Date : September 23, 2010 Time : 12:00 pm – 2:30 pm Location : NC Hospital Association Dial in : 1-866-922-3257

1. Date: September 23, 2010 Time: 12:00 pm – 2:30 pm Location: NC Hospital Association Dial in: 1-866-922-3257 Participant Code: 654 032 36#

2. Agenda Discussion Document – Not for Distribution

3. Objectives of Today’s Meeting • Consider practical steps needed as we move into Phase 2 • Review comments received from the public regarding the NC HIE Operational Plan and discuss potential implications for Phase 2. • Review Phase 2 project deliverables and workstreams and begin to develop plan for next phase of work. • Discuss financing of the NC HIE. Discussion Document – Not for Distribution

4. CEO Report

5. CEO Report • Operational Plan submission and ONC review • Contract with HWTF • Executive Search Firm selection • Local counsel selection for development of bylaws and 501(c)(3) process • NC HIE Staffing and Support • Education and Communication Plan • Legal/Policy Workgroup Update • ONC/NHIN Discussion Discussion Document – Not for Distribution

6. Milestones Met & Next Steps:Taking Stock of NC HIE’s Past Accomplishments and Future Workstreams

7. Operational Plan Submission and ONC Review Process

8. Operational Plan Drafting and Submission August 17 • Board meeting to review July and August recommendations and preliminary Operational Plan components August 19– August 25 • Board and public review of revised Operational Plan draft August 27 • Board call to review revised version of Operational Plan (revisions based on public comment) August 27 – August 30 • Final draft prepared for submission to ONC by August 31 August 31 • Operational Plan successfully submitted to ONC Discussion Document – Not for Distribution

9. Operational Plan Public Comments and Potential Implications for Phase 2

10. Public Comments Public Comment Process • Plan released for public review on August 19; comments accepted through August 25 • Approximately 30 comment letters received from wide range of stakeholders; 150 component comments addressing all sections of the Operational Plan • Comments reviewed and addressed by Board during August 27 teleconference Next Steps • Discuss issues raised that have implications for Phase 2 Discussion Document – Not for Distribution

11. Consumer Empowerment • Most common type of comment received • Consumer access to health information • Patient Portal • Personal Health Record • Mechanism for Informal Public Feedback/Input • In addition to Consumer Advisory Council and Public Comment Period at close of Workgroup and Board meetings Discussion Document – Not for Distribution

12. Governance Model • Representation on Board and Workgroups • Smaller labs and pathology groups • State Lab for Public Health • RHIOs • Long-Term Care • North Carolina EMS • Suggested creation of an EHR Vendor Advisory Group Discussion Document – Not for Distribution

13. Qualified Organizations • Some expressed concern, others strong support • One concern: Impact of Qualified Organizations on existing RHIOs • Participation fees • Support for equitable cost sharing (i.e., smaller providers contribute less than larger, better capitalized providers) • Flexibility in participation approach • Some stakeholders (e.g., North Carolina EMS, State Lab for Public Health) expressed concerns about their roles vis-à-vis Qualified Organization approach • Question of providers with non-certified/non-standard EHR systems Discussion Document – Not for Distribution

14. Consent Model • Most comments expressed support for Full Opt-Out but concern with Partial Opt-Out due to associated complexity and potential negative impact on integrity/comprehensiveness of the patient’s record • Concern with patients’ ability to restrict disclosure on provider-by-provider basis • Concern with potential future ability to filter by data type • Suggestion to exchange only limited data set in order to avoid need for data filtering • Support for change in law to allow mental health providers to disclose information to the HIE without affirmative patient consent Discussion Document – Not for Distribution

15. Additional Areas of Consideration • Potential NC HIE services • Administrative transactions • Standardizing processes to reduce confusion or duplication (e.g., Quality Reporting, EHR workflows) • Importance/difficulty of lab normalization • Access to additional data sources • Medicaid/CCNC data • Alignment with health reform • Patient-Centered Medical Home • Accountable Care Organizations • Emphasis within NC HIE Vision Statement on inclusivity Discussion Document – Not for Distribution

16. Phase 2 Workstreams and Key Deliverables

17. Timeline of ONC Requirements and Responsibilities • Support Meaningful Use (in 2011): Develop policy and technical strategies to ensure at least one option for EPs/EHs in 2011 for: • E-prescribing • Receipt of structured lab results • Exchange of patient care summaries • Sustainability Plan (due Feb 2011): “An annual report on sustainability that includes a business plan with feasible public/private financing mechanisms for ongoing information exchange.” • Federal Alignment Plan (due Feb 2011): “An annual report on statewide HIE alignment with other federal programs.” • Monitor and Track HIE Capabilities (in 2011): States responsible for tracking measures identified in Operational Plan • Assure Trust of Information Sharing (in 2011): State responsible for developing a privacy and security framework that addresses the elements of the HHS HIT Privacy and Security Framework Discussion Document – Not for Distribution

18. Phase 2 Milestones Governance Tasks/Timeline Discussion Document – Not for Distribution

19. Phase 2 MilestonesTechnical and Clinical Operations Tasks/Timeline Discussion Document – Not for Distribution

20. Phase 2 MilestonesLegal and Policy Tasks/Timeline Discussion Document – Not for Distribution

21. Phase 2 MilestonesFinance Tasks/Timeline Discussion Document – Not for Distribution

22. Open Discussion of Next Steps

23. Financing the NC HIE

24. Financing for Statewide HIE Cooperative Agreement and “Ballpark” Cost Estimates* *For discussion purposes only. Full business plan and costs have not been calculated. Intended solely as a high level ballpark estimate for context. Discussion Document – Not for Distribution

25. Financing for Statewide HIE Other Potential Funding Sources Discussion Document – Not for Distribution

26. Financing Approaches in Other States Vermont Utah Tennessee State appropriations Federal grants Federal grants State appropriations (including $13M in new funds) Capital Stage Claims based fee thru 2015 • Health IT Fund was created using a 0.199 percent fee on all medical claims. • Began with support from a legislative appropriation and a commitment by medication history client to pay transactional fees Mixed Model • Assessing charges to Qualified Organizations • State funding to providers for care improvement goals Membership Fees • Payers, Hospitals, Practices each pay 33% of ongoing annual costs • Payers have option to pay by PM/PM or by click • Hospitals pay by % of market share • Practices pay set fee. Operational Stage Discussion Document – Not for Distribution

27. Open Public Comment and Closing Comments

28. Open Public Comment & Closing Comments Next Steps Upcoming Meetings Board Meeting – October 22 Questions or Comments? Contact nc.hie@healthwellnc.com Discussion Document – Not for Distribution