Utah Digital Health Commission Meeting Minutes
Friday July 11, 2008, 10:00 a.m. -12:00 p.m.
Utah Department of Health
288 North 1460 West, Room 114
Salt Lake City, Utah
Members Present: Joseph Cramer (Chair), Scott Barlow, Rulon Barlow, Natalie Gochnour, Deb LaMarche, Brad LeBaron, Chet Loftis, Dennis Moser, Mark Munger, Marc Probst, Jan Root, Nancy Staggers
Staff Members: Wu Xu, Francesca Lanier (UDOH, Office of Public Health Informatics)
Guests: Sharon Donnelly (HealthInsight) Henry W. Gardner (Zion’s Bank), Mary Hubbard, Stephen Clyde (Utah State University)
Introduction and update: Joseph Cramer welcomed everyone and informed the Commission that media began to be interested in the Commission’s role in e-health. He just had an interview with the Ogdan Standard Examiner on patient privacy issues.
Motion: Rulon Barlow made a motion to accept the minutes from the March UDHSC meeting with correction of a few spelling errors. Dennis Moser seconded. The motion passed unanimously.
HHS ONC’s request for state input: Francesca Lanier, Utah HISPC Project Director, reported that the Office of the National Coordinator's (ONC) in the US DHSS request to identify Utah's top 3-5 health IT and HIPAA-related issues associated with challenges to interoperable exchange. The commission made following comments:
Variation in privacy and security business practices and policies create a barrier to electronic clinical health information exchange. Consumers, organizations, and state and federal entities share concern for maintaining the privacy and security of health information and must work together simultaneously for solutions. Consistent cross-state privacy and security laws and requirements for health care may facilitate greater interoperability. [For example, common state license requirements or reciprocity.] Harmonizing existing federal regulations that all states must comply with can reduce some of the variation in misunderstanding and differing applications that compound challenges to interoperable electronic exchange of health information.
For example: HIPAA Privacy Rule - Patient authorization/consent interchangeable use of terms and language confuses what is required. HIPPA Security Rule - Standards for authenticating and ensuring only authorized persons access patient information are increasingly important in an electronic environment. As more organizations move towards electronic exchange of health information it becomes increasingly important to move towards national standards for authentication and authorization protocols. 42 CFR Part 2 Variation in treatment facilities', integrated delivery systems' and physicians' understanding and interpretation of the regulation, how it relates to other federal regulations (HIPAA) and the application of the regulation may restrict the exchange of health information for legitimate treatment purposes.
Prioritizing priorities: Joseph Cramer led the review of retreat summaries and asked whether we missed any important areas of digital health services in the discussion at the retreat. The eight areas are: Health system reform and e-health, workforce and education, use of HIT, data and transparency, telehealth, rural health, business community, clinical health information exchange (cHIE), and e-prescribing. The commissioners agreed that the retreat covered major issues in e-health and did not add any additional areas to the summary. Brad LeBaron commented that the commission should focus on few things, maybe just Job One. Marc Probst pointed out that lack of knowledge about the state overall activities or e-health portfolio made the prioritization hard. Joseph Cramer asked whether the informatics staff could do an inventory. Natalie Gochnour emphasized that the Commission’s priority needed to be linked to the reform and focused on drivers of healthcare cost. The cost drivers could be duplicated service, efficiency (do the care right at the first time), best practice in disease management, care-coordination and reimbursement. Can cHIE improve those areas? Chet Loftis asked what is the DHSC role and what is the government role in e-health. He states that the government role is to know what is going on and facilitate the collaboration between government/public sector with private sector.
Planning for the first priority: The commission agreed on the need of a priority list. Deb LaMarche reminded the commission that we should periodically oversee all areas in e-health although not every area would be the priority for the commission in different times, such as telehealth. Joseph Cramer proposed to the commission develops a time table to look at a few areas per year, such as cHIE, e-prescribing, rural health, telehealth, etc. Nancy Staggers suggested to form a small work group to propose a priority plan for the commission to consider at the next meeting. Jan Root and Chet Loftis volunteered to serve on the priority work group.
“e-Health Community”: Dean Mary Hubbard from College of Science, Utah State University and Stephen Clyde, Asso. Professor, Dept of Computer Science, USU, in behalf of Representative Rhonda Menlove and Utah State University, invited the commission to visit Logan. They proposed to make Cache Valley the 1st digitalized health service community in Utah. USU has collaborated with UDOH on child health information “CHARM” systems for eight years. Currently CHARM is working with UHIN to reach out to more private clinics. Cache Valley could be a pilot for an “e-Health Community” for various statewide e-health initiatives. Joe Cramer emphasized the community leadership and stakeholder relationship for a community-based initiative. Rulen Barlow asked whether the HIT adoption targets all or most of healthcare providers in a community. Marc Probst was interested in the scope of an e-health community initiative. Several members expressed interests to visit Logan. The commission was interested in this initiative but would like to make sure that it could fit in the overall strategies in the state. Stephen Clyde said that they would need at least two months to get the initiative organized, then the commission could consider whether to hold a meeting in Logan.
Election of chair and the procedure: Joseph Cramer proposed to have an election of the chair since we have had several new members. Wu Xu discussed the procedure of chair election and also asked whether the commission would like to establish a vice-chair position. All attending commissioners agreed to establish a vice-chair position and have term limits for chair and vice chair.
Motion: Brad LeBaron made a motion that The Commission's Chair will be elected by the commission members every two years. The Chair's term length is two years with a term limit of two-terms. The Commission's Vice Chair will be elected by the commission members every two years. The Vice Chair will automatically become the Chair when the Chair's position is vacant. The total terms for a member to serve as the Vice Chair then Chair are two terms/four years. Chet Loftis second. The motion passed unanimously.
Other businesses: Jan Root asked whether the commission could endorse the cHIE initiative and express its support in a letter signed by the chair to the UHIN board. Marc Probst clarified that a commissioner’s vote represents an individual citizen’s position, rather than the position of a commissioner’s organization.
Motion: Jan Root proposed a motion that the Chair Dr. Cramer writes a support letter on the cHIE initiative to the UHIN board. Chet Loftis second The motion passed unanimously.
Wu Xu informed the commission that due to the new working schedule under the “Working 4 Utah”, DHSC meeting dates will be changed from Fridays to Thursdays.
Dr. Cramer adjourned the meeting at noon.