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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 !"##$%&'()%(#**#+'+,#'-.'/)0)1+.,2'3#)-/#14' 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 ! ( ( ! ! !( !(!( (! ! (! !(!( (! ! ! (( ( (! !((!!(( !((!( !( (! !( ! ( !( (! (! ( (!!( ! ( !( !( !( !( ! ! !( !( !(!((! !(!( !( !( !( ! !( ! ! ( !(!(!(!(!(!(!(!(!(!(!!(!!( !( !( !( (((! !! !!! ! !!(( (( ( (( !! !(!(!( ( (( ( ((! !(!((( !!!!!!!!!!!!!!!!(((!(!(!(!(!( ( ( (((((( !(!( !! ((!(((((!(((!(( !( !!! !(!( !( !(!(!( ((( !!! ( (! ! !(!( ((( !(!!!!!!(!(!(!(!!( ! ((!! (( !(!(! ( ! !(!(!( !( !!!!(!( ((!!!!(!( ( (! (!(!!(!(!( ! (! !(!(!(!(!(!(!(!( !(!((((( !! ((((((( ( ((( ( ! (( (( (( !!!!!!! ! !!! ! !(!(!(!(!(!(!(!(!(!(!(!!(!!(!( (! !!!( (((!(!!((!((!!! !!(!(( !(!!!(!( !(!(!(!(!( !(!(!(!(!( !!(!( !!!!!!!!!!! (!(!(!(!! !(!( !(!(!(!(! ((( (( (! !!! !! (( !! !( ( (((((! !( ! ((((( ! !(!(!(!(!(!( ( ((((!(!(!(!((!((!( ( ( !(!( !! !( ! !!!!!!! ! ! ! !(!( !( !( ( !(!(!( !! (!!!!( !(!(( !( (! !( !( ! !( !( ( (((( ((( ( ((( ! !!!! !!! (( ! !!! !! !(!(!( !(((!( !(! !( ! !( ( !( ( !!(!( ! !( (( !( !( !( ! (! !( ! !( ! !(!( ( ! !( (! (((! !! ! ! (! (! ! (( !! ! !(!(!((!(!(!(!(!(!( (((((! !(!(!(( !!!!! ( (( !!!!!(( !(!(( (! ! ! (! !( ((((((((((( ( !(!(!(!(!(!!((!(!(!(!(!(!(!(!(!(!(( ( (( (! !(!(!(!!((!(!(!(!(!(!(!(!(!(!(!(!(!(!(!( (! !( !( ( !! !(!( (( !! ( (((( ( (( !( ( ( !(((!( !! ((( ( ( !!((( !!((((( (((( (!(! !!!!!((!!!!! !!!!! ! ! ((((( (( !!! !!! (( (( (((( !!!!!!!! ! (! ( ! !! ( ! ! ! ((!( ( ( (((((((( !((!((!!(!(!(!((!!(!(!(!(!(!(!(!(! !!!!! ( (( !( !(!(! !( !( !( (((((((( ( !( !(!( !( !( ! ! (!(!(!(! !(!( ! ((( !( !( ( ( (!((!! (!(!(!(!(!(!(!(!(!(!(! !(!( !(!( !(!( !(!(!(!( (( (((( ((( (( ( !!!! ! (! ( !! ( ( !( ( ! !( ! !! !!! !! ! (( ! ( (( ! (!(!!(!( ((((((((((( ( (!!((!(!!!(!!!(!! !!!!!!!! ! ! !!!!!! !! !(!((! (( ((((( !( !(!( !(!(!( !!(!(!(!(! !! ((( !! ( (( !! ! !!!( ( ( ((( ((((((((((!(!( ( (! (! !!!!!! !( (! !( ( !( ! ! (! !( (! !( !( (! !( ( ! !( !( !!!!! !(!(!( !(!(!(!(!(!(!(!((!(!(!(!(!(! !(!( !(!( !!!! ! ( (((( ( ! !(!(!(!( !!!!! !(!!( !!!!!!! !(! ((((( (((((( ( !!! ( ((((((( !( !( !( !(!( ((!( ( !(!(!( ! ((( (( ( ( ( !! !(!(!( ! !! !!!!!!! ( ! ! ((!!!! ! ! (((( ( ( !!!! (((( !(!(!(!( !( !(!(!( (!(!(!(! !( !(!( ( (((((((( !( ( !(!(!!(!!!(!!(( ! !!!!! !! (! !(!( ! !! ! ! ! !! !!! !!!!!! ! ! !! ! !! !!!! (( ! ! ( ( ( ! ( ( ! ( !( !( (( !( !((!!(!((!(!(!(! ( ! !( ( !( (! ( !( 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
Object Description
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Title | OHIET Operational |
OkDocs Class# | H1350.3 O61p 3/2011 |
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Full text | 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 !"##$%&'()%(#**#+'+,#'-.'/)0)1+.,2'3#)-/#14' 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 ! ( ( ! ! !( !(!( (! ! (! !(!( (! ! ! (( ( (! !((!!(( !((!( !( (! !( ! ( !( (! (! ( (!!( ! ( !( !( !( !( ! ! !( !( !(!((! !(!( !( !( !( ! !( ! ! ( !(!(!(!(!(!(!(!(!(!(!!(!!( !( !( !( (((! !! !!! ! !!(( (( ( (( !! !(!(!( ( (( ( ((! !(!((( !!!!!!!!!!!!!!!!(((!(!(!(!(!( ( ( (((((( !(!( !! ((!(((((!(((!(( !( !!! !(!( !( !(!(!( ((( !!! ( (! ! !(!( ((( !(!!!!!!(!(!(!(!!( ! ((!! (( !(!(! ( ! !(!(!( !( !!!!(!( ((!!!!(!( ( (! (!(!!(!(!( ! (! !(!(!(!(!(!(!(!( !(!((((( !! ((((((( ( ((( ( ! (( (( (( !!!!!!! ! !!! ! !(!(!(!(!(!(!(!(!(!(!(!!(!!(!( (! !!!( (((!(!!((!((!!! !!(!(( !(!!!(!( !(!(!(!(!( !(!(!(!(!( !!(!( !!!!!!!!!!! (!(!(!(!! !(!( !(!(!(!(! ((( (( (! !!! !! (( !! !( ( (((((! !( ! ((((( ! !(!(!(!(!(!( ( ((((!(!(!(!((!((!( ( ( !(!( !! !( ! !!!!!!! ! ! ! !(!( !( !( ( !(!(!( !! (!!!!( !(!(( !( (! !( !( ! !( !( ( (((( ((( ( ((( ! !!!! !!! (( ! !!! !! !(!(!( !(((!( !(! !( ! !( ( !( ( !!(!( ! !( (( !( !( !( ! (! !( ! !( ! !(!( ( ! !( (! (((! !! ! ! (! (! ! (( !! ! !(!(!((!(!(!(!(!(!( (((((! !(!(!(( !!!!! ( (( !!!!!(( !(!(( (! ! ! (! !( ((((((((((( ( !(!(!(!(!(!!((!(!(!(!(!(!(!(!(!(!(( ( (( (! !(!(!(!!((!(!(!(!(!(!(!(!(!(!(!(!(!(!(!( (! !( !( ( !! !(!( (( !! ( (((( ( (( !( ( ( !(((!( !! ((( ( ( !!((( !!((((( (((( (!(! !!!!!((!!!!! !!!!! ! ! ((((( (( !!! !!! (( (( (((( !!!!!!!! ! (! ( ! !! ( ! ! ! ((!( ( ( (((((((( !((!((!!(!(!(!((!!(!(!(!(!(!(!(!(! !!!!! ( (( !( !(!(! !( !( !( (((((((( ( !( !(!( !( !( ! ! (!(!(!(! !(!( ! ((( !( !( ( ( (!((!! (!(!(!(!(!(!(!(!(!(!(! !(!( !(!( !(!( !(!(!(!( (( (((( ((( (( ( !!!! ! (! ( !! ( ( !( ( ! !( ! !! !!! !! ! (( ! ( (( ! (!(!!(!( ((((((((((( ( (!!((!(!!!(!!!(!! !!!!!!!! ! ! !!!!!! !! !(!((! (( ((((( !( !(!( !(!(!( !!(!(!(!(! !! ((( !! ( (( !! ! !!!( ( ( ((( ((((((((((!(!( ( (! (! !!!!!! !( (! !( ( !( ! ! (! !( (! !( !( (! !( ( ! !( !( !!!!! !(!(!( !(!(!(!(!(!(!(!((!(!(!(!(!(! !(!( !(!( !!!! ! ( (((( ( ! !(!(!(!( !!!!! !(!!( !!!!!!! !(! ((((( (((((( ( !!! ( ((((((( !( !( !( !(!( ((!( ( !(!(!( ! ((( (( ( ( ( !! !(!(!( ! !! !!!!!!! ( ! ! ((!!!! ! ! (((( ( ( !!!! (((( !(!(!(!( !( !(!(!( (!(!(!(! !( !(!( ( (((((((( !( ( !(!(!!(!!!(!!(( ! !!!!! !! (! !(!( ! !! ! ! ! !! !!! !!!!!! ! ! !! ! !! !!!! (( ! ! ( ( ( ! ( ( ! ( !( !( (( !( !((!!(!((!(!(!(! ( ! !( ( !( (! ( !( 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 |
Date created | 2011-07-07 |
Date modified | 2011-07-07 |