1. 1 Vermont Health Information Technology Plan (VHITP) Workgroup Meeting April 11, 2007 VERMONT INFORMATION TECHNOLOGY LEADERS

2. 2 Agenda Status and timeline Review Plan Sections: –Revised Use NarrativesRevised Use Narratives –Revised Standards Section and open issuesStandards Section –Technology Section first draftTechnology Section –Vision Section first draftVision Section Discussion on upcoming Sections: –Funding/Financing –Governance From last month's agenda: –Patient control

3. 3 Where are we Finalized Use Narratives Workgroup Topics –Education –Funding –Security and Privacy VHITP Draft –Skeleton –Standards –Technology –Vision “The checklist” – key decisions The timeline – who and when do we need to bring in?

4. 4 Plan Sections - Update

5. 5

6. 6 12 Weeks to go 1.April meeting (4/11/07) 2.Draft sections 3.Draft sections 4.Draft sections 5.May meeting (5/9/07) 6. 7. 8. 9. 10.June meeting (6/13/07) 11. 12.Plan due at end of week (6/30/07)

7. 7 The “Checklist” Recommendations at the application level for EMRs in provider practices “There are other aspects of government involvement, such as access to the health information infrastructure by municipalities…” “Input from the Vermont business community” “A mechanism for soliciting and managing patient, consumer, and citizen input”...and on today’s agenda.

8. 8 Use Narratives and Vision Additional updates Still open for feedback Draft Vision Section includes some narratives; others in Appendix

9. 9 Standards Updates How much emphasis do we want to put on the concept of "compliance" and should this concept be limited to HIE standards in particular and not HIT standards in general? Should we have distinguish between HIE and HIT standards and focus only on the HIE side in terms of recommendations and/or requirements? –A standard that stakeholders should keep an eye on but is not recommended or required at this time (not mature enough, etc.) –A standard that is recommended and may be implemented (to be in "compliance" with the Plan?) –A standard that is recommended and should/must be implemented –A standard that must be implemented in order to participate in any way with the HIEN Should we mention the CON in particular or leave it to others to modify the CON process based on the Plan?

10. 10 Technology Draft posted VITL as the HIEN Phases “Document centric” vs. “Data centric”? “Provider centric” vs. “Patient centric”? IHE Profiles

11. 11 Funding Initiative - VITL Establish interim fund Issue RFP for software / implementation vendors Publish criteria for pilot sites Select pilot sites Monitor progress

12. 12 Funding - VHITP What to say beyond EMR funding initiative? Provide technical and operational assistance to practices (for HIT or HIE participation) Provide incentives for re-using data rather than repeating services (for example, provide a CPT Code or modifier to an existing CPT code for “looking up” results versus placing new orders). To help ensure sustainability, provide appropriate funding to organizations supplying HIE/HIT services What about VITL?

13. 13 Governance Embace HISPC’s HIE Commission concept? –Evolving standards and compliance –Patient Control –Break the Glass Benefits –Credibility –Potential for increased involvement Drawbacks –Why can’t VITL play this role? –Compare to other states –Do we really need yet another organizational structure?

14. 14 Patient Control/ Consent/Centeredness Do we need a consensus on a more specific policy/direction? Potential options: 1.Patient Control as an overarching principle; all HIEN participants adhere to the principle (must be defined of course) 2.Consent as the principle 3.No change

15. 15 Understanding patient concerns General concerns about data security –Breaches in the news Concern about disclosure/use of data beyond treatment –Personnel at health care facility –Insurance company –Employer –Public Health Concern about disclosure/use of data for treatment –Current/past conditions prejudicial to treatment –Embarrassment –Patients lie / withhold Education as a cross-cutting need. Discrimination / Identity Theft / Embarrassment Marketing

16. 16 Framework for Patient Consent Recognize limitations under current law and under paper records (basis for educational campaign) Recognize that HIT and HIE do in fact diminish to some degree the patient’s control Distinction between: –Complete longitudinal health record as an exchange document – Exchanging all clinical observations –Subset or condensed record (CCD/CCR, labs, demographics, medications, imaging) (and what does VHITP have to say about this?) Establish physician requirements –OK with defined subset –OK with opt-out –Not OK with arbitrary omissions Are we faced with a 100% provider opt-out vs. a 2% patient opt-out situation? Can we combine an understanding of what is exchanged with informed consent to reach an optimal solution? Still, what is the Granularity of Consent?

17. 17 HISPC Framework “Patient authorization for release of information” as the organizing principle for the electronic exchange of health information outside of those areas that remain covered by HIPAA or relevant state or federal law. The principle includes three core components: 1.Providing a patient the right to make an informed choice to participate in a health information exchange, including the right to opt-in and to opt-out at any time, acknowledging that an informed choice is dependent on the ability to know what health information is in the exchange as well as to whom the information is given; 2.Whether then the patient can block portions of his or her record from being accessed by treating providers who would normally have access to it under HIPAA Treatment, Payment, and Operations (TPO) rights; and 3.If "blocking" was permitted, what liability protections can be put in place for the treating provider.

18. 18 Project Website