, and interdependencies within the overall project • Description of how the state will leverage current HIE capacities • Description of state-level shared services and repositories to be leveraged (if applicable) • Explanation of standard operating procedures and processes for HIE services will be developed and implemented (not

required)

Legal/Policy • Description of how statewide HIE will comply with applicable federal and state legal policy requirements, including the process for developing and implementing policy requirements

• Description of interdependence of governance and oversight mechanisms• Description of plans for privacy and security harmonization and plans for interstate coordination • Address how state will comply with federal requirements for data protection

Consumer Engagement

• Consumer engagement and outreach plan• Communication messages and educational deliverables for dissemination


Progress in North CarolinaGovernanceConsiderations Status Discussion, Remaining Questions to Address

Vision for HIT and HIE in North Carolina

From NC HIE Strategic Plan:

The HIE vision for North Carolina is safe and secure access to patient health information which benefits the health, safety, efficiency and quality of care for all – a future in which all residents of North Carolina are afforded ready access to and equal opportunity for accurate and secure health information whenever and wherever it is needed.

Objectives for realizing value


1. Promote, facilitate and support the development and implementation of health information exchange systems that provide interoperability among healthcare providers.

2. Promote statewide deployment and use of EHRs, especially among priority providers working with medically underserved populations.

3. Safeguard privacy and security of electronic health information

4. Develop a framework for implementation and sustainability of HIT

5. Conduct robust evaluation of process & outcome at end of years 2 and 4

6. Develop policy, processes, and technology to support informed consumer engagement in HIE flow.

Measures of success

No measures were identified in strategic plan. Candidate measures include process and outcome goals for technology adoption and utilization, levels of participation in exchange, achievement of quality and safety objectives, efficiency and cost reduction, etc.


Progress in North CarolinaGovernance

Considerations Status Discussion, Remaining Questions to Address

Governance Body roles

North Carolina will identify a non-profit organization that will be responsible for both governance and technical operations.

Governance Body charter, by-laws

Charter and by-laws need to be developed

Roles of key organizations

Need to articulate roles, relationships between: NCHICA, Health and Wellness Trust Fund, State government, and anticipated Governance Body

Role of regional/community exchanges

Decisions need to be addressed regarding the locus of exchange. Across the state, will each region have a single HIOs to coordinate policy and technical implementation?

What are the near and long term connectivity options for regions not currently covered by HIO?

Statewide policy framework

Structure and decision making process for collaborative process to be determined. Workgroup charters and membership needs to be developed.

Enforcement

Authority and accountability mechanisms, including contracts, regulations, and or accreditation need to be addressed. Agreement as to whether participants in statewide HIE will be required to abide by policies developed through collaborative process

Use of Statewide HIE services

Will participation in statewide HIE networks be optional?

Will there be requirements to use statewide services for access to state gov’t services and data?


Progress in North CarolinaTechnical Architecture


Technical architectural principles


1. The NC HIE architecture must be flexible and adaptable to accommodate existing and emerging HIE implementation scenarios.

2. Given the potential total funding amount available to North Carolina, funding multiple HIE platforms is not feasible.

3. Aligned with “meaningful use” criteria as defined by the federal government.

4. The NC HIE architecture must align with NHIN core services and specifications.

5. The HIE platform will be vendor and technology neutral. Service‐oriented architecture will be in alignment with but neutral to major vendor SOA platforms.

6. Privacy and security services will comply with all HIPAA requirements and applicable federal and state regulations.

7. Community HIOs across North Carolina will be able to exchange health information, as well as connect to the NHIN through the NC Shared HIE Services environment.

8. Access and exchange services will be provided in order to leverage existing statewide information assets such as CCNC INC, PHIN, MMIS, commercial laboratories, and IDNs.

Inventory of HIE capabilities

Inventory of HIOs and capacities of various exchanges has been outlined in NC HIE Strategic Plan:

Additional baseline data on exchange capabilities required to identify gaps and complete needs assessment.


Progress in North CarolinaTechnical Architecture


Technical service selection and prioritization

Candidate selection and prioritization criteria identified in in NC HIE Strategic Plan: (1) the clinical value generated (e.g., quality improvement), (2) the degree of competition for the service, (3) the breadth and depth of potential clients, (4) anticipated net revenue and return on investment, (5) technical difficulty; and (6) costs for service provision.

Criteria need to be refined in light of meaningful use and proposed NHIN services and mapped to candidate services

Technical service costs Need to develop estimated costs for start-up and ongoing support of

candidate services.

Technology deployment plan

Need to identify technical specifications, detailed phasing, draft RFPs.


Progress in North CarolinaPrivacy and Security


Privacy vision From HIT Task Force Report:

1. Assure privacy and security of health information;

2. Improve healthcare quality and coordination – behavioral and physical;

3. Improve healthcare safety;

4. Reduce healthcare costs or create efficiencies;

5. Assure the education of NC health professionals (current and future) to incorporate HIT into their practices;

6. Enable individuals, providers, and communities to make the best decisions for improving consumer and population health; and

7. Enable appropriate health services research.

Privacy principles

Outlined in NC HIE Strategic Plan. Principles need to be agreed upon by new Governance Body.

Review of existing NC privacy and security laws and regulations

Strategic plan and Operational Plan Status indicates a thorough inventory and analysis needs to be conducted.


Progress in North CarolinaPrivacy and Security


Scope of privacy and security policies

Will privacy and security policies apply to all forms of exchange, ranging from point-to-point to many-to-many?

AccessAgreement as to whether those involved in health information exchange will be required/allowed to filter certain types of sensitive health.

ConsentAgreement as to whether consent will be required in order to ready it for exchange by uploading it to a HIO.


Progress in North CarolinaFinancing


Environmental data

In January of 2009, significant initial work was completed by NCHICA as part of their NHIN Trial Implementation Contract to develop a sustainability and business plan for North Carolina.

Additional work required to update inventory of revenue resources and mechanisms including providers, payers, population, boarder states, existing HIOs, etc.

Cost modelDevelop total cost of ownership model (over four year period) based on selected HIE services.

Revenue modelDevelop revenue models for the state based on environmental data and high-level assumptions.

Updated budget Update ONC State HIE Cooperative Agreement budget.

Issues and risk mitigation strategies

Develop as required by ONC State HIE FOA.

Controls and reporting Develop as required by ONC State HIE FOA.


Progress in North CarolinaBusiness and Technical Operations


Business requirements

Identify and prioritize business requirements for use cases and prioritization of services

Clinical requirements

Identify and prioritize clinical requirements for use cases and prioritization of services

Technical service selection and prioritization

Candidate selection and prioritization criteria identified in in NC HIE Strategic Plan: (1) the clinical value generated (e.g. quality improvement), (2) the degree of competition for the service, (3) the breadth and depth of potential clients, (4) anticipated net revenue and return on investment, (5) technical difficulty; and (6) costs for service provision.

Criteria need to be refined in light of meaningful use and proposed NHIN services and mapped to candidate services

Detailed project schedule (2010-2013)

Develop detailed project plan as required by ONC State HIE FOA.

Staffing plans Develop staffing plans as required by ONC State HIE FOA.

Coordination with state agencies

Coordination approach discussed in NC HIE Strategic Plan:

Coordination with federal efforts

Coordination approach discussed in NC HIE Strategic Plan:

Standard operating procedures

Develop as required by ONC State HIE FOA.


ATTACHMENTS


Project ImplementationHigh Level Milestones & Activities

* Mid-May... Kick-off Meeting

- Review Operational Plan requirements

- Present timeline, key issues, models, and information needs

- Identify Steering Committee

* May 24 – June 4..... Work Group Launch

- Finalize Work Group charters, membership, launch kick off meetings

* June 4 – July 9.... Develop Recommendations

- Work Groups meet bi-weekly

- June 25...Steering Committee review high-level draft

* July 9 - July 30.... Develop Draft Plan for Comment

- Jul ??... Transmit First Draft Ops Plan to Steering Committee for review

- Jul ??... Release Ops Plan for Comment (7 business days)

* July 30 – Aug 23.... Finalize Operational Plan

- Jul ??... Transmit Final Draft Ops Plan to Steering Committee for review

- Jul ??... Transmit Final Version Ops Plan to Steering Committee for review

Documents

North Carolina Health Information Exchange Board Meeting Developing an Operational Plan for Statewide HIE in North Carolina May 14, 2010