June 13, 2011
In Person Attendees:
- James Anfield, Blue Cross and Blue Shield
- Charles Cox, Metro Chicago HIE
- Gail Fournier, Metro Chicago HIE
- Mary Anne Kelly, MCHC
- Elizabeth McKnight, CHITREC
- Wesley Valdes, UIC/OHIT
Attended by Phone:
- Terry Bainter, NIHIE
- Roger Holloway, Northern Illinois Health Care Network
- Bala Hota, Cook County Health and Hospital System
- Peter Ingram, Sinai Health System
- Stanley Krok, Children's Memorial Hospital
- Steve Lawrence, IHIP
- John Lynch, Provena Health
- Jay McCutcheon, SIU
- Bill Odman, HIESI
- Morris Rang, Blessing Hospital
- Mary Ring, Illinois Critical Access Hospital Network
- Crystal VanDeventer, Lincoln Land HIE
Office of Health Information Technology (OHIT)
- Mark Chudzinski
- Joseph Duffy
- Ivan Handler
- John Lekich
- Mary McGinnis
Ivan Handler, Chief Technology Officer of the Office of Health Information Technology (OHIT), opened the meeting at 9:00 a.m. hosted by OHIT at the State of Illinois J.R. Thompson Center in Downtown Chicago, with a telephone conference call-in number. It was noted that notice of the meeting and the agenda were posted on the OHIT Web site and at the Chicago meeting location no later than 48 hours prior to the meeting. Roll was taken, and the ability of those attending by telephone to hear and participate was confirmed.
OHIT Update: HIE Infrastructure RFP
Mr. Handler discussed the release by the State of Illinois of a Request for Proposal (RFP) for the acquisition of the core services of the state-level health information exchange (ILHIE), and the vendor conference to take place that afternoon. The RFP reflects the ILHIE Strategic and Operational Plan submitted to and approved by the Office of National Coordinator for Health Information Technology (ONC) of the Federal Department of Healthcare and Family Services, which had provided the State of Illinois an $18.8M grant under the American Recovery and Reconstruction Act (ARRA) of 2009 for the development and implementation of the state-level HIE. Most of those funds are earmarked for the acquisition of the ILHIE's technology infrastructure. A copy of the RFP can be obtained from the State of Illinois BID Web site, a link to which is located on OHIT's Web site (www.hie.illinois.gov); OHIT's responses to the questions posed by participants in today's vendor conference will also be posted. The deadline for submission of bids is July 22, 2011. OHIT intends to select and finalize the contract with the Vendor during September 2011, have a project implementation plan ready by November 2011, and launch the initial core services (the patient, provider and public health entity directories) of the ILHIE by April 2012.
The selected Vendor will be responsible for developing statewide HIE services using a Software as a Service (SaaS) model. A possible cloud-based architecture is presented in the RFP. OHIT expects the software suite for these ILHIE-unique services to eventually be released under an opensource license. Furthermore, OHIT expects the Vendor to help create an opensource project (through SourceForge, CodePlex, Bitbucket, Freshmeat or similar organizations) and to be responsible for the maintenance and enhancement of these ILHIE-unique services at a future time.
Vendors are expected to propose a scalable, packaged solution that works in an integrated fashion across the following areas: hosting services; provider directory management; payer directory management; public health entity directory management; master patient index management; record locator service management; user and system authentication management; patient consent management; transaction monitoring and auditing; health information data exchange/transport services; integrity surveillance; privacy and security compliance; Web-based patient portal; and systems operations, help desk and technical support. However, each of the components should operate independently, and as necessary, integrate with other components via standards-based interoperability. This will provide an environment where it will be possible to seamlessly introduce new products or replace products provided in the initial solution suite, as may be desired in the event better offerings than may be available today come into existence.
OHIT intends to leverage existing and emerging national standards as much as possible and expects the selected Vendor to deliver various services utilizing the most current and evolving national level standards, including but not limited to: NHIN, NIEM, MITA, SNOMED, LOINC, HL7, and X12.
After the initial deployment of the ILHIE the selected Vendor will also be the State's partner on an ongoing basis to evolve and enhance the functions and features of the HIE to meet the expected changes and new directions in the state of the art related to sharing of medical record data across various entities. This includes sharing electronic patient data directly with patients, across providers, payers and public health entities through direct links with the ILHIE, links with regional and local intrastate exchanges, across interstate exchanges, and with national level exchanges and repositories such as those operated by the federal Centers for Disease Control (CDC).
While the ILHIE core services will enable connectivity among ILHIE participants for the exchange of health information, the ILHIE can also be viewed as a platform which will enable the provision of services which utilize one or more of the ILHIE core services. Significant among such anticipated users of the ILHIE's platform are the agencies of the State of Illinois engaged in the health care services. The various directories created and maintained by the ILHIE (e.g. patients, providers, payers, public health agencies) can be used by existing State systems such as the Medicaid Management Information System (MMIS), the Provider Incentive Payment (PIP) program, and the immunization and other registries of the Department of Public Health, for which the ILHIE should collect appropriate fees. When made available to users in the private sector, a thoughtfully-developed platform could serve to stimulate the development of new software applications and services of value to Illinois patients and healthcare providers.
In the ensuing discussion, the following concerns were expressed:
- OHIT needs to develop and communicate a clear strategic vision of the ILHIE's role and future services, that includes consideration of the role of the emerging local/regional HIE initiatives in Illinois, with whom there has not been much dialogue to date;
- OHIT needs to be more transparent regarding its intended uses of its $18.8 M ARRA grant funds and its proposed business plan, and consider providing financial assistance in support of the emerging local/regional HIE initiatives in Illinois;
- OHIT needs to provide the emerging local/regional HIE initiatives guidance regarding the costs that will be payable to the ILHIE for use of the ILHIE services;
- OHIT needs to provide guidance regarding the technical aspects of connectivity with the ILHIE and among the ILHIE participants, including specifics of participant authentication requirements and implementation timelines; and
- OHIT needs to provide detailed guidance regarding the division of technical functions and responsibilities among the ILHIE and the ILHIE participants, and relevant timelines.
Mr. Handler acknowledged the concerns that had been expressed, and the frustration that the leaders of the emerging local/regional HIE initiatives have experienced in their preparation and implementation of business plans in the midst of financial and technical infrastructure uncertainty. OHIT is not unfamiliar with such concerns, as it faces a formidable challenge in aligning the ILHIE with Federal and State laws and policies, evolving technologies, emerging local/regional initiatives, and the limited resources that are available. It is anticipated that certain of these concerns will be better addressed once a Vendor has been selected, with whom the details of the ILHIE infrastructure can be finalized. Mr. Handler noted that the ILHIE architecture as reflected in the RFP is presently at a fairly high and abstract level, and needed to be developed further with greater specificity. OHIT will continue to monitor relevant developments at the Federal level, such as the criteria for Stage 2 Meaningful Use incentive payments, and advocate whenever possible for needed Federal guidance and support.
OHIT Update: HL7/IHE Message Standards Project
Mr. Handler advised that OHIT had initiated a project examining the proposed use and adequacy of the HL7 and IHE messaging standards. Industry commentators have suggested that these standards may lack the necessary specificity to facilitate uniform implementation and interoperability, particularly in environments with web-enabled services and XML. Progress at the Federal level in the development of national standards to facilitate HIE appears to be limited, and the pursuit of HIT interoperability does not appear to have been a guiding criteria in the ONC's designation of the certification requirements for EHR systems eligible for Meaningful Use incentive payments. OHIT welcomes the involvement of workgroup members in this standards review project.
In the ensuing discussion a concern was expressed as to the creation in Illinois of standards that are additional to, and possibly conflict with, national standards already formulated, or being formulated, under ONC supervision. Mr. Handler acknowledged that OHIT should not be creating technical requirements that are not consistent with national standards and initiatives, but noted that OHIT in collaboration with other States is well positioned to be instrumental in the formulation of technical requirements that promote HIE interoperability, which would be adopted at the ONC level.
OHIT Update: University of Illinois SHARPS cooperation
As noted in the RFP, certain of the ILHIE services will be unique and as a result, the selected Vendor may need to engineer these services. OHIT anticipates that current market solutions satisfying OHIT's privacy, security and patient consent requirements for fostering public trust in the ILHIE may be lacking. The ILHIE 4-layer architecture envisions a Privacy and Security layer which will include a cluster of Web services that control an ILHIE user's access to the data repositories. OHIT is presently exploring with the University of Illinois SHARPS program (Strategic Healthcare IT Advanced Research Projects on Security, http://sharps.org/research/projects) how to incorporate the latest concepts in healthcare data privacy and security management into an open source XACML and SAML prototype that can inform the engineering efforts of the ILHIE Vendor for the ILHIE's Privacy and Security layer services. It is anticipated that such ILHIE services would be available for use of any ILHIE participant in place of application-specific privacy and security modules.
Progress Reports from Local HIEs
- Metro Chicago Health Information Exchange (Metro Chicago HIE). Mary Anne Kelly reported that following the collection of executed Letters of Intent from hospitals that intend to be participants in the HIE, Metro Chicago HIE is now in the process of transitioning founding members of the HIE to being early adopters. A contract with a vendor (Microsoft and CSC) has been signed, and it is anticipated that the exchange of data through the HIE will begin at the start of 2012. The governance structure has also advanced, with the formation of an Advisory Committee that has already met twice. Gail Fournier reported that kick-off meetings with early adopters are already scheduled for the upcoming weeks.
- Northern Illinois Health Information Exchange (NIHIE). Roger Holloway reported that work is continuing on the development of the NIHIE governance structure, and is interested in further exploration of issues related to privacy/security/consent. Tiani Spirit has been selected as the HIE vendor, but formal contracting has yet to be completed.
- Illinois Health Exchange Partners (IHEP). Steve Lawrence reported that IHEP has engaged a law firm to work on the HIE's operating agreements. IHEP is adding members to its founders group, hopes to have some services operational by the end of the year.
- Lincoln Land Health Information Exchange (LLHIE). Jay McCutcheon reported that work was still proceeding on legal aspects, including the execution of relevant agreements. Medicity has been selected as the HIE vendor.
- Southern Illinois Health Information Exchange (HIESI). Bill Odman reported that HIESI is currently engaged in a pilot project with NextGen, together with ICAHN and Southern Illinois Healthcare (SIH), and is postponing until September its vendor selection process, pending results of the NextGen pilot. Vendor selection criteria, similar to an RFP, have been developed and vendors were reviewed. The financial circumstances in the Southern Illinois medical trading area are such that a vendor's willingness to subsidize the development and implementation of the local HIE is a critical consideration, absent Federal or State financial support. HIESI had been anticipating that OHIT would be sharing with the local HIE initiatives some of its ARRA grant funds, but it is now known that that is unlikely.
- Illinois Critical Access Hospital Network Exchange (ICAHN Exchange). Mary Ring commented further on the joint initiative with HIESI and SIH that Bill Odman had described. ICAHN is already using the NextGen solution, and is awaiting on the installation of the new version at 3 of the ICAHN members. The ICAHN Exchange is moving ahead as planned.
- Central Illinois Health Information Exchange (CIHIE). There was no report.
A simple report template had been prepared by Mr. Handler for the last (May 17) meeting of the work group, but was not subsequently circulated, so discussion of the template for gathering information from the emerging local/regional HIE initiatives regarding their status in respect of key milestones was defer="defer"red.
Use of Direct and commercial HISPs
Mr. Handler noted that the ONC is heavily promoting the adoption by HIEs of the Direct protocol, developed as part of the National HIE Network initiative (NwHIN), for the secure point-to-point routing of messages with health information. OHIT has noted the entry into the market of several commercial providers of Internet access who plan to offer Healthcare ISP (HISP) services, including the issuance to users of trust credentials and secure addresses. OHIT has decided that instead of OHIT establishing a state-level HISP in competition with emerging commercial providers, the State would facilitate provider access to the commercial HISPs by offering a public portal which would promote the available HISPs and facilitate provider enrollment. OHIT is not currently seeing much user demand in Illinois for HISP services.
Privacy and Security
Mr. Handler noted that the policy environment, at the Federal and State level, regarding the privacy and security of protected health information (PHI) is complex, lacking in uniformity and in flux. The technical challenge that we face in designing the ILHIE is to provide it with sufficient flexible functionality that can accommodate changing business rules of patient consent management, applied in a granular manner to categories of PHI, categories of data recipients, and categories of PHI disclosure circumstances. Relevant inputs from patients and data custodians for the application of the data access business rules need to be collected and shared across various enterprise systems. Preliminary explorations of these matters with the University of Illinois SHARPS experts suggest the development of a prototype that facilitates the cross-domain transport and validation of secure tokens.
Mr. Handler noted that each of the seven emerging local/regional HIE initiatives has been invited to make a presentation regarding its development and implementation status at the upcoming meeting of the IL HIE Authority Board on June 22, 2011 in Springfield, IL.
Concern was expressed regarding the unavailability on the OHIT Web site of minutes from prior meetings of this work group and of other work groups.
In response to questions regarding the State's Provider Incentive Program (PIP) and the availability of incentive payments to qualified Medicaid providers for meaningful use of certified EHRs, Mr. Handler noted that a meeting on this matter was scheduled for later that day, and that it was presently anticipated that the State's PIP will be operational in August or September of this year.
There were no comments offered from the general public.
The meeting was adjourned at 10:15 a.m.