Date : July 9, 2010 Time : 10:30 am – 1:00 pm Location : NC Hospital Association

1. Date: July 9, 2010 Time: 10:30 am – 1:00 pm Location: NC Hospital Association 2400 Weston Parkway, Cary, NC 27513 Dial in: 1-866-922-3257 Participant Code: 654 032 36#

2. Agenda

3. New NC Health IT Website Launched www.healthit.nc.gov 3

4. Meeting Schedule Revisions

5. Meeting Objectives • Reach consensus on other key aspects of HIE Consent Policy under Pathway 1 (i.e., assuming compliance with existing law) including: • Where and By Whom Consent Is Obtained • Consent for Uploading • Granularity of Patient Control Over Health Information • Durability and/or Revocability of Consents • Emergency Access to PHI Absent Consent • Minors Consent

6. NC Statewide HIE Cooperative Agreement Timeline Strategic Plan Operational Plan Stakeholder Outreach Biweekly+ Workgroup Meetings with Monthly Board Meetings Strategic Plan Submitted to HHS LaunchPhase 2 Publish Draft Operational Plan for Review/ Comment NC HIE Formed Workgroups Formed & Begin Meeting Submit Operational Plan to HHS State HIE Grant App. • Convene Advisory Board & Workgroups • Draft Operational Plan • Publish Draft Operational Plan for Review • Engage and educate stakeholders Funding Announcement Letter of Intent Submitted 6

7. NC Statewide HIE Operational Plan Development Timeline Operational Plan Consensus Recommendations Drafting of Operational Plan Governance WG: Confirm governance model, advise on scope of governance, craft recommendations on bylaws and board structure for new entity; develop recommendation for consumer engagement plan approach Clinical/Technical WG: Recommendations on technical architecture approach for statewide HE, begin prioritization of core and value-added services, begin landscape assessment Governance WG: Participation policies and enforcement mechanisms for the statewide HIE; develop recommendations on roles of State in public/private partnershipprocesses for coordination with other ARRA funded programs in the state Clinical/Technical WG: Development of clinical and business use cases, prioritization for core and value-added services, technical approach May 14 – initial NC HIE Board Meeting Master project planning, develop WG charters and workplans; stakeholder meetings, Legal/Policy WG meetings Aug. 31: Submit Operational Plan to HHS Legal/Policy WG: Conduct legal scan for NC laws related to consent for treatment purposes; draft legal principles; conduct legal scan for NC laws related to health information data security; develop recommendations on approach to 4As; develop initial consent approach recommendation under existing law Finance WG: Develop financial model assumptions; data collection to inform financial models. Legal/Policy WG: Finalize consent approach recommendation under existing law; develop recommendations for an “ideal” consent policy not restricted by current law and approach to changing the law; develop recommendations on breach policy principles and role based access principles; develop security recommendations beyond access; review emerging consent policies in neighboring states and identify barriers. Finance WG: Develop 2-3 financial models based on modeling assumptions and develop process for sustainability planning. • Compile NC HIE Board & Workgroup recommendations and decisions • Draft Operational Plan – iterative process with WG review • Publish Draft Operational Plan for Public Review Workgroups formed Workgroups formed 7

8. Policy Subcommittee– June 28, 2010 Meeting

9. Policy Subcommittee– June 28, 2010 Meeting (cont.)   *NC law requires consent for the disclosure of health information for treatment by certain types of providers (and may require consent for disclosure of communicable disease information). Before serious consideration is given to a consent for access policy that allows providers to upload/disclose information without consent, the NC HIE may need to consult state agencies to determine they will consider such a policy a violation of NC law. New York adopted this type of model but only with the express consent of the appropriate governing authorities.

10. Pathway 1: Where and By Whom Should Consent Be Obtained?

11. Pathway 1: Where and By Whom Should Consent Be Obtained? • Subcommittee Discussion of Pathway 1 at June 28 Meeting: • If HIE adopts a repository model, Subcommittee members tended to favor uploading data prior to consent with accessing provider responsible for obtaining consent. • Subcommittee members tended to not favor of allowing patients to deny access on a provider-by-provider basis. 11

12. Pathway 1: Should Consent Be Required for Uploading?

13. Pathway 1: How Granular a Level of Control Should Consumers Have Over Their Health Information? 13

14. Pathway 1: How Durable and/or Revocable Should Consents Be? * Note that in a consent to access model, every health care provider would be required to renew their consents consistent with NC law governing mental health information because there would be no way of knowing whether or not mental health information was in the exchange. Under a consent to disclose model, only mental health providers would have to renew their consents consistent with the law.

15. Pathway 1: Should Access to PHI Be Permitted in An Emergency Even Absent Patient Consent? * Note that any decision about whether to allow for break the glass access should be informed by the opinion of NCHHS or other governing authorities as to whether such access would violate NC law, which requires consent for treatment by certain providers (and potentially requires consent for the disclosure of communicable disease information.)

16. Pathway 1: How Should Services to Which Minors May Consent Be Handled?

17. Other Consent Issues for Future Consideration • “Mechanics” of consent • Public health reporting • De-identified data • Improvement and evaluation of local/community HIO operations • Disclosures to government agencies for health oversight • Requests for restrictions on disclosures to payer organizations (new HITECH requirement) • Others?

18. Next Steps • Upcoming Meetings • Board Meeting – July 13th • Next Legal/Policy Subcommittee Meeting and Security Subcommittee Meeting – July 14th • Questions or Comments? • Contact: nc.hie@healthwellnc.com 18

19. Open Public Comment

20. ATTACHMENTS

21. Comparative Analysis of Select State Consent Policies

22. Comparative Analysis of Select State Consent Policies

23. Comparative Analysis of Select State Consent Policies

24. Comparative Analysis of Select State Consent Policies

25. Comparative Analysis of Select State Consent Policies

26. Comparative Analysis of Select State Consent Policies

27. Expectations of the NC HIE Workgroups • Participants have been nominated and invited to participate by the NC HIE governing board co-chaired by Secretary Lanier Cansler and Dr. 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. 27