Oklahoma Health !

nformation Exchange Trust

Sustainability Plan
Augu 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 complete medical 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, right timing, right security (OHIET, 2011, p. 3).
The continuance of OHIET beyond federal funding engagement is a deliberate plan to build on the social capital derived in the operational phase. The continuance of OHIET is based on the Franchise 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, and state support. The alignment of incentives to participate in OHIET is essential (Deloitte Center for Health Solutions, 2006). The result of participation in OHIET will be connectivity to the national or regional superhub for health information exchange. Activities will be conducted on behalf of the health information organizations (HlOs) that cannot be completed on a state level by 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 to

changes 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 Protection and Affordable Care Act (Affordable Care Act) ensures a position for a statewide coordination role for OHIET. Essential Role of OHIET in Credentialing and Safety The 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/or data are exchanged within an HlO..

Authorization-Facilitate management of an individual's permission/authorization to share information about the location of health information or apply restrictions on access to specified health information. Personal ldentification-Utilize a standard person identity/information correlation process to uniquely identify an individual. Location of Health !nformation-Provide functionality that will locate where health information exists for identified individuals. Transport and Content Standards-Transport types: (1) requests for and their responses to location of information, (2) requests for data, (3) data itself, and (4) other types of messages (such as notifications of the availability of new data). To destinations using general industry-recognized transport types and authorized recipient's specified mode. To and from electronic addresses that are unambiguously identified in a
standardized manner.
Data Transactions-Provide functionality that will enable data transactions to occur among 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, notifying public health about the occurrence of a bio-hazard event, informing individuals about the availability of a clinical trial, and determining hospital census for disaster planning. Auditing and Logging-Log and audit all (intentional or unintentional) connections and disconnections to network services and all network configuration changes, generating alerts/notifications for system activity outside the normal range of monitoring

levels/thresholds. Time-Sensitive Data Access-Enable time-sensitive data request/response interactions to specific target systems (e.g., query of immunization registry request for current medication list). Communications-Communicate health information using HITSP-identified standard content and message formats. Data Storage-Enable the ability to aggregate data from disparate sources to facilitate communications. For example, temporarily hold information as it is being collected to communicate a concise summary of the information; or permanently store data from uncoordinated sources across time to support a data registry (Department of Health and Human Services, 2AO7, p.541. Estimated Income and Expenses The estimated cost of OHIET sustainability annually is S1,050,700. The income may be derived

from

o 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 case development, grant making, project management, regulatory affairs, and items untold

the frontier of HIT develops. 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% federal match for administrative services on Medicaid covered lives (estimated at 17% of the state population). The benefits to Medicaid are analytical support for comparative private insurance data, community quality measure analytics, and potential establishment or management of state registries for genetic, infectious diseases, or chronic diseases.
as

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

1. Estimated lncome and Expense for

OHIET Annually

lncome
HIO certification fees 4%
S S S

30,000 200,000 566,000 500,000 100,000

of

revenues

Medicaid administrative fee

State support Products & services

s s

Tota! lncome
Expenses

s L,396,000

Personnel Chief Executive Officer Clerical Support Fringe Benefit

S S

160,000 40,000 60,000 260,000 14,000 7,500 200,000 96,000 100,000 100,000 200,000

s
S

Subtotal Personnel & Fringe

Travel
Su

s
S

pplies Privacy and security testing

Lega I services

Contractual
S S S

Financial & grant management Evaluation & analytics Social marketing

s
S S S S

Telephone & lnternet

Occupancy & liability

7,200
54,000

Printing & publication Tota! Expenses

L2,000

S 1,05o,7oo

Expenses are derived from maintenance of min jmum.staff for administration with extensive contractual staffforthe conduct ofoperations. The contractual costs are anticipated to be competitive bid for quality assurance on the privacy and security integrity; legal services for contract and privacy and security agreement maintenance; financial and grant management to include audit, and grant development expenses;

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evaluation and analytics inclusive of community analytics and Medicaid administrative

analytics; and social marketing for public engagement and information.

Timeline The timeframe for advancement of the sustainability plan is beginning in calendar year 2013 for certification and revenue fees, FY14 for Medicaid administrative fees, and legislative support.
Table

2.

lncome Timeline 2013

2014

Income

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

of revenues
fe e

HIO Certification Fees

4% Medicaid administrative
State support Products

& services

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

Outcome Measures
Outcomes measures By December 3L,2OL4, the sustainability plan will be tested and actionable. Determine if your plan business model is sustainable over time ldentify what adjustments may be required to create a long-term, sustainable model Secure final agreements/contracts with all of your stakeholders committing to the HIO ldentify and secure funding (Government lnformation Technology Agency, 2008, p. 55).

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References

Deloitte Center for Health solutions. (2006). Health information exchange (HlE) business models: The path to sustainable financial success. Retrieved from http://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 from http://www.hci3.orglsites/default/files/files/HRSA%20CCBH%2OFinal%Z0Report%20Rev ised.pdf Department of Health and Human Services. (2007). The community: American health information community (Meeting materials). Retrieved from http://www.hhs.gov/hea lthit/documents/AH tCBinde120071023.pdf Government lnformation Technology Agency. (2008, April 28). Rural healthcare information technology adoption project: RHIO formation guide, version 1. Retrieved from http ://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.