Board Meeting - PA eHealth Partnership Authority

PA eHealth Partnership Authority
Board Meeting
PEMA Building
Harrisburg, PA
July 11, 2014
Today’s Agenda
Welcome and Emergency Procedures
Roll Call and Introductions
Consent Agenda*
Board Committees: Audit* and Finance
Highlighting HIOs in PA
Executive Director Report
Safety Net Provider Committee Update
Improving HIE in PA & the HIO Recommendations*
Strategic Plan discussion and guidance
2015 Meeting Dates
Public Comment
Wrap Up
(* Denotes Action Required)
Consent Agenda
• May 30th meeting summary
Board Committees
• Audit Committee
– Selection of auditor for 2013 and 2014
financial audits
• Financial Committee
– Formation status
Highlighting HIOs in PA
• New educational opportunity
• 1st overview presentation by
HealthShare Exchange of Southeastern
Pennsylvania (HSX)
• Soliciting for future HIO overviews
Executive Director Report Topics
• Budget update and implications
• Quarterly Report highlights for period of
March through May 2014
• Current highlights and key items
– Fund Development efforts
– Plenary update and draft agenda
– State Innovation Model grant
Budget Update
• Appropriation status
• Rebudget processes within Commonwealth
– Strategic foundation needed to rebudget in July:
Board’s strategic plan direction
Vendor’s cost estimates from HIO recommendations
Staff’s assessment of services and support needs
– Timing of rebudget effort and Authority approval
• ONC notice of grant award impacts on
budgeting efforts
Budget Update
• Current Fiscal Year (FY) state appropriation of
• Projected carryover to current FY - $2.9M - if
all forecasted adjustments can be performed
once ONC NGA matter resolved
• Sustainability model efforts on hold pending
outcome of HIO recommendations and
strategic direction
Budget Update
• Staffing
– Reduction in contract staff
– Administrative Assistant hiring
– Potential for additional staff based on:
Work related to HIO recommendations
Board’s strategic plan direction
Public Health Gateway build-out and related funding
SIM grant work and related funding
Staffing Model is Expected to Change
Quarterly Report /Domain Highlights
Program Management
Program Management
What is the HISP landscape?
Is DIRECT being adopted across the state?
Is DIRECT being utilized across the state?
What is the HIE landscape?
Is HIE being adopted across the state?
Is HIE utilization increasing across the state?
What is the status of P3N?
Is the program on track?
What is the status of program staffing?
Total Money Budgeted This Year
Total Money Spent This Month
Total Spent Year To Date
What is the financial status of the Authority?
What is the status of capacity building grant programs?
What is the status of Authority procurement activities?
What is the status of registry/public health related HIE?
Are standardized forms being adopted?
What is the legal and regulatory landscape?
What is the status of opt-outs?
What is the status of HIT Coordination Efforts?
What is the status of communications efforts?
What is the status of stakeholder relations?
Reporting period:
March – May 2014
In Development
On Track/No Risk
Slightly Behind Schedule/Medium Risk
Behind Schedule/Serious Risk
Program Accomplishment Highlights
• Planning for handling of opt-out requests prior to P3N go-live
• Align Authority policy documents with Truven contract and
• Work associated with HIO concerns initiated at April Board
• Onboarding of new Chairman
• Board Audit Committee formation
• Financial audit quote development, vendor selection, vendor
• Finalization of draft plenary budget, formation of planning
committee, initial identification of keynote speakers, initial
sponsorship solicitation
• Contract status
– Base contracts with Truven for P3N and Maximus for
Independent Verification and Validation
– Change order process with Truven for modifications
regardless of cost or no-cost changes. Four pending change
Public Health Gateway
Forcing consent form upload when consent status changed
Standard reply message when Opt-Out scenario exists
Identity proofing pilot participation with Office of Administration’s
effort with the National Strategy for Trusted Identities in
Cyberspace (NSTIC)
– Strategic direction discussions and budget implications
from today’s meeting
Procurements (continued)
• Open Procurements
– Financial auditing
– Plenary venue
• Possible Procurements
– Information Security auditing based on outcome of final
certification requirements
Timeline for Final Stages of P3N Pilot
P3N Operations Next Steps
Complete consent process piloting and production
data validation including a refresher training for
Lehigh Valley and St. Luke’s. Work with Vale-U-Health
and their vendor through fall timeframe.
Identify and apply lessons learned from final phase of
pilot to Certification Program including HIO
onboarding packet, consent management process
including reference materials, and P3N operations
Declare production status
Solidify and implement sustainability model
Solidify HIO onboarding schedule
Public Health Gateway (PHG)
• Continuing Electronic Lab Reporting Proof of
Technology project
• Funding request submitted to CMS on May 13, 2014,
to complete the development of the original PHG
project scope. Includes “onboarding” effort with
potential to support grant programs in excess of $10
million to offset fees related to eligible professionals
and hospitals to connect an EHR to an HIO or for
HIOs to connect to P3N.
Public Health Gateway (continued)
• Securing the 10% funding obligation to onboarding
funding request presents a substantial challenge
• Anticipate PHG Executive Council meeting in late July
• PHG plans being leveraged in plans to respond to
State Innovation Model testing grant
DIRECT Operations
• Evaluating modifications to HISP Certification
program to align more closely with the current
DirectTrust, Electronic Healthcare Network
Accreditation Commission (EHNAC)-based
accreditation program
• Three HISPs in various stages of certifying:
– DataMotion needs to complete testing and send in the contract
– HealthShare needs to complete testing and send in the contract
– Prelude Services is just beginning the process
Communications & Outreach Highlights
• Advanced educational materials with
Committee input:
– A general consumer brochure (“Electronic Health
Records”), which explains the basics of eHIE.
– An opt-out brochure (“Sharing Information for Better
Care”) for HIO and provider use.
• General awareness efforts through website
redesign, standing monthly meetings,
presentations, and media placement
• Revised media relations tool with more
features at reduced cost
Advisory Committee Highlights
P3N Operations
Tiger Team(s)
Clinical (ClinC)
Technical Manager
HIE Trust
Deputy Director
HISP Trust
Ops/Certification Lead(s)
Privacy, Security
and Standards
Director of Communications
Standards Tiger
Super Protected
Executive Privacy Officer
Study Team(s)
Finance and
Payer (PayerC)
Executive Director
Deputy Director
Safety Net
Standing Committees
Limited Duration Workgroups
Primary Authority Liaison
Legal, Privacy and Security Highlights
• Consent framework and feedback on forms
• Collaborative work on PAeHI’s “Ensuring
Privacy and Security of Health Information
Exchange in Pennsylvania” White Paper
• Super 3 and HIPAA alignment efforts
– Engagement of numerous entities within
HIV/AIDS, Mental Health and Substance Abuse
– Plans to move toward producing
recommendations for Board
Upcoming Activity Highlights
• New strategic plan based on board direction
• Rebudget
• Creating new program schedules in alignment
with strategy
• P3N operational maintenance planning
• Schedule HIO onboarding
• Continuity of operations preparedness (COOP)
Fund Development
• Donor database and foundation database subscriptions
– Donor database provides central source for information
– Foundation database provides background info, helps
identify opportunities
• Immediate focus will be on IAPD 90/10 funding for PHG
and onboarding efforts
• Long-term to help offset subscription fees and state
• Provide funds for the “should do” & “could do” lists
• Tuesday October 21st & Wednesday October 22nd @
Crowne Plaza* - Downtown Harrisburg
• Revised draft agenda provided in packet materials
• Plenary Planning Workgroup consists of four
stakeholders with Authority staff
• Will be seeking board member assistance as
facilitators for various sessions
• Welcome board assistance in identifying sponsors
within own organization or companies where you
have connections
* (pending final approvals)
State Innovation Model
Pennsylvania Health Care
Innovation Plan
FOA released May 22nd
Deadline for submission July 21st
New or redefined requirements
• Places new focus on Population Health
• Requires an integrated HIT plan for the state
• Places great focus on state policy and regulatory
Health Information Technology Approach
• Develop a coordinated HIT strategy among
• Increase the use of HIT by providing incentives and
technical assistance to providers to adopt EHRs
and connect to HIOs
• Streamline the flow of information
• Data reporting and analytics
• Enhance the use of Telemedicine
Contact Information
Marcela Diaz Myers M.D.
Pennsylvania Center for Practice Transformation and Innovation
[email protected]
Jennifer Miller
Assistant Director
Pennsylvania Center for Practice Transformation and Innovation
[email protected]
Safety Net Provider Committee
• Status
• Next steps
Improving HIE in Pennsylvania
• Several-month, iterative development process
with 7 HIOs, Truven, Maximus, Authority staff and
an occasional Board member
• Recommendations produced and distributed in
advance for review
– One-on-one discussions with most Board members
– Content summarized in slides as discussion tool
• Today’s process to review, discuss and vote to
obtain Board direction on advancing work into
strategic plan and budget
Recommendations 1, 2 and 3
#1 Consumption of historical consent decisions
#2 Retention of master patient index
#3 P3N relay gateway to HealtheWay
Status of these recommendations:
– Endorsed by all HIOs except SLUHN (no opinion)
– No action identified beyond existing plans
– No additional scope, time or cost impact identified
– No Board action required at this time
Recommendation 4
• #4 Make public health gateway a priority
• Status:
– Endorsed by all HIOs except SLUHN (no opinion)
– Reaffirmed importance to HIOs
– No immediate action identified beyond existing
plans, but includes several future discussion topics
– No additional scope, time or cost impact identified
– No Board action required at this time
Recommendation 5
• Resolution: The Authority shall not offer any service
to any entity other than to a certified HIO or HISP
without review and approval by the Board
• Endorsed by all HIOs except SLUHN, Vale-U-Health
(no opinion)
• Staff Actions:
– Discuss certification framework definition of HIO with HIE
Trust Community (HIETCC)
– Identify currently planned functions that require
retrospective Board approval (if any)
• Minimal scope, time or cost impact
Recommendation 6
• Resolution: New strategic plan shall include
collaboration with certified HIOs and HISPs to
identify and vet potential additional direct or indirect
incentives and policy levers on providers for
participation with certified HIOs or HISPs
• Endorsed by all HIOs
– KeyHIE Concern: no incentive for ongoing operations
• Staff Actions:
– Inform Board regarding scope and cost for additional
proposed work, should funding be identified
• Minimal scope, time or cost impact
Recommendation 9
• Resolution: Conduct research and analysis to determine
feasibility and cost to expand currently planned consent
registry to permit Super Protected Data (SPD) opt-in
• Endorsed by all HIOs (HSX with several comments)
• Impact of implementation not yet known
– Effort to develop this detail and impact will likely require
additional analyst/paralegal resource ($120k-$150k/year)
– Truven impact expected to be relatively small (~$20k)
– Additional staff effort not scoped
Recommendation 7
• Resolution: Make the use of the P3N clinical
document registry an optional feature for certified
HIOs, and create an XCA gateway for clinical
document exchange between those HIOs using the
P3N registry and those not using the registry
• Endorsed by all HIOs (comments from KeyHIE, HSX,
Tapestry), except Vale-U-Health (disagree)
• Required to garner participation by some HIOs
Recommendation 7 (continued)
• Staff Actions (with HIETCC):
– Modify participation agreement to require exchange
among certified HIOs
– Determine options for accounting of disclosures
– Address definition of “Treatment, Payment and
Operations” (TPO)
• Scope, Time and Cost Impact
– Presented for both Recommendation 7 & 8 together
because the two efforts are closely related
Recommendation 8
• Resolution: Leverage state-level MPI to allow P3N,
upon query, to provide certified HIOs with a list of
other HIOs who have a known relationship with the
patient based on the content of the state-level MPI
• Endorsed by all HIOs (comments from KeyHIE and
HSX) except Vale-U-Health (disagree)
• Supports Recommendation 7
• Staff Actions (with HIETCC):
– Update certification framework and onboarding process
– Analyze ability to leverage in interstate exchange
– Analyze ability to leverage for alerts
Recommendation 7 & 8 Impact
• Truven
– One-time fee of $176k
– Approximately eight weeks duration, at least one change request
– Solution enables three different P3N participation models
• Authority
– 180 hours effort each for IT/Procurements Mgr and Technical Architect
– Lesser efforts for Executive Director, Deputy Director, Program
Manager, Policy & Privacy Officer, and Press Secretary
– Three to four month delay in some other activities (i.e. onboarding)
– $35k to $45k in Authority staff effort
– Does not include subsequent analysis efforts regarding accounting of
disclosures (Rec 7), interstate exchange (Rec 8) or alerts (Rec 8)
Strategic Plan Process
• Building on existing plan with input from
plenary and multiple Board discussions
• Proposed framework distributed in advance
and discussed in some one-on-one meetings
Vision, Mission and Guiding Principles
Table of contents
Content approach
“Must do, should do, could do” chart
Strategic Plan Framework
• Today’s process will focus on:
• Mission
• Vision
• Guiding Principles
• Today’s Board direction will enable:
– Development of draft strategic plan narrative by staff for
Board’s review, commenting, discussion and vote/adoption
– Board officers, with staff support, to apply the strategic
framework in the state’s July rebudget effort
Fiscal Year 2014/2015 Meeting Dates
• Proposed FY 2014/2015 Board meetings
(July 1, 2014-June 30, 2015)
– In-person
o Note change for January 2015 to the 16th
– Telephonic meeting dates
• Extend approach to FY 2015/2016 dates?
(July 1, 2015-June 30, 2016)
Wrap Up
• Public Comment
• Wrap up/Next steps
• Executive Session