Oklahoma Health !nformation Exchange Trust

Sustainability PlanAugu st 2AL2

Val Sehottn Hxerutive Dinertor

Oklahoma Health lnformation Exchange

Sustainability Plan

The Oklahoma Health lnformation Exchange (OHIET) is a public trust indentured for the purpose

OHIET has been conceived to ensure (short term)that every Oklahoma Eligible Provider(EP) has access to the services that will enable them to meet Stage 1 Meaningful Use

(S1MU); and (longer term) that every Oklahoman has the benefit of their completemedical record being available in real time by any provider they see. Additionally, OHIET

will ensure the "5 Rights of HlE": right information, right patient, right provider, righttiming, right security (OHIET, 2011, p. 3).

The continuance of OHIET beyond federal funding engagement is a deliberate plan to build onthe social capital derived in the operational phase. The continuance of OHIET is based on theFranchise Model (Department of Health and Human Services, ZAO7al.

Figure 1. Health lnformation Exchange and OHIET Function

National Super:Hub

Ana lytics

Advocacy

Sustainability of OHIET requires a combination of funding from feeq product/service sales, andstate support. The alignment of incentives to participate in OHIET is essential (Deloitte Centerfor Health Solutions, 2006). The result of participation in OHIET will be connectivity to thenational or regional superhub for health information exchange. Activities will be conducted onbehalf of the health information organizations (HlOs) that cannot be completed on a state levelby any one H|O--public policy, social marketing, collaborative engagement of HlOs, HIO

credentialing, and privacy and security integrity.

Figure 2. Logic Model for OHIET

OHIET must be dynamic in the health information technology (HlT) market, responding tochanges in technology, and funding. The anticipated dependence on HIT to reduce health care

costs, increase patient safety, and improve coordination of care under the Patient Protectionand Affordable Care Act (Affordable Care Act) ensures a position for a statewide coordinationrole for OHIET.

Essential Role of OHIET in Credentialing and SafetyThe role of OHIET in credentialing and annual review of the HlOs is essential to assure quality.Elements include oversight and testing of .

Authentication-Enable authentication of an entity's users (systems, software tools,and individuals) as well as independent users whenever location of information and/ordata are exchanged within an HlO..

Authorization-Facilitate management of an individual's permission/authorization toshare information about the location of health information or apply restrictions onaccess to specified health information.Personal ldentification-Utilize a standard person identity/information correlationprocess to uniquely identify an individual.Location of Health !nformation-Provide functionality that will locate where healthinformation exists for identified individuals.Transport and Content Standards-Transport types: (1) requests for and theirresponses to location of information, (2) requests for data, (3) data itself, and (4) othertypes of messages (such as notifications of the availability of new data). To destinationsusing general industry-recognized transport types and authorized recipient's specifiedmode. To and from electronic addresses that are unambiguously identified in astandardized manner.Data Transactions-Provide functionality that will enable data transactions to occuramong authorized entities and/or users upon specific trigger events, such as:Automatically sending final lab results for any previously sent preliminary results,sending any changes in medications prescribed, reporting medication errors, notifyingpublic health about the occurrence of a bio-hazard event, informing individuals aboutthe availability of a clinical trial, and determining hospital census for disaster planning.Auditing and Logging-Log and audit all (intentional or unintentional) connections anddisconnections to network services and all network configuration changes, generatingalerts/notifications for system activity outside the normal range of monitoringlevels/thresholds.Time-Sensitive Data Access-Enable time-sensitive data request/response interactionsto specific target systems (e.g., query of immunization registry request for currentmedication list).Communications-Communicate health information using HITSP-identified standardcontent and message formats.Data Storage-Enable the ability to aggregate data from disparate sources to facilitatecommunications. For example, temporarily hold information as it is being collected tocommunicate a concise summary of the information; or permanently store data fromuncoordinated sources across time tosupport a data registry (Department of Health and Human Services, 2AO7, p.541.

Estimated Income and ExpensesThe estimated cost of OHIET sustainability annually is S1,050,700. The income may be derivedfrom

o Certification fees/renewal certification and a percentage of revenues (a%) for each HlO.The benefit to the HIO derives from policy setting, advocacy, convener, use casedevelopment, grant making, project management, regulatory affairs, and items untoldas the frontier of HIT develops.

o Medicaid administrative fee is 90:10 match frbm the Oklahoma Health Care Authority.The 10% of state funding is from the fees from the HlOs matched to the 90% federalmatch for administrative services on Medicaid covered lives (estimated at 17% of thestate population). The benefits to Medicaid are analytical support for comparativeprivate insurance data, community quality measure analytics, and potentialestablishment or management of state registries for genetic, infectious diseases, orchronic diseases.

Product and service fees may be a variety of sources. lnsurer fees may provide a sourceof product funding for HlOs or OHIET. Analytics services will quality assurance, andcomparison with Medicaid/Medicare services will be instrumental in cost management.The state match will be derived from engagement of state legislature to assure acertification and monitoring process for the Hlos (similar to the State lnsuranceCommission).

Table 1. Estimated lncome and Expense for OHIET Annually

30,000

200,000

566,000

500,000

100,000

s L,396,000

160,000

40,000

60,000

260,000

14,000

7,500

200,000

96,000

100,000

100,000

200,000

7,200

54,000

L2,000

S 1,05o,7oo

Expenses are derived from maintenance of min jmum.staff for administration with extensivecontractual staffforthe conduct ofoperations. The contractual costs are anticipated to becompetitive bid for

o quality assurance on the privacy and security integrity;. legal services for contract and privacy and security agreement maintenance;o financial and grant management to include audit, and grant development expenses;

lncome

HIO certification fees

4% of revenues

Medicaid administrative fee

State support

Products & services

Tota! lncome

Expenses

Personnel

Chief Executive Officer

Clerical Support

Fringe Benefit

Subtotal Personnel & Fringe

Travel

Su pplies

Contractual

Privacy and security testing

Lega I services

Financial & grant management

Evaluation & analytics

Social marketing

Telephone & lnternet

Occupancy & liability

Printing & publication

Tota! Expenses

S

S

S

s

s

S

S

s

S

s

S

S

S

S

s

S

S

S

S

. evaluation and analytics inclusive of community analytics and Medicaid administrativeanalytics; and

o social marketing for public engagement and information.

TimelineThe timeframe for advancement of the sustainability plan is beginning in calendar year 2013 forcertification and revenue fees, FY14 for Medicaid administrative fees, and legislative support.

Table 2. lncome Timeline

2013 2014

Income

HIO Certification Fees

4% of revenues

Medicaid administrative fe e

State support

Products & services

J FMAMJ JA SONDJ FMAMJ JA.SO.N'D

The income and value add to the HlOs would be enhanced by grant development for statewideinitiatives from federal, state, and private sources for community analytics, or HIO infrastructureenhancements. The mutual benefit of a statewide infrastructure such as OHIET for developingpolicy and programs is conducive to HIO function at state and federal levels.

Outcome MeasuresOutcomes measuresBy December 3L,2OL4, the sustainability plan will be tested and actionable.

o Determine if your plan business model is sustainable over timeo ldentify what adjustments may be required to create a long-term, sustainable modelo Secure final agreements/contracts with all of your stakeholders committing to the HIO

o ldentify and secure funding (Government lnformation Technology Agency, 2008, p. 55).

References

Deloitte Center for Health solutions. (2006). Health information exchange (HlE) business models:The path to sustainable financial success. Retrieved fromhttp://www.providersedge.com/ehdocs/ehr_articles/Health_lnfo_Exchange_Business_Models.pdf

Department of Health and Human Services. (2OO7a, May 221. Health information exchange:From start up to sustainability. Retrieved fromhttp://www.hci3.orglsites/default/files/files/HRSA%20CCBH%2OFinal%Z0Report%20Revised.pdf

Department of Health and Human Services. (2007). The community: American healthinformation community (Meeting materials). Retrieved fromhttp://www.hhs.gov/hea lthit/documents/AH tCBinde120071023.pdf

Government lnformation Technology Agency. (2008, April 28). Rural healthcare informationtechnology adoption project: RHIO formation guide, version 1. Retrieved fromhttp ://www. a zgita. gov/ehea Ith/rh ita/rh iofo rmatio ngu ide. pdf

Oklahoma Health Care Authority. (2011). Oklahoma Health lnformation Exchange Trust:Operational plan. Oklahoma City, OK: Author.