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New Hampshire Health Information Organization Board of Directors Meeting Minutes April 8, 2014 125 Airport Road Concord, NH 03301 I. Call to order Ms. Eldredge called to order the regular meeting of the New Hampshire Health Information Organization (NHHIO) Board of Directors at 8:02am on April 8, 2015.
II. Roll call The following members were present: Mary Beth Eldredge, Deb Mullen, Patricia Witthaus, Charles Fanaras, Kirsten Platte, Lorraine Nichols, David Querusio, Bill Baggeroer, Dan Waszkowski MD, Denise Purington and Mike Lehrman. The following members were present by phone: Christine Rosenwasser MD. The following members were absent: Mark Guptill, David Briden, Victor St. Pierre, Richard Lafleur MD, and Carol LaCross. The following non-members were present: Jeffrey Loughlin, Micky Tripathi, Jackie Baldaro, Elizabeth Shields, Kathy Bizarro, Nancy Fennell, Brian Donovan and Jaime Dupuis. Name Bill Baggeroer Carol LaCross Christine Rosenwasser, MD Daniel Waszkowski, MD (NHMS) David Briden (NHHA) David Querusio Deb Mullen (Home Care) Denise Purington Kirsten Platte (BSPC) Lorraine Nichols Mark Guptil (BH) Mary Beth Eldredge Michael Lehrman Patricia Witthaus (CAH) Richard Lafleur, MD Victor St. Pierre Charles Fanaras, RPh (Pharm)
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Approval of minutes from the January 14, 2014 meeting: Ms. Platte requested that the minutes reflect the board decision to include CHAN as a pilot site for purposes of contract extension. The minutes were approved with the changes noted; 11 in favor; 0 opposed; 0 abstentions.
III. New business IV. Updates and committee reports Board Chair Ms. Eldredge reported that the executive committee has been working hard the strategic planning process. She has sent a note to the hospital CIOs regarding answering the needs
assessment survey that has been sent to stakeholders. She discussed the need for each board member to reach out to their various constituents to support completion of the stakeholder needs survey. She noted that there is an opportunity for reporting from the survey that will be important as well as having stakeholders present at the session on May 5, 2015. Project Update Mr. Loughlin reported that the New Hampshire Hospital went live this week on the Netsmart electronic health record. Ms. Eldredge recommended capitalizing on the fact that the New Hampshire Hospital is now live and making sure that this is communicated out to the community. Mr. Loughlin reported that Genesis Careline has gone live with exchanging C-CDA documents with Catholic Medical Center. Ms. Eldredge discussed that board members should be reaching out to their constituents and trading partners, for example Dartmouth Hitchcock is reaching out to physical therapy to introduce them to the value of joining the NHHIO. Mr. Loughlin will recirculate the reach out letter that the communications workgroup created a few months back. Mr. Loughlin reported the NHHIO will be co-hosting a Rhapsody Client workshop with Orion Health on April 21, 2015 and looks to have good attendance so far from all the Rhapsody customers. Mr. Loughlin discussed the status of grant applications for Health Information Exchange Adoption Support and also a new grant opportunity, the New Hampshire SIM II, has been released by the fiscal committee. The SIM II grant is $1.8 million dollar planning grant, the NHHIO is named within the grant itself and will have a large role in the planning as well as running one or two workgroups. Mr. Loughlin presented a list of pilot organization contract extensions to include Exeter HospitalMay 2013, Elliot Hospital -May 2013, NH DHHS -May 2013, Seacoast June 2013, CHAN-July 2013, and Dartmouth Hitchcock-August 2013. A motion was made for the board to allow a contract extension to December 31, 2016 to Exeter Hospital, Dartmouth Hitchcock Medical Center, Elliot Hospital, Seacoast Mental Health Center, CHAN, and NH DHHS at no additional cost. The extension of the early adopter contracts were approved; 9 in favor; 0 opposed; 3 abstentions. Mr. Tripathi provided an educational presentation of Hl7’s Fast Healthcare Interoperability Resources (FHIR) project. He described the growing movement to get the market to the next level of interoperability. HL7 is looking at internet exchange patterns, exchange based on restful APIs, and security as a part of the standards development process. This is significant as it opens up different ways of interoperability. Mr. Tripathi reported that Meaningful Use (MU) Stage 3 requirements are now out; he and Dr. John Halamka provided an overview and review of Stage 3 in Dr. Halamka’s blog recently. He reported that one of the positive aspects of the requirements is pointing towards open APIs to help organizations like the NHHIO attempting to tighten up C-CDA requirements. MU Stage 3 has a requirement for receiving a certain percentage of documents whereas MU Stage 2 applied
incentives to senders and not receivers. MU Stage 3 does not state that you have to receive a specific document type. The current calendar requires that by 2017 providers and hospitals will have the choice of attesting to Stage 2 or Stage 3. By 2018 everyone will need to be on MU Stage 3. It is important to note that there was a clear, definitive statement that Stage 3 is the last stage. The expectation is that providers who want to stay in Medicare & Medicaid would need to continue to attest but no further stages will be introduced. Eligible Professionals (EP) and Eligible Hospitals (EH) need to receive a certain amount of documents from non-clinical setting so visiting nurse association (VNA) would count but nursing homes would not. He commented that the concept of Voluntary Certifications have been included for MU Stage 3 and are completely immature standards. The vendor community is communicating that “voluntary” means nothing to them and would need customers to make requests before they will consider development. Mr. Tripathi described in more detail FHIR, which is a restful API and is a standard that allows browser functionality to facilitate or execute browser query and response. An example of an API is Amazon.com browsing; this is an API generating a query and returning a response. OOff and OID Connect are for security needs and delegated secure access and is a way for organizations to trust each other; there is one place to trust, validate users and let users in. Currently exchange is based on the vehicle of the C-CDA, and the C-CDA is really inefficient. They also are not good for building advanced functionality. The current system is not able to give just a certain amount of data but only the full C-CDA; FHIR takes functionality to the next level. The Argonaut project, vendors and provider organizations have come together as the market demand is outpacing the standards development. The project is a private sector initiative to accelerate a document API and the 16 MU data elements. This is essentially a code and document sprint that will take these two together and rapidly accelerate them to be available in early June for vendors to pick it up to begin to use them. The vendors have agreed that they will pick up this API and accelerate to testing right away. Orion Health has two of its senior leaders working on FHIR, Matthew David Hay and David Leach, and is very involved from a technical perspective. All the large vendors are participating, such as Epic, Cerner, and McKesson, and the State of New Hampshire would prove to be a really good laboratory for piloting this in the short future. Mr. Tripathi reported that FHIR is an HL7 acronym for the standard, and the Argonaut project is focused on developing the implementation guide for the standard. The expectation is that for Stage 3 the Office of the National Coordinator (ONC) may just certify to the Argonaut charter; ONC is not certifying FHIR, though that they expect to certify the FHIR spec in the future. The standard is not ready right now, if you are an HL7 member, you are able to vote on the 16 data elements. The NHHIO is going to need more of an ecosystem around receiving and the use of record locator. This does support the NHHIO model of not storing data, query and retrieve directly out of the other system what structured data that you want.
IRS 990, NHCT-2A and A133 Audit Mr. Loughlin discussed the Form 990 and the A-133 with the group. He noted that there were no significant findings in the A-133, the one finding or deficiency in the NHHIO process is the same deficiency noted last year. Mr. Lehrman explained to the group why it is a deficiency finding. The following footnote: 014-01 Audit footnote, using outside auditors, is generally added when an organization does not have a CPA on board to prepare a financial report to the accounting standards and rely on outside auditors, such as the NHHIO is doing. It is not a major
issue and is not classified as “Significant”. He further explained that the rules of engagement from the accounting world indicate that this is not a requirement. This is a conscious decision to have an outsourced agency perform this function and is not something that the NHHIO should be overly concerned about. Ms. Platte inquired about the Low Risk consideration, the running down of federal dollars. Ms. Eldredge asked the finance committee to look into the definition of this classification meaning. Mr. Loughlin noted that there is a line on the budget for professional fees of $15,000, which is an additional withhold for the Massachusetts eHealth Collaborative (MAeHC) for meeting certain contract requirements or milestones. In the past, the board approved the MAeHC contract and the executive committee approved the awarding of the milestones, moving forward that as the executive committee approves these payments, the award will be brought to the full board also. Ms. Platte asked a question about the NHHIO rent and is it currently at fair market rate. Ms. Bizarro of the NHHA reported that a recent analysis has been completed and the current rent the NHHIO is paying is at fair market value. Mr. Baggeroer asked a question about the exact timing for the list of board members attached to the Form 990. He noted that Jay Couture is present on the list and Ms. Witthaus’ last name is missing. Mr. Loughlin noted that the list is being reviewed and updated. A motion was made for the approval of the Form 990 and New Hampshire CHTA. The Form 990 and New Hampshire CHTA were approved; 12 in favor; 0 opposed; 0 abstentions Grant Funding Opportunity Mr. Loughlin discussed the NHHIO’s recent submission for the Health Information Adoption Support Grant. He noted that there were a large number of organizations applying for this grant and with only twelve (12) awards being awarded; it is difficult to ascertain the NHHIO’s chances of receiving an award. He explained the majority of the focus of the grant will be on the behavioral health community, post- acute, long term community and Federally Qualified Health Centers across the state, and their staffs to join in and support interoperability, participate in communities of practice and a peer learning network. The NHHIO asked for $1.8 million dollars and approximately $744,000 would be given out in terms of grants to the target community. Each of the organizations will be given approximately $3,000 in grant funding, requiring a $1,000 in kind match from participants. The NHHIO would apply 40 hours of staff support to each organization. Other Business, Advisory Group and Committee Reports a) Governance Committee Ms. Platte reported that conflict of interest forms have been disseminated and will need to be signed and returned on or before the next board meeting. b) Nominating Committee Ms. Nichols brought forward a candidate for appointment to the NHHIO Board of Directors, Ms. Ann D’arcy-James, RHIA from Exeter Hospital. Ms. D’arcy-James is a health information management professional at Exeter Hospital. Mr. Briden asked Mr. Loughlin to communicate on his behalf and in full disclosure, as he is not able to be present at today’s
meeting that Ms. D’arcy James does report to him in her role at Exeter Hospital; neither Ms. D’arcy-James or Mr. Briden have concerns about this fact. The group discussed her qualifications and her level of influence at the state level and with other HIM professionals across the state. A motion was made for the approval of Ms. Ann D’arcy-James for appointment to the NHHIO Board of Directors. The appointment of Ms. Ann D’arcy-James, RHIA to the board of directors of the New Hampshire Information Organization was approved; 12 in favor; 0 opposed; 0 abstentions Ms. Purington suggested that the idea of candidate diversity and perhaps adding a legislator to the board, as well as other important candidate factors such as level of influence at a state level, be discussed at the May board meeting. Ms. Eldredge agreed that a discussion about potential board candidate roles, attributes and requirements is important. She asked that a copy of the NHHIO board member candidate requirements be recirculated to the group. Mr. Baggeroer recommended that the future road map be determined before making final decisions about additional candidate roles to potentially join the board. f)
Finance Committee Mr. Lehrman reported that the committee has not met since the last board meeting. Mr. Loughlin reported that the NHHIO is currently on target against budget. He noted that the audit is moving forward well with no issues noted and he is waiting for the final report.
g) Technology Advisory Group Ms. Eldredge reported that the committee has not met since the last board meeting. h) Outreach & Education Group Ms. Mullen asked the group if all board members have been assigned to a committee or work group as she has not had board members attending the outreach and education work group meetings. Ms. Eldredge will look into this and report back to the group. Ms. Mullen noted that the work group has not met since the last board meeting and will be reviewing the schedule of future meetings. i)
Legislation Advisory Group Mr. Loughlin reported that he presented the annual update to the DHHS legislative oversight committee. He explained that Representative McMahon made a point to discuss with him the use and disclosure issues that remain with NHHIO. He felt that he was supportive. There is a concern that there is a risk as the intent was to cover all health information exchange activities in the state not just the NHHIO
Other Updates Mr. Baggeroer notified the group that the New Hampshire Hospital went live on the Netsmart electronic health record this past week. Ms. Mullen reported to the group about a company called Tiger Text who has partnered with Verizon as a reseller of secure text services. She found the company services to be intriguing and is wondering if the NHHIO has interest in becoming a reseller.
Mr. Loughlin reported that the NHHIO staff is now able to use their NHHIO based Gmail accounts for communications. V. Next Board of Director’s meeting a) The next Board of Director’s meeting will take place: 8:00am May 13, 2015 at 125 Airport Road, Concord, NH. VI. Adjournment With no further business to discuss, the meeting adjourned at 9:36am Minutes respectfully submitted by: Jackie Baldaro