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

2. Project Team Workgroup Facilitation and Coordination
Project Management
Bernstein
Dutton
Pawlak
Garcimonde
Governance
Legal &
Policy
Clinical & Tech
Operations
Finance
Bernstein
Belfort
Kwan
Ray
Olberg
Pawlak
du Pont
Apodaca
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3. Planning Approach Project Deliverables
Key Work Product...
Statewide HIE Operational Plan
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
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4. Planning Approach Three 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
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5. Planning Approach Stakeholder Engagement and Workflow
Governance Board/Steering Committee
Manatt facilitates analysis and track & document decisions
Governance Work Group
Legal & Policy
Work Group
Clinical & Tech Operations Work Group
Finance Work Group
Draft and Final Plans
Components of Strategic and Operational Plan
Compile Drafts, Feedback, and Public Input
Engagement is transparent & inclusive...“stakeholders support what they create”
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6. Planning Approach Guide Stakeholders...Sample
Threshold Question
What financing mechanisms should be used to sustain statewide HIE services?
Identify Threshold Questions
Options
Exchange fees (transaction, subscription)
Assessments
Gain sharing
Assess Options, Pros, Cons, Risks
Resolution
Key consideration...Fed funding insufficient to build/operate statewide HIE
Reaching a decision...Authority to execute, practical considerations
Resolve
Methodology based on planning and operational experiences in nine (9) states
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7. Work Group Methodology Integration of Key Deliverables
Governance Work Group
Legal &
Policy
Work Group
Clinical & Tech Operations Work Group
Finance
Work Group
Define roles, decision making authority
Identify goals
Define measures
Identify privacy issues
Define options
Identify policy/tech requirements
Identify clinical/business objectives
Define architecture
Identify services
Detail functions, options
Develop high-level costs
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
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8. Planning Approach Workgroup Facilitation
May
June
July
Aug
Identify
Key
Issues
Assess
Options
Refine
Plan
Finalize
Plan
Work Group Activities
Work Group Deliverables
Membership
Charters
Clinical/business priorities
Use cases
Technical architecture
Implementation req’ments
Sustainability model
Budget
Operational Plan 1st Draft
Completed Operational Plan
Clinical/business priorities
Use cases
Tech architecture
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9. Work Group Charters/Deliverables Sample
Purpose
To develop working cost and business models for sustainable HIE services in North Carolina.
Operational Plan Requirements
1. Project Schedule ( )
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
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10. Example: Strategic Plan 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 10
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11. Example: Operational Plan 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 11
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12. Progress in North Carolina Governance
Considerations
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
Promote, facilitate and support the development and implementation of health information exchange systems that provide interoperability among healthcare providers.
Promote statewide deployment and use of EHRs, especially among priority providers working with medically underserved populations.
Safeguard privacy and security of electronic health information
Develop a framework for implementation and sustainability of HIT
Conduct robust evaluation of process & outcome at end of years 2 and 4
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.
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13. Progress in North Carolina Governance
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?
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14. Progress in North Carolina Technical Architecture
Considerations
Status
Discussion, Remaining Questions to Address
Technical architectural principles
From NC HIE Strategic Plan:
The NC HIE architecture must be flexible and adaptable to accommodate existing and emerging HIE implementation scenarios.
Given the potential total funding amount available to North Carolina, funding multiple HIE platforms is not feasible.
Aligned with “meaningful use” criteria as defined by the federal government.
The NC HIE architecture must align with NHIN core services and specifications.
The HIE platform will be vendor and technology neutral. Service‐oriented architecture will be in alignment with but neutral to major vendor SOA platforms.
Privacy and security services will comply with all HIPAA requirements and applicable federal and state regulations.
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.
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.
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15. Progress in North Carolina Technical Architecture
Considerations
Status
Discussion, Remaining Questions to Address
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.
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16. Progress in North Carolina Privacy and Security
Considerations
Status
Discussion, Remaining Questions to Address
Privacy vision
From HIT Task Force Report:
Assure privacy and security of health information;
Improve healthcare quality and coordination – behavioral and physical;
Improve healthcare safety;
Reduce healthcare costs or create efficiencies;
Assure the education of NC health professionals (current and future) to incorporate HIT into their practices;
Enable individuals, providers, and communities to make the best decisions for improving consumer and population health; and
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.
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17. Progress in North Carolina Privacy and Security
Considerations
Status
Discussion, Remaining Questions to Address
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?
Access
Agreement as to whether those involved in health information exchange will be required/allowed to filter certain types of sensitive health.
Consent
Agreement as to whether consent will be required in order to ready it for exchange by uploading it to a HIO.
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18. Progress in North Carolina Financing
Considerations
Status
Discussion, Remaining Questions to Address
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 model
Develop total cost of ownership model (over four year period) based on selected HIE services.
Revenue model
Develop 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
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19. Progress in North Carolina Business and Technical Operations
Considerations
Status
Discussion, Remaining Questions to Address
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 ( )
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
Standard operating procedures
Develop as required by ONC State HIE FOA.
HIE services should be prioritized with consideration to
•Impact on patient experience and outcomes
•Ability to support processes that ensure quality of care and patient safety
•Ability of the HIE to have a ROI for its services
•Technological evolution of providers and consumers
There should be a primary focus on core services related to HIE and to support providers’ ability to meet meaningful use criteria
Services “redundant” to existing services/capabilities (e.g. claims process) should notbe prioritized
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20. Discussion Document – Not for Distribution
ATTACHMENTS
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21. Project Implementation High 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 Work Group Launch
- Finalize Work Group charters, membership, launch kick off meetings
* June 4 – July Develop Recommendations
- Work Groups meet bi-weekly
- June 25...Steering Committee review high-level draft
* July 9 - July 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 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
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