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North Carolina Health Information Exchange

Clinical and Technical Operations Workgroup

11 th Meeting

Date: April 15, 2011 Time: 9:00 am – 11:00 am Location: NC Medical Society, 222 N Person St., Raleigh, NC Dial in: 1-866-922-3257; Participant Code: 654 032 36#

Agenda

Topic Welcome and Meeting Objectives Building the RFP for Statewide HIE Services Statewide HIE RFP Requirements

• Points of clarification • Key modifications

Request for Comments

•Overview and discussion of responses

Next Steps Public Comment Leads

Co-Chairs NC HIE MAeHC Manatt NC HIE Co-Chairs

Time

9:00 – 9:10 9:10 – 9:40 9:40 – 10:10 10:10 – 10:45 10:45 – 10:50 10:50 – 11:00

Statewide HIE RFP

Building the RFP for Statewide HIE Services

High level overview of the procurement process

RFP draft review process – Getting from today until April 25

11 Mon 18 Workgroup Members ask questions and provide suggested edits back to NC HIE and MAeHC 12 Tue 13 Wed 19 Workgroup Members ask questions and provide suggested edits back to NC HIE and MAeHC 26 20 NC HIE and MAeHC incorporate suggested edits and send RFP Draft 2 to Workgroup Members 27 14 Thu 21 Workgroup Members attend Conference Call to offer final suggested edits and revisions Fri 15 RFP Draft 1 to Workgroup Members 22 NC HIE and MAeHC incorporate final suggested edits and finalize RFP 28 25 **RFP Release to Technical Services Vendors 29 **Letters of intent and questions due from Technical Services Vendors 5

Introduction to the RFP draft

Request for Proposal - Table of Contents

Section 1: Executive Summary Section 2: Introduction to NC HIE Section 3: Scope of Work. This section includes: • Overviews of the statewide HIE organizational approach, clinical functions, and envisioned technical approach including core, value-added, and non-functional services • Key assumptions regarding the healthcare delivery landscape and the current rollout/integration plan • Reference to key documents including the Strategic and operational plans and the full list of reconciled requirements Section 4: Overview of the procurement process including the Schedule of Activities Section 5: NC HIE Evaluation Criteria Section 6: Disclaimers for the proposal process Section 7: Terms and Conditions that will be used in the contract with a selected Vendor Section 8: Detailed instructions for Vendor responses Appendix A: Services and Requirements Template Appendix B: Resumes Appendix C: Pricing and Cost Template Appendix D: Financial Information

Critical dependencies

A successful and timely RFP release is dependent upon completion of the following critical items – All items are currently on schedule and we’ll reach to you for input to finalize all items: •Requirements •Rollout assumptions •RFP Legal Language (Terms and Conditions, Disclaimers) •Evaluation Criteria •Evaluation Team Recruitment

Statewide HIE RFP

Statewide HIE Requirements

Statewide HIE Requirements: Compilation

 NC HIE received feedback from 13 Work Group members  NC HIE has inventoried and compiled more than 400 individual comments, suggestions, and recommendations in the file NC HIE Inventory of Feedback on Requirements_Final.xls.

Statewide HIE Requirements: Integration of Feedback

Steps Taken from March 18 Workgroup Discussion

• Reviewed requirements with individuals for clarification • Restructured requirements to consolidate security functions • Categorized and incorporated Request for Comments with Work Group recommendations • Modified specific requirements for clarity and further segmented functional requirements to architectural components • Summarized and reviewed requirements and comments with MAeHC

Classification of Work Group’s Input

• Acknowledged: Comment is read and understood. Comments will be transmitted to the RFP team for their consideration.

• Changed or clarified: The original functional requirement’s intent is kept intact but the language is modified per the reviewer’s recommendation.

• Added: The reviewer introduced a new function or suggested that an existing be split into multiple requirements.

• Removed: Requirement was removed as recommended.

Statewide HIE Requirements: Concepts Requiring Clarification



Core vs Value-added HIE Services

 Core services refer to the system architecture that is shared across the system.  Value-added services are the functions that are utilized by end-users. Comments relating to how value-added services are packaged for communication and marketing purposes are acknowledged.



Key principles used to modify requirements (credit to Jim Murphy):

 Define requirements with objectives and leave to the vendor to describe how to meet the objectives  Restrict asking questions as functional requirements  Ensure that any redundancies ask for the same level of detail across sections 

Repeated Requirements

 Vendors responding to the RFP may propose multiple systems, hence there are some repeated requirements. A provider directory may be separate from an identity management system, but both will require integration to role based access and logging.

Statewide HIE Requirements: Key changes from previous version



Security section now includes:

  Baseline privacy and security requirements Audit and logging   Identity Management and Authentication Transactional logging is maintained separately as a core service 

System response times for core and value-added services are not specified, rather vendors are asked to document and define their performance measure approach



Added functional requirements to support future federation of core services



Modified undefined standards for provider directory export and security assertion expressions to request vendor approach rather than establishing functional requirements 12

Statewide HIE RFP

Request For Comments

Request for Comments: Overview

Input Received 24 sets of comments from a wide variety of organizations...

• 9 vendors • 6 associations • 4 individuals/organizations delivering care • 3 State government agencies • 2 Regional Health Information Organizations

Comments available online at http://www.ncdhhs.gov/healthit/ Topics Addressed

 Participation in statewide HIE  Value proposition and location of HIE services  Selection of HIE services  Sequencing and deployment of HIE services  Considerations for other work groups

RFC Responses: Participation in Statewide HIE

Comments

• Is it the expectation that existing HIE’s connect directly to each other, or would there be a

requirement to connect via the NC HIE?

• Is an HIE allowed to enter an exchange agreement directly with a federal or state agency?  Participation in the statewide HIE will be voluntary.

 Organizations may connect with whomever they like and will not be required to use the NC HIE infrastructure to exchange data.  It is our goal to create a shared infrastructure that eliminates the need to create and maintain costly, multiple point-to-point connections.

RFC Responses: Sequencing and Deployment of HIE Services

Comments

• Do not implement this system until most of the value-added functions are included. If the provider cannot

easily use the HIE network to accomplish this, he/she will scrap the system and never come back. The first impression is the most important.

• Beginning with a minimum set of core services is essential to demonstrate value and engender long-term

support and the funding necessary to build out a more fully-functional capabilities that most providers will need to optimize the potential for HIE.

• We recommend the RFP articulate a modular approach for adding services over time rather than all at once. 

The NC HIE Board has committed to the development of a robust, first class statewide HIE that delivers the services to improve the quality, safety, effectiveness, and efficiency of care.



Services will be delivered in phases over time.

 By December 2011, we expect to have available a foundational set of services, including core and selected HIE services.  Additional capabilities will be deployed based on an assessment of the value, cost, complexity of the candidate service.

RFC Responses: Value Proposition and Location of HIE Services

Comments

• What additional value will the NC HIE provide to the organizations already participating in an HIE? • We believe Qualified Organizations and even some hospitals will choose to provide many of the advanced

services contemplated by the NC HIE. Making them mandatory as part of the NC HIE will duplicate the services and the cost for implementation and maintenance, as well as disincentivize innovation at the QO level.

• Our system already provides terminology translation services within out IT systems. If these service are in the

Statewide HIE we essentially pay twice.

 NC HIE will deliver value in two ways: (1) offering a cost-effective mechanism for securely identifying and retrieving data across systems; and (2) providing and facilitating access to value-added services.

 NC HIE is committed to ensuring that all organizations in the state have access to a rich array of HIE services.

 Given the nature of the statewide HIE as a “system-of-systems”, there will be some duplication of processes and data.  We have a systemic design approach that tolerates duplication in so far as it provides value and it doesn’t create inefficiencies.

RFC Responses: Candidates for Statewide HIE Services

Respondents from regional exchanges indicated that the following are attractive candidates for statewide HIE services and activities:

Services

• • • • •

CCD/CCR exchange Immunization registry integration Access to State and federal resources (substance abuse, disease registries, etc) Public Health Reporting which could be rolled into a quality reporting service. Nw-HIN integration

Activities

•

Standardization of policy/governance across other NC-based HIEs

•

State-level group purchasing power

•

Patient educational materials.

 We will integrate these suggestions into the plan for selection and deployment of services.

RFC Responses: Feedback Applicable to Other Work Groups

Legal and Policy Considerations

• Authentication: Are we going to require the authentication of every individual behind the firewalls of every

enterprise or will we rely on agreements to ensure that only properly individuals authorized by that enterprise may request and receive message content that contains PHI?

• Cross-State Exchange: Leverage the policy work that has been done to facilitate cross-state and multi-state

exchange.

• Access and Disclosure: To share information with schools (school nurses), the HIE must establish policies that

comply with the Family Educational Rights and Privacy Act (FERPA).

• Data ownership and stewardship: Policies for data access, use and control need to be created. The HIE must

determine the “gold” standard for each data source and agree who owns the data, including duplicate record tables and data transaction logs.

• Patient’s role: Determine the patient’s role in accessing and/or updating data stored by the HIE. Education to the

patients on the HIE will need to be provided in a clear, concise, and easily understandable method.

Finance Considerations

• Minimize the costs that will be passed onto providers • Ensure the system is affordable for organizations and providers in underserved areas  These comments will be shared with the appropriate Work Groups

Public Comment

Next Steps

Upcoming Meetings

• Requirements Meeting – April 19 • Final RFP Draft Review – April 21

Key Dates

• Release of RFP – April 25 • Responses to RFP due – May 20

Attachments

Clinical & Technical Operations Work Group Members

Statewide HIE Components

Core HIE Services

– Foundational services hosted by NC HIE that facilitate exchange health information across organizational boundaries, such that multiple entities can: • Identify and locate each other in a manner they both trust; • Reconcile the identity of the individual patient to whom the information pertains; • Exchange information in a secure manner

Security Services Message / Record Routing / Return Receipt Transaction Logging Terminology Service Patient Matching / RLS Provider Directory Identity Management and Authentication Consent Management Transformation Service NHIN Gateway Value-Added HIE Services

– Services that support the clinical priorities and use cases to help providers, patients, and care givers improve the safety, quality, and cost effectiveness of heath care. – Value-added services will be accessible via core services – Value-added Services can be offered at the state, regional, or enterprise level.

– Value-Added services will be incrementally deployed based on feasibility, cost, and magnitude of benefits

CCD Exchange Lab Results Delivery Lab Normalization Lab routing for reporting Quality Reporting Rad Image Delivery Immuniz Access Procedure Results Delivery Access to Aggregated Data Rad Results Delivery Disease Surveillance Clinical Decision Support Med Hx CCD Translation Phase 1 Value Added Services proposed in Operational Plan Phase 2 Value-Added Services proposed in Operational Plan

Final decision regarding phased implementation will be informed by forthcoming statewide HIE RFP

Technical Relationships: Core HIE Services, QOs, & QO Participants

Key Points:

* Core services provide a foundation for identifying QOs, ensuring security, and providing a gateway to other QOs and additional HIE services * QOs link to core services by conformance to interoperability specifications * QOs provide a gateway to core services for their participants NC HIE Example QOs...

Security Services Consent Management Provider Directory Terminology Service Message / Record Routing / Return Receipt Transformation Service Identity Management and Authentication Patient Matching / RLS Transaction Logging NHIN Gateway

Large Hospital System Physicians (IPA, PHO, PO) Regional HIO Example QO Participants...

Physician Practice Physician Practice Physician Practice Hospital

Technical Relationships: Value-added Services, QOs, & QO Participants

Key Points:

* Value-added Services are available to network participants and can be hosted by different entities. For example: 1. NC HIE could host a CCD Exchange service 2. The Dept of Health could host an Immunization Access service 3. A QO could host a CCD Translation service * Based on considerations of efficiency and practicality, the NC HIE Tech/Clinical Ops Work Group continues to evaluate the ideal location for Value-added Services Physician Practice Physician Practice NC Immunization Registry

2. Immuniz Access

Large Hospital System

3. CCD Translation

NC HIE

1. CCD Exchange Security Services Consent Management Provider Directory Terminology Service Message / Record Routing / Return Receipt Transformation Service Identity Management and Authentication Patient Matching / RLS Transaction Logging NHIN Gateway

Large Hospital System Physician Practice Physician Practice Physicians (IPA, PHO, PO) Regional HIO Physician Practice Hospital