Utah Digital Health Commission Meeting Minutes
Friday November 9, 2007
10:00 a.m. -12:00 a.m.
Utah Department of Health
288 North 1460 West
Salt Lake City, Utah
Members Present: Joseph Cramer, Rod Ross, Chet Loftis, Scott Barlow, Rulon Barlow, Deb LaMarche, Brad LeBaron, Via Video Conferencing: Dennis Moser, Via Telephone Representative Ronda Menlove, Michael Jenson
Members Absent: Terry Holmes and Mark Munger
Staff Members: Wu Xu, Humaira Shah
Guests: Sharon Donnelly (HealthInsight), Bette Vierra (AUCH), Francesca Lanier (UDOH), Jan Root (UHIN), Lon Vombaur (UHIN), Dan Dellenbach (Zions Bank), and Henry W. Gardner (Zions Bank)
Welcome, Introduction, and Updates: Joseph Cramer, UDHS commission chair, welcomed everyone. He reviewed the DHsC presentation to the legislative committee on October 17, 2007. He and Barry Nangle reported to the house and senate health and human service interim committee. The commission’s website was underdevelopment. It will have pictures of the commission members, minutes, policy statements, etc.
Motion: Scott Barlow made a motion to accept the minutes from the last UDHSC meeting in its current form. Dennis Moser seconded. The motion passed unanimously.
Medicaid EMR Project: Sharon Donnelly, Director of HIT Strategy at HealthInsight reported the Medicaid EMR project’s progress. They are working with primary care doctors and pediatricians. Since the project began this summer they were able to recruit 40 practices as required. She talked about how to promote successful adoptions of EMRs. They found predictable factors, things like the doctors in a clinic have to be ready for EMR; and other clinics in the system have to be ready. Motivations for EMRs adoptions are discussed. The top motivation was cost; it costs a clinic less to run their business with EMR; it is a return investment and enable them to code more accurately. The top barrier to EMR is cost as well. It costs small practice more than large practice. Then there’s the time to invest in new changes. There are too many choices of a tool (narrowing down needs). We need to understand how EMR interferes with patient relationships, etc. Adopting the EMR doesn’t necessarily get to better care. It’s really important, if you have an EMR and to know how to use it better.
Motion: Joseph Cramer made the motion that the Commission recommends that the department continuously facilitate the effort to help EMR adoption, make these tools more readily available and used in the Medicaid provider community for the delivery of care to reduce cost, improve quality and access, with the inclusion of seeking grants and resources. Michael Jenson seconded the motion. Rod Ross, Chet Loftis, Scott Barlow, Rulon Barlow, Deb LaMarche, Brad LeBaron, and Dennis Moser were in favor of the motion. Motion was passed unanimously.
Commission Membership: Joseph Cramer mentions that term ending is coming up and he wants to extend retirement dates and offer a continued opportunity for those people to serve on the commission. There is an obligation for members to attend 75% of meetings. Because of this requirement, there is an open position on the commission; and it is the information technology professional. He explains that there is an opportunity to serve in this position and that there is one recommendation to approach others in the technology community including Richard Nelson, who is the chairman of the Utah technology council. The council is the trade association for over 40 technology companies in the state. Deb LaMarche proposes to have somebody that’s involved in ITE in the broad sense and someone who can jump in and already understand what the issues are and don’t have to spend their first year trying to figure out what to do. She nominated Jan Root, the Executive Director for UHIN, Mark Probst, the CIO of Intermountain Healthcare and Mike Peterson, one of the real contributors to the UTN board.
Standardized “Notice of Privacy Practice” to Patient: Francesca Lanier explains that the emergence of a networked electronic health information environment will transform patient care and improve the efficiency and effectiveness of the health system; At the same time, the emerging electronic health information infrastructure and the massive increase in the volume of health data that is easily collected, linked, and disseminated create unprecedented privacy and perceived security risks that needs to be adequately and appropriately addressed.
She then talks about Model Policies that they developed by incorporating the basic privacy and security principles and the basic requirements set forth in HIPAA, seek to achieve a balance between maintaining the confidentiality of health information and maximizing the benefits of using such information. Integration of these privacy measures into the emerging networked health care environment can ensure that the benefits of electronic health information are realized while the confidentiality of health information is preserved.
She talked about the Policy Recommendations: To exceed HIPAA’s requirements by also requiring disclosures to individuals of certain information related to the cHIE. For example, under the standard policy, the Privacy Notice should inform individuals about the following:
- information that the Participant (physician or health provider) may make available through the cHIE,
- who is able to access the information, and
- how they (patient) can have information concerning them removed from the cHIE.
Joseph Cramer suggests that instead of using the word “remove”, perhaps the word “edit” should be used and it may include the removal and also the correction of information. Jan Root explains that HIPPA doesn’t allow you to edit your medical information; it allows you to amend it. She thinks that the Policy Recommendation” is that some people don’t want their information available at all, which is a different thing than amend. Francesca explains that if a patient doesn’t want her information being exchanged then she thinks that the patient should have the right to have that honored. Then she discusses the Purpose and Principles. These are not HIPAA requirements, but rather build and expand upon the current privacy law. This recommended policy change would exceed HIPAA’s requirements by providing suggestions for additional, voluntary protections that could be implemented on the provider level to enhance consumer protections and alleviate consumers concerns regarding participation in the cHIE.
This recommended policy promotes the privacy principles of openness and transparency, purpose specification and minimization, use limitation, collection limitation, and individual participation and control. In addition, the model policy helps ensure that information is collected and shared electronically in a fair manner with the knowledge of relevant individuals, which is particularly important in a networked environment where the technology may be unfamiliar to average users.
Statewide Clinical Information Exchange Initiative: Jan Root, Executive Director for Utah Health Information Network, explains that the goal of the community Health Information Exchange (cHIE) is to create a secure, real-time system whereby a Utah health care provider can, with patient permission, be able to access basic medical information about their patients no matter where the patient receives their care in Utah. She then explained the process which was created by the UHIN Board of Directors who authorized the formation of the clinical health information exchange task force which is charged with two things: 1) to recommend a vendor(s) through a process to the board for achieving cHIE; 2) to develop a substantially defendable business case. The board met with the governor to discuss this with him and Dr. Cramer was there representing the DHSC and asked for the governors political support in this concept. She explains that under the features of this system, it is intended to accomplish secure, real time communication of basic, with standardized information and they would adopt national standards wherever possible, a basic clinic interface tool is being proposed for clinicians who do not have an EMR so they can participate in the information exchange, it’s basically to move both claims and clinical information through the same secure pipeline.
2008 General Session Draft Legislation “Amendments to UDHSC Act”: Joseph Cramer introduces Representative Menlove over the phone. Representative Menlove asked feedback on the bill’s highlights: the amendments of clarifying the member appointment process; gaining informatics staff support but removing the need for senatorial endorsement; new responsibility on privacy and other related issues; and placing emphasis on the rural health providers and special populations. The committee discussed the renaming of the commission to committee. The reason for the renaming in the department is to make a standard action for all advisory committees. Joseph Cramer and attending DHSC members oppose it, because the importance of the original legislation was to make it a commission. It also makes a difference as we communicate with others.
Motion: Joseph Cramer proposed a motion to keep the name as a commission. Motion was passed unanimously.
Meeting Evaluation/Conclusion: Joseph Cramer brings the meeting to a conclusion and plans on the next meeting in January and the upcoming retreat in March. At the January meeting, we will have the legislature information, discuss and understand more various eHealth initiatives.