NC Health Information Exchange: Governance Workgroup

1. NC Health Information Exchange:Governance Workgroup August 9, 2011Presenter: Jeff Miller

2. Organizational Approach – A Range of Choices Statewide HIE is the market Regional HIEs Statewide network of diverse qualified organizations Market determines structure • Statewide HIE builds infrastructure • NC HIE’s focus on local adoption/ governance • Divides NC into territories • Statewide HIE provides governance, manages monopolies • Range of “QOs” make up core structure • Statewide HIE provides policy guidance, core services and interoperability • Value-added services benefitting the range of participants • No core services • Private market addresses interoperability • Focuses on education and policy guidance

3. Organizational Approach – NC HIE’s Choice Statewide HIE is the market Regional HIEs Statewide network of diverse qualified organizations Market determines structure • Statewide HIE builds infrastructure • NC HIE’s focus on local adoption/ governance • Divides NC into territories • Statewide HIE provides governance, manages monopolies • Range of “QOs” make up core structure • Statewide HIE provides policy guidance, core services and interoperability • Value-added services benefitting the range of participants • No core services • Private market addresses interoperability • Focuses on education and policy guidance

4. Characteristics of Qualified Organizations Community Business Model Governance Technology Technically, the QO has the responsibility connect its Participants into a network that can be integrated with the NCHIE. It may chose to offer information services that are unique to its specific community A QO must be a business or government entity as it will enter into contracts with its Participants and with NCHIE. This business entity must be stable and sustainable A QO needs a locus that the Participants recognize and value. This locus can be represented by geography, business structure, medical specialty, professional association, or many other characteristics As with any community, the QO must have an established Governance policy by which decisions are made and behaviors enforced to the benefit of the community. This includes the definition of the roles and expectations of the Participants

5. Addressing a Diverse Set of Participants Organizational Resources NC HIE Services QO Responsibilities Safety Net • NC HIE will assist QO’s by providing low cost, high availability technology services on a subcontract basis • NC HIE will work with other facets of the NC health ecosystem to create a Safety Net to ensure that no provider is left behind

6. NC HIE QO Enablement Services – aka Virtual QO Practices • NC HIE will assist organizations wishing to establish a QO by contracting to provide the technology services to connect the participants to the network – both QO and NC HIE. • This effort will leverage Core Services technology and operations • NC HIE will provide technical assistance in Participant on boarding, integration, training, and technical operations • QO is still responsible for • Establishing and maintaining the community • Managing the business relationship with the Participants • Providing appropriate Governance including privacy and data use policies Hospital s Coastal Connect HIE (Medicity) NC HIE (Orion) Practices Hospital s County XYZ QO

7. QO Enrichment Services • In addition to assisting QO’s with Enablement Services, NC HIE will develop a set of Enrichment Services that can be used by any QO to enhance the offerings to its Participant group • Examples of Enrichment Services could include SaaS EMR offerings, Analytics, enhanced message gateways, etc. • These services can be “resold” or provide to the QO Participant community • The QO will have the option of rebranding some of these services to help further the QO goals within the community • Enrichment Services are not mandatory and are not included in the Base Membership Fee. These services are configurable by each QO • The Enrichment Services program will focus on opportunities where there are economies of scale or opportunities but requirements for local customization

8. Safety Net Program • The objective of the Safety Net Program is to ensure that every provider has the ability to participate in the NC HIE program • Focus areas • Address market segments with unique financial challenges (e.g. free clinics) • Provide safe haven for “independent” provider • Many different models have been explored • NCHIE as a QO • Create a “newco” to be Safety Net QO • Leverage existing QO activities • Current recommendation • NC HIE will collaborate with other NC health entities to create an assistance program to assist those organizations with financial needs • NC HIE will work with N3CN and traditional safety net providers to create a QO option for this group

9. Summary Why is our “diverse QO” structure the best option? Local Flexible Efficient Diverse Capable Our approach encourages the accelerated adoption of new capabilities in the QO community Diversity is encouraged by the lack of a singular view of QO community By promoting the use of established investments in the core services and identifying common needs across the QO’s, this approach is very cost efficient With the ability to configure different approaches and capabilities into a QO offering, flexibility is preserved Recommended approach continues to focus on “local” communities established and maintained by those communities