1. health and fitness

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)
Jan-15
Aug-14
A
Sep-14
Nov-14
A
R
A
R
Jan-15
A
A
R
Mar-15
Apr-15
A
R
A
A
R
A
R
R
R
A
A
R
R
R
A
A
A
R
A
R
R
A
A
R
A
A
A
A
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