Date : April 21, 2011 Time : 1:00 pm – 3:30 pm Conference Call ONLY

1. Date: April 21, 2011 Time: 1:00 pm – 3:30 pm Conference Call ONLY Dial in: 1-866-922-3257 Participant Code: 654 032 36#

2. Agenda 2

3. CEO Report 3

4. CEO Report Communications Firm ONC Budget Approval Operations Update CCNC Medication Management Challenge Grant Update 4

5. NC HIE Financing 5

6. Collaborative Infrastructure NCHIE Board of Directors Governance Work Group Tech/Clin Ops Work Group Finance Work Group Legal/Policy Work Group Executive Committee NC HIE Operations/ Staff POLICY RECOMMENDATIONS • Develop financing model • Finalize initial payment methodology/mechanics • Develop sustainability plan • Review bylaws • Define the parameters of Qualified Organizations and develop QO criteria • Define oversight and enforcement mechanisms • Proposed legislation to facilitate opt-out • Propose legislation to harmonize state medical record law • Draft set of detailed privacy & security policies and procedures • Hire RFP consultant • Define HIE RFP review process • Develop detailed consensus specifications • Draft and issue RFP 6

7. Finance: Timeline and Tasks Develop Financing Model Finalize initial payment methodology / mechanics Finalize participation agreements and obtain funding commitments • Refine approach through Finance Work Group • Outreach to stakeholders for feedback and input 7

8. Financing Approach...Current Status • In December 2010, NC HIE developed a four year (2011-2014) model that projected: • Total administrative and operational costs for robust Statewide HIE... $24.4 million • Total revenue from ONC Cooperative Agreement ............................... $11.9 million • Anticipated shortfall .............................................................................. $12.5 million • Key characteristics agreed upon to date: • Participation in the statewide HIE is voluntary. • Participants can pay through one of two mechanisms (“pay-as-you-go” or “pre-pay”). • Goals of pre-payment option is to: (1) lock in multiyear commitments from a critical mass of constituents; (2) reduce administrative burden; (3) ensure sufficient funding to cover the anticipated shortfall ($12.5 million over four years). • Pre-payment targets based on an agreed allocation per stakeholder category • Hospitals (35%) • Providers (10%) • Commercial Health Plans (35%) • Medicaid (20%) 8

9. Financing Approach...Proposed Mechanism for Prepayment • For pre-payers first installment (50% of total) due at time of initial closing ; remaining 50% at “Go-live Date” • Pre-payments treated as accrued revenue and credits • Pre-payment credit of 20% is equivalent to roughly 6% interest • Regardless of status as either pre-pay or pay-as-you-go, there will be a common service charge for all organizations of same classification (size, type) • Organizations pre-paying will have priority in implementation rollout 9

10. Financing Approach...Cost and Revenue Projections • NC HIE will  seek prepayments to fund the anticipated four year funding gap. • NC HIE has developed a “scenario calculator” to test different scenarios to illustrate the interplay between prepayment and pay-as-you-go options and varying cost considerations • The “scenario calculator” allows us to adjust three variables: • Estimated administrative and technical costs for Statewide HIE over four years • The number of entities that choose to Pre-pay • The rate of participation for entities that choose Pay-As-They-Go 10

11. “Base” Scenario in Calculator...Base Assumptions in Three Variables

12. Next Steps.... The Finance Workgroup accepted a pre-pay approach that involves a credit, commitment windows, common pricing to all stakeholders (of the same class) Action items: Staff to build detailed legal document NC HIE, working with communications firm, will develop a strategy to engage stakeholders and get feedback and refine accordingly, and begin obtaining commitments based on any such refinement.

13. NC HIE Bylaws 13

14. Additional Workgroup Updates 14

15. Workgroup Snapshot 15

16. Governance 16

17. Statewide HIE Governance: Timeline and Tasks Develop Qualified Organization Criteria Define Oversight Roles and Enforcement Mechanisms Develop Participation Agreements • Define parameters of Qualified Organizations in the HIE participation model • Develop written criteria for Qualified Organization designation • Develop recommendations related to QO application process. 17

18. Proposed Selection Criteria for Qualified Organizations (WORKING DRAFT - FOR DISCUSSION ONLY) Organized as a non-profit or for-profit corporation whose articles of incorporation have been filed with the North Carolina Department of the Secretary of State (or that has a certificate of good standing if incorporated in a state other than North Carolina). Agree to comply with Statewide Policy Guidance (including technical specifications and privacy and security requirements) and ensure QO participants comply with them. Agree to comply with “fair information” policy principles and require that QO participants comply with them. Provide list of current NC HIE participants (as defined by the NC HIE Board), updated on a regular basis in compliance with the process established by the NC HIE Board, and plan for adding more participants. Annually submit a Program Plan that describes specific activities in which the QO will engage. Demonstrate financial viability as required by the NC HIE Board (currently under discussion). Includes demonstration of adequate and appropriate insurance coverage. Important Topics to Consider in Selection of Criteria • Extent to which criteria limit entities that could serve as QOs • Establishing and maintaining overall system efficiency & integrity • Understanding the administrative implications of compliance Criteria are in draft form. Workgroup will submit a final formal recommendation to the board for consideration at future meeting.

19. Next Steps... April 26, 2011 Workgroup meeting: Finalize Qualified Organization selection criteria recommendations for Board Future Workgroup meetings: Develop recommendations related to selection process. High level overview of steps might include: NC HIE establishes application process for interested entities. NC HIE establishes application review process. NC HIE establishes process to notify applicant and the public that an organization has been deemed as a QO. NC HIE establishes ongoing re-qualification process. Develop recommendations related to enforcement and oversight: Define Metrics Create evaluation process (ongoing compliance) Establish processes for Dispute resolution Organizations seeking to voluntarily rescind QO status Expulsion of non-compliant QOs

20. Legal and Policy 20

21. Legal & Policy: Timeline and Tasks Finalize Draft Legislation Develop and Finalize Privacy and Security Policy and Procedures • Opt Out Consent legislation has been passed by the Senate, pending in House. 21

22. Legal & Policy: Development of Privacy & Security Policies March Meeting: • Definitions • Eligible Participants • Access to Protected Health Information for Treatment, Payment and Health Care Operations • Minimum Necessary Requirement • Emergency Access • Access Rights of the NC HIE Workforce April 25 Meeting: • Review Revisions to Above Sections • Opt Out Consent Rights • Restrictions on Access • Accounting of Disclosures • De-Identified Data Additional Policies to Be Defined at Future Meetings: • Access to Data by Researchers • Access to Data by Government Agencies • Access by Patients • Responding to Subpoenas and Discovery Requests • Security Policies (includes Breach) • Sanctions 22

23. Clinical and Technical Operations 23

24. Clinical/Tech Operations: Timeline and Tasks Develop HIE RFP Review Proposals, Negotiate, Award Contract for HIE Services Develop, Deploy, Test, and Accept HIE Services and Connect to Qualified Organizations • Secure RFP consultant • Define HIE RFP review process and recruit evaluators • Develop detailed specifications • Draft RFP 24

25. Massachusetts eHealth Collaborative NC HIE Team Micky Tripathi, Ph.D., MPP (Project Officer) - Mr. Tripathi is the president and CEO of MAeHC and will lead the MAeHC team for the NC HIE project. Mr. Tripathi is a nationally-recognized thought leader in the health information industry. His leadership experience ranges from policy guidance at the Federal level, to collaborative strategic planning at the State and community levels, to implementation of health IT systems at the front line of healthcare delivery. Mark Belanger, MBA (Project Director) – Mr. Belanger is the Director of Strategy at MAeHC and will manage the NC HIE project. Mr. Belanger has expertise in healthcare strategic planning and deep experience in the healthcare information industry. Mr. Belanger currently manages the statewide HIE vendor procurement project in the state of Missouri and the statewide HIE project for the state of New Hampshire. Nael Hafez, MBA (Technology Director) – Mr. Hafez is MAeHC’s director of technical services and will provide subject matter expertise to the NC HIE project. Mr. Hafez has expertise in the full life-cycle of community-wide health information exchange, from planning and design, to vendor selection, to deployment and ongoing operations. Jacqueline Baldaro, MHA (Project Manager) – Ms. Baldaro is a Project Manager at MAeHC and will provide daily management of the project plan, project schedule, communications, and reporting. Ms. Baldaro has expertise in healthcare strategic planning, network development, business model design, enterprise design, and operations management.

26. Overview of MAeHC Qualifications and Recent Experience Highlights of MAeHC’s relevant experience and qualifications: State-level HIE technical services vendor procurement: MAeHC is currently completing the technical services vendor selection process with the Missouri HIO State-level HIE strategic and operational planning: MAeHC led the statewide HIE strategic and operational planning process for the State of New Hampshire. Throughout 2010, MAeHC facilitated 6 multi-stakeholder workgroups, drafted the state’s strategic and operational plans, and gained approval of the plans by ONC. MAeHC is now engaged to assist NH stakeholders implement the plan. Regional Extension Center: MAeHC is operating the REC for the state of New Hampshire and is providing REC services in Massachusetts, New York, and Rhode Island. Community-wide EHR, HIE, and Quality Data Center deployment: From 2004-2009 MAeHC worked with 3 Massachusetts pilot communities to facilitate community-wide exchange of health information and quality data. Beacon Community Technical Assistance: MAeHC was engaged by the ONC to provide technical services to 3 Beacon communities regarding a unified approach to interfacing between major HIE and EHR vendors. Federal Policy guidance: President and CEO of MAeHC, Micky Tripathi, is the Co-Chair of the Health Exchange Working Group of the HIT Policy Committee and a member of the NHIN Working Group, the Meaningful Use Working Group, the Certification/Adoption Working Group, and the privacy & security tiger team. 26

27. Statewide HIE Technical Requirements • Clinical & Technical Operations Workgroup went through a prioritization process for Operational Plan. • Across past four months, Workgroup has refined priorities and defined requirements on a more granular level. • In addition, the NC HIE received comments from 24 additional NC stakeholders through a public request for comment process. • NC HIE has inventoried and compiled more than 400 individual comments, suggestions, and recommendations. 27

28. Timeline for Statewide HIE Services RFP • Mar- Apr 24... Finalize requirements, develop evaluation procedures/team • Apr 25............ Release RFP • May 20........... Vendors responses due • Jun 7.............. Best and Final Offers from vendors • Jun 16............ Present final recommendations to NC HIE Board • July 20........... Vendor contract finalized 28

29. Overview of Technology Services Vendor Selection Process We are Here Translate plan, preferences, and requirements – release RFP Select and prepare evaluation team Review written responses and down select Conduct finalist product demos Conduct reference calls Conduct BAFO workshops Select technology partner Contract with technology partner 29

30. Evaluation Process for Statewide HIE Services RFP - DRAFT 6-8 Candidates will emerge Meet Minimal Req’ts RFP Responses Review with CT Operations Workgroup Grade Candidates Each member of Evaluation Committee will grade Candidates based on established scorecard then the Committee will consolidate and normalize the scorecard Review current candidate scorecards with WG and collect feedback Expectation is that we will receive around 20-30 responses Staff will filter against a set of minimum requirements and completeness Rank Vendors Select Finalists Review with CT Operations Workgroup Oral Presentations Rankings will be reviewed with WG and feedback will be documented Each finalists will do two presentations: technical and non-technical Vendors will be ranked in two categories: functional and business by Evaluation Committee Based on scorecards and CT WG feedback, Evaluation Committee will select 2-4 finalists Select Vendor Review with Executive Committee/Board Negotiate Contract Board Approves Contract Evaluation Committee will select a recommended vendor 30

31. Evaluation Committee - DRAFT • Members of RFP Evaluation Committee • Three members of NC HIE Staff • Three members selected from a group nominated by CT Operations Workgroup • One representative from MAeHC • One or two experts drawn from the community to augment review team • Requirements for Participation • Document all Conflicts of Interest • Sign Confidentiality Agreement • Sign Representation Agreement • Commit to full time participation during the Evaluation Week • Technical/Clinical/Business experience relevant to the creation of the HIE and associated services • Evaluation Committee participants will be 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 rather than representing their individual organizational priorities. 31

32. Open Public Comment and Closing Comments 32

33. ATTACHMENTS

34. Core HIE Services Foundational services hosted by NC HIE that facilitate exchange health information across organizational boundaries, such that multiple entities can: Identify and locate each other in a manner they both trust; Reconcile the identity of the individual patient to whom the information pertains; Exchange information in a secure manner Statewide HIE Components Security Services Provider Directory Message / Record Routing / Return Receipt Identity Management and Authentication Transaction Logging Consent Management Terminology Service Transformation Service Patient Matching / RLS NHIN Gateway Value-Added HIE Services • Services that support the clinical priorities and use cases to help providers, patients, and care givers improve the safety, quality, and cost effectiveness of heath care. • Value-added services will be accessible via core services • Value-added Services can be offered at the state, regional, or enterprise level. • Value-Added services will be incrementally deployed based on feasibility, cost, and magnitude of benefits CCD Exchange Lab Results Delivery Lab Normalization Lab routing for reporting Quality Reporting Immuniz Access Rad Results Delivery Med Hx Rad Image Delivery Procedure Results Delivery Disease Surveillance CCD Translation Access to Aggregated Data Clinical Decision Support Phase 1 Value Added Services proposed in Operational Plan Phase 2 Value-Added Services proposed in Operational Plan Final decision regarding phased implementation will be informed by forthcoming statewide HIE RFP 34

35. Technical Relationships: Core HIE Services, QOs, & QO Participants Key Points: • Core services provide a foundation for identifying QOs, ensuring security, and providing a gateway to other QOs and additional HIE services • QOs link to core services by conformance to interoperability specifications • QOs provide a gateway to core services for their participants NC HIE Security Services Provider Directory Message / Record Routing / Return Receipt Identity Management and Authentication Transaction Logging Consent Management Terminology Service Transformation Service Patient Matching / RLS NHIN Gateway Example QOs... Physicians (IPA, PHO, PO) Regional HIO Large Hospital System Example QO Participants... Physician Practice Hospital Physician Practice Physician Practice 35

36. Technical Relationships: Value-added Services, QOs, & QO Participants Key Points: • Value-added Services are available to network participants and can be hosted by different entities. For example: • NC HIE could host a CCD Exchange service • The Dept of Health could host an Immunization Access service • A QO could host a CCD Translation service • Based on considerations of efficiency and practicality, the NC HIE Tech/Clinical Ops Work Group continues to evaluate the ideal location for Value-added Services Physician Practice Physician Practice Large Hospital System NC Immunization Registry 3. CCD Translation 2. Immuniz Access NC HIE Security Services Provider Directory Message / Record Routing / Return Receipt Identity Management and Authentication Transaction Logging 1. CCD Exchange Consent Management Terminology Service Transformation Service Patient Matching / RLS NHIN Gateway Physicians (IPA, PHO, PO) Regional HIO Large Hospital System Physician Practice Hospital Physician Practice Physician Practice 36

37. Mission Statement of the NC HIE As included in its Operational Plan, the mission of the NC HIE is: • To provide a secure, sustainable technology infrastructure to support the real time exchange of health information to improve medical decision-making and the coordination of care.

38. Expectations of the NC HIE Work Groups • Participants have been nominated and invited to participate by the NC HIE governing board co-chaired by Secretary Lanier Cansler and Mr. 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.

39. Governance Work Group Co-Chairs • Ben Money, NC Community Health Association • Tom Bacon, UNC School of Medicine, AHEC Members* • Connie Bishop, MSN RN, NC Nurses Association • Jacquelyn Boyden, Boyden Healthcare Consulting • Janis Curtis, Duke Health System • Craigan Gray, DHHS DMA • Mark Gregory, Kerr Drugs • Don Horton, LabCorp • Steve Keene, NC Medical Society • Harry Reynolds, IBM • Craig Richardville, Carolinas Healthcare System • Pam Silberman, NC Institute of Medicine • Craig Souza, NC Healthcare Facilities Association • Sam Spicer, New Hanover Regional Medical Center * NC HIE is currently evaluating the potential inclusion of a representative from a local HIE due to the departure of representative from WNC DataLink,

40. Clinical/Technical Operations Work Group Co-Chairs • Allen Dobson, CCNC • J.P. Kichak, UNC Hospital Members • Ben Alexander, WakeMed • Cynthia Cox, Raleigh Medical Group • Sam Cykert, AHEC, Moses Cone • Michael Fenton, NC CIO Office • John Graham, UNC Institute for Public Health • Susan Helm-Murtagh, BCBSNC • Arlo Jennings, Mission Hospitals • Yan Wang Kolbas, NC Nurses Association • Bill Leister, LabCorp • Keith McNeice, Carolinas Healthcare System • John A. (Sandy) McNeill, NC Health Care Facilities Association • Don Spencer, UNC Health Care • Angela Taylor, NC DHHS • James Tcheng, Duke University • John Torontow, Piedmont Health

41. Finance Work Group Co-Chairs • Maureen O’Connor, BCBSNC • Dr. Dave Tayloe, Goldsboro Pediatrics Members • Mark Bell, NC Hospital Association • Brian Harris, Rural Health Group, Inc. • Yvonne Hughes, Coastal Connect HIE • Mark Miller, Novant Health • John Minnich, CSC • Steve Owen, NC Medicaid • Phred Pilkington, Cabarrus County Health Dept. • Devdutta Sangvai, MD, Duke University Medical Center

42. Legal/Policy Work Group – Legislation and Implementation Subcommittee Co-Chairs • Senator Josh Stein • Representative Jeff Barnhart Members • Linda Attarian, NC DHHS (Vice-Chair) • Judith Beach, Quintiles • Mark Botts, UNC School of Government • Chris Collins, NC Office of Rural Health and Community Care • Brian Forrest, Access Healthcare • Chris Hoke, NC Department of Health & Human Services • Linwood Jones, North Carolina Hospital Association • Trish Markus, Smith Moore Leatherwood • Barbara Morales-Burke, Blue Cross Blue Shield of North Carolina • Melanie Phelps, North Carolina Medical Society • Troy Trygstad, Community Care of North Carolina • Robin Wright, NCHICA Consumer Advisory Council • Bill Wilson, AARP