2 nd Meeting Date : June 23, 2010 Time : 11:30 am – 2:00 pm

1. 2nd Meeting Date: June 23, 2010 Time: 11:30 am – 2:00 pm Location: NC Hospital Association 2400 Weston Parkway, Cary, NC Dial in: 1-866-922-3257 Participant Code: 654 032 36#

2. Agenda

3. Meeting Objectives • Finalize Workgroup Charter and Statewide HIE Principles • Advance Recommendations on Statewide HIE Approach • Review remaining options • Walk through decision-making criteria, implications • Begin the process of defining clinical functions • Begin the process of prioritizing HIE services

4. NC HIE Operational Plan Calendar Governance, Clinical/Technical Ops, Finance WG Meetings Legal/Policy WG Meetings NC HIE Board Meetings Operational Plan version releases Operational Plan due to ONC WG conference calls as needed

5. Board Feedback: Clinical/Tech Operations Workgroup

6. Board Feedback: Governance Workgroup

7. Board Feedback: Legal and Policy Workgroup

8. Board Feedback: Finance Workgroup

9. Charter and Principles

10. Principles for Statewide HIEClinical

11. Principles for Statewide HIEClinical...Continued

12. Principles for Statewide HIEClinical...Continued

13. Principles for Statewide HIETechnical

14. Principles for Statewide HIETechnical...Continued

15. Statewide HIE Approaches

16. Statewide HIE ApproachMaking a Choice • Implications of your choice • Will influence where and how exchange will occur • Will define roles and responsibilities amongst stakeholders • Information required to choose • Distinction between the two options • Assessment of current HIE patterns in North Carolina

17. Statewide HIE ApproachTwo Remaining Options 3. Hosted, Shared HIE Services 1. Specification of Standards 2. Statewide Technical Architecture 4. Single Statewide HIE Facilitate Operate

18. Statewide HIE ApproachTech Architecture vs. Hosted Shared HIE Services 2. Statewide Technical Architecture 3. Hosted, Shared HIE Services Context of an Existing System • Statewide process defines architectural requirements and implementation guidelines • Describes how an entity will perform a function; doesn’t create the function • Existing implementations connect to a specific shared service which provides an implementation endpoint to organizations that do not have their own implementation and connects to existing deployments • Defines who participates and deploys an operational service Key Distinction Example Locate a patient record • A statewide service orchestrates across existing indexes and provides a consolidated response • Systems may connect directly to a hosted service for identity resolution or link their own index to the statewide system • Existing MPIs allow for patient discovery and respond with patient identifiers • Each index must connect to each other and applications are left to resolve multiple identity responses

19. Statewide HIE ApproachTech Architecture vs. Hosted Shared HIE Services 2. Statewide Technical Architecture 3. Hosted, Shared HIE Services • Best suited for situations with limited inter-organizational HIE or for services that are difficult to operate • Provides an operational solution • If built upon common needs, the shared services provide a cost effective utility • Best suited in situations with high volumes of inter-organizational HIE • Provides flexibility for regional technical variation Advantages Disadvantages • Possible disagreement regarding which services to select • Some local implementations may not be compatible • Utilization and operations dependent upon stakeholders’ willingness to create services • Increase costs over alternative approaches as it requires organizations to develop and perform services

20. Statewide HIE ApproachCurrent Patterns of Exchange in North Carolina* * Data collection is being coordinated with Finance Workgroup ** We will also seek information on capabilities of DHHS public health systems and MMIS

21. Clinical Functions

22. Clinical FunctionsHow States Frame Clinical Functions • 1. Focus on “Use Cases” • Organized around AHIC-defined use cases (e.g., Med Hx, eRx) • Example States: Maryland, New York (HEAL 5) • 2. Focus on Disease Condition • Tools to assist treatment of specific disease conditions (e.g., diabetes) • Example States: Tennessee • 3. Focus on Patient-Centered Medical Home-Like Model • Tools to augment and amplify PCMH and similar care coordination models • Example States: New York (HEAL 10)

23. Clinical Functions Clinical Functions and Data Movement National Labs eRx Networks Local Labs Public Health Agencies Gov’t Agencies Payers Patients and Caregivers 1. Build a complete record 2. Facilitate effective coordination 3. Automate Reporting, Registry Access Med Info Referrals Public health reporting Engage Patients Quality reporting Lab result

24. Clinical FunctionsMapping Clinical Functions to Services...Sample matrix

25. Clinical FunctionsNext Steps... • Manatt Deliverables • Expand and refine definition of clinical functions • Workgroup Deliverables • Identify key functions, begin prioritization

26. Prioritizing HIE Services

27. Statewide HIE ServicesOperational State and Regional HIEs ● Current functionality as of Feb 2010  Planned functionality as of Feb 2010

28. Statewide HIE ServicesProposed Sequencing of Services in Other States

29. Statewide HIE ServicesDimensions for Prioritization • What is the Clinical and Admin Value? • Higher the value = greater the case for statewide service • How relevant to Stage 1 Meaningful Use? • Higher the relevance = greater the case for statewide service • How prevalent in the market place? • Lower the prevalence = greater the case for statewide service • How difficult to implement? • Harder to implement = greater the case for statewide service • How variable are deployments? • More variability = greater the case for statewide service

30. Statewide HIE ServicesPrioritization Matrix * Direct value to clinicians in practices, clinics, and hospitals

31. Statewide HIE ServicesNext Steps... • Manatt Deliverables • Manatt distribute revised prioritization matrix • Workgroup Deliverables • Affirm prioritization assessment • Assign services to implementation stages

32. Public Comment and Next Steps

33. Next Steps • Objectives for Next Meeting • Review and provide feedback on “strawman” statewide HIE infrastructure • Recommend core services and candidate value-added services • Prioritize revised clinical function matrix • Upcoming Meetings • Clinical and Technical Operations Workgroup – July 8 • Board Meeting – July 13 • Questions or Comments? • Contact anita.massey@nc.gov.

34. ATTACHMENTS

35. 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.