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Executive Order 29 Interim Report Governor's Health…
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Executive Order 29
Interim Report
Governor's Health Information
Technology Council
April 17, 2007
COMMONWEALTH OF VIRGINIA
OFFICE OF THE GOVERNOR
Executive Order 29
ESTABLISHING THE
HEALTH INFORMATION TECHNOLOGY COUNCIL
Importance of the Issue
Building and improving our health information technology infrastructure is
critical to providing quality health care. As the complexity of our health care
system continues to grow, health care providers must leverage information
technology to improve patient safety and health outcomes. It is critical that
Virginia health care providers employ health information technology to provide
the best care for patients. Improving health care technology infrastructure offers
the potential for both improving the quality and safety of patient care and helping
control costs.
Health care information technology is important in both institutional and
non-institutional settings. It is important for the Commonwealth to encourage the
development of appropriate, interoperable health care information technology to
improve the quality of care and help control costs. As was recognized in the 2006
Appropriation Act, at the request of my administration, an appropriate first step is
to convene major stakeholders and leading thinkers on this issue.
Establishing the Council
By virtue of the authority vested in me as Governor under Article V of the
Constitution of Virginia and under the laws of the Commonwealth, including but
not limited to Section 2.2.-134 of the Code of Virginia, and subject always to my
continuing and ultimate authority and responsibility to act in such matters, I
hereby establish the Governor's Health Information Technology Council.
2
In addition to the responsibilities identified in the 2006 Appropriation Act,
the Council shall have the following responsibilities:
1. Establish an interoperability framework drawing from and complying with
the standards of the National Health Information Network (NHIN).
2. Build public-private partnerships to increase adoption of electronic medical
records for physicians in the Commonwealth.
3. Identify areas where health information technology can lower health care
costs for the Commonwealth of Virginia as an employer and health insurer.
4. Provide an interim report to the Governor by October 15, 2006
recommending amendments to the state budget that will spur the
development, implementation, and ongoing use of Virginia's health
information technology infrastructure.
5. Recommend funding and strategies necessary to encourage long-term
sustained adoption and interoperability of health information technology in
the Commonwealth in a report to the Governor by December 1, 2006.
6. Examine other issues as may seem appropriate.
The Council shall consist of 15 members to be appointed by the Governor
and to serve at his pleasure, in accordance with the parameters laid out in the 2006
Appropriation Act. Additional members may be appointed at the Governor's
discretion. The Secretaries of Health and Human Resources and Technology will
co-chair the Council and will be responsible for convening the Council.
The Council shall meet at the call of the co-chairs to oversee the
development of the health information technology infrastructure in the
Commonwealth. Members of the Council shall serve without compensation. They
may receive reimbursement for expenses incurred in the discharge of their official
duties.
Staff support shall be provided through the Office of the Governor, the
Secretaries of Technology and Health and Human Resources, and such other
agencies as the Governor may designate. It is my intention to create a cross-
secretarial team to provide staff support to this effort. It is also my intention to
draw whenever possible on private sector expertise. Direct expenses for this
effort, exclusive of staff time, are estimated at $9,000.
3
This Executive Order shall become effective upon its signing and shall
return in full force and effect until July 7, 2007, unless amended or rescinded by
further executive order. It is my intention to renew this executive order as
provided for in 2.2-134 at the appropriate time.
Given under my hand and under the Seal of the Commonwealth of Virginia
th
this 7 day of July 2006.
Timothy M. Kaine, Governor
4
TABLE OF CONTENTS
Executive Order 29...................................................................................................... 2
TABLE OF CONTENTS.................................................................................................... 5
Health IT Council Membership .......................................................................................... 6
Staff Acknowledgements .................................................................................................... 7
Executive Summary ............................................................................................................ 8
Background ....................................................................................................................... 11
Section I Business Case Subcommittee ......................................................................... 14
Section II Physician Subcommittee ............................................................................... 18
Section III Privacy Subcommittee ................................................................................. 21
Section IV Ranking Subcommittee................................................................................ 24
Recommendations............................................................................................................. 25
Outcomes .......................................................................................................................... 26
5
Health IT Council Membership
Co-Chairs
The Honorable Marilyn Tavenner, Secretary of Health and Human Resources
The Honorable Aneesh Chopra, Secretary of Technology
Members
Barbara Baldwin of Richmond, chief information officer for the University of Virginia
Health Systems;
Golden H. Bethune of Hampton, executive vice-president and administrator of Riverside
Regional Medical Center;
Elizabeth T. Brown of Virginia Beach, director of information for technology and long
term care and home care services at Sentara Healthcare;
Nancy Davenport-Ennis of Yorktown, chief executive officer of the Patient Advocate
Foundation;
Ronald DeCesare, Jr. of Annandale, chief executive officer of Professional Healthcare
Resources;
Dr. Don E. Detmer of Crozet, chief executive officer and president of the American
Medical Informatics Association;
The Honorable Janet D. Howell of Reston, member of the Senate of Virginia;
Dr. Gopinath Jadhav of Richmond, physician for Southside Gastroenerology;
Bob Johnson of Potomac, Maryland, senior vice-president of Consumer Sales at Sprint
Nextel;
David Merritt of Alexandria, project director for the Center for Health Transformation;
Gil Minor, III of Richmond, chairman and chief executive officer for Owens and Minor;
Balan Nair of McLean, chief information officer and executive vice-president of
technology operations at AOL;
Dr. Keith H. Newby, Sr. of Norfolk, physician at Cardiology and Arrhythmia
Consultants, Inc.;
The Honorable Samuel A. Nixon, Jr. of Richmond, member of the Virginia House of
Delegates;
The Honorable John M. O'Bannon, III of Richmond, member of the Virginia House of
Delegates;
Megan Philpotts Padden of Norfolk, vice-president of government programs and e-
business at Sentara Health Plans;
Joseph Roach of Martinsville, chief executive officer of Memorial Hospital;
Chas W. Roades, Jr. of Vienna, executive director of research for the Advisory Board
Co.;
Richard D. Shinn of Midlothian, director of public affairs for the Virginia Primary Care
Association;
Anna Slomovic of Arlington, chief privacy officer at Revolution Health Group;
Larry T. Wilson of Gate City, physician at Holston Medical Group;
Michele M. Vilaret of Alexandria, director of telecommunication standards for the
National Association of Chain Drug Stores.
6
Staff Acknowledgements
Kim Barnes, Policy Analyst, Virginia Department of Health
Heidi Dix, Assistant Secretary of Health and Human Resources
Thomas Gates, Assistant Secretary of Technology
Betty Jolly, Policy Education Director, Department of Health Professions
Aryana Khalid, Assistant Secretary of Health and Human Resources
Greg Walton, Executive Advisor to the Health IT Council
7
Executive Summary
In August of 2006, the Health IT Council membership began the work of identifying and
encouraging long-term sustained adoption and interoperability of health information
technology. Governor Timothy M. Kaine in Executive Order 29 established the Health
Information Technology Council and charged that body with recommending the most
innovative and effective investments for the $1.5 million appropriated by the 2006
General Assembly to encourage the adoption of electronic health records throughout the
Commonwealth and in compliance with federal standards.
The Council was continuing the work of the 2005 Governor's Task force on Information
Technology in Health Care. which had examined the state of readiness in the
Commonwealth for electronic standardized health information. The Task Force found
excellent progress within hospital and health systems; health plans committed to
increased use of electronic health records; nursing facilities just beginning to undertake
efforts to implement information technology resources; and safety net providers operating
a practice management system purchased from one vendor. Barriers to the overall state
adoption rate were seen most clearly in the office of the physician, particularly the small
office. (Given that physicians in small practices account for 88 percent of all outpatient
visits and four-fifths of physicians work in small practices, this group represents a sizable
adoption gap.) In the final analysis, electronic health information adoption in Virginia
was underway. However, each effort was independent and proceeding at its own pace.
The Task force recommended a budget for 2006 to promote the adoption of best provider
practices, a master patient index and a continuation of executive appointees to further
electronic health records adoption.
Executive Order 29 directs technology infrastructure as critical in order to improve
patient safety and health outcomes. The statutory mandate in the 2006 Appropriations
Act (Item 293) of $500,000 in the first year of the biennium and $800,000 in the second
year directs funding to partner the state with providers and businesses toward
interoperability. General Assembly's budget language created a mechanism for
distributing the $1.3 million in funding designated for "encouraging the adoption of
electronic health records throughout the Commonwealth."
The Council took the work of 2005 and the fast lane approach and set out to provide an
unbiased approach for determining providers and business partners mature enough to
have the potential to jumpstart adoption in the Commonwealth. To determine readiness to
implement, Council issued a request for information (RFI) on August 21, 2006,
announcing its intention to seek Statements of Interest (SOI) from private entities and
public-private partnership. On August 31st, an information conference was held for
8
interested parties, with the Statements of Interest due Friday, September 15, 2006. Sixty-
one (61) proposals were submitted. The Council eliminated the proposals that were not
action ready (studies) and completed its evaluation of the 56 remaining proposals by
October 15th based on a probability index that drew the pool down to 34 proposals. Of
the thirty-four (34) remaining a letter rank of A, B, or C was awarded. This probability of
success exercise, or risk map, brought the proposals earning a high enough "grade" to be
considered an "A" down to 15. Three of the four subcommittees were charged with an
evaluation of the remaining proposals based on the authority specific to their field:
business, physician, and privacy/security. The Business Case subcommittee graded the
15 proposals that were ranked as an "A" and handed off their ratings of business viability
with scores from 100 to 0 to the Physician Communication and Privacy/Security
subcommittees. These two subcommittees reviewed the proposals that had ranked above
80 on the 100 point scale.
The fourth subcommittee, the Ranking Committee, then developed a weighted grid
system to combine the input of the 3 other subcommittees. The proposals were ranked
according to business case score and then awarded points based on the previous rankings
of the Physician Committee and the Privacy Committee. Finally these scores were
weighted as 70% for Business and 15% each for Privacy and Physician.
The Submission Collection Tool used in the RFI and in the probability index used in each
committee identified objectively those partners whose businesses/practices were already
mature in the field of changing medical technology and changing physician/health
delivery cultures. In addition, the collection tool looked for a culture of action-
orientation from its potential partners as well as a teaching-orientation. (projects able to
be replicated across practices and the state.) Teaching-orientation is an important piece,
not just for Virginia, but from the point of view of national leadership in the electronic
health record field. "To be connected" Michael O. Leavitt, Secretary Health and Human
Services, has repeatedly called the first step to true transparency in health care.
Finally, project proposals were judged on their ability to (1) drive adoption of ambulatory
health records in the Commonwealth, (2) improve interoperability of medical records,
and (3) leverage the Commonwealth's role as a large purchaser of healthcare to lower
costs.
Friday December 1, 2006, the Health IT Council made its recommendation to the
Governor for how the $500,000 in funding designated by the General Assembly for this
year should be spent. The Council gave the green light to 3 projects while making a point
to praise many of the projects that didn't receive funding. The Council felt that due to the
relatively small amount of funding available this year it was better to concentrate it in a
9
few projects to maximize the possibility of success. The Council recommended that the
Virginia Department of Health negotiate with the top three rated proposals (MedVirginia,
Community Care Network of Virginia, and CareSpark) to determine if there is flexibility
in their requests. The goal is to fund as many projects as possible without endangering the
likelihood of their success. On February 28th, Governor Kaine announced that each
project would receive $250,000 in funding.
The electronic health record has the capacity to improve the quality of life in ways that
previous generations could not even imagine. This is a beginning. Next steps for this
Council will be organizing procurement for the master patient index, directing money to
Health IT funding priorities; identifying appropriate support for proposals of superior
merit that fiscal restraints eliminated from funding consideration; developing an approved
but not funded list; finding market-led ways to bring better health care to patients at
lower cost and with less hassle; and other duties as identified by the Chairs.
This report begins with a brief introduction followed by chapters relating to the findings
of the Council recommendations.
10
Background
Synopsis of 2005 EHR Task Force
In April 2005 Governor Mark Warner issued Executive Directive 6 (ED 6) creating the
Governor's Task Force on Information Technology in Health Care charged with
conducting a one-year study to advise the Governor and the General Assembly on the
current status of Virginia's proliferation of electronic health records. The goal stated in
ED 6, in addition to determining the state readiness benchmark, included a next step of
advising how to get information about patients out of paper files and into electronic
databases that can connect to one another so that any doctor in Virginia can access all the
information needed to help any patient at any time and in any place.
The Electronic Health Record (EHR) was identified as a longitudinal electronic record of
patient health information generated by one or more encounters in any care delivery
setting. Included in this information would be patient demographics, progress notes,
problem lists, vital signs, past medical history, review of systems, immunizations,
laboratory data, radiology reports, and other components of medical records. The EHR
has the ability to generate a complete record of a clinical patient encounter, as well as
supporting other care-related activities directly or indirectly via interface - including
evidence-based decision support, quality management, and outcomes reporting.
Four subcommittees were formed to map the state of adoption of electronic health
records in Virginia. Subcommittee 1 surveyed where EHR is in Virginia today and
identified current best practices from Virginia and other states, including funding;
Subcommittee 2 surveyed EHR in private medical practices; Subcommittee 3 surveyed
and analyzed the current state of EHR in hospitals and institutions; and Subcommittee 4
explored EHR Interoperability, governance, policy and legal issues.
The Task Force Subcommittees found rapid progress within hospital and health systems
in terms of EHR adoptions, even relative to other states. Information technologies are
already the norm in non-clinical areas of hospitals and quickly becoming the norm for
clinical areas as well. In addition, health plans surveyed evidenced a broad
understanding and commitment to the value of wider health care IT development. In
general, health plans are committed to a system that can assure greater patient safety,
improved quality and increased efficiency through the increased use of electronic health
records. There is a broad understanding by health plans of the benefits and value of
broader health care IT development. For example, integrated delivery system-model
health plans (e.g., Kaiser and Sentara) are utilizing sophisticated information
management systems that will enhance the quality of patient care. Adoption in Virginia's
nursing facilities, like their counterparts around the country, are just now beginning to
seriously undertake efforts to implement information technology resources beyond those
associated with basic financial management. Information provided by responses from
VHCA members representing nearly 50% of all Virginia nursing facility beds indicates
significant IT implementation activities in a number of clinical areas including care
planning, MDS assessment and submission, dietary management, quality assurance and
11
therapy management. Less than 15% of Virginia nursing facilities are actively using,
implementing or testing EHR resources and applications. Safety net providers or
Federally Qualified Community Health Center organizations in Virginia (who serve the
uninsured and underserved populations throughout the state in eighty-eight (88) urban
and rural sites) coordinated their information technology efforts to establish a statewide
network and operate a practice management system purchased from one vendor.
Barriers to the overall state adoption rate were seen most clearly in the office of the
physician, particularly the small office. This suggested a need for greater support for
practices, particularly smaller ones, in this quest if the benefits expected from EHRs are
to be realized. Given that physicians in small practices account for 88 percent of all
outpatient visits and four-fifths of physicians work in small practices, this group
represents a sizable adoption gap.
In brief, some of the work needed to implement electronic health information adoption in
Virginia was found to be underway. However, each effort was independent and
proceeding at its own pace. There was found to be limited progress made toward ensuring
the interoperability of any systems across sectors and regions.
Based on its findings of disparate quality and innovation from system to system and
region to region and provider to provide and the gap of interoperability across all sectors
and regions, the Task Force offered five recommendations:
Recommendation # 1: Establish an ongoing statewide electronic health care
group or council to construct financial models and a probability index to
determine best practice projects to be funded or supported by the Commonwealth.
Recommendation # 2: In the state's role as a purchaser, work closely with the
Departments of Human Resource Management and Medical Assistance Services
to establish incentives for EHR adoption
Recommendation # 3: Appropriate state monies to facilitate increased eHealth
initiatives.
Recommendation #4: Identify and support the implementation of a master
patient index, (MPI) system that facilitates the secure and accurate linkage of
patient medical information that resides in different systems for patients and
authorized users.
Recommendation #5: Provide a separate and coordinate alliance to concentrate
on the health information workforce requirements.
Task Force members were unanimous in their view that states serve a valuable role as
laboratories for national solutions and that the Commonwealth could achieve the vision
of pervasive, real time, electronic health records through a journey of several years which
will require significant degrees of collaboration across providers, health plans and public
12
sectors. The strategy behind these recommendations is to connect all providers in the
Commonwealth. The report was submitted to Governor Warner on November 1, 2005.
Granting Process
A request for information (RFI) was issued on August 21, 2006, announcing the
Governor's Health Information Technology Council intention to seek Statements of
Interest (SOI) from private entities and public-private partnerships qualified and
experienced with electronic health records (EHR) implementation. Project proposals were
judged on their ability to:
1. drive adoption of ambulatory health records in the Commonwealth;
2. improve interoperability of medical records; and
3. leverage the Commonwealth's role as a large purchaser of healthcare to lower
costs.
The RFI was an outgrowth of Governor Kaine's Executive Order 29 of July 20, 2006,
which formed the Council for Health Information Technology and implemented the
General Assembly's budget language to create a mechanism for distributing the $1.3
million in funding designated for "encouraging the adoption of electronic health records
throughout the Commonwealth."
The Office of Health Information Technology received 61 proposals for evaluation by the
Governor's Health IT Council. These proposals were submitted by a geographically
diverse group of partners representing a broad spectrum of information technology
applications. Proposals can be grouped by project outcome into three broad categories
based on the RFI criteria they were focused on. These include those proposals that
extend electronic health record adoption, those that seek to improve quality and reduce
costs and those that seek to exchange information and improve interoperability. Fifty-
seven percent of the proposals dealt with the issue of data exchange and the mechanisms
needed to improve interoperability. Thirty percent of the proposals were mechanisms to
extend electronic health record adoption and thirteen percent of the proposals represented
IT solutions to improve quality and reduce costs.
After an initial understanding of all proposals, the Governor's Health IT Council adopted
a gated review process to be used in determining the applicants' merit for grant funding.
The first review was conducted to ascertain the strength and potential of the proposal's
business case and of the partnership's potential ability to deliver upon its vision. The
second review was conducted to judge the potential of the proposal to involve and assist
the physician community in providing quality, cost-effective healthcare to the citizens of
the Commonwealth. The third review was conducted to ascertain the ability of the
proposal to protect the privacy and security of personal health information. The final
review was conducted to prioritize the proposals based upon the recommendations of the
previous reviews. A detailed explanation of the review process can be found in the
subsequent sections of this report.
13
Section I Business Case Subcommittee
The Health IT Council received an impressive number of responses considering the short
time that applicants had to respond. To get this number down to a manageable size for
the Business Case Subcommittee to review, the Chairman asked staff to take a first pass
in reviewing the proposals. This first pass looked to identify proposals that were purely
for studies, did not contain a provider partner, or for some other reason were not
actionable. After this initial pass thirty-four proposals remained.
At the request of the Business Case Subcommittee Chair, the Council's Executive
Advisor also provided a letter rank of A, B, or C to the remaining proposals to help triage
the work of the Council. This letter ranking was based on the Executive Advisor's vast
experience and knowledge based with electronic health records as well as what he
considered to be good proposals for the Commonwealth.
After reviewing the Executive Advisor's grades, the Business Case Subcommittee graded
the 15 proposals that were ranked as an A. Each member of the Subcommittee was give
two to three proposals to review. In order to grade the proposals, the Business Case
Subcommittee developed an evaluation mechanism based on the following four criteria
areas:
· Financing and Readiness - 30% of total score
· Impact - 30% of total score
· Technology and Scalability - 30% of total score
· Geography and Stakeholder Diversity - 10% of total score
The following table shows the evaluation method used by the Business Case
Subcommittee to determine the ranking of the various proposals. The evaluation
mechanism was quite detailed so that the Subcommittee would be looking at the
proposals from a variety of angles. The Business Case Subcommittee developed the
evaluation mechanism through internal review and suggestions/modifications from the
Health IT Council.
14
Evaluation of Grant Applications
Business Case Subcommittee
Applicant:
Reviewed by:
Instructions: Please use this form to evaluate and score each application assigned to
you, each of which was ranked as an A by Greg Walton, executive advisor to the
council. You are encouraged to use this form to score the applications that were
ranked as a B and C by Mr. Walton. If you choose not to use this form to evaluate
those applications, please use your own criteria at your discretion. For each item
identified below, circle the number to the right that best fits your judgment of its
quality. Please return your submissions to David Merritt, subcommittee chair, by
October 25, to dmerritt@gingrichgroup.com.
Exc
Po
Financing and Readiness (30% of total score) elle
or
nt
Funding will start, maintain, or complete the proposal (1 for
1 2 3 4 5
new project; 5 for completion of project)
Financial sustainability of the proposal 1 2 3 4 5
Financial viability of applicant and partners 1 2 3 4 5
State of readiness of the applicant and partners 1 2 3 4 5
Applicant influence over partners and process 1 2 3 4 5
Financial commitment of partnering organizations 1 2 3 4 5
Add the numbers above for
section total
Impact (30% of total score)
Proposal would bring value to the participating citizens 1 2 3 4 5
Proposal would bring value to the region 1 2 3 4 5
Proposal would bring value to the Commonwealth of
1 2 3 4 5
Virginia
Supports the Governor's health care priorities by (please add
1 2 3 4 5
the number of yes answers to get question total):
Reducing nursing/healthcare staffing shortages Yes (1) No (0)
15
Evaluation of Grant Applications
Business Case Subcommittee
Expanding access to care (Medicaid, SCHIP, the
Yes (1) No (0)
uninsured)
Improving long-term care, home care, and/or care for
Yes (1) No (0)
the aging
Improving patient safety Yes (1) No (0)
Promoting wellness and prevention Yes (1) No (0)
Supports federal health IT initiatives as outlined by HHS 1 2 3 4 5
Promotes the continuity of care rather than episodic care 1 2 3 4 5
Add the numbers above for
section total
Technology and Scalability (30% of total score)
Viability of the technology 1 2 3 4 5
Scalability of the technology, both internally and externally 1 2 3 4 5
Experience in the field (i.e., is this an untested technology?) 1 2 3 4 5
Ease-of-use, training and need for continuing education for
1 2 3 4 5
users
Increases the adoption of health IT 1 2 3 4 5
Promotes interoperability 1 2 3 4 5
Add the numbers above for
section total
Geography and Stakeholder Diversity
(10% of total score)
Depth of partnerships among health care stakeholders 1 2 3 4 5
Geographic environment for actual proposal
Rural Yes (1) No (0)
Urban Yes (1) No (0)
Technology can be deployed in both rural and urban 1 2 3 4 5
environments
Add the numbers above for
section total
Overall
Total
16
Top scores were given to the following five proposals:
· MedVirginia with a score of 91;
· Community Care Network of Virginia with a score of 89;
· Valley Health with a score of 81;
· Care Spark with a score of 81; and
· Inova Health-Erickson Retirement Communities with a score of 80;
Once the Business Case Subcommittee completed its evaluations, the Physician and
Privacy Subcommittees reviewed the proposals that ranked above 80 on the 100-point
scale developed by the Business Case subcommittee. This resulted in a total of five
proposals being reviewed.
The Council members serving on the Business Case Subcommittee are as follows:
Chair: David Merritt
Members: Bob Johnson; Barbara Baldwin; Gil Minor; The Honorable Sam Nixon; Don
Detmer, M.D.; Richard Shinn; Balan Nair
Staff: Heidi Dix and Aryana Khalid
17
Section II Physician Subcommittee
The Request for Information process, outlined earlier in this document, sought
Statements of Interest around the themes of increasing physician adoption of Electronic
Health Records, software interoperability and leveraging the role of the Commonwealth
to lower cost and raise quality using information technology. Each of these themes
impacts the practice of medicine. The need to have strong ongoing communications with
approximately 33 thousand physicians licensed to practice in Virginia is an ongoing
critical success factor for all projects.
This subcommittee gathered input about electronic Health Record issues and
opportunities around the Commonwealth as well as guided the ongoing efforts to
communicate with physicians active in pilot projects, physician associations and other
groups of physicians around the state. Meetings were held with the Medical Society of
Virginia as well as the Virginia Hospital and Healthcare Association to determine ranking
of RFIs from associations.
Following the ranking by the Business Committee of numerical scores for grants meeting
the criteria of the RFI, the Physician Subcommittee took the top scorers (grade of 80 and
above) and ranked those applicants based on three criteria: Implementation: Ease of
Adoption (40% of total score); Interoperability: (40% of total score); and Smaller
Practice Subsidies (20% of total score). Top scores were given to MedVirginia,
Community Care and Valley Health.
The Council members serving on the Physician Communication Subcommittee are as
follows:
Chair: Larry Wilson, M.D.
Members: Keith Newby, M.D.; Delegate John O'Bannon, M.D., 73rd District of
Virginia; Julie Christopher, Commissioner of Aging; Ronald DeCesare, Jr., chief
executive officer of Professional Healthcare Resources; Patrick Finnerty, Director of
Medical Assistant Services; Mary Habel, Health Benefits program, Department of
Human Resources; Gopinath Jadhav, M.D.; James Reinhard, MD. Commissioner Mental
Health, Mental Retardation, and Substance Abuse Department
Staff: Betty Jolly, Policy Education Director, Department of Health Professions
18
Evaluation of Grant Applications
Physician Communication Subcommittee
Applicant:
Reviewed by:
Instructions: Please use this form to evaluate and score each application assigned a merit
number of 80 or above by the Business Case Subcommittee. You are also encouraged to use
this form to score any applications that you wish to evaluate. This subcommittee is bound by
two basic questions: (1) what proposals can earn physician loyalty, coming closest to being
designed with physician intent to treat patients effectively and maximize their use of time ( in
addition to being designed to support the business of the medical practice and proposals,
which is the ranking provided by the Business Case Subcommittee); and, (2) what proposals
hold the best potential for a "federated model" that could be shared or co-oped by authorized
access and according to formalized business agreements, probably to include peer-to-peer
requests. If you choose not to use this form to evaluate applications, please use your own
criteria at your discretion or you may choose to give an overall total score for each of the three
divisions rather than discrete questions provided. For each item identified below, put a check
in the characterization to the right that best fits your judgment of its quality. Please return
your submissions to Larry Wilson, M.D., subcommittee chair, by November 15 to
ltw@hmgkpt.com or Betty Jolly, staff, betty.jolly@dhp.virginia.gov who will compile and
forward.
Implementation: Ease of Adoption
Low Medium High
(40% of total score)
Proposal functionalities in achieving secure electronic
communication with patients
Proposal functionalities in achieving computerized physician order
entry
Proposal functionalities in achieving electronic viewing of patients'
test results
Proposal functionalities in achieving e-prescribing
Proposal functionalities in achieving electronic eligibility
verification and claims submission;
Overall appeal to physicians in order to capture their utilization,
loyalty and reliance on it as a vehicle for improved patient care
Ability to service and train
Add the numbers above for section
19
Evaluation of Grant Applications
Physician Communication Subcommittee
total
Interoperability: (40% of total score)
Cross-enterprise document exchange has commonalities present to
transfer clinical practice from site to site
Cross-domain patient identification management
Technical support planning: methods for contacting, hours of
operation, requests for enhancements and customizations
Ability to targeting the smaller practice (one to 15 providers)
Ability to target the medium-sized providers (10-99 providers)
Ability to target the large practices (greater than 100 providers)
Systems conforms to an industry-wide framework for implementing
standards
Promotes optimal patient care.
Add the numbers above for section
total
Smaller Practice Subsidies (20% of total score)
Potential to include small practices in large electronic networks; for
example proposal has potential to share both technology overhead
and human resources, and might choose a centralized database or
shared utility approach to house data and make it available to
smaller providers as well as large providers.
Add the numbers above for section
total
Overall Total
20
Section III Privacy Subcommittee
As Virginia automates patient records it is the intent of the Commonwealth to fully
protect the privacy of patient health information. First, this means compliance with all
Federal and Virginia laws. Secondly, defining proactive measures to continually raise the
public confidence and trust in the Commonwealth's actions insuring patient privacy.
The Privacy and Security Subcommittee conducted a proposal review with a keen focus
on the protection of the patient. In addition, the Subcommittee issued general principles
on this subject to act as guidance for the public's review of health IT options. Below is a
listing of these principles.
After the Business Case Committee scored the proposals for the quality of the business
case, the Privacy and Security Committee reviewed the top scorers (grade of 80 and
above) on whether these proposals complied with privacy protection principles. In most
cases, the information provided in the proposals was not sufficient for a detailed
evaluation, so the Committee decided to vote "yes" or "no" based on the general
information in the proposals. MedVirginia, CareSpark and Inova and Erickson proposals
were ranked as yes, Community Health Centers ranked as no and the members were
undecided concerning Valley Health.
General privacy principles for Virginia Health IT
Principle I: Openness and Transparency
There should be a general policy of openness with respect to personal data. Individuals
should be able to know what information exists about them, the purpose of its use, who
can access and use it, and where it resides.
Principle II: Purpose Specification and Minimization
The purposes for which personal data are collected should be specified at the time of
collection, and the subsequent use should be limited to those purposes, related purposes,
or ones that have been specified at the time of change of purpose.
Principle III: Collection Limitation
Personal health information should only be collected for specified purposes, should be
obtained by lawful and fair means, and where possible, with the knowledge and consent
of the individual.
Principle IV: Individual Participation and Control
Individuals should control access to their personal information. Individuals should have
the right to:
· Have personal data relating to them communicated within a reasonable time (at an
affordable charge, if any), and in a form that is readily understandable
· Be given reasons if a request is denied and to be able to challenge such a denial
· Challenge data relating to them and have it rectified, completed, or amended
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Principle V: Data Integrity and Quality
All personal data collected should be relevant to the purposes for which they are to be
used and should be accurate, complete and current.
Principle VI: Security Safeguards and Controls
Reasonable security safeguards against such risks as loss or unauthorized access,
destruction, use, modification, or disclosure should protect person
Principle VII: Accountability and Oversight
Entities in control of personal health data must be held accountable for implementing
these information practices.
The Council members serving on the Privacy Subcommittee are as follows:
Chair: Anna Slomovic
Members: Golden Bethune, Nancy Davenport-Ennis, The Honorable Janet Howell,
Michele Vilaret
Staff: Kim Barnes, Policy Analyst, Virginia Department of Health
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Review Criteria
Evaluation questions: Principle I
1. What information will be made available to individuals about the program in
this grant?
Evaluation questions: Principle II
1. Does this grant use information originally collected for another purpose? If so,
how is the purpose of original collection related to the purpose for which data
will be used under this grant?
2. If new information is collected during the grant, what mechanism is in place
to ensure that the terms on which the information is collected during the grant
are integrated into future uses and disclosures of the data?
3. Will personal information be shared? If so, with which organization(s) and for
what purpose(s)?
4. Does the grant involve data analysis to identify previously unknown patterns,
individuals or concerns? (Sometimes this is referred to as data mining) If so,
what are the purposes of these analyses?
5. Are policies and procedures in place to review requests for alternative data
use?
6. Are proper processes in place for data deidentification?
Evaluation questions: Principle III
1. What notice is provided to the individual before the information is collected,
used or disclosed?
2. Do individuals have the right to consent to or refuse to participate?
3. Do individuals have a right to designate what particular types of information
they want shared? For example, can HIV test results be withheld from being
shared?
4. What are the sources of personal information? (Individual, EHR system,
automatically collected by servers, pulled from some existing data store, etc.)
5. Why is each type of information necessary?
6. How were data integrity, privacy and security analyzed as part of the
technology selection process? What design choices were made to enhance
privacy?
Evaluation questions: Principle IV
1. What are the procedures that allow individuals to gain access to their own
information used under this grant?
2. What are the procedures for correcting inaccurate or erroneous information?
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Section IV Ranking Subcommittee
The Ranking Subcommittee met immediately following the November 17th meeting of
the full Council to determine their process. The subcommittee acted on the premise that
their role was to provide a structure to balance the work of the previous three
subcommittees and not to re-do their work by considering business case, physician, or
privacy concerns again. The subcommittee also decided to rank only projects that had
been graded by all three of the other subcommittees and therefore only ranked the 5
projects that had scored above an 80 on the business case ranking.
The subcommittee decided to assign both numerical scores and percentage weights to the
work of the previous committees. First the business case scores were converted into 1st
through 5th place with point totals starting at 25 for 1st place and descending in 5 point
increments to 5 pts for 5th. Because of a tie for 3rd place each project was awarded 12.5
pts. The Privacy subcommittees work was then awarded 5 pts for approval and 0 pts for
no approval. The Physician subcommittees work was translated into 5 pts for a "Low"
score, 10 pts for a "Medium" score, and 15 pts for a "High" score. Finally, business case
was weighted at 70% and Physician and Privacy at 15% each. The following table
resulted:
Business Privacy Physician Ranking
Project
(70%) (15%) (15%) Score
MedVirginia 25 5 15 20.5
Community Care Network 20 0 15 16.25
Valley Health 12.5 0 15 11
CareSpark 12.5 5 5 10.25
Erickson 5 5 10 5.75
The subcommittee then forwarded this chart as its recommendation to the entire Council
for its review during the December meeting.
The Council members serving on the Privacy Subcommittee are as follows:
Chair: Chas Roades
Members: Joe Roach, The Honorable Aneesh Chopra, The Honorable Marilyn
Tavenner, Megan Philpotts Padden, Jim Burns, M.D.
Staff: Thomas Gates, Assistant Secretary of Technology
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Recommendations
Alteration of Ranking Weights
At its December 1, 2006 meeting, the Full Council met to review the work of the Ranking
Committee and make proposals. Some members objected to the ranking committee's
choice of point totals. They believed that the awarding of only 5 points for a proposal
that met the Privacy Subcommittee's standards while giving 15 points to a proposal that
scored a "high" from the Physician committee undervalued the impact privacy should
have on the Council's recommendation. By consensus the Council changed the point
total from 5 to 15 for a project approved by the Privacy Subcommittee. The change
reordered the chart approved by the Ranking Subcommittee by switching CareSpark and
Valley Health. And the following order was adopted:
Business Privacy Physician Ranking
Project
(70%) (15%) (15%) Score
MedVirginia 25 15 15 22
Community Care Network 20 0 15 16.25
CareSpark 12.5 15 5 11.75
Valley Health 12.5 0 15 11
Erickson 5 15 10 7.25
Total Cost for Ranked Projects
Ranking Cost
Project
Score
MedVirginia 22 $248,000
Community Care Network 16.25 $335,000
CareSpark 11.75 $390,000
Valley Health 11 $300,000
Erickson 7.25 $274,500
Total - $1,547,500
Recommendation for Funding
The Council decided to only allocate the FY07 funding totally $500,000. Because the
total cost of the ranked projects exceeds the funds available by a large margin a
discussion took place on the merits of partial funding. The Council wanted to avoid
spreading money around so much that projects would be compromised. However, a
consensus emerged that partial funding was a good alternative if the grantees still
believed they could produce value with less money. The Council, therefore,
recommended that the Department of Health and the Co-Chairs negotiate with the top
three ranked projects to see if their projects could be fit within the $500,000 available.
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Next Steps
The Council plans to meet in early 2007 to discuss lessons learned from the first round
process and make plans for distributing the second year monies. They will likely allow
applicants for the first round to update their proposals but not allow new applicants to
enter the pool.
Outcomes
First Round Grants Awarded
On February 28, 2007 Governor Kaine announced that MedVirginia, the Community
Care Network of Virginia, and CareSpark all agreed to accept $250,000* and that some
FY08 funds had been moved forward to this fiscal year to accomplish the third award.
*
MedVirginia will receive only $248,000 their total request.
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