SustiNet Health Partnership
Health Information Technology
Advisory Committee
Health Information Technology Committee Regular Meeting
January 8, 2010
Meeting Minutes - DRAFT
Teleconference Participants: Mark Boxer, Co-chair; Marie Smith, Co-chair; Victor Villagra; John Brady; Scott Cleary; Ryan O’Connell; Angelo Carraba; Alex Hutchinson; Meg Hooper;
Rob Aseltine
Office of the Healthcare Advocate: Michael Foy Mitchell
Mark Boxer began the teleconference by welcoming everyone and asking members to review and approve the December minutes. John Brady made a motion to accept the minutes, Victor Villagra seconded, and all members approved the motion. Mark said that one of the topics discussed at last month’s meeting was the need to better understand the work that has taken place within DPH and within e-health CT to be sure that there isn’t duplication of activities. Mark said that on each upcoming agenda, there will be a representative from an initiative that’s already in place who will share information about what his/her organization has already accomplished. In addition, today there will be discussion about assigning leadership to portions of the workplan in order to utilize a “divide and conquer” strategy. Mark also invited members to offer input for future agenda items.
Marie Smith said that there are participants in today’s call who are under consideration for Committee membership. Mark said the process for adding members is the same as that used for current members; biographies are submitted to Marie or him, reviewed by Jamie Mooney and Jeff Kramer and then reviewed by the SustiNet Board of Directors for approval. Marie reiterated that today’s call is being recorded, and that the minutes would be transcribed and posted on the SustiNet website www.ct.gov/sustinet . Marie spoke of the proposed meeting schedule. She said that most of the meetings would be held by teleconference, but there is a possibility of conducting webinars. Michael Mitchell said the Committee has the capability to do this; however there is a question of the cost and whether the budget allows for this. Marie asked if a Committee member could assume the cost if the state budget didn’t allow SustiNet to do so. Michael said that he thought that would be ok, but said that he would have to discuss this with Vicki Veltri, SustiNet’s legal counsel, to be certain. Michael said that he should have an answer early next week. Marie said that she’d like to set up a regularly scheduled time to conduct meetings, specifically every two weeks on Fridays from noon to 1:30 pm, from now until July 1st, and she asked for feedback. Several members said that this worked for them, so this schedule was agreed upon. Michael asked members to provide 48 hours notice for public posting if there need to be changes made to this schedule. Alex Hutchinson asked what the process would be if members knew they couldn’t participate in meetings. Marie said that she and Mark would like to receive email messages regarding members being unable to attend.
Marie asked for feedback on the Committee workplan. She said that although the workplan was developed last summer, recent federal initiatives will impact some aspects of it. She also said that this is posted on the SustiNet website. She asked members to contribute what they feel are gaps, updates or anything that needs reconsideration in the workplan. Alex said that as he reviewed the workplan, he noticed it contained a large variety of things, including activities related to data gathering and also various components to be implemented. He asked if it was the focus of the Committee to be involved in actual implementation. Marie said that she feels that the goal of the Committee is to formulate a plan but not to be involved with the implementation phase, and Mark agreed. Alex said that some of the wording was daunting and confusing, implying identifying and tracking, and developing and implementing. Mark said that the Committee isn’t an operating entity; Marie agreed and said that the plan should be realistically actionable, which must be considered in framing the plan. Mark said that he felt that the Committee would be an evolving mechanism, so that perhaps some day the Committee could provide oversight, but for now the focus should be on the specific deliverable of making recommendations.
Marie said that the issues around “meaningful use” are becoming clearer. She said electronic health records involve not just installing hardware and software, but also providing people with meaningful use, so this must be kept in mind while the Committee develops its plan. Angelo Carraba said that from his experience with this process, this will be a moving target, with the 60 day windows for comment causing this to be a work in progress that will take longer than 6 months to complete. Marie agreed, saying that the Committee needs to keep a finger on the pulse of where things are, and being aware of changes regarding whatever is delivered. Angelo said that federal guidelines would have to be incorporated into this Committee’s plan.
Marie asked members to look at the workplan with her so that members could claim leadership of the various sections. The first topic is organizational tasks, which contains items such as developing the core elements; looking at priority issues, barriers, costs, and financing; assembling studies on HIT and the CT Plan; assessing best practices on HIT in other states; and basically data collection and review. Ryan O’Connell said that he could comment on the southwestern part of CT, where things are and the organizations he has worked with. Meg Hooper said that there are many initiatives already in place, yet they are not being tracked by the state. Meg and Angelo both said they would be willing to take part in this. John said that he could contribute information from members of the CT Hospital Association, and Ryan also agreed to participate.
The next topic is the response to ARRA, which is the stimulus federal health reform. Meg said that as stimulus coordinator for DPH, she is keeping track of stimulus opportunities. She said that the brief that she had sent to all the members was a compilation of the information that she’s aware of, but that she knows there are many more opportunities. She said that there are other IT related ARA funds; there is a broadband activity, and the Community Health Centers are receiving direct funds from the stimulus act for HIT. This was an opportunity to explore some of the direction to providers, and how this related to the RHIO that DPH is trying to push forward. Meg said that not all of this will be available for the state of CT or private providers due to restrictive eligibility requirements, but she wanted to make people aware of what’s available from stimulus funding.
Meg asked that if anyone had any additional information that they share it with her. She also said that she felt that when the health reform bill is finalized, there will be additional opportunities for IT infrastructure and coordination. Marie said that she had received the brief from Meg, who had emailed it to the entire Committee. Marie asked if this was a one time document or would it be updated. Meg said that it would be updated and that she would continue to send updated versions to the Committee. Michael said that he could post any information such as this on the SustiNet website, but said that he would prefer that it be sent to him by the co-chairs. Marie said that if there is information to be shared with Committee members only and not to be posted on the website, members could designate the information as such. Michael also requested that if information is to be distributed immediately, he needs to be informed of that. Scott Cleary said that when he makes his presentation later in this call, he will discuss the HIT Regional Extension Center opportunities that e-health CT is pursuing. Meg said that the list she had sent was specifically about stimulus opportunities, and didn’t include healthcare reform efforts. Marie said that when healthcare reform is finalized this will impact stimulus opportunities. She also said that efforts in place around the state will probably be captured by the workgroup formed as a coordination effort of ongoing activities, some of which will be discussed by Scott today and other speakers in the future. Non-stimulus and non-healthcare reform will be captured in that category.
Marie said that the next topic is logistics, which involves recommending vendors to provide reduced cost, high quality digitization of paper medical records for use with approved software; recommending integration systems with EMR; and using subscribing providers integrated into a single electronic network for each SustiNet member. Marie said that in general, logistics will involve interoperability. Ryan said he’s done some research for his local community and also for other hospitals, so he offered to work on this subgroup. Angelo said that CMS’s IPA has done a review of a large number of systems. He said that he’s come up with a preferred list of systems that seem to be easily operable by a general practitioner. He also said that he could ask them to make a presentation. Alex said that he’s already reached out to Ken Lalime, who is Executive Director of the CMS IPA. Additionally, Alex said that the logistics section seems to be pretty narrowly focused around the digitization of paper; he asked if this is intended to get into software systems and basic EMR capabilities or will it be limited to this specific category. Angelo asked if documents would be scanned or transferred from an institution to an operating system. Ryan said that the first line in this section refers to scanning documents, so the second one doesn’t make sense; scanned documents can’t be integrated. He said that he interprets the first line as being about approved medical records systems rather than scanned documents. Marie said that she hasn’t read through the entire 500 pages about meaningful use, but she feels that digitizing records isn’t going to be that fruitful. She added that since the workplan was created in July 2009, there may need to be some changes in the language used. Alex said that if the Committee would be looking at this in a broader context, he would be willing to contribute his time to this subgroup. He also said that he would follow-up on the CMS IPA and with other stakeholders who have input here.
Marie said that the next category is market research, outreach and enrollment. There are only two tasks included in this category; the first is to develop and implement appropriate financial incentives for early subscriptions by participating providers, and the second is to recommend methods to eliminate or minimize transition costs for healthcare providers. Marie said that she thought this category would involve a start on market research outreach and enrollment. Angelo and Alex both agreed to work on this subgroup.
Marie brought up the next category, financing. The first task is to determine appropriate financing options, including but not limited to financing through CT health and educational facilities, future governance entities established pursuant to the SustiNet Act. The second item is to recommend a way to permit subscribing providers to receive the proportionate share of systemic cost savings that are attributable to the implementation of EMR. John and Meg offered to work on this subgroup.
Marie discussed the last category, which is to finalizing the report of recommendations to be submitted in July. She and Mark agreed to assume leadership of this, along with constant input from Committee members. Marie said that in one of the earliest SustiNet Board meetings, there was discussion about whether these workplans were a starting point, and that the Committees and Task Forces could enhance, refine, and update them as needed. She continued by saying that this is how this entire project should be approached. The first task for each member is to go through the assigned section of the workplan and be sure that it is a good fit. She asked that Committee members do this so that it could be discussed at the next meeting. This would be a good time for members to make changes or bounce ideas off other members.
Scott Cleary gave this e-healthConnecticut Presentation . The vision of e-health CT is to be a not for profit transparent organization governed by the community and focused on public good. It’s a resource that stands ready to serve people in CT. e-health CT doesn’t anticipate being the only health information exchange in the state, but does believe that an overarching statewide resource such as itself would make a lot of sense. Angelo is the board chair of e-health CT, representing the physician community. There are several hospital CIO’s on the board, as well as representation from the CT Pharmacists Association, CT Health Policy, AERP which represents consumers, Quest which represents lab and ancillary service providers, Qualidigm, which is the state Quality Improvement organization and is recognized by CMS, Community Health Centers and Staywell, representing safety net providers, and UConn. In addition to these members, there are payors on the board, such as Aetna, and there is someone from Anthem who has been nominated and is being considered for the board. e-health CT has been meeting monthly for four years.
There is a program known as Connecticut Health Quality Cooperative (CHQC) which addresses e-health CT’s quality reporting, with HIT adoption as the focus, and with the hope of being federally designated as a health information technology regional extension center. e-health CT has applied for this designation, but doesn’t expect to be selected and designated in the first cycle of award; they are preparing to submit another revised full application by the end of January, and are hoping to hear good news by the end of March. Scott emphasized that e-health CT is not statewide right now, and will need additional support from various state authoritative agencies to help it become established if it goes beyond the pilot stage. So far, what has been developed by the proper privacy policy committee, the pilot participants and DSS is an opt in model containing a universal record release authorization form that would state clearly to the patient that if they opt in, all of their information would flow to the exchange, including sensitive information. If they opt out, there is a form signed indicating that their information would not flow. Sensitive information, which is protected by federal law, requires a new consent form each time information is released; e-health is addressing this issue, hoping to resolve it within the pilot. Scott said that e-health CT will be conducting a physician survey this month to assess their readiness for EHR, to learn what they are currently using and what their needs and barrier are. The information collected will be used as part of the previously mentioned federal application. In concluding his presentation, Scott expressed optimism that e-health CT could be a resource to all, including SustiNet.
Alex spoke favorable about Scott’s presentation, and asked if e-health CT is the only entity currently pursuing the health information exchange in CT. Scott said that they are the only ones in the state pursuing the federal designation for the Health Information Technology Regional Center (HITRC). Regarding health information exchange, there are many efforts going on in communities around the state. Scott spoke positively about these efforts, and said that he sees e-health CT as being an overarching HIE as a complementary thing. Marie asked Scott if he could describe e-health CT’s stance on the EHR and HIE vendor selection process that’s in place, and how that might impact the state in going forward with this. Scott replied that this isn’t currently in place; if federal designation is achieved, there will be an open procurement process to select vendors. Presumably there would be quantity discounts, negotiated services and support arrangements. Ryan asked about quality reporting, saying that he had met with Ken Lalime once, and he had indicated that CMS was receiving a large quantity of data on their providers from claims. Ryan asked Scott if e-health CT has a plan to switch over to EMR’s for this data. Scott responded that this was absolutely what they wanted to do. Additionally, Scott said that on January 21st, from 4 - 5:30 pm, UConn is hosting an open forum for anyone who might be interested in the HITRC adoption initiative. This is a way to gauge customer interest and to learn of others who might provide services to the HITRIC. Scott asked that anyone interested in this send him an email at scleary@gosmcpartners.com .
Marie asked Scott for clarification on whether the DSS Medicaid population would be one of a number of HIE’s that would plug into a statewide HIE. Scott replied that e-health CT’s mission is to perhaps be a statewide HIE, but it needs to be determined by DPH and the legislature what the state’s approach will be with respect to whether to utilize statewide or local resources. While not being presumptuous about this, e-health is building this so that it could be statewide. Victor asked Scott if some of the logistics work has already been done, and if so he wanted to know how the Committee could leverage this; also if there are any mechanisms for this Committee to interact very closely with e-health CT so that efforts won’t be duplicated. Marie said that one of the things that this Committee needs to do as its work progresses, especially early in the effort, is to hear from others who are already involved with this type of work. She continued by saying that first the other efforts should be catalogued so that the Committee has a repository of information to draw from. Secondly, it needs to be determined how the Committee will review the information and from that can be determined how to leverage it. Victor said that it will be important to link the key stakeholders across the state, and he added that he feels that the efforts of e-health CT are quite impressive. Marie said that under the organizational tasks section of the workplan, there is an item that calls for assessing connections between this Committee and other state agencies; maybe this should include other key stakeholders for ongoing initiatives.
Scott said that e-health has monthly board meetings on the first Mondays of the month at 6:00 pm and that anyone can attend. This Committee could send a person or a group to attend in order to keep in touch with what’s going on. Marie pointed out that Angelo could keep this Committee updated because of his connection to e-health CT.
Marie spoke briefly about trying to compile a list of other presentations that the Committee could schedule for the next few meetings. Some possibilites already mentioned include Ken Lalime from CMS IPA, someone from DPH who could describe their efforts, someone from DSS who could speak about the medication transformation grant, and someone from a Community Health Center. Victor said that there is an initiative in NY as part of the Taconic IPA that could present an excellent real world example of adopting EMR’s. He asked if the financing of this and other efforts should be included as part of this Committee’s discussions. Marie said that she would discuss this with the Board of Directors. Michael said that questions such as this should be discussed with this Committee’s Board Representative. Marie added that she and Mark review the minutes from the other task groups and committees regularly.
Meeting was adjourned.
Next meeting will be 1/22/10 from noon – 1:30 pm.
