State HIE Cooperative Agreement Program September 18, 2009 Michigan Coalition for HIT

State HIE Cooperative Agreement Program Key Information

State HIE Cooperative Agreement Program Matching Requirements

State HIE Cooperative Agreement Program Eligibility Criteria Designation letter from the Governor Appointed State Government HIT Coordinator who is a state official and will coordinate state government participation in HIE. Demonstration of a multidisciplinary board or commission in an advisory or governing capacity with broad stakeholder representation. Goal must be to use information technology to improve health care quality and efficiency through the authorized and secure electronic exchange and use of health information. Certification that it has adopted nondiscrimination and conflict of interest policies that demonstrate a commitment to transparent, fair, and nondiscriminatory participation by stakeholders.

State HIE Cooperative Agreement Program Funding Formula Base Allocation – For all states, D.C, and Puerto Rico = $4 million Equity Adjustment – Additional funds will be added to this base amount to account for differences in existing health care delivery environment. The following are the sources of information to be used for these equity adjustments along with the associated weights for each: PCP Populations –(40% of total allocation) Short‐Term (Acute) Care Hospital –(30% of total allocation) Medically Underserved and Rural Providers –(25% of total allocation). State Population – (15% of the total allocation). The ONC will provide applicants with the allowable award amount before September 30.

State HIE Cooperative Agreement Program Summary

State HIE Cooperative Agreement Program Federal Roles & Responsibilities The federal government will advance interoperability and health information exchange through a variety of regulatory and programmatic activities. HHS will: Provide technical assistance and collaborate with states to promote, monitor and share efficient, scalable and sustainable mechanisms for HIE within and across states. Conduct a national program evaluation and offer technical assistance for state‐level evaluations in an effort to implement lessons learned that will ensure appropriate and secure HIE resulting in improvements in quality and efficiency. Harmonize and regulate standards and certification criteria to enable interoperability and HIE. Advance standards‐based HIE through the development of the Nationwide Health Information Network (NHIN) and establish a governance mechanism for the NHIN informed by HIE activities across states and regions

State HIE Cooperative Agreement Program State Roles & Responsibilities States will be expected to use their authority, programs, and resources to: Develop and implement Strategic and Operational Plans Develop state level directories and enable technical services for HIE within and across states. Remove barriers and create enablers for HIE, particularly those related to interoperability across laboratories, hospitals, clinician offices, health plans and other health information trading partners. Convene health care stakeholders to ensure trust in and support for a statewide approach to HIE. Ensure that an effective model for HIE governance and accountability is in place. Coordinate an integrated approach with Medicaid and state public health programs to enable information exchange and support monitoring of provider participation in HIE as required for Medicaid meaningful use incentives. Develop or update privacy and security requirements for HIE within and across state borders.

State HIE Cooperative Agreement Program “State Plan” Requirements

State HIE Cooperative Agreement Program “State Plan” Requirements States must submit and receive approval of a Strategic Plan and an Operational Plan. ONC expects that State Plans will reflect the existing variety of HIE approaches and levels of readiness. An assessment of the Strategic and Operational Plans will be part of the application award process if submitted with the application. ONC will use this information to tailor each state cooperative agreement to reflect the level of readiness. States that have a State Plan approved by the National Coordinator prior to award will begin the performance period with implementation funding.

State HIE Cooperative Agreement Program 5 “Essential Domains” To realize HIE states need to plan, implement and evaluate activities across five essential domains: Governance: Convening stakeholders and creating trust and consensus on an approach for statewide HIE and to provide oversight and accountability of HIE to protect the public interest. Finance: Identification and management of financial resources necessary to fund health information exchange. Technical Infrastructure: The architecture, hardware, software, applications, network configurations and other technological aspects that physically enable the technical services for HIE in a secure and appropriate manner. Business and Technical Operations: Operational and management activities including procurement, identifying requirements, process design, functionality development, project management, help desk, systems maintenance, change control, program evaluation, and reporting. Legal/Policy: Legal and policy frameworks with which HIE is administered including and privacy security requirements, data sharing agreements, federal and state laws and regulations, and multi‐state policy harmonization activities.

State HIE Cooperative Agreement Program Application Components A Project Abstract (1 page) A Project Narrative (25-40 page range) Strategic Plan (if available) Operational Plan (if available) Four separate 1-year budget narrative/justification Letters of Commitment from key stakeholders Letter from Governor

State HIE Cooperative Agreement Program Michigan’s Approach HIE is a priority for Michigan’s Governor and Legislature Michigan is a leader is a statewide approach for HIE Michigan created a landmark roadmap with the MiHIN Conduit to Care and invested $10 million to implement the MiHIN Conduit to Care Michigan has a strong foundation of HIE capacity: HIT Commission Health Information Privacy & Security Collaborative (HISPC) 9 MiHIN Regions MiHIN Resource Center Michigan has a coordinated approach to all HIT and HIE Programs in the Recovery Act

State HIE Cooperative Agreement Program Michigan’s Approach Michigan has a strategic plan Needs to be updated Needs expanded information to be consistent with the “5 Essential Domains” Michigan is working on an operational plan Needs work to be consistent with the “5 Essential Domains” Needs stakeholder input (equivalent to the Conduit to Care process) to fill-in and finalize

State HIE Cooperative Agreement Program Michigan’s Approach A Project Abstract A Project Narrative Strategic Plan (submitting Conduit to Care but not as a final strategic plan) Operational Plan Four separate 1-year budget narrative/justification Letters of Commitment from key stakeholders Letter from Governor

State HIE Cooperative Agreement Program Michigan’s Approach What needs to be done to have a complete approach for Michigan? Technical Architecture Business & Technical Operations Plan Financial plan Functioning governance structure Privacy & Security policies for system development and use Stakeholder engagement, feedback, input and buy-in on all components of strategic & operational plan

Stakeholder Engagement A wide array of stakeholders must be engaged to give input throughout all aspects of the project Engage the MiHIN Regional entities to build off of their significant progress Form structured workgroups to get focused, detailed input Hold public review and input sessions to ensure consideration of all perspectives Utilize tools for transparency like an online work space where all documents and information are readily available

Michigan’s Timeline Finalized Strategic & Operational Plans Due ~April 2010 Letter of Intent Due September 11 Applications Due October 16 Notice of Awards December 15 September October November December 2009 2010 Continuous, in-depth planning to meet April 2010 Due Date Workgroup Informational Session September 18 Cooperative Agreement Signed January 15, 2010 HIT Commission October 15 HIT Commission September 10

Stakeholder Engagement What we can do before Grant due date: Provide information about stakeholder engagement process Overview of State HIE Cooperative Agreement Program Initial workgroup focus and deliverables Membership examples Timelines

Stakeholder Engagement What we will do after grant is submitted: Form Initial Structure: Governance/Finance Workgroup Finance sub-group Measurement sub-group Technical Workgroup Privacy/Security sub-group Clinical Workgroup Hold public review & input sessions on workgroup output Provide a website that has all information, documents, meeting notices, agendas, minutes etc. Provide sessions for HIT and HIE vendors Workgroup sessions are not open to HIT and HIE vendors

Workgroup Formation Timeline Early September – provide information about workgroups to garner interest Late September – announce sign-up and nomination process Mid-October – announce workgroup schedules and start meeting.

Workgroup Formation Principles Open & Inclusive Meetings are open to the public Transparent Meeting information will be readily available to anyone Diverse Workgroups will include membership from diverse representation Scalable & Feasible Workgroups may need to be scaled to an efficient number of voting members. Web-ex and Teleconference will be used where appropriate.

Governance & Finance Workgroup Time Expectations: approx. 4 hrs./week First Deliverables: Establish a short-term governance structure Provide input to updated Strategic and Operational Plans Serve as the group to approve all workgroup work products as it goes to the Strategic and Operational plans Establish a Finance subgroup The finance subgroup will first determine mechanisms for meeting match requirements of the cooperative agreement program Establish Measurement subgroup

Governance & Finance Workgroup Membership Examples Physician involved in direct patient care in rural settings CMO of major healthcare systems Leadership from payers/insurers Patient & consumer representatives Hospital CEOs that are involved in an HIE effort Senior representatives of MDIT & MDCH Public health representatives Medicaid representatives Representative of major self-insured employers Representative of Federally Qualified Health Centers Representative of MI University/Health Professional Schools Hospital CIO that is involved in a regional HIE effort Non-physician clinicians

Technical Workgroup Time Expectations: Approx. 4 hr./week First Deliverables: Review of vendor Request for Proposal Development of a Technical Architecture Develop the standards for HIE connections to the MiHIN backbone Develop the security and privacy standards Perform a technical assessment of HIE stakeholders Develop the specifications, standards and design the state wide services Establish Privacy/Security subgroup 

Technical Workgroup Membership Examples* Co-chairs (2)* – One from the state and one from a stakeholder organization Representatives from HIEs across the state – IT Director, CIO or other technical staff Representatives from health systems across the state – IT Director, CIO or other technical staff Physicians and physician informaticists Representatives payers/insurers State system architect Medical researchers * Co-chairs will also serve on Governance/Finance

Clinical Workgroup Time Expectations: Approx. 1 hr./week First Deliverables: Business analysis and problem definition (qualitative and quantitative) Solution definition and prioritization Articulation of value proposition Business architecture Use case models and test cases Functional and quality of service requirements

Clinical Workgroup Membership Examples* Co-Chairs (2) – From the State of Michigan and from a stakeholder organization (preferably a clinician or clinician informaticist) Representatives from the Department of Community Health Representatives from Provider Organizations: Hospitals, Group Practices, Small Office Practices; these members should represent multiple practice settings and clinician roles esp. from primary care and underserved areas Representatives from a Population or Public Health Agency Representatives from Michigan Medicaid Health Plans Health Services Researchers Quality Improvement Organizations Representatives from Patient or Consumer Organizations Representatives from Rural Healthcare Providers Participants in Patient-Centered Medical Home Initiatives Representatives from Visiting Nurse Agency or Long Term Care * Co-chairs serve on Governance/Finance

Get Involved www.michigan.gov/mihinworkgroups www.michigan.gov/mdch