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1 Workgroup Name: Health Information Exchange Summary Co-Chairs: Jeff Benning and Peter Schuna MDH Staff: Melinda Hanson and Anne Schloegel Workgroup Meetings: 5 Workgroup Community of Interest: 150 ( distribution list) Members Actively Participating: estimated 30 per meeting (in-person or via phone) Total Hours Contributed: estimated 450 hours (5 meetings x 30 members/meeting x 3 hours per meeting) Major Workgroup Activities Meetings: November 5 and December 14, 2015 Gathered input from stakeholders (e.g., SIM e- Health grantees, e-health Roadmap workgroups, REACH, and State-Certified HIE vendors). Created list of 12 key barriers to HIE; proposed 19 recommendations for collective action (one or more for each of 12 barriers) Meetings: January 14 and February 18, 2016 Completed survey designed to gauge perceived impact and priority, discussed results and prepared recommendations for Advisory Committee including eight priority recommendations for collective action. Appendix B: Summary of Results of Recommendation Prioritization from HIE WG Barriers and Collective Recommendation Survey Appendix C: Summary of Collective Recommendations Comments Appendix D: HIE WG Barriers and Recommendations Survey Tool Meeting: April 21, 2016 Developed Working Action Plan to Address HIE Barriers (Appendix A) that includes objectives, identified activities, and proposed short and long-term outcomes, that would measure what does success look like? Meeting: July 26, 2016 Review 1) Working Action Plan to Address HIE Barriers 2) Minnesota Health Information Network (MNHIN) definition 3) Minnesota HIE Framework to Support Accountable Health Major Deliverables / Actions Identified 12 key barriers to HIE and proposed 19 recommended actions Appendix E: Summary of Barriers and Recommendations; Appendix F: HIE Workgroup Charge Advisory Committee Action: February 25, 2016 Endorsed HIE Workgroup report, including summary of key barriers to HIE, recommended actions to address barriers and priority recommendations for collective action. Highlighted three emerging themes: implement practical approaches to get HIE going; address policy issues needed to support HIE address equity issues to help achieve interoperability across continuum of care (e.g., providers/settings not eligible for meaningful use). Directed HIE workgroup to begin developing action plans for the priority recommendations. Requested draft work plan be presented at April 28 meeting. Advisory Committee Action: April 28, 2016 Endorsed Working Action Plan to Address HIE Barriers and authorized continuation of HIE WG charge through September to take advantage of the momentum toward Statewide HIE implementation. Some comments included: HIE is essential, but remains complex, Barriers intertwined, address concurrently when possible, Heading in the right direction, Approved action plan objectives, Actions need clarification and examples Add Medicaid programs (e.g., IHPs) July 21, 2016

2 Appendix A Draft worksheet for discussion only Working Action Plan to Address HIE Barriers Health information exchange (HIE) is happening in Minnesota but barriers still remain. The Minnesota e-health Initiative s HIE Workgroup gathered input from multiple sources and stakeholders (e.g., SIM e-health grantees, e-health Roadmap workgroups, REACH, and State-Certified HIE vendors) to create a list of 12 barriers to HIE. The Workgroup discussed these barriers, issues, opportunities and challenges and proposed 19 recommendations for collective action (one or more identified for each barrier). The 19 recommendations highlighted three emerging themes: 1) implement practical approaches to get HIE going; 2) address policy issues needed to support HIE implementation; and 3) address equity issues to help achieve interoperability across the continuum of care (e.g., providers and settings not eligible for meaningful use). Based on HIE Workgroup ranking for impact and priority, top ranked eight recommendations were endorsed by the e-health Advisory Committee on February 25, These recommendations represent seven HIE barriers, and the HIE workgroup was charged with developing action plans to support implementation of them. This Worksheet represents the work of the HIE workgroup who developed objectives, identified activities, and proposed short and long-term outcomes, that would measure what does success look like? for each of the action plans. This Working Action Plan to Address HIE Barriers was presented and endorsed at the April 28, 2016, e-health Advisory Committee meeting. A general approach to health information exchange in Minnesota must incorporate a principle of continuous process improvement (apply, evaluate, and retool), and include the following key elements: Coordinate with the Minnesota e-health Advisory Committee, Align with the Federal Interoperability Roadmap, Implement incrementally Focus on collective efforts and actions, Build on current clinical and hospital capabilities, including certified health care home clinics and other certification programs, Leverage Minnesota HIE infrastructure (e.g., market-based, vendor involvement, innovation, state-certified HIE service providers), and Address barriers, starting with top-ranked recommendations, with specific actions toward HIE implementation. HIE Barriers Addressed in Action Plan (in order of recommendation ranking) Barrier 11: Minnesota HIE approach is not fully implemented Barrier 8: Key transactions need to be prioritized (e.g., notification and alerting, care summaries) and supported statewide Barrier 9: Selecting an HIE service provider is complicated by rapidly evolving market Barrier 6: There are challenges to HIE implementation (e.g., workflow) Barrier 5: It is difficult to understand and execute legal and policy requirements (e.g., Minnesota privacy & consent) Barrier 3: Establishing partner relationships/agreements is often difficult, time-consuming and costly Barrier 2: There are competing organizational priorities Health Information Exchange Workgroup Page 1 of 5 May 6, 2016

3 Draft worksheet for discussion only Objective Actions and Considerations Key Lead/ Partners 1. Increase the number MDH-OHIT, of health and health MNHIN, care providers HIE WG, participating in a e-health AC, State-Certified HIO. providers Actions: a. Convene State-Certified HIE Service Providers (HIOs and HDIs) to define roles and core HIE functions of the Minnesota Health Information Network (MNHIN), and a process for consensus development to support identified priority transactions. b. Review current data on providers connected to HIO infrastructure and identify data sources, definitions, and goals for additional provider settings. c. Use vision of MN HIE approach to help potential HIOs and providers identify how they may connect to MN HIE. d. Identify funding opportunities to help providers connect to MNHIN infrastructure (e.g., CMS 90/10 HIE funding to promote connections among Medicaid providers and Meaningful Use-Eligible Professionals and Hospitals). e. Learn from MN communities, other state HIE models, and federal initiatives (Roadmap, Carequality) for potential use in MN approach to HIE. f. Review and consider potential improvements to HIE related laws for 2017 legislative session. Considerations: Update data elements in SQRMS and MNHIN quarterly reporting DHS priorities and involvement Align with federal initiatives (e.g., ONC Interoperability Roadmap) Start Date April 2016 Short-Term Outcomes ( ) MNHIN Document completed and endorsed by e-health Advisory Committee By December 2016, 25% of providers (e.g., clinics and hospitals) connected to an HIO directly or through an HDI. Establish goals for other settings. Long-Term Outcomes (2-3 years ) By December 2018, 50% of MU EPs and EHs, and 50% of non-mu eligible providers are connected to an HIO, directly or through an HDI. Health Information Exchange Workgroup Page 2 of 5 May 6, 2016

4 Draft worksheet for discussion only Objective Actions and Considerations Key Lead/ Partners 2. From a list of core MDH-OHIT, MN e-health HIE MNHIN, HIE transactions that WG, Advisory support Committee accountable care All providers organizations and meaningful use, increase the number of providers implementing (testing or in production) top ranked transactions. 3. Increase the number of providers, who are not currently connected, to identify how they will connect to statewide HIE. Actions: a. Identify and publicize top ranked transactions to work together to implement. b. Using the Minnesota HIE approach, rank potential transactions by value, impact and ease of implementation for statewide adoption. c. Identify top two transactions and pilot implementation, or review process if already implemented. d. Develop proposed approach and plan for implementing topranking transactions. e. Identify ways to measure implementation for each priority transaction. f. Develop guidelines for implementation. g. Inform providers regarding implementation plan options. Obtain feedback for provider implementation plans. Considerations: Utilize 2016 Interoperability Standards Advisory (ONC). Consider method for evaluating process and impact of each transaction implemented. Actions: a. Providers will be actively informed of Minnesota HIE approach and options for connecting to HIE services. b. Identify roles of HIOs/HDIs/Providers and the benefits of connecting to an HIO in statewide HIE approach. c. Coordinate discussions with potential HIOs, or other interested providers, on role within statewide HIE approach. d. Establish & seek funding to implement communications plan. e. Develop brief summary fact sheet to describe the Minnesota HIE approach, how it aligns with the federal interoperability roadmap, and builds upon existing capabilities. f. Create a profile of, and disseminate information about, HIE provider service options for providers to connect to statecertified HIE entities. g. Collect and share successful HIE stories. Considerations: Minnesota HIE approach must align with federal initiatives for future funding opportunities MDH-OHIT, MNHIN, HIE WG, All providers Start Date July 2016 Aug 2016 April 2016 June 2016 Short-Term Outcomes ( ) List of core transactions endorsed by Advisory Committee, By December 2016, transactions identified with preliminary approach for implementation By December 2016, 20% of providers who are not currently connected will identify how they will connect to statewide HIE Communication plan developed and implemented for perspectives of providers and of HIE service providers Long-Term Outcomes (2-3 years ) By December 2018, 25% of providers will have implemented at least two top ranked transactions. By December 2018, transactions implemented with evaluation of process and impact completed. HIO/HDI/Provider roles in HIE statewide well established. By December 2018, 50% of providers who were not connected in 2015, will identify how they will connect to statewide HIE Profile updated as HIOs and HDIs change Health Information Exchange Workgroup Page 3 of 5 May 6, 2016

5 Draft worksheet for discussion only Objective Actions and Considerations Key Lead/ Partners 4. Increase the Actions: MDH-OHIT, number of a. Gather information to understand needs and develop MNHIN, providers and guidance to support HIE implementation, including the HIE WG provider types who following: achieve integrated b. Identify types of technical assistance needed by different HIE for meaningful provider settings. use transactions c. Technical: functionality to enhance/improve workflow within (organizational and across HIOs (e.g., patient matching improvement). policy to connect d. Standards: Federal (ONC) 2016 Interoperability Standards vs. technical ability Advisory, identifying specific standards to focus on initially to integrate health statewide by all providers, and best implementation information for practices. use). e. Governance: use and definition, learning from examples of current HIOs. f. Identify resources for funding technical assistance for HIE implementation. Considerations: Aligns with ONC Interoperability Roadmap 5. Using assessment data from prior studies and environmental scans, update and publish information on Minnesota privacy and security status and needs. Aligns with MN e-health Roadmap recommendations Actions: a. Distribute SIM Minnesota funded privacy and security work product (e.g., Gray Plant Mooty modular guidance documents and use case analysis, and Hielix guidance materials) b. Provide educational sessions and seminars to disseminate information (e.g., conferences). c. Establish strategy for public education per Communications Plan. Considerations: Consider Consumer Engagement project for guidance in public education plan MDH-OHIT, Contracts, HIE Stakeholders, Consumers Start Date July 2016 Sept 2016 April 2016 Short-Term Outcomes ( ) By December 2016, gather information to identify best practices for implementing topranked transactions. Identify best practices for implementing topranked transactions Guidance specific to Minnesota privacy laws, security and consent is disseminated per communications plan By January 2017, guidance specific to Minnesota privacy, security and consent is disseminated per communications plan Educational sessions provided and documented Long-Term Outcomes (2-3 years ) By July 2017, 10 % of providers from 4 different provider types (hospital, clinic, nursing home, and public health) have integrated HIE information. By July 2017, guidance for workflow/technical, standards, and governance disseminated Privacy, security and consent requirements executed statewide and easy to understand by providers and consumers Health Information Exchange Workgroup Page 4 of 5 May 6, 2016

6 Draft worksheet for discussion only Objective Actions and Considerations Key Lead/ Partners 6. Increase the Actions: HIE WG, number of a. Establish expectations around HIE (e.g., rules of the road) to provider providers with improve process of building partner relationships for HIE. stakeholder established b. Identify activities that will lower cost, time, and difficulty of s agreements to: 1) partnership. MDH-OHIT, share health c. Collect sample Rules of the Road from vendors, other states, MNHIN information and Carequality, etc. to compare. electronically with d. Share lessons learned from SIM projects, consultants, and care partners other grantees. and/or 2) establish e. Use consensus building to develop MN expectations around an agreement with HIE partnerships. an HIO/HDI. f. Identify and share useful tools for establishing HIE partnerships (e.g., sample agreement for HIE).Incorporate metrics into provider survey to support HIE agreements. g. Incorporate metrics into provider survey to support HIE agreements. Start Date June 2016 Short-Term Outcomes ( ) By December 2016, create Minnesota expectations around HIE partnerships Long-Term Outcomes (2-3 years ) By December 2018, 50% of providers will have at least one agreement for statewide HIE services. By December 2018, Stakeholders re-evaluate and update MN expectations around HIE partnerships. 7. Identify policy levers and implementation options to increase the use of statewide HIE in Minnesota. Actions: a. Identify and recommend policy levers to advance HIE participation statewide. b. Identify and publish barriers to HIE to policymakers before legislative session c. Consult with Minnesota e-health Advisory Committee on need, method and process for convening appropriate groups to impact policy levers. d. Recommend payer related policy levers to increase HIE adoption and use. e. Recommend program certification policy levers to increase HIE adoption and use (e.g., Health Care Home Certification HIE requirement). f. Establish measures to evaluate and measure the impact of policy levers. g. Educate and Inform providers through Communication Plan and HIE Workgroup. MDH-OHIT e-health Advisory Committee, input from other groups as appropriate July 2016 Summary Report developed from HIE WG 2016 activities for dissemination By December 2016, convene appropriate groups to review payer related HIE policy levers, programs identified for certification requirements with potential HIE component policy levers, and other potential policy levers and methods for implementation. Policymakers use information to increase funding for HIE activities By December 2017, HIE Policy levers are implemented as part of payer and program certification requirements. By December 2018, e-health Advisory Committee will review and evaluate implementation and impact of policy levers. Health Information Exchange Workgroup Page 5 of 5 May 6, 2016

7 Appendix B MN e-health HIE WG Barriers and Collective Recommendations Survey Results Introduction Attached are compiled responses from the HIE workgroup feedback survey (12 responses were received). Please review these in advance of the February 18 webinar. We asked you to rate these for each recommendation: HIE Impact (on a scale of 1-5, 1 being lowest and 5 being highest), refers to improving HIE in the state. Your priority (on a scale of 1-5, 1 being lowest and 5 being highest) refers to your perception of the need to accomplish this recommendation to advance HIE in the state. Materials include three diagrams and supporting information: 1. A scatter diagram showing the average impact and priority ratings of all responses. These were rated on scale of 1 to 5, but all showed strong ratings so the axes are adjusted to reflect this. 2. A bar chart of average priority ratings, sorted high to low. 3. A bar chart of average impact ratings, sorted high to low. 4. A table with the complete list of barriers and recommendations. Use this as your reference for the charts. 5. A table with any comments provided about the recommendations. Note that these compiled findings are intended to be a discussion tool, not a decision tool. Please review them, applying your own lens to our discussion during the webinar. Specifically, we will discuss: Do the survey results affirm the workgroup s consensus? Are there any surprises or concerns? Is there need for clarification or strengthening of any recommendation? Can recommendations be consolidated or any eliminated? 1 DRAFT FOR DISCUSSION February 9, 2016

8 Impact/Priority Scatter Diagram R R07 R05 R10 Priority (Average) 3.5 R02 R15 R09 R03 R04 R14 R R13 R12 R R19 R17 R11 R01 R Impact (Average) 2 DRAFT FOR DISCUSSION February 9, 2016

9 R08 R10 R16 R05 R15 R14 R04 R03 R09 R07 R02 R12 R18 R01 R13 R11 R19 R06 R17 Average Impact Average on scale 1-5 (Low: 1, High: 5) 3 DRAFT FOR DISCUSSION February 9, 2016

10 Average Priority R08 R05 R10 R07 R15 R09 R16 R14 R04 R03 R02 R12 R18 R13 R11 R01 R19 R17 R Average on scale 1-5 (Low: 1, High: 5) 4 DRAFT FOR DISCUSSION February 9, 2016

11 Barrier Recommendation 1. The business case and economic incentives are unbalanced R01. Collect and share stories that illustrate the value proposition for health information exchange (HIE). R02. Develop and share model(s) (or templates) to evaluate the value proposition for HIE including cost and perceived benefit assessment. 2. There are competing organizational priorities R03. Align the Minnesota HIE approach with federal meaningful use and EHR certification requirements, and educate providers as to how they align R04. Review and identify potential policy levers and incentive and/or requirements to promote adoption and use to advance HIE statewide 3. Establishing partner relationships/ agreements is often difficult, time-consuming and costly R05. Build on others experiences, sharing lessons learned to establish rules of the road for information sharing, including but not limited to: i. Provide guidance on establishing relationships and governance for HIE between partners. ii. Clarify expectations for aligning with the Minnesota HIE requirements (i.e. connection to an HIO either directly or through an HDI) iii. Recommend and develop approach for key transactions. 4. There are limited availability and access to skilled, knowledgeable workforce R06. Leverage existing surveys to determine the status and gaps of skills and knowledge needed to support HIE including Leadership, Informatics and IT (e.g. Hospital and Ambulatory Assessments, MDH Interoperability Assessment, other setting-specific assessments) 5. It is difficult to understand and execute legal and policy requirements (e.g. Minnesota privacy and consent) R07. Support and monitor dissemination of the materials by the SIM grantees on consent, develop lessons learned, and identify future needs and opportunities for ongoing education needs HIE Impact Average on scale of 1-5 with 1 low and 5 high (Min, Max) Impact Ranking (1 highest, 19 lowest) Priority Average on scale of 1-5 with 1 low and 5 high (Min, Max) Priority Ranking (1 highest, 19 lowest) 3.2 (1, 5) (1, 4) (1, 5) (1, 5) (1, 5) (1, 5) (1, 5) (1, 5) (1, 5) (1, 5) (1, 4) (1, 4) (2, 5) 10 4 (2, 5) 4 5 DRAFT FOR DISCUSSION February 9, 2016

12 Barrier Recommendation 6. There are challenges to HIE implementation and integration (e.g. workflow) R08. Provide guidance and education on implementing priority transactions and integrating HIE into practice with options depending on whether HIE integrates into the EHR, does not integrate into the EHR, or the provider does not have an EHR. 7. Technical and data standard practices lack consensus for approaches for implementation R09. Examine best standards and practices to implement technical aspects of core HIE functions and transactions, including but not limited to: i. Improve Patient Matching between HIE repositories, and when a provider queries for a patient. ii. Identify type of information each provider would need based on role, and when triggers to exchange is needed based on role (RACI model). iii. Sending message from Care Coordinators to patient portal to request consent for specified HIE transactions. iv. Notify patient and update portal each time the individual visits a provider and gives additional consent. 8. Key transactions need to be prioritized (e.g., ADTs) to support implementation statewide R10. Prioritize HIE transactions for implementation (ADT, CCD, PH transactions, Closed Loop Referrals, etc.) so providers and State-Certified HIE Service Providers can focus on priorities 9. Selecting an HIE Service Provider is complicated by the rapidly evolving market. R11. Create and share a summary of the Minnesota HIE approach including ongoing communication of changes in HIE service provider market 10. There is insufficient education, communication and technical assistance for providers R12. Develop options for more timely and current methods to effectively educate and communicate on HIE and link providers to technical assistance resources. R13. Focus education on HIE adoption for organizations with EHRs as well as for those without an EHR. 11. Minnesota HIE approach is not fully implemented. HIE Impact Average on scale of 1-5 with 1 low and 5 high (Min, Max) Impact Ranking (1 highest, 19 lowest) Priority Average on scale of 1-5 with 1 low and 5 high (Min, Max) Priority Ranking (1 highest, 19 lowest) 4.5 (3, 5) (3, 5) (2, 5) (1, 5) (3, 5) (1, 5) 2.9 (1, 5) (1, 5) (1, 5) (1, 4) (1, 4) (1, 4) DRAFT FOR DISCUSSION February 9, 2016

13 Barrier Recommendation R14. Create a summary update on Minnesota s market-based HIE approach including status, gaps in implementation and policy actions recommended to fill the gap. R15. Develop core HIE functions (e.g., patient matching, consent management) and core HIE transactions (e.g., ADT, CCDA), both short term and long term HIE Impact Average on scale of 1-5 with 1 low and 5 high (Min, Max) Impact Ranking (1 highest, 19 lowest) Priority Average on scale of 1-5 with 1 low and 5 high (Min, Max) 3.9 (2, 5) (1, 5) 8 4 (1, 5) (1, 5) 5 Priority Ranking (1 highest, 19 lowest) R16. Convene State-Certified HIE Service Providers (Minnesota Health Information Network MN HIN) to identify: i. Options for developing and implementing core HIE functions and transactions, ii. Content of reciprocal agreements template, iii. Mechanism for patient matching and queries between State-Certified entities, iv. Identify need for any Statewide Shared Services, including Directory of Direct Addresses and workflow implications v. Standards for priority transactions, and vi. Process for mutual updates/upgrades for standards. 4.4 (2, 5) (1, 5) 7 R17. Develop strategy to inform and assist providers to self-identify role 2.6 (1, 5) (1, 5) The lack of individual engagement diminishes the demand for HIE (e.g. consumers/patients accessing portals) R18. Collect data from consumers and/or review studies on consumers use of HIT to determine their level of access and use of patient portals, what functions are desired in a patient portals, and how they prefer to communicate with their providers. R19. Explore use of EHR tethered portals and potential HIO patient portals as value add use for providers who do not implement the patient portal options through the EHR. 3.3 (1, 5) 13 3 (1, 5) (1, 4) (1, 5) 17 7 DRAFT FOR DISCUSSION February 9, 2016

14 Appendix C MN e-health HIE WG Barriers and Collective Recommendations Comments R01 R02 R03 R04 R05 R06 R07 The value proposition stories tend to focus on end game scenarios where all these features are in place and all is right in the world. Short term scenarios are focused on projects that benefit meaningful use participants. I don t think this recommendation actually addresses the issue in the shaded area. In my opinion, HIE in Minnesota will continue to be limited to hospital systems and test projects until support and funding is made available to the non-hospital entities to enable their participation in this initiative. The first barrier that is listed is the one that is the most important to solve and the recommendations provided don t offer a solution to that barrier. Hospital systems and payers are the main beneficiaries of HIE at this point.; The Roadmap priority settings have done this already.; A general comment - for me the priority is driven by the impact to improving HIE in the state so the numbers in the two columns are identical.; We ve had several stories over the years. I think people need to see How something is done, not sure hearing about it is sufficient anymore; (Lack of) Articulating the value proposition for HIE is a huge barrier.; There is still resistance by some providers when we talk about exchanging data and making data freely available to outside providers. Similar to previous answer. The models are based on if we had these things in place then this scenario would happen. There aren t any support processes or funding sources in place for nonmeaningful use participants to act on the if portion of the model. I don t think this recommendation actually addresses the issue in the shaded area. This makes sense from a hospital standpoint. Another comment related to the shaded statement: LTC organizations are being challenged with reduced reimbursement and nursing shortages. The stated goal in many cases is to bypass LTC. LTC organizations like ours are working on creating non-nursing home business lines, recruiting staff, and creating operational efficiencies that will prevent us from working on things like HIE without funding and support.; Very similar to convincing health plans to align their quality goals for P4P. Was quite well received; MU may be near its end game and it does not reach a number of provider groups. However, this may make it a bit simpler for smaller hospital/medical entity and should be seriously considered because of that. Without this, we re spending public dollars for a number of short term and unsustainable experiences versus creating a long term strategy that benefits the entire health care system and clients.; Any requirements for LTC will need software investment to create capabilities and efficiencies.; Ambivalent because I am not sure the political forces are aligned to promote this yet.; We may not make state wide progress without policy change. We don t need to recreate the wheel and could benefit by building upon work/products developed by colleagues across the state, as well as national examples.; Is this the same as #8?; Can this realistically be done in a tight timeframe and within budget constraints? It would help peripheral groups like dentistry a lot in building methods to communicate with other health care clinicians and networks. ; Critical step; lots in place already; 4 priority settings really need help with this. I think we all already know what needs to be done to act upon our collective wisdom, vs. collecting more information that validates what isn t working.; Only useful if work is done to address the gaps.; The Workforce group is tackling this already. The priority for the HIE group is to support the work already being done. See #3; I think this barrier is very significant one, especially for small clinics and providers; I think we need to start moving out of the grant based development environment in order to make a strong use case for long term financial viability. I certainly want to learn what and how they did things and then see if it fits with a non-grant driven environment. ; High priority. ; Would help if some of the materials were specifically focused on minors and adolescents; Need to take

15 R08 R09 R10 R11 R12 R13 R14 R15 R16 advantage of the expertise in the data privacy and security workgroup, and disseminate their knowledge. The roadmap work will only proceed up to, but not including implementation guidance. The four priority settings will need the next step also. ; I believe this has the greatest potential for ancillary provider groups such as dentistry. ; Critical need for implementing especially smaller provider orgs. See #3; All of these things would be beneficial but aren t that useful to LTC unless incorporated into our EHR. Providing additional mechanisms for LTC providers to access hospital and third party portals, repositories, or exchanges just adds another step to our existing work processes. ; We must always have an eye towards national exchange. Do not recreate what is already done elsewhere. If we do research and implement a standard or practice we will need a mechanism to inform other parts of the national HIE framework of our findings.; This consent issue is important - Mixing Portals into the Mix is a nice idea but will lead to a more complex HIE Landscape. ; Probably a critical area to create better information sharing across the major plans and groups. May be the best way to get various IT departments to work together. My concern is that this will result in a solution that may leave groups like dentistry on the sidelines and the developed solution may not provide a value proposition for groups like dentists, thereby reducing the desire to engage.; Critical infrastructure; For the 4 priority settings, this is a bit over our heads. ADT between EPIC and the rest of the primary care/community/behavioral health providers is essential! ; Need funding and support for software development, interface development, and workflow redesign for LTC to be successful. ; I think it s critical that we identify the BASICs of what should be exchanged. ; Focus on just a very few and see if we have the tools to drive those transactions. At a minimum, we should learn what it would take to drive transactions, if we cannot accomplish some basic ones where standards already are solid. ; ADT is key focus/priority area for ; I think this would make a huge difference in HIE adoption within the state. Is interesting, but we need actionable! ; YES! I think this has been well done already and the impact has been good, but is not a driving force at this time. Much education is being done with the roadmap work. Implementation will need to be worked on though. How is this recommendation different from recommendation #8; Yes Providers in different domains have different interests even within Organizations that have EHR s Distinguish clearly Inter enterprise Exchange and INTRA Enterprise exchange - We struggle with each of these but the focus of HIE is to Exchange between Eco-systems and promote a diverse but structurally compatible HIE Landscape where Meaningful Exchange is accomplished ; At this point, I think we need to create a strong case for the value of HIE, so would not be too concerned with those who do not yet see value in it. Nice to know, but again, more interested in solving the problems than describing them; I don t understand this one. Who would be developing these? Aren't they already occurring? Or is this the same as #8?; Good learning tool; Critical that something happens soon to fill the gaps / identify actions needed. Good technical information that will enable HIE function adoption across multiple sites/providers.; As more HIE Service Providers enter the MN market, it will be imperative for them to cooperate; Same as 8.10 above to me; Critical infrastructure component. Good to collect and share tools to help everyone get to adoption of HIE; This will be a complex and potentially costly project. May take a lot of time, but has potential for creating a more standardized approach to control costs and methodologies in the future.; Must pull all the MN service providers together and quickly develop plan for moving key core HIE functions forward as well as supporting the 2016 priority ADT transactions.; Vendors must be incented to work

16 together.; Statewide Directory of Direct addresses is critical for providers to meet MU requirements; I don t feel educated enough on this topic to comment, so probably a high priority. R17 I do not understand this recommendation; Don t understand statement; Don t recall this discussion and cannot remember what we were getting at; Not sure I know what this means. R18 Unless clients are engaged, trust and value both access to information as well as exchange, this is an academic conversation; I don t believe the bolded statement. We need the efficiencies of HIE whether the individual is engaged or not. ; Only truly useful if all economic and cultural groups are studied. Not just middle class persons. The Effort will need to be HUGE. Rural PH agencies are pushing for their clients to utilize the PHR as there is only one within the region. Metro PH are not pushing for this as each clinic has its own and if you have a chronic disease each provider you see will have their own PHR and these do not communicate with each other providing MORE Confusion. ; Not sure consumers yet know what can and should be available. Would be interesting to compare those with chronic diseases seeing multiple clinicians to those that infrequently access the health care system. R19 Many of our clients do not have consistent access to the internet and/or do not read English. ; Likely we will need multiple ways of setting up patient portals in order to meet the needs across the broad marketplace. Not sure portals are well enough developed yet to totally understand there use and capabilities.

17 Apepndix D MN e-health HIE WG Barriers and Collective Recommendations Survey This list includes the barriers and recommendations discussed during the workgroup activities. To assist in prioritizing these we are asking workgroup members and other stakeholders to rate your opinion on the HIE impact and priority in Minnesota. Please complete this form by entering both your impact and achievability rating for each recommendation below. HIE Impact (on a scale of 1-5, 1 being lowest and 5 being highest), refers to improving HIE in the state. Your priority (on a scale of 1-5, 1 being lowest and 5 being highest) refers to your perception of the need to accomplish this recommendation to advance HIE in the state Feel free to comment on your ratings, including your thoughts on how to accomplish this recommendation, using the right-most column. Please do not add rows or columns to the table. No response is needed in the shaded rows. Your input is requested by end of day February 8, 2016, by to Melinda.hanson@state.mn.us. If you cannot complete this electronically, please fax to Melinda at What is your name and organization? Barrier Recommendation 1. The business case and economic incentives are unbalanced 1. Collect and share stories that illustrate the value proposition for health information exchange (HIE). 2. Develop and share model(s) (or templates) to evaluate the value proposition for HIE including cost and perceived benefit assessment. 2. There are competing organizational priorities 3. Align the Minnesota HIE approach with federal meaningful use and EHR certification requirements, and educate providers as to how they align 4. Review and identify potential policy levers and incentive and/or requirements to promote adoption and use to advance HIE statewide HIE Impact Low (1) High (5) Your Priority Low (1) High (5) Comments 1 January 26, 2016

18 Barrier Recommendation 3. Establishing partner relationships/ agreements is often difficult, time-consuming and costly HIE Impact Low (1) High (5) Your Priority Low (1) High (5) Comments 5. Build on others experiences, sharing lessons learned to establish rules of the road for information sharing, including but not limited to: i. Provide guidance on establishing relationships and governance for HIE between partners. ii. Clarify expectations for aligning with the Minnesota HIE requirements (i.e. connection to an HIO either directly or through an HDI) iii. Recommend and develop approach for key transactions. 4. There are limited availability and access to skilled, knowledgeable workforce 6. Leverage existing surveys to determine the status and gaps of skills and knowledge needed to support HIE including Leadership, Informatics and IT (e.g. Hospital and Ambulatory Assessments, MDH Interoperability Assessment, other settingspecific assessments) 5. It is difficult to understand and execute legal and policy requirements (e.g. Minnesota privacy and consent) 7. Support and monitor dissemination of the materials by the SIM grantees on consent, develop lessons learned, and identify future needs and opportunities for ongoing education needs 2 January 26, 2016

19 Barrier Recommendation 6. There are challenges to HIE implementation and integration (e.g. workflow) 8. Provide guidance and education on implementing priority transactions and integrating HIE into practice with options depending on whether HIE integrates into the EHR, does not integrate into the EHR, or the provider does not have an EHR. HIE Impact Low (1) High (5) Your Priority Low (1) High (5) Comments 7. Technical and data standard practices lack consensus for approaches for implementation 9. Examine best standards and practices to implement technical aspects of core HIE functions and transactions, including but not limited to: i. Improve Patient Matching between HIE repositories, and when a provider queries for a patient. ii. Identify type of information each provider would need based on role, and when triggers to exchange is needed based on role (RACI model). iii. Sending message from Care Coordinators to patient portal to request consent for specified HIE transactions. iv. Notify patient and update portal each time the individual visits a provider and gives additional consent. 8. Key transactions need to be prioritized (e.g., ADTs) to support implementation statewide 10. Prioritize HIE transactions for implementation (ADT, CCD, PH transactions, Closed Loop Referrals, etc.) so providers and State-Certified HIE Service Providers can focus on priorities 3 January 26, 2016

20 Barrier Recommendation 9. Selecting an HIE Service Provider is complicated by the rapidly evolving market. 11. Create and share a summary of the Minnesota HIE approach including ongoing communication of changes in HIE service provider market 10. There is insufficient education, communication and technical assistance for providers 12. Develop options for more timely and current methods to effectively educate and communicate on HIE and link providers to technical assistance resources. 13. Focus education on HIE adoption for organizations with EHRs as well as for those without an EHR. 11. Minnesota HIE approach is not fully implemented. HIE Impact Low (1) High (5) Your Priority Low (1) High (5) Comments 14. Create a summary update on Minnesota s market-based HIE approach including status, gaps in implementation and policy actions recommended to fill the gap. 15. Develop core HIE functions (e.g., patient matching, consent management) and core HIE transactions (e.g., ADT, CCDA), both short term and long term 4 January 26, 2016

21 Barrier Recommendation 16. Convene State-Certified HIE Service Providers (Minnesota Health Information Network MN HIN) to identify: HIE Impact Low (1) High (5) Your Priority Low (1) High (5) Comments i. Options for developing and implementing core HIE functions and transactions, ii. Content of reciprocal agreements template, iii. Mechanism for patient matching and queries between State-Certified entities, iv. Identify need for any Statewide Shared Services, including Directory of Direct Addresses and workflow implications v. Standards for priority transactions, and vi. Process for mutual updates/upgrades for standards. 17. Develop strategy to inform and assist providers to self-identify role 12. The lack of individual engagement diminishes the demand for HIE (e.g. consumers/patients accessing portals) 18. Collect data from consumers and/or review studies on consumers use of HIT to determine their level of access and use of patient portals, what functions are desired in a patient portals, and how they prefer to communicate with their providers. 19. Explore use of EHR tethered portals and potential HIO patient portals as value add use for providers who do not implement the patient portal options through the EHR. 5 January 26, 2016

22 Appendix E Draft for Discussion Only Table 1: Summary of Key Barriers and Issues, Opportunities and Challenges and Proposed Recommendations for Collective Action to Advance Health Information Exchange Key Barriers and Issues Opportunities and Challenges Proposed Recommendations and Considerations for Collective Action 1. The business case and economic incentives are unbalanced a. Value proposition not strong enough or of equal importance for all providers b. Cost for HIE outweighs perceived benefit and so long-term financial sustainability is a concern Understand and quantify the value proposition for HIE, including any cost-benefit (e.g., improved care coordination/reduced hospital readmissions) or potential return on investment. Quantify results of accountable care delivery/financial arrangements (e.g., ACOs, IHPs) to encourage more providers to participate in value-based payment arrangements, which need HIE to be successful. Increase use of HIE, especially by large health systems and other health and health care providers so access to necessary information is available to improve care coordination, decrease the total cost of care and eventually decrease cost for HIE participation. 2. There are competing organizational priorities a. Upgrades to EHR b. Other IT projects c. Other non-it projects d. Other organizations with competing priorities Prioritize HIE while meeting other requirements such as ICD-10, meaningful use and payment reform. Identify reasons to allocate HIE funding as a top priority, when currently only the desire for HIE exists. Assess (state-certified) HIE providers to identify partners to best meet the organization s HIE needs 1. Collect and share stories that illustrate the value proposition for health information exchange (HIE). 2. Develop and share model(s) and templates to evaluate the value proposition for HIE including cost and perceived benefit assessment. Other considerations for collective action: Include payer representatives and other stakeholders in applied research and HIE workgroup discussions. Apply recommendations for all patients keeping health equity and potential HIE incentives in mind Describe how the value proposition (e.g., improved outcomes, quality of life, quality of care, population health) can justify the cost. 3. Align the Minnesota HIE approach with federal meaningful use and EHR certification requirements, and educate providers as to how they align 4. Review and identify potential policy levers that could help advance HIE statewide e.g recent ONC list of policy levers Other considerations for collective action: Encourage payers to establish incentives and/or requirements to promote adoption and use of HIE. 3. Establishing partner relationships/agreements is often difficult, time-consuming and costly a. Partner engagement Focus partners on shared vision and goals for HIE, although needs for specific transactions differ, each is dependent on others ability to exchange information. 4. Build on others experiences, sharing lessons learned to establish rules of the road for information sharing, including but not limited to: i. Provide guidance on establishing relationships and governance for HIE between partners. Minnesota e-health Initiative HIE Workgroup Page 1 of 7 January 25, 2016

23 Draft for Discussion Only Key Barriers and Issues Opportunities and Challenges Proposed Recommendations and Considerations for Collective Action b. Developing consensus between partners takes time Promote stakeholder engagement to find realistic, streamlined, and coordinated HIE solutions. Exchange health information with providers outside of any formal ACO, and including behavioral health to realize benefits of individuals total care outcomes and quality improvement opportunities. Identify ways to financially support organizations that provide care coordination, but do not employ physicians- for the purchase and implementation of EHR software for health information exchange. Encourage (identify incentives for) large hospital systems to engage with state-certified vendors to provide HIE transactions with independent and community providers using different EHR vendors. Partnering with similar HIO initiatives to develop common frameworks can bring efficiencies and lay the groundwork for future reciprocal agreements to enable clinical data to move between communities. Leverage joint purchasing power if sharing an HIE vendor. 4. There is limited availability and access to a skilled, knowledgeable workforce a. Right staff b. Right leaders at the table for planning c. Changes in organizational leadership Identify skill sets needed for HIE planning and implementation. Promote the use and need for HIE across the organization so support is available when changes occur in organizational leadership. Promote and support Minnesota training and education available to improve skillsets for HIE implementation and data analytics for health care professionals. ii. Clarify expectations for aligning with the Minnesota HIE requirements (i.e. connection to an HIO either directly or through an HDI) iii. Recommend and develop approach for key transactions. Other considerations for collective action: Work with key stakeholder groups (e.g., e-health Advisory Committee, associations) to endorse rules of the road for HIE implementation. Rules of the Road to consider Provider to Provider, Provider to Vendor, Vendor to Vendor (HIOs and HDIs) 6. Leverage existing surveys to determine current status and gaps in skills and knowledge needed to support HIE including leadership, informatics and IT (e.g., hospital and ambulatory assessments, MDH Interoperability Assessment, other setting-specific assessments) Other considerations for collective action: Promote and support the workforce workgroup, Normandale Community College training grant, and other educational institution offered programs Evaluate IT and HIE education needs for leadership staff across organizations. Engage organization members in setting priorities for community level HIE. Inform e-health Workforce Ad-Hoc Group on priority skill sets needed and workflow implications including skills needed to implement and fully utilize HIE. Minnesota e-health Initiative HIE Workgroup Page 2 of 7 January 15, 2016

24 Draft for Discussion Only Key Barriers and Issues Opportunities and Challenges Proposed Recommendations and Considerations for Collective Action Catalog/link current Minnesota programs offering HIT/informatics / e- health related training, courses, certificates and degree programs. 5. It is difficult to understand and execute legal and policy requirements(e.g., Minnesota privacy & consent) a. Challenges implementing Minnesota consent laws Verify and educate each other on single interpretation of consent laws and consent process technically and operationally. Verify individual consent is not required for population health analytics. Provide consensus on opt-in/opt-out, verifying: a. Considering cost of system set up, individual s choice to opt-in or opt-out will apply to all settings. b. Considering technical set up, an individual s choice to opt-out of HIE, means their data is also not available for emergencies. c. Regardless of individual s decision to opt-in or opt-out of HIE, an individual s data is still available in the clinical data repository in the event the individual changes their mind on that decision. Share templates and best practices that have been developed around privacy and security. 6. There are challenges to HIE implementation and integration (e.g., workflow) a. Workflow impact b. Implementation guidance for HIE Specify a standard list of provider types and what transactions each provider type needs to for optimal care service. Promote implementation of these standards in organization EHR. Maintain latest EHR upgrade, including review for implementation impact to 2015 EHR Certification level. 7. Technical and data standard practices lack consensus. a. Lacking HIE model/infrastructure Identify and incorporate standards to achieve interoperability. 7. Support and monitor dissemination of the training materials, tools and templates including the materials developed by the SIM project. grantees on consent, develop lessons learned, and identify future needs and opportunities for ongoing education needs Other considerations for collective action: Review work of Privacy and Security Workgroup and SIM grantees and implement recommended leading practices to meet requirements for current laws. Share templates around privacy and security. Review and consider options for Opt-out implementation structure. Evaluate individual and care giver avenues for providing consent to preferred care coordinators, providers, and programs to optimize their health. 8. Provide guidance and education on implementing priority transactions and integrating HIE into practice with options depending on whether HIE integrates into the EHR, does not integrate into the EHR, or the provider does not have an EHR. Other considerations for collective action: Promote use of HIE wherever organization workflows include faxing and phone. 9. Identify standards and best practices to implement technical aspects of core HIE functions and transactions, including: i. Improve patient matching (e.g., between HIE repositories, provider queries. Minnesota e-health Initiative HIE Workgroup Page 3 of 7 January 15, 2016

25 Draft for Discussion Only Key Barriers and Issues Opportunities and Challenges Proposed Recommendations and Considerations for Collective Action b. Agreed upon interoperable standards across multiple groups/vendors c. Identify common shared services Specify to EHR vendors what functions and technical capabilities are needed for HIE and interoperability a. Transactions sent should be integrated into their EHR not a PDF format that requires separate viewing. b. CCD/CCDAs are translated from the format sent to a format that can be integrated into their EHR and translated back for sending from their EHR. c. Encourage development of modules that provide the HIE capacity and capabilities. Include requirement of MN state-certification in EHR/HDI vendor contract process, for the vendor who is providing the HIE transactions. Contract with an EHR/HDI vendor who offers provider portal option as an HIE alternative - if the provider does not plan to implement an EHR in near future. Maintain latest EHR upgrade, including vendor s upgrade to EHR Certification Key transactions have not been prioritized (e.g., ADTs) a. Identify essential transactions b. Guidance and technical assistance needed to implement the transactions. Collaborate to identify statewide priority transactions and standards, including, but also beyond, meaningful use transactions Verify and educate on the disadvantages of faxing (not HIE and a privacy and security issue), which takes the same amount of workflow time as Direct Collaboratively develop best possible processes, standards and storage of public health reporting transactions. 9. Selecting an HIE Service Provider is complicated by the rapidly evolving market a. HIE continues to evolve Integrate data into EHRs so provider does not have to log into additional portals for patient information. ii. Identify type of information each provider may need based on role, and when triggers to exchange is needed based on role (RACI model). iii. Sending message from Care Coordinators to patient portal to request consent for specified HIE transactions. iv. Notify patient and update portal each time the individual visits a provider and gives additional consent. Other considerations for collective action: Work with key stakeholder groups (i.e., e-health Advisory Committee, associations) to endorse rules of the road and utilize them with HIE implementation. Assess and identify solutions to limited broad band capability and capacity across the state. Encourage integration of data into EHRs so the provider does not need to manually enter the data 10. Prioritize HIE transactions for implementation (ADT, CCD, PH transactions, Closed Loop Referrals, etc.) so providers and State- Certified HIE Service Providers can focus on priorities Other considerations for collective action: Work with key stakeholder groups (i.e., e-health Advisory Committee, associations) to endorse rules of the road and utilize them with HIE implementation. Develop an implementation strategy, and roadmaps for implementing public health transactions. 11. Update and share a summary of the Minnesota HIE approach including ongoing communication of changes in HIE service provider market Minnesota e-health Initiative HIE Workgroup Page 4 of 7 January 15, 2016

26 Draft for Discussion Only Key Barriers and Issues Opportunities and Challenges Proposed Recommendations and Considerations for Collective Action b. EHR vendors provide HIE services c. Advancing HIE vendor capabilities d. Consolidation and start-ups e. HIOs emerging at local level f. Improved technical assistance for HIO/HDI selection Have affordable and sustainable HIE solutions available. Promote creation and use of patient portals so individuals and their families can drive their health care consent, scheduling, bill payment, selfmonitoring, and interaction with all providers. Consider natural partners for HIO connection before considering option to build one on your own. Identify priority use case for own organization, while also trying to accommodate priority use cases of provider partners in HIE environment. Other considerations for collective action: Improve guidance and technical assistance for HIO/HDI selection process. Identify population health database avenues for outcome improvement. Identify advantages of Minnesota state-certification to encourage EHR/HIE vendors. Update guidance / tools / tips for providers connecting to MN HIE vendors. 10. There is insufficient education, communication and technical assistance for providers a. Broad education and communication b. Individual technical assistance Collaboratively provide guidance on: a. Impact of implementing Direct vs Query-based HIE and best practices in Minnesota. b. Defining roadmap of how to get to HIE implementation c. Concepts needed for baseline education in HIE 101. Clarify whether connecting with other organizations through the same system is sufficient HIE. Share realistic anticipatory guidance as to the complexity of implementing HIE and technical suggestions so challenges are understood before beginning implementation Offer transparency around HIE current practices, successes, and future collaborative plans for HIE for SIM grantees as well as those implementing without grant funding. 12. Develop options for more timely and current methods to effectively educate and communicate on HIE and link providers to technical assistance resources. 13. Focus education on HIE adoption for organizations with EHRs as well as for those without an EHR. Other considerations for collective action: Utilize SIM grant e-health roadmap work and use cases to internalize approach to HIE. State-Certified HIE Service Providers to review and recommend to HIE Workgroup Direct vs Query-based HIE infrastructure priorities, uses, and industry best practices with limited time and resources for making implementation happen in Minnesota. Identify and develop marketing strategies to educate Minnesota public on HIE Minnesota e-health Initiative HIE Workgroup Page 5 of 7 January 15, 2016

27 Draft for Discussion Only Key Barriers and Issues Opportunities and Challenges Proposed Recommendations and Considerations for Collective Action 11. The Minnesota HIE approach is not fully implemented a. Challenges understanding Minnesota approach to HIE b. Governance c. Shared Services decisions Alleviate concern about having to connect to multiple solutions to achieve goals by verifying statewide HIE approach. Identify alternative approach for MN HIN for smaller organizations who are trying to connect with all large system providers where their patients may be seen Clarify the statewide approach that encompasses state mandates, laws, and payer contracts. Encourage EHRs and HISP organizations who provide HIE transactions for providers to become part of the Minnesota solution by becoming state-certified. Review other state approaches to HIE to identify best approach for Minnesota market-based concept. Review governance and policies for the exchange of information through the HIE Identify need for Directory of Direct Addresses, currently not in use, and the potential National Directory option. If determined to be needed on a statewide level, identify best process and access to the Directory of Direct Addresses. Collaboratively identify process for understanding who has primary responsibility for a patient s care. 9. Collaboratively identify best uses of clinical data repositories (potentially through HIOs), including data stored, accessibility, and use for Population Health Analysis Increase HIE participation so demand by providers prompts vendor solutions. Understand long range financial sustainability of the Minnesota model. 14. Create a summary update on the Minnesota market-based HIE approach including status, gaps in implementation and policy actions recommended to fill the gap. 15. Identify core HIE functions (e.g., patient matching, consent management) and core HIE transactions (e.g., ADT, CCDA), both short term and long term 16. Convene State-Certified HIE Service Providers (Minnesota Health Information Network MN HIN) to identify: i. Options for developing and implementing core HIE functions and transactions, ii. Content of reciprocal agreements template, iii. Mechanism for patient matching and queries between State- Certified entities, iv. Identify need for any Statewide Shared Services, including Directory of Direct Addresses and workflow implications v. Standards for priority transactions, and vi. Process for mutual updates/upgrades for standards. 17. Develop strategy to inform and assist providers to self-identify role in MN HIN infrastructure current and long term. Other considerations for collective action: Identify and obtain funding mechanisms to implement Minnesota s core HIE functions and transactions, engaging payers, providers, hospital systems, state/federal government, and vendors. Identify what value add services could be provided by HIO and by HDIs for providers with EHRs, and for those without EHRs. Examine HIE infrastructure of HIOs, HDIs, and providers for opportunities to create population research databases for improving and managing population health Minnesota e-health Initiative HIE Workgroup Page 6 of 7 January 15, 2016

28 Draft for Discussion Only Key Barriers and Issues Opportunities and Challenges Proposed Recommendations and Considerations for Collective Action 12. The lack of individual engagement diminishes the demand for HIE (e.g., consumers/patients accessing portals) a. Access to Patient Portal b. Use of Patient Portal beyond viewing (consent management, scheduling, payments, selfmonitoring tools, etc.) c. Bi-directional communication with providers Allow individuals to identify primary care coordinator, and give consent for access to patient portal information to improve care coordination. Brainstorm options for individual care plans through HIE potential for patient portal use during and after hospital, or other program, discharges. Promote real-time alert notification for those entities the individual has consented to in the patient portal Identify gaps in broadband services for internet availability for patient portal and telehealth use by individuals and their families. Promote expansion of broadband in those areas to delete gaps in services. 18. Collect data from consumers and/or review studies on consumers use of HIT to determine their level of access and use of patient portals, what functions are desired in a patient portals, and how they prefer to communicate with their providers. 19. Explore use of EHR-tethered portals and potential HIO patient portals as value add use for providers who do not implement patient portal options through the EHR. Other considerations for collective action: Identify at what point(s) in the health system that patient education would improve the use and understanding of HIE by the individual/care giver; follow-up on patient education for patient portal access and use Evaluate individual and care giver perceived benefit to: seek access to a patient portal; confirm health data presented is accurate; alert provider of any inaccurate health data on patient portal; identify key programs/providers adding value to health care, and provide health information consent (and s if necessary) for those providers; when available, link patient monitoring devices to patient portal; use other self-monitoring tools through patient portal; when available, message provider or care coordinator with personal health concerns and questions; when available, schedule appointments though patient portal; when available, complete surveys through patient portal; when available, bill pay through patient portal; maintain responsibility for health; encourage others to use patient portal services Minnesota e-health Initiative HIE Workgroup Page 7 of 7 January 15, 2016

29 Appendix F Health Information Exchange Workgroup Charge Minnesota e-health Health Information Exchange Context Health information exchange (HIE) is the electronic transmission of health-related information between organizations using nationally recognized standards (Minn. Stat. 62J.498 sub.1 (f)). The goal of health information exchange is to help make health information available, when and where it is needed, to improve the quality and safety of health and health care. In Minnesota, many efforts are underway to help achieve the secure electronic exchange of clinical information between organizations using nationally recognized standards. Other than electronic prescribing, most of the health information exchange happening in Minnesota is primarily between affiliated hospitals and clinics or those using the same EHR system. Federal requirements through meaningful use now requires more health information exchange happen among health care providers that are not related health care entities. Minnesota s approach to health information exchange has been to support a market-based strategy for secure HIE that allows for private sector innovation and initiative, yet uses government oversight to ensure fair practices, sustainability and compliance with state and federal privacy, security and consent protections. Although significant progress has been made, Health information exchange rates are low with most exchange occurring between affiliated clinics and hospitals (i.e., hospitals and clinics that are part of the same health network). It is essential to understand the barriers to HIE and interoperability and to identify opportunities to address the issues associated with the barriers. Workgroup Charge Review and recommend actions to address identified barriers and challenges to HIE and interoperability Review current landscape and recommend a strategic approach and actions for implementing specific transactions (e.g., ADTs) Review and validate updates to the Minnesota HIE Framework for Accountable Health Review and validate updates to A Practical Guide to Understanding HIE, Assessing Your Readiness and Selecting HIE Options in Minnesota Workgroup Process The workgroup will continue to build upon Minnesota community needs and key national health information exchange activities. The Health Information Exchange workgroup charge builds on the foundation and accomplishments of the previous work focusing on recommending actions to increase the adoption and use of HIE and making progress on interoperability. Workgroup Tasks 1. October 2015 February 2016: Understand Minnesota laws related to HIE including recent updates Review and discuss key barriers to implementing HIE and interoperability in Minnesota Identify actions (guidance, best practices, or policy changes) to address identified barriers and gaps to implementing HIE and achieving interoperability 2. January May 2016: Review current landscape and develop a preliminary strategic framework for use of specific transactions (e.g., ADTs) and recommendation for a path forward. Identify gaps and provide comments for health information exchange including materials from the Privacy and Security Workgroup and discuss options. Identify gaps and provide comments for the Minnesota HIE Framework and Guidance for Accountable Health Identify gaps and provide comments for A Practical Guide to Understanding HIE, Assessing Your Readiness and Selecting HIE Options in Minnesota. 3. Ongoing Related Activities: Recommend resources and actions that will help increase implementation of HIE statewide. 1

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