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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 Oklahoma’s Revised Strategic Plan for the State Health Information Exchange Cooperative Agreement Program (SHIECAP) Submitted by: Oklahoma Health Information Exchange Trust March 11, 2011 OHIET Revised Strategic Plan Page 1 Table of Contents Page 1. Strategic Plan 1.1. Oklahoma Approach to Health Information Technology .................................4 1.1.1. History of Health Information Technology in Oklahoma .............................. 4 1.1.2. Vision, Mission and Goals of Oklahoma Health Information Exchange Trust ...................................................................... 6 1.1.3. Purpose of Oklahoma Health Information Exchange Trust ........................... 9 1.1.4. Operations Plan Elements ........................................................................... 11 1.2. Environmental Scan Outcomes in Oklahoma.................................................. 12 1.2.1. Current and Planned HIOs for Oklahoma .................................................... 12 1.2.1.1. Heartland HealthNet.............................................................................. 13 1.2.1.2. SMRTNET................................................................................................ 13 1.2.1.3. OPHX ...................................................................................................... 13 1.2.1.4. GOCHC.................................................................................................... 14 1.2.1.5. GTHAN.................................................................................................... 14 1.2.1.6. Summary of the Current Gaps in HIE in the State of Oklahoma ........... 14 1.2.2. Broadband.................................................................................................... 14 1.2.3. Levels of Technology Development and EHR Adoption in Oklahoma......... 18 1.2.4. E‐prescribing Readiness and Adoption........................................................ 19 1.2.5. Laboratory Readiness................................................................................... 20 1.2.6. Additional Statewide Readiness .................................................................. 22 1.3. Oklahoma’s Strategy for Stage 1 Meaningful Use .......................................... 23 1.4. Health Information Exchange Coordination Strategies................................... 26 1.5. Domain Area Strategies ................................................................................. 27 1.5.1. Governance ................................................................................................. 27 1.5.1.1. Structure to Achieve Results ................................................................. 27 1.5.1.2. Decision Making Authority .................................................................... 28 1.5.1.3. Set Up and Membership Representation ............................................. 29 OHIET Revised Strategic Plan Page 2 1.5.1.4. Oklahoma Health Information Technology Coordinator ...................... 30 1.5.1.5. Alignment with Nationwide Health Information Network Governance ........................................................................ 30 1.5.1.6. Alignment with State Medicaid Hit Plan ............................................... 30 1.5.1.7. Standards .............................................................................................. 31 1.5.1.8. Accountability and Transparency ......................................................... 32 1.5.1.9. Continued Opportunities for Improvement .......................................... 32 1.5.2. Finance ........................................................................................................ 32 1.5.2.1. Business Model ......................................................................................... 32 1.5.2.2. Approach to Sustainability ....................................................................... 34 1.5.3. Technical Infrastructure .............................................................................. 34 1.5.3.1. Interoperability ........................................................................................ 34 1.5.3.1.1. Nationwide Health Information Network Connectivity......................... 34 1.5.3.1.2. Standards Adoption ............................................................................... 35 1.5.3.2. Enabling Meaningful Use in Oklahoma..................................................... 35 1.5.3.3. Approach to Technical Architecture: “Network of Networks” Model ..... 35 1.5.3.4. Health Information Technology Components .......................................... 37 1.5.3.4.1. Electronic Health Records ..................................................................... 37 1.5.3.4.2. eMPI....................................................................................................... 37 1.5.3.4.3. Scalability .............................................................................................. 37 1.5.3.4.4. Public Health Technology ...................................................................... 38 1.5.3.4.5. Broadband ............................................................................................. 39 1.5.3.5. Approach to Clinical and Quality Assurance Measures............................ 39 1.5.4. Business and Technical Operations ............................................................. 40 1.5.4.1. Implementation ........................................................................................ 40 1.5.4.2. Project Management ............................................................................... 40 1.5.4.3. Leveraging Existing Health Information Technology Capacities and Services .......................................................................... 41 1.5.4.4. Communications, Education and Marketing Strategy.............................. 41 OHIET Revised Strategic Plan Page 3 1.5.5. Legal / Policy ............................................................................................... 42 1.5.5.1. Privacy and Security ................................................................................ 43 1.5.5.2. State Laws ............................................................................................... 46 1.5.5.3. Policies and Procedures .......................................................................... 47 1.5.5.4. Trust Agreements .................................................................................... 47 1.5.5.5. Oversight of Information Exchange and Enforcement ........................... 47 2. Operational Plan (under separate cover) 3. Appendices – Strategic and Operational Plans 48 3.1 Project Schedule ............................................................................................ 49 3.2 Legislation, Senate Bill 1373 .......................................................................... 50 3.3 Oklahoma Health Information Exchange Trust Indenture ............................ 58 3.4 Oklahoma Health Information Exchange Trust Bylaws ................................ 78 3.5 Oklahoma Health Information Technology Coordinator Position Description 91 3.6 Governor Henry’s State Designation Letter .................................................. 94 3.7 Position Description of Advisory Board Members......................................... 96 3.8 List of Participants in Oklahoma State Health Information Exchange Cooperative Agreement Program .............................................................. 104 3.9 Glossary of Acronyms .................................................................................... 107 3.10 Oklahoma Standard Authorization to Use or Share Protected Health Information (PHI)................................................. 110 3.11 Letters of Endorsement ................................................................................. 112 3.12 Parity Check with PIN .................................................................................... 119 3.13 Governor Henry’s Re‐Designation Letter....................................................... 125 3.14 Biographical Information on OK’s HIT Coordinator ....................................... 126 3.15 Resumes of OHIET Trustees........................................................................... 129 OHIET Revised Strategic Plan Page 4 1. Strategic Plan 1.1. Oklahoma Approach to Health Information Technology 1.1.1. History of Health Information Technology in Oklahoma For over half a decade, collaborative efforts of public and private entities have established a strong foundation from which Oklahoma draws support for advancing Health Information Exchange (HIE) under the State Health Information Exchange Cooperative Agreement Program (SHIECAP). In 2004, Oklahoma took an initial step toward development of a state HIE by participating in the Health Information Security and Privacy Collaborative (HISPC) program. Through HISPC, a broad base of stakeholders from Oklahoma's health care community, including providers, payors, government agencies, professional trade organizations and private consumer advocates, collectively identified barriers and studied how to overcome them while promoting a secure HIE. This key work culminated in the enactment of the Oklahoma Health Information Exchange Act, allowing a Standard Authorization Form for sharing protected health information. The form can support exchange of either paper or electronic medical records and serves as a valuable education resource for consumers concerning the scope of exchanges requiring authorization under federal and state privacy law. The initial HISPC collaborative workgroup continues to exist as a council pursuant to a 2008 executive order issued by Oklahoma Governor Brad Henry. (This group is represented in the advisory board of the new Oklahoma Health Information Exchange Trust (OHIET), the state designated entity (SDE) for Oklahoma’s SHIECAP funds and activities.) In 2005, the Secure Medical Records Transfer Network (SMRTNET) became one of Oklahoma's first operational regional health information organizations (HIO). Since that time, a number of other exchanges have emerged within the state, including Heartland HealthNet, Oklahoma Physicians Health Exchange, Greater Oklahoma City Hospital Council Exchange (GOCHC), and the Greater Tulsa Health Access Network (Greater THAN). These exchanges have connected healthcare providers from both urban and rural areas, health systems and public partners for purposes of data exchange. In 2008, Oklahoma received notice of its selection as one of 12 communities to participate in the Center for Medicare and Medicaid Services (CMS) Electronic Health Records (EHR) Demonstration Project. Although CMS cancelled this project in 2009 to align funding opportunities with those passed under the American Recovery and Reinvestment Act of 2009 (ARRA), Oklahoma's selection reflected the state's record for advancing HIE through multi‐stakeholder involvement and readiness for adoption and exchange using Health Information Technology (HIT). OHIET Revised Strategic Plan Page 5 Oklahoma’s HIE History at a Glance Year Event Results 2004 OK participates in HISPC • OK HIE Act • Standard Authorization Form 2005 SMRTNET (state’s first HIO) became operational • Paved way for several other regional HIOs 2008 OK selected for CMS EHR demonstration project • Acknowledgment of accomplishments of HIE in OK 2009 Health Information Infrastructure Advisory Board (HIIAB) set up by legislature • OHCA became hub for state agencies exchange 2010 Oklahoma Health Information Exchange Trust (OHIET) set up by legislature GTHAN receives Beacon Community grant • OHIET became SDE for OK SHIECAP and governance of state HIE • Major new HIE for NE OK In 2009, the Oklahoma legislature demonstrated Oklahoma's commitment to HIE amongst government agencies by enacting legislation that created the Health Information Infrastructure Advisory Board (HIIAB). The board is comprised of a number of state agencies involved in various aspects of public health. The legislation directed the board to assist Oklahoma's Medicaid Agency, OHCA, in developing strategic approaches for adoption of electronic medical records technologies and HIE. The legislation also directed OHCA to serve as the hub for exchange amongst state agencies. Finally, Oklahoma’s 2010 legislative session enacted SB 1373, setting up a new public trust, the Oklahoma Health Information Exchange Trust (OHIET). OHIET serves as the organizational structure and state‐designated entity (SDE) for SHIECAP funding and activities. OHIET is a state‐beneficiary public trust created under legislation expressly aimed at establishing an entity capable of serving not only as Oklahoma's permanent SDE during the SHIECAP grant period, but that will also ensure the state meets future meaningful use requirements and the full advancement of HIE throughout the state. Working closely with the state’s Regional Extension Center (REC), Beacon Community, other HIOs, and our broadband initiatives, OHIET will expand existing resources and leverage new and increasing resources to promote future HIE activities and meet the goals set by ONCHIT. OHIET Revised Strategic Plan Page 6 1.1.2. Vision, Mission and Goals of OHIET Vision Statement: Every Oklahoman will benefit from the improved quality and decreased cost of healthcare 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. Mission Statement: OHIET will enable all Oklahoma providers to rapidly locate and access sources of patient data maintained anywhere in the state, in accordance with all state and federal laws. OHIET will facilitate electronic access to shared patient data utilizing a single query which may be submitted either in conjunction with, or separate from, an electronic medical record. OHIET will operate in a secure environment and will eventually be self‐sustaining ‐‐ not relying upon state‐appropriated funds. OHIET will ensure that key data elements, as required for Meaningful Use and patient safety, be accessible statewide and nationally, including the Nationwide Health Information Network (Direct) and will include structured lab data, pharmacy data, and immunizations from all willing and available providers whom contract with Medicaid across the state, as relevant for the provider type. OHIET will work with providers, state agencies, payors and stakeholder organizations to develop and operate statewide HIE capabilities via a network of networks, which will be electronically accessible to all participating providers. OHIET will work with all stakeholders to provide operational oversight1 and to create and adopt standards, master patient identification protocols, provider indices, record locator services, and related technical infrastructure to assure statewide access to patient data regardless of which HIE network houses the patient data. OHIET will ensure seamless and secure integration and transmission of data throughout all HIE networks in Oklahoma and into neighboring networks. OHIET will leverage existing HIE infrastructure, both operational and planned, to close service and care gaps and facilitate urban, suburban and rural connections for all willing hospitals and providers. OHIET will advocate for the use of HIE/HIT by all providers and patients throughout the state, as well as promote legislation and policies that will enhance and enable effective use of HIE/HIT. OHIET will assist in the public awareness and education on information, use and merits of the HIE and HIT systems. 1 Intended to reflect the participatory management created by the Advisory Board, as well as the ”network of networks” concept where individual networks participating in the state HIE manage their own data and operations. This also assures that the state won’t usurp operational control of these networks. OHIET Revised Strategic Plan Page 7 OHIET may either subsidize the expansion of coverage into service gap areas with financial support for interface development or related infrastructure needs, and/or contract directly with vendors to address unmet needs, as required. OHIET is not obligated to support or encourage any single HIE effort, but is intended to act in the best interest of the providers and patients of Oklahoma. OHIET may provide financial support for the development of basic needs common to all Oklahoma‐based HIE networks. OHIET will collaborate and coordinate with other ARRA funded initiatives in the state including the Regional Extension Center and Beacon Community efforts to leverage resources, avoid duplication of cost and work efforts, and share best practices. OHIET Clinical Quality and Performance Improvement Goals include: Oklahoma is one of the worst‐performing states in healthcare in the nation. The Commonwealth Fund, both in 2007 and again in 2009, ranked Oklahoma’s overall health system 50th among the states in the United States. Public health researchers have observed that Oklahomans born today have a shorter age‐adjusted life expectancy than their parents. Clear gaps are evident in the performance of the health systems.. Oklahoma believes a strong HIE infrastructure is a key element to alleviate health disparities in our state and raise the overall health quality. OHIET is collaborating with the REC, our Beacon Community and the regional HIOs in the state, to align efforts to meet HIE goals and objectives. OHIET Revised Strategic Plan Page 8 OHIET Clinical Quality and Performance Improvement Goals State Objectives (Qualitative Targets) Measurable Outcomes (Quantitative Targets) Anticipated Health IT Outputs (Target Year) COST-EFFICIENCY Justification: Oklahoma ranks 45th in the nation in terms of re-hospitalization rates. Improving HIE usage will result in fewer re-hospitalizations and duplicated services, thereby lowering health care expenditures by an estimated 5-7%. 10% reduction in overall hospital readmissions and ED visits regarding asthma, COPD and CHF CE1: Reduce preventable hospitalizations and Emergency Department visits for Ambulatory Care and sensitive conditions 5-7% decrease in total aggregate State Medicaid and Medicare expenditures CE2: Reduce duplicate and inappropriate testing, diagnostic procedures, and specialty referrals Reduce the number of duplicate lab tests by 10%; reduce referrals to specialty care by 10% CE3: Reduce costs for duplicate technologies/eMPI/governance and legal across providers, institutions and other ARRA efforts TBD Advanced HIE implementation rates and provider adoption rates beyond 75% (2015) QUALITY OF CARE Justification: Connecting underserved populations to HIEs will allow faster access to other facilities and specialists and support improvements to transitions of care. Increasing the number of HIE users leads to better communication and more accurate diagnoses, thereby improving medication reconciliation and reducing the number of adverse drug events or medical errors. QC1: Increase timely access to specialty care for rural, tribal, uninsured and other potentially underserved populations Decrease patient wait times for initial specialist opinion to 10 business days via HIE messaging and e-referrals. (We are testing this data on a regional basis.) QC2: Improve transitions of care and patient safety by improving the medication reconciliation process TBD Enhanced communication between healthcare providers (2015) OHIET Revised Strategic Plan Page 9 and accuracy across inpatient settings and provider offices POPULATION HEALTH Justification: The Oklahoma State Health Rankings demonstrates how all the goals tie to health disparities. Increasing statewide vaccination rates and prevention screening will improve care for those currently whose needs are currently unmet, thereby reducing health disparities. In addition, chronic disease management efforts can be focused on high-risk populations due to improved HIE tools for communication and epidemiological analysis. 10% increase in the number of Pneumovax and Influenza vaccinations 10-20% increase in the number of lipid panels performed PH1: Increase the number of patients using preventative services 3-5% increase in the number of patients having regular mammograms and PSAs PH2: Improve public health outcomes for CHF, DM, smoking cessation and alcohol usage 5-10% reduction in smoking rates and alcohol usage. Reduction of 1% in population aggregate HgA1C for DM. Decrease CHF admissions by 10% Evaluation tools that allow for advanced analytics and performance feedback systems (2015) 1.1.3. Purpose of OHIET OHIET has the following items expressly delineated into the articles of indenture for the public trust: a) Establish and maintain a framework for the statewide exchange of health information, and encourage the widespread adoption and use of EHR systems among Oklahoma health care providers, hospitals, pharmacies, laboratories, payors and patients. b) Promote and facilitate the sharing of health information among health care providers within Oklahoma and in other states by providing for the transfer of health information, medical records and other health data in a secure environment for the benefit of patient care, patient safety, reduction of duplicate medical tests, reduction of administrative costs and any other benefits deemed appropriate by the trust. c) Establish and adopt minimum standards and requirements for the use of health information and the requirements for participation in trust‐certified OHIET Revised Strategic Plan Page 10 HIEs for persons or entities including, but not limited to, health care providers, payors, laboratories, pharmacies and local HIEs. d) Establish minimum standards for accessing the HIEs certified by the trust to ensure that the appropriate security and privacy protections apply to health information, consistent with applicable federal and state standards and laws. The trust shall have the power to suspend, limit or terminate the right to participate in certified HIE for non‐compliance or failure to act, with respect to applicable standards and laws, in the best interests of patients, users of certified HIE or the public. The trust may seek all remedies allowed by law to address any violation of the terms of participation in certified HIE or applicable statutes and regulations. e) Identify and overcome barriers to the adoption of EHR systems. Efforts may include assistance with broadband initiatives and researching the rates and patterns of dissemination and use of EHR systems throughout the state. Partner closely with the REC and professional organizations to ensure rural Oklahoma providers, hospitals, laboratories and pharmacies can contribute and receive data via HIE. f) Solicit and accept grants, loans, contributions or appropriations from any public or private source and expend those moneys, through contracts, grants, loans or agreements, on activities it considers suitable to the performance of its duties. g) Determine, charge and collect appropriate fees, charges, costs and expenses from certified healthcare provider or entity in connection with its contractual duties. h) Employ, discharge or contract with staff, including administrative, technical, expert, professional and legal staff, as is necessary or convenient to carry out the purposes stated in this Article III (Please see Appendix 3.3, OHIET Indenture) . i) To plan, establish, develop, construct, enlarge, remodel, improve, make alterations, extend, maintain, equip, operate, lease, furnish and regulate inter‐HIE exchange for the benefit of patients. j) To construct, install, equip and maintain any hardware, software, technology, equipment and programs necessary for the interoperability of HIEs certified by the trust. k) To construct, equip and maintain any facilities for the development, maintenance and operation of the interoperability HIEs certified by the trust. l) To acquire by lease, purchase or otherwise, and to plan, establish, develop, construct, enlarge, improve, extend, remodel, maintain, equip, operate, furnish, regulate and administer any and all physical properties (real, personal or mixed), intellectual properties (copyrights, trademarks, patents, licenses), rights, privileges, immunities, benefits and any other things of value, OHIET Revised Strategic Plan Page 11 designated or needed in establishing, maintaining and operating the core components required for the interconnection of multiple exchanges. m) To finance, refinance and enter into contracts of purchase, lease‐purchase or other interest in, or operation and maintenance of, the properties and other assets listed in paragraphs (e) and (f) above, and revenue thereof, and to comply with the terms and conditions of any such contracts, leases or other contracts made in connection with the acquisition, equipping, maintenance and disposal of any of said properties; and to relinquish, dispose of, rent or otherwise make provisions for properties owned or controlled by the trust but no longer needed for trust purposes. n) To transact business anywhere in the state of Oklahoma to the extent it benefits the citizens of the beneficiary. o) To provide funds for the cost of financing, refinancing, acquiring, constructing, purchasing, equipping, maintaining, leasing, repairing, improving, extending, enlarging, remodeling, holding, storing, operating and administering the core components required for the interconnections of HIEs and any or all of the properties and assets indicated in paragraphs (e) and (f) above needed for executing and fulfilling the trust purposes as set forth in this instrument and all other charges, costs and expenses necessarily incurred in connection therewith and in so doing, to incur indebtedness, either unsecured or secured by all or any part of the trust estate and its revenues. p) To expend all funds coming into the hands of the trustees as revenue or otherwise for the payment of any indebtedness incurred by the trustees for purposes specified herein, and in the payment of the aforesaid costs and expenses, and in payment of any other obligation properly chargeable against the trust estate, and to distribute the residue and remainder of such funds to the beneficiary upon termination of the trust. 1.1.4. Operations Plan Elements In the Operations Plan that follows, execution of OHIET strategies are outlined in six key areas, as follows. Emphasis, in the Operations Plan for the first year is around executing these elements in pursuit of meeting Stage 1 Meaningful Use in Oklahoma. 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 OHIET Revised Strategic Plan Page 12 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. 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. 1.2. Environmental Scan Outcomes for Oklahoma 1.2.1. Current and Planned HIOs for Oklahoma The environmental scan depicts Oklahoma’s multiple regional HIEs in their varying stages of development or operation. The regional HIEs are the foundation for the statewide “network of networks” and are committed to participate in a statewide interoperable exchange of healthcare data and the attendant enabling activities. Each regional HIE is described further in this section. EHR adoption rates were higher than expected for providers eligible for incentive payments. Understanding of EHR functionality by office staff, however, was shown to be sub‐optimal and an area of needed focus to meet OHIET objectives. All HIEs included in this study are focusing on the core elements of the CCD including demographics, drug allergies, prescription history, coded problems, structured lab data and the ability to both receive data and transmit data. These HIE have contributed to the growing set of standards that will be adopted by OHIET. Areas of focus for both the REC and OHIET include functionality to meet meaningful use in both e‐prescribing and lab ordering and reporting. OHIET, the REC and the regional HIOs have incorporated faculties to ensure all providers, hospitals, pharmacies and laboratories have appropriate information and guidance to enable/select their core EHR and institutional electronic systems and extending these services to all areas of the state. OHIET Revised Strategic Plan Page 13 NHIN Direct may be leveraged as an agent to deliver HIE for those providers and hospitals that choose not to participate in an existing or future network within the OHIET network of networks. A summary of each HIE follows. 1.2.1.1. Heartland HealthNet Heartland HealthNet is owned by the Oklahoma State University Center for Health Sciences (OSU‐CHS). Its membership is comprised of rural critical access hospitals and OSU faculty. Heartland HealthNet currently exchanges referral data within its HIE. The exchange of clinical data is planned for a summer 2010 implementation. Heartland HealthNet’s original mission to connect four small rural hospitals to a large tertiary hospital center has grown to include OSU adjunct faculty and clinics. Heartland HealthNet is based on Covisint’s ExchangeLink product. Cloud applications are available to bring services into a customized view. ExchangeLink also supports interfaces to the majority of EHR vendors. 1.2.1.2. Secure Medical Records Transfer Network of Oklahoma (SMRTNET) SMRTNET is a public non‐profit system of networks including Greater Oklahoma City Hospital Council GOCHC, Norman Physician Hospital Organization (NPHO), Open Access Network for all Oklahoma providers, the northeast Oklahoma network, and the Health Alliance for the Uninsured. SMRTNET has also supplied HIE planning services to the Greater Tulsa Health Access Network (Greater THAN, a Beacon Community network), Tulsa Hospital Council, the state’s community health centers, and several other networks currently in development. Networks using SMRTNET share over $2 million in assets and harmonize HIE to HIE data exchange through common policy, consensus management, shared legal documents and shared security measures. The current shared SMRTNET database includes a master patient index (MPI) of approximately 4 million patients, 16 million diagnoses, 52 million immunizations/results, and data provided by over 11,000 providers from all 77 counties in the state of Oklahoma. SMRTNET is exchanging data across urban, suburban and rural care areas and includes both hospital and ambulatory data. SMRTNET currently includes structured data for diagnosis, immunizations, drug allergies, medications, laboratory results and incorporates e‐prescribing through its portal. Thousands of physicians, practitioners and nurses across the state are currently and actively using SMRTNET to provide safe and high quality patient care. SMRTNET evolved as part of an Agency for Healthcare Research and Quality (AHRQ) effort to develop working model HIEs for the country. The outcome is successfully providing networking services that include private providers, hospitals, Native American tribes, state agencies, universities and mental health facilities. The cost to develop this capacity has exceeded $4 million over a five‐year period. Currently, there are 46 entities exchanging data across Oklahoma; 23 in the rural areas and 23 in urban areas. OHIET Revised Strategic Plan Page 14 1.2.1.3. Oklahoma Physicians Health Exchange (OPHX) Norman Physician Hospital Organization (NPHO) is operating an integrated clinical network using a community EHR. NPHO selected eClinicalWorks as the platform to create a community electronic record for patients. Electronic Health Exchange (eEHX) provides interoperability between the NPHO physicians, ambulatory centers and hospitals connecting their EHRs. Additional data sources and services have been added to the OPHX by joining SMRTNET as an affiliate. Approximately 150 providers in the Norman and Purcell areas participate in the OPHX effort. OPHX currently allows the secure passage of a CCD, electronic messaging, referrals, laboratory orders, results and prescription history. 1.2.1.4. Greater Oklahoma City Hospital Council Exchange (GOCHC) GOCHC started with nine hospitals to form a regional HIE to improve the efficiency and overall coordination of care to all patients. GOCHC began its initiative three years ago with a special focus on caring for the uninsured presenting in emergency departments. The focus has expanded well beyond the ER to include all providers, hospitals and data contributors in the greater Oklahoma City region. The exchange has grown to 30 hospital members across the state and the Health Alliance for the Uninsured clinics. The GOCHC exchange is a SMRTNET affiliate with a separate governing body. 1.2.1.5. Greater Tulsa Health Access Network (GTHAN) GTHAN exists to improve health outcomes for the citizens of the greater Tulsa area. The project has received a $12 million Beacon Community grant from ONC. The HIE will provide access to 1,600 providers and improve the care coordination and disease outcomes of their patients. The group has selected Covisint ExchangeLink to accomplish the task and will provide a significant resource for NE Oklahoma, rural, urban and suburban hospitals, providers, laboratories and pharmacies with best practice for EHR adoption to facilitate the expansion of HIE. GTHAN will also provide additional insight as a newly established HIE and collaborative community effort for technology, standards and best practices for HIE to OHIET. 1.2.1.6. Summary of the Current Gaps in HIE in the State of Oklahoma With a six year maturation of HIEs in the state, Oklahoma has a very good start on coverage. Major HIOs are running and exchanging data in most populated parts of the state. These facilities will be bolstered and improved by the additional funds afforded them by ARRA. Elements of Stage 1 Meaningful Use will be met by all eligible providers through existing and planned HIOs and, where broadband coverage is limited, by ASP models and other functionality made available by SMRTNET. We anticipate no difficulty in meeting Stage 1 HIE access requirements in FY2011. OHIET Revised Strategic Plan Page 15 1.2.2. Broadband The disparity in broadband infrastructure between the urban and rural areas of Oklahoma is problematic, particularly in areas where bandwidth is unavailable or unaffordable. Oklahoma has received three grants, through ARRA, that make great headway on bringing broadband access throughout the state. The Oklahoma Community Access Network (OCAN) received $74 million to build more than 1,000 miles of fiber‐optic cable along 13 segments of interstates and highways in 33 counties. Exhibit 1 – Proposed Broadband Backbone for the State of Oklahoma An excerpt from the OCAN Executive Summary: The Oklahoma Community Access Network (OCAN) proposal presents an unprecedented opportunity for Oklahoma to meet the demands of life in the 21st century. Easy and reliable access to technology for Oklahomans to travel along the information highway is as essential in today’s world as the construction of rail was to Oklahoma’s settlement. OHIET Revised Strategic Plan Page 16 Oklahoma is the 20th largest state in the nation with a population of just over 3.5 million people. 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. The action plan for Oklahoma’s future is focused squarely on today’s knowledge‐based economy requiring highly educated, technology proficient Oklahomans who can access and use investments in technology infrastructure to their benefit. With Oklahoma’s significant rural base across a geographically large area, access to broadband is the key to growth and prosperity. Creating access to basic services through technology means Oklahomans in the most remote areas of the state can be in contact with public service providers, can access distant learning and health care services and can communicate with their government and one another more readily. OCAN’s proposal seeks to build 1, 005 miles of new middle‐mile fiber infrastructure to connect 32 anchor institutions in underserved and unserved areas of the state where a broadband penetration rate barely reaches 25% in some cases. 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. OCAN’s grant request is $73,998,268 with a proposed cash and in‐kind match of 20.4%. OCAN’s proposal will leverage existing state assets with federal funding to address the great disparity in broadband access between urban and rural areas of Oklahoma. OCAN principals have more than thirty decades of experience developing and sustaining public/private partnerships with broadband and telecommunications providers. It is the goal of the OCAN proposal to expand its partnerships with the commercial provider community to provide broadband to all areas of the state in the most cost‐effective and efficient manner possible. In addition to the private providers mentioned specifically in the application, other partnerships are being pursued and will continue following the submission of this application. It is anticipated that 863 jobs will be created as a result of this project. OHIET Revised Strategic Plan Page 17 Community Anchor Institutions Miles from Current Anchor Institution City Backbone 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 OHIET Revised Strategic Plan Page 18 Additionally, 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. Finally, Pine Telephone Co. received about $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. OHIET is in contact with the OCAN team and we will work in concert to ensure alignment of goals and plans. We do not anticipate broadband limitations to impact ability to meet Stage 1 Meaningful Use or future OHIET goals. We believe the OCAN and other broadband plans greatly enhance the HIE plans for Oklahoma. 1.2.3. Levels of Technology Development and EHR Adoption in Oklahoma Oklahoma’s providers and hospitals are in various stages of automation, with larger, more urban organizations generally having partially or fully implemented EHRs versus smaller and rural practices and hospitals including Critical Access Hospitals, on the slower end of adoption. Mid‐sized organizations, such as Federally Qualified Health Centers (FQHCs)/Rural Health Clinics (RHCs) and multi‐provider groups, fall somewhere in the middle when using, adopting and implementing EHR/EMR solutions. Exhibit 2 shows the results of overall EHR adoption among eligible provider groups for incentive payments. Exhibit 2 Percentage of Providers Reporting EHR/EMR by Group Indian Health Service (IHS) providers have the highest rate of current EHR adoption of any provider category in Oklahoma. IHS has access to EHR capabilities through the federal Resource and Patient Management System (RPMS). Of the 475 IHS health professionals that responded, 88% indicated they had an EHR/EMR. OHIET Revised Strategic Plan Page 19 Only 23% of the rural hospitals surveyed indicated they had an EHR/EMR. 54% of urban hospitals surveyed have an existing EMR. Of all surveyed, only 64% of hospitals reported having access to broadband services (36% reported no broadband access). Exhibit 3 Indian Health Service and Tribal Providers Regarding Oklahoma’s Community Health Center (CHC) organizations, 15 of 17 (88%) have implemented an ambulatory EHR; most CHCs currently have broadband service. The REC, regional HIOs and OHIET are working together to identify and target most needy areas, set up faculties for guidance and information provision on EHR/EMR, and engineer a set of solutions to meet Stage 1 Meaningful Use. 1.2.4. E‐prescribing Readiness and Adoption Electronic prescribing capabilities are growing in Oklahoma. In 2009, according to SureScripts, 18% of all physicians have systems that allow the routing of prescriptions electronically and 10% of all prescriptions were routed electronically. Only 3% of patient visits, however, resulted in a medication history request. The Oklahoma Pharmacy Association reports that 85‐90% of all pharmacies are currently capable of accepting electronic prescriptions (corporate pharmacies at 100% while independent pharmacies are at 75‐80% including rural areas). OHIET and other state leaders will spearhead activities to drive adoption of e‐prescribing by all pharmacies statewide. OHIET has a program to partner with small pharmacies, which may find the start‐up costs of electronic prescribing prohibitive, that offers a financial incentive program to assist them with these costs. To drive EHR adoption and create demand for e‐prescribing capability at the pharmacy level, a collaboration between the Oklahoma Pharmacy Association, the REC, and State Medical Associations to assist and guide rural providers on benefits and best practices of EHR. In addition, OHCA (the state Medicaid agency) has aligned with SureScripts to include in their contracts a requirement that state Medicaid participating pharmacies participate in electronic prescribing. OHIET Revised Strategic Plan Page 20 OHIET recognizes that a successful statewide HIE requires complete pharmacy electronic prescription data and that this is a key component for helping all providers and hospitals qualify under Meaningful Use. OHIET also recognizes the challenges for electronic prescribing as they relate to controlled substances and intends to promote the development of protocols to allow this functionality in a seamless fashion for providers and pharmacies as these issues are further clarified. 1.2.5. Laboratory Readiness Another key component of meeting Meaningful Use criteria for providers and hospitals is the ability to transmit structured lab data. OHIET intends to certify standards by which laboratory data can pass from HIE to HIE via LOINC coding. Ultimately, success of this program is contingent upon the thorough adoption of EHR and, as stated elsewhere in this plan, we will partner with the REC and professional and hospital associations to ensure the infrastructure and services are adequate to meet Meaningful Use by all eligible providers. The initial 2011 goal for OHIET will be for laboratory result reporting with consideration for the submission of laboratory orders in 2013 and beyond. The analysis of Oklahoma’s current laboratory electronic result reporting is taken from data collected by SoonerCare. The top 19 paid laboratories by SoonerCare represent 82% of all SoonerCare dollars paid to labs in 2010. The list follows. 1 DIAGNOSTIC LABORATORY OF OKLAHOMA OKLAHOMA CITY OK 73108 $7,563,764.57 2 OK STATE DEPT OF HLTH PUBLIC HLTH LAB OKLAHOMA CITY OK 73117 $4,322,648.51 3 REGIONAL MED LAB TULSA OK 74114 $3,462,095.35 4 CLINICAL PATHOLOGY LAB AUSTIN TX 78754 $1,582,117.03 5 NATIONAL HLTH LAB DALLAS TX 75230 $1,529,819.42 6 QUEST DIAGNOSTICS CLINICAL LABORATORY INC SJ CAPISTRANO CA 92675 $1,318,773.44 7 SAINT FRANCIS OUTREACH SERVICES LLC TULSA OK 74136 $1,066,615.57 8 AMERITOX, LTD MIDLAND TX 79705 $844,472.87 9 PACIFIC TOXICOLOGY LABORATORIES CHATSWORTH CA 91311 $829,815.66 10 QUEST DIAGNOSTICS CLINICAL LABORATORY INC IRVING TX 75063 $825,186.80 OHIET Revised Strategic Plan Page 21 11 OUHSC GENETICS LAB OKLAHOMA CITY OK 73104 $645,658.89 12 GENZYME GENETICS SANTA FE NM 87505 $560,186.32 13 GENZYME GENETICS WESTBOROUGH MA 01581 $522,369.12 14 LABORATORY CORPORATION OF AMERICA SAN ANTONIO TX 78213 $504,770.25 15 HEARTLAND PATHOLOGY CONSULTANTS PC EDMOND OK 73034 $430,464.78 16 WINDSOR PARK MEDICAL CLINIC OKLAHOMA CITY OK 73107 $395,238.59 17 MEDICAL DIAGNOSTICS LABORATORIES LLC HAMILTON NJ 08690 $365,380.04 18 BIO REFERENCE LABORATORIES INC ELMWOOD PARK NJ 07407 $355,268.83 19 DIAGNOSTIC PATHOLOGY SERVICES PC OKLAHOMA CITY OK 73112 $344,373.84 $27,469,019.88 OHIET is in the process of confirming the following set of assumptions: 1. This is representative of the pay portions to labs from all major payors in our state. 2. The 19 labs listed have electronic results reporting capabilities. 3. The remaining 18 to 20% of labs registered in the state are likely draw stations and small laboratories that have access to electronic resulting via their selected reference laboratories. OHIET recognizes the gap in laboratory reporting will be primarily via rural hospital laboratories including critical access hospitals. The REC and EHR adoption is intended to help close this gap as well as close partnership with reference laboratories to expend their electronic/technologic infrastructure to comply with Meaningful Use for all providers within the state. OHCA currently requires all laboratories, under contract with their organization, comply with OHIET and HL7 laboratory reporting standards. It is the intention of OHIET to partner with private payors, as well, to facilitate the same actions in their contracts with laboratories. OHIET Revised Strategic Plan Page 22 1.2.6. Additional Statewide Readiness OHIET believes EMPI services will be critical to the success of HIE utilization, adoption and ‘network to network’ connections. OHIET is currently working on the feasibility of providing a statewide EMPI to regional HIEs . Provider directories present another challenge for Oklahoma as a primarily rural state. OHIET is presently working on the feasibility of partnering with state HIOs to maintain an updated and cohesive provider directory. This is a pathway to ensure adequate electronic exchange, referrals, reporting and messaging to facilitate the highest quality and the safest patient care. OHIET has established a working group to define the minimum requirements of a CCD for HIE and to develop protocols for ‘network of networks’ sharing in order to create consolidated views for providers and avoid the need for multiple HIE connections. OHIET is setting up collaborative teams with payor organizations within the state. Key outcomes of this association are the active participation in the statewide HIE and the preparation for 2013 and beyond for requirements for electronic eligibility checking and prior approvals. OHIET is considering record locator services, credentialing services, public health reporting services, immunization reporting and consent management services as areas with potential for leveraged services across the state, overall healthcare cost reduction and as revenue sources for OHIET. Other platforms, established by our two state university medical programs and large hospitals, provide springboards for OHIET. Oklahoma benefits from a well developed set of telemedicine networks. These networks are operational and provide specialty care to rural and underserved areas. This infrastructure provides a pathway to further the goals of OHIET and meet Meaningful Use. OHIET Revised Strategic Plan Page 23 1.3. Oklahoma’s Strategy for Stage 1 Meaningful Use Element: Eprescribing available to all eligible providers Gap Recognized Strategy Actions Actors 1. There are approx 25% pharmacies in the state that do not have e-prescribing faculties. 2. Rural pharmacies not on board because they do not have the ‘market pull’ by local providers; they see no need to undergo the expense • Determine areas of greatest need • Reduce capital requirements • Create demand from providers to drive e-prescribing capabilities at the pharmacy-level • Create demand from payors at the pharmacy-level • Team with small pharmacies and offer financial incentive programs to assist with start up costs • Train local providers on benefits of e-prescribing and on alternatives, i.e., internet prescribing and the advantages to the end users (patients) • Develop curriculum to educate end users, providers and pharmacies • OHCA and SureScripts have contract req’s for Medicaid participating pharma’s to provide e-prescribing – leverage this and encourage other payors to participate similarly • OHIET/OPA/REC/OSMA • OHIET/OPA/REC/OSMA • OHCA/SureScripts/Payor s Element: Receipt of structured lab results available to all eligible providers Gap Recognized Strategy Actions Actors 1. The large labs are in compliance. For the smaller labs, especially those associated with rural providers, it is unknown. 2. Rewards for MU are not as apparent for labs • Focus on laboratory result reporting first; confirm capabilities of large labs and those receiving payment from largest payors in OK • Provide incentives to labs • Demonstrate benefits • Form team with labs to understand landscape and areas requiring most intervention • Create education/awareness campaign with key benefits for labs and stakeholders • OHCA requires labs under contract to comply with OHIET and HL7 lab reporting standards; work with private payors to develop same • OHIET/Labs/Payors • OHIET/REC/HIOs • OHIET/OHCA/Payors OHIET Revised Strategic Plan Page 24 Element: Sharing patient care summaries across unaffiliated organizations available to all eligible providers Gap Recognized Strategy Actions Actors 1. Sharing patient care summaries will require HIE connectivity to hospitals and EP’s. Less than 5% of EP’s are live with HIE. 2. HIE Networks will need to share and combine CCD’s to EP’s on other HIE networks. 3. EMPI and Provider Registries will be a rate limiting factor of cross connections 4. HIPAA and HITECH Implications of internetwork connections. • OHIET will endorse a network of networks and will support the existing and new HIE networks connections to EP’s • OHIET will collaborate with the REC and EP’s and MU funding to support their HIE connectivity • OHIET will help establish standards for network to network connectivity and security protocols and messaging protocols consistent with Direct. • OHIET will work with existing networks, new networks and potentially create services for EMPI and Provider Registries for the State • Exploration of DURSA (sp) and current state HIE legal policies • Incentive programs for HIE’s and EP’s in areas of low penetration of HIE. Particularly rural areas. • Collaboration between the REC and HIE networks to do support and offerings of HIE with EHR to EP’s. • Education to EP’s and marketing to EP’s of the benefits and use case of HIE. • Establish inter-network HIE connection standards for security and privacy. • Assess current EMPI and provider directory services live in the state as well as proposed solutions to ensure the success of a network of networks model. Awareness that OHIET may have to create an add on service to parallel the network of networks. • Exploration of current legal and governance agreements, DURSA and develop a strategy to protect EP’s who have contributed data to HIE in case of a data breach or end user misuse of HIE data. • OHIET • REC • Agencies • Existing Networks • New Networks • EP’s • Medical Associations OHIET Revised Strategic Plan Page 25 Element: Ensuring broadband access availability Gap Recognized Strategy Actions Actors 1. 36% hospitals report no access to broadband 2. Disparity of access to broadband between rural and urban parts of state • Align project with ~$90M ARRA funds for state broadband initiatives • Provide awareness and guidance to providers/pharma/labs on EHR/HIE • Enable work-arounds to areas without broadband access • Work with OCAN and others to dovetail technology req’ts and goals for access throughout the state • Create consultancy, communications, education to assist rural constituents • Team with vendors to create array of solutions for rural providers • OHIET/OCAN/OSU/Sec’y of State • OHIET/REC/HIOs • OHIET/Vendor community Element: Promoting effective use by all eligible providers Gap Recognized Strategy Actions Actors 1. 23% of rural and 54% of urban hospitals have EMR 2. 47% of non-hospital professionals have EHR • Create ‘pull’ by providers • Provide help, guidance and education to direct users of the HIE and the end users of healthcare • Ensure compliance with state and fed req’ts that result in better health outcomes for the state • Establish valuable products and services that will be standardized centrally and made available through local HIOs: vital stat’s; eMPI; immunization registries, etc. • Provide continuing incentives for providing by working with policies and legislation that promote HIE and better quality health outcomes for the state • Team with REC, Beacon, universities and others to provide survey, analysis, education, guidance, etc. to providers • Set up clear governance and policies and avenues for providers to achieve S1 MU and other req’ts • OHIET/HIOs/vendors • OHIET/REC/HIOs/Univ/Trainers • OHIET/REC/legislators OHIET Revised Strategic Plan Page 26 1.4. Health Information Exchange Coordination Strategies Coordination of strategies is hardwired with the Oklahoma authority responsible for Medicaid. The Oklahoma Health Care Authority (OHCA) is the state’s Medicaid agency and they were the State Designated Entity (SDE) in the SHIECAP proposal process (prior to OHIET’s establishment in the 2010 state legislative session) . OHCA has contributed many resources to the SHIECAP effort from the response to the ARRA FOA to the continued work in domain areas determining, documenting and implementing the strategic and operational approaches to a statewide HIE. In parallel process, OHCA staff have authored and received approval on the State Medicaid HIT Plan (SMHP). This set up has ensured a dovetailing of strategies between these efforts. Collaboration will be preserved between OHIET and OHCA in that John Calabro, the former OHCA Chief Information Officer who co‐chaired the Statewide Oversight Committee for SHIECAP, was appointed by Governor Henry of Oklahoma as the state’s first permanent Health Information Technology Coordinator. Mr. Calabro led an effort that focused on inclusiveness and collaboration of key stakeholders and ensured plans were coordinated with concurrent activities of HIIAB, Oklahoma’s REC, our Beacon Community grantee, OKHISPC and others. Regarding outreach to educate providers on the Medicaid EHR Incentive Program, the SHIECAP oversight work group coordinated with professional associations such as the Oklahoma Medical Association, Oklahoma Osteopathic Association, Oklahoma Hospital Association, Oklahoma Primary Care Association the FQHCs and RHCs, and the REC through operational provider workshops and quarterly meetings. Medicare Coordination Along With Other Federal Programs OHIET and the HIIAB are collaborating to attain widespread use of HIE by healthcare providers. Through partnerships with the REC, Beacon Community and professional and hospital organizations, OHIET will align incentives and drive adoption of EHR along with CMS, Medicaid and other federal programs. The OHIET ‘network of networks’ will result in an effective statewide HIE that will allow healthcare providers to exchange clinical information through their local HIEs, such as medication histories and laboratory results, electronic prescription history and medical summaries via a CCD at the point‐of‐care, and make better informed decisions with their patients. These plans will promote and support the effort of eligible professionals who wish to achieve Meaningful Use. The planned OHIET ‘network of networks’ will also outline Oklahoma’s current and future strategies to leverage existing EHR capacity, investment and broad stakeholder commitment to advance the HIE goals in Oklahoma. As indicated earlier in the Strategic Plan, the EHR incentive payments for Meaningful Use are a cornerstone of the Oklahoma HIE initiative and, supporting the ability of Medicare providers to participate in the Oklahoma EHR Incentives Program is a key objective. Oklahoma’s environmental scan and results of statewide HIE planning efforts have OHIET Revised Strategic Plan Page 27 indicated that the inclusion of Medicare data, along with other federal programs in statewide and interstate HIE, will be critical to the widespread use and sustainability of HIE in the state. OHIET will continue to request its federal partners make this data available so that Oklahoma providers can use the data and achieve Meaningful Use. OHIET is willing to work with Medicare, IHS, Department of Defense, Veterans Administration, and other federal programs to create a workable data exchange. 1.5. Domain Area Strategies 1.5.1. Governance 1.5.1.1. Structure to Achieve Results The Oklahoma Legislature passed Senate Bill 1373 (Appendix 3.2), which Governor Brad Henry signed into law on June 10, 2010. This legislation expressly approves the creation of a state‐beneficiary public trust named the Oklahoma Health Information Exchange Trust (OHIET). The trust has a governing board of seven trustees appointed by state officials as follows: three by the Governor; two by the Senate; and two by the House of Representatives. (Trustees are indentified in Exhibit 4.) OHIET is Oklahoma's state designated entity (SDE) to facilitate and expand the electronic movement and use of health information among organizations within Oklahoma and to ensure the goals of SHIECAP station behalf of Oklahoma. An Advisory Board, consisting of representatives from 18 to 25 organizations, will provide input and support to the board of trustees. (Exhibit 5, following.) OHIET recognizes that core infrastructure must be obtained via EHR’s for eligible providers, hospitals, laboratories and pharmacies in order to facilitate HIE and Meaningful Use criteria for the state. As previously mentioned in this plan, OHIET intends to promote the installation and adoption of EHR technology through partnerships with the REC, the regional HIOs, the university systems and others to provide training, guidance, consultation and information. OHIET will assure the development of statewide HIE standards based upon consensus of local and regional HIOs. In addition, standards will be inclusive of criteria for laboratory reporting, electronic prescribing and CCD receipt, generation, transfer and re‐generation . OHIET will monitor compliance with these standards. OHIET will disseminate best practices, help to ensure understanding of HIE and its policies and work to promote and sustain electronic HIE within Oklahoma. OHIET will ensure there are a clear strategic plan and a shared vision for the development of the statewide collaboration (short‐term and long‐term) and a fair representation of networks in the statewide governing body – in keeping with the ”network of networks” model. OHIET Revised Strategic Plan Page 28 Oklahoma’s Health Information Technology Coordinator also serves as the Executive Director of OHIET. The State HIT Coordinator, Mr. John Calabro, was appointed by the Governor Henry. Mr. Calabro sets the charter for the organization as decreed by the trustees, oversees the daily operations of OHIET, and serves as the public face of the organization. Mr. Calabro is in process of evaluating additional supporting staff; budgeted are a Chief Operating Officer, charged with top level management and daily outcomes in all domain areas, a business analyst to provide data collation, synthesis and analysis, and executive support. Each domain area is additionally supported by Advisory Board task forces and by paid industry experts. The Executive Director is an ex‐officio member of the board of trustees without voting privilege. Exhibit 4, OHIET Board of Trustees Trustee Appointer and Term Robert H. Roswell, MD, Board Chairman Gov. Henry July 31, 2014 Jenny Alexopulos, DO, Board Vice Chair & Secretary Rep. Benge July 31, 2013 Samuel T. Guild Board Treasurer Sen. Coffee July 31, 2012 Julie Cox-Kain Gov. Henry July 15, 2015 Craig W. Jones Rep. Benge July 31, 2015 David Kendrick, MD Sen. Coffee July 31, 2015 Brian Yeaman, MD Gov. Henry July 31, 2011 1.5.1.2. Decision Making Authority All powers granted to OHIET under the Oklahoma Public Trust Act and other applicable local, state and federal laws will be exercised by and under the authority of the trustees. Additionally, the property, business and affairs of OHIET will be managed under the direction of the trustees in a manner consistent with the trust indenture (Appendix 3.3) and the bylaws of the trust (Appendix 3.4). The number of trustees will be seven (7) as prescribed in Oklahoma law. The conduct of the trust, including specifics of trustee terms, voting requirements, meeting procedures and so forth are prescribed by the trust indenture. OHIET will have an Advisory Board to provide representation of major constituencies served and to assist in the activities of the trust (Exhibit 5). Recommendations from the Advisory Board will be presented as an agenda item at a duly called meeting. The OHIET Revised Strategic Plan Page 29 trustees will give deference to and due consideration of the recommendations of the Advisory Board. The Advisory Board also will perform such other functions as may be directed by the trustees in connection with or in furtherance of OHIET. Subject to the approval of the trustees, the Advisory Board will be entitled to establish rules, regulations, policies and procedures relating to its operation, and standing and ad hoc committees and workgroups, in furtherance of its functions. 1.5.1.3. Set Up and Membership Representation OHIET trustees will have a working knowledge of HIE and background in health care. The OHIET Advisory Board provides broad stakeholder representation to the organization and will be composed of not fewer than 17 nor more than 25 persons including, at a minimum, one representative from each of the following: Exhibit 5 Advisory Board Member Organizations 1. Oklahoma Health Care Authority [Medicaid], Lynn Puckett, Director Contract Services 2. Oklahoma State Department of Health [Public Health], Rebecca Moore 3. Oklahoma Department of Mental Health and Substance Abuse Services, Terri White, OK Sec’y of Health 4. University of Oklahoma Health Sciences Center, Kevin Elledge, ED of Ops 5. Oklahoma State University Center for Health Sciences, Dr. James Hess, COO 6. A nominee of the Indian Health Service Office responsible for Oklahoma, Dr. Farris, CMO 7. A representative of Tribal interests, Mitch Thornbrugh, Cherokee Nation 8. Oklahoma Hospital Association, Rick Snyder, COO 9. Oklahoma Osteopathic Association, Dennis Carter, DO 10. Oklahoma Pharmacy Association, Jim Spoon 11. Oklahoma State Medical Association, Dr. Kent T. King 12. Oklahoma State Chamber of Commerce, Matt Robison, VP Small Business & Workforce Development 13. Security and privacy representative nominated by the Oklahoma Health Information Security and Privacy Council, Robn Green, OSDH and Vice Chair of OKHISPC 14. A HIE representative as nominated by the OHIET Board, Joseph Walker, Greater THAN 15. A consumer appointed by the Governor, pending 16. A nominee of the Oklahoma Regional Extension Center steering committee, Jonathan Kolarik, RN, Director of HIT 17. Oklahoma Association of Health Plans, Bill Hancock, VP & GM, CommunityCare Managed Health Plan 18. Representative of Oklahoma rural providers, Val Schott, Oklahoma State University 19. A second HIE representative as nominated by the OHIET Board, Mark Jones, SMRTNET Representation from up to six additional organizations OHIET Revised Strategic Plan Page 30 The trustee board may add up to eight additional memberships to the Advisory Board, from what is described in the trust indenture, as need for additional expertise and representation becomes evident. One representative of rural providers and one additional representative of HIE expertise have been added to the original 17 named in the indenture. 1.5.1.4. Oklahoma HIT Coordinator The Oklahoma HIT Coordinator (HITC) exists to provide leadership, direction, management and coordination of HIT strategy for the state of Oklahoma, which includes the implementation of federal and state requirements for HIT and HIE efforts. The HITC works cooperatively with multiple stakeholders, including healthcare providers, health plans, health profession schools, consumers, technology vendors, public health agencies and healthcare purchasers to identify existing resources, needs, commonalities of interest and project priority. Additionally, the Oklahoma HITC manages the plan that prescribes activities necessary to facilitate and expand the electronic movement and use of health information among organizations consistent with both state and federal HIT strategic plans. Oklahoma’s HITC also serves as the Executive Director of OHIET and he must carry out the responsibilities of this position along with the other duties of HITC. (Appendix 3.5 – Oklahoma HIT Coordinator Position Description used to guide the selection team in the process of identifying and choosing the office holder.) John Calabro, former CIO of OHCA, was selected and appointed by Governor Brad Henry as Oklahoma’s first permanent HIT Coordinator. Mr. Calabro took office on December 1, 2010. 1.5.1.5. Alignment with Nationwide Health Information Network (NHIN) Governance OHIET‘s governance model is designed to be compatible with emerging NHIN governance principles and functions. A pathway to Stage 1 Meaningful Use compliance is OHIET becoming the certifying authority of HIE in Oklahoma. Alignment with NHIN governance is designed as part of this certification process. In further compliance with developing policies and procedures from NHIN and ONCHIT, OHIET and our partners have planned curriculum and guidance to assist providers with both. Should entities fall outside of the OHIET network of networks, alignment directly with NHIN is Oklahoma’s strategy for Stage 1 Meaningful Use. 1.5.1.6. Alignment with State Medicaid Hit Plan (SMHP) This Strategic Plan, as well as the Operational Plan, under separate cover, are written in coordination with the initiatives set forth on the SMHP by the Medicaid agency, OHCA. The OHCA Chief Information Officer, Mr. John Calabro, (Mr. Calabro is now the appointed OHIET Revised Strategic Plan Page 31 State HIT Coordinator for Oklahoma) co‐chaired the Statewide Oversight Committee for the SHIECAP, and OHCA staff members participate on each of the domain area workgroups to ensure coordination of planning efforts. Emphasis is placed on collaboration of stakeholders and coordination of activities. This plan and the operational plan were developed for OHIET, by representatives from the Health Information and Infrastructure Advisory Board, Oklahoma’s Regional Extension Center, Beacon grant awardee, the Oklahoma Regional Extension Center, and key stakeholders throughout the state of Oklahoma. (A full list can be seen in Appendix 3.8). Outreach to educate providers on the Medicaid EHR Incentive Program was coordinated with professional associations such as the Oklahoma Medical Association, Oklahoma Hospital Association, Oklahoma Primary Care Association, the FQHCs and RHCs, and the REC through operational provider workshops and quarterly meetings to educate providers and minimize duplication of efforts. Collaboration with OHCA to assist providers in meeting Stage 1 Meaningful Use include contract provisions, set out by OHCA, with pharmacies, labs, and providers that enforce use of the OHIET network of networks. 1.5.1.7. Standards OHIET’s execution strategy is around development and promulgation of standards within the state in the following four, key areas: 1. Develop a process for evaluating and certifying health information organizations to ensure that every region of the state is served by a high‐quality health information exchange. Areas of focus for this activity will include, but not be limited to, evaluation of governance, technology, privacy and security policies and capabilities, and financial stability. 2. Consider, plan and implement 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 may include: a. Establishment of a statewide policy for privacy and security; b. Provision of electronic master indices services for person/provider/patient; c. Development of state agency data services (i.e., Immunization registry, vital statistics, etc.) to support all certified HIOs; d. The creation of a process and/or technology to enable statewide reporting of health and healthcare system outcome metrics from the network of HIE networks; and e. The potential establishment and oversight of a ‘health benefits exchange’ for the state. 3. 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, and judicial processes required to achieve these changes. OHIET Revised Strategic Plan Page 32 4. Interact and coordinate with equivalent organizations and leadership in neighboring states and regions, as well as the NHIN to ensure the seamless exchange of appropriate health information for patients receiving care in multiple states or regions. 1.5.1.8. Accountability and Transparency OHIET will employ rigorous accountability and transparency practices that include at least monthly status reports to the board of trustees and to the public. The trust is subject to the Open Meetings Act and adheres to the specific requirements therein. OHIET’s website, www.ohiet.org provides an outlet for public review and input. Financial accountability and transparency practices are set through the public sector and rule‐making authority of OHIET, as well as the contractual requirements of the Office of the National Coordinator of Health Information Technology (ONCHIT) and ARRA. OHIET’s board of trustees has financial oversight of the organization and is led by treasurer, Sam Guild. Regional and local HIEs will be held accountable for appropriate implementation of HIE practices through certification and accreditation policies of the governance entity. OHIET vendor contracts articulate accountability and transparency requirements. 1.5.1.9. Continued Opportunities for Improvement It is critical that all stakeholders have a place at the table in shaping HIE policy in Oklahoma. Experience of the REC, Beacon, existing HIOs, pharmacies, laboratories, hospitals and physicians enhance the success of OHIET. These entities participated and strengthened the work done in the SHIECAP process to date through the oversight work group, task forces in each domain area, and formally through other forums and informally through each member of the large team. As OHIET evolves, it will strive to continually take on new challenges to prepare the stakeholders within the state for later phases of Meaningful Use and become more skilled at optimizing input from valued stakeholders. OHIET seeks continued input through its advisory board, its consultants and through new channels including the OHIET website and the many planned outreach programs of OHIET and its partners. 1.5.2. Finance 1.5.2.1. Business Model To further the efforts of OHIET, the trust will establish a budget in line with our four areas of strategic execution, and specifically how these elements work toward meeting Stage 1 Meaningful Use across the state and set up for further meaningful use criteria: OHIET Revised Strategic Plan Page 33 1. Evaluate and certify regional HIOs to ensure that all parts of the state are served by a high quality HIE. 2. Develop and implement services and technologies that are best suited to centralized, statewide implementation. 3. Identify and assemble policy and statutory changes needed to support ongoing, appropriate, and secure health information exchange in Oklahoma. 4. Interact and coordinate with HIEs in neighboring states and regions, as well as the Direct Project. Key budget categories, in order to conduct OHIET business, include: 1. Human resources and support: OHIET plans a skeletal staff, led by the Executive Director and supported by a COO and analysts; overhead for these individuals is kept to a minimum, using donated office space and services where possible. They will be aided by legal, business, and domain area consultants to assist in professional execution of OHIET work. Financial management, oversight and reporting are required. It is anticipated that Advisory Board committees and Trustees will provide critical support in all these areas, allowing minimal levels of staffing in each to accomplish OHIET business. 2. Service and technology development: The assessment and development of products and services that would benefit the state and the regional HIOs to centralize. This may include master indices, data registries and vital statistics, reporting and metrics tools, etc. Focus will be on elements that encourage and stimulate the adoption of use of the HIOs/HIE. 3. HIE/HIO development: Closing gaps to meet Meaningful Use includes elements from partnering with other organizations to provide education, training and consulting services to eligible providers, to providing financial incentives to outlying cases where the benefits of the HIO/HIE are not immediate (i.e., in rural and/or under‐privileged areas of the state). 4. Advocacy and policy: Develop of policy for certification and compliance with OHIET and ONCHIT criteria to advocacy and policy development in the legislative arena are required for OHIET’s present and future success. In addition to the requirements set out by SHIECAP and ONCHIT, OHIET understands the need to generate funds at least equal those required for federal matching dollars in initial years of operations and to then be in a position to maintain the operation and administration of the “network of networks” in the future. This strategy is designed to accomplish both. OHIET will build ‘value add’ products and services with an eye toward market desirability in order to generate required revenues and become self‐sustaining. OHIET Revised Strategic Plan Page 34 FFY 2010 began October 1, 2009. The bulk of FFY2011 dollars will go toward ensuring Oklahoma meets Stage 1 Meaningful Use criteria. Budget details are included in the Operational Plan, Section 2. The establishment of statewide HIE, where every hospital and healthcare provider has access to patient information at the point‐of‐care will cost well beyond the funding available through this grant funding. OHIET will strive to catalyze and promote ways, through existing, planned and future local/regional HIOs, to accomplish this ambitious goal. 1.5.2.2. Approach to Sustainability The federal stimulus funding is designed to last four years, at which time the Office of the National Coordinator will hold HIEs accountable for sustainable revenue generating business models. The HIE business models will need to deliver value to a wide variety of stakeholders. Several sustainability models have been considered. Because OHIET is a “network of networks” model, customers are the state’s local and regional HIEs. Several discussions between OHIET and representatives from planned and existing HIEs have given rise to many ideas for value added products and services OHIET might provide for fees. Initially, OHIET plans to provide credentialing and certification services for fees to HIOs. Ancillary services to these, such as consultation, data sharing, etc., have revenue potential as well. Moving beyond the first few years and as the relationships between OHIET and regional HIEs mature, sustainability models will be designed to continually work toward raising patient care, ensuring efficiencies, and continuing to meet state and federal goals. 1.5.3. Technical Infrastructure 1.5.3.1. Interoperability 1.5.3.1.1. NHIN Connectivity OHIET’s interoperability strategy is to facilitate and promote connectivity across the state and also to neighboring states via NHIN. This ”network of networks” model provides flexibility for providers, facilities and other health‐related workers to join a network that bests suits their geographical location, referral patterns and business model while maximizing the ability to connect systems. OHIET Revised Strategic Plan Page 35 OHIET will assist in the creation of HIE processes that will accommodate both federated and centralized data connections across the state. At this time, Oklahoma intends to federate to bordering states and the NHIN. NHIN connectivity will be prioritized as the national effort moves forward and OHIET includes NHIN standards in certification criteria for HIE networks. 1.5.3.1.2. Standards Adoption OHIET’s bylaws (Appendix 3.4) establish the trust as the standard‐setting body for Oklahoma’s statewide HIE effort. Oklahoma will adopt ONC standards and HIE certification criteria. OHIET will facilitate the collaboration of state HIEs to determine and develop HIE standards for the state. All entities connecting to OHIET must pass a certification process. OHIET will assist in the streamlining of the certification process for qualified, eligible parties. 1.5.3.2. Enabling Meaningful Use in Oklahoma OHIET will assist providers in meeting all stages of Meaningful Use criteria. A summary of our plan to help meet Stage 1 Meaningful Use appears in Section 1.3. OHIET recognizes the criticality of meeting these goals by end of fiscal year 2011 and is directing all actions toward this outcome. Similar plans and operations for meeting goals will be developed as further stages of Meaningful Use are defined by ONCHIT. 1.5.3.3. Approach to Technical Architecture “Network of Networks” Model Oklahoma’s statewide HIE technical architecture strategy proposes a federated network model and contemplates a consolidated statewide Enterprise Master Patient Index (eMPI) and record locator service. The federated network creates the connection for the ”network of networks” approach adopted by Oklahoma. HIE networks will interconnect to form the statewide HIE, excepting IHS participants and tribal entities (who have established connection with NHIN and will maintain statewide connectivity via NHIN). OHIET services will be those that are leveraged by centrality of ownership, location, purchasing power, etc., to the benefit and use of the local HIEs. This model will be cost effective without recreating a large centralized infrastructure or duplicating costs and efforts of local HIEs. In addition, this will enhance OHIET’s sustainability by making it a value‐add, low cost organization. IHS and tribal entities may either connect directly or through a local network. OHIET Revised Strategic Plan Page 36 Exhibit 6: Oklahoma Statewide HIE Logical Architecture OHIET Revised Strategic Plan Page 37 Exhibit 6 depicts the Oklahoma logical statewide HIE technical approach. Networks, IHS and tribal entities will need to be certified before exchanging live data through the statewide network. OHIET will work to assist in timely certification of all participants wanting to use the network. The payors and state agencies will be encouraged to enhance their infrastructure to connect to state HIE to perform payor‐related tasks not associated with direct clinical care of patients. These tasks include electronic claims transactions, eligibility checking and quality reporting. OHIET will facilitate connections with the payors and state agencies for these functions. 1.5.3.4. Health Information Technology Components 1.5.3.4.1. Electronic Health Records (EHR) Any EHR in the state of Oklahoma will be required to adhere to national standards, including CCD exchange capabilities. All EHRs connected to OHIET must also adhere to policies of privacy and security, data integrity and so forth as promulgated by OHIET. OHIET reserves the right to remove EHRs that do not meet these requirements from the state program. OHIET’s role is to ascertain adoption rates and processes of state providers; identify gaps in uptake and analyze data that lead to patterns; work with state partners and national best practices to establish an array of solutions that will lead to meeting ONCHIT and Meaningful Use criteria; determine roles in implementing solutions and how best OHIET can participate; monitor closely and measure outcomes; adjust until goals are realized. 1.5.3.4.2. eMPI The eMPI is a key component of the statewide HIE. The statewide HIE strategy to enable cross‐network identity management is a pivotal goal for the statewide effort. Tracking patients across networks of care, state lines and the nation to provide a continuum of care is critical to providing patient‐centered care. OHIET is central to establishing an eMPI for the state. At present, OHIET is working on acquiring the bases for this data and a path to complementing it and making it available statewide. 1.5.3.4.3. Scalability The Oklahoma HIE strategy positions itself for future growth. Initial goals are to bolster EHR adoption, core systems in laboratories and pharmacies and connect existing and planned networks. This will promote use by providers seeking to achieve and demonstrate Meaningful Use and ensure that valuable and needed data is available at the point of care. Scalability is an important factor in meeting OHIET goals to ultimately see HIE coverage over the entire state. OHIET Revised Strategic Plan Page 38 OHIET���s role will be to ensure Phase 1 Meaningful Use requirements are met and then to continue to focus on necessary elements to be required in phases 2 and 3 of Meaningful Use, such as electronic eligibility checking, credentialing, and electronic order submission. 1.5.3.4.4. Public Health Technology The Oklahoma State Department of Health (OSDH) is in the process of planning, designing, developing, upgrading and expanding OSDH systems to allow EHR entities to meet Stage 1 Meaningful Use criteria (capability for OSDH to be able to accept EHR immunization data and verify that the Immunization electronic data submission is successful) and Stages 2 and 3 criteria and timeframes when defined. Specific OSDH projects have been initiated to upgrade both the Oklahoma State Immunization Information System (OSIIS) and Laboratory Information Management System (LIMS). Development of an OSIIS replacement is underway to modernize the system to meet industry best practices as well as conversion of the system to Microsoft .NET and SQL Server technologies. The completed OSIIS product will include an Unsolicited Vaccination Update (VXU) database repository that is envisioned to serve as the primary repository for incoming and future (Stage 2) outgoing Health Level Seven (HL7) messages (current projection is HL7 V2.5.1). Stage 3 meaningful use requirements are unknown at this time. OSDH is currently compiling information from larger Oklahoma related EHR’s and entities for prioritization in establishing and testing standardized processes for data import into the VXU repository. Multiple interoperability prototype projects with messaging partners are under discussion and consideration. Among these is a prototype project with VisionShare (now ABILITY) to receive Immunization VXU messages via DIRECT from EHRs and forward to OSDH using PHINMS transport. This enables Immunization messaging to OSDH via PHINMS or DIRECT. A Request for Proposal (RFP) for the OSDH LIMS has been developed that includes primary deliverables of HL7 accessioning, results reporting, and data repository interfaces. The RFP is currently transitioning through the procurement process. Simultaneous to OSIIS and LIMS development, the OSDH is proceeding with the development and incorporation of an internal Enterprise Master Person Index (eMPI) necessary to achieve interoperability between both internal and external systems. The eMPI project is currently focusing on the linkage of OSDH systems including OSIIS, Vital Records, Public Health Client Information System (PHOCIS), and other key databases and registries of the agency. The development of an agency eMPI is considered a priority need in assuring the OSDH can meet expected requirements for Stages 2 and 3 Meaningful Use criteria and to interact with the HIE. OHIET Revised Strategic Plan Page 39 1.5.3.4.5. Broadband The current status of broadband in Oklahoma is as described in Section 1.2.2 in the Environmental Scan. Access to broadband throughout the state is a concern and OHIET is working with the Secretary of State, Susan Savage, who leads the Oklahoma Community Access Network (OCAN) effort to build a fiber backbone to reach across the state. In the meantime, OHIET is working to identify feasible work‐around models that will allow eligible providers to meet Stage 1 Meaningful Use this year. These include ASP models and other technologies currently tested and in use in the state through SMRTNET and others. 1.5.3.5. Approach to Clinical and Quality Assurance Measures OHIET will regularly collect, report and monitor a set of performance measures to accurately track the Oklahoma HIE effort and assess readiness for new phases of work. In addition to the required measurements, OHIET will use the existing Physician Quality Reporting Initiative (PQRI) model with de‐identified patient information and adapt it to meet Meaningful Use criteria and requirements. OHIET will conduct clinical and quality assurance surveys to establish baselines statistics and update annually to capture changes over time. The planned tasks are: • Define clinical user specifications, including data sharing requirements, data use agreements and policies, quality‐related technology requirements, and data access standards; • Assist in data collection with state Medicaid and CMS for attestation and verification of Meaningful Use by hospitals and eligible providers; • Compile performance and evaluation metrics identified by the task forces; • Identify best practice case studies; • Determine performance specifications and set quality standards and goals; • Generate strategies for incorporating best practices, lessons learned and continuous improvement efforts; • Create a plan, in conjunction with the REC, Beacon, existing HIOs and organizations with high levels of adoption of EHR and HIE for dissemination of best practices and knowledge transfer of strategies for current and future implementations and security and protection of data; • Highlight areas of non‐performance or under‐performance and provide analysis on trends, exceptions, etc. Peformance metrics and methodologies for obtaining, analyzing and reporting are discussed in OHIET’s Operational Plan, Section 2. OHIET Revised Strategic Plan Page 40 1.5.4. Business and Technical Operations 1.5.4.1. Implementation The OHIET Operational Plan (Section 2) provides the particulars of implementation of the work of OHIET. Executive oversight is provided to the organization by the seven‐member board of trustees. Trustees have impressive records and knowledge of HIE and the health care industry and provide perspective of clinicians, academics, hospitals, payors, IT professionals, state agencies, regional HIEs, urban and rural settings (please see Exhibit 4). Daily operations of OHIET is performed by OHIET staff: the Executive Director, John Calabro (also the state HIT Coordinator); the Chief Operating Officer and an analyst, both to be named. These three individuals oversee operations conducted in each of the domain areas, with assistance from vendors and consultants. Procurement and contracting procedures to engage domain expertise have been established by the trust, and follow state and federal guidelines. OHIET benefits from the Advisory Board. An 18‐member Advisory Board has been identified in the trust indenture (Appendix 3.3 and Exhibit 5) and an additional seven member organizations are allowed. The Advisory Board provides representation from healthcare providers, including those that serve low income and underserved populations as well as from rural areas, health plans, patient or consumer organizations that represent the population to be served, HIT vendors, health care purchasers and employers, public health agencies, health profession schools, universities and colleges, clinical researchers and other users of HIT such as the support and clerical staff of providers and others involved in the care coordination of patients. The Advisory Board is meant to advise the Board of Trustees as well as augment OHIET staff in each domain area in the implementation phase of this work. Advisory Board members are individuals who enjoy the concurrence on recommendations for their respective organizations. An impressive group of individuals, many Advisory Board members have been advising and working on domain task forces in order to inform this and the operational plan. A list of these representatives is given in Appendix 3.8. 1.5.4.2. Project Management Classic project management tools and approaches are in use to implement OHIET business and conduct project work. OHIET employs individuals who have been trained and have deep experience in the arena of project management. Project tracking tools include scheduling, cost accounting, reporting on project progress, communications, meeting minutes, assigned responsibilities and so on. Project management extends to procurement in project estimating, vendor identification, due diligence, creation of bid packages, vendor selection, contracting and contract management and oversight as well as performance evaluation by working with vendors to take and report out specific project metrics and to oversee remediation when metrics indicate intervention. It extends to accounts payable by approving invoices and providing parallel tracking of work progress to that of vendors. OHIET Revised Strategic Plan Page 41 Quality control and assurance are key deliverables by the project management team. Final deliverables include work conducted professionally, in keeping with the tone and tenor of ONCHIT, on time, on or under budget and of the highest caliber. Project management philosophy is ‘by exception’, enabling streamlining of information for executive staff and boards. Working meetings keep running minutes of assigned tasks with due dates and current status. Goals are established for each task force. Escalation processes are established in line with goals. Tracked tasks and issues are escalated according to an agreed process. 1.5.4.3. Leveraging Existing HIE Capacities and Services OHIET services will be leveraged through existing HIOs. Multiple regional HIE efforts have or will have HIE capacities that can be shared with the statewide effort: eMPI, e‐Rx, immunization data, labs, prescriptions, patient look‐up, patient demographics, Record Locator Services (RLSs) exist in current networks within the state. These services of existing HIOs will be expanded upon to facilitate the network of networks that will form OHIET. Alternatively, OHIET may choose to engage in new technology or other partnerships to provide additional or extended services. Services or capabilities for the statewide HIE will be competitively bid to take advantage of existing efforts and economies of scale. This will facilitate a cost‐effective model without recreating a large centralized infrastructure and duplicating costs and efforts of the existing HIOs. In addition, this will ensure that OHIET is a sustainable organization with low, long‐term operational costs. 1.5.4.4. Communications, Education and Marketing (CEM) Strategy The purpose of the CEM strategy is twofold: 1. To inform, educate and engage health care providers and organizations, the public, and other key stakeholders about the benefits of HIT adoption and use, and HIE‐related activities in Oklahoma; and 2. To engage key stakeholder organizations that will be instrumental in helping communicate important information to their members and constituents, and assisting with these activities. HIE, HIT, EHR, etc., are confusing topics to even the initiated users of such services. Coupled with the myths and misinformation about any emerging technologies or services as well as the confounding elements of healthcare and its ancillary services and the landscape becomes ripe for confusion very quickly. De‐mystifying HIE and HIT and articulating end user benefits to a widely segregated market space of direct and indirect users are the key tasks in the CEM strategy. Topics of the plan include: OHIET Revised Strategic Plan Page 42 1. Overarching themes that describe and define OHIET; these include key values, priority goals, overall mission, etc., and will result in branding, image, and architecture for OHIET messaging. 2. Prioritization of effort aligned with ONCHIT and Meaningful Use goals that are the initial focus of OHIET and a plan to provide CEM to critical areas; this will include targeted communications, public awareness and education to groups essential to achieving Stage 1 Meaningful Use criteria, and then to subsequent initiatives critical to meet the goals and purpose of OHIET. 3. Development of materials to accomplish content of topics 1 and 2; this will include communications packages, image and content for all media, website and user interface, educational materials, and marketing collateral; each targeted to specific market segments. Generally, the project relies on current ongoing communication activities that have proved to be successful in making information about HIE in Oklahoma available and accessible to stakeholders in the health community. These activities play an important role in the overall communications strategy for this project are selected and employed on an “as needed” basis. Written presentations, meeting minutes, and other materials are available on the OHIET website. An important element of OHIET is the ability to collaborate; this extends to the CEM effort as well. Best practices and partnerships are leveraged to garner the highest efficiencies in connecting with target audiences. OHIET has already successfully collaborated with organizations such as the Oklahoma Hospital Association (OHA), Oklahoma State Medical Association (OSMA), and the Oklahoma Osteopathic Association (OOA) to communicate important information to providers about HIT and HIE. Coordination of education and public awareness campaigns with the REC, OSU and others targeting special needs populations (including work force and training facilities) is woven into the plan. As borne out by the environmental scan, the rural areas and the unaffiliated organizations will be priority targets in order to achieve Stage 1 Meaningful Use. Interviews of CEM consultants have already resulted in discussions of key messages and communications required to target a multiple segment marketplace. Communications and education are tailored to various stakeholder audiences including Information technology, including professional and social networking sites, are to be incorporated to gain efficiencies and reach a broader audience, wherever possible. This aligns with methods for information dissemination and modalities to adequately ‘connect’ with the desired audiences including a general audience, policymakers, Oklahoma legislators, health plans, hospitals, long‐term care, home health, physician organizations, community clinics, public health departments, local Regional Health Information Organizations (RHIOs), ancillary service organizations (i.e., lab, pharmacy, imaging), vendors, the public, consumer advocates, health care payors, purchasers and employers. Coordinated messaging with other key groups in the state who are providing public and targeted outreach including the local HIOs, the REC, the colleges and universities and various other groups is in the plan. Also included are activities aimed at broadening existing collaborations to include additional health care organizations, providers and consumers. OHIET Revised Strategic Plan Page 43 OHIET has a value added role to play in the CEM efforts in the state. This is an appropriate ‘central’ role where the investment will be leveraged across the state. The plan centers on working with the regional HIOs and helping them drive the messages and awareness required for their success. 1.5.5. Legal / Policy 1.5.5.1. Privacy and Security Oklahoma Privacy and Security Landscape Oklahoma generally adheres to Health Insurance Portability and Accountability Act (HIPAA) and 42 C.F.R. Part 2 standards for use and disclosure of protected health information (PHI), with limited exceptions for certain classes of information. Hence, Oklahoma usually does not require authorization for exchange of Protected Health Information (PHI) for purposes of payment, treatment or health care operations. Examples of instances where Oklahoma may require authorization for exchange include records containing substance abuse information,2 reportable communicable or non‐communicable disease information,3 and certain information concerning minors.4 In these instances, disclosure requires either authorization or additional notice concerning the nature of records subject to disclosure. Like other states, Oklahoma's privacy laws present some barriers to both intra‐state and inter‐state exchange by imposing heightened requirements on certain disclosures. Stakeholders from Oklahoma's health care community, however, have actively worked to reduce such impediments. As participants in the HISPC process, these stakeholders studied how to improve the state's privacy laws in order to promote secure and efficient HIE. The HISPC process presently continues, with the initial federally‐sponsored collaborative now functioning as a state council (OKHISPC) under a 2008 executive order issued by Oklahoma Governor Brad Henry. Oklahoma Health Information Exchange Legislation To date, Oklahoma's HISPC efforts have already resulted in successful enactment of two laws that have improved HIE in the state. First, the HISPC collaborative worked with the Oklahoma legislature in 2007 to pass the Oklahoma Health Information Exchange Act.5 The Act directed the Oklahoma Department of Health to adopt and promulgate a uniform authorization for the exchange of health information that complies with both federal and state privacy law. (Appendix 2 See 43A O.S. § 1‐109. 3 See 63 O.S. § 1‐502.2. 4 See 63 O.S. § 2602. 5 See 63 O.S. §§ 7100.1‐7100.7. OHIET Revised Strategic Plan Page 44 3.10) The Authorization, and related patient and provider instructions, expressly sets forth the instances where Oklahoma requires authorization for exchange and makes clear Oklahoma does not generally require authorization for purposes of payment, treatment and health care operations. Second, OKHISPC worked with the Oklahoma legislature in 2008 to amend the state's patient‐physician/psychotherapist privilege to clarify the privilege does not prohibit disclosures of protected health information otherwise permitted under state and federal privacy law.6 OKHISPC continues to study future opportunities to foster HIE. Further, many of Oklahoma's HISPC council and collaborative stakeholders will also have an active role in connection with OHIET's efforts to similarly promote HIE. Privacy and Security Under OHIET As further set out in Sections 1.5.5.2 through 1.5.5.5 below, OHIET will specifically require compliance with applicable state and federal privacy laws as an express condition under the trust agreements governing participation in the exchange. By incorporating and applying these statutory and regulatory provisions, OHIET will clearly reference the standards by which participants must conduct HIE. HHS Privacy and Security Framework: OHIET will achieve, in significant part, the eight objectives of the HHS Privacy and Security Framework through similarly incorporating aspects of these objectives as conditions for participation under trust agreements with exchange participants. Individual Access: The OHIET trust agreement will foster individual access to personal health information by requiring exchange participants to provide access to individual records and disclosure accounting in accordance with the Privacy Rule7 and the HITECH Act.8 Exchange participants may provide access through a number of means, including but not limited to: a secure web‐portal, personal health records, or direct provision of information by the exchange participant to the individual or the individual's designee. Exchange participants will be responsible for putting measures in place to secure the authentication of the individual requesting access to information. Correction: The OHIET trust agreement will require exchange participants to comply with the Privacy Rule9 and provide individuals with the opportunity to request corrections to PHI generated or maintained by the exchange participant. OHIET anticipates the agreement will also contain additional language concerning the specific manner in which exchange 6 See 12 O.S. § 2503(D)(5). 7 See 45 C.F.R. § 164.524. 8 See 42 U.S.C. § 17935(e). 9 See 45 C.F.R. § 164.526 OHIET Revised Strategic Plan Page 45 participants must provide notice and documentation of disputed information in connection with disclosures. Openness and Transparency: From an organizational standpoint, Oklahoma selected the state‐beneficiary public trust as the structure for OHIET in large part due to the inherent openness and transparency of such entities. Oklahoma permits the creation of state‐beneficiary public trusts that operate for the express benefit of the state and its citizens. Oklahoma law requires such entities comply with the Oklahoma's Open Meetings Act,10 Open Records Act,11 Administrative Procedures Act,12 Public Competitive Bidding Act,13 and Public Trust Competitive Bidding requirements.14 These acts will ensure public access and opportunity for input and involvement in OHIET's efforts to foster HIE in Oklahoma. From an operational standpoint, OHIET will also encourage exchange participants to exhibit similar openness and transparency concerning participation in the exchange. Specifically, the OHIET trust agreement will recommend exchange participants provide patients and consumers with clear notice, preferably via the participant's Notice of Privacy Practices, regarding how the participant will use and disclose information through the exchange; the choices the individual may exercise with respect to the information (e.g., access15, accounting of disclosures16, request for restriction17); and the privacy and security measures applied to safeguard such data. Individual Choice: OHIET will adopt a consent model that allows for exchange of protected health information amongst participants, in accordance with minimal necessary requirements of the Privacy Rule18, in all instances where federal and/or state law permit disclosure absent authorization. As noted above, exchange participants should provide individuals with clear notice concerning these uses and disclosures through the exchange; instances where individual authorization is necessary; and the choices individuals may exercise with respect to protected health information. Collection, Use, and Disclosure Limitation: OHIET trust agreements will expressly require exchange participants to adhere to the minimum necessary requirements of the Privacy Rule19 to govern the collection, use and disclosure of information amongst exchange participants. Subject to such requirements, the trust agreements will permit exchange participants to use, collect and disclose 10 See 25 O.S. §§ 3101‐312. 11 See 51 O.S. §§ 24A.1‐24A.29. 12 See 75 O.S. §§ 250‐323. 13 See 61 O.S. §§ 101‐138. 14 See 60 O.S. § 176(H). 15 45 C.F.R. § 165.524; 42 U.S.C. § 1795(e). 16 42 U.S.C. § 17935(c). 17 45 C.F.R. § 164.522; 42 U.S.C. § 17935(a). 18 See 45 C.F.R. § 164.502(b); 42 U.S.C. § 17935(b). 19 See 45 C.F.R. § 164.502(b); 42 U.S.C. § 17935(b). OHIET Revised Strategic Plan Page 46 information for treatment, payment, health care operations and public health reporting required by state and federal law. Data Quality and Integrity: Pursuant to OHIET's enabling legislation,20 OHIET trust agreements will make exchange participants responsible for ensuring accuracy and integrity of data utilized for HIE. Safeguards: OHIET trust agreements will require exchange participants to comply with the Security Rule21 provisions in order to achieve administrative, technical and physical safeguards for accessing, maintaining and transmitting protected health information. Further, OHIET will consider recommending a common set of procedures and mechanisms to verify the credentials and authenticate the identity of persons requesting and accessing information for exchange. OHIET will also consider recommending standard privacy and security training guidelines for review and use by exchange participants. Accountability: As further discussed in Section 1.5.5.3, through the express application of the Privacy and Security Rules, along with other applicable state and federal privacy laws, OHIET trust agreements will clearly signal exchange participants must comply with such requirements and bear responsibility for instances of breach or other non‐compliance. In addition, the standard procedures and training guidelines referenced immediately above could serve as another resource toward ensuring exchange participants implement appropriate accountability measures on an institutional level. 1.5.5.2. State Laws OHIET anticipates working in conjunction with OKHISPC and engaging in ongoing efforts to identify and analyze potential changes to state privacy laws to better serve HIE, both within Oklahoma and with other states. An Oklahoma statute subject to present discussion and analysis concerning potential amendment requires a disclosure statement to accompany an authorization releasing records containing reportable communicable or non‐communicable disease information.22 The statute requires the statement to appear in bold‐faced type and inform the individual authorizing release of the potential for inclusion of such information in the disclosure. Stakeholders from Oklahoma's health care community and OKHISPC have expressed concern that the detailed requirements of this statute present a barrier to exchange. 20 See generally 63 O.S. § 1‐132(F). 21 45 C.F.R. §§ 145.302‐145.318. 22 See 63 O.S. § 1‐502.2. OHIET Revised Strategic Plan Page 47 At the time of drafting, however, OHIET does not have any specific plans or proposals to modify this or other state laws. Likewise, although OHIET has not yet entered into discussions or negotiations with other states concerning HIE, OHIET will monitor HIE efforts of other states and pursue communications with other states where doing so could work to further inter‐state coordination and secure exchange of health information. 1.5.5.3. Policies and Procedures OHIET anticipates utilizing the trust agreements discussed under 1.5.5.4 below as the primary means of achieving adherence to uniform practices and procedures. 1.5.5.4. Trust Agreements As noted throughout, OHIET trust agreements with exchange participants will serve as the contractual mechanism OHIET will use to achieve uniform adoption of and compliance with the consent model for exchange; the privacy and security requirements under which exchange must occur; and the penalty provisions for acts of breach or non‐compliance with federal or state law. 1.5.5.5. Oversight of Information Exchange and Enforcement OHIET trust agreements will expressly inform exchange participants that oversight authority and enforcement power for breaches and/or other acts of non‐compliance with state and federal law rests with the government or regulatory agency charged with such power. The standard policies, procedures, and training materials OHIET anticipates recommending will further serve as best practices to mitigate the probability of breaches or other misuse of information. The trust agreements will require exchange participants, and empower OHIET, to provide notice of breaches and/or acts of non‐compliance to appropriate government or regulatory officials where applicable law mandates such action. Finally, the trust agreements will provide for termination of a participant's agreement as a penalty in certain enumerated circumstances involving breach or non‐compliance with federal or state law. End of Oklahoma State Health Information Exchange Cooperative Agreement Program Revised Strategic Plan OHIET Revised Strategic Plan Page 48 Appendices Project Month 1 2 3 4 5 6 7 8 9 101112131415161718192021222324252627282930313233343536373839404142434445464748495051 Year Calendar Month N D J F M A M J J A S O N D J F M A M J J A S O N D J F M A M J J A S O N D J F M A M J J A S O N D J State Trust developed State Coordinator for HIT selected Strategic Plan completed Operational Plan completed Strategic and Operational Plan approval Evauate other certification processes Identify elements of certification Seek existing and planned HIO input into certification requirements Finalize certification process requirements Begin certifying HIOs Broadband program designed Broadband program implemented MU Incentives (Medicaid, Medicare) inplace Community HIO Planning Program Designed Community HIO Planning Program in place HIE Voucher program designed HIE Voucher program in place eRX Pharmacy assistance program designed eRx Pharmacy assistance program in place Shared Services evaluation Identification and prioritization of desired shared services Purchasing phase for shared services Implementation of shared services Consider Policy needs Prioritize policy needs Establish legislative agenda Privacy and Security framework Facilitate connections between HIOs and border health systems and HIOs Manage communications with ONC and CMS Strategy for interaction with Health Benefits Exchange project Strategy for facilitating interactions between state agencies and HIOs Coordination Policy Shared Services Incentive programs Certification Process 2013 2014 Planning Phase 2009 2010 2011 2012 3/31/2010 OKLAHOMA HEALTH INFORMATION TECHNOLOGY COORDINATOR 1 STATE OF OKLAHOMA Job Description Job Title: Oklahoma Health Information Technology Coordinator Agency: Oklahoma Health Information Exchange Trust (“OHEIT”) Reports To: State of Oklahoma Governor Date Completed: March 31, 2010 Salary Range: TBD (depending upon experience) PART I: DESCRIPTION OF POSITION Position Purpose: This position exists to provide leadership, direction, management and coordination of healthcare information technology strategy for the State of Oklahoma which will include the implementation of federal and state requirements for healthcare information technology (HIT) and health information exchange (HIE). This individual will work cooperatively with multiple stakeholders including health care providers, health plans, health profession schools, consumers, technology vendors, public health agencies, and health care purchasers to identify existing resources, needs, commonalities of interest, project priority, and to develop a plan which prescribes the needed activities to facilitate and expand the electronic movement and use of health information among organizations consistent with the both state‐ and federal‐ health information technology strategic plans. Principal Activities: The principal activities and responsibilities include the following: • Provide health informatics leadership, vision, and direction to the HIT office in collaboration with the Oklahoma State Health Information Exchange Governance Committee. • Provide expertise, including research and analysis required to establish and maintain a strategy for implementing health information exchange in Oklahoma • Identify new grant opportunities; serve as principle investigator (PI) as needed for grants and direct the preparation of grant applications for funding for planning and implementing HIT/HIE in Oklahoma. • Review grant proposals to evaluate informatics components for issues relating to readiness, collaboration, interoperability and certification. • Assist HIT projects with conducting studies of existing and proposed information systems and their impacts. • Collect and analyze data on statewide HIT systems. • Prepare written and oral reports, manuscripts and other communications summarizing the findings of analyses and studies and disseminate the results. • Present data, study findings and recommendations to the Governance Board, Advisory Board, state agencies, legislators and other partners/stakeholders as needed to support the statewide HIT/HIE system decision‐making process. • Act as the State lead for HIT/HIE and participate in state, regional and national health/scientific meetings focused on HIT/HIE. 3/31/2010 OKLAHOMA HEALTH INFORMATION TECHNOLOGY COORDINATOR 2 • Act as the designated Oklahoma representative at meetings related to HIE and associated grants • As needed, serve as an interface between the partners/stakeholders and the OHEIT staff on identifying and addressing informatics issues. • Coordinate statewide activities related to the implementation of HIT/HIE in Oklahoma in order to improve the efficiency and effectiveness of health data collection, analysis and use to improve the health of individuals and their communities. • Provide direction in the development of the state HIT/HIE strategic plan. • Coordinate resources and activities to assist with readiness assessments of public and private health care entities to implement electronic information systems that meet federal and state requirements and fit within the state HIE plan. • Solicit input from relevant public and private partners/stakeholders, including consumers, about the needs and barriers to implementing HIE in Oklahoma including barriers to interoperability and ways to utilize opportunities and reduce barriers. • Foster pilot projects and coordinate HIE‐related activities in collaboration with public and private healthcare providers and health plans. • Collaborate with federal standards and policy committees to develop common data reporting formats and methods of transmission within Oklahoma and across state borders for all pertinent health data. • Maintain relationships with public and private partners/stakeholders for the purpose of insuring coordination of all electronic health information systems planning, development, implementation and interoperability. • Provide training and information on ONC, NHIN administrative and technical requirements for system interoperability and secure data exchange using the Web and other communication methods. • Perform other duties in support of the statewide HIT activities. • Represent Oklahoma on national HIE/HIT issues and activities. Supervisory Responsibilities: This position has supervisory responsibilities. PART II: KNOWLEDGE AND BACKGROUND REQUIREMENTS Qualifications: This position requires a strong leader possessing excellent health informatics skills and strong experience with information systems and information technology. The work of this position requires expert knowledge of healthcare processes and systems both private and public, program management, technological planning, organizational behavior, public policy development and analytical evaluation and research skills. It requires the incumbent to develop a strong working knowledge of the statewide private sector healthcare infrastructure; information technology, medical informatics, legislative processes and operation of state agencies. Preference: Preference will be given to applicants with the following qualifications: • An individual with an advanced clinical degree including nursing, medicine, dentistry or pharmacy. • An individual with clinical practice experience. 3/31/2010 OKLAHOMA HEALTH INFORMATION TECHNOLOGY COORDINATOR 3 • Masters or higher degree. • Significant expertise and knowledge in HIT/HIE, particularly related to improving clinical quality. • Significant knowledge and experience in HIT/HIE public policy. • Recognized leadership skills and experience in managing, creating or developing health information technology. • Extensive knowledge of information management principles, information technology strategies and trends, and systems oversight abilities. Qualified candidates will possess the following: Education: Post baccalaureate degree from an accredited college or university with additional training in business administration, public administration, finance, management information systems, public health, health care management, or medical informatics. Experience: Seven (7) years of pertinent work experience within the healthcare and/or public health or industry. Three (3) years of program or project management experience which include: • Analyzing business processes and outcomes • Financial reporting • Planning, developing, and implementing information technology systems • Managing large projects • Writing and administrating grants • Facilitating meetings Researching, interpreting and explaining technical information such as laws, regulations and requirements. Language Skills: Ability to read, analyze, and interpret technical documents, general business periodicals, professional journals, technical procedures, or governmental regulations. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to questions from stakeholders. Mathematical Skills: Ability to work with mathematical concepts such as probability and statistical inference with the ability to apply concepts to practical situations. Reasoning Ability: Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Computer Literacy: Knowledge of health information technology concepts, including hardware, software, networking, and associated costs and budgeting. Must have significant knowledge of healthcare data standards (vocabularies, messaging, and security) and experience in communicating these complex topics to learners and listeners at all levels. Physical Demands/Work Environment: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. To: Advisory Board Member Organization RE: Appointment of Personnel to Serve with the Oklahoma Health Information Exchange Trust Advisory Board Dear : Recently passed into Oklahoma Legislation by Senate Bill 1373 was the establishment of a public trust, 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 transmission of electronic health data both intra‐ and interstate thereby raising the overall quality of health of the population while making access more effective and affordable. Your organization has already made significant contribution to this (the Oklahoma State Health Information Exchange Cooperative Agreement Program) and other areas of HIT/HIE. Because of your commitment and leadership, we have included your organization as a founding member of OHIET’s Advisory Board. Request: The Board of Trustees of OHIET requests that you nominate one individual to serve as your representative. This individual should be a leader in your organization; they should represent a consensus opinion of your organization; they should bring a deep level of understanding of your organization and the constituencies you serve; they should be willing to collaborate with a diverse set of views and devise creative paths and solutions; they should be critical thinkers and have the ability to understand and eliminate bias. Depending upon the role your representative takes, the time commitment from him/her will range from one to four hours per week. We ask that representatives serve for a minimum term of one year. We very much appreciate your generosity in allowing this valuable employee to work with us. We believe, with the assistance of organizations like yours, we will improve the overall quality of care for the citizens of Oklahoma. Once you have selected your representative, please send notification to this office, _____________. We look forward to learning your member individual by October 15, 2010. Thank you once again the effort you and your organization put toward these endeavors. Signed by Trustees Follows: more information about the position, Advisory Board and OHIET. To: Advisory Board Member Organization Re: Appointment of Personnel to Serve with the Oklahoma Health Information Exchange Trust Advisory Board 2/8 Position Purpose: To represent the views and desires of your organization, to collaborate with several other concerned constituents, and to add leadership and expertise to the Oklahoma Health Information Exchange Trust (OHIET) and towards its intentions to meet stated goals. To provide opinion and advice to the Board of Trustees; to work on task forces at a domain‐specific level in order to make learned recommendations to the Board; to perform discrete tasks as might be necessary.
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Title | OHIET Strategic Plan Rev March 2011 Final |
OkDocs Class# | H1350.3 S898p 3/2011 |
Digital Format | PDF, Adobe Reader required |
ODL electronic copy | Downloaded from agency website: http://tools.okhca.org:82/OKHIE/STRATEGIC%20AND%20OPERATIONAL%20PLANS/STRATEGIC%20AND%20OPERATIONAL%20PLANS/OHIET%20Strategic%20Plan%20Rev%20March%202011%20Final.pdf |
Rights and Permissions | This Oklahoma state government publication is provided for educational purposes under U.S. copyright law. Other usage requires permission of copyright holders. |
Language | English |
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 Oklahoma’s Revised Strategic Plan for the State Health Information Exchange Cooperative Agreement Program (SHIECAP) Submitted by: Oklahoma Health Information Exchange Trust March 11, 2011 OHIET Revised Strategic Plan Page 1 Table of Contents Page 1. Strategic Plan 1.1. Oklahoma Approach to Health Information Technology .................................4 1.1.1. History of Health Information Technology in Oklahoma .............................. 4 1.1.2. Vision, Mission and Goals of Oklahoma Health Information Exchange Trust ...................................................................... 6 1.1.3. Purpose of Oklahoma Health Information Exchange Trust ........................... 9 1.1.4. Operations Plan Elements ........................................................................... 11 1.2. Environmental Scan Outcomes in Oklahoma.................................................. 12 1.2.1. Current and Planned HIOs for Oklahoma .................................................... 12 1.2.1.1. Heartland HealthNet.............................................................................. 13 1.2.1.2. SMRTNET................................................................................................ 13 1.2.1.3. OPHX ...................................................................................................... 13 1.2.1.4. GOCHC.................................................................................................... 14 1.2.1.5. GTHAN.................................................................................................... 14 1.2.1.6. Summary of the Current Gaps in HIE in the State of Oklahoma ........... 14 1.2.2. Broadband.................................................................................................... 14 1.2.3. Levels of Technology Development and EHR Adoption in Oklahoma......... 18 1.2.4. E‐prescribing Readiness and Adoption........................................................ 19 1.2.5. Laboratory Readiness................................................................................... 20 1.2.6. Additional Statewide Readiness .................................................................. 22 1.3. Oklahoma’s Strategy for Stage 1 Meaningful Use .......................................... 23 1.4. Health Information Exchange Coordination Strategies................................... 26 1.5. Domain Area Strategies ................................................................................. 27 1.5.1. Governance ................................................................................................. 27 1.5.1.1. Structure to Achieve Results ................................................................. 27 1.5.1.2. Decision Making Authority .................................................................... 28 1.5.1.3. Set Up and Membership Representation ............................................. 29 OHIET Revised Strategic Plan Page 2 1.5.1.4. Oklahoma Health Information Technology Coordinator ...................... 30 1.5.1.5. Alignment with Nationwide Health Information Network Governance ........................................................................ 30 1.5.1.6. Alignment with State Medicaid Hit Plan ............................................... 30 1.5.1.7. Standards .............................................................................................. 31 1.5.1.8. Accountability and Transparency ......................................................... 32 1.5.1.9. Continued Opportunities for Improvement .......................................... 32 1.5.2. Finance ........................................................................................................ 32 1.5.2.1. Business Model ......................................................................................... 32 1.5.2.2. Approach to Sustainability ....................................................................... 34 1.5.3. Technical Infrastructure .............................................................................. 34 1.5.3.1. Interoperability ........................................................................................ 34 1.5.3.1.1. Nationwide Health Information Network Connectivity......................... 34 1.5.3.1.2. Standards Adoption ............................................................................... 35 1.5.3.2. Enabling Meaningful Use in Oklahoma..................................................... 35 1.5.3.3. Approach to Technical Architecture: “Network of Networks” Model ..... 35 1.5.3.4. Health Information Technology Components .......................................... 37 1.5.3.4.1. Electronic Health Records ..................................................................... 37 1.5.3.4.2. eMPI....................................................................................................... 37 1.5.3.4.3. Scalability .............................................................................................. 37 1.5.3.4.4. Public Health Technology ...................................................................... 38 1.5.3.4.5. Broadband ............................................................................................. 39 1.5.3.5. Approach to Clinical and Quality Assurance Measures............................ 39 1.5.4. Business and Technical Operations ............................................................. 40 1.5.4.1. Implementation ........................................................................................ 40 1.5.4.2. Project Management ............................................................................... 40 1.5.4.3. Leveraging Existing Health Information Technology Capacities and Services .......................................................................... 41 1.5.4.4. Communications, Education and Marketing Strategy.............................. 41 OHIET Revised Strategic Plan Page 3 1.5.5. Legal / Policy ............................................................................................... 42 1.5.5.1. Privacy and Security ................................................................................ 43 1.5.5.2. State Laws ............................................................................................... 46 1.5.5.3. Policies and Procedures .......................................................................... 47 1.5.5.4. Trust Agreements .................................................................................... 47 1.5.5.5. Oversight of Information Exchange and Enforcement ........................... 47 2. Operational Plan (under separate cover) 3. Appendices – Strategic and Operational Plans 48 3.1 Project Schedule ............................................................................................ 49 3.2 Legislation, Senate Bill 1373 .......................................................................... 50 3.3 Oklahoma Health Information Exchange Trust Indenture ............................ 58 3.4 Oklahoma Health Information Exchange Trust Bylaws ................................ 78 3.5 Oklahoma Health Information Technology Coordinator Position Description 91 3.6 Governor Henry’s State Designation Letter .................................................. 94 3.7 Position Description of Advisory Board Members......................................... 96 3.8 List of Participants in Oklahoma State Health Information Exchange Cooperative Agreement Program .............................................................. 104 3.9 Glossary of Acronyms .................................................................................... 107 3.10 Oklahoma Standard Authorization to Use or Share Protected Health Information (PHI)................................................. 110 3.11 Letters of Endorsement ................................................................................. 112 3.12 Parity Check with PIN .................................................................................... 119 3.13 Governor Henry’s Re‐Designation Letter....................................................... 125 3.14 Biographical Information on OK’s HIT Coordinator ....................................... 126 3.15 Resumes of OHIET Trustees........................................................................... 129 OHIET Revised Strategic Plan Page 4 1. Strategic Plan 1.1. Oklahoma Approach to Health Information Technology 1.1.1. History of Health Information Technology in Oklahoma For over half a decade, collaborative efforts of public and private entities have established a strong foundation from which Oklahoma draws support for advancing Health Information Exchange (HIE) under the State Health Information Exchange Cooperative Agreement Program (SHIECAP). In 2004, Oklahoma took an initial step toward development of a state HIE by participating in the Health Information Security and Privacy Collaborative (HISPC) program. Through HISPC, a broad base of stakeholders from Oklahoma's health care community, including providers, payors, government agencies, professional trade organizations and private consumer advocates, collectively identified barriers and studied how to overcome them while promoting a secure HIE. This key work culminated in the enactment of the Oklahoma Health Information Exchange Act, allowing a Standard Authorization Form for sharing protected health information. The form can support exchange of either paper or electronic medical records and serves as a valuable education resource for consumers concerning the scope of exchanges requiring authorization under federal and state privacy law. The initial HISPC collaborative workgroup continues to exist as a council pursuant to a 2008 executive order issued by Oklahoma Governor Brad Henry. (This group is represented in the advisory board of the new Oklahoma Health Information Exchange Trust (OHIET), the state designated entity (SDE) for Oklahoma’s SHIECAP funds and activities.) In 2005, the Secure Medical Records Transfer Network (SMRTNET) became one of Oklahoma's first operational regional health information organizations (HIO). Since that time, a number of other exchanges have emerged within the state, including Heartland HealthNet, Oklahoma Physicians Health Exchange, Greater Oklahoma City Hospital Council Exchange (GOCHC), and the Greater Tulsa Health Access Network (Greater THAN). These exchanges have connected healthcare providers from both urban and rural areas, health systems and public partners for purposes of data exchange. In 2008, Oklahoma received notice of its selection as one of 12 communities to participate in the Center for Medicare and Medicaid Services (CMS) Electronic Health Records (EHR) Demonstration Project. Although CMS cancelled this project in 2009 to align funding opportunities with those passed under the American Recovery and Reinvestment Act of 2009 (ARRA), Oklahoma's selection reflected the state's record for advancing HIE through multi‐stakeholder involvement and readiness for adoption and exchange using Health Information Technology (HIT). OHIET Revised Strategic Plan Page 5 Oklahoma’s HIE History at a Glance Year Event Results 2004 OK participates in HISPC • OK HIE Act • Standard Authorization Form 2005 SMRTNET (state’s first HIO) became operational • Paved way for several other regional HIOs 2008 OK selected for CMS EHR demonstration project • Acknowledgment of accomplishments of HIE in OK 2009 Health Information Infrastructure Advisory Board (HIIAB) set up by legislature • OHCA became hub for state agencies exchange 2010 Oklahoma Health Information Exchange Trust (OHIET) set up by legislature GTHAN receives Beacon Community grant • OHIET became SDE for OK SHIECAP and governance of state HIE • Major new HIE for NE OK In 2009, the Oklahoma legislature demonstrated Oklahoma's commitment to HIE amongst government agencies by enacting legislation that created the Health Information Infrastructure Advisory Board (HIIAB). The board is comprised of a number of state agencies involved in various aspects of public health. The legislation directed the board to assist Oklahoma's Medicaid Agency, OHCA, in developing strategic approaches for adoption of electronic medical records technologies and HIE. The legislation also directed OHCA to serve as the hub for exchange amongst state agencies. Finally, Oklahoma’s 2010 legislative session enacted SB 1373, setting up a new public trust, the Oklahoma Health Information Exchange Trust (OHIET). OHIET serves as the organizational structure and state‐designated entity (SDE) for SHIECAP funding and activities. OHIET is a state‐beneficiary public trust created under legislation expressly aimed at establishing an entity capable of serving not only as Oklahoma's permanent SDE during the SHIECAP grant period, but that will also ensure the state meets future meaningful use requirements and the full advancement of HIE throughout the state. Working closely with the state’s Regional Extension Center (REC), Beacon Community, other HIOs, and our broadband initiatives, OHIET will expand existing resources and leverage new and increasing resources to promote future HIE activities and meet the goals set by ONCHIT. OHIET Revised Strategic Plan Page 6 1.1.2. Vision, Mission and Goals of OHIET Vision Statement: Every Oklahoman will benefit from the improved quality and decreased cost of healthcare 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. Mission Statement: OHIET will enable all Oklahoma providers to rapidly locate and access sources of patient data maintained anywhere in the state, in accordance with all state and federal laws. OHIET will facilitate electronic access to shared patient data utilizing a single query which may be submitted either in conjunction with, or separate from, an electronic medical record. OHIET will operate in a secure environment and will eventually be self‐sustaining ‐‐ not relying upon state‐appropriated funds. OHIET will ensure that key data elements, as required for Meaningful Use and patient safety, be accessible statewide and nationally, including the Nationwide Health Information Network (Direct) and will include structured lab data, pharmacy data, and immunizations from all willing and available providers whom contract with Medicaid across the state, as relevant for the provider type. OHIET will work with providers, state agencies, payors and stakeholder organizations to develop and operate statewide HIE capabilities via a network of networks, which will be electronically accessible to all participating providers. OHIET will work with all stakeholders to provide operational oversight1 and to create and adopt standards, master patient identification protocols, provider indices, record locator services, and related technical infrastructure to assure statewide access to patient data regardless of which HIE network houses the patient data. OHIET will ensure seamless and secure integration and transmission of data throughout all HIE networks in Oklahoma and into neighboring networks. OHIET will leverage existing HIE infrastructure, both operational and planned, to close service and care gaps and facilitate urban, suburban and rural connections for all willing hospitals and providers. OHIET will advocate for the use of HIE/HIT by all providers and patients throughout the state, as well as promote legislation and policies that will enhance and enable effective use of HIE/HIT. OHIET will assist in the public awareness and education on information, use and merits of the HIE and HIT systems. 1 Intended to reflect the participatory management created by the Advisory Board, as well as the ”network of networks” concept where individual networks participating in the state HIE manage their own data and operations. This also assures that the state won’t usurp operational control of these networks. OHIET Revised Strategic Plan Page 7 OHIET may either subsidize the expansion of coverage into service gap areas with financial support for interface development or related infrastructure needs, and/or contract directly with vendors to address unmet needs, as required. OHIET is not obligated to support or encourage any single HIE effort, but is intended to act in the best interest of the providers and patients of Oklahoma. OHIET may provide financial support for the development of basic needs common to all Oklahoma‐based HIE networks. OHIET will collaborate and coordinate with other ARRA funded initiatives in the state including the Regional Extension Center and Beacon Community efforts to leverage resources, avoid duplication of cost and work efforts, and share best practices. OHIET Clinical Quality and Performance Improvement Goals include: Oklahoma is one of the worst‐performing states in healthcare in the nation. The Commonwealth Fund, both in 2007 and again in 2009, ranked Oklahoma’s overall health system 50th among the states in the United States. Public health researchers have observed that Oklahomans born today have a shorter age‐adjusted life expectancy than their parents. Clear gaps are evident in the performance of the health systems.. Oklahoma believes a strong HIE infrastructure is a key element to alleviate health disparities in our state and raise the overall health quality. OHIET is collaborating with the REC, our Beacon Community and the regional HIOs in the state, to align efforts to meet HIE goals and objectives. OHIET Revised Strategic Plan Page 8 OHIET Clinical Quality and Performance Improvement Goals State Objectives (Qualitative Targets) Measurable Outcomes (Quantitative Targets) Anticipated Health IT Outputs (Target Year) COST-EFFICIENCY Justification: Oklahoma ranks 45th in the nation in terms of re-hospitalization rates. Improving HIE usage will result in fewer re-hospitalizations and duplicated services, thereby lowering health care expenditures by an estimated 5-7%. 10% reduction in overall hospital readmissions and ED visits regarding asthma, COPD and CHF CE1: Reduce preventable hospitalizations and Emergency Department visits for Ambulatory Care and sensitive conditions 5-7% decrease in total aggregate State Medicaid and Medicare expenditures CE2: Reduce duplicate and inappropriate testing, diagnostic procedures, and specialty referrals Reduce the number of duplicate lab tests by 10%; reduce referrals to specialty care by 10% CE3: Reduce costs for duplicate technologies/eMPI/governance and legal across providers, institutions and other ARRA efforts TBD Advanced HIE implementation rates and provider adoption rates beyond 75% (2015) QUALITY OF CARE Justification: Connecting underserved populations to HIEs will allow faster access to other facilities and specialists and support improvements to transitions of care. Increasing the number of HIE users leads to better communication and more accurate diagnoses, thereby improving medication reconciliation and reducing the number of adverse drug events or medical errors. QC1: Increase timely access to specialty care for rural, tribal, uninsured and other potentially underserved populations Decrease patient wait times for initial specialist opinion to 10 business days via HIE messaging and e-referrals. (We are testing this data on a regional basis.) QC2: Improve transitions of care and patient safety by improving the medication reconciliation process TBD Enhanced communication between healthcare providers (2015) OHIET Revised Strategic Plan Page 9 and accuracy across inpatient settings and provider offices POPULATION HEALTH Justification: The Oklahoma State Health Rankings demonstrates how all the goals tie to health disparities. Increasing statewide vaccination rates and prevention screening will improve care for those currently whose needs are currently unmet, thereby reducing health disparities. In addition, chronic disease management efforts can be focused on high-risk populations due to improved HIE tools for communication and epidemiological analysis. 10% increase in the number of Pneumovax and Influenza vaccinations 10-20% increase in the number of lipid panels performed PH1: Increase the number of patients using preventative services 3-5% increase in the number of patients having regular mammograms and PSAs PH2: Improve public health outcomes for CHF, DM, smoking cessation and alcohol usage 5-10% reduction in smoking rates and alcohol usage. Reduction of 1% in population aggregate HgA1C for DM. Decrease CHF admissions by 10% Evaluation tools that allow for advanced analytics and performance feedback systems (2015) 1.1.3. Purpose of OHIET OHIET has the following items expressly delineated into the articles of indenture for the public trust: a) Establish and maintain a framework for the statewide exchange of health information, and encourage the widespread adoption and use of EHR systems among Oklahoma health care providers, hospitals, pharmacies, laboratories, payors and patients. b) Promote and facilitate the sharing of health information among health care providers within Oklahoma and in other states by providing for the transfer of health information, medical records and other health data in a secure environment for the benefit of patient care, patient safety, reduction of duplicate medical tests, reduction of administrative costs and any other benefits deemed appropriate by the trust. c) Establish and adopt minimum standards and requirements for the use of health information and the requirements for participation in trust‐certified OHIET Revised Strategic Plan Page 10 HIEs for persons or entities including, but not limited to, health care providers, payors, laboratories, pharmacies and local HIEs. d) Establish minimum standards for accessing the HIEs certified by the trust to ensure that the appropriate security and privacy protections apply to health information, consistent with applicable federal and state standards and laws. The trust shall have the power to suspend, limit or terminate the right to participate in certified HIE for non‐compliance or failure to act, with respect to applicable standards and laws, in the best interests of patients, users of certified HIE or the public. The trust may seek all remedies allowed by law to address any violation of the terms of participation in certified HIE or applicable statutes and regulations. e) Identify and overcome barriers to the adoption of EHR systems. Efforts may include assistance with broadband initiatives and researching the rates and patterns of dissemination and use of EHR systems throughout the state. Partner closely with the REC and professional organizations to ensure rural Oklahoma providers, hospitals, laboratories and pharmacies can contribute and receive data via HIE. f) Solicit and accept grants, loans, contributions or appropriations from any public or private source and expend those moneys, through contracts, grants, loans or agreements, on activities it considers suitable to the performance of its duties. g) Determine, charge and collect appropriate fees, charges, costs and expenses from certified healthcare provider or entity in connection with its contractual duties. h) Employ, discharge or contract with staff, including administrative, technical, expert, professional and legal staff, as is necessary or convenient to carry out the purposes stated in this Article III (Please see Appendix 3.3, OHIET Indenture) . i) To plan, establish, develop, construct, enlarge, remodel, improve, make alterations, extend, maintain, equip, operate, lease, furnish and regulate inter‐HIE exchange for the benefit of patients. j) To construct, install, equip and maintain any hardware, software, technology, equipment and programs necessary for the interoperability of HIEs certified by the trust. k) To construct, equip and maintain any facilities for the development, maintenance and operation of the interoperability HIEs certified by the trust. l) To acquire by lease, purchase or otherwise, and to plan, establish, develop, construct, enlarge, improve, extend, remodel, maintain, equip, operate, furnish, regulate and administer any and all physical properties (real, personal or mixed), intellectual properties (copyrights, trademarks, patents, licenses), rights, privileges, immunities, benefits and any other things of value, OHIET Revised Strategic Plan Page 11 designated or needed in establishing, maintaining and operating the core components required for the interconnection of multiple exchanges. m) To finance, refinance and enter into contracts of purchase, lease‐purchase or other interest in, or operation and maintenance of, the properties and other assets listed in paragraphs (e) and (f) above, and revenue thereof, and to comply with the terms and conditions of any such contracts, leases or other contracts made in connection with the acquisition, equipping, maintenance and disposal of any of said properties; and to relinquish, dispose of, rent or otherwise make provisions for properties owned or controlled by the trust but no longer needed for trust purposes. n) To transact business anywhere in the state of Oklahoma to the extent it benefits the citizens of the beneficiary. o) To provide funds for the cost of financing, refinancing, acquiring, constructing, purchasing, equipping, maintaining, leasing, repairing, improving, extending, enlarging, remodeling, holding, storing, operating and administering the core components required for the interconnections of HIEs and any or all of the properties and assets indicated in paragraphs (e) and (f) above needed for executing and fulfilling the trust purposes as set forth in this instrument and all other charges, costs and expenses necessarily incurred in connection therewith and in so doing, to incur indebtedness, either unsecured or secured by all or any part of the trust estate and its revenues. p) To expend all funds coming into the hands of the trustees as revenue or otherwise for the payment of any indebtedness incurred by the trustees for purposes specified herein, and in the payment of the aforesaid costs and expenses, and in payment of any other obligation properly chargeable against the trust estate, and to distribute the residue and remainder of such funds to the beneficiary upon termination of the trust. 1.1.4. Operations Plan Elements In the Operations Plan that follows, execution of OHIET strategies are outlined in six key areas, as follows. Emphasis, in the Operations Plan for the first year is around executing these elements in pursuit of meeting Stage 1 Meaningful Use in Oklahoma. 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 OHIET Revised Strategic Plan Page 12 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. 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. 1.2. Environmental Scan Outcomes for Oklahoma 1.2.1. Current and Planned HIOs for Oklahoma The environmental scan depicts Oklahoma’s multiple regional HIEs in their varying stages of development or operation. The regional HIEs are the foundation for the statewide “network of networks” and are committed to participate in a statewide interoperable exchange of healthcare data and the attendant enabling activities. Each regional HIE is described further in this section. EHR adoption rates were higher than expected for providers eligible for incentive payments. Understanding of EHR functionality by office staff, however, was shown to be sub‐optimal and an area of needed focus to meet OHIET objectives. All HIEs included in this study are focusing on the core elements of the CCD including demographics, drug allergies, prescription history, coded problems, structured lab data and the ability to both receive data and transmit data. These HIE have contributed to the growing set of standards that will be adopted by OHIET. Areas of focus for both the REC and OHIET include functionality to meet meaningful use in both e‐prescribing and lab ordering and reporting. OHIET, the REC and the regional HIOs have incorporated faculties to ensure all providers, hospitals, pharmacies and laboratories have appropriate information and guidance to enable/select their core EHR and institutional electronic systems and extending these services to all areas of the state. OHIET Revised Strategic Plan Page 13 NHIN Direct may be leveraged as an agent to deliver HIE for those providers and hospitals that choose not to participate in an existing or future network within the OHIET network of networks. A summary of each HIE follows. 1.2.1.1. Heartland HealthNet Heartland HealthNet is owned by the Oklahoma State University Center for Health Sciences (OSU‐CHS). Its membership is comprised of rural critical access hospitals and OSU faculty. Heartland HealthNet currently exchanges referral data within its HIE. The exchange of clinical data is planned for a summer 2010 implementation. Heartland HealthNet’s original mission to connect four small rural hospitals to a large tertiary hospital center has grown to include OSU adjunct faculty and clinics. Heartland HealthNet is based on Covisint’s ExchangeLink product. Cloud applications are available to bring services into a customized view. ExchangeLink also supports interfaces to the majority of EHR vendors. 1.2.1.2. Secure Medical Records Transfer Network of Oklahoma (SMRTNET) SMRTNET is a public non‐profit system of networks including Greater Oklahoma City Hospital Council GOCHC, Norman Physician Hospital Organization (NPHO), Open Access Network for all Oklahoma providers, the northeast Oklahoma network, and the Health Alliance for the Uninsured. SMRTNET has also supplied HIE planning services to the Greater Tulsa Health Access Network (Greater THAN, a Beacon Community network), Tulsa Hospital Council, the state’s community health centers, and several other networks currently in development. Networks using SMRTNET share over $2 million in assets and harmonize HIE to HIE data exchange through common policy, consensus management, shared legal documents and shared security measures. The current shared SMRTNET database includes a master patient index (MPI) of approximately 4 million patients, 16 million diagnoses, 52 million immunizations/results, and data provided by over 11,000 providers from all 77 counties in the state of Oklahoma. SMRTNET is exchanging data across urban, suburban and rural care areas and includes both hospital and ambulatory data. SMRTNET currently includes structured data for diagnosis, immunizations, drug allergies, medications, laboratory results and incorporates e‐prescribing through its portal. Thousands of physicians, practitioners and nurses across the state are currently and actively using SMRTNET to provide safe and high quality patient care. SMRTNET evolved as part of an Agency for Healthcare Research and Quality (AHRQ) effort to develop working model HIEs for the country. The outcome is successfully providing networking services that include private providers, hospitals, Native American tribes, state agencies, universities and mental health facilities. The cost to develop this capacity has exceeded $4 million over a five‐year period. Currently, there are 46 entities exchanging data across Oklahoma; 23 in the rural areas and 23 in urban areas. OHIET Revised Strategic Plan Page 14 1.2.1.3. Oklahoma Physicians Health Exchange (OPHX) Norman Physician Hospital Organization (NPHO) is operating an integrated clinical network using a community EHR. NPHO selected eClinicalWorks as the platform to create a community electronic record for patients. Electronic Health Exchange (eEHX) provides interoperability between the NPHO physicians, ambulatory centers and hospitals connecting their EHRs. Additional data sources and services have been added to the OPHX by joining SMRTNET as an affiliate. Approximately 150 providers in the Norman and Purcell areas participate in the OPHX effort. OPHX currently allows the secure passage of a CCD, electronic messaging, referrals, laboratory orders, results and prescription history. 1.2.1.4. Greater Oklahoma City Hospital Council Exchange (GOCHC) GOCHC started with nine hospitals to form a regional HIE to improve the efficiency and overall coordination of care to all patients. GOCHC began its initiative three years ago with a special focus on caring for the uninsured presenting in emergency departments. The focus has expanded well beyond the ER to include all providers, hospitals and data contributors in the greater Oklahoma City region. The exchange has grown to 30 hospital members across the state and the Health Alliance for the Uninsured clinics. The GOCHC exchange is a SMRTNET affiliate with a separate governing body. 1.2.1.5. Greater Tulsa Health Access Network (GTHAN) GTHAN exists to improve health outcomes for the citizens of the greater Tulsa area. The project has received a $12 million Beacon Community grant from ONC. The HIE will provide access to 1,600 providers and improve the care coordination and disease outcomes of their patients. The group has selected Covisint ExchangeLink to accomplish the task and will provide a significant resource for NE Oklahoma, rural, urban and suburban hospitals, providers, laboratories and pharmacies with best practice for EHR adoption to facilitate the expansion of HIE. GTHAN will also provide additional insight as a newly established HIE and collaborative community effort for technology, standards and best practices for HIE to OHIET. 1.2.1.6. Summary of the Current Gaps in HIE in the State of Oklahoma With a six year maturation of HIEs in the state, Oklahoma has a very good start on coverage. Major HIOs are running and exchanging data in most populated parts of the state. These facilities will be bolstered and improved by the additional funds afforded them by ARRA. Elements of Stage 1 Meaningful Use will be met by all eligible providers through existing and planned HIOs and, where broadband coverage is limited, by ASP models and other functionality made available by SMRTNET. We anticipate no difficulty in meeting Stage 1 HIE access requirements in FY2011. OHIET Revised Strategic Plan Page 15 1.2.2. Broadband The disparity in broadband infrastructure between the urban and rural areas of Oklahoma is problematic, particularly in areas where bandwidth is unavailable or unaffordable. Oklahoma has received three grants, through ARRA, that make great headway on bringing broadband access throughout the state. The Oklahoma Community Access Network (OCAN) received $74 million to build more than 1,000 miles of fiber‐optic cable along 13 segments of interstates and highways in 33 counties. Exhibit 1 – Proposed Broadband Backbone for the State of Oklahoma An excerpt from the OCAN Executive Summary: The Oklahoma Community Access Network (OCAN) proposal presents an unprecedented opportunity for Oklahoma to meet the demands of life in the 21st century. Easy and reliable access to technology for Oklahomans to travel along the information highway is as essential in today’s world as the construction of rail was to Oklahoma’s settlement. OHIET Revised Strategic Plan Page 16 Oklahoma is the 20th largest state in the nation with a population of just over 3.5 million people. 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. The action plan for Oklahoma’s future is focused squarely on today’s knowledge‐based economy requiring highly educated, technology proficient Oklahomans who can access and use investments in technology infrastructure to their benefit. With Oklahoma’s significant rural base across a geographically large area, access to broadband is the key to growth and prosperity. Creating access to basic services through technology means Oklahomans in the most remote areas of the state can be in contact with public service providers, can access distant learning and health care services and can communicate with their government and one another more readily. OCAN’s proposal seeks to build 1, 005 miles of new middle‐mile fiber infrastructure to connect 32 anchor institutions in underserved and unserved areas of the state where a broadband penetration rate barely reaches 25% in some cases. 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. OCAN’s grant request is $73,998,268 with a proposed cash and in‐kind match of 20.4%. OCAN’s proposal will leverage existing state assets with federal funding to address the great disparity in broadband access between urban and rural areas of Oklahoma. OCAN principals have more than thirty decades of experience developing and sustaining public/private partnerships with broadband and telecommunications providers. It is the goal of the OCAN proposal to expand its partnerships with the commercial provider community to provide broadband to all areas of the state in the most cost‐effective and efficient manner possible. In addition to the private providers mentioned specifically in the application, other partnerships are being pursued and will continue following the submission of this application. It is anticipated that 863 jobs will be created as a result of this project. OHIET Revised Strategic Plan Page 17 Community Anchor Institutions Miles from Current Anchor Institution City Backbone 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 OHIET Revised Strategic Plan Page 18 Additionally, 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. Finally, Pine Telephone Co. received about $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. OHIET is in contact with the OCAN team and we will work in concert to ensure alignment of goals and plans. We do not anticipate broadband limitations to impact ability to meet Stage 1 Meaningful Use or future OHIET goals. We believe the OCAN and other broadband plans greatly enhance the HIE plans for Oklahoma. 1.2.3. Levels of Technology Development and EHR Adoption in Oklahoma Oklahoma’s providers and hospitals are in various stages of automation, with larger, more urban organizations generally having partially or fully implemented EHRs versus smaller and rural practices and hospitals including Critical Access Hospitals, on the slower end of adoption. Mid‐sized organizations, such as Federally Qualified Health Centers (FQHCs)/Rural Health Clinics (RHCs) and multi‐provider groups, fall somewhere in the middle when using, adopting and implementing EHR/EMR solutions. Exhibit 2 shows the results of overall EHR adoption among eligible provider groups for incentive payments. Exhibit 2 Percentage of Providers Reporting EHR/EMR by Group Indian Health Service (IHS) providers have the highest rate of current EHR adoption of any provider category in Oklahoma. IHS has access to EHR capabilities through the federal Resource and Patient Management System (RPMS). Of the 475 IHS health professionals that responded, 88% indicated they had an EHR/EMR. OHIET Revised Strategic Plan Page 19 Only 23% of the rural hospitals surveyed indicated they had an EHR/EMR. 54% of urban hospitals surveyed have an existing EMR. Of all surveyed, only 64% of hospitals reported having access to broadband services (36% reported no broadband access). Exhibit 3 Indian Health Service and Tribal Providers Regarding Oklahoma’s Community Health Center (CHC) organizations, 15 of 17 (88%) have implemented an ambulatory EHR; most CHCs currently have broadband service. The REC, regional HIOs and OHIET are working together to identify and target most needy areas, set up faculties for guidance and information provision on EHR/EMR, and engineer a set of solutions to meet Stage 1 Meaningful Use. 1.2.4. E‐prescribing Readiness and Adoption Electronic prescribing capabilities are growing in Oklahoma. In 2009, according to SureScripts, 18% of all physicians have systems that allow the routing of prescriptions electronically and 10% of all prescriptions were routed electronically. Only 3% of patient visits, however, resulted in a medication history request. The Oklahoma Pharmacy Association reports that 85‐90% of all pharmacies are currently capable of accepting electronic prescriptions (corporate pharmacies at 100% while independent pharmacies are at 75‐80% including rural areas). OHIET and other state leaders will spearhead activities to drive adoption of e‐prescribing by all pharmacies statewide. OHIET has a program to partner with small pharmacies, which may find the start‐up costs of electronic prescribing prohibitive, that offers a financial incentive program to assist them with these costs. To drive EHR adoption and create demand for e‐prescribing capability at the pharmacy level, a collaboration between the Oklahoma Pharmacy Association, the REC, and State Medical Associations to assist and guide rural providers on benefits and best practices of EHR. In addition, OHCA (the state Medicaid agency) has aligned with SureScripts to include in their contracts a requirement that state Medicaid participating pharmacies participate in electronic prescribing. OHIET Revised Strategic Plan Page 20 OHIET recognizes that a successful statewide HIE requires complete pharmacy electronic prescription data and that this is a key component for helping all providers and hospitals qualify under Meaningful Use. OHIET also recognizes the challenges for electronic prescribing as they relate to controlled substances and intends to promote the development of protocols to allow this functionality in a seamless fashion for providers and pharmacies as these issues are further clarified. 1.2.5. Laboratory Readiness Another key component of meeting Meaningful Use criteria for providers and hospitals is the ability to transmit structured lab data. OHIET intends to certify standards by which laboratory data can pass from HIE to HIE via LOINC coding. Ultimately, success of this program is contingent upon the thorough adoption of EHR and, as stated elsewhere in this plan, we will partner with the REC and professional and hospital associations to ensure the infrastructure and services are adequate to meet Meaningful Use by all eligible providers. The initial 2011 goal for OHIET will be for laboratory result reporting with consideration for the submission of laboratory orders in 2013 and beyond. The analysis of Oklahoma’s current laboratory electronic result reporting is taken from data collected by SoonerCare. The top 19 paid laboratories by SoonerCare represent 82% of all SoonerCare dollars paid to labs in 2010. The list follows. 1 DIAGNOSTIC LABORATORY OF OKLAHOMA OKLAHOMA CITY OK 73108 $7,563,764.57 2 OK STATE DEPT OF HLTH PUBLIC HLTH LAB OKLAHOMA CITY OK 73117 $4,322,648.51 3 REGIONAL MED LAB TULSA OK 74114 $3,462,095.35 4 CLINICAL PATHOLOGY LAB AUSTIN TX 78754 $1,582,117.03 5 NATIONAL HLTH LAB DALLAS TX 75230 $1,529,819.42 6 QUEST DIAGNOSTICS CLINICAL LABORATORY INC SJ CAPISTRANO CA 92675 $1,318,773.44 7 SAINT FRANCIS OUTREACH SERVICES LLC TULSA OK 74136 $1,066,615.57 8 AMERITOX, LTD MIDLAND TX 79705 $844,472.87 9 PACIFIC TOXICOLOGY LABORATORIES CHATSWORTH CA 91311 $829,815.66 10 QUEST DIAGNOSTICS CLINICAL LABORATORY INC IRVING TX 75063 $825,186.80 OHIET Revised Strategic Plan Page 21 11 OUHSC GENETICS LAB OKLAHOMA CITY OK 73104 $645,658.89 12 GENZYME GENETICS SANTA FE NM 87505 $560,186.32 13 GENZYME GENETICS WESTBOROUGH MA 01581 $522,369.12 14 LABORATORY CORPORATION OF AMERICA SAN ANTONIO TX 78213 $504,770.25 15 HEARTLAND PATHOLOGY CONSULTANTS PC EDMOND OK 73034 $430,464.78 16 WINDSOR PARK MEDICAL CLINIC OKLAHOMA CITY OK 73107 $395,238.59 17 MEDICAL DIAGNOSTICS LABORATORIES LLC HAMILTON NJ 08690 $365,380.04 18 BIO REFERENCE LABORATORIES INC ELMWOOD PARK NJ 07407 $355,268.83 19 DIAGNOSTIC PATHOLOGY SERVICES PC OKLAHOMA CITY OK 73112 $344,373.84 $27,469,019.88 OHIET is in the process of confirming the following set of assumptions: 1. This is representative of the pay portions to labs from all major payors in our state. 2. The 19 labs listed have electronic results reporting capabilities. 3. The remaining 18 to 20% of labs registered in the state are likely draw stations and small laboratories that have access to electronic resulting via their selected reference laboratories. OHIET recognizes the gap in laboratory reporting will be primarily via rural hospital laboratories including critical access hospitals. The REC and EHR adoption is intended to help close this gap as well as close partnership with reference laboratories to expend their electronic/technologic infrastructure to comply with Meaningful Use for all providers within the state. OHCA currently requires all laboratories, under contract with their organization, comply with OHIET and HL7 laboratory reporting standards. It is the intention of OHIET to partner with private payors, as well, to facilitate the same actions in their contracts with laboratories. OHIET Revised Strategic Plan Page 22 1.2.6. Additional Statewide Readiness OHIET believes EMPI services will be critical to the success of HIE utilization, adoption and ‘network to network’ connections. OHIET is currently working on the feasibility of providing a statewide EMPI to regional HIEs . Provider directories present another challenge for Oklahoma as a primarily rural state. OHIET is presently working on the feasibility of partnering with state HIOs to maintain an updated and cohesive provider directory. This is a pathway to ensure adequate electronic exchange, referrals, reporting and messaging to facilitate the highest quality and the safest patient care. OHIET has established a working group to define the minimum requirements of a CCD for HIE and to develop protocols for ‘network of networks’ sharing in order to create consolidated views for providers and avoid the need for multiple HIE connections. OHIET is setting up collaborative teams with payor organizations within the state. Key outcomes of this association are the active participation in the statewide HIE and the preparation for 2013 and beyond for requirements for electronic eligibility checking and prior approvals. OHIET is considering record locator services, credentialing services, public health reporting services, immunization reporting and consent management services as areas with potential for leveraged services across the state, overall healthcare cost reduction and as revenue sources for OHIET. Other platforms, established by our two state university medical programs and large hospitals, provide springboards for OHIET. Oklahoma benefits from a well developed set of telemedicine networks. These networks are operational and provide specialty care to rural and underserved areas. This infrastructure provides a pathway to further the goals of OHIET and meet Meaningful Use. OHIET Revised Strategic Plan Page 23 1.3. Oklahoma’s Strategy for Stage 1 Meaningful Use Element: Eprescribing available to all eligible providers Gap Recognized Strategy Actions Actors 1. There are approx 25% pharmacies in the state that do not have e-prescribing faculties. 2. Rural pharmacies not on board because they do not have the ‘market pull’ by local providers; they see no need to undergo the expense • Determine areas of greatest need • Reduce capital requirements • Create demand from providers to drive e-prescribing capabilities at the pharmacy-level • Create demand from payors at the pharmacy-level • Team with small pharmacies and offer financial incentive programs to assist with start up costs • Train local providers on benefits of e-prescribing and on alternatives, i.e., internet prescribing and the advantages to the end users (patients) • Develop curriculum to educate end users, providers and pharmacies • OHCA and SureScripts have contract req’s for Medicaid participating pharma’s to provide e-prescribing – leverage this and encourage other payors to participate similarly • OHIET/OPA/REC/OSMA • OHIET/OPA/REC/OSMA • OHCA/SureScripts/Payor s Element: Receipt of structured lab results available to all eligible providers Gap Recognized Strategy Actions Actors 1. The large labs are in compliance. For the smaller labs, especially those associated with rural providers, it is unknown. 2. Rewards for MU are not as apparent for labs • Focus on laboratory result reporting first; confirm capabilities of large labs and those receiving payment from largest payors in OK • Provide incentives to labs • Demonstrate benefits • Form team with labs to understand landscape and areas requiring most intervention • Create education/awareness campaign with key benefits for labs and stakeholders • OHCA requires labs under contract to comply with OHIET and HL7 lab reporting standards; work with private payors to develop same • OHIET/Labs/Payors • OHIET/REC/HIOs • OHIET/OHCA/Payors OHIET Revised Strategic Plan Page 24 Element: Sharing patient care summaries across unaffiliated organizations available to all eligible providers Gap Recognized Strategy Actions Actors 1. Sharing patient care summaries will require HIE connectivity to hospitals and EP’s. Less than 5% of EP’s are live with HIE. 2. HIE Networks will need to share and combine CCD’s to EP’s on other HIE networks. 3. EMPI and Provider Registries will be a rate limiting factor of cross connections 4. HIPAA and HITECH Implications of internetwork connections. • OHIET will endorse a network of networks and will support the existing and new HIE networks connections to EP’s • OHIET will collaborate with the REC and EP’s and MU funding to support their HIE connectivity • OHIET will help establish standards for network to network connectivity and security protocols and messaging protocols consistent with Direct. • OHIET will work with existing networks, new networks and potentially create services for EMPI and Provider Registries for the State • Exploration of DURSA (sp) and current state HIE legal policies • Incentive programs for HIE’s and EP’s in areas of low penetration of HIE. Particularly rural areas. • Collaboration between the REC and HIE networks to do support and offerings of HIE with EHR to EP’s. • Education to EP’s and marketing to EP’s of the benefits and use case of HIE. • Establish inter-network HIE connection standards for security and privacy. • Assess current EMPI and provider directory services live in the state as well as proposed solutions to ensure the success of a network of networks model. Awareness that OHIET may have to create an add on service to parallel the network of networks. • Exploration of current legal and governance agreements, DURSA and develop a strategy to protect EP’s who have contributed data to HIE in case of a data breach or end user misuse of HIE data. • OHIET • REC • Agencies • Existing Networks • New Networks • EP’s • Medical Associations OHIET Revised Strategic Plan Page 25 Element: Ensuring broadband access availability Gap Recognized Strategy Actions Actors 1. 36% hospitals report no access to broadband 2. Disparity of access to broadband between rural and urban parts of state • Align project with ~$90M ARRA funds for state broadband initiatives • Provide awareness and guidance to providers/pharma/labs on EHR/HIE • Enable work-arounds to areas without broadband access • Work with OCAN and others to dovetail technology req’ts and goals for access throughout the state • Create consultancy, communications, education to assist rural constituents • Team with vendors to create array of solutions for rural providers • OHIET/OCAN/OSU/Sec’y of State • OHIET/REC/HIOs • OHIET/Vendor community Element: Promoting effective use by all eligible providers Gap Recognized Strategy Actions Actors 1. 23% of rural and 54% of urban hospitals have EMR 2. 47% of non-hospital professionals have EHR • Create ‘pull’ by providers • Provide help, guidance and education to direct users of the HIE and the end users of healthcare • Ensure compliance with state and fed req’ts that result in better health outcomes for the state • Establish valuable products and services that will be standardized centrally and made available through local HIOs: vital stat’s; eMPI; immunization registries, etc. • Provide continuing incentives for providing by working with policies and legislation that promote HIE and better quality health outcomes for the state • Team with REC, Beacon, universities and others to provide survey, analysis, education, guidance, etc. to providers • Set up clear governance and policies and avenues for providers to achieve S1 MU and other req’ts • OHIET/HIOs/vendors • OHIET/REC/HIOs/Univ/Trainers • OHIET/REC/legislators OHIET Revised Strategic Plan Page 26 1.4. Health Information Exchange Coordination Strategies Coordination of strategies is hardwired with the Oklahoma authority responsible for Medicaid. The Oklahoma Health Care Authority (OHCA) is the state’s Medicaid agency and they were the State Designated Entity (SDE) in the SHIECAP proposal process (prior to OHIET’s establishment in the 2010 state legislative session) . OHCA has contributed many resources to the SHIECAP effort from the response to the ARRA FOA to the continued work in domain areas determining, documenting and implementing the strategic and operational approaches to a statewide HIE. In parallel process, OHCA staff have authored and received approval on the State Medicaid HIT Plan (SMHP). This set up has ensured a dovetailing of strategies between these efforts. Collaboration will be preserved between OHIET and OHCA in that John Calabro, the former OHCA Chief Information Officer who co‐chaired the Statewide Oversight Committee for SHIECAP, was appointed by Governor Henry of Oklahoma as the state’s first permanent Health Information Technology Coordinator. Mr. Calabro led an effort that focused on inclusiveness and collaboration of key stakeholders and ensured plans were coordinated with concurrent activities of HIIAB, Oklahoma’s REC, our Beacon Community grantee, OKHISPC and others. Regarding outreach to educate providers on the Medicaid EHR Incentive Program, the SHIECAP oversight work group coordinated with professional associations such as the Oklahoma Medical Association, Oklahoma Osteopathic Association, Oklahoma Hospital Association, Oklahoma Primary Care Association the FQHCs and RHCs, and the REC through operational provider workshops and quarterly meetings. Medicare Coordination Along With Other Federal Programs OHIET and the HIIAB are collaborating to attain widespread use of HIE by healthcare providers. Through partnerships with the REC, Beacon Community and professional and hospital organizations, OHIET will align incentives and drive adoption of EHR along with CMS, Medicaid and other federal programs. The OHIET ‘network of networks’ will result in an effective statewide HIE that will allow healthcare providers to exchange clinical information through their local HIEs, such as medication histories and laboratory results, electronic prescription history and medical summaries via a CCD at the point‐of‐care, and make better informed decisions with their patients. These plans will promote and support the effort of eligible professionals who wish to achieve Meaningful Use. The planned OHIET ‘network of networks’ will also outline Oklahoma’s current and future strategies to leverage existing EHR capacity, investment and broad stakeholder commitment to advance the HIE goals in Oklahoma. As indicated earlier in the Strategic Plan, the EHR incentive payments for Meaningful Use are a cornerstone of the Oklahoma HIE initiative and, supporting the ability of Medicare providers to participate in the Oklahoma EHR Incentives Program is a key objective. Oklahoma’s environmental scan and results of statewide HIE planning efforts have OHIET Revised Strategic Plan Page 27 indicated that the inclusion of Medicare data, along with other federal programs in statewide and interstate HIE, will be critical to the widespread use and sustainability of HIE in the state. OHIET will continue to request its federal partners make this data available so that Oklahoma providers can use the data and achieve Meaningful Use. OHIET is willing to work with Medicare, IHS, Department of Defense, Veterans Administration, and other federal programs to create a workable data exchange. 1.5. Domain Area Strategies 1.5.1. Governance 1.5.1.1. Structure to Achieve Results The Oklahoma Legislature passed Senate Bill 1373 (Appendix 3.2), which Governor Brad Henry signed into law on June 10, 2010. This legislation expressly approves the creation of a state‐beneficiary public trust named the Oklahoma Health Information Exchange Trust (OHIET). The trust has a governing board of seven trustees appointed by state officials as follows: three by the Governor; two by the Senate; and two by the House of Representatives. (Trustees are indentified in Exhibit 4.) OHIET is Oklahoma's state designated entity (SDE) to facilitate and expand the electronic movement and use of health information among organizations within Oklahoma and to ensure the goals of SHIECAP station behalf of Oklahoma. An Advisory Board, consisting of representatives from 18 to 25 organizations, will provide input and support to the board of trustees. (Exhibit 5, following.) OHIET recognizes that core infrastructure must be obtained via EHR’s for eligible providers, hospitals, laboratories and pharmacies in order to facilitate HIE and Meaningful Use criteria for the state. As previously mentioned in this plan, OHIET intends to promote the installation and adoption of EHR technology through partnerships with the REC, the regional HIOs, the university systems and others to provide training, guidance, consultation and information. OHIET will assure the development of statewide HIE standards based upon consensus of local and regional HIOs. In addition, standards will be inclusive of criteria for laboratory reporting, electronic prescribing and CCD receipt, generation, transfer and re‐generation . OHIET will monitor compliance with these standards. OHIET will disseminate best practices, help to ensure understanding of HIE and its policies and work to promote and sustain electronic HIE within Oklahoma. OHIET will ensure there are a clear strategic plan and a shared vision for the development of the statewide collaboration (short‐term and long‐term) and a fair representation of networks in the statewide governing body – in keeping with the ”network of networks” model. OHIET Revised Strategic Plan Page 28 Oklahoma’s Health Information Technology Coordinator also serves as the Executive Director of OHIET. The State HIT Coordinator, Mr. John Calabro, was appointed by the Governor Henry. Mr. Calabro sets the charter for the organization as decreed by the trustees, oversees the daily operations of OHIET, and serves as the public face of the organization. Mr. Calabro is in process of evaluating additional supporting staff; budgeted are a Chief Operating Officer, charged with top level management and daily outcomes in all domain areas, a business analyst to provide data collation, synthesis and analysis, and executive support. Each domain area is additionally supported by Advisory Board task forces and by paid industry experts. The Executive Director is an ex‐officio member of the board of trustees without voting privilege. Exhibit 4, OHIET Board of Trustees Trustee Appointer and Term Robert H. Roswell, MD, Board Chairman Gov. Henry July 31, 2014 Jenny Alexopulos, DO, Board Vice Chair & Secretary Rep. Benge July 31, 2013 Samuel T. Guild Board Treasurer Sen. Coffee July 31, 2012 Julie Cox-Kain Gov. Henry July 15, 2015 Craig W. Jones Rep. Benge July 31, 2015 David Kendrick, MD Sen. Coffee July 31, 2015 Brian Yeaman, MD Gov. Henry July 31, 2011 1.5.1.2. Decision Making Authority All powers granted to OHIET under the Oklahoma Public Trust Act and other applicable local, state and federal laws will be exercised by and under the authority of the trustees. Additionally, the property, business and affairs of OHIET will be managed under the direction of the trustees in a manner consistent with the trust indenture (Appendix 3.3) and the bylaws of the trust (Appendix 3.4). The number of trustees will be seven (7) as prescribed in Oklahoma law. The conduct of the trust, including specifics of trustee terms, voting requirements, meeting procedures and so forth are prescribed by the trust indenture. OHIET will have an Advisory Board to provide representation of major constituencies served and to assist in the activities of the trust (Exhibit 5). Recommendations from the Advisory Board will be presented as an agenda item at a duly called meeting. The OHIET Revised Strategic Plan Page 29 trustees will give deference to and due consideration of the recommendations of the Advisory Board. The Advisory Board also will perform such other functions as may be directed by the trustees in connection with or in furtherance of OHIET. Subject to the approval of the trustees, the Advisory Board will be entitled to establish rules, regulations, policies and procedures relating to its operation, and standing and ad hoc committees and workgroups, in furtherance of its functions. 1.5.1.3. Set Up and Membership Representation OHIET trustees will have a working knowledge of HIE and background in health care. The OHIET Advisory Board provides broad stakeholder representation to the organization and will be composed of not fewer than 17 nor more than 25 persons including, at a minimum, one representative from each of the following: Exhibit 5 Advisory Board Member Organizations 1. Oklahoma Health Care Authority [Medicaid], Lynn Puckett, Director Contract Services 2. Oklahoma State Department of Health [Public Health], Rebecca Moore 3. Oklahoma Department of Mental Health and Substance Abuse Services, Terri White, OK Sec’y of Health 4. University of Oklahoma Health Sciences Center, Kevin Elledge, ED of Ops 5. Oklahoma State University Center for Health Sciences, Dr. James Hess, COO 6. A nominee of the Indian Health Service Office responsible for Oklahoma, Dr. Farris, CMO 7. A representative of Tribal interests, Mitch Thornbrugh, Cherokee Nation 8. Oklahoma Hospital Association, Rick Snyder, COO 9. Oklahoma Osteopathic Association, Dennis Carter, DO 10. Oklahoma Pharmacy Association, Jim Spoon 11. Oklahoma State Medical Association, Dr. Kent T. King 12. Oklahoma State Chamber of Commerce, Matt Robison, VP Small Business & Workforce Development 13. Security and privacy representative nominated by the Oklahoma Health Information Security and Privacy Council, Robn Green, OSDH and Vice Chair of OKHISPC 14. A HIE representative as nominated by the OHIET Board, Joseph Walker, Greater THAN 15. A consumer appointed by the Governor, pending 16. A nominee of the Oklahoma Regional Extension Center steering committee, Jonathan Kolarik, RN, Director of HIT 17. Oklahoma Association of Health Plans, Bill Hancock, VP & GM, CommunityCare Managed Health Plan 18. Representative of Oklahoma rural providers, Val Schott, Oklahoma State University 19. A second HIE representative as nominated by the OHIET Board, Mark Jones, SMRTNET Representation from up to six additional organizations OHIET Revised Strategic Plan Page 30 The trustee board may add up to eight additional memberships to the Advisory Board, from what is described in the trust indenture, as need for additional expertise and representation becomes evident. One representative of rural providers and one additional representative of HIE expertise have been added to the original 17 named in the indenture. 1.5.1.4. Oklahoma HIT Coordinator The Oklahoma HIT Coordinator (HITC) exists to provide leadership, direction, management and coordination of HIT strategy for the state of Oklahoma, which includes the implementation of federal and state requirements for HIT and HIE efforts. The HITC works cooperatively with multiple stakeholders, including healthcare providers, health plans, health profession schools, consumers, technology vendors, public health agencies and healthcare purchasers to identify existing resources, needs, commonalities of interest and project priority. Additionally, the Oklahoma HITC manages the plan that prescribes activities necessary to facilitate and expand the electronic movement and use of health information among organizations consistent with both state and federal HIT strategic plans. Oklahoma’s HITC also serves as the Executive Director of OHIET and he must carry out the responsibilities of this position along with the other duties of HITC. (Appendix 3.5 – Oklahoma HIT Coordinator Position Description used to guide the selection team in the process of identifying and choosing the office holder.) John Calabro, former CIO of OHCA, was selected and appointed by Governor Brad Henry as Oklahoma’s first permanent HIT Coordinator. Mr. Calabro took office on December 1, 2010. 1.5.1.5. Alignment with Nationwide Health Information Network (NHIN) Governance OHIET‘s governance model is designed to be compatible with emerging NHIN governance principles and functions. A pathway to Stage 1 Meaningful Use compliance is OHIET becoming the certifying authority of HIE in Oklahoma. Alignment with NHIN governance is designed as part of this certification process. In further compliance with developing policies and procedures from NHIN and ONCHIT, OHIET and our partners have planned curriculum and guidance to assist providers with both. Should entities fall outside of the OHIET network of networks, alignment directly with NHIN is Oklahoma’s strategy for Stage 1 Meaningful Use. 1.5.1.6. Alignment with State Medicaid Hit Plan (SMHP) This Strategic Plan, as well as the Operational Plan, under separate cover, are written in coordination with the initiatives set forth on the SMHP by the Medicaid agency, OHCA. The OHCA Chief Information Officer, Mr. John Calabro, (Mr. Calabro is now the appointed OHIET Revised Strategic Plan Page 31 State HIT Coordinator for Oklahoma) co‐chaired the Statewide Oversight Committee for the SHIECAP, and OHCA staff members participate on each of the domain area workgroups to ensure coordination of planning efforts. Emphasis is placed on collaboration of stakeholders and coordination of activities. This plan and the operational plan were developed for OHIET, by representatives from the Health Information and Infrastructure Advisory Board, Oklahoma’s Regional Extension Center, Beacon grant awardee, the Oklahoma Regional Extension Center, and key stakeholders throughout the state of Oklahoma. (A full list can be seen in Appendix 3.8). Outreach to educate providers on the Medicaid EHR Incentive Program was coordinated with professional associations such as the Oklahoma Medical Association, Oklahoma Hospital Association, Oklahoma Primary Care Association, the FQHCs and RHCs, and the REC through operational provider workshops and quarterly meetings to educate providers and minimize duplication of efforts. Collaboration with OHCA to assist providers in meeting Stage 1 Meaningful Use include contract provisions, set out by OHCA, with pharmacies, labs, and providers that enforce use of the OHIET network of networks. 1.5.1.7. Standards OHIET’s execution strategy is around development and promulgation of standards within the state in the following four, key areas: 1. Develop a process for evaluating and certifying health information organizations to ensure that every region of the state is served by a high‐quality health information exchange. Areas of focus for this activity will include, but not be limited to, evaluation of governance, technology, privacy and security policies and capabilities, and financial stability. 2. Consider, plan and implement 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 may include: a. Establishment of a statewide policy for privacy and security; b. Provision of electronic master indices services for person/provider/patient; c. Development of state agency data services (i.e., Immunization registry, vital statistics, etc.) to support all certified HIOs; d. The creation of a process and/or technology to enable statewide reporting of health and healthcare system outcome metrics from the network of HIE networks; and e. The potential establishment and oversight of a ‘health benefits exchange’ for the state. 3. 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, and judicial processes required to achieve these changes. OHIET Revised Strategic Plan Page 32 4. Interact and coordinate with equivalent organizations and leadership in neighboring states and regions, as well as the NHIN to ensure the seamless exchange of appropriate health information for patients receiving care in multiple states or regions. 1.5.1.8. Accountability and Transparency OHIET will employ rigorous accountability and transparency practices that include at least monthly status reports to the board of trustees and to the public. The trust is subject to the Open Meetings Act and adheres to the specific requirements therein. OHIET’s website, www.ohiet.org provides an outlet for public review and input. Financial accountability and transparency practices are set through the public sector and rule‐making authority of OHIET, as well as the contractual requirements of the Office of the National Coordinator of Health Information Technology (ONCHIT) and ARRA. OHIET’s board of trustees has financial oversight of the organization and is led by treasurer, Sam Guild. Regional and local HIEs will be held accountable for appropriate implementation of HIE practices through certification and accreditation policies of the governance entity. OHIET vendor contracts articulate accountability and transparency requirements. 1.5.1.9. Continued Opportunities for Improvement It is critical that all stakeholders have a place at the table in shaping HIE policy in Oklahoma. Experience of the REC, Beacon, existing HIOs, pharmacies, laboratories, hospitals and physicians enhance the success of OHIET. These entities participated and strengthened the work done in the SHIECAP process to date through the oversight work group, task forces in each domain area, and formally through other forums and informally through each member of the large team. As OHIET evolves, it will strive to continually take on new challenges to prepare the stakeholders within the state for later phases of Meaningful Use and become more skilled at optimizing input from valued stakeholders. OHIET seeks continued input through its advisory board, its consultants and through new channels including the OHIET website and the many planned outreach programs of OHIET and its partners. 1.5.2. Finance 1.5.2.1. Business Model To further the efforts of OHIET, the trust will establish a budget in line with our four areas of strategic execution, and specifically how these elements work toward meeting Stage 1 Meaningful Use across the state and set up for further meaningful use criteria: OHIET Revised Strategic Plan Page 33 1. Evaluate and certify regional HIOs to ensure that all parts of the state are served by a high quality HIE. 2. Develop and implement services and technologies that are best suited to centralized, statewide implementation. 3. Identify and assemble policy and statutory changes needed to support ongoing, appropriate, and secure health information exchange in Oklahoma. 4. Interact and coordinate with HIEs in neighboring states and regions, as well as the Direct Project. Key budget categories, in order to conduct OHIET business, include: 1. Human resources and support: OHIET plans a skeletal staff, led by the Executive Director and supported by a COO and analysts; overhead for these individuals is kept to a minimum, using donated office space and services where possible. They will be aided by legal, business, and domain area consultants to assist in professional execution of OHIET work. Financial management, oversight and reporting are required. It is anticipated that Advisory Board committees and Trustees will provide critical support in all these areas, allowing minimal levels of staffing in each to accomplish OHIET business. 2. Service and technology development: The assessment and development of products and services that would benefit the state and the regional HIOs to centralize. This may include master indices, data registries and vital statistics, reporting and metrics tools, etc. Focus will be on elements that encourage and stimulate the adoption of use of the HIOs/HIE. 3. HIE/HIO development: Closing gaps to meet Meaningful Use includes elements from partnering with other organizations to provide education, training and consulting services to eligible providers, to providing financial incentives to outlying cases where the benefits of the HIO/HIE are not immediate (i.e., in rural and/or under‐privileged areas of the state). 4. Advocacy and policy: Develop of policy for certification and compliance with OHIET and ONCHIT criteria to advocacy and policy development in the legislative arena are required for OHIET’s present and future success. In addition to the requirements set out by SHIECAP and ONCHIT, OHIET understands the need to generate funds at least equal those required for federal matching dollars in initial years of operations and to then be in a position to maintain the operation and administration of the “network of networks” in the future. This strategy is designed to accomplish both. OHIET will build ‘value add’ products and services with an eye toward market desirability in order to generate required revenues and become self‐sustaining. OHIET Revised Strategic Plan Page 34 FFY 2010 began October 1, 2009. The bulk of FFY2011 dollars will go toward ensuring Oklahoma meets Stage 1 Meaningful Use criteria. Budget details are included in the Operational Plan, Section 2. The establishment of statewide HIE, where every hospital and healthcare provider has access to patient information at the point‐of‐care will cost well beyond the funding available through this grant funding. OHIET will strive to catalyze and promote ways, through existing, planned and future local/regional HIOs, to accomplish this ambitious goal. 1.5.2.2. Approach to Sustainability The federal stimulus funding is designed to last four years, at which time the Office of the National Coordinator will hold HIEs accountable for sustainable revenue generating business models. The HIE business models will need to deliver value to a wide variety of stakeholders. Several sustainability models have been considered. Because OHIET is a “network of networks” model, customers are the state’s local and regional HIEs. Several discussions between OHIET and representatives from planned and existing HIEs have given rise to many ideas for value added products and services OHIET might provide for fees. Initially, OHIET plans to provide credentialing and certification services for fees to HIOs. Ancillary services to these, such as consultation, data sharing, etc., have revenue potential as well. Moving beyond the first few years and as the relationships between OHIET and regional HIEs mature, sustainability models will be designed to continually work toward raising patient care, ensuring efficiencies, and continuing to meet state and federal goals. 1.5.3. Technical Infrastructure 1.5.3.1. Interoperability 1.5.3.1.1. NHIN Connectivity OHIET’s interoperability strategy is to facilitate and promote connectivity across the state and also to neighboring states via NHIN. This ”network of networks” model provides flexibility for providers, facilities and other health‐related workers to join a network that bests suits their geographical location, referral patterns and business model while maximizing the ability to connect systems. OHIET Revised Strategic Plan Page 35 OHIET will assist in the creation of HIE processes that will accommodate both federated and centralized data connections across the state. At this time, Oklahoma intends to federate to bordering states and the NHIN. NHIN connectivity will be prioritized as the national effort moves forward and OHIET includes NHIN standards in certification criteria for HIE networks. 1.5.3.1.2. Standards Adoption OHIET’s bylaws (Appendix 3.4) establish the trust as the standard‐setting body for Oklahoma’s statewide HIE effort. Oklahoma will adopt ONC standards and HIE certification criteria. OHIET will facilitate the collaboration of state HIEs to determine and develop HIE standards for the state. All entities connecting to OHIET must pass a certification process. OHIET will assist in the streamlining of the certification process for qualified, eligible parties. 1.5.3.2. Enabling Meaningful Use in Oklahoma OHIET will assist providers in meeting all stages of Meaningful Use criteria. A summary of our plan to help meet Stage 1 Meaningful Use appears in Section 1.3. OHIET recognizes the criticality of meeting these goals by end of fiscal year 2011 and is directing all actions toward this outcome. Similar plans and operations for meeting goals will be developed as further stages of Meaningful Use are defined by ONCHIT. 1.5.3.3. Approach to Technical Architecture “Network of Networks” Model Oklahoma’s statewide HIE technical architecture strategy proposes a federated network model and contemplates a consolidated statewide Enterprise Master Patient Index (eMPI) and record locator service. The federated network creates the connection for the ”network of networks” approach adopted by Oklahoma. HIE networks will interconnect to form the statewide HIE, excepting IHS participants and tribal entities (who have established connection with NHIN and will maintain statewide connectivity via NHIN). OHIET services will be those that are leveraged by centrality of ownership, location, purchasing power, etc., to the benefit and use of the local HIEs. This model will be cost effective without recreating a large centralized infrastructure or duplicating costs and efforts of local HIEs. In addition, this will enhance OHIET’s sustainability by making it a value‐add, low cost organization. IHS and tribal entities may either connect directly or through a local network. OHIET Revised Strategic Plan Page 36 Exhibit 6: Oklahoma Statewide HIE Logical Architecture OHIET Revised Strategic Plan Page 37 Exhibit 6 depicts the Oklahoma logical statewide HIE technical approach. Networks, IHS and tribal entities will need to be certified before exchanging live data through the statewide network. OHIET will work to assist in timely certification of all participants wanting to use the network. The payors and state agencies will be encouraged to enhance their infrastructure to connect to state HIE to perform payor‐related tasks not associated with direct clinical care of patients. These tasks include electronic claims transactions, eligibility checking and quality reporting. OHIET will facilitate connections with the payors and state agencies for these functions. 1.5.3.4. Health Information Technology Components 1.5.3.4.1. Electronic Health Records (EHR) Any EHR in the state of Oklahoma will be required to adhere to national standards, including CCD exchange capabilities. All EHRs connected to OHIET must also adhere to policies of privacy and security, data integrity and so forth as promulgated by OHIET. OHIET reserves the right to remove EHRs that do not meet these requirements from the state program. OHIET’s role is to ascertain adoption rates and processes of state providers; identify gaps in uptake and analyze data that lead to patterns; work with state partners and national best practices to establish an array of solutions that will lead to meeting ONCHIT and Meaningful Use criteria; determine roles in implementing solutions and how best OHIET can participate; monitor closely and measure outcomes; adjust until goals are realized. 1.5.3.4.2. eMPI The eMPI is a key component of the statewide HIE. The statewide HIE strategy to enable cross‐network identity management is a pivotal goal for the statewide effort. Tracking patients across networks of care, state lines and the nation to provide a continuum of care is critical to providing patient‐centered care. OHIET is central to establishing an eMPI for the state. At present, OHIET is working on acquiring the bases for this data and a path to complementing it and making it available statewide. 1.5.3.4.3. Scalability The Oklahoma HIE strategy positions itself for future growth. Initial goals are to bolster EHR adoption, core systems in laboratories and pharmacies and connect existing and planned networks. This will promote use by providers seeking to achieve and demonstrate Meaningful Use and ensure that valuable and needed data is available at the point of care. Scalability is an important factor in meeting OHIET goals to ultimately see HIE coverage over the entire state. OHIET Revised Strategic Plan Page 38 OHIET���s role will be to ensure Phase 1 Meaningful Use requirements are met and then to continue to focus on necessary elements to be required in phases 2 and 3 of Meaningful Use, such as electronic eligibility checking, credentialing, and electronic order submission. 1.5.3.4.4. Public Health Technology The Oklahoma State Department of Health (OSDH) is in the process of planning, designing, developing, upgrading and expanding OSDH systems to allow EHR entities to meet Stage 1 Meaningful Use criteria (capability for OSDH to be able to accept EHR immunization data and verify that the Immunization electronic data submission is successful) and Stages 2 and 3 criteria and timeframes when defined. Specific OSDH projects have been initiated to upgrade both the Oklahoma State Immunization Information System (OSIIS) and Laboratory Information Management System (LIMS). Development of an OSIIS replacement is underway to modernize the system to meet industry best practices as well as conversion of the system to Microsoft .NET and SQL Server technologies. The completed OSIIS product will include an Unsolicited Vaccination Update (VXU) database repository that is envisioned to serve as the primary repository for incoming and future (Stage 2) outgoing Health Level Seven (HL7) messages (current projection is HL7 V2.5.1). Stage 3 meaningful use requirements are unknown at this time. OSDH is currently compiling information from larger Oklahoma related EHR’s and entities for prioritization in establishing and testing standardized processes for data import into the VXU repository. Multiple interoperability prototype projects with messaging partners are under discussion and consideration. Among these is a prototype project with VisionShare (now ABILITY) to receive Immunization VXU messages via DIRECT from EHRs and forward to OSDH using PHINMS transport. This enables Immunization messaging to OSDH via PHINMS or DIRECT. A Request for Proposal (RFP) for the OSDH LIMS has been developed that includes primary deliverables of HL7 accessioning, results reporting, and data repository interfaces. The RFP is currently transitioning through the procurement process. Simultaneous to OSIIS and LIMS development, the OSDH is proceeding with the development and incorporation of an internal Enterprise Master Person Index (eMPI) necessary to achieve interoperability between both internal and external systems. The eMPI project is currently focusing on the linkage of OSDH systems including OSIIS, Vital Records, Public Health Client Information System (PHOCIS), and other key databases and registries of the agency. The development of an agency eMPI is considered a priority need in assuring the OSDH can meet expected requirements for Stages 2 and 3 Meaningful Use criteria and to interact with the HIE. OHIET Revised Strategic Plan Page 39 1.5.3.4.5. Broadband The current status of broadband in Oklahoma is as described in Section 1.2.2 in the Environmental Scan. Access to broadband throughout the state is a concern and OHIET is working with the Secretary of State, Susan Savage, who leads the Oklahoma Community Access Network (OCAN) effort to build a fiber backbone to reach across the state. In the meantime, OHIET is working to identify feasible work‐around models that will allow eligible providers to meet Stage 1 Meaningful Use this year. These include ASP models and other technologies currently tested and in use in the state through SMRTNET and others. 1.5.3.5. Approach to Clinical and Quality Assurance Measures OHIET will regularly collect, report and monitor a set of performance measures to accurately track the Oklahoma HIE effort and assess readiness for new phases of work. In addition to the required measurements, OHIET will use the existing Physician Quality Reporting Initiative (PQRI) model with de‐identified patient information and adapt it to meet Meaningful Use criteria and requirements. OHIET will conduct clinical and quality assurance surveys to establish baselines statistics and update annually to capture changes over time. The planned tasks are: • Define clinical user specifications, including data sharing requirements, data use agreements and policies, quality‐related technology requirements, and data access standards; • Assist in data collection with state Medicaid and CMS for attestation and verification of Meaningful Use by hospitals and eligible providers; • Compile performance and evaluation metrics identified by the task forces; • Identify best practice case studies; • Determine performance specifications and set quality standards and goals; • Generate strategies for incorporating best practices, lessons learned and continuous improvement efforts; • Create a plan, in conjunction with the REC, Beacon, existing HIOs and organizations with high levels of adoption of EHR and HIE for dissemination of best practices and knowledge transfer of strategies for current and future implementations and security and protection of data; • Highlight areas of non‐performance or under‐performance and provide analysis on trends, exceptions, etc. Peformance metrics and methodologies for obtaining, analyzing and reporting are discussed in OHIET’s Operational Plan, Section 2. OHIET Revised Strategic Plan Page 40 1.5.4. Business and Technical Operations 1.5.4.1. Implementation The OHIET Operational Plan (Section 2) provides the particulars of implementation of the work of OHIET. Executive oversight is provided to the organization by the seven‐member board of trustees. Trustees have impressive records and knowledge of HIE and the health care industry and provide perspective of clinicians, academics, hospitals, payors, IT professionals, state agencies, regional HIEs, urban and rural settings (please see Exhibit 4). Daily operations of OHIET is performed by OHIET staff: the Executive Director, John Calabro (also the state HIT Coordinator); the Chief Operating Officer and an analyst, both to be named. These three individuals oversee operations conducted in each of the domain areas, with assistance from vendors and consultants. Procurement and contracting procedures to engage domain expertise have been established by the trust, and follow state and federal guidelines. OHIET benefits from the Advisory Board. An 18‐member Advisory Board has been identified in the trust indenture (Appendix 3.3 and Exhibit 5) and an additional seven member organizations are allowed. The Advisory Board provides representation from healthcare providers, including those that serve low income and underserved populations as well as from rural areas, health plans, patient or consumer organizations that represent the population to be served, HIT vendors, health care purchasers and employers, public health agencies, health profession schools, universities and colleges, clinical researchers and other users of HIT such as the support and clerical staff of providers and others involved in the care coordination of patients. The Advisory Board is meant to advise the Board of Trustees as well as augment OHIET staff in each domain area in the implementation phase of this work. Advisory Board members are individuals who enjoy the concurrence on recommendations for their respective organizations. An impressive group of individuals, many Advisory Board members have been advising and working on domain task forces in order to inform this and the operational plan. A list of these representatives is given in Appendix 3.8. 1.5.4.2. Project Management Classic project management tools and approaches are in use to implement OHIET business and conduct project work. OHIET employs individuals who have been trained and have deep experience in the arena of project management. Project tracking tools include scheduling, cost accounting, reporting on project progress, communications, meeting minutes, assigned responsibilities and so on. Project management extends to procurement in project estimating, vendor identification, due diligence, creation of bid packages, vendor selection, contracting and contract management and oversight as well as performance evaluation by working with vendors to take and report out specific project metrics and to oversee remediation when metrics indicate intervention. It extends to accounts payable by approving invoices and providing parallel tracking of work progress to that of vendors. OHIET Revised Strategic Plan Page 41 Quality control and assurance are key deliverables by the project management team. Final deliverables include work conducted professionally, in keeping with the tone and tenor of ONCHIT, on time, on or under budget and of the highest caliber. Project management philosophy is ‘by exception’, enabling streamlining of information for executive staff and boards. Working meetings keep running minutes of assigned tasks with due dates and current status. Goals are established for each task force. Escalation processes are established in line with goals. Tracked tasks and issues are escalated according to an agreed process. 1.5.4.3. Leveraging Existing HIE Capacities and Services OHIET services will be leveraged through existing HIOs. Multiple regional HIE efforts have or will have HIE capacities that can be shared with the statewide effort: eMPI, e‐Rx, immunization data, labs, prescriptions, patient look‐up, patient demographics, Record Locator Services (RLSs) exist in current networks within the state. These services of existing HIOs will be expanded upon to facilitate the network of networks that will form OHIET. Alternatively, OHIET may choose to engage in new technology or other partnerships to provide additional or extended services. Services or capabilities for the statewide HIE will be competitively bid to take advantage of existing efforts and economies of scale. This will facilitate a cost‐effective model without recreating a large centralized infrastructure and duplicating costs and efforts of the existing HIOs. In addition, this will ensure that OHIET is a sustainable organization with low, long‐term operational costs. 1.5.4.4. Communications, Education and Marketing (CEM) Strategy The purpose of the CEM strategy is twofold: 1. To inform, educate and engage health care providers and organizations, the public, and other key stakeholders about the benefits of HIT adoption and use, and HIE‐related activities in Oklahoma; and 2. To engage key stakeholder organizations that will be instrumental in helping communicate important information to their members and constituents, and assisting with these activities. HIE, HIT, EHR, etc., are confusing topics to even the initiated users of such services. Coupled with the myths and misinformation about any emerging technologies or services as well as the confounding elements of healthcare and its ancillary services and the landscape becomes ripe for confusion very quickly. De‐mystifying HIE and HIT and articulating end user benefits to a widely segregated market space of direct and indirect users are the key tasks in the CEM strategy. Topics of the plan include: OHIET Revised Strategic Plan Page 42 1. Overarching themes that describe and define OHIET; these include key values, priority goals, overall mission, etc., and will result in branding, image, and architecture for OHIET messaging. 2. Prioritization of effort aligned with ONCHIT and Meaningful Use goals that are the initial focus of OHIET and a plan to provide CEM to critical areas; this will include targeted communications, public awareness and education to groups essential to achieving Stage 1 Meaningful Use criteria, and then to subsequent initiatives critical to meet the goals and purpose of OHIET. 3. Development of materials to accomplish content of topics 1 and 2; this will include communications packages, image and content for all media, website and user interface, educational materials, and marketing collateral; each targeted to specific market segments. Generally, the project relies on current ongoing communication activities that have proved to be successful in making information about HIE in Oklahoma available and accessible to stakeholders in the health community. These activities play an important role in the overall communications strategy for this project are selected and employed on an “as needed” basis. Written presentations, meeting minutes, and other materials are available on the OHIET website. An important element of OHIET is the ability to collaborate; this extends to the CEM effort as well. Best practices and partnerships are leveraged to garner the highest efficiencies in connecting with target audiences. OHIET has already successfully collaborated with organizations such as the Oklahoma Hospital Association (OHA), Oklahoma State Medical Association (OSMA), and the Oklahoma Osteopathic Association (OOA) to communicate important information to providers about HIT and HIE. Coordination of education and public awareness campaigns with the REC, OSU and others targeting special needs populations (including work force and training facilities) is woven into the plan. As borne out by the environmental scan, the rural areas and the unaffiliated organizations will be priority targets in order to achieve Stage 1 Meaningful Use. Interviews of CEM consultants have already resulted in discussions of key messages and communications required to target a multiple segment marketplace. Communications and education are tailored to various stakeholder audiences including Information technology, including professional and social networking sites, are to be incorporated to gain efficiencies and reach a broader audience, wherever possible. This aligns with methods for information dissemination and modalities to adequately ‘connect’ with the desired audiences including a general audience, policymakers, Oklahoma legislators, health plans, hospitals, long‐term care, home health, physician organizations, community clinics, public health departments, local Regional Health Information Organizations (RHIOs), ancillary service organizations (i.e., lab, pharmacy, imaging), vendors, the public, consumer advocates, health care payors, purchasers and employers. Coordinated messaging with other key groups in the state who are providing public and targeted outreach including the local HIOs, the REC, the colleges and universities and various other groups is in the plan. Also included are activities aimed at broadening existing collaborations to include additional health care organizations, providers and consumers. OHIET Revised Strategic Plan Page 43 OHIET has a value added role to play in the CEM efforts in the state. This is an appropriate ‘central’ role where the investment will be leveraged across the state. The plan centers on working with the regional HIOs and helping them drive the messages and awareness required for their success. 1.5.5. Legal / Policy 1.5.5.1. Privacy and Security Oklahoma Privacy and Security Landscape Oklahoma generally adheres to Health Insurance Portability and Accountability Act (HIPAA) and 42 C.F.R. Part 2 standards for use and disclosure of protected health information (PHI), with limited exceptions for certain classes of information. Hence, Oklahoma usually does not require authorization for exchange of Protected Health Information (PHI) for purposes of payment, treatment or health care operations. Examples of instances where Oklahoma may require authorization for exchange include records containing substance abuse information,2 reportable communicable or non‐communicable disease information,3 and certain information concerning minors.4 In these instances, disclosure requires either authorization or additional notice concerning the nature of records subject to disclosure. Like other states, Oklahoma's privacy laws present some barriers to both intra‐state and inter‐state exchange by imposing heightened requirements on certain disclosures. Stakeholders from Oklahoma's health care community, however, have actively worked to reduce such impediments. As participants in the HISPC process, these stakeholders studied how to improve the state's privacy laws in order to promote secure and efficient HIE. The HISPC process presently continues, with the initial federally‐sponsored collaborative now functioning as a state council (OKHISPC) under a 2008 executive order issued by Oklahoma Governor Brad Henry. Oklahoma Health Information Exchange Legislation To date, Oklahoma's HISPC efforts have already resulted in successful enactment of two laws that have improved HIE in the state. First, the HISPC collaborative worked with the Oklahoma legislature in 2007 to pass the Oklahoma Health Information Exchange Act.5 The Act directed the Oklahoma Department of Health to adopt and promulgate a uniform authorization for the exchange of health information that complies with both federal and state privacy law. (Appendix 2 See 43A O.S. § 1‐109. 3 See 63 O.S. § 1‐502.2. 4 See 63 O.S. § 2602. 5 See 63 O.S. §§ 7100.1‐7100.7. OHIET Revised Strategic Plan Page 44 3.10) The Authorization, and related patient and provider instructions, expressly sets forth the instances where Oklahoma requires authorization for exchange and makes clear Oklahoma does not generally require authorization for purposes of payment, treatment and health care operations. Second, OKHISPC worked with the Oklahoma legislature in 2008 to amend the state's patient‐physician/psychotherapist privilege to clarify the privilege does not prohibit disclosures of protected health information otherwise permitted under state and federal privacy law.6 OKHISPC continues to study future opportunities to foster HIE. Further, many of Oklahoma's HISPC council and collaborative stakeholders will also have an active role in connection with OHIET's efforts to similarly promote HIE. Privacy and Security Under OHIET As further set out in Sections 1.5.5.2 through 1.5.5.5 below, OHIET will specifically require compliance with applicable state and federal privacy laws as an express condition under the trust agreements governing participation in the exchange. By incorporating and applying these statutory and regulatory provisions, OHIET will clearly reference the standards by which participants must conduct HIE. HHS Privacy and Security Framework: OHIET will achieve, in significant part, the eight objectives of the HHS Privacy and Security Framework through similarly incorporating aspects of these objectives as conditions for participation under trust agreements with exchange participants. Individual Access: The OHIET trust agreement will foster individual access to personal health information by requiring exchange participants to provide access to individual records and disclosure accounting in accordance with the Privacy Rule7 and the HITECH Act.8 Exchange participants may provide access through a number of means, including but not limited to: a secure web‐portal, personal health records, or direct provision of information by the exchange participant to the individual or the individual's designee. Exchange participants will be responsible for putting measures in place to secure the authentication of the individual requesting access to information. Correction: The OHIET trust agreement will require exchange participants to comply with the Privacy Rule9 and provide individuals with the opportunity to request corrections to PHI generated or maintained by the exchange participant. OHIET anticipates the agreement will also contain additional language concerning the specific manner in which exchange 6 See 12 O.S. § 2503(D)(5). 7 See 45 C.F.R. § 164.524. 8 See 42 U.S.C. § 17935(e). 9 See 45 C.F.R. § 164.526 OHIET Revised Strategic Plan Page 45 participants must provide notice and documentation of disputed information in connection with disclosures. Openness and Transparency: From an organizational standpoint, Oklahoma selected the state‐beneficiary public trust as the structure for OHIET in large part due to the inherent openness and transparency of such entities. Oklahoma permits the creation of state‐beneficiary public trusts that operate for the express benefit of the state and its citizens. Oklahoma law requires such entities comply with the Oklahoma's Open Meetings Act,10 Open Records Act,11 Administrative Procedures Act,12 Public Competitive Bidding Act,13 and Public Trust Competitive Bidding requirements.14 These acts will ensure public access and opportunity for input and involvement in OHIET's efforts to foster HIE in Oklahoma. From an operational standpoint, OHIET will also encourage exchange participants to exhibit similar openness and transparency concerning participation in the exchange. Specifically, the OHIET trust agreement will recommend exchange participants provide patients and consumers with clear notice, preferably via the participant's Notice of Privacy Practices, regarding how the participant will use and disclose information through the exchange; the choices the individual may exercise with respect to the information (e.g., access15, accounting of disclosures16, request for restriction17); and the privacy and security measures applied to safeguard such data. Individual Choice: OHIET will adopt a consent model that allows for exchange of protected health information amongst participants, in accordance with minimal necessary requirements of the Privacy Rule18, in all instances where federal and/or state law permit disclosure absent authorization. As noted above, exchange participants should provide individuals with clear notice concerning these uses and disclosures through the exchange; instances where individual authorization is necessary; and the choices individuals may exercise with respect to protected health information. Collection, Use, and Disclosure Limitation: OHIET trust agreements will expressly require exchange participants to adhere to the minimum necessary requirements of the Privacy Rule19 to govern the collection, use and disclosure of information amongst exchange participants. Subject to such requirements, the trust agreements will permit exchange participants to use, collect and disclose 10 See 25 O.S. §§ 3101‐312. 11 See 51 O.S. §§ 24A.1‐24A.29. 12 See 75 O.S. §§ 250‐323. 13 See 61 O.S. §§ 101‐138. 14 See 60 O.S. § 176(H). 15 45 C.F.R. § 165.524; 42 U.S.C. § 1795(e). 16 42 U.S.C. § 17935(c). 17 45 C.F.R. § 164.522; 42 U.S.C. § 17935(a). 18 See 45 C.F.R. § 164.502(b); 42 U.S.C. § 17935(b). 19 See 45 C.F.R. § 164.502(b); 42 U.S.C. § 17935(b). OHIET Revised Strategic Plan Page 46 information for treatment, payment, health care operations and public health reporting required by state and federal law. Data Quality and Integrity: Pursuant to OHIET's enabling legislation,20 OHIET trust agreements will make exchange participants responsible for ensuring accuracy and integrity of data utilized for HIE. Safeguards: OHIET trust agreements will require exchange participants to comply with the Security Rule21 provisions in order to achieve administrative, technical and physical safeguards for accessing, maintaining and transmitting protected health information. Further, OHIET will consider recommending a common set of procedures and mechanisms to verify the credentials and authenticate the identity of persons requesting and accessing information for exchange. OHIET will also consider recommending standard privacy and security training guidelines for review and use by exchange participants. Accountability: As further discussed in Section 1.5.5.3, through the express application of the Privacy and Security Rules, along with other applicable state and federal privacy laws, OHIET trust agreements will clearly signal exchange participants must comply with such requirements and bear responsibility for instances of breach or other non‐compliance. In addition, the standard procedures and training guidelines referenced immediately above could serve as another resource toward ensuring exchange participants implement appropriate accountability measures on an institutional level. 1.5.5.2. State Laws OHIET anticipates working in conjunction with OKHISPC and engaging in ongoing efforts to identify and analyze potential changes to state privacy laws to better serve HIE, both within Oklahoma and with other states. An Oklahoma statute subject to present discussion and analysis concerning potential amendment requires a disclosure statement to accompany an authorization releasing records containing reportable communicable or non‐communicable disease information.22 The statute requires the statement to appear in bold‐faced type and inform the individual authorizing release of the potential for inclusion of such information in the disclosure. Stakeholders from Oklahoma's health care community and OKHISPC have expressed concern that the detailed requirements of this statute present a barrier to exchange. 20 See generally 63 O.S. § 1‐132(F). 21 45 C.F.R. §§ 145.302‐145.318. 22 See 63 O.S. § 1‐502.2. OHIET Revised Strategic Plan Page 47 At the time of drafting, however, OHIET does not have any specific plans or proposals to modify this or other state laws. Likewise, although OHIET has not yet entered into discussions or negotiations with other states concerning HIE, OHIET will monitor HIE efforts of other states and pursue communications with other states where doing so could work to further inter‐state coordination and secure exchange of health information. 1.5.5.3. Policies and Procedures OHIET anticipates utilizing the trust agreements discussed under 1.5.5.4 below as the primary means of achieving adherence to uniform practices and procedures. 1.5.5.4. Trust Agreements As noted throughout, OHIET trust agreements with exchange participants will serve as the contractual mechanism OHIET will use to achieve uniform adoption of and compliance with the consent model for exchange; the privacy and security requirements under which exchange must occur; and the penalty provisions for acts of breach or non‐compliance with federal or state law. 1.5.5.5. Oversight of Information Exchange and Enforcement OHIET trust agreements will expressly inform exchange participants that oversight authority and enforcement power for breaches and/or other acts of non‐compliance with state and federal law rests with the government or regulatory agency charged with such power. The standard policies, procedures, and training materials OHIET anticipates recommending will further serve as best practices to mitigate the probability of breaches or other misuse of information. The trust agreements will require exchange participants, and empower OHIET, to provide notice of breaches and/or acts of non‐compliance to appropriate government or regulatory officials where applicable law mandates such action. Finally, the trust agreements will provide for termination of a participant's agreement as a penalty in certain enumerated circumstances involving breach or non‐compliance with federal or state law. End of Oklahoma State Health Information Exchange Cooperative Agreement Program Revised Strategic Plan OHIET Revised Strategic Plan Page 48 Appendices Project Month 1 2 3 4 5 6 7 8 9 101112131415161718192021222324252627282930313233343536373839404142434445464748495051 Year Calendar Month N D J F M A M J J A S O N D J F M A M J J A S O N D J F M A M J J A S O N D J F M A M J J A S O N D J State Trust developed State Coordinator for HIT selected Strategic Plan completed Operational Plan completed Strategic and Operational Plan approval Evauate other certification processes Identify elements of certification Seek existing and planned HIO input into certification requirements Finalize certification process requirements Begin certifying HIOs Broadband program designed Broadband program implemented MU Incentives (Medicaid, Medicare) inplace Community HIO Planning Program Designed Community HIO Planning Program in place HIE Voucher program designed HIE Voucher program in place eRX Pharmacy assistance program designed eRx Pharmacy assistance program in place Shared Services evaluation Identification and prioritization of desired shared services Purchasing phase for shared services Implementation of shared services Consider Policy needs Prioritize policy needs Establish legislative agenda Privacy and Security framework Facilitate connections between HIOs and border health systems and HIOs Manage communications with ONC and CMS Strategy for interaction with Health Benefits Exchange project Strategy for facilitating interactions between state agencies and HIOs Coordination Policy Shared Services Incentive programs Certification Process 2013 2014 Planning Phase 2009 2010 2011 2012 3/31/2010 OKLAHOMA HEALTH INFORMATION TECHNOLOGY COORDINATOR 1 STATE OF OKLAHOMA Job Description Job Title: Oklahoma Health Information Technology Coordinator Agency: Oklahoma Health Information Exchange Trust (“OHEIT”) Reports To: State of Oklahoma Governor Date Completed: March 31, 2010 Salary Range: TBD (depending upon experience) PART I: DESCRIPTION OF POSITION Position Purpose: This position exists to provide leadership, direction, management and coordination of healthcare information technology strategy for the State of Oklahoma which will include the implementation of federal and state requirements for healthcare information technology (HIT) and health information exchange (HIE). This individual will work cooperatively with multiple stakeholders including health care providers, health plans, health profession schools, consumers, technology vendors, public health agencies, and health care purchasers to identify existing resources, needs, commonalities of interest, project priority, and to develop a plan which prescribes the needed activities to facilitate and expand the electronic movement and use of health information among organizations consistent with the both state‐ and federal‐ health information technology strategic plans. Principal Activities: The principal activities and responsibilities include the following: • Provide health informatics leadership, vision, and direction to the HIT office in collaboration with the Oklahoma State Health Information Exchange Governance Committee. • Provide expertise, including research and analysis required to establish and maintain a strategy for implementing health information exchange in Oklahoma • Identify new grant opportunities; serve as principle investigator (PI) as needed for grants and direct the preparation of grant applications for funding for planning and implementing HIT/HIE in Oklahoma. • Review grant proposals to evaluate informatics components for issues relating to readiness, collaboration, interoperability and certification. • Assist HIT projects with conducting studies of existing and proposed information systems and their impacts. • Collect and analyze data on statewide HIT systems. • Prepare written and oral reports, manuscripts and other communications summarizing the findings of analyses and studies and disseminate the results. • Present data, study findings and recommendations to the Governance Board, Advisory Board, state agencies, legislators and other partners/stakeholders as needed to support the statewide HIT/HIE system decision‐making process. • Act as the State lead for HIT/HIE and participate in state, regional and national health/scientific meetings focused on HIT/HIE. 3/31/2010 OKLAHOMA HEALTH INFORMATION TECHNOLOGY COORDINATOR 2 • Act as the designated Oklahoma representative at meetings related to HIE and associated grants • As needed, serve as an interface between the partners/stakeholders and the OHEIT staff on identifying and addressing informatics issues. • Coordinate statewide activities related to the implementation of HIT/HIE in Oklahoma in order to improve the efficiency and effectiveness of health data collection, analysis and use to improve the health of individuals and their communities. • Provide direction in the development of the state HIT/HIE strategic plan. • Coordinate resources and activities to assist with readiness assessments of public and private health care entities to implement electronic information systems that meet federal and state requirements and fit within the state HIE plan. • Solicit input from relevant public and private partners/stakeholders, including consumers, about the needs and barriers to implementing HIE in Oklahoma including barriers to interoperability and ways to utilize opportunities and reduce barriers. • Foster pilot projects and coordinate HIE‐related activities in collaboration with public and private healthcare providers and health plans. • Collaborate with federal standards and policy committees to develop common data reporting formats and methods of transmission within Oklahoma and across state borders for all pertinent health data. • Maintain relationships with public and private partners/stakeholders for the purpose of insuring coordination of all electronic health information systems planning, development, implementation and interoperability. • Provide training and information on ONC, NHIN administrative and technical requirements for system interoperability and secure data exchange using the Web and other communication methods. • Perform other duties in support of the statewide HIT activities. • Represent Oklahoma on national HIE/HIT issues and activities. Supervisory Responsibilities: This position has supervisory responsibilities. PART II: KNOWLEDGE AND BACKGROUND REQUIREMENTS Qualifications: This position requires a strong leader possessing excellent health informatics skills and strong experience with information systems and information technology. The work of this position requires expert knowledge of healthcare processes and systems both private and public, program management, technological planning, organizational behavior, public policy development and analytical evaluation and research skills. It requires the incumbent to develop a strong working knowledge of the statewide private sector healthcare infrastructure; information technology, medical informatics, legislative processes and operation of state agencies. Preference: Preference will be given to applicants with the following qualifications: • An individual with an advanced clinical degree including nursing, medicine, dentistry or pharmacy. • An individual with clinical practice experience. 3/31/2010 OKLAHOMA HEALTH INFORMATION TECHNOLOGY COORDINATOR 3 • Masters or higher degree. • Significant expertise and knowledge in HIT/HIE, particularly related to improving clinical quality. • Significant knowledge and experience in HIT/HIE public policy. • Recognized leadership skills and experience in managing, creating or developing health information technology. • Extensive knowledge of information management principles, information technology strategies and trends, and systems oversight abilities. Qualified candidates will possess the following: Education: Post baccalaureate degree from an accredited college or university with additional training in business administration, public administration, finance, management information systems, public health, health care management, or medical informatics. Experience: Seven (7) years of pertinent work experience within the healthcare and/or public health or industry. Three (3) years of program or project management experience which include: • Analyzing business processes and outcomes • Financial reporting • Planning, developing, and implementing information technology systems • Managing large projects • Writing and administrating grants • Facilitating meetings Researching, interpreting and explaining technical information such as laws, regulations and requirements. Language Skills: Ability to read, analyze, and interpret technical documents, general business periodicals, professional journals, technical procedures, or governmental regulations. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to questions from stakeholders. Mathematical Skills: Ability to work with mathematical concepts such as probability and statistical inference with the ability to apply concepts to practical situations. Reasoning Ability: Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Computer Literacy: Knowledge of health information technology concepts, including hardware, software, networking, and associated costs and budgeting. Must have significant knowledge of healthcare data standards (vocabularies, messaging, and security) and experience in communicating these complex topics to learners and listeners at all levels. Physical Demands/Work Environment: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. To: Advisory Board Member Organization RE: Appointment of Personnel to Serve with the Oklahoma Health Information Exchange Trust Advisory Board Dear : Recently passed into Oklahoma Legislation by Senate Bill 1373 was the establishment of a public trust, 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 transmission of electronic health data both intra‐ and interstate thereby raising the overall quality of health of the population while making access more effective and affordable. Your organization has already made significant contribution to this (the Oklahoma State Health Information Exchange Cooperative Agreement Program) and other areas of HIT/HIE. Because of your commitment and leadership, we have included your organization as a founding member of OHIET’s Advisory Board. Request: The Board of Trustees of OHIET requests that you nominate one individual to serve as your representative. This individual should be a leader in your organization; they should represent a consensus opinion of your organization; they should bring a deep level of understanding of your organization and the constituencies you serve; they should be willing to collaborate with a diverse set of views and devise creative paths and solutions; they should be critical thinkers and have the ability to understand and eliminate bias. Depending upon the role your representative takes, the time commitment from him/her will range from one to four hours per week. We ask that representatives serve for a minimum term of one year. We very much appreciate your generosity in allowing this valuable employee to work with us. We believe, with the assistance of organizations like yours, we will improve the overall quality of care for the citizens of Oklahoma. Once you have selected your representative, please send notification to this office, _____________. We look forward to learning your member individual by October 15, 2010. Thank you once again the effort you and your organization put toward these endeavors. Signed by Trustees Follows: more information about the position, Advisory Board and OHIET. To: Advisory Board Member Organization Re: Appointment of Personnel to Serve with the Oklahoma Health Information Exchange Trust Advisory Board 2/8 Position Purpose: To represent the views and desires of your organization, to collaborate with several other concerned constituents, and to add leadership and expertise to the Oklahoma Health Information Exchange Trust (OHIET) and towards its intentions to meet stated goals. To provide opinion and advice to the Board of Trustees; to work on task forces at a domain‐specific level in order to make learned recommendations to the Board; to perform discrete tasks as might be necessary. |
Date created | 2011-07-07 |
Date modified | 2011-07-07 |
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