3 rd Meeting Date : July 8, 2010 Time : 8:30 am – 11:00 am Location : NC Hospital Association 2400 Weston Parkway, C

1. 3rd Meeting Date: July 8, 2010 Time: 8:30 am – 11:00 am Location: NC Hospital Association 2400 Weston Parkway, Cary, NC 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 Objectives • To confirm decisions from June 23 Workgroup meeting for recommendation to the board. • To develop recommendations regarding governance rules for participation in the statewide HIE.

5. 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. 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 partnership; processes 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; review emerging consent policies in neighboring states and identify barriers; develop recommendations for changes to current law to support data exchange; develop recommendations on breach policy principles and role based access principles; develop security recommendations beyond access. 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

7. Updates from Other Workgroups

8. Technical/Clinical Operations Workgroup – June 23, 2010 Meeting

9. Finance Workgroup - June 23, 2010 Meeting

10. Legal/Policy Workgroup – July 2, 2010 Meeting

11. Review of Key Decisions from June 23 Governance Workgroup Meeting

12. Governance Workgroup - June 23, 2010 Meeting

13. Implied Decisions in NC HIE Strategic Plan – Oct. 2009

14. Implied Decisions in NC HIE Strategic Plan – Oct. 2009

15. Implied Decisions in NC HIE Strategic Plan – Oct. 2009

16. Governing Participation in the Statewide HIE

17. Strategic Approaches for North Carolina Statewide HIE Structure Regional HIEs given Exclusive Territories – Statewide HIE Provides Governance, Outreach Statewide Network Comprised of Diverse Qualified Organizations Market Determines Structure – Statewide HIE Backfills Statewide HIE is the Market • Abandon core services focus, leaving the private market to address interoperability • Provide backfills where market fails to assure ‘No provider left behind’ • Focus on education, convening, and statewide policy guidance • Clinical/Technical Operations Workgroup advised against this option • Range of “qualified organizations” pursuing regional or localized exchange are core structure • Statewide HIE provides statewide policy guidance, core services to enable interoperability • Statewide HIE may provide value-added services that benefit a range of participants to support sustainability. • Divide North Carolina into markets/territories assigned to existing HIEs, new HIEs or the Statewide HIE • Statewide HIE provides governance, manages monopolies for public good • Statewide HIE works with regional HIEs to develop service matrix to avoid duplication and to support joint sustainability. • Statewide HIE is primary vehicle for HIE • Statewide HIE builds infrastructure, consolidates HIEs for economies of scale • NC HIEs focus on local governance, adoption • Clinical/Technical Operations Workgroup advised against this option

18. Considerations for Qualified Organization and Territory-Based HIE Models Territory-Based / Regional HIEs Qualified Organizations • Allows for greater level of control – limited number of “on ramps.” • Potential cost savings due to fewer “on ramps.” • Could present higher level of risk – failure of one regional entity will impact many providers. • Requires significant stakeholder education and outreach. • Requires developing geographic boundaries and potentially close collaboration among competitors. • Responsibilities for service offerings more readily defined (some owned by Statewide HIE, others by RHIOs). • Allows for a greater level of flexibility – wider range of entities can participate / serve as “on-ramps.” • Complexity could present need for greater level of administrative and technical support. • Policies and procedures would need to be adopted by and monitored across a larger and more diverse participant body. • Potential for more variation in core and value-added service needs.

19. New York Regional HIO Model

20. The RHIOs Serve as “On-Ramps” for Statewide HIE

21. Statewide Network Comprised of Diverse Qualified Organizations and Participants NHIN Gateway Interstate Connectivity Hospitals Physician Groups Clinics Clinic Clinic Labs Hospital System Public Health Lab Enterprise Private Network Payers Long Term Care EHR Light One Example: Statewide Health Information Exchange Network FQHC Providers Hospital RHC Labs RHIO Medicaid RHIO Clinical Lab Lab MMIS Eligibility Paid Claims Hospital RHC Hospital RHC FQHC

22. Complex HIE Landscape in North Carolina • Multiple efforts and investments made across state in electronic exchange of health information. • NC HIE Workgroup members have expressed a commitment to leveraging existing efforts to the extent possible. • Many entities that could serve as data aggregators, for example: • Regional HIEs (WNCHN Datalink, CCHIE, Sandhills, Southern Piedmont) • Statewide Exchange Services (Public Health Surveillance, NCHEX) • Academic Medical Centers with Faculty Practices • Large, Complex Health Systems • Community Care of North Carolina (CCNC) • Others

23. Key Questions for Discussion • What is a Qualified Organization? • What is the Value of Being Part of Statewide HIE for a Qualified Organization? • How do Qualified Organizations Join the Statewide HIE? • What are a Qualified Organization or Participant’s Responsibilities as a Participant in Statewide HIE? • What is the Cost for Qualified Organizations to Participate in the Statewide HIE? • What Happens if a Qualified Organization or Participant Withdraws from the Statewide HIE? • How do providers or organizations unaffiliated with a Qualified Organization connect to the Statewide HIE? • What are a Qualified Organization or Participant’s Responsibilities as a Participant in Statewide HIE? • How Should Relationships Be Governed?

24. What is a Qualified Organization? A Qualified Organization is a health care organization or aggregator of organizations that is capable of fulfilling the technical, legal, policy, and procedural obligations defined by the Statewide HIE, and willing to enter a binding contract with the Statewide HIE that specifies these requirements and the legal consequences entailed therein. Qualified Organizations may be, but are not limited to: Provider Networks Hospitals Health systems Integrated delivery networks (IDNs) Provider groups Consortia of providers FQHCs/RHCs Public Health Regional HIOs • Private Networks • Clearinghouses • Pharmacy • Vendor • Lab enterprise • Medicaid Network • Payors

25. What is the Value of Being Part of Statewide HIE for Qualified Organizations? Facilitate satisfaction of meaningful use requirements among Qualified Organizations and Participants Increase access to important data at point of care by enabling HIE with organizations outside of a Qualified Organization’s existing network infrastructure more rapidly and at lower cost Offer broader referral and care coordination services to its members since they can now send/receive summary clinical information from organizations external to the Qualified Organization or Participant Access to North Carolina state government information, possibly including Medicaid data Lower development cost of shared services offered through participation in statewide HIE such as MPI, consent management, lab orders and results delivery, medication reconciliation Possible electronic access to public health data Access to best practices and learnings gathered by the Statewide HIE Participation in multi-state/interstate HIE and the NHIN Other?

26. How do Qualified Organizations Join the Statewide HIE? Part governance, part technical: Participation agreement/contract with the Statewide HIE, binding them to compliance with the Statewide HIE’s policy guidance and rules? Must integrate with and connect to the Statewide HIE

27. What is the Cost for Qualified Organizations to Participate in the Statewide HIE? Financial models are still under development. Cost considerations may include: Upfront connectivity costs Membership costs in proportion to the number of participants or the number of transactions Staging of costs based on which value-added services, in addition to core services, the Qualified Organization or Participant wishes to utilize Overall per participant costs should decrease with broader participation

28. What are a Qualified Organization or Participant’s Responsibilities as a Participant in Statewide HIE? Agree to send and receive health information to and from participants in accordance with the Statewide HIE’s rules Comply with all of the Statewide HIE’s policy guidance and rules Enforce the Statewide HIE’s rules with all of its own members and participants, including technology vendors that it employs Participation in governance process managed by Statewide HIE (e.g. participation in Workgroups or Advisory Bodies) Participation in generation and evolution of technical, legal, and other policy guidance as deemed necessary by governance process

29. What Happens if a Qualified Organization or Participant Withdraws from the Statewide HIE? Participation in statewide HIE is voluntary Withdrawal from participation is subject to reasonable withdrawal rules and processes

30. How do providers or organizations unaffiliated with a Qualified Organization connect to the Statewide HIE? If the NC HIE decides as policy it must fulfill a commitment to “no provider left behind” the Statewide HIE must offer every provider the opportunity to connect to the Statewide HIE network Options to insure every provider has access to at least one qualified organization (for example): Requiring that a qualified organization accept any provider that applies – with possible subsidies to the participant or the qualified organization in cases where the costs exceed the provider’s ability to pay Requiring that qualified organizations “bring on” a portion of providers who would otherwise lack access to statewide HIE (e.g. 10% of total provider participants) Offer a low-cost portal to enable participation in statewide HIE Coordination with the Regional Extension Center (REC) to identify small and solo practitioners for alignment with a qualified organization or connectivity via a low-cost portal

31. How Should Relationships Be Governed? The State would enter into a contract with the Statewide HIE The Statewide HIE would enter into a technical services contract (likely through an RFP process) to build a service offering consisting of core services and some value-added services The Statewide HIE would “certify” Qualified Organizations; Qualified Organizations will have a participation agreement/contract with the Statewide HIE, binding participants to compliance with the Statewide HIE’s policy guidance and rules Qualified Organizations (RHIOs, hospital systems, private networks, Medicaid, others) would be able to connect to the Statewide HIE to access core and value-added services Statewide policy guidance would include: Privacy and security rules Technical rules Financial rules Vendor contract requirements Ongoing governance structure and participation

32. NC HIE Governance Domain of Operational Plan

33. NC HIE – Governance Domain of Operational Plan • Combined Strategic & Operational Plan • Structure of Governance Domain in Plan: • Overview • NC HIE Public/Private Partnership • Articles of Incorporation • By-laws Recommendations • Board of Directors • Committees • Workgroups • Conflicts of Interest • Transparency • Authority and Involvement of the State in the PPP • Governance of Participation in the NC HIE • Alignment with Other Programs

34. Next Steps Upcoming Meetings Board Meeting – July 13 Workgroup Meeting – July 22 (note location change: NC IOM) Questions or Comments? - Contact nc.hie@healthwellnc.com