Oklahoma's revised operational plan for the State Health Information Exchange Cooperative Agreement Program (SHIECAP) : regarding American Recovery and Reinvestment Act, State Health Information Exchange Cooperative Agreement Program /

              Submitted To:
Office of National Coordinator for Health Information Technology
Department of Health and Human Services
Regarding:
American Recovery and Reinvestment Act
State Health Information Exchange Cooperative Agreement Program
Opportunity #EP-HIT-09001
CFDA# 93.719
Every Oklahoman will
benefit from the improved
quality and decreased cost
of health care afforded by
the secure and appropriate
communication of their
health information to all
providers involved in their
care, raising the health
status of individuals and
the entire state population.
– Oklahoma Health
Information Exchange
Trust Vision Statement
Submitted by:
Oklahoma Health Information Exchange Trust
March 11, 2011
Oklahoma’s Revised Operational Plan
for the
State Health Information Exchange Cooperative
Agreement Program (SHIECAP)
OHIET OKLAHOMA HEALTH INFORMATION EXCHANGE TRUST / OPERATIONAL PLAN - MARCH 2011 PAGE 1
Oklahoma Health Information Exchange Trust
Operational Plan
Table of Contents
1. Strategic Plan (under separate cover)
2. Operational Plan
2.1 Introduction to Operational Plan & Detailed Project Schedule .................................... 3
2.2 The Operational Set Up and Program Team......................................................................... 7
2.2.1 Set Up to Coordinate with Other ARRA Programs .............................................................. 10
2.2.1.1 Medicare Coordination Along With Other Federal Programs ................................ 10
2.2.1.2 Oklahoma Regional Extension Center .................................................................... 11
2.2.1.3 Beacon Community ................................................................................................ 12
2.2.1.4 Challenge Grant ..................................................................................................... 14
2.2.1.5 Work Force Development ...................................................................................... 15
2.2.1.6 Education ............................................................................................................... 16
2.2.1.7 Broadband ............................................................................................................. 17
2.2.2 Coordination with Other States .......................................................................................... 20
2.2.3 Framework Within Other Health Care Endeavors .............................................................. 21
2.2.3.1 Health Benefits Exchange Grant ............................................................................ 21
2.2.3.2 Oklahoma Health Access Portal ............................................................................. 22
2.3 Operational Approach By Domain Area
2.3.1 Governance .......................................................................................................................... 24
2.3.1.1 OHIET Internal Governance ................................................................................... 24
2.3.1.2 Policy Assistance .................................................................................................... 25
2.3.1.3 Certification and Credentialing .............................................................................. 26
2.3.1.4 Clinical Quality and Performance Evaluation ......................................................... 26
2.3.2 Finance ................................................................................................................................ 35
2.3.2.1 Cost Estimates and Staffing Plans .......................................................................... 36
2.3.2.2 Revenue Sources and Long-Term Sustainability ..................................................... 42
2.3.2.3 Controls and Reporting .......................................................................................... 46
2.3.2.4 Procurement and Contracting ................................................................................ 47
OHIET OKLAHOMA HEALTH INFORMATION EXCHANGE TRUST / OPERATIONAL PLAN - MARCH 2011 PAGE 2
2.3.3 Technical Infrastructure ....................................................................................................... 49
2.3.3.1 Standards and Certifications .................................................................................. 50
2.3.3.2 Technical Architecture ........................................................................................... 51
2.3.3.3 Security and Privacy................................................................................................ 51
2.3.3.4 Technology Deployment ........................................................................................ 51
2.3.4 Business and Technical Operations ..................................................................................... 53
2.3.4.1 Current Health Information Exchange Capacities ................................................. 53
2.3.4.2 State Level Shared Services and Repositories ....................................................... 55
2.3.4.3 Standard Operating Procedures for Health Information Exchange ....................... 56
2.3.4.4 Communications, Education and Marketing.......................................................... 56
2.3.5 Legal / Policy ........................................................................................................................ 60
2.3.5.1 Establish Requirements ......................................................................................... 60
2.3.5.2 Privacy and Security Harmonization....................................................................... 60
2.3.5.3 Federal Requirements ............................................................................................ 61
2.4 Issues, Risks, Dependencies ..................................................................................................... 61
2.5 Plan for Stage 1 Meaningful Use Compliance ..................................................................... 61
3. Appendices – Strategic and Operational Plans................................................................ 68
3.1 Project Schedule............................................................................................................................... 69
3.2 Legislation, Senate Bill 1373.............................................................................................................. 70
3.3 Oklahoma Health Information Exchange Trust Indenture................................................................. 78
3.4 Oklahoma Health Information Exchange Trust Bylaws ..................................................................... 98
3.5 Oklahoma Health Information Technology Coordinator Position Description.................................. 111
3.6 Governor Henry’s State Designation Letter ...................................................................................... 114
3.7 Position Description of Advisory Board Members............................................................................. 116
3.8 List of Participants in Oklahoma State Health Information Exchange
Cooperative Agreement Program .................................................................................................. 124
3.9 Glossary of Acronyms....................................................................................................................... 127
3.10 Oklahoma Standard Authorization to Use or Share Protected Health Information (PHI).................. 130
3.11 Letters of Endorsement.................................................................................................................... 132
3.12 Parity Check with PIN ....................................................................................................................... 139
3.13 Governor Henry’s Re-Designation Letter........................................................................................... 145
3.14 Biographical Information on OK’s HIT Coordinator............................................................................ 146
3.15 Resumes of OHIET Trustees............................................................................................................... 149
Table of Contents, cont’d.
OHIET OKLAHOMA HEALTH INFORMATION EXCHANGE TRUST / OPERATIONAL PLAN - MARCH 2011 PAGE 3
2. Operational Plan
2.1 Introduction to Operational Plan & Detailed Project Schedule
Oklahoma’s SHIECAP efforts achieved a major milestone during the 2010 state legislative session with
the passage and signing of Senate Bill 1373 creating the Oklahoma Health Information Exchange Trust
(OHIET). The purpose of OHIET is to ensure complete coverage of the state by health information
exchanges (HIEs) and the secure and appropriate transmission of electronic health data both intra-and
interstate. Governor Brad Henry requested transfer to OHIET the distinction of State Designated
Entity (SDE) from the Oklahoma Healthcare Authority (OHCA), who had been leading and managing the
SHIECAP effort in Oklahoma to that time.
Oklahoma’s Strategic Plan and this Operational Plan are a result of the work begun in the SHIECAP
process and fine-tuned by the OHIET seven-member board of trustees and advisory board consisting of
20 stakeholders defined by ONC for SHIECAP and bolstered by others identified by the trustees. (Ref:
Section 2.2, Exhibit 4 - Table for Advisory Board members).
OHIET has been conceived to ensure (short term) that every Oklahoma Eligible Provider (EP) has access
to the services that will enable them to meet Stage 1 Meaningful Use (S1MU); and (longer term) that
every Oklahoman has the benefit of their complete medical record being available in real time by
any provider they see. Additionally, OHIET will ensure the “5 Rights of HIE”: right information, right
patient, right provider, right timing, right security.
In order to achieve these goals, OHIET’s focus is on 6 primary activities:
1. Develop a process certifying health information organizations to ensure that every region of the
State is served by a high-quality health information organization. Areas of focus for this activity will
include, but not be limited to, evaluations of governance, technology, privacy & security policies
and capabilities, and financial stability.
2. Design grant programs that fit the overall state strategy to meet S1MU and following meaningful
use stages.
3. Ensure the plan, development and implementation of shared services and technologies that
are best suited to centralized, statewide implementation, in support of the network of health
information organizations in the State. Areas of focus for this activity include a) a state-wide
policy for privacy and security, b) an electronic master person, provider, or patient index services
and/or standards, c) state agency data services (i.e. immunization registry, vital statistics, etc.)
to support all certified HIOs, d) a process and/or technology to enable state-wide reporting of
health and healthcare system outcome metrics from the network of HIO networks, and e) and
participation in a health insurance exchange for the state.
4. Identify and assemble policy and statutory changes needed to support ongoing, appropriate, and
secure health information exchange in Oklahoma and provide information and support as needed
throughout the legislative, executive, or judicial processes required to achieve the changes.
OHIET OKLAHOMA HEALTH INFORMATION EXCHANGE TRUST / OPERATIONAL PLAN - MARCH 2011 PAGE 4
5. Coordinate activities for Inter-HIO, Inter-HIT (i.e., Beacon, Challenge, Benefits Exchange grants)
and Interstate HIE, to ensure the seamless exchange of appropriate health information for patients
receiving care in multiple states or regions and to streamline efforts and resources expended.
6. Evaluate and monitor the continuing HIE activities throughout the state and others that may impact
our state HIE endeavor.
The implementation of these activities is the focus of this Operational Plan.
OHIET’s schedule is in keeping with the requirements set out by ONC and the rigorous requirements of
Meaningful Use. Additionally, there are business goals: ramping up, generating revenues, achieving
financial sustainability and so forth. Some key milestones that indicate progress in the overall plan
are shown in Exhibit 1, with a Detailed Project Schedule provided in Appendix 3.1. Key events and
milestones for OHIET in FY2011 are shown in Exhibit 2 and an amplification of FY2011 is found in
section 2.5, Plan for Stage 1 Meaningful Use Compliance. The operational plan that follows outlines in
detail how OHIET intends to make these milestones a reality.
Exhibit 1 – Project Schedule Milestones
Task Milestone
Governance
Conduct first meeting with new Trustees 10/5/2010
Governor appoints permanent HIT Coordinator for OK 10/30/2010
Governor redesignates OK SDE to OHIET 11/30/2010
First Advisory Board Meeting 12/7/2010
Credentialing HIE/HIO approved 7/5/2011
Finance
Approve FY2011 Budget 4/5/2011
Sign first contracts 4/5/2011
Approve detailed financial plan 8/5/2011
Organization sustained by own financial resources 10/1/2012
Communications, Grants & Coordination
Start first outreach program 5/3/2011
Award first grant 6/7/2011
First statewide conference 12/1/2011
First regional conference held 3/1/2012
Technical Infrastructure
Infrastructure plan for statewide coverage complete 5/3/2011
Establish standards and certifications required for each network to participate in
the network of networks and ensure interface and operations standards
6/7/2011
Plan for compliance with standards and certifications for interoperability in place 1/1/2013
OHIET OKLAHOMA HEALTH INFORMATION EXCHANGE TRUST / OPERATIONAL PLAN - MARCH 2011 PAGE 5
Exhibit 1 – Project Schedule Milestones, cont’d
Task Milestone
Business & Technical Operations
Describe existing state and regional HIE capacity and other shared services and
directories and approach to leverage to meet HIE Strategic Plan
4/5/2011
Develop incremental plan to reach all geographies and providers across the state 4/5/2011
Design SOP to be used 7/5/2011
Clinical Quality/Performance Evaluation/Credentialing
First credentialing evaluation takes place 7/15/2011
Stage 1 Meaningful Use criteria met in Oklahoma 9/30/2011
Stage 2 Meaningful Use criteria met in Oklahoma 9/30/2012
Stage 3 Meaningful Use criteria met in Oklahoma 9/30/2013
HIE implementation rates and provider adoption rates >75% 9/30/2014
10% reduction in preventable hospital readmissions and ED visits regarding
Asthma, COPD, and CHF
9/30/2015
5-7% decrease in total per capita State Medicaid and Medicare expenditures 9/30/2016
Reduce the number of duplicate lab tests by 10% 9/30/2015
Reduce referrals to specialty care by 10% 9/30/2015
Enhanced communications between healthcare providers 9/30/2011
10% increase in the appropriate administration of Pneumovax and influenza
vaccinations
9/30/2014
5% increase in the number of lipid panels performed on Oklahomans by age 20 9/30/2015
3-5% increase in the number of patients having regular mammograms and colon
cancer screens
9/30/2014
5% improvement in documentation of smoking rates and alcohol use and in number
of interventions offered
9/30/2014
BMI captured on 95% patients over 13 years of age 9/30/2014
Legal/Policy
Sign Trust ByLaws 10/5/2010
Adopt plans for privacy and security statewide and consistency with other states 5/3/2011
Legislation passed to enhance use of HIEs in Oklahoma 5/31/2012
OHIET OKLAHOMA HEALTH INFORMATION EXCHANGE TRUST / OPERATIONAL PLAN - MARCH 2011 PAGE 6
1/27/11
10/5/10
11/2/10
12/7/10
1/4/11
2/1/11
3/1/11
4/5/11
5/3/11
6/7/11
7/5/11
8/5/10
9/6/11
¥ First
Board
of
Trustees
Mee;ng
¥ Officers
Elected
¥ Bylaws
Adopted
OHIET
Key
Events
&
Deliverables
Chart
FY2011
¥ John
Calabro
appointed
OK
HIT
Coordinator
¥ ONC
Technical
Consultant
Visit
¥ First
Advisory
Board
Mee;ng
¥ Opera;onal
Direc;on
Set
by
Trustees
¥ Advisory
Board
Member
Approvals
Complete
¥ Challenge
Grant
Submission
Approved
¥ LOI
Approved
for
Pa;ent-­‐Centered
Medical
Home
Grant
Challenge
Grant
Award
No;ce
Health
Benefits
Exchange
Award
No;ce
2/16/11
Approve
Re-­‐submi[al
of
OHIET
Strategic
Plan
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ONC
Site
Visit
Beacon
Community
GTHAN
Kick-­‐off
Challenge
Grant
¥ Present
Opera;onal
Plan
for
Approval
¥ Launch
Opera;ons
Teams
2/18/11
Approve
Challenge
Grant
Re-­‐Scope
&
Budget
OHIET
Strategic
&
Opera;onal
Plans
Re-­‐submit
to
ONC
Gap
Analysis
Informa;on
Complete
State
Designated
En;ty
Transfer
Complete
¥ Present
Plans
for
Stage
1
Meaningful
Use
(S1MU):
Remote
Access
(Broadband),
E-­‐
Prescribing,
Labs,
CCD
¥ Receive
Technical
Infrastructure
Strategy
for
HIE
Coverage
Throughout
Oklahoma
¥ Receive
Recommenda;ons
for
State
Level
Shared
Services
and
Repositories
¥ Set
Up
Infrastructure
for
Collabora;on
and
Best
Prac;ces
Sharing
Teams
in
Place
To
Execute
S1MU
Plans
¥ Approve
S1MU
Execu;on
Plans
&
Test
Criteria
¥ Adopt
Privacy
&
Security
Policies
¥ Approve
Marke;ng/Communica;ons
(MarComm)
Plan
¥ Receive
Plan
for
Overall
HIE
Coverage
Throughout
Oklahoma
¥ Approve
Shared
Services
Plan
Accomplished
Planned
S1MU
Team
Leads
Collaborate
9/30/11
Adver;se
to
Grantee
Candidates
Curriculum
Development
&
Delivery
MarComm
Development
&
Delivery
Select
First
Round
Grantees
First
Round
Grant
dork
Implementa;on
Select
Second
Round
Grantees
Second
Round
Implementa;on
¥ Receive
HIE/HIO
Defini;ons
and
Criteria
for
Approval
¥ Define
HIO
Interface
Criteria
¥ Assign
Creden;aling
Team
¥ Approve
Controls
&
Repor;ng
Policies
¥ Approve
Creden;aling
&
Performance
Evalua;on
Plan
¥ Receive
Detailed
Financial
Plan
¥ Approve
FY2012
Budget
¥ Approve
FY2012
Opera;ng
Plan
¥ Adopt
Standard
Opera;ng
Procedures
¥ Review
Evalua;on
&
Test
Data
¥ Begin
Final
Test
All
Systems
for
S1MU
Final
Punchlist
S1MU
¥ Final
Data
&
Evalua;on
Review
S1MU
¥ Approve
S1MU
Submi[al
to
ONC
¥ Approve
End
of
Year
Reports
¥ S1MU
Met
¥ Report
to
ONC
¥ Ra;fy
Inter-­‐Local
Agreements
&
Sign
First
Contracts
¥ Approve
Procurement
&
Contrac;ng
Policies
¥ Approve
Staffing
Plan
¥ Present
FY2011
Budget
for
Approval
¥ Assign
Fiscal
Agent
¥ Review
&
Approve
Qualified
Vendor
Lists
Exhibit 2 – Key Elements and Deliverables
OHIET OKLAHOMA HEALTH INFORMATION EXCHANGE TRUST / OPERATIONAL PLAN - MARCH 2011 PAGE 7
2.2 The Operational Set Up and Program Team
In support of the country’s efforts to promote effective health information technology (HIT), ARRA
appropriated more than $45 billion to assist in electronically transforming the health care system.
Stakeholders of OHIET greatly value this opportunity to both expand Oklahoma’s existing and future
HIT/HIE initiatives as well as help offset the provider costs of implementing the electronic information
systems required to support Electronic Health Records (EHRs).
Oklahoma’s earnestness to complete the tasks set out by ONC is communicated by the quality of
people leading the effort in our state.
The OHIET Board of Trustees provides guidance and oversight to the overall effort and directly manages
implementation of parts of this plan. Trustees were selected by Oklahoma elected officials as,
individually, those possessing good experience with HIE and, collectively, comprising a representation
and knowledge of clinicians, practitioners, academics, executives, state agencies, urban and rural,
health care organizations from safety net to urban health centers, and the breadth of the geography of
Oklahoma. (Ref: Exhibit 3 - List of Appointed Trustees)
The OHIET staff will lead and manage the day-to-day business of the organization and drive activities to
stated goals. OHIET’s executive director also serves as Oklahoma’s HIT Coordinator and is an Ex Officio
member of the board of trustees. In November, 2010, Governor Henry appointed John Calabro as the
state HIT Coordinator and by doing so, identified OHIET’s lead officer. Mr. Calabro brings much to the
organization having served as deputy HIT Coordinator throughout the SHIECAP process and as our state
Medicaid agency’s CIO. Mr. Calabro’s service in this position ensures a well-knit approach by OHIET
with the OCHA and other state agencies’ activities that impact OHIET. (Ref: Mr. Calabro’s biographical
information in Appendix 3.14)
As specified in OHIET’s indenture, an advisory board supports the trust and provide recommendations,
interests and opinions to the trustees . The advisory board has the dual purpose of representing the
interests and opinions of their organizations or constituencies and of performing ad hoc investigations
required by OHIET. The group of 20 individuals work in task forces largely in line with the original
SHIECAP domain areas. As may be required, additional resources, such as domain experts and
consultants, will be used to complete tasks. Work will be performed in task forces and small groups.
Recommendations, generated from this work, are to be ratified by a quorum of the advisory board
and provided to the board of trustees for their consideration. (Ref: Advisory board organization and
individual representatives are provided in Exhibit 4)
OHIET OKLAHOMA HEALTH INFORMATION EXCHANGE TRUST / OPERATIONAL PLAN - MARCH 2011 PAGE 8
Exhibit 3 - OHIET Board of Trustees
OHIET Trustee Current Position Qualifications Rep (geog)
Nominator/
Term
Jenny Alexopulos, DO Sr Associate Dean of Clinical Services; Prof. of Family Medicine, OSU Physician, clinician, academic; experience in start up HIE Tulsa
Rep. Benge,
July 31, 2013
Julie Cox‐Kain, MPH Chief Operating Officer, Oklahoma State Department of Health
Experience spans the state's health systems and facilities;
represents state agencies and safety net programs
State
Gov. Henry,
July 15, 2015
Samuel T. Guild
Sam Guild, Vice President Clinical Services, Jane Phillips Medical
Center
Hospital executive with experience in a start up HIE Bartlesville
Sen. Coffee,
July 31, 2012
Craig W. Jones, FACHE President Oklahoma Hospital Association
Hospital facilitator, helped start Greater OKC HIE network;
represents rural, urban, HIS/Tribes, academic and state agency
interests in professional role
State
Rep. Benge,
July 31, 2015
David Kendrick, MD
CEO, Greater Tulsa Health Access Network (GTHAN) HIE; As't
Provost Strategic Planning, OUHSC; Chief, Div'n Medical Informatics;
George Kaiser Chair in Community Medicine, Assoc. Prof. Internal
Medicine & Pediatrics, OU School of Community Medicine
Founder, GTHAN; Principle Investigator $12M Beacon Community
CAP; 3 successful healthcare start‐ups, 2 in OK; Physician,
clinician, academic; Formal training in Medical Informatics and
Public Health focused on clinical R&E science
NE OK
Sen. Coffee,
July 31, 2015
Robert H. Roswell, MD
Senior Associate Dean, OU College of Medicine, Professor of
Medicine in the College of Medicine, Professor Health
Administration and Public Policy, OU College of Public Health
Physician, academic and oversees management of an urban
medical center; directs a course in Health Information Systems;
former chair of the OK Governor's Health Information Security
and Privacy Council; previously served as the Under Secretary for
Health for the Department of Veterans Affairs
OKC
Gov. Henry,
July 31, 2014
Brian Yeaman, MD
Chief Medical Informatics Officer for Norman Regional, Medical
Director of Informatics for Norman PHO/HIE, Medical Director of
Informatics for the Greater Oklahoma City HIE
Governance and Oversight Workgroup for State HIE effort,
Steering Committee member for Regional Extension Center,
Physician Support to SMRTNET; start up of two HIEs; PI for
SHIECAP Challenge Grant for $1.7M
Norman, OKC,
OHA Hospitals
Gov. Henry,
July 31, 2011
OHIET OKLAHOMA HEALTH INFORMATION EXCHANGE TRUST / OPERATIONAL PLAN - MARCH 2011 PAGE 9
Organization Appointed Representative
1. Oklahoma Health Care Authority Garth L. Splinter, MD, State Medicaid Director
2. Oklahoma State Department of Health Becki Moore, Data Warehouse Manager
3.
Oklahoma Department of Mental Health
and Substance Abuse Services
Terri White, Commissioner
4.
University of Oklahoma Health Sciences
Center
Kevin Elledge, Executive Director of Operations, University
of Oklahoma Physicians
5.
Oklahoma State University Center for
Health Sciences
Dr. Jim Hess, COO
6.
A nominee of the Indian Health Service
Office responsible for Oklahoma
Dr. John Farris, Chief Medical Officer
7. A representative of Tribal interests Mr. Mitchell Thornbrugh, Cherokee Nation CIO
8. Oklahoma Hospital Association Rick Snyder, CFO and VP, Finance & Information Services
9. Oklahoma Osteopathic Association Dennis J. Carter, DO, past president
10. Oklahoma Pharmacists Association Jim Spoon
11. Oklahoma State Medical Association Kent T. King, MD, past president
12. The State Chamber of Oklahoma
Matt Robison, Vice President Small Business and Workforce
Development
13.
Security and privacy representative
nominated by the Oklahoma Health
Information Security and Privacy Council
Robn Green, HIPAA Privacy Officer, OSDH, and Vice Chair of
OKHISPC
14.
A HIO representative as nominated by
the OHIET Board
Joe Walker, Medical Informatics Project Manager, OUHSC,
and Director of Operations, GTHAN
15.
A consumer representative nominated
by the governor
Sean Voskuhl, Associate State Director AARP Oklahoma
16.
A nominee of the Oklahoma Regional
Extension Center steering committee
Jonathan Kolarik, MBA, RN, Director of HIT
17. Oklahoma Association of Health Plans
Bill Hancock, Vice President & General Manager of
CommunityCare Managed Health Plan
18. Representative of Rural Providers
Val Schott, Director, Rural Health Policy & Advocacy,
Director, Oklahoma Office of Rural Health, OSU Center for
Health Sciences
19.
A HIO representative as nominated by
the OHIET Board
Mark Jones, SMRTNET
20.
A HIO representative as nominated by
the OHIET Board
Lynn Puckett, Contracts Service Director for OHCA and PI on
the Benefits Exchange Grant
Exhibit 4: OHIET Advisory Board Members
OHIET OKLAHOMA HEALTH INFORMATION EXCHANGE TRUST / OPERATIONAL PLAN - MARCH 2011 PAGE 10
2.2.1 Set Up to Coordinate with Other ARRA Programs
The total ARRA funds awarded to Oklahoma are approximately $3.2 billion (February 17,
2009, to December 31, 2010) with associated jobs totals reported to be 8,675. Of the funds
awarded, roughly 55-60% has been received from the federal government to date, leaving
ample opportunity for OHIET to impact and leverage other ARRA dollars coming into the state.
OHIET’s Executive Director, Mr. Calabro, will be responsible for keeping track of ARRA awards,
the recipients and the intent of the funds in order to coordinate with and make the most of
all ARRA funding with ties to the State Health Information Exchange Cooperative Agreement
Program (SHIECAP). He will coordinate closely with the Oklahoma Secretary of State, who is
charged with oversight of ARRA projects and funding, and with the Department of Commerce,
who manages much funding within the state.
The individuals listed below are trustees and advisory board members who lend themselves
to coordinate with other related efforts taking place both within the state and more broadly.
Specifically, to coordinate with other ARRA programs within Oklahoma, the following individuals
are point persons.
ARRA Program Point Person(s) Orgn/OHIET Role
Medicaid in OK Garth Splinter, MD OHCA; AB Member
OK REC Jonathan Kolarik REC; AB Member
Beacon Community – GTHAN David Kendrick
Joe Walker
GTHAN; Trustee
GTHAN; AB Member
Challenge Grant – NRMC Brian Yeaman NRMC; Trustee
Health Benefits Exchange Grant – OHCA Lynn Puckett OHCA; AB Member
Work Force Development Matt Robison OK State Chamber of
Commerce; AB Member
Education Jenny Alexopulos, DO
Robert Roswell, MD
Val Schott
OSUCHS; Trustee
OUHSC; Trustee
OSUCHS; AB Member
Broadband Mark Jones SMRTNET; AB Member
Exhibit 5: OHIET’s Coordination Point Persons
Mr. Calabro, by virtue of his position as both OK HIT Coordinator and as the executive director of
OHIET, will provide continuity through all these activities and play an active role to ensure open
communication amongst them and alignment of goals.
2.2.1.1. Medicare Coordination Along With Other Federal Programs
The purpose of OHIET is to make HIE availability to all eligible providers throughout the
state of Oklahoma. A key result from this effort is the maximum number of Oklahoma
Medicare and Medicaid eligible professionals and hospitals qualify and receive
OHIET OKLAHOMA HEALTH INFORMATION EXCHANGE TRUST / OPERATIONAL PLAN - MARCH 2011 PAGE 11
payment incentives for Meaningful Use as defined by federal law and the Center for
Medicare and Medicaid Services (CMS) rule. It also encourages the widespread use
of EHRs by health care providers allowing them to participate fully in the Oklahoma
EHR incentives program available from the federal and state governments under
the Medicare and Medicaid programs. Significant incentives, laid out by the OHCA
(the Medicare/Medicaid organization in the state) help drive this adoption. OHCA is
working closely with OHIET to streamline contract incentive language to encourage
HIT/HIE adoption and to meet the goals of the two organizations for providers.
The Oklahoma EHR Incentive Program payments for Meaningful Use are a key impetus
to Medicaid providers to employ EHR and participate in HIE. Further, Oklahoma’s
environmental scan of statewide EHR/HIE adoption revealed that the inclusion of
Medicare data, along with other federal programs in statewide and interstate HIE, are
critical to the widespread use and sustainability of HIE in the state. OHIET’s position is
to request federal partners make this data available to enable Oklahoma providers to
achieve Meaningful Use. OHIET looks forward to working with Medicare, Indian Health
Service (IHS), Department of Defense, Veterans Administration and other federal
programs to create a workable data exchange.
OHIET is also responsible to ensure that products and services best suited for central
and ubiquitous distribution are developed and available to users. The OHCA is a
key collaborator in the development of such products and services and is now, as a
recipient of a Health Benefits Exchange Grant (BXG), in a position to make significant
strides in this area. OHIET is working closely with OHCA to ensure objectives for both
organizations are met without duplicative effort.
Lynn Puckett, PI on the BXG, Contracts Services Manager for OHCA and an OHIET
Advisory Board member, is participating in the design and implementation of such
services for OHCA and is responsible for steering the daily alignment between the
two organizations. This is a top priority for senior management of both the OHCA and
OHIET.
2.2.1.2. Oklahoma Regional Extension Center
The Oklahoma Foundation for Medical Quality (OFMQ) and its associated Oklahoma
Foundation for Medical Quality Health Information Technology (OFMQHIT) REC
is committed to collaborating with OHIET in its efforts to improve the quality and
decrease the cost of health care, raising the health status of individuals in the state.
OFMQ HIT recognizes that an important component of working with providers to
achieve Meaningful Use will be facilitating interoperability and information exchange.
Some specific alliances between the REC and OHIET are as follows.
To enable Oklahoma providers to meet Stage 1 Meaningful Use:
1. On e-prescribing -- Ensure development of curriculum and training to local
(primarily rural) providers on advantages to e-prescribing and the alternatives
that enable e-prescribing (i.e., internet) where locally unavailable.
OHIET OKLAHOMA HEALTH INFORMATION EXCHANGE TRUST / OPERATIONAL PLAN - MARCH 2011 PAGE 12
2. On electronic receipt of lab results – Create and deliver education and awareness
campaigns on key benefits to use electronic transfers to providers.
3. On sharing patient care summaries – Create use case on the benefits of HIE;
assist in training of HIE protocols as established/promulgated by OHIET; provide
information on incentive programs to local eligible providers.
4. On generally promoting the effective use of HIE – provide assistance on surveying
current and future uptake, analysis of gaps and hindrances, education and
guidance in field to providers and in bringing OFMQ training and outreach to
specialists.
The REC will work with local HIOs, professional associations, and agencies as well as
OHIET on the above work.
OFMQ REC is also an integral partner with OHIET on performing the work outlined
in the Challenge Grant. The REC is working closely with Dr. Brian Yeaman, PI on the
Challenge Grant, on the work of training, hooking up and monitoring effects of HIE in
Long Term Care Facilities (LTCFs) in central Oklahoma and to provide analysis and best
practices to further this work throughout the state. The second site, as part of the
Challenge Grant, is GTHAN in the Tulsa area of the state.
As a point of contact, Jonathan Kolarik, Director of HIT for OFMQ and an OHIET
Advisory Board member, will be the ongoing link between the two organizations on the
above and other work.
2.2.1.3. Beacon Community
The Greater Tulsa Health Access Network (Greater THAN) was founded in 2009 by
health care and community leaders dedicated to the improvement of health and
quality of life for all Oklahomans living in the Tulsa region. The charter members of
Greater THAN invested significant time and resources in a 100-day planning project
which produced a health care IT strategic plan for the region and a roadmap for
implementation of that plan.
In May of 2010, Tulsa was named one of 17 Beacon Communities in the U.S., and
Greater THAN received a $12 million award to leverage health care IT in unique and
effective ways to improve health in the Tulsa region. The challenge is significant: with
high rates of obesity, diabetes, cardiovascular disease deaths and severe mental illness,
coupled with low access to care for many in the region, Greater THAN must use health
care IT to make a significant difference in these poor health outcomes in a very short
period of time.
Recognizing the complexity of this task, as well as the need for resources well beyond
those provided by the Beacon program, the leadership of Greater THAN has worked
hard from the very beginning to partner with other health care IT-related efforts,
especially those funded by ARRA. Greater THAN works closely with local community
colleges and universities to establish informatics training programs; partners with the
OHIET OKLAHOMA HEALTH INFORMATION EXCHANGE TRUST / OPERATIONAL PLAN - MARCH 2011 PAGE 13
REC to ensure efficient recruiting of providers and the selection of best technologies;
and serves on the leadership associated with OHIET to guide the implementation of
the state HIE effort in a way that will complement and even capitalize on the Beacon
Community effort.
Three of the seven Trustees of OHIET are from the Beacon region, and Greater THAN
members have participated in the governance, technology, finance, and evaluation
work groups from the SHIECAP proposal phase to the present. Prior to the SHIECAP
program, Greater THAN leaders worked actively to organize the state’s HIE effort.
GTHAN fully supports OHIET and its efforts to implement statewide HIE.
In addition to providing technical and governance experience to the state effort,
Greater THAN hopes to provide a clear pathway forward on technology. The Beacon
Program funds enable Greater THAN to bring the following four interventions to the
region:
1. Advanced HIE platform: Second or third generation software platforms are now
available and by purchasing the most advanced HIE solution, we hope the Tulsa
region’s HIE will set new standards for capabilities and performance.
2. Community-wide care coordination system: The Doc2Doc study, a three-year
randomized controlled trial of an online community-wide care coordination
platform has just concluded, with nearly 60,000 patient referrals and online
consultations completed, and more than 1,100 different providers touched. The
Beacon Program will expand access to the Doc2Doc platform to many more users
and communities in the region.
3. Community-wide decision support: As the volume and complexity of data
available in HIOs increases, providers and patients will soon become overwhelmed.
Left unaddressed, this could dramatically hinder the success of the HIE and
certainly could limit the usefulness of the HIE at the point-of-care. By implementing
an intelligent decision support system, which automatically combs through the
patients’ data looking for opportunities to improve care and create clear, concise
estimates of risk to educate providers, a decision-support system could be critical
to the success of HIE. The Greater THAN Beacon Community plans to implement
the Archimedes Indigo decision support tool. Greater THAN will be the first HIE
implementation of this tool and could serve as a model for the rest of the state and
even the nation.
4. Advanced analytics: Nearly every health care organization is faced with the
daunting challenge of making intelligent use of the enormous volumes of data they
gather to guide business and clinical decisions. This is because of the wide variety of
data, from a wide variety of disciplines (medicine, nursing, business, management,
etc.) that must be considered, and especially the large number of silos containing
that data. The rise of HIE provides a tremendous opportunity to provide a single
common source of clinical and business analytics to an entire community. Greater
THAN is focused on acquiring or building a Business Intelligence solution that will
OHIET OKLAHOMA HEALTH INFORMATION EXCHANGE TRUST / OPERATIONAL PLAN - MARCH 2011 PAGE 14
meet a variety of use-cases, ranging from public health reporting and disease
surveillance to supporting the planning of public transportation based on health
care access patterns and needs.
Thus, Greater THAN hopes to serve as a kind of proving ground for technologies
and approaches that may become useful throughout the state.
In daily activities, GTHAN is working with OHIET to establish work demarcations
between the local HIE/HIOs and OHIET’s over-arching structure as network of
networks. Strategies and execution plans are being co-designed to effect Stage
1 Meaningful Use. GTHAN is providing lessons learned and best practices to the
working teams of OHIET. Coordination of these efforts is being shepherded by Dr.
David Kendrick, founder and CEO of GTHAN and an OHIET trustee, and Joe Walker,
Director of Operations for GTHAN and an OHIET advisory board member.
2.2.1.4. Challenge Grant
“Improving Long-term and Post-acute Care Transitions.” The OHIET Challenge grant
focuses on improving transitions of care between hospitals and LTCFs by implementing
electronic information exchange to support patient care during and after patient
transfers. In addition to the implementation of the technology to support electronic
exchange of patient-specific information, focus will also be on improving the workflow
and processes associated with care transitions to ensure effective use of information
to improve patient care. There is a clear need to engage LTCF providers in information
sharing efforts, especially to support sharing of care summaries across transitions in
care and maintenance of an accurate and up to date medication list for patients.
The OHIET Challenge Grant is an 18-month pilot to be followed by 18 months of shared
best practice and workflows with other Health Information Organizations (HIO’s) across
the state. The Beacon Community (GTHAN) is named as the next site.
This three-year collaboration with providers, hospitals, Accountable Care Organizations
(ACO’s) and payers is to reach meaningful use and state HIE goals related to improved
patient safety associated with transitions of care. The continuous monitoring of
results, lessons learned and best practices, will be shared statewide through the REC,
the Beacon Community and OHIET. Ultimately, OHIET may advocate OHIET policy
and/or legislation that would guide acute care and LTCFs on improved patient transfer
activities.
Seven to ten LTCFs in one geographically defined area and serviced by the Norman
Regional Health System are in the first phase of this program. Desired results are to
improve the care for patients by reducing re-hospitalizations through promotion of
seamless transitions of care from hospitals to LTCFs (focusing on those LTCFs for which
there is intervention). In the second 18 months, working closely with the Beacon
community (GTHAN), the project will be scaled to test the usefulness of standardized
transfer data elements for LTCFs.
OHIET OKLAHOMA HEALTH INFORMATION EXCHANGE TRUST / OPERATIONAL PLAN - MARCH 2011 PAGE 15
Oklahoma Foundation for Medical Quality (OFMQ), the REC for the state, is providing
implementation assistance for the LTCFs, oversight support, measurement and
continuous feed back to host organizations. OFMQ is a subcontractor to OHIET on the
Challenge Grant.
The Challenge Grant goal is to identify a standardized medication reconciliation and
patient transfer protocol that illustrates to other states and nationally the favorable
interaction between EHR, HIE and patient outcomes. OHIET is keenly interested in
developing scalable interventions that can be shared across our state and beyond.
Dr. Brian Yeaman, Chief Medical Information Officer for Norman Regional Health
System and OHIET Trustee, is the Principal Investigator on the Challenge Grant.
2.2.1.5. Work Force Development
OHIET plans for work force development include direct collaboration between higher
education, professional education programs and association training programs to
provide definitive materials on HIE/HIT; establish needs and opportunities in Oklahoma
for HIT/HIE; and design curricula to ensure the smooth execution of state programs and
goals regarding HIE/HIT. In direct support of these initiatives are trustees and advisory
board members who are leaders of universities, associations, and learning facilities.
Matt Robison, with the Oklahoma State Chamber of Commerce, is in charge of work
force development there and will lead the effort of collaborative plans on work force
development for the trust.
An example of cooperation with another ARRA supported program is the Health
Information Technology Program at Tulsa Community College (TCC). TCC is offering
“Information Technology Professionals in Health Care: Community College Consortia
to Educate Information Technology Professionals in Health Care.” The mission of TCC is
to offer continuing education certificate programs using nationally developed curricula
that provide a trained workforce with the requisite knowledge and skills to support:
• The adoption and implementation of EHR;
• The electronic exchange and use of health information among health care
providers, public health authorities, HIE organizations and/or Regional Health
Information Organizations (RHIOs);
• Redesign of the workflow within health care settings to maximize efficient and
meaningful use benefits of the EHR;
• Maintenance of quality data standards;
• Maintenance of privacy and security standards for health information.
TCC is offering continuing education certification for four of the HIT workforce roles
delineated by the ONC. These training roles are as follows:
• Practice Workflow and Information Management Redesign Specialist
OHIET OKLAHOMA HEALTH INFORMATION EXCHANGE TRUST / OPERATIONAL PLAN - MARCH 2011 PAGE 16
• Clinician/Practitioner Consultant
• Implementation Manager
• Trainer
The curriculum packages determine the certificate programs. The training began in late
2010. The anticipated length of the certificate programs is six months or less. There are
stipends available to assist students with tuition and fees. The TCC curricula are available
via distance learning, hybrid courses and in the traditional classroom setting.
2.2.1.6. Education
This effort is being spearheaded for OHIET by three trustees and physicians, Axelopulos,
Kendrick and Roswell, who are also faculty members and leaders at Oklahoma’s
two university medical centers. The University of Oklahoma Health Sciences Center
(OUHSC) has received 18 ARRA awards (approximately $7.8 million) from the National
Institute of Health (NIH) for research. These funds have greatly increased both basic
science and translational research programs at the institution, as well as increased
research staff. In addition, these grants have resulted in expanded informatics
infrastructure and technical support services at the institution, which through
its primary hospital affiliate, the Oklahoma University Medical Center, is already
exchanging electronic health information with other providers throughout the state.
As the largest osteopathic hospital in the country, Oklahoma State University Medical
Center (OSUMC) is significantly involved in clinical training for medical students,
nurses, therapists and technicians from several area schools and colleges. With rural
development and outreach programs as one of its primary goals, OSU Center for Health
Services (OSU CHS) and the OSU Center for Rural Health received the following funding:
• $1.6 million grant from the Federal Office of Rural Health Policy to install EHRs in
critical access hospitals in rural areas of the state. OSU CHS provided $650,000 in
matching funding to place EHRs in these small rural hospitals.
• $250,000 and $290,000 USDA grants dedicated to telemedicine, of which OSU CHS
matched at 50% and 25%, respectively.
• A $297,000 Congressional appropriation for telemedicine equipment.
• And a $299,000 grant for a mannequin training lab in Enid, Oklahoma, at one of its
rural residency training sites.
The OSUMC operates an extensive telehealth network providing a variety of services
including approximately 25,000 radiological services monthly to Oklahoma rural
hospitals.
The OSU Center for Rural Health manages the Medicare Rural Hospital Flexibility (FLEX)
program and the Small Hospital Improvement Program (SHIP), collectively serving 62
Oklahoma rural hospitals with less than 50 beds.
OHIET OKLAHOMA HEALTH INFORMATION EXCHANGE TRUST / OPERATIONAL PLAN - MARCH 2011 PAGE 17
Val Schott, who chairs the OHIET advisory board and directs OSU CHS’s programs for
Rural Health Policy & Advocacy and the Oklahoma Office of Rural Health will be the
point person to coordinate efforts between these programs and OHIET.
2.2.1.5. Broadband
The disparity in broadband infrastructure between the urban and rural areas of
Oklahoma is problematic, particularly where bandwidth is unavailable or unaffordable.
Oklahoma is by population the 28th largest state and geographically the 20th largest
state in the nation with a population of just over 3.7million people1 . Sixty percent of
the population resides in the two metropolitan areas of Tulsa and Oklahoma City. The
remaining forty percent are spread across the state in communities ranging in size from
a few hundred people to 25,000.
As reported in the Strategic Plan, Oklahoma has received several grants, through ARRA,
that make great headway in bringing broadband across the state.
The Oklahoma Community Access Network (OCAN) received $74 million to place fiber-optic
cable along 13 segments of interstates and highways in 33 counties.
The OCAN project will build 1,005 miles of new middle-mile fiber infrastructure to
connect 32 anchor institutions in under and un-served areas of the state where a
broadband penetration is often less than 25%. The fiber route selected touches 35 of
Oklahoma’s 77 counties, approximately 89% of the state’s population, and is on state
highway right-of-way. Within five miles of the proposed fiber build are 1,096 schools,
libraries, medical or health care providers, public safety entities, community colleges,
institutions of higher education, along with other community support organizations
and government facilities.
OCAN’s middle-mile infrastructure will support a variety of last-mile projects of
particular interest to private sector providers who, along with local, state and
tribal entities, have voiced their support for the project’s goals. OCAN’s impact, as
additional fiber connections are constructed, will mean unprecedented access to
essential services for rural Oklahomans. A number of state agencies own, manage and
maintain telecommunications infrastructures, both wireless and wireline to include
the Oklahoma State Regents for Higher Education, Office of State Finance, Oklahoma
Department of Transportation, and the Oklahoma Turnpike Authority who have worked
for over a year to provide a foundation for OCAN’S application.
1 Data for Oklahoma show that the five most populous incorporated places and their 2010 Census counts are
Oklahoma City, 579,999; Tulsa, 391,906; Norman, 110,925; Broken Arrow, 98,850; and Lawton, 96,867. Overall
population is 3,751,351 people. Source as reported in the 2010 US Census data.
OHIET OKLAHOMA HEALTH INFORMATION EXCHANGE TRUST / OPERATIONAL PLAN - MARCH 2011 PAGE 18
Exhibit 6 – Proposed Broadband Backbone for the State of Oklahoma
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State of Oklahoma Map - Broadband Proposal for Fiber Backbone
Legend
ODOT Facilities within 5 Miles of Fiber - 40
County Seats within 5 Miles of Fiber - 23
FireStations within 5 Miles of Fiber - 240
DPS Troop HQ within 5 Miles of Fiber - 7
Correctional Institutions within 5 Miles of Fiber - 72
Police Departments within 5 Miles of Fiber - 137
Libraries within 5 Miles of Fiber - 51
Health Departments within 5 Miles of Fiber - 24
Hospitals within 5 Miles of Fiber - 43
HigherEd within 5 Miles of Fiber - 18
VoTechs within 5 Miles of Fiber - 9
Private Schools within 5 Miles of Fiber - 32
Public Schools within 5 Miles of Fiber - 443
Indian Health Service within 5 Miles of Fiber - 15
State Fiber - 1100 Miles
IRU Fiber Backbone - 107 Miles
Proposed Fiber Backbone - 1005 Miles
Counties
CSMG Broadband Penetration Data
4 Counties (25% - 27%)
23 Counties (28% - 35%)
25 Counties (36% - 43%)
16 Counties (44% - 50%)
9 Counties (51% - 63%)
77% of Counties Touched by Broadband Proposal
89% of Population Touched by Broadband Proposal
ADAIR
ALFALFA
ATOKA
BEAVER
BECKHAM
BLAINE
BRYAN
CADDO
CANADIAN
CARTER
CHEROKEE
CHOCTAW
CIMARRON
CLEVELAND
COAL
COMANCHE
COTTON
CRAIG
CREEK
CUSTER
DELAWARE
DEWEY
ELLIS
GARFIELD
GARVIN
GRADY
GRANT
GREER
HARMON
HARPER
HASKELL
HUGHES
JACKSON
JEFFERSON
JOHNSTON
KAY
KINGFISHER
KIOWA LATIMER
LEFLORE
LINCOLN
LOGAN
LOVE
MAJOR
MARSHALL
MAYES
MCINTOSH
MCCURTAIN
MCCLAIN
MURRAY
MUSKOGEE
NOBLE
NOWATA
OKLAHOMA OKFUSKEE
OKMULGEE
OSAGE
OTTAWA
PAWNEE
PAYNE
PITTSBURG
PONTOTOC
POTTAWATOMIE
PUSHMATAHA
ROGERS
ROGER MILLS
SEMINOLE
SEQUOYAH
STEPHENS
TEXAS
TILLMAN
TULSA
WAGONER
WASHINGTON
WASHITA
WOODS
WOODWARD
OHIET OKLAHOMA HEALTH INFORMATION EXCHANGE TRUST / OPERATIONAL PLAN - MARCH 2011 PAGE 19
Anchor Institution City
Miles from
Backbone
Current
Capacity
Community Colleges
Ardmore Higher Education Center Ardmore 6.5 2xFE (200)
Carl Albert State College Poteau 0.2 2xDS3 (90)
Carl Albert State College Sallisaw 0.1 DS3 (45)
Cheyenne and Arapaho Tribal College Weatherford 1
Conners College Warner 2 DS3 (45)
Comanche Nation Tribal College Lawton 1 2xT1 (3)
Eastern Oklahoma State College McAlester 2 DS3 (45)
Eastern Oklahoma State College* Wilburton 0 DS3 (45)
Northern Oklahoma College Enid 2 DS3 (45)
Redlands Community College El Reno 0.7 FE (100)
Seminole State College Seminole 2 DS3 (45)
Western Oklahoma State College Altus 0 DS3 (45)
Health Care/Hospitals
Atoka Memorial Hospital Atoka
Mary Hurley Hospital Coalgate
Choctaw Hospital Hugo
Lawton Indian Hospital Lawton 0
Seiling Municipal Hospital Seiling
Jefferson County Hospital Waurika
Woodward Hospital Woodward
Libraries
Duncan Public Library Duncan 0 1.54 Mbps
Public Safety
DPS - Highway Patrol Troop HQ Durant 0 T1 (1.5)
DPS - Highway Patrol Troop HQ Enid 0 T1 (1.5)
CLEET Ada
Universities
Cameron University Duncan
Cameron University* Lawton
East Central University Ada
Northwestern OSU Enid
Northwestern OSU Woodward
Southeastern OSU* Durant
Southeastern OSU - McCurtain Co. Idabel
Southwestern OSU Sayre
Southwestern OSU* Weatherford
Exhibit 7: Community Anchor Institutions
OHIET OKLAHOMA HEALTH INFORMATION EXCHANGE TRUST / OPERATIONAL PLAN - MARCH 2011 PAGE 20
Other grants include:
Oklahoma Communication Systems, Inc. (parent company, TDS Telecommunications
Corp.) received $3.5 million from the U.S. Department of Agriculture, matched by
about $1.2 million in private money. The project brings high-speed Internet service to
residents and businesses near Inola, Bristow, Fletcher and Cyril.
Pine Telephone Co. received approximately $9.7 million from the USDA to offer 3G
universal mobile broadband service in Coal, Latimer, Le Flore and Pittsburg counties
within the Choctaw Nation.
Cimarron Telephone Co. in Mannford, Oklahoma, will partner with the government
to bring new broadband services to 21,500 people, 933 local businesses and 35
community institutions in Payne, Osage, Creek, Pawnee and Okfuskee counties,
according to the Department of Agriculture. That share represents the bulk of the
funding, at $42.2 million.
Little Rock, Arkansas-based Windstream Communications was chosen as the
government’s partner to bring new broadband services to 4,000 people in parts
of Cherokee and Adair counties in Oklahoma. Wyandotte Telephone Co. was given
$700,000 for additional services for 460 people, and Utopian Wireless Corporation
was granted $300,000 for wireless broadband services around Prague, Oklahoma, for
3,400 people, 100 businesses and 33 community institutions. The federal program’s
goal is to create jobs and expand economic, health care, educational and public safety
services in underserved rural communities. This initiative is the second round of rural
broadband expansion for rural Oklahoma in furthering statewide interoperability. Prior
to this in March 2010, the Agriculture Department gave $11.7 million to Pioneer Long
Distance Inc. and Panhandle Telephone Cooperative Inc. to develop better services in
western Oklahoma and the Panhandle.
These grants provide tremendous impact in the state’s connectivity. OHIET is working
in concert with these grantees to ensure alignment of goals and plans. For the 10-11%
outside the range of these plans, OHIET is developing work-arounds that still allow
providers to meet Stage 1 MU criteria. SMRTNET has a working model with Direct that
will allow providers to meet Stage 1 criteria. OHIET is working with the REC and others
to provide means of placing these solutions where required with eligible providers.
Mark Jones, founder of SMRTNET and OHIET AB member, will spearhead this effort on
behalf of OHIET.
2.2.2. Coordination with Other States
There are several vehicles in place for Oklahoma to immediately coordinate with other states
and begin to import/export lessons learned and best practices. As a Theme 2 Challenge Grant
awardee, Oklahoma commits to work closely with Colorado, Massachusetts and Maryland, the
other Theme 2 grantees, as well as the 14 other states that submitted plans for Theme 2 but were
not awarded. Oklahoma plans to convene regular meetings with the other grantees, from the
beginning of the projects, and set up regular correspondence with the other states. Dr. Yeaman,
Principal Investigator, will lead this effort.
OHIET OKLAHOMA HEALTH INFORMATION EXCHANGE TRUST / OPERATIONAL PLAN - MARCH 2011 PAGE 21
A key component of the Health Benefits Exchange is to coordinate with other award recipients.
The other states receiving grants were Kansas, Maryland, a multistate consortium headed by the
University of Massachusetts Medical School, New York, Oregon, and Wisconsin. This is a group
of seven grantees that will work quickly and closely to succeed in their heady goals in this arena.
Lynn Puckett, Principal Investigator, will lead this effort.
The Beacom Community grant awarded to GTHAN, has propagated much collaboration between
state efforts. Dr. Kendrick, Principal Investigator, leads the effort with the assistance of Joe
Walker (OUHSC and OHIET AB member) in coordinating programs, best practices and efforts
with the other Beacon Communities.
Oklahoma participates in CMS sponsored Medicaid regional meetings to discuss cross border
issues with provider incentive payments, as well as holds regular meetings with border state HIT
coordinators.
As a member of Health Information Privacy and Security Collaboration (HISPC), Oklahoma HISPC
participated in two multi-state collaboratives focusing on sharing data across state borders.
John Calabro, Oklahoma’s HIT Coordinator, is actively representing Oklahoma in interstate and
national HIT/HIE endeavors.
2.2.3. Framework with Other State & National Endeavors
2.2.3.1. Health Benefits Exchange Grant
Oklahoma has been awarded $54.6 million in federal funding to develop information
technology products, services and infrastructure that will enable rapid expansion and
effectiveness of HIE/HIT within the state and nationally.
Oklahoma received one of seven awards totaling $241 million to help states design and
use information technology needed to operate health insurance exchanges. Exchanges
are state-regulated plans in which small businesses and individuals are to pool money
to buy health insurance. States are mandated to have the exchanges ready by 2014 so
that those residents who do not have insurance can shop for insurance plans.
Oklahoma was selected as an “early innovator” state to develop exchange information
technology models to be shared with and tailored by other states. With the grant, the
state will have three years to work on the system created in 2003 by the Oklahoma
Health Care Authority (OHCA). OHCA, which uses the system for its SoonerCare Online,
will receive the multimillion dollar grant. Earlier, the state received a $1 million federal
grant to plan how to establish the required health insurance exchanges.
Oklahoma applied for a grant in October under former Governor Brad Henry’s
administration. Current Governor, Mary Fallin, continues to support the plan.
OHIET OKLAHOMA HEALTH INFORMATION EXCHANGE TRUST / OPERATIONAL PLAN - MARCH 2011 PAGE 22
OHIET is already in close collaboration with the OHCA. This grant allows Oklahoma
to pursue, at pace, development of products and services identified as best suited
for centralized development and distribution. As part of OHIET’s charter, it will work
closely with the OHCA to provide guidelines, performance criteria and standards to
the products and services under development in this program. OHIET also provides a
neutral hub for all payers to come together to determine and pursue needs. OHIET is
already active in this role.
Collaboration is institutionalized between OHIET and OHCA. Lynn Puckett is the
Prinipal Investigator on this grant and serves on the OHIET advisory board. Mr.
Calabro, ExDir of OHIET and OK HITC, is involved in both endeavors on a daily basis.
2.2.3.2. Oklahoma Health Access Portal (OHAP)
To enable legislation that certain insurance coverage will need to be obtained through
a health insurance exchange, Oklahoma has a connector portal, OHAP. OHAP will
provide tools to six key stakeholders in the health care delivery process:
1. Patients will be able to access the portal and research available insurance products.
Interactive technologies will gather information needed to recommend plans
for which the patient is eligible. The patient will be able to create side-by-side
comparisons of the available plans and to seek more information from agents for
those plans. In addition, a series of “what if” scenarios will be available for patients
to test the performance of all plans under consideration to enable them to choose
the best plan to meet their needs. As an example, the interactive “tool” might
answer “With plan A, what happens if I lose my job?” or “With Plan B, what if I go on
long-term disability from my job?”
2. Payors will interact with the portal to provide information on their plans, including
details on eligibility, coverage terms and as much of the “fine print” as can possibly
be codified in a database. Payors will be responsible for keeping this information up-to-
date—this will be accomplished by establishing, through statute, that the OHAP-listed
version of a plan’s terms and requirements supersedes any other versions of
the plan that have been created. Thus, payors will be incented to keep their listings
fresh and up-to-date.
In addition, payors will receive patient references through the site and will use the
system to have secure conversations with patients prior to contract execution.
Finally, payors will use the site to interaction with the Provider Credentialing System,
described in more detail below under “Providers.”
3. Employers will use the site to compare and contrast plans and companies under
consideration to become their payor, in many of the same ways that the individual
patients would use the system. In particular, “what-if” analyses for employers
would have the added dimension of considering the health of the population they
OHIET OKLAHOMA HEALTH INFORMATION EXCHANGE TRUST / OPERATIONAL PLAN - MARCH 2011 PAGE 23
are responsible for and the effects of rare events on the future insurability of that
population. Sample questions to be answered here would include “What if one of
my employees develops cancer?” or “What if our company institutes a wellness
program?”
4. Providers will use the portal system in several ways. First, providers may use the
eligibility assessment tools to help connect patients with appropriate insurance
products (more below on this). Second, providers will use the site as the primary
reference for the terms and obligations of specific plans (as noted in 2 above). Third,
providers will utilize the portal to file a standardized credentialing application and
follow its progress through each of the payors. This is a critical service that we can
offer to providers in Oklahoma, who currently spend thousands of hours each year
completing company-specific and in some cases specialty-specific applications for
credentials. The entire process can take six to nine months to complete, during
which the provider has no information about the progress of their applications, and
worse yet, cannot see patients— or at least cannot charge for seeing patients—
insured by the companies with whom their application is pending. Standardizing and
automating this process will be an enormously valuable service to providers, and is
one that should generate revenue for the sustainability plan.
5. Evaluators will use the portal to interact with dashboard level data on the
functioning of the system. These reports would show metrics like system utilization,
number of connections made, number of and details on patients who fail to qualify
for any particular plans, and comparison data on the coverage being offered by price
and eligibility profile. It is expected that the tools and reports used by the evaluators
would start simple and evolve over time to support increasingly comprehensive
views of program performance and opportunities for improvement.
6. Administrators will use the portal to configure user accounts, role-based
permissions, review audit trails on any sensitive data or Protected Health
Information (PHI) collected by the system.
OHIET OKLAHOMA HEALTH INFORMATION EXCHANGE TRUST / OPERATIONAL PLAN - MARCH 2011 PAGE 24
2.3. Operational Approach By Domain Area
2.3.1. Governance
Governance domain area goals include:
2.3.1.1. OHIET’s Internal Governance
OHIET’s enabling legislation (Appendix 3.2) and Trust Indenture (Appendix 3.3)
establish OHIET’s governance structure, which is comprised of a Board of Trustees
(Exhibit 3), Advisory Board (Exhibit 4) and Executive Director (ExDir) (Appendix 3.14).
The OHIET Board of Trustees (resumes are found in Appendix 3.15) is the decision-making
body for the trust. Under the terms of OHIET’s indenture, the affirmative
vote of four (4) trustees is generally required for the trust to take action. The
trustees receive administrative and operational support from the ExDir, his staff and
consultants, and the Advisory Board.
Oklahoma’s Governor, President Pro Tempore of the Oklahoma State Senate, and
Speaker of the Oklahoma House of Representatives appoint OHIET’s seven trustees.
Oklahoma’s Attorney General approved OHIET’s organizational documents pursuant to
Oklahoma’s Public Trust Act. Governor Brad Henry signed a formal acceptance of the
Governance
# Goal Status
1
Set up separate, neutral organziton to oversee and protect HIE/HIO operations
and effectiveness
Complete
2 Agree upon vision, values and mission for the new organization Complete
3 Determine purpose of the organization and align structure and roles to achieve In progress
4 Ensure organization goals and purpose encompass ONC goals and requirements Complete
5 Develop credentialing program In progress
6
Define categories of HIE/HIO and associated qualifying criteria for
credentialing each
In progress
7
Evaluate and report clinical quality and performance outcomes of HIE/HIO
operations throughout Oklahoma
TBD
8 Ensure quality and completeness of goals of all OHIET domain areas Ongoing
9 Ensure completion of Meaningful Use goals (all stages) Ongoing
10 Establish quality teams, goals and criteria In progress
11 Define metrics and create data dictionary TBD
12 Report outcomes Monthly report
13
Dynamic update of metrics and evaluation tools to measure most
meaningful data
TBD
OHIET OKLAHOMA HEALTH INFORMATION EXCHANGE TRUST / OPERATIONAL PLAN - MARCH 2011 PAGE 25
benefit of the trust on behalf of the state of Oklahoma and its citizens, and the OHIET’s
indenture was filed with the Oklahoma Secretary of State. With that filing, OHIET
became operational. Governor Henry submitted a request to re-designate Oklahoma’s
SDE as OHIET. This re-designation is now in process.
At the Board of Trustees first board meeting, held October 5, 2010, the trustees
adopted the bylaws (attached as Appendix 3.4). The bylaws set forth policies and
procedures for the internal operating structure of OHIET. The board also began the
process of asking representative organizations for their nominations to the Advisory
Board. The first meeting of the Advisory Board was held on December 7, 2010. By
early January 2011, all named advisory board positions were filled.
The Advisory Board (AB) is made up of 20 individuals. These individuals represent
host organizations or constituencies that include and go beyond those recommended
by ONC for input into the SHIECAP process. Elected officials, Val Schott as Chairman
and Mitch Thornbrugh serves as Vice Chairman, lead the board activities. Standing
meetings are monthly. Tasks are assigned and performed in task forces approximately
aligned with the SHIECAP domain areas. The AB develops recommendations for the
trustees on assigned tasks and other issues raised from within. The board of trustees
is obligated, by statute, to consider all recommendations from the AB. Ongoing
communication takes place between boards. Trustee board meetings have a standing
agenda item for AB report out and business. The ExDir is an Ex Officio member of
OHIET Board of Trustees. He, and the Chairman and/or Vice Chairman of the AB attend
monthly meetings of both boards for clarity and continuity.
The OHIET ExDir also serves as Oklahoma’s HIT Coordinator. This set up places OHIET
in a central position with access to all HIT/HIE activities in the state and provides good
communication flow between OHIET and other state and nationally HIE programs.
One of the first and, indeed, most defining pieces of business is a task requested of the
AB to define ‘HIO’ and the various categories it might take. These definitions will be
the crux of OHIET’s basic business in credentialing HIE/Os. Criteria for credentialing will
be further defined for each category identified. This work is in process at this writing.
2.3.1.2. Policy Assistance
Policy development and standards identification are underway in the following areas:
privacy and security, technology and data usage, contracting and procurement,
auditing and reporting, and penalties for violations or breaches of standards or trust
participation agreements.
Other areas for policy consideration include
• Consent Model
• Expansion of Good Samaritan protections to HIE
• Limited liability to data sources in error
OHIET OKLAHOMA HEALTH INFORMATION EXCHANGE TRUST / OPERATIONAL PLAN - MARCH 2011 PAGE 26
• Support for HIO sustainability modles
o Telemedicine/telehealth
o Care coordination support
o Care management
Consideration of these initial sets of policies and procedures will occur during the first
six months of OHIET’s operation as the SDE. Governance is a standing task force of the
AB. Monitoring and refreshing policies and procedures are part of their purview.
OHIET also has a dynamic legislative agenda. This plan will be written and led by the
OHIET ExDir, John Calabro, who provides a legislative update to trustees as a standing
agenda item at monthly board meetings.
2.3.1.3. Certification and Credentialing
A key value-added service OHIET brings to the state HIE/HIO infrastructure is the
ability to provide standards, policies and protocols to each HIE/HIO operating here
and, in turn, to ensure to the public that each HIE/HIO is operating to these criteria.
Certification is to be re-established on an annual basis. This element of OHIET activity
is also a major component of our sustainability model. The intent is to earn a fee for
these services from the participating HIOs.
Elements to be evaluated and certified include:
• Governance structure, particularly inclusiveness
• Privacy and security framework: Policy and procedures
• Technology:
o Security
o Standards-based data transmission/storage
• Financial stability
• Ability to report accurately on OHIET’s outcome and performance metrics.
2.3.1.4. Clinical Quality and Performance Evaluation
The OHIET certification and credentialing process establishes metrics that all certified
HIOs are required to report, including:
• Clinical quality
• Adoption, utilization
• Geographic coverage
And the timing and structure required for reporting on the above.
OHIET OKLAHOMA HEALTH INFORMATION EXCHANGE TRUST / OPERATIONAL PLAN - MARCH 2011 PAGE 27
Surveys to be established include:
• Do no harm arm
• Patient/Provider satisfaction
Additionally, goals for the Clinical Quality and Performance Evaluation domain include:
OHIET has identified a set of metrics to be captured at baseline. Exhibit 7 (following)
lists measures that the evaluation team will capture to meet the reporting
requirements. Exhibit 8 lists a set of performance metrics. The evaluation team is
currently identifying and assessing additional data elements, which will be added for
longitudinal data collection and analyses to guide and evaluate the implementation of
each phase.
Clinical Quality/Performance Evaluation
# Goal Status
1 HIE implementation rates and provider adoption rates >75% 2014
2
10% reduction in preventable hospital readmissions and ED visits regarding
Asthma, COPD, and CHF
2015
3 5‐7% decrease in total per capita State Medicaid and Medicare expenditures 2016
4 Reduce the number of duplicate lab tests by 10% 2015
5 Reduce referrals to specialty care by 10% 2015
6 Enhanced communications between healthcare providers 2011
7
10% increase in the appropriate administration of Pneumovax and influenza
vaccinations
2014
8 5% increase in the number of lipid panels performed on Oklahomans by age 20 2015
9
3‐5% increase in the number of patients having regular mammograms and colon
cancer screens
2014
10
5% improvement in documentation of smoking rates and alcohol use and in
number of interventions offered
2014
11 BMI captured on 95% patients over 13 years of age 2014
OHIET OKLAHOMA HEALTH INFORMATION EXCHANGE TRUST / OPERATIONAL PLAN - MARCH 2011 PAGE 28
Exhibit 7. Reporting Requirements
Reporting Requirement Metric Method and data source Initial Target
Governance
What proportion of the governing organization do
public stakeholders represent?
% of Governance Board representing
public entities
# board members from public entities/total
number of board members
50%
What proportion of the governing organization do
private sector stakeholders represent?
% of Governance Board representing
private entities
# board members from private entities/total
number of board members
50%
Does the governing organization represent
government, public health, hospitals, employers,
providers, payors and consumers?
Yes or No for each stakeholder type Count representatives Yes to all
Does the state Medicaid agency have a designated
governance role in the organization?
Yes or No Attestation of the state Medicaid agency (OHCA) Yes
Has the governing organization adopted a strategic
plan for statewide HIT?
Yes or No Ratification of Strategic Plan Yes
Has the governing organization approved and
started implementation of an operational plan for
statewide HIT?
Yes or No Requires governance ratified strategic plan
and operational plan, both of which have been
approved by the ONC
Yes
Are governing organization meetings posted and
open to the public?
Yes or No Review of meeting policies and communications
methods
Yes
Do regional HIE initiatives have a designated
governance role in the organization?
Yes or No Review of organizational chart, board composition,
and self attestation
Yes
Finance
Has the organization developed and implemented
financial policies and procedures consistent with
state and federal requirements?
Yes or No, Narrative description Independent review of written policies and
procedures of the organization
Yes
Does organization receive revenue from both
public and private organizations?
Yes or No, Graphical breakdown Categorize incoming revenue as public or private
sources and chart
Yes, fulfill matching
requirements
What proportion of the sources of funding to
advance statewide HIE are obtained from federal
assistance, state assistance, other charitable
contributions, and revenue from HIE services?
% of total revenues from each type of
organization indicated
Track revenues and source. Report proportion of
each as a fraction of total revenue
Revenue from sustainable
source, fulfill matching
requirements
Of other charitable contributions listed above,
what proportion of funding comes from health
care providers, employers, health plans, and
others (please specify)?
% of total revenues, and % of “other
charitable contributions” derived
from each stakeholder group.
Track revenues and source. Report proportions
as % of total revenues and % of “other charitable
contributions” by stakeholders
Revenue from sustainable
source
OHIET OKLAHOMA HEALTH INFORMATION EXCHANGE TRUST / OPERATIONAL PLAN - MARCH 2011 PAGE 29
Exhibit 7. Reporting Requirements
Has the organization developed a business plan
that includes a financial sustainability plan?
Yes or No Detailed pro forma will be reviewed by
independent expert
Yes
Does the governance organization review the
budget with the oversight board on a quarterly
basis?
Yes or No Review of meeting agendas and minutes. Yes
Does the recipient comply with the Single Audit
requirements of the Office of Management and
Budget (OMB)?
Yes or No Independent review of processes to determine Yes
Is there a secure revenue stream to support
sustainable business operations throughout and
beyond the performance period?
Yes or No Detailed pro forma evaluated Yes
Technical Infrastructure
Is the statewide technical architecture for
HIE developed and ready for implementation
according to HIE model(s) chosen by the
governance organization?
Yes or No Determined based on 1) initial needs assessments,
2) governance organization decision, and 3)
capacity of the technical architecture to meet both
governance and technical needs. A document,
called the Technical Architecture Plan, will be
created to support this assessment and subject
matter experts will review this document to
determine the answer.
Yes
Does statewide technical infrastructure integrate
state-specific Medicaid management information
systems?
Yes or No Determined by cataloguing the interfaces planned
between the Medicaid Management Information
Systems (MMIS) and the HIE system(s).
Yes
Does statewide technical infrastructure integrate
regional HIE?
Yes or No Determined by cataloging the interfaces planned
between regional HIEs and the statewide technical
infrastructure
Yes
What proportion of health care providers in
the state are able to send electronic health
information using components of the statewide
HIE technical infrastructure?
1. % of providers (by type) who could
be sending health information (by
type) via the HIE
2. % of providers who actually are
sending data
This will be calculated using information on 1)
the types of information that must be shared,
2) the preferred protocols for data exchange,
3) number of providers (by type) who currently
have systems capable of sending the required
information electronically via the preferred
protocols, and 4) the number of providers in the
process of implementing such systems and their
estimated go-live dates (to establish a trajectory
that hopefully will intersect with the roll-out of
statewide HIE). Metrics 2 and 3 will be used to
monitor the progress and success of the roll out.
1. 100% by end of year 2
2. 40% by end of year 2
OHIET OKLAHOMA HEALTH INFORMATION EXCHANGE TRUST / OPERATIONAL PLAN - MARCH 2011 PAGE 30
Exhibit 7. Reporting Requirements
What proportion of health care providers in
the state are able to receive electronic health
information using components of the statewide
HIE technical infrastructure?
1. % of providers (by type) who could
be receiving health information
(by type)
2. %of providers who actually are
receiving data
This will be calculated using information on 1)
the types of information that must be shared,
2) the preferred protocols for data exchange,
3) number of providers (by type) who currently
have systems capable of receiving the required
information electronically via the preferred
protocols, and 4) the number of providers in the
process of implementing such systems and their
estimated go-live dates (to establish a trajectory
that hopefully will intersect with the roll-out of
statewide HIE). Metrics 2 and 3 will be used to
monitor the progress and success of the roll out.
1. 100% by end of year 2
2. 40% by end of year 2
Business and Technical Operations
Is technical assistance available to those
developing HIE services?
Yes or No and quantitative report of
volume of assistance provided
Recruit technical expertise to provide support.
Establish formal technical assistance processes
and procedures, including issue tracking and
support. Report statistics on new issue tickets and
resolution of issues.
50% of open tickets resolved
in <24 hours,
90% in 72 hrs.
Is the statewide governance organization
monitoring and planning for remediation of HIE as
necessary throughout the state?
Yes or No Measurements will be a completed assessment
of existing HIE, and documented plan for the
incorporation of those HIEs into the State
Plan from governance, financial, and technical
perspectives. As implementation phase begins,
milestones in this plan will be tracked and met.
Yes, planned milestones
met.
What percent of health care providers have access
to broadband?
% of providers with broadband
access by type
There will be a baseline assessment then semi-annually
with the Corporation Commission.
100% by end of year 2
What statewide shared services or other
statewide technical resources are developed and
implemented to address business and technical
operations?
List of statewide shared services
and technical resources, stage
of implementation of each, and
utilization of each.
Catalog statewide-shared services and technical
resources, and then track their stages of
implementation and ultimately, utilization.
Complete list, with % of
implementation complete
and % of eligible providers
Legal/Policy
Has the governance organization developed and
implemented privacy policies and procedures
consistent with state and federal requirements?
Yes or No Written privacy policy and procedure reviewed and
evaluated by credentialed independent experts in
coordination with OKHISPC
Yes
How many trust agreements have been signed? # of agreements signed, % of offered
agreements signed
Track the number of potential agreements, number
signed and number refused
60% of potential
agreements by year 2
Do privacy policies, procedures and trust
agreements incorporate provisions allowing for
public health data use?
Yes or No Written policies reviewed and evaluated by
independent experts. Public health data use will
be defined by federal guidance and interpreted
as necessary by a governance committee (which
includes IHS and AI/AN staff representatives).
Yes
OHIET OKLAHOMA HEALTH INFORMATION EXCHANGE TRUST / OPERATIONAL PLAN - MARCH 2011 PAGE 31
Exhibit 8. Performance Measures
Performance measure Metric Method and Data sources Initial target
Percent of providers participating in HIE
services enabled by statewide directories
or shared services
% of providers using shared
services
Number of providers with logins to shared
services each month divided by the total
number eligible to use shared services.
40% at year 2
Percent of pharmacies serving people
within the state that are actively
supporting electronic prescribing and refill
requests
% of new scripts that are
electronic
% of refill requests that are
electronic
Number of scripts written electronically
divided by the total number of scripts filled
Number of refill requests submitted
electronically to providers by pharmacies
divided by the total number of refills
completed
40% of scripts should be
electronic by end of year 2.
40% of refill requests should
be electronic by the end of
year 2.
Percent of clinical laboratories serving
people within the state that are actively
supporting electronic ordering and results
reporting
% of lab tests ordered
electronically
% of lab results delivered
electronically
Number of lab tests ordered electronically
divided by the total number of lab tests
ordered
Number of lab test results delivered
electronically divided by total number of lab
tests
40% ordered electronically
95% of test results delivered
electronically
Provider participation in HIE by Meaningful
Use requirement met
Identity of providers who
demonstrate Meaningful Use
% of providers demonstrating
Meaningful Use by requirement
Given finalized list of requirements, the
HIE will be used to assess the number and
identity of providers who meet relevant
Meaningful Use criteria
40% of providers meet
Meaningful Use criteria
Electronic exchange of clinical summaries % of clinical summaries available
electronically
Number of clinical summaries in HIE
divided by the total number of encounters
documented
25% available electronically
by the end of year 2
Immunizations available via HIE % of childhood and adult
immunizations documented
electronically and available in HIE
% of providers documenting
immunization administration
electronically
Number of immunization administrations
available electronically divided by the total
need for vaccines.
Number of providers entering immunization
administrations each month divided by the
total number of providers in the state
99% of immunization records
available electronically by
the end of year 2 and 80%
of providers documenting
immunizations electronically
by the end of year 2
Public health reporting % of reports to state and local
public health agencies occurring
electronically
Number of electronic reports to public health
agencies of vital statistics, reportable conditions,
etc. divided by total number of reports
50% of reports via electronic
means by the end of year 2
OHIET OKLAHOMA HEALTH INFORMATION EXCHANGE TRUST / OPERATIONAL PLAN - MARCH 2011 PAGE 32
Domains for Evaluation
The OHIET evaluation plan captures and tracks performance measures across
five domains. The findings will be utilized for: (1) internal project evaluation and
performance improvement activities as directed by the HIT Policy Committee; and
(2) external reporting to stakeholders within Oklahoma and for national program
evaluation activities. The five domains of evaluation include Adoption, Patient
Satisfaction, Provider Satisfaction, Financial and Health Outcomes. Additional
measures will be selected and updated as necessary by the Performance and
Evaluation Subcommittee.
Adoption measures include all required performance measures to reflect the extent
to which Oklahoma providers have adopted EHRs and are successfully demonstrating
Meaningful Use through exchange of electronic health information. Data is being
collected from each of Oklahoma’s 77 counties. It will be examined at the county
level and then aggregated to yield statewide data. Individual county adoption and
Meaningful Use data is being collected and reviewed in close collaboration with the
Oklahoma HIT REC under the leadership of the OFMQ. Adoption measures include the
percent of providers participating in HIE services enabled by statewide directories or
shared services; the percent of pharmacies serving people within the state that are
actively supporting electronic prescribing and refill requests; and the percent of clinical
laboratories serving people within the state that are actively supporting electronic
ordering and results reporting.
Patient satisfaction measures are included because work conducted through the
Oklahoma Health Information Security and Privacy Council has reported concerns
about security and privacy of electronic health information as the greatest barrier
to patient acceptance of EHRs and HIE in Oklahoma. Patient satisfaction measures
are likely to include survey data designed to assess patient confidence in health data
security and privacy; patient ability to obtain and share electronic health information
with providers (“How readily was your health information data, recorded by one
doctor, available at the time of care in another doctor’s office?” and “How much
information you, as a patient, provided/shared was represented in the exchange and
perhaps contributed in your care?”); and, eventually, ease of exchanging data between
personal health record software and provider systems. The patients’ satisfaction with
care is a functional indicator of the tangible impact of HIE. OHIET will endeavor to
measure this.
Provider satisfaction measures are being developed to assess the level of satisfaction
among physicians and other health care professionals and hospitals about EHR use
and HIE in Oklahoma. These survey measures include the level of satisfaction with
data security and privacy; ease of obtaining and sharing medical information with
other providers; ease of reporting quality measures; and the overall value or return on
investment associated with EHR use and HIE in Oklahoma.
OHIET OKLAHOMA HEALTH INFORMATION EXCHANGE TRUST / OPERATIONAL PLAN - MARCH 2011 PAGE 33
Cost measures are included to collect data over time to examine potential association
between the use of HIT and per capita health care costs in Oklahoma. It is expected
an inverse correlation will be seen as current literature has shown that the use of HIT
reduces medical errors, eliminates duplicated tests and services, increases delivery of
needed preventive care and evidence based medical services, and improves overall
care coordination. The measures also assess the relative cost share for adopting
HIT across state, federal, private payor and provider sources. Financial measures
include per capita health care expenditures for Oklahoma beneficiaries of Medicaid,
Medicare, Veteran Affairs (VA), IHS, private payors and self-pay sources; and provider
expenditures for EHR technology purchase and those for connection to the Oklahoma
Health Information Exchange (OKHIE) network; and annual cost per provider and
hospital bed to access the Oklahoma HIE network. Measures should also include the
distribution of monetary benefit of implementing HIE versus the cost of implementing
HIE incurred by various health care participants.
Health outcome measures are an essential component of the evaluation plan
because the overarching goal of Oklahoma’s HIE effort is the improvement of health
outcomes for all Oklahomans. Selected measures from the United Health Foundation
and Commonwealth Fund annual state health rankings, in which Oklahoma has
traditionally performed very poorly, will be used in the evaluation process. Examples of
the process of care and health outcome measures include preventable hospitalization
rates, immunization rates, geographic disparity index, proportion of adults receiving
recommended screening and preventive care, proportion of those with chronic
conditions receiving recommended services, and the incidence of preventable adverse
medical events in hospitalized patients.
Methodology
Working with the Performance and Evaluation Subcommittee, the actual survey
instruments, collection of data and statistical analysis will be performed by OUHSC
and OSU Center for Rural Health in an effort to eliminate any bias in the process,
guaranteeing the accuracy of results. Previously, both OUHSC and OSU have
successfully performed similar support and analytical services for Oklahoma state
agencies and health care providers.
The evaluation takes a mixed method approach, including both quantitative and
qualitative analyses. Cost and health outcome measures may be derived from
databases that the Oklahoma Insurance Department (OID) and the State Department
of Health collect and maintain. Working with the state’s professional organizations
such as the Oklahoma State Medical Association (OSMA) and the Oklahoma
Osteopathic Association (OOA), a survey instrument, web- or paper-based, is being
completed by a sample of physicians to track HIT adoption and physician satisfaction.
Similarly, a sample of patients, recruited through consumer organizations such
American Association of Retired Persons (AARP) or the Oklahoma City Inter-Tribal
Health Board (OCAITHB), are being asked to complete a survey on patient satisfaction.
Qualitative information regarding the project is collected via semi-structured or
OHIET OKLAHOMA HEALTH INFORMATION EXCHANGE TRUST / OPERATIONAL PLAN - MARCH 2011 PAGE 34
key informant interviews. These interviews are conducted with members of OHIET,
stakeholder participants, and OHCA staff, to assess the progress, strengths and
weaknesses of the project, and identify ongoing process improvement strategies for
the project.
Evaluators
The Department of Health Administration and Policy and the Biostatistics and
Epidemiology Research Design and Analysis Center (BSE RDAC) managed by the
Department of Biostatistics and Epidemiology, at the College of Public Health, OUHSC,
and the Department of Medical Informatics at OU/Tulsa are charged with the task of
performing the project’s evaluation, tracking performance measures, and reporting.
The BSE RDAC’s mission includes serving the Health Sciences Center, along with public,
community and private health entities by providing biostatistic and epidemiological
support for projects and programs that involve clinical or health data. The center
has dedicated research facilities and utilizes server space that is maintained and
administered according to policies and procedures related to electronic storage
of protected health information, security and electronic back-up by the OUHSC
Information Technology Department. Data security is further enhanced by the policies
and procedures of the center. BSE RDAC staff maintains a variety of software programs
and statistical packages and possesses the necessary skill sets to use them.
The Department of Medical Informatics at OU-Tulsa has Oklahoma’s only formally
trained medical informaticists, as well as substaintial expertise in the development
and deployment of enterprise clinical information systems. In addition, the informatics
team has experience with technology evaluation, systems architecture design and
clinical information systems interoperability. The OU informatics team makes wide
use of the previously mentioned tools and additionally employs software design and
engineering principles to achieve practical systems whose evolution is guided by data.
The OSU Center for Rural Health, a designated state agency housed at the OSU Center
for Health Sciences (CHS), will provide consultation on the evaluation related to
Oklahoma’s rural populations and work closely with the OUHSC evaluation team. The
Center for Rural Health is home to Oklahoma’s State Office of Rural Health and the
Oklahoma Area Health Education Center. The OSU Center for Rural Health’s mission
includes rural research and program applications. Through these programs, the center
works very closely with rural hospitals, physicians and the communities it serves. The
center is equipped to provide research and data analysis support, including secure
data storage on network servers managed by OSU Information Technology Department
and full compliance with human subject protection requirements.
Dr. David Kendrick, OU SOCM faculty and physician, Beacon Community PI, and OHIET
trustee is the point person on Clinical Quality and Performance Evaluation.
OHIET OKLAHOMA HEALTH INFORMATION EXCHANGE TRUST / OPERATIONAL PLAN - MARCH 2011 PAGE 35
2.3.2. Finance
Finance goals include:
2.3.2.1 Cost Estimates and Staffing Plans
Financial summary for OHIET follows.
OHIET Organization
Board of Trustees
John Calabro
Executive Director &
State HIT Coordinator*
Advisory Board
Business Analyst
FTE = 4.0
•ExDir/OKHIT Coordinator is a full‐time state employee position and is responsible to lead the OHIET organization as well as for the other duties
required of the OK HIT Coordinator position.
OHIET Advisory Board Domain Area Task Forces
• Finance
• Legal
• HR
• Audit
• Accounting
• Reporting
• Procurement
• Interoperability –
HIO Interface
• Shared Services &
Repositories
• Tech Standards &
Guidelines
• IT
• Planning
• Project Mgnt
• Analysis
• Best Practices
• Intra & Inter State
Coordination
• General Operations
• S1 MU Grant
Programs
• Public Relations
• Education/Awarene
ss Building
• Curriculum
Coordination
Finance & Legal Technical
Infrastructure
Outreach &
Coordination
Business & Technical
Operations
• Policies
• Ethics
• Compliance
• Clinical Quality
• Performance
Evaluation
Governance
Grants Manager
Chief Operations Officer
& Meaningful Use
Compliance Officer
Finance
# Goal Status
1 Design realistic and appropriate sustainability plan for OHIET In progress
2 Establish baseline and annual budget and resource plans In progress
3 Identify, qualify and source staff, experts and non‐human assets required In progress
4 Adopt employment policies Apr‐11
5 Develop and adopt written purchasing procedures In progress
6 Establish financial controls and reporting Jun‐11
7 Develop detailed financial plan In progress
OHIET OKLAHOMA HEALTH INFORMATION EXCHANGE TRUST / OPERATIONAL PLAN - MARCH 2011 PAGE 36
OHIET EXPENSES and REVENUES
Item FFY 2010 FFY 2011 FFY 2012 FFY 2013 FFY 2014 Subtotals
Personnel Details
Oklahoma HIT Coordinator $160,000 $160,000 $164,800 $169,744 $654,544
FRINGE : Retirement [16.5%] $26,400 $26,400 $27,192 $28,008 $108,000
FICA [7.7%] $12,320 $12,320 $12,690 $13,070 $50,400
Insurance [19.9] $31,840 $31,840 $32,795 $33,779 $130,254
Workers Comp [0.7%] $1,120 $1,120 $1,154 $1,188 $4,582
Unemployment [0.3%] $480 $480 $494 $509 $1,964
$0 $232,160 $232,160 $239,125 $246,299 $949,743
Chief Operating Officer $31,250 $125,000 $128,750 $132,613 $417,613
FRINGE : Retirement [16.5%] $5,156 $20,625 $21,244 $21,881 $68,906
FICA [7.7%] $2,406 $9,625 $9,914 $10,211 $32,156
Insurance [19.9] $6,219 $24,875 $25,621 $26,390 $83,105
Workers Comp [0.7%] $219 $875 $901 $928 $2,923
Unemployment [0.3%] $94 $375 $386 $398 $1,253
$0 $45,344 $181,375 $186,816 $192,421 $605,956
Business Analyst $20,000 $60,000 $61,800 $63,654 $205,454
FRINGE : Retirement [16.5%] $3,300 $9,900 $10,197 $10,503 $33,900
FICA [7.7%] $1,540 $4,620 $4,759 $4,901 $15,820
Insurance [19.9] $3,980 $11,940 $12,298 $12,667 $40,885
Workers Comp [0.7%] $140 $420 $433 $446 $1,438
Unemployment [0.3%] $60 $180 $185 $191 $616
$0 $29,020 $87,060 $89,672 $92,362 $298,114
Grants Manager $30,000 $60,000 $61,800 $63,654 $215,454
FRINGE : Retirement [16.5%] $4,950 $9,900 $10,197 $10,503 $35,550
FICA [7.7%] $2,310 $4,620 $4,759 $4,901 $16,590
Insurance [19.9] $5,970 $11,940 $12,298 $12,667 $42,875
Workers Comp [0.7%] $210 $420 $433 $446 $1,508
Unemployment [0.3%] $90 $180 $185 $191 $646
$0 $43,530 $87,060 $89,672 $92,362 $312,624
Staffing $0 $306,524 $500,595 $515,613 $531,081 $1,853,813
Personnel Summary
6.a. Personnel $0 $241,250 $405,000 $417,150 $429,665 $1,493,065
6.b. Fringe Benefits $0 $108,804 $182,655 $188,135 $193,779 $673,372
Total Personnel $0 $350,054 $587,655 $605,285 $623,443 $2,166,437
Travel & Training
Ground Transportation $500 $3,000 $5,000 $5,150 $5,305 $18,955
Registration Fees $500 $2,500 $3,000 $3,000 $3,090 $12,090
Airfare $7,500 $12,000 $12,360 $12,731 $13,113 $57,704
Overnight $5,000 $8,000 $8,240 $8,487 $8,742 $38,469
Per Diem $1,500 $1,500 $1,545 $1,591 $1,639 $7,775
6.c. Travel $15,000 $27,000 $30,145 $30,959 $31,888 $134,992
February 23, 2011 Page 1 of 1
OHIET EXPENSES and REVENUES
Item FFY 2010 FFY 2011 FFY 2012 FFY 2013 FFY 2014 Subtotals
Equipment
IT $15,000 $7,500 $6,000 $12,000 $40,500
Telephone & Toll Charges $3,250 $3,348 $3,448 $3,551 $13,597
Copier & Fax $5,000 $1,000 $1,030 $1,061 $8,091
6.d. Equipment $0 $23,250 $11,848 $10,478 $16,612 $62,188
Supplies
Supplies $36,188 $60,750 $62,573 $64,450 $223,960
6.e. Supplies $0 $36,188 $60,750 $62,573 $64,450 $223,960
OHIET OKLAHOMA HEALTH INFORMATION EXCHANGE TRUST / OPERATIONAL PLAN - MARCH 2011 PAGE 37
OHIET EXPENSES and REVENUES
Item FFY 2010 FFY 2011 FFY 2012 FFY 2013 FFY 2014 Subtotals
Governance
Policy Development $75,000 $150,000 $50,000 $35,000 $35,000 $345,000
Credentialing & Compliance $0 $75,000 $75,000 $50,000 $50,000 $250,000
Travel & Other Misc Expenses $1,000 $33,750 $18,750 $12,750 $7,500 $73,750
Total Operations $76,000 $258,750 $143,750 $97,750 $92,500 $668,750
Clinical Evaluation
Grad Students, Clerical & Other Support $10,000 $24,000 $24,720 $25,462 $84,182
Outsourced Professional Services $57,000 $115,000 $118,450 $122,004 $412,454
Indirect $3,000 $60,000 $56,650 $53,200 $49,645 $222,495
Subawards/Consortium/Contractual $55,000 $56,650 $58,350 $60,100 $230,099
Other $20,000 $20,600 $21,218 $21,855 $83,673
Total Clinical Evaluation $3,000 $202,000 $272,900 $275,937 $279,065 $1,032,902
Finance & Legal
Legal Contracts $140,000 $75,000 $75,000 $60,000 $12,000 $362,000
Legal Retainer $50,000 $50,000 $50,000 $25,000 $175,000
HR & Recruiting $50,000 $35,000 $10,000 $10,000 $105,000
Accounting $15,000 $15,450 $15,914 $16,391 $62,754
Audit $15,000 $15,450 $15,914 $16,391 $62,754
Payroll $5,000 $5,150 $5,305 $5,464 $20,918
Reporting $6,000 $6,180 $6,365 $6,556 $25,102
Total Finance & Legal $140,000 $216,000 $202,230 $163,497 $91,802 $813,529
Technical Infrastructure
Domain Experts and PTE $255,000 $150,000 $250,000 $90,000 $50,000 $795,000
Tech Standards & Guidelines $50,000 $50,000 $35,000 $5,000 $140,000
HIO Interface $75,000 $75,000 $20,000 $7,500 $177,500
PHR (Incentives/Grants) $300,000 $300,000 $50,000 $25,000 $675,000
Infrastructure (Incentives/Grants) $750,000 $500,000 $150,000 $0 $1,400,000
eRx (Incentives/Grants) $500,000 $100,000 $50,000 $25,000 $675,000
Labs (Incentives/Grants) $300,000 $75,000 $50,000 $25,000 $450,000
CCD (Incentives/Grants) $300,000 $75,000 $50,000 $25,000 $450,000
ntenance Standards (Incentives/Grants) $25,000 $25,000 $25,000 $75,000
Decision Support Tools $80,000 $100,000 $25,000 $25,000 $230,000
Evaluation/Identification of Outliers $95,000 $95,000 $50,000 $25,000 $265,000
Audit Trail $75,000 $75,000 $25,000 $175,000
Support & Other Misc Expenses $125,000 $128,750 $132,613 $50,000 $436,363
Total Technical $255,000 $2,725,000 $1,848,750 $802,613 $312,500 $5,943,863
Business & Technical Operations
Project Management $120,000 $150,000 $150,000 $120,000 $50,000 $590,000
Analytics $50,000 $50,000 $50,000 $50,000 $200,000
Best Practice Sharing $25,000 $25,000 $25,000 $25,000 $100,000
Administrative Services $0 $60,000 $60,000 $60,000 $60,000 $240,000
Travel & Other Misc Expenses $1,000 $31,500 $31,500 $27,000 $7,500 $98,500
Total Operations $121,000 $316,500 $316,500 $282,000 $192,500 $1,228,500
February 23, 2011 Page 2 of 3
OHIET EXPENSES and REVENUES
Item FFY 2010 FFY 2011 FFY 2012 FFY 2013 FFY 2014 Subtotals
Governance
Policy Development $75,000 $150,000 $50,000 $35,000 $35,000 $345,000
Credentialing & Compliance $0 $75,000 $75,000 $50,000 $50,000 $250,000
Travel & Other Misc Expenses $1,000 $33,750 $18,750 $12,750 $7,500 $73,750
Total Operations $76,000 $258,750 $143,750 $97,750 $92,500 $668,750
Clinical Evaluation
Grad Students, Clerical & Other Support $10,000 $24,000 $24,720 $25,462 $84,182
Outsourced Professional Services $57,000 $115,000 $118,450 $122,004 $412,454
Indirect $3,000 $60,000 $56,650 $53,200 $49,645 $222,495
Subawards/Consortium/Contractual $55,000 $56,650 $58,350 $60,100 $230,099
Other $20,000 $20,600 $21,218 $21,855 $83,673
Total Clinical Evaluation $3,000 $202,000 $272,900 $275,937 $279,065 $1,032,902
Finance & Legal
Legal Contracts $140,000 $75,000 $75,000 $60,000 $12,000 $362,000
Legal Retainer $50,000 $50,000 $50,000 $25,000 $175,000
HR & Recruiting $50,000 $35,000 $10,000 $10,000 $105,000
Accounting $15,000 $15,450 $15,914 $16,391 $62,754
Audit $15,000 $15,450 $15,914 $16,391 $62,754
Payroll $5,000 $5,150 $5,305 $5,464 $20,918
Reporting $6,000 $6,180 $6,365 $6,556 $25,102
Total Finance & Legal $140,000 $216,000 $202,230 $163,497 $91,802 $813,529
Technical Infrastructure
Domain Experts and PTE $255,000 $150,000 $250,000 $90,000 $50,000 $795,000
Tech Standards & Guidelines $50,000 $50,000 $35,000 $5,000 $140,000
HIO Interface $75,000 $75,000 $20,000 $7,500 $177,500
PHR (Incentives/Grants) $300,000 $300,000 $50,000 $25,000 $675,000
Infrastructure (Incentives/Grants) $750,000 $500,000 $150,000 $0 $1,400,000
eRx (Incentives/Grants) $500,000 $100,000 $50,000 $25,000 $675,000
Labs (Incentives/Grants) 300,000 $75,000 50,000 25,000 450,000
CCD (Incentives/Grants) $300,000 75,000 50,000 $25,000 450,000
ntenance Standards (Incentives/Grants) 25,000 25,000 $25,000 $75,000
Decision Support Tools $80,000 100,000 25,000 230,000
Evaluation/Identification of Outliers $95,000 $95,000 $50,000 $25,000 $265,000
Audit Trail $75,000 75,000 175,000
Support & Other Misc Expenses 125,000 $128,750 $132,613 50,000 436,363
Total Technical $255,000 $2,725,000 $1,848,750 $802,613 $312,500 $5,943,863
Business & Technical Operations
Project Management $120,000 $150,000 $150,000 $120,000 $50,000 $590,000
Analytics $50,000 $50,000 $50,000 $50,000 $200,000
Best Practice Sharing $25,000 $25,000 $25,000 $25,000 $100,000
Administrative Services $0 $60,000 $60,000 $60,000 $60,000 $240,000
Travel & Other Misc Expenses $1,000 $31,500 $31,500 $27,000 $7,500 $98,500
Total Operations $121,000 $316,500 $316,500 $282,000 $192,500 $1,228,500
February 23, 2011 Page 2 of 3
OHIET OKLAHOMA HEALTH INFORMATION EXCHANGE TRUST / OPERATIONAL PLAN - MARCH 2011 PAGE 38
OHIET EXPENSES and REVENUES
Item FFY 2010 FFY 2011 FFY 2012 FFY 2013 FFY 2014 Subtotals
Outreach & Coordination
Grants Management $122,500 $57,500 $21,250 $7,500 $208,750
Curriculum Development $75,000 $50,000 $50,000 $10,000 $185,000
Training $100,000 $120,000 $75,000 $25,000 $320,000
Outreach/Advertising for Grants $25,000 $25,000 $25,000 $5,000 $80,000
Brand Development/Logo/Website $35,000 $23,000 $15,500 $7,500 $81,000
All Media Production/Buy $600,000 $600,000 $250,000 $50,000 $1,500,000
Account Management/PR Retainer $37,000 $37,000 $37,000 $10,000 $121,000
Total Outreach $0 $994,500 $912,500 $473,750 $115,000 $2,495,750
Contractual Obligations
Governance $76,000 $258,750 $143,750 $97,750 $92,500 $668,750
Clinical Evaluation $3,000 $202,000 $272,900 $275,937 $279,065 $1,032,902
Finance & Legal $140,000 $216,000 $202,230 $163,497 $91,802 $813,529
Technical Infrastructure $255,000 $2,725,000 $1,848,750 $802,613 $312,500 $5,943,863
Business & Technical Operations $121,000 $316,500 $316,500 $282,000 $192,500 $1,228,500
Outreach & Coordination $0 $994,500 $912,500 $473,750 $115,000 $2,495,750
6.f. Contractual $595,000 $4,712,750 $3,696,630 $2,095,546 $1,083,367 $12,183,293
Other
Office Rental $12,000 $24,000 $24,000 $24,000 $84,000
Office Furniture $7,500 $12,500 $12,500 $12,500 $45,000
Insurance $2,500 $2,575 $2,652 $2,732 $10,459
6.h. Other $0 $22,000 $39,075 $39,152 $39,232 $139,459
Match Calculation
Annualized Totals $610,000 $5,171,241 $4,426,103 $2,843,993 $1,858,992 $14,910,329
Match Rate 100.0000% 90.9091% 87.5000% 75.0000%
Potential Federal Share $610,000 $4,701,128 $3,872,840 $2,132,995 $0 $11,316,963
Maximum Federal Share $610,000 $4,701,128 $3,572,613 $0 $0 $8,883,741
In‐kind $0
Revenues $0 $470,113 $853,490 $2,843,993 $1,858,992 $6,026,588
Overall $610,000 $5,171,241 $4,426,103 $2,843,993 $1,858,992 $14,910,329
FORM 424 ‐ SECTION B ‐ BUDGET CATEGORIES
6. Object Class Categories FFY 2010 FFY 2011 FFY 2012 FFY 2013 FFY 2014 Subtotals
6.a. Personnel $241,250 $405,000 $417,150 $429,665 $1,493,065
6.b. Fringe Benefits $108,804 $182,655 $188,135 $193,779 $673,372
6.c. Travel $15,000 $27,000 $30,145 $30,959 $31,888 $134,992
6.d. Equipment $23,250 $11,848 $10,478 $16,612 $62,188
6.e. Supplies $36,188 $60,750 $62,573 $64,450 $223,960
6.f. Contractual $595,000 $4,712,750 $3,696,630 $2,095,546 $1,083,367 $12,183,293
6.g. Construction
6.h. Other $22,000 $39,075 $39,152 $39,232 $139,459
6.i. Total Direct Charges (6.a. ‐ 6.h.) $610,000 $5,171,241 $4,426,103 $2,843,993 $1,858,992 $14,910,329
6.j. Indirect Charges
6.k. TOTALS (sum of 6.i. and 6.j.) $610,000 $5,171,241 $4,426,103 $2,843,993 $1,858,992 $14,910,329
FORM 424 ‐ SECTION D ‐ FORECASTED CASH NEEDS
FFY 2010 FFY 2011 FFY 2012 FFY 2013 FFY 2014 Subtotals
13. Federal $610,000 $4,701,128 $3,572,613 $8,883,741
14. Non‐Federal $470,113 $853,490 $2,843,993 $1,858,992 $6,026,588
$610,000 $5,171,241 $4,426,103 $2,843,993 $1,858,992 $14,910,329
February 23, 2011 Page 3 of 3
OHIET OKLAHOMA HEALTH INFORMATION EXCHANGE TRUST / OPERATIONAL PLAN - MARCH 2011 PAGE 39
Budget Narrative
Human Resources
The OHIET staffing plan includes 4.0 FTEs to meet the mission of the organization in
the first years of existence. OHIET’s structural design is to have the Executive Director,
John Calabro, serve also as Oklahoma’s HIE Coordinator. ONC requirement dictates the
HIT Coordinator must be a state employee. Since OHIET is a public trust, Mr. Calabro,
therefore, will be seconded to the organization to serve. In his capacity as Executive
Director, he provides ultimate leadership to the organization and is responsible for
business outcomes and quality of performance. As HIT Coordinator, Mr. Calabro’s role
expands to lead the state in all HIT/HIE efforts, as well as represent Oklahoma on the
national HIT/HIE front. This design ensures coordination and collaboration among HIT/
HIE entities in the state and that OHIET activities serve to engender the success and
propagation of the local and regional HIEs. OHIET is responsible for Mr. Calabro’s salary
and will be reimbursed by organizations that benefit from his other obligations. For
instance, 5% of Mr. Calabro’s time is allocated to each of the Health Benefits Exchange
Grant and to the Challenge Grant.
The Chief Executive Officer (COO) is responsible for the daily operations of OHIET,
ensuring budget adherence of the organization and of OHIET projects. The COO
manages overall efforts in the domain areas and is responsible for the performance
of each domain. The COO runs the OHIET office and all internal operations and is the
point person for all business activities. Importantly, the COO is the ultimate point
person for coordination and assurance of Meaningful Use activities conducted and
overseen by OHIET. On this effort, he reports directly to the board of trustees and has
specific authorities to ensure smooth and timely execution of work leading to S1 MU
compliance and future stages for MU.
Direct reports to the COO include a business analyst who is the key liaison to task forces
and consultants conducting project-based work for OHIET, and a grants manager.
The business analyst is responsible to monitor and record work accomplished by teams,
assist teams to muster resources required, provide research and analytical skills, and
collate results for further synthesis, evaluation and reporting. He is also responsible
for storage of raw data, synthesis and analysis of data as required to make data driven
recommendations.
The grants manager is responsible for coordination, communication and management
of grants that OHIET has been awarded as well as those OHIET may elect to make. The
grants manager works closely with the Outreach & Coordination task force, providing
support and leadership to the team.
Task forces are set up in each domain area, slightly redefined from the SHIECAP
process. They are: Governance, Finance & Legal, Technical Infrastructure, Business &
Technical Operations. Two additional task forces have been identified and are Outreach
OHIET OKLAHOMA HEALTH INFORMATION EXCHANGE TRUST / OPERATIONAL PLAN - MARCH 2011 PAGE 40
& Coordination and Stage 1 Meaningful Use. The Outreach & Coordination task force
takes on issues pertaining to public awareness, education, grant management, and
coordination activities. The Stage 1 Meaningful Use task force includes the leads
for work conducted in each key requirement area and deal with issues to ensure the
successful execution of programs to meet Stage 1 criteria. All work will be project
based. These task forces will be chaired by members of the advisory board and/or
trustees and will be supported by OHIET staff and paid consultants.
The board of trustees has the ultimate authority over the conduct and decisions
of OHIET. Trustees have elected a chairman (Dr. Roswell), a vice chairwoman (Dr.
Alexopulos) and a treasurer (Mr. Guild) as their officers. These individuals have
specified duties for the operations of the board. Trustees are also serving as point
persons in several key areas (Exhibit 5). The board of trustees, the OHIET staff and the
domain teams will each enjoy the support and guidance of the Advisory Board. The
board of trustees and the Advisory Board are comprised of individuals donating their
time to OHIET.
For additional expertise, OHIET will conduct managed competitions of qualified
vendors.
Overhead & Expenses
Fringe for salaried employees is calculated at the rate of 45.1%. This is the rate of OHCA,
the interim SDE. It may be possible for OHIET, once operational, to reduce this rate.
Travel allotted includes that anticipated to execute the work of OHIET throughout
the state as well as travel required to meet the terms of the SHIECAP initiative, three
individuals making four overnight trips to Washington, DC, or elsewhere per year.
Grant Programs
To meet OHIET objectives of:
• Ensuring every Oklahoman benefits fro the five ‘rights’ of HIE; and
• Ensuring every eligible provider has the opportunity to meet Stage 1 Meaningful Use
OHIET is deploying a strategic grant program coupled with outreach and coordination
as the primary means of meeting these objectives. OHIET is placing over $3 million in
FY2011 and over $2 million in FY2012 of our funds toward this end.
Grant strategies include:
• Fill broadband gap: our state ARRA programs will cover approximately 89% of our
population. OHIET will provide grants to fund gap strategies to areas that either are
part of the 11% remaining without broadband or where the broadband program
doesn’t reach them in time to meet S1 MU.
OHIET OKLAHOMA HEALTH INFORMATION EXCHANGE TRUST / OPERATIONAL PLAN - MARCH 2011 PAGE 41
• Encourage EHR adoption: the REC has the primary responsibility. Where gaps exist,
partner with REC to identify and fund additional REC services.
• Assist HIOs: support rapid cycle planning processes; fund governance, clinical,
quality, financial, privacy and technology activities at the local level to help drive
standards and adoption.
• Drive HIE adoption: provide vouchers to providers who are otherwise ready for
S1MU but have not identified an HIE and require HIE selection prior to a specific
date; push information about HIO out to providers.
• eRX assist: partner with Oklahoma Pharmacy Association to identify pharmacies
in need of assistance to connect with Surescripts; provide vouchers for training,
financial assistance, etc.
• Lab assist: similar program to eRX, as might be necessary. Large regional labs have
capability of covering most of the state. The Oklahoma State Health Department
just issued an RFP to upgrade their Laboratory Information Management System to
be compatible with the state initiatives. OSDH will then be able to share data on lab
tests which are sent to the health department.
Product/Service Development
Because OHIET is a “network of networks,” the emphasis of the organization is
to provide resources and value in areas that can be leveraged by the local and
regional networks. These areas include providing certain technical products and
services, education and training of and outreach to multiple and targeted audiences,
coordination among varying entities and contracts. Each of these areas is seen as
key to OHIET’s success and to fulfillment of the tenets of ONC. This is the basis of the
organizational design.
Meeting Stage 1 Meaningful Use and Associated Costs
Costs allocated directly to S1 MU are approximately $3,683,000 and are primarily
in the form of grants, as described above, and outreach, public awareness and
coordination activities that complete the strategy to meet S1 MU in Oklahoma.
Section 2.5 provides greater detail on these activities.
Forecasted Needs
Forecasted revenue needs begin in FY2011, with a match for federal grant funds of
$470,113. They continue with match obligations in FY2012 of $853,490. The first
three years of OHIET are the ”ramp” years when it puts in place its operations and
assists the local and regional HIEs in reaching the state HIE goals and Stage 1 MU.
It is also FY2012 when this federal grant funding is exhausted. By FY2013, OHIET
will require $2.84mm in revenues to sustain operations and by FY2014 the required
revenues for OHIET are anticipated to flatten out well under $1.9mm per annum.
OHIET OKLAHOMA HEALTH INFORMATION EXCHANGE TRUST / OPERATIONAL PLAN - MARCH 2011 PAGE 42
2.3.2.2. Revenue Sources and Long-Term Sustainability
FFY 2010 FFY 2011 FFY 2012 FFY 2013 FFY 2014 Totals
Budget $610,000 $5,171,241 $4,426,103 $2,843,993 $1,858,992 $14,910,329
Federal Funds $610,000 $4,701,128 $3,572,613 $0 $0 $8,883,741
Required Revenues $0 $470,113 $853,490 $2,843,993 $1,858,992 $6,026,588
OHIET revenues must equal the total annual sum of federal matching requirements
and the cost to sustain programs necessary to carry out the OHIET mission.
OHIET’s goal is to remain a very streamlined organization. Major tasks during the
Cooperative Agreement Program phase include developing a certification process;
managing incentive programs; executing communications, public outreach and
awareness campaigns; and developing policies in support of HIE.
Beyond the Cooperative Agreement Program phase, OHIET key tasks, as currently
perceived, narrow to focus on certifying and re-certifying HIE/HIOs and continuing
policy development in support of HIE.
As a network of networks, OHIET’s customers are the existing and upcoming HIOs in
the state. Focus is on value added products and services that benefit HIOs by making
them accessible and leveraged on a centralized basis and on minimizing costs of both
HIOs and OHIET. OHIET works closely with existing HIOs to determine these services
and their value. For FY2011, the OHIET match comes roughly from:
$100,000 reimbursement for Mr. Calabro’s time
$150,000 in kind matching
Balance from revenues for providing credentialing and other services to HIOs.
State HIE/HIOs’ customer base is as follows. Potential beneficiaries to the HIE system
in Oklahoma include:
Total Resident Population of Oklahoma (2008) i 3,687,050
All Oklahoma Hospitals ii 149
Licensed Nursing Homes iii 325
Rural Health Clinics and FQHC iv 53
Non Federal Physicians v 8,712
Physician Assistants vi 1,072
Registered Nurses vii 26,760
Dentists viii 2,210
Licensed Pharmacies (current - all) ix 1,610
OHIET OKLAHOMA HEALTH INFORMATION EXCHANGE TRUST / OPERATIONAL PLAN - MARCH 2011 PAGE 43
All Health Related State Agencies 10
County Health Departments 88
DMHSAS Facilities x 154
Combination life, health, and medical insurance carriers
and Exclusive health and medical insurance carriers xi
200
Federally Regulated CLIA Labs in Oklahoma xii 3,213
Permitted X-Ray Tubes (Imaging Facilities)
Local HIEs look to these sources for fees to their systems.
i http://factfinder.census.gov
ii http://www.cms.gov/CostReports/02_HospitalCostReport.asp#TopOfPage
iii http://www.statehealthfacts.org/profileind.jsp?ind=411&cat=8&rgn=38
iv Ibid.
v Ibid.
vi Ibid.
vii Ibid.
viii Ibid.
ix http://lv.pharmacy.state.ok.us/
x State Operated and Contracted Mental Health, Substance Abuse and Residential Treatment Facilities; http://
www.ok.gov/odmhsas/About_ODMHSAS/
xi Oklahoma Insurance Department and 2002 Economic Census
xii https://www.cms.gov/CLIA/20_CLIA_Laboratory_Demographic_Information.asp#TopOfPage
OHIET OKLAHOMA HEALTH INFORMATION EXCHANGE TRUST / OPERATIONAL PLAN - MARCH 2011 PAGE 44
Funding Options
The following tables illustrate the revenue streams contemplated by OHIET.
Exhibit 9: Fees for Service
OHIET intends to have the major funding stream be 1. from setting up standards, protocols
and policies to ensure the smooth and secure transmission of data from HIO to HIO and
beyond state borders for local and regional HIE/HIOs to use. Additionally, OHIET will
certify HIE/HIOs to ensure protocols are being met and the safety of patient data and
system users. These are the basic elements of the credentialing services OHIET provides.
2. Other value added services to HIO customers include development of products and
services that can be used by all such as patient and provider indices, standard contracts,
collated and synthesized information for reporting, best practice repository, etc.
3. Electronic Vendor Credentialing provides assurance to the public that vendors have
passed state certification processes.
4. OHIET will be an aggregation point for statewide data and analytics including key metrics
and data shared by all HIOs. Other products might include benchmarking services,
quality rankings, and facility and provider report cards.
5. As the industry matures, OHIET anticipates a transaction-based revenue stream is
feasible. This type of fee would be designed in unison with local and regional networks
and would be a more efficient and accurate means of assessing fees.
Exhibit 10: Additional Revenue Possibilities
1. Issue Bonds- OHIET has the capability to issue bonds for public need. SB 1373, the legislation
that established the trust, specifically includes section 60-176 which allows bonds.
2. Medicaid Incentive Payments- It is possible to require providers who receive payment from
Medicaid to contribute to the state HIE plan (RE: Nebraska plan). This would be a one-time
source of revenue and could be as much as $15M.
3. High Risk Pool- The Oklahoma High Risk Pool (OHRP) is run by the OHRP Board of Directors
and now has a federal component. The health care reform legislation omits the need for
OHRP in 2014. The pool is presently funded by a levy on health insurance plans. OHIET
proposes diverting the money that is currently going to fund the high-risk pool to OHIET
in 2014, when reform takes place. Studies indicate this to be a viable option as health
insurance carriers save the most money from a robust exchange of data. xiii
4. Patient Portion- legislate a nominal record management fee be assessed for every electronic
health care transaction. For Medicaid patients, this fee would be charged to OHCA.
This fee is two-fold: It is an attempt to generate nominal income, as well as get patients
involved in their own health care. This is not a cost that can be passed on to insurance
companies, but actually borne by the patient.
The CDC estimates that the average person visits a physician or ambulatory care unit 3.67
times per year. In Oklahoma, that translates into 13.2 million ambulatory visits per year. xiv
OHIET OKLAHOMA HEALTH INFORMATION EXCHANGE TRUST / OPERATIONAL PLAN - MARCH 2011 PAGE 45
Exhibit 10: Additional Revenue Possibilities
6. Federal Revenue- The trust will seek further grant funding in line with the vision, values
and mission of the trust. This has already taken place by the award of the SHIECAP
Challenge Grant.
7. Donations- The is capable of accepting private funding and may elect to pursue these in
the future.
xiii According to State Health Facts from Kaiser Website health insurers currently pay approximately $10 million per year to
cover losses in the Oklahoma Health Insurance High Risk Pool. http://statehealthfacts.org/profileind.jsp?cat=7&sub=89&rgn=38
xiv CDC Ambulatory Medical Care Utilization Estimates for 2006 National Health Statistics Reports Number 8 August 6, 2008
The trust has the latitude to issue bonds, obtain loans or maintain a risk-based
contract for services. Revenue bonds are a type of low interest loan; the budget must
be confirmed in order to determine how much to borrow. Bonds can cover the entire
administration, study, Request for Proposal (RFP) process and most likely will be issued
in phases, refinanced, etc. There is no risk as long as a revenue stream is identified.
The OHIET detailed financial report will include the following revenue/cost
information:
• Administering and sustaining all aspects of OHIET;
• Revenue models for the initial “ramp phase”;
• Revenue models to address the “mature phase,” which will include a fee-based
model with continued adoption of collaboration partners; and
• Create a long-term plan to identify the value-added component or return on
investment for beneficiaries of the system that will be readily understood by end-users.
The first OHIET detailed financial plan is due in May 2011.
Variables Impacting the Long-Term Cost of OHIET
The total cost of operating and maintaining the “network of networks” will be
dependent upon several variables including:
• The number of transmissions taking place on the system
• The number and size of regional HIEs directly connecting to the network and the
number of health data systems outside of the state that want to connect to the
network
• The number of different interfaces to disparate systems that must be implemented
and the work required to enable data sharing between the disparate providers and
state agencies involve