2 nd Meeting Date : June 23, 2010 Time : 8:30 am – 11:00 am Location : NC Hospital Association

1. 2nd Meeting Date: June 23, 2010 Time: 8:30 am – 11:00 am Location: NC Hospital Association 2400 Weston Parkway, Cary, NC Dial-in: 1-866-922-3257; Participant Code 654 032 36#

2. Agenda

3. NC Statewide HIE Cooperative Agreement Timeline Strategic Plan Operational Plan Stakeholder Outreach Biweekly+ Workgroup Meetings with Monthly Board Meetings Strategic Plan Submitted to HHS LaunchPhase 2 Publish Draft Operational Plan for Review/ Comment NC HIE Formed Workgroups Formed & Begin Meeting Submit Operational Plan to HHS State HIE Grant App. • Convene Advisory Board & Workgroups • Draft Operational Plan • Publish Draft Operational Plan for Review • Engage and educate stakeholders Funding Announcement Letter of Intent Submitted Discussion Document – Not for Distribution

4. Expectations of the NC HIE Workgroups • Participants have been nominated and invited to participate by the NC HIE governing board co-chaired by Secretary Lanier Cansler and Dr. Charlie Sanders for your expertise in your field and your commitment to improving health care quality, access, and affordability for all North Carolinians. • Workgroup members are asked to draw on their expertise and perspective from across industries sectors with an eye toward supporting the greater goal of a statewide resource for North Carolina. • Workgroups are expected to be multi-stakeholder, nonpartisan and all discussions, meetings and decision-making processes to be fully transparent. • Workgroups are asked to consider multiple stakeholder group perspectives when working toward solutions. • Workgroups will be asked to make consensus-based recommendations to the NC HIE governing board. In cases where consensus is not reached, the workgroup is expected to put forth a balanced, fair consideration of the pros and cons of an issue. • Workgroup members are expected to respect the opinions and input of others and to engage in fair meeting conduct to work toward consensus recommendations. • Workgroup members are strongly encouraged to attend meetings in person whenever possible. • Public stakeholder input is encouraged.

5. Meeting Objectives:Key Decisions • NC HIE Strategic Plan Verification as Relates to Governance Domain • Recommend Bylaw Provisions Related to Board Selection, Transparency, Conflicts of Interest • Recommend Key Components of a Consumer Engagement Plan

6. June 15, 2010 NC HIE Board Meeting

7. NC HIE Board Discussion: Crafting a Vision Statement A good vision statement includes: Aspirational statement that outlines long term goals with respect to the purpose of HIE and provides a framework for strategic planning (the image of the future we seek to create) Actionable statement of near term goals and activities Actionable statement of mid-term goals and activities In concert with a vision statement, the organization must develop a framework to evaluate and measure success Discussion Document – Not for Distribution 7

8. NC HIE Board Discussion: Proposed Approach Vision for near- and mid-term goals will evolve out of the Workgroup process. In order to for goals and activities to be substantial, actionable and measurable, additional time is needed for Workgroups to make recommendations to the Board. The Board should discuss component #1 (aspirational vision) today to help set an overall framework for components #2 and #3. The Workgroups, led by the Clinical/Technical Operations Workgroup, should be tasked with bringing recommendations to the board for components #2 and #3. Discussion Document – Not for Distribution 8

9. NC HIE Board Discussion: North Carolina Vision – From Oct. 2009 Strategic Plan Discussion Document – Not for Distribution 9

10. Comparison of Statewide HIE Vision Statements from Other States Discussion Document – Not for Distribution 10

11. Governance Workgroup - June 9, 2010 Meeting

12. Technical/Clinical Operations Workgroup – June 9, 2010 Meeting

13. June 8, 2010 Subcommittee Meetings Discussion Document – Not for Distribution

14. Finance Workgroup – June 9, 2010 Meeting

15. Strategic Plan Verification

16. Implied Decisions in NC HIE Strategic Plan – Oct. 2009

17. Implied Decisions in NC HIE Strategic Plan – Oct. 2009

18. Bylaw Provisions Related to Board Selection, Transparency, Conflicts of Interest

19. Basic Attributes of Governing Boards • Size of the governing board • Makeup of the board • Staggered terms & term limits • Nomination process for new board members & vacancies • Internal structure • Executive Committees • Working Groups • Advisory Council(s) • Operations Council • Conflicts of Interest policy

20. Current NC HIE Board – 20 Members, 2 Ex Officio Co-Chairs • Lanier Cansler, Secretary NC Dept. of Health and Human Services • Dr. Charlie Sanders, Past Chair of GSK, Pediatric Health Advocate Members • Dr. Bill Atkinson, WakeMed • Tom Bridges, Henderson County Health Department • Dr. Hadley Callaway, NC Medical Society • Anthony Civello, Kerr Drugs • Dr. Sam Cykert, Area Health Education Centers (REC) • Dr. Allen Dobson, Community Care of NC • Dr. Gloria Frelix, Old North State Medical Society • David King, LabCorp • Becky Kitzmiller, NC Nurses Association • Ben Money, NC Community Health Centers Association • Dr. Warren Newton, NC Healthcare Quality Alliance • John Richter, Long term Care • Dr. Bill Roper, CEO UNC Hospitals • Dr. George Saunders, NC Medical Board • Dr. Sam Spicer, NC Healthcare Information and Communications Alliance (NCHICA) • Senator Josh Stein, Consumer Representative • Dr. Dave Tayloe, American Academy of Pediatrics • Brad Wilson, CEO Blue Cross Blue Shield of NC Ex Officio Members • Steve Cline, State HIT Coordinator, NC Department of Health and Human Services • Jerry Fralick, NC Chief Information Officer

21. KEY DECISION • Recommendation on size of NC HIE Governing Board?

22. Size of Governing Board • Alternatives include: • Large board with internal committees • Smaller board supported by working groups and possibly an “operations council” where each body is staffed with participants having appropriate qualifications • Current Size NC Board: 20

23. Size of Governing Board

24. KEY DECISION • Recommendation on composition of NC HIE governing board.

25. Board Composition

26. Board Composition Should any stakeholder groups not be allowed to hold a voting seat on the board?

27. Board Composition

28. Board Composition: Comparative Analysis

29. KEY DECISION • Recommendation on board term limits.

30. Board Member Terms, Term Limits & Staggered Terms

31. KEY DECISION • Recommendation on board member nomination process and vacancies.

32. New Board Member Process

33. Removal of Members and Vacancies

34. KEY DECISION • Recommendation on committee and/or advisory body structure.

35. Committee Structure • Committees and Advisory Bodies • Standing Committees such as: • Executive • Finance • Nominating • Operations Councils • Advisory Committees such as • Consumer • Provider/Practitioner • Technical Infrastructure • Privacy/Security • Communications • Workgroups versus Advisory Committees

36. Board of Directors Committee Structure • One Approach: • Staffed with thought leaders • Ultimate responsibility and authority to adopt rules. Standing Board Committees Workgroups Special or Advisory Committees • Board members • Decisions related to governing the organization and responsibilities of the Board of Directors • Subject matter experts (may or may not include board members) • Studies issues and makes recommendations to Board of Directors • Subject matter experts or specific stakeholder group advisors such as Consumers or Practitioners • May provide guidance to the workgroups or directly to the board

37. Operations Council Working Groups Board of Directors Committee Structure • One Approach: • Thought leaders • Ultimate responsibility and authority to adopt rules. • Staffed with people having organizational experience in HIE • Allocates issues to Working Groups for study • Vets recommendations of Working Groups and makes recommendations to Board • Subject matter experts • Studies issues and makes recommendations to Operations Council

38. Committee Structure

39. KEY DECISION • Recommendation on conflicts of interest framework for bylaws.

40. Conflicts of Interest • Most (if not all) state HIO bylaws require the adoption of a conflict of interest policy but do not define the policy in the bylaws (MO, NY, TN) • Some states define a conflict of interest policy as part of their bylaws (ME, VT). Common characteristics include: • Requires disclosure of conflict • Recusal • Definition of the terms of conflict

41. KEY DECISION • Recommendation on transparency framework for bylaws.

42. Transparency • As a public/private partnership the organization has a responsibility to offer transparency. Policies to support this goal often include: • Notification of any upcoming board meetings and/or associated workgroup or advisory committee meetings posted and available to the public. • Board meetings and associated workgroup or advisory committee meetings open to the public. • Some states further specify in bylaws that in addition to open meetings, board votes and actions, organizational finances and any procurement processes including solicitations, bids and results must be disclosed to the public. • Some states allow for flexibility in their transparency framework to recognize there may be specific instances where transparency should be limited and expressly provide the board the ability to go into closed session. Areas that may be protected from public disclosure may include: • Personnel decisions • Sensitive issues that require individual privacy or discretion (such as harassment claims, removing a CEO or Exec Director from office, etc.)

43. Components of a Consumer Communications & Engagement Plan

44. Consumer Engagement Requirements • Statewide Cooperative Agreement Requirements • Patients/Consumers have some manner of representation in governance process • Required communications plan includes a consumer engagement component • Policy frameworks protect consumer interests

45. Definition of a Consumer Representative for Discussion • Some state HIOs elect to define specific characteristics for Consumer Representatives on the board, even if their approach to board composition is not expressly an approach that requires allocated seats. Consumer Representative Characteristics Compiled from Other States For purposes of service on the Board of the Statewide HIO, a consumer representative should exhibit the following characteristics: • Do not typically have a financial stake in the healthcare system; • Affiliation with a nonprofit, mission oriented organization(s) that represent a specific constituency of consumers or patients • Are a trusted source of information in the community; • Speak from a global perspective and have experience representing the diverse needs and wants of consumers and patients; • Have networks to empower and mobilize the community (e.g., email lists websites, meetings, newsletters, and conferences) and share information and messages; • Have established relationships with the media, policymakers, and elected officials; and • Have a background in health care or an understanding of the health care system. • Capable of reflecting the viewpoints and concerns of consumers and patients • Others?

46. Components of a Consumer Engagement Strategy for Discussion • How do we earn the trust of consumers and patients? • What really engages a consumer or patient? • What tools work for a consumer or patient? • How do we know if we are engaging consumers or patients? • Are there key consumer or patient groups that should be engaged? • Are there key points of engagement? • Are there social media outlets that can/should be leveraged? • Are there potential partnerships with NC foundations or other organizations?

47. Components of a Consumer Engagement Strategy for Discussion • Possible Next Steps: • Recommendation for consumer representation in governance • Subcommittee of Governance Workgroup drafts consumer communication and engagement principles document for review • Recommendation to establish a consumer communication and engagement workgroup in Phase II (post Operational Plan) • Recommendation that consumer communication and engagement plan be a component of a larger stakeholder communication plan as part of ARRA HIT-HIE activity coordination • Other

48. NC HIE Operational Plan Calendar Governance, Clinical/Technical Ops, Finance WG Meetings Legal/Policy WG Meetings Legal/Policy Subcommittee Meetings NC HIE Board Meetings Operational Plan version releases Operational Plan due to ONC WG conference calls as needed

49. Next Steps Upcoming Meetings Workgroup Meeting – July 8 Board Meeting – July 13 Questions or Comments? - Contact anita.massey@nc.gov 49 49 Discussion Document – Not for Distribution