NC HIE Board Meeting

Implementing Statewide HIE in North Carolina

Date: May 19, 2011Time: 12:00 pm – 2:30 pm

NC Hospital Association 2400 Weston Pkwy, Cary, NC

Dial in: 1-866-922-3257 Participant Code: 654 032 36#

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Agenda

12:00 pm – 12:15 pm

Welcome and Roll Call Secretary Cansler

Approval of Minutes from April 21, 2011 Meeting

Unfinished Board Business• Re-affirmation of Officers

Executive Committee Update

12:15pm – 12:45pm

CEO Update Jeff Miller

12:45pm – 2:00pm

Work Group Updates– Legal/Policy– Governance

Work Group Chairs

2:00 pm – 2:15 pm

New Business Secretary Cansler

2:15 pm – 2:30 pm

Open Public Comment & Closing Comments Secretary Cansler

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Unfinished Board Business

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Board Unfinished Business

• Requirements for 501(c)(3) filing• As required by Bylaws, the Board needs to affirm Initial Officers and

Executive Committee• Lanier Cansler – Co-Chairperson• Charles Sanders – Co-Chairperson• Hadley Callaway – Vice Chairman• Brad Wilson – Secretary• Allen Dobson – Treasurer• Bill Atkinson – Past Co-Chairperson• George Saunders – Director at Large

• Conflict of Interest Documents• Sent to all Board Members, Employees, and Key Contractors

• Other Unfinished Business

Board Schedule and Agenda

Date Venue Scheduled Topics Key Decisions

Jun 16 Phone •Technology Services RFP Status and Plan

•Legal/Policy Workgroup Review

• Approve Vendor selection for Technology Services

• Approve Privacy Policy

Jul 21 NC IOM • Technology Services Contract

•2H11 Operational Plan•Initial FY2012 Planning

Meeting

• Approve Vendor contract• Approve 2H11 Operating Plan

Aug 18 Phone

Sept 22 TBD Board Retreat NC HIE staff will schedule an all day board meeting focused on 2012 planning

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CEO Update

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Operations Update

•Staffing and Support Services– CTO and VP, Finance and Operations candidates

–Over 500 applications for 2 openings–Identified 7-10 qualified candidates per role–Interviewed 3-4 candidates per role–Finalists identified and offer letters forthcoming

–Legal Counsel

•Marketing Communications– Capstrat contract signed– Interviews with hospital stakeholders being scheduled

Policy Summaries

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Hiring Policy• Defines policies and procedures for hiring new employees• Mandates that all new positions be approved by CEO and that the position be either

• a new role included in the approved budget• the result of a transition of a contractor/consultant role• a replacement for an existing role

• Prescribes that all openings will be • documented with specific skills and requirements •publicly posted for minimum of 15 days• have a minimum of three candidates to be interview

• Defines approval and exception processes

Executive Compensation• Defines policies and procedures for setting senior executive compensation• Mandates that all compensation packages for senior executives will be approved by the Executive Committee• Requires that CEO/HR provide Comparative Baseline consisting of total compensation levels of at least 2 comparable roles• Requires that any additional compensation (e.g. moving expenses, allowances, etc.) be defined and justified• Requires that, other than CEO, all senior executives will be hire “at will”•Defines approval and exception processes

Authorizations and Purchase Limits

• Defines policies and procedures for both approving and executing financial commitments of the organization• Requires Finance to set up a purchasing process and provide quarterly reports to the Board• Sets maximum approval levels of • $75,000 – CEO• $250,000 – Executive Committee• $250,000+ - Board

• Sets signing authorities for approved contracts at• $250,000 – CEO• $250,000 - Treasurer

• Defines delegation process

These policies will help streamline the start up operations until a complete set of policies and procedures can be completed

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• Finance• Status of ONC Grant Funding• Finance strategy

– Draft Prepayment for Services Agreement shared with Executive Committee– CMS Guidance on Medicaid support of HIE’s

• Service Development• Vendor selection process for Technology Services has been initiated

• 32 Vendors have submitted a Letter of Intent• RFP Response is due on Friday, May 20th

Operations Update

Translate plan, preferences, and

requirements – release RFP

Select and prepare

evaluation team

Review written responses and down

select

Conduct finalist product demos

Conduct BAFO

workshops

Select technology

partner

Contract with

technology partner

Conduct reference

calls

We are Here

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Work Group Updates

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Legal and Policy

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Legal & Policy: Timeline and Tasks

2011

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

Finalize Draft Legislation

Finalize Draft Legislation Develop and Finalize Privacy and Security Policy and ProceduresDevelop and Finalize Privacy and Security Policy and Procedures

Recent Accomplishments• Opt Out consent legislation has been passed by the Senate, pending in House.

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Legal & Policy: Development of Privacy & Security Policies March 18 Meeting: Definitions Eligible Participants Access to Protected Health Information for Treatment, Payment and Health Care Operations Minimum Necessary Requirement Emergency Access Access Rights of the NC HIE Workforce

April 25 Meeting: Review Revisions to Above Sections Opt Out Consent Rights Restrictions on Access Accounting of Disclosures De-Identified Data

May 13 Meeting: Access to Data by Researchers Access to Data by Government Agencies Responding to Subpoenas and Discovery Requests

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Legal & Policy: Next Steps

• Finalize privacy policies for submission to Board

• Develop security policies

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Governance

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Statewide HIE Governance: Timeline and Tasks

2011

Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

Develop Qualified Organization Criteria

Develop Qualified Organization Criteria

Develop Participation Agreements

Develop Participation Agreements

Define Oversight Roles and Enforcement Mechanisms

Define Oversight Roles and Enforcement Mechanisms

Recent Accomplishments• Finalized recommendations for Qualified Organization selection criteria

• Developed preliminary recommendations for• Oversight mechanisms• Enforcement approach and escalation process

• Discussed considerations for NC HIE serving as a “Qualified Organization” and the implications for oversight

Recommended Selection Criteria for Qualified Organizations

1. Be organized as a non-profit or for-profit corporation whose articles of incorporation have been filed with the North Carolina Department of the Secretary of State (or that has a certificate of good standing if incorporated in a state other than North Carolina).

2. Agree to comply with NC HIE’s Statewide Policy Guidance (including technical specification and privacy and security requirements) and ensure that QO participants comply with them.

3. Agree to comply with, and ensure that its participants comply with, NC HIE’s Fair Information Policy Principles

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DRAFT Fair Information Policy Principles*• Individual Access and Control: Individuals should be provided with a simple and timely means to access and

obtain their individually identifiable health information in a readable format and form. Further, there should be openness and transparency about policies, procedures and technologies that directly affect individuals and/or their individually identifiable health information, including their ability to opt-out or otherwise limit disclosure.

• Collection, Use and Disclosure Limitation: Individually identifiable health information should be collected, used and/or disclosed only to the extent necessary to accomplish a specified purpose(s) and never to discriminate inappropriately.

• Data Quality and Integrity: Persons and entities should take reasonable steps to ensure that individually identifiable health information is complete, accurate and up-to-date to the extent necessary for the person’s or entity’s intended purposes and has not been altered or destroyed in an unauthorized manner. Further, individuals should be provided with a timely means to dispute the accuracy or integrity of their individually identifiable health information, and to have erroneous information corrected or to have a dispute documented if their request are denied.

• Safeguards: Individually identifiable health information should be protected with reasonable administrative, technical and physical safeguards to ensure its confidentiality, integrity and availability and to prevent unauthorized or inappropriate access, use or disclosure.

• Commitment to Reciprocity and Timeliness: Participants in the HIE should exchange individually identifiable health information freely with other providers and organizations that have been formally approved to participate in the HIE to coordinate patient care in accordance to the manner, timeframe, technical standards and implementation specifications defined in North Carolina’s Statewide Policy Guidance.

• Accountability: These principles should be implemented, and adherence assured, through appropriate monitoring and other means and methods should be in place to report and mitigate non-adherence and breaches.

18*The principles may evolve based on ongoing development and refinement of privacy and security policies

Recommended Selection Criteria for Qualified Organizations5. Provide to NC HIE a list of current participants, updated on a regular basis in

compliance with a process to be established by the NC HIE Board, and a plan for adding more participants.

6. Submit and annually update a Program Plan that describes specific activities in which the QO will engage, including:

• Marketing the HIE and recruiting participants• Enrolling and billing participants for QO and HIE services• Collecting and maintaining agreements with their QO participants• Maintaining a customer support process to field participant questions• Creating and maintaining a fair grievance process• Allocating resources for participation in statewide HIE collaborative process• Overseeing, auditing, and reporting QO participants’ compliance with the Statewide

Policy Guidance and any other applicable requirements

7. Demonstrate financial viability:(a) On an annual basis:

• Submit a detailed business plan, including a three-year projection of expenses and income and other sources of future revenues.

• Submit a rate plan outlining fee structures for HIE service for participants in the QO.• Submit results of annual independent financial audit.

(b) Demonstrate adequate liability coverage relevant to the exchange of individually identifiable health information (e.g., directors’ and officers’ liability, data theft, data mismanagement, data generation errors, data breach, etc.), in accordance with such standards as may be required by the NC HIE board of directors.

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Governance: Next Steps

• NC HIE staff to develop:

– QO application process

– Oversight process

– Enforcement procedures

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New Business

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Open Public Comment and Closing Comments

ATTACHMENTS

Mission Statement of the NC HIE

As included in its Operational Plan, the mission of the NC HIE is:

• To provide a secure, sustainable technology infrastructure to support the real time exchange of health information to improve medical decision-making and the coordination of care.

Expectations of the NC HIE Work Groups

• Participants have been nominated and invited to participate by the NC HIE governing board co-chaired by Secretary Lanier Cansler and Mr. Charlie Sanders for your expertise in your field and your commitment to improving health care quality, access, and affordability for all North Carolinians.

• Workgroup members are asked to draw on their expertise and perspective from across industries sectors with an eye toward supporting the greater goal of a statewide resource for North Carolina.

• Workgroups are expected to be multi-stakeholder, nonpartisan and all discussions, meetings and decision-making processes to be fully transparent.

• Workgroups are asked to consider multiple stakeholder group perspectives when working toward solutions.

• Workgroups will be asked to make consensus-based recommendations to the NC HIE governing board. In cases where consensus is not reached, the workgroup is expected to put forth a balanced, fair consideration of the pros and cons of an issue.

• Workgroup members are expected to respect the opinions and input of others and to engage in fair meeting conduct to work toward consensus recommendations.

• Workgroup members are strongly encouraged to attend meetings in person whenever possible.

• Public stakeholder input is encouraged.

Governance Work Group

Members• Connie Bishop, MSN RN, NC Nurses

Association• Jacquelyn Boyden, Boyden Healthcare

Consulting• Janis Curtis, Duke Health System• Craigan Gray, DHHS DMA• Mark Gregory, Kerr Drugs• Don Horton, LabCorp

Co-Chairs• Ben Money, NC Community Health Association• Tom Bacon, UNC School of Medicine, AHEC

• Steve Keene, NC Medical Society• Janice Lato, WNC Health Network• Harry Reynolds, IBM• Craig Richardville, Carolinas Healthcare System• Pam Silberman, NC Institute of Medicine• Craig Souza, NC Healthcare Facilities Association• Sam Spicer, New Hanover Regional Medical

Center

Clinical/Technical Operations Work Group

Members• Ben Alexander, WakeMed• Cynthia Cox, Raleigh Medical Group • Sam Cykert, AHEC, Moses Cone• Michael Fenton, NC CIO Office• John Graham, UNC Institute for Public Health• Susan Helm-Murtagh, BCBSNC• Arlo Jennings, Mission Hospitals• Yan Wang Kolbas, NC Nurses Association

Co-Chairs• Allen Dobson, CCNC • J.P. Kichak, UNC Hospital

• Bill Leister, LabCorp• Keith McNeice, Carolinas Healthcare

System• John A. (Sandy) McNeill, NC Health Care

Facilities Association• Don Spencer, UNC Health Care• Angela Taylor, NC DHHS• James Tcheng, Duke University• John Torontow, Piedmont Health

Finance Work Group

Members• Mark Bell, NC Hospital Association• Brian Harris, Rural Health Group, Inc.• Yvonne Hughes, Coastal Connect HIE• Mark Miller, Novant Health• John Minnich, CSC

Co-Chairs• Maureen O’Connor, BCBSNC• Dr. Dave Tayloe, Goldsboro Pediatrics

• Steve Owen, NC Medicaid• Phred Pilkington, Cabarrus County

Health Dept.• Devdutta Sangvai, MD, Duke

University Medical Center

Legal/Policy Work Group – Legislation and Implementation Subcommittee

Members• Linda Attarian, NC DHHS (Vice-Chair)• Judith Beach, Quintiles• Mark Botts, UNC School of Government• Chris Collins, NC Office of Rural Health and

Community Care• Brian Forrest, Access Healthcare• Chris Hoke, NC Department of Health &

Human Services• Linwood Jones, North Carolina Hospital

Association

Co-Chairs• Senator Josh Stein • Representative Jeff Barnhart

• Trish Markus, Smith Moore Leatherwood• Barbara Morales-Burke, Blue Cross Blue

Shield of North Carolina• Melanie Phelps, North Carolina Medical

Society• Troy Trygstad, Community Care of North

Carolina• Robin Wright, NCHICA Consumer

Advisory Council• Bill Wilson, AARP