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Health Information Exchange: Transforming Health Care in Texas

2016 Annual Report

Connecting Texans. Enhancing Care.

Message from the Board Chair & Chief Executive Officer

2016 was a transformative year for the Texas Health Services Authority (THSA) with the appointment of a new board chair, six new board members, and the selection of a new CEO. The geographic and professional diversity of the Board’s new membership will play a critical role in ensuring THSA can fulfill its mission and vision in the coming years.

Since its inception in 2007, THSA has implemented market-based solutions to expand the use of health information exchange (HIE) and health information technology (HIT) in Texas. THSA expects its continuation of this approach will ensure a smooth and successful transition to a private, non-profit entity in 2021. In 2016 we set forth in motion the process of working with a business consultant to determine the most practical and efficient services that will generate revenues to guide this transition.

There have been many advancements in HIE and HIT in 2016 that will aid the healthcare community as the industry transitions to value-based reimbursement in 2017. The THSA Board of Directors and staff are dedicated to aligning our service offerings with the needs of the ever-changing healthcare market in Texas.

Dr. David Fleeger George Gooch Board Chair Chief Executive Officer

THSA 2016 ANNUAL REPORT JANUARY 2017

THSA | 5900 Southwest Pkwy | Bldg 2 - Ste 201 | Austin, TX 78735 | HIETexas.org

OUR

MISSIONWe will promote and coordinate the development of a seamless electronic health information infrastructure to improve the quality, safety, and efficiency of the Texas health care sector while protecting individual

privacy.

OUR

VISIONWe will be recognized as a trusted leader in the development of electronic health information exchange infrastructure that enhances health care quality and efficiency for all patients.



Governor Abbott Appoints New Board Chair & Six New Board Members to THSAIn June 2016, Governor Greg Abbott reappointed and named Dr. David Fleeger as presiding officer of the Texas Health Services Authority (THSA) Board of Directors. Governor Abbott also appointed Dr. David “Dave” Allen, Dr. Paula Anthony-McMann, Dr. Brandon Charles, Dr. Mark S. Lane, Andrew Lombardo and Deborah “Debbie” Marino, and reappointed Dr. Frederick “Fred” Buckwold, Shannon Calhoun, Matthew “Matt” Hamlin, William “Bill” Phillips Jr. and Dr. Stephen “Steve” Yurco for terms set to expire June 15, 2017. Additionally, the Governor appointed Michael “Mike” Maples and Melanie Williams to serve as ex officio members with terms set to expire June 15, 2017.

David Fleeger, M.D. of Austin is a surgeon and president of Central Texas Colon and Rectal Surgeons. He serves on the board of trustees for the Texas Medical Association and the Central Texas Catholic Healthcare Guild. He is a fellow of the American College of Surgeons and American Society of Colon and Rectal Surgeons and a delegate for the American Medical Association. Dr. Fleeger received a Bachelor of Science in biology from Baylor University and a Doctor of Medicine from Texas A&M University.

David “Dave” Allen, D.N.P. of San Antonio is the director of professional nursing at Methodist Specialty and Transplant Hospital and previously served as the director of advance practice nursing for Brooke Army Medical Center and the United States Army Institute of Surgical Research Burn Center. He completed his military service having served as a Surgical Intensive Care Unit Staff Nurse for the 115th Army Field Hospital deployed to Adder, Iraq, earning an honorable discharge from both the United States Army and the United States Air Force. He is a member of the American Association of Critical Care Nurses and the American Organization of Nurse Executives and previously served as chair for the Brooke Army Medical Center Facility Nurse Practice Council and the Brooke Army Medical Center Evidence Based Practice Committee. Allen received a Bachelor of Science in nursing from Clarkson College, a Master of Science in nursing critical care from The University of Texas Health Science Center at San Antonio and a Doctor of Nursing Practice from the University of Alabama.

Paula Anthony-McMann, Ph.D. of Tyler is the vice president and chief information officer for the East Texas Medical Center Regional Healthcare System. She is a member of the College of Healthcare Information Management Executives, Healthcare Information Management Systems Society and the Academy of Human Resource Development. She is a fellow for the American College of Healthcare Executives and she previously served on the board of directors for the American Hospital Association- Solutions Division, CASA for Kids of East Texas, North Texas RCIC, Tyler Area Chamber of Commerce and Tyler Area Economic Development Council. Anthony-McMann received Bachelor of Arts in biology and psychology from Wesleyan University, a Masters of Business Administration from Case Western Reserve University and a Doctorate of Philosophy in human resource development from The University of Texas at Tyler.

Brandon Charles, M.D. of Coppell is the regional vice president and chief medical officer for Amerigroup Texas. He is a member of the American Board of Obstetrics and Gynecology and the Texas Association of Health Plans and a clinical member of the American Heart Association. Dr.

THSA Appoints New Leadership



Charles studied biology and chemistry at The University of Texas at Dallas before receiving a Doctor of Medicine from Texas Tech University Health Sciences Center. He is also a graduate of the General Management Program at Harvard Business School.

Mark S. Lane, M.D. of Lampasas is a board-certified family physician and owner of Family Medicine Rural Health Clinic and serves on the staff of Rollins-Brook Community Hospital. He is a member of the American Academy of Family Physicians, Texas Academy of Family Physicians, Texas Medical Association and Tri-County Medical Society. Additionally, he serves as a physician volunteer for the Cove Free Medical Clinic. Dr. Lane received a Bachelor of Science in chemistry and biology from West Texas State University and a Doctor in Medicine from Texas Tech Health Science Center School of Medicine.

Andrew Lombardo of Harlingen is the executive director for the Rio Grande Valley Health Information Exchange and previously served as the patient information exchange product manager for Valley Baptist Health System. He is a member of the Healthcare Information and Management Systems Society, Texas Association of Healthcare Information Organizations and the Rio Grande Valley Healthcare Preparedness Coalition. Lombardo received a Bachelor of Science in business administration from Southwest Texas State University and a Master of Science in library sciences from the University of North Texas.

Deborah “Debbie” Gray Marino of San Antonio is the vice president of community relations for SWBC. She is a member of the Spurs Sports and Entertainment non-profit Silver and Black Give Back and United Way-Women’s Leadership Literacy Committee. She also serves on the executive board for the Witte Museum and is tri-chair for the San Antonio Chamber of Commerce and a past member of the Commission on the Status of Women-San Antonio and the Texas Education Agency Accountability Policy Advisory Committee. Marino received a Bachelor of Science in journalism from Texas A&M University.



THSA Appoints New Chief Executive OfficerIn August 2016, the Texas Health Services Authority selected George Gooch as its new chief executive officer. Prior to this appointment, Gooch served as the THSA’s interim CEO.

“I am grateful for the trust that the board has placed in me,” Gooch said after his selection. “I look forward to working with our local HIE partners, the provider community, state leaders and all stakeholders to build the infrastructure and support that will allow secure health information exchange to expand for the benefit of all Texans.”

Gooch previously served as the Director of Policy and Planning for the Texas Health Services Authority. Prior to that, he was a practicing attorney focused on healthcare fraud and abuse in Houston, helping healthcare providers navigate the myriad of state and federal regulations involved in running a healthcare organization.

Gooch was also a staff member of the Texas Senate Committee on Health & Human Services, where his expertise on privacy and security legislation helped lead to the creation of the Texas Health Services Authority’s SECURETexas certification program. Gooch is a graduate of the University of Houston Law Center, where he received a legal masters in health law. He also received a Bachelor of Business Administration in Entrepreneurial Management from Texas Christian University.

THSA Appoints New Leadership

George Gooch



THSA completed a multi-phase Sunset process during the 2015 legislative session, which will result in the THSA transitioning to a private, non-profit organization beginning September 1, 2021. The Texas Sunset Advisory Commission, which oversees the Sunset process, continues to monitor implementation of Sunset legislation from prior sessions.

THSA is happy to report that it remains in compliance with Senate Bill 203 (84R, 2015), that details THSA’s Sunset requirements. THSA does not foresee any issues that would impair compliance between now and the 2021 Sunset date.

In the meantime, the THSA board of directors and staff are dedicated to implementing a fiscally conservative, cost-effective approach to implementing services that meet the needs of all Texans.

Legislative Update: THSA Receives Compliance Approval from Lawmakers



HIETexas continues to make great progress in building out its network to better connect healthcare providers so patients’ healthcare information may follow them wherever they go. In 2016, Healthcare Access San Antonio (HASA) successfully connected to HIETexas. HASA serves multiple areas in the state outside of San Antonio, and continues to grow. With this connection, HIETexas dramatically increased HIE coverage in the state, thus allowing increased exchange of patient data.

HIETexas also joined Carequality, a public-private, multi-stakeholder collaborative that seeks to enable seamless connectivity across all participating health exchange networks. With this new partnership, HIETexas has begun interoperability testing with Carequality members, CareEverywhere and Surescripts. HIETexas has completed all tests with CareEverywhere in the test environment, and is beginning production testing.

Texas also remains one of 140 live production participants in the eHealth Exchange, a national network for secure, trusted and interoperable health information exchange (HIE) managed by The Sequoia Project. The eHealth Exchange currently connects approximately 50 percent of U.S. hospitals, 30,000 medical groups, over 100 million patients, and is a completely federated network.

HIETexas Facilitating Intra-State Connections

Healthcare Access San Antonio (HASA), the local HIE that serves the San Antonio area and other areas in the state, continues to make progress in connecting to HIETexas, a secure network of local and private HIEs offering local HIEs a set of State-Level Shared Services that enable health care providers to electronically exchange patients’ health information across Texas and the nation through the eHealth Exchange. HASA is now live with HIETexas, able to exchange bi-directionally with anyone in the state, and respond to requests from outside the state.

The Integrated Care Collaboration (ICC) made great strides as it entered its third year as an HIETexas participant. Because of its participation with HIETexas, ICC has been able to deploy an updated gateway that allows them to query the eHealth Exchange. HIETexas participation also enabled ICC

HIETexas:Progress in Connecting Texans



to increase the frequency of its patient demographics update from one day to two hours, which allows a patient’s medical record to “follow them” closer to real time. As many patients often see multiple providers in a single day, this is especially useful in ensuring the swift and efficient transfer of medical records. ICC is now able to exchange bi-directionally with the eHealth Exchange participants via HIETexas.

Greater Houston Healthconnect (GHH) is also entering its third year as an HIETexas participant showing great benefits to its users. GHH has the ability to respond to queries from eHealth Exchange participants outside the state, and the ability to query and share information with HIETexas-connected organizations inside the state of Texas.

The THSA encourages all HIE stakeholders to provide input on any items related to HIE or HIT at www.hietexas.org/contact. All THSA meetings are open to the public. Details on upcoming meetings are available at www.hietexas.org. Your participation and feedback is important to us and leads to better-informed decisions that benefit all Texans.



Paso del Norte Health Information Exchange (PDN HIE) is a public HIE based in El Paso, TX. The organization currently provides HIE services to healthcare providers mostly from the El Paso area, although the organization aspires to serve several counties in southern New Mexico and communities across western Texas. PDN HIE is currently serving three hospitals. In the first half of 2017, the organization anticipates connecting with the Veteran’s Administration, the Department of Defense, two additional hospitals and a large academic practice. PDN HIE is currently working with local partners to become an active participant in HIE Texas.

The PDN ApproachIn 2016, PDN HIE adopted a new strategy, which is called “Navigate.” Through Navigate, PDN HIE provides services similar to those previously provided by Regional Extension Centers, assisting with electronic medical records (EMR) selection, adoption and optimization. Using a subscription model, PDN HIE has two staff members helping healthcare practices with reporting and regulations associated with their digital data. Currently, PDN HIE serves 92 physicians across 27 practices in the El Paso area.

The OutcomeThe purpose of our “Navigate” strategy is twofold.

To leverage the efficiencies and benefits of a digitally connected healthcare system, communities need to have robust utilization of health information technology. While HIE is a key aspect of health information technology (HIT), HIEs have a reciprocal relationship with EMRs and the efficiency of their utilization. In El Paso, there are dozens of practices run by one or two physicians. Due to their size, these organizations cannot afford a dedicated staff member to facilitate EMR utilization. PDN HIE staff provide consulting services specific to the needs of the practice.

Providing this assistance also helps PDN HIE build relationships with physicians and other healthcare providers. The consulting service is a cost effective way to demonstrate to providers that PDN HIE is their ally. For example, in the last four months, two Navigate clients went through Centers for Medicare & Medicaid Services audits. In both cases, PDN HIE staff helped the single physician practices pass the audit. The assistance helped each practice save approximately $18,000 in lost revenue. Both practices now recognize that PDN HIE is not “an expense” – it is an integral partner that contributes to their practice’s clinical and financial success.

In 2017, PDN HIE will roll out a new product to connect small practices to the community health record. Beyond interoperability, the product will allow practice leadership to view their quality measures in real-time and to compare their performance to state and national data. This tool will dovetail nicely with Navigate and give PDN HIE’s clients new assets to travel through today’s HIT environment.

Local HIE Spotlight: How Paso Del Norte is helping “Navigate” HIE



Local HIEs: Enabling Secure Electronic Exchange of Health Information

Local HIE organizations are the foundation of the statewide health information exchange in Texas. Local HIEs enable the secure electronic exchange of patient data at the local level, which allows for interoperability at the state level and beyond. At the heart of local HIEs and HIETexas, a strong security framework protects patient data and ensures patient preferences and privacy are respected.

To strengthen and streamline health information exchange in Texas, HIETexas provides HIE-to-HIE connectivity between local exchanges in Texas and across the country. Through HIETexas, local exchanges can access critical functions that provide operational savings, and offer uniformity in administrative, legal and compliance functions.

HIETexas currently supports the following services and use cases for enhanced interoperability:

• Clinical Document Exchange/Statewide Record Locator Service. Allows local HIE participants to securely discover and retrieve specific sets of patient data outside their local HIE for authorized purposes.

• eHealth Exchange. Enables local HIE participants to discover patients, and query and retrieve documents from other states and federal agencies through a single gateway between HIETexas and the eHealth Exchange. Allows federal agencies to query local HIEs in Texas.

• Federated Trust Framework. Supports a technical and legal framework to ensure information exchanged between local HIEs is secure, confidential and accurate.



In 2016, THSA continued to promote SECURETexas. We highlighted and shared a new study by the Poneman Institute with Texas providers and covered entities who found that health care data breaches cost far more than security breaches sustained in other industries. According to the study:

• Nearly 90% of all health care organizations suffered at least one data breach in the past two years.

• The average cost of a lost or stolen health record was $402, more than 80% higher than the average cost across all U.S. industries.

• The average cost per breach for the health care industry was $2.2 million.• Total data breach costs for the health care industry are estimated to be $6.2 billion.• Cybercrime-based attacks continue to be the No. 1 cause of breaches.

In addition to the expensive crisis measures required by law when a data breach occurs, federal fines can quickly follow. A New York hospital received a $4.8 million HIPAA fine as a result of protected health information of its patients being accessible online. A California hospital also paid a $4 million HIPAA fine for medical records being posted online. A $3 million HIPAA fine was assessed against a Florida health insurer when over 1 million patient records were compromised following the theft of two unencrypted laptops.

SECURETexas is the first state program of its kind in the country offering privacy and security certifications for past compliance with state and federal laws.

The program offers individuals and entities involved in the use of electronic health records an affordable and officially sanctioned process to ensure they have the proper protections in place for their patients’ health information.

The many benefits of certification include:• Serving as a mitigating factor for any civil or administrative penalties at the time of an alleged

violation of the Texas Medical Records Privacy Act.• Serving as objective third-party evidence of your entity’s history of prior compliance with

HIPAA administrative provisions, which must be a considered factor in determining civil money penalties by the HHS Office for Civil Rights.

• Streamlining any audit or review brought forth by state or federal oversight agencies, thus allowing your organization more time to concentrate on what matters most — patient care.

Importantly, a single SECURETexas fee can offset the costs an organization may be paying to multiple attorneys and consultants to assess compliance with state and federal requirements. More details can be found at www.securetexas.org.

SECURETexas: Health Information Privacy & Security Certification - An Update



While 2016 was an exciting and transformative year for THSA, there is still much work to be done as we forge ahead in 2017. We will continue to build on the fundamentals of the Texas State HIE Strategic Plan by focusing on the following new and exciting opportunities:

• IAPD Funding for HIE. THSA will play an integral role in expanding HIE services to the Texas Medicaid population through funding opportunities available from the Centers for Medicare and Medicaid Services HIE Implementation Advanced Planning Document (IAPD).

• Business Planning Services. THSA has initiated a business planning process to work collaboratively with stakeholders and THSA staff to evaluate current and future state-level shared services in keeping with the THSA’s mission and vision. The local, state, and national HIE landscape has changed over the past few years, and now is the perfect time for HIETexas to ensure that it meets the current and future needs of the market.

• Legal Services. In support of its mission to expand utilization of health information exchange and health information technology, the THSA provides legal services to its local HIEs and to other entities engaging in legal work related to HIE and HIT. This helps reduce legal and financial barriers to participation in HIE and HIT.

All of these items will allow THSA to continue to fulfill its mission and vision.

Looking Ahead to 2017

Follow HIETexas on Twitter (@HIETexas) to stay up-to-date on the latest news in health information technology, electronic health records and health information exchange.



THSA Financials

Audited Statement of Assets, Liabilities and Net Assets - Accrual Basis September 30, 2016

ASSETS

CURRENT ASSETS

Cash in Bank $3,855,943.67

Accounts Receivable $7,500.00

Accounts Receivable - other $300.42

TOTAL CURRENT ASSETS $3,863,744.09

PROPERTY AND EQUIPMENTFurniture $17,441.80

Computer Equipment $11,062.86

Office Equipment $2,734.00

Less: Accumulated Depreciation $(29,945.67)

TOTAL PROPERTY AND EQUIPMENT $1,292.99

OTHER ASSETSSecurity Deposits Paid $11,134.00

Prepaid Insurance $12,535.36

TOTAL OTHER ASSETS $23,669.36

TOTAL ASSETS $3,888,706.44

LIABILITIES AND NET ASSETS

CURRENT LIABILITIES Accounts Payable $137,212.33

Business Credit Card $966.88

TOTAL CURRENT LIABLITIES $138,179.21

OTHER LIABILITIES

HHSC Deferred Grant Revenue $183,676.01

TOTAL LIABILITIES $ 321,855.22

NET ASSETSNet assets beginning of year $4,936,574.38

Current year net revenues - unrestricted $(1,369,723.16)

TOTAL NET ASSETS $3,566,851.22

TOTAL LIABILITIES AND NET ASSETS $3,888,706.44



THSA Financials

Audited Statement of Revenue, Expenses and Other Changes in Net Assets - Accrual Basis Year Ended September 30, 2016

Federal Grant Related Activity

Non-Grant Related Activity Total

REVENUES

HEALTH AND HUMAN SERVICES ARRA FEDERAL GRANT

$22,444.50 - $22,444.50

HIETEXAS PARTICIPANT FEES - $45,000.00 $45,000.00

HIETEXAS ACCREDITATION FEEDS - $2,750.00 $2,750.00

CE P&S CERTIFICATION FEES - $7,500.00 $7,500.00

OTHER INCOME - - -

TOTAL REVENUES $22,444.50 $55,250 $77,694.50

EXPENSES

PERSONNEL COSTS - $546,991.20 $546,991.20

FRINGE BENEFITS - $96,427.80 $96,427.80

TRAVEL - $27,296.08 $27,296.08

ACCOUNTING SERVICES - $10,275.00 $10,275.00

AUDIT AND TAX SERVICES $23,300.00 $23,300.00

LEGAL SERVICES - - -

COMM/MARKETING - $148,934.21 $148,934.21

OTHER CONSULTANT SERVICES - $11,856.12 $11,856.12

STATE SHARED SERVICES $22,444.50 $389,532.54 $411,977.04

RURAL WHITE SPACE EXCHANGE, EDUCATION & MARKETING

- - -

OFFICE SPACE AND EXPENSES - $76,709.31 $76,709.31

DEPRECIATION EXPENSE - $6,246.60 $6,246.60

INSURANCE - $38,742.61 $38,742.61

TELEPHONE AND INTERNET - $15,905.65 $15,905.65

EHEALTH EXCHANGE TESTING FEES - $8,678.08 $8,678.08

OTHER FEES & EXPENSES - $24,077.96 $24,077.96

TOTAL EXPENSES $22,444.50 $1,424,973.16 $1,447,417.66

NET REVENUES BEFORE INTEREST INCOME - $(1,369,723.16) $(1,369,723.16)

CURRENT YEAR CHANGE IN NET ASSETS - $(1,369,723.16) $(1,369,723.16)



2016 THSA Board Members & Staff

BOARD OF DIRECTORSDAVID FLEEGER, CHAIR Surgeon Central Texas Colon and Rectal Surgeons

STEPHEN YURCO, VICE CHAIR Physician and Partner Clinical Pathology Associates

MATTHEW HAMLIN, TREASURER Regional Vice President Quest Diagnostics

FRED BUCKWOLD, SECRETARY Senior Vice President - Medical Affairs Community Health Choice in Houston

DAVID ALLEN Associate Vice President of Clinical Operations Methodist Specialty & Transplant Hospital

PAULA ANTHONY-MCMANN Vice President & Chief Information Officer East Texas Medical Center Regional Healthcare System

SHANNON CALHOUN Regional Vice President National Rural Accountable Care Consortium

BRANDON CHARLES Physician, Regional Vice President & Chief Medical Officer Amerigroup Texas

MARK LANE Physician & Owner - Family Medicine Rural Health Clinic Staff Member - Rollins-Brook Community Hospital

ANDREW LOMBARDO Executive Director Rio Grande Valley Health Information Exchange

DEBORAH GRAY MARION Vice President of Community Relations SWBC

WILLIAM PHILLIPS, JR. Vice President and CIOUniversity Health System

STAFF GEORGE GOOCH Chief Executive Officer

ERIC HEFLIN Chief Technology Officer

ANNE KIMBOL General Counsel

ANNIE NABERS Policy Analyst

CONTACT 5900 Southwest Parkway Building 2 - Suite 201 Austin, Texas 78735 Phone: 512.814.0321 • Fax: 512.814.0322 www.HIETexas.org

@HIETexas

From left to right: Melanie Williams, Deborah Marino, Andrew Lombardo, Shannon Calhoun,

David Allen, David Fleeger (chair), Stephen Yurco (Vice Chair), Mark Lane, Fred Buckwold, Paula

Anthony-McMann, Brandon Charles, Bill Phillips

Not pictured: Matt Hamlin, Mike Maples

EX-OFFICIOMIKE MAPLES Texas Department of State Health Services

MELANIE WILLIAMS Texas Department of State Health Services

Health Information Exchange: Transforming Health Care in ... · Calhoun, Matthew “Matt” Hamlin,...

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