HEAL NY -- Phase 5 HEALTH INFORMATION TECHNOLOGY GRANTS ADVANCING INTEROPERABILITY AND COMMUNITY-WIDE EHR ADOPTION RGA No. 0708160258 Governor Nelson A. Rockefeller Empire State Plaza Conference Room 6 Albany, New York September 28, 2007 1:00 p.m APPEARANCES: Lori Evans Marybeth Hefner Robert Veino Laurie Fazioli Joseph LeDuc Keegan Bailey Tracy Raleigh Larry Volk James Figge Ivan Gotham Michael Flynn. 2 1 MS. EVANS: How is everyone 2 doing? Good. Well, welcome. It's a little 3 bit after 1, so I thought we would let the 4 games begin. And before we start, I wanted 5 to thank this amazing group of people to my 6 left that have supported this process. And I 7 think we're all still amazed that we got 8 everything out last Friday. And it was the 9 last day of summer, and we said we would get 10 it out by the summer so we used every last 11 possible minute we could, but thank you all 12 so much for all of your help. And maybe 13 we'll just go down and do introductions real 14 quick. Marybeth. 15 MS. HEFNER: My name is Marybeth 16 Hefner, and I'm the Director of the Bureau of 17 Accounts Management in the Health Department 18 which is responsible for the contracting 19 process in the Department. 20 MR. VEINO: I'm Bob Veino, DOH 21 counsel's office. 22 MS. FAZIOLI: I'm Laurie Fazioli 23 with HEAL New York. 24 MR. LEDUC: Joe LeDuc, HEAL New 25 York. 3 1 MR. BAILEY: Keegan Bailey, 2 Office of Health Information Technology 3 Transformation. 4 MR. VOLK: Larry Volk from the 5 Dormitory Authority. 6 MS. RALEIGH: Tracy Raleigh with 7 the Dormitory Authority. 8 MR. FIGGE: Jim Figge with the 9 Office of Health Insurance Programs. 10 MR. GOTHAM: Ivan Gotham, 11 Information Systems and Health Statistics 12 Group. 13 MS. FLYNN: Michael Flynn, the 14 Immunization Program. 15 MS. EVANS: All right, thank you 16 all, and again thank you so much for your 17 help. It has been a real team effort to get 18 us to where we are today, and we've been 19 looking forward to this day especially. And 20 our agenda is as follows. I'm going to go 21 over some quick ground rules, and that 22 because Marybeth told me that I had to. And 23 that I'm going to do a quick overview of the 24 RGA and then hand it over to Laurie and Joe, 25 and they're going to talk about the 4 1 application process and the award process. 2 And then they are going to hand it over to 3 Keegan, and he's going to talk about the 4 allowable costs, and then we'll get into 5 questions and answers. And, hopefully, we'll 6 just be about an hour between all of us, 7 maybe a little bit longer, but we wanted to 8 leave as much time as we could to address 9 your questions. 10 So before we really start, here are 11 the ground rules, and the first one 12 essentially says that anything we say today 13 here really doesn't matter. No, not really, 14 but that the -- it's sort of an unofficial 15 proceeding, and the official responses appear 16 in writing on the website, and we will be 17 prepared to publish that full document by 18 October 26. 19 Private questions cannot be answered, 20 so make sure you ask yours in a group setting 21 here today, and then you'll also be able to 22 submit e-mail questions up until October 12. 23 So if you don't ask a question here, you'll 24 still have another couple of weeks to submit 25 it. And we'll try to answer the questions as 5 1 they come in and post them, but at the latest 2 we will have them all up by October 26. 3 And a transcript of this conference 4 will be published, and an attendee list will 5 also be published. Did I cover everything? 6 Yeah, okay, great. 7 All right, so turning to -- turning 8 to the overview, I know there were a lot of 9 acronyms and analogies in the set of 10 documents, and I promise not to introduce any 11 more at least for a few more weeks. And I 12 also told the team up here that I wouldn't 13 say that shine -- you shine your CHITA during 14 the day or say that CHITAs aren't eligible to 15 apply for SHIN-NYs. We've had quite a fun 16 time about teasing ourselves about the 17 acronyms. 18 But we are here today to really help 19 lay this out at a high level and again answer 20 your questions. And I think, you know, the 21 overarching goal of HEAL New York Phase 5, 22 and this Health Information Technology Grant 23 Application, is to really start to lay a 24 foundation. We want Health IT to support 25 improvements in health care quality and 6 1 affordability and outcomes for New Yorkers 2 through vastly improved availability and uses 3 of health information. And in order to do 4 this we need to evolve and develop an 5 organizational and a clinical and a technical 6 infrastructure, and a lot of the concepts in 7 the grant are about those set of activities 8 and how we're trying to combine them to 9 develop New York's health information 10 infrastructure. 11 And so I'll say a little more about 12 the goals in a minute and go over the 13 investment framework -- that's section 2 of 14 the document -- say a little bit about the 15 collaboration process and then a little bit 16 about evaluation. 17 So the next slide, as I was saying, 18 is really about again supporting improvements 19 in health care quality, affordability and 20 outcomes for New Yorkers, really starting to 21 build the infrastructure and capacity we need 22 and really setting three foundations related 23 to organizational infrastructure, clinical 24 adoption and technology infrastructure, and 25 really combining those and addressing them 7 1 together so that we can realize value along 2 the way. We can realize the benefit of 3 vastly improving the availability and the 4 uses of health information, so it's a key 5 concept in terms of those three foundations, 6 and a lot of the discussion around RHIOs and 7 then introducing the Community Health 8 Information Technology Adoption 9 collaborations really emphasize the 10 importance of each of those activities, and 11 again how we combine them and evolve them 12 together through these grant projects. 13 And the other concept that was 14 introduced -- if you go back up -- is this 15 notion of cross-sectional interoperability. 16 And when I get to the technical framework, 17 and as you saw in the RGA it was figure 1, 18 being able to take a cross-section of the 19 Statewide Health Information Network for New 20 York that's focused on health information 21 exchange capabilities, a clinical informatic 22 service component that's focused on 23 aggregating and analyzing data for quality 24 purposes and for population health purposes, 25 and then the actual information tool or the 8 1 electronic health record for the clinician 2 are personal health tools for consumers and 3 how we really take a cross-section of those 4 and advance them in a coordinated fashion. 5 And taking that cross-sectional approach is 6 important because it helps us start to get 7 benefit right from the start for clinicians. 8 It helps us focus on community-based 9 adoption, which is what we need to do, to 10 have benefits internal to a group of doctors, 11 especially when they implement electronic 12 health records, due to some of the network 13 externalities or some of the market 14 imperfections that exist when it comes to 15 Health IT. And then also being able to 16 integrate, I think, the demand side coming 17 from the clinicians and the supply side which 18 gets to the evolving health information 19 exchange capacity through the infrastructure 20 we're developing, again so we can start to 21 realize value right from the start. 22 So those are some of the -- a little 23 bit of the thinking into these concepts that 24 I think are really, really, important, again 25 combining organizational, clinical and 9 1 technical and then driving cross-sectional 2 interoperability. 3 So moving to the next slide, the next 4 one, this figure is in the document. It 5 really just illustrates what I just described 6 in terms of the Statewide Health Information 7 Network for New York. And again this is 8 where we are driving the health information 9 exchange or the interoperable health 10 information exchange capacity, that next 11 layer of clinical informatic services and 12 then above that where we have electronic 13 health records for clinicians, personal 14 health tools for consumers and other 15 community portals for public health purposes. 16 And, again, emphasizing here the 17 organizational piece of interoperability and 18 the people component, again getting back to 19 that organizational foundation that's so 20 critical. 21 The next slide. All right, so 22 getting to sort of the overall framework. 23 And, you know, initially sort of the first 24 dimension was that technical framework, those 25 three high level building blocks on the slide 10 1 that we just showed you before. And the 2 second part was being able to take -- to 3 focus on clinical investment priorities, and 4 each of these clinical investment priorities 5 has a corresponding use case, and in essence 6 we want these to be goal. We want you to 7 demonstrate these as the goals of your 8 project. And they're listed here, and each 9 of the gray categories has an assigned set of 10 use cases, and we'll go through that in a 11 little while, but some of the key points 12 here, as they're very high level clinical and 13 business requirements in the use cases, 14 they're meant to serve as a guide for you to 15 respond to how you will demonstrate them 16 based on the project that you will be 17 choosing. And as part of the project award 18 you'll really have a chance, as a grantee, to 19 hone these use cases, to iterate them, to 20 work on them and really refine them quite a 21 bit. So again they're meant to be as a guide 22 here. They're meant to serve as a real 23 clinical foundation and a clinical goal for 24 your projects, but again there will be plenty 25 of time as an awardee to really hone them and 11 1 get them to a state where they can turn into 2 technical requirements and then feed into an 3 architectural design. But we had a great 4 time thinking about these. We had teams of 5 people working on each of them. And again 6 when we get to the grant categories, which is 7 the next slide -- I'll say a little bit more 8 about them. 9 So we have this technical framework. 10 We have the clinical investment priorities in 11 the corresponding use cases. And given that, 12 we have three categories of grant 13 applications. And category 1 is the 14 Statewide Health Information Network for New 15 York, which we have been affectionately 16 referring to as SHIN-NY. And this is where 17 we want to develop the organizational and 18 technical capacity to achieve 19 interoperability, to achieve health 20 information exchange. And the RHIO 21 applicants -- and I'll talk about -- I'll go 22 through the eligible applicants in a few 23 minutes, but RHIOs are the only applicants 24 that are eligible to apply for the Statewide 25 Health Information Network for New York. You 12 1 have to demonstrate two out of the following 2 four use cases, so either connecting New 3 Yorkers and clinicians, health information 4 exchange for public health, interoperable 5 electronic records for Medicaid, or quality 6 reporting for outcomes. So again 7 demonstrating two out of the four as part of 8 your application. And we really want -- you 9 know, we introduced this term, and it is a 10 new term, the Statewide Health Information 11 Network for New York, but I want to emphasize 12 that there are -- its regional 13 implementations, its regional health 14 information exchange projects, and trying to 15 drive common health information exchange 16 capabilities in this same way across the 17 regions. So we're not all of a sudden 18 jumping to say this is about inter RHIO 19 interoperability. It's not about that. It's 20 about technical capacity in your region but 21 coming together and, through the statewide 22 collaboration process, trying to drive common 23 health information exchange approaches 24 together. Because at the end of the day we 25 want to avoid having an extra layer of 13 1 technology to have to connect all of the 2 regions. We want to try and avoid that as 3 much as possible. So the focus really is on 4 what you need to do in your region -- the 5 technical capacity for health information 6 exchange, the organizational capacity, but 7 trying to infuse, through the collaboration 8 process, some common approaches related to 9 the concepts introduced in Section 7.2, which 10 is the technical discussion document where we 11 have this common health information exchange 12 protocol, and each of the four health 13 exchange services can communicate with other 14 services that they need to fulfill this 15 function through this protocol. And again 16 that's going to help us drive a common 17 nervous system across the State at a regional 18 level. So I really wanted to emphasize that 19 point in terms of focusing on the regional 20 capacity and what you need to do in your 21 region to make health information exchange a 22 reality, but again layering on this statewide 23 collaboration process to help drive common 24 approaches. Hopefully that's clear. 25 We'll have up to eight awards, and 14 1 "up to" is an important emphasis. And 55 2 percent of the available funds, or 58.16 3 million, are available in this category, are 4 expected to be awarded in this category. And 5 Laurie and Joe and Keegan will say a little 6 bit more about that during their 7 presentation. So that's category 1. 8 Category 2 is Pilot Implementations 9 of Clinical Informatic Services. And as we 10 stated in the RGA, these are community-based 11 quality and population health tools which 12 aggregate, analyze measure and report data to 13 support quality reporting, to support 14 population health reporting, to support new 15 options of payment and to facilitate quality 16 interventions. So the RHIOs and the CHITAs 17 can apply for grants in this category. 18 In the grant application, you have to 19 discuss how you will demonstrate one out of 20 the following two use cases -- the quality 21 reporting for outcomes use case, and also the 22 clinical decision support and the health 23 information exchange environment use case. 24 We have attached a few documents related to 25 the quality reporting use case. It's really 15 1 based on the Office of the National 2 Coordinator's quality use case that they've 3 published, in addition to New York State's 4 priorities with respect to quality measures. 5 And then we've asked that applicants that are 6 interested in demonstrating the clinical 7 decision support use case, submit that as 8 part of their application, and that will be 9 considered in the evaluation process. 10 There will be a minimum of two awards 11 in this category and a maximum of four. And 12 45 percent of the total funds available, or 13 47.58 million, is expected to be available 14 for not only this category but the electronic 15 health record category as well. So we're 16 really going to combine category 2 and 3, 17 follow our award process that Laurie will 18 explain, and really use the scores to award 19 these categories together. And, again, 20 Laurie will go through that a little bit more 21 during her presentation. 22 And then category 3 is community-wide 23 interoperable electronic health record 24 adoption. And this is about ambulatory care, 25 clinician office-based electronic health 16 1 record adoption in a defined care 2 coordination zone, which you define as the 3 applicant that includes clinically affiliated 4 providers to drive results delivery into the 5 electronic health record and to help advance 6 effective use in adoption. So again 7 ambulatory care clinicians with clinically 8 affiliated providers, again to support 9 results delivery into the electronic health 10 record to advance adoption. 11 The RHIOs and the CHITAs can both 12 apply for this category, and through your 13 grant application you are required to 14 demonstrate one out of the following three 15 use cases -- immunization reporting with 16 electronic health records, quality reporting 17 for prevention and interoperable health 18 records for Medicaid. I think some of the 19 key concepts in this category are really 20 important in that the care coordination zone 21 needs to have sufficient scale so that the 22 group of doctors or the community of 23 clinicians that are adopting electronic 24 health records will be big enough to realize 25 the benefit internal to that group. We're 17 1 trying to help compensate for some of the 2 market imperfections when it comes to Health 3 IT from an economic perspective. Think of 4 the fax machine problem, right? To have real 5 value using a fax machine, you need lots of 6 people using it. So the scale of a care 7 coordination zone is important to help drive 8 benefits internal to that group of clinicians 9 in the care coordination zone, and 10 interoperability and the requirements around 11 working on the results delivery, again so 12 results from the providers get interfaced 13 into the electronic health record, that's -- 14 you know, emphasizing the importance of those 15 clinically affiliated providers is really 16 important and then for that results 17 capability to be able to interface to the 18 Statewide Health Information Network for New 19 York. So we're really setting a foundation 20 to drive interoperable electronic health 21 records. So those are really important 22 concepts, purposeful concepts in those 23 categories. And again the emphasis on the 24 small -- the solo and small practices is 25 critical, and those small and solo practices 18 1 that have contracts with and serve Medicaid 2 beneficiaries and also serve long-term care 3 providers are also an important emphasis 4 that's in the grant application. 5 So in this category we have up to 6 eight awards, emphasizing the "up to." And 7 again 45 percent of the total available 8 funds, or 47.58 million, is expected to be 9 available for this category and the clinical 10 informatic services, so again we'll be 11 awarding them based on score. 12 Okay, the next slide is the state 13 collaboration process. It's in Section 4. 14 It describes the statewide collaboration 15 process that the New York e-Health 16 Collaborative will be facilitating. This is 17 a really important role to bring together all 18 project awardees, to collaborate with each 19 other and with us to drive and advance the 20 implementation of the grant awards. And I 21 mentioned the importance of the collaboration 22 process when I talked about the Statewide 23 Health Information Network for New York 24 category, in being able to convene projects 25 and again help drive common technical 19 1 approaches and standards in a coordinated 2 fashion, getting back to the point where we 3 want to try and avoid that extra layer of 4 interoperability that we would need to 5 connect the regions across the State. We 6 don't want siloed regions, so it's going to 7 be a balance of, again, focusing on the 8 regional needs and the success that we want 9 in the regions, but collaborating with 10 partners across the State to drive technical 11 approaches. And the statewide collaboration 12 process will also be an important vehicle for 13 the other projects as well, because if you 14 get -- if you think back to figure 1 and that 15 image and how the layers build on each other, 16 at the end of the day they're all 17 interconnected, so we want to have the 18 convening process support the connection 19 points between the projects. And obviously, 20 depending upon the use cases you pick, that 21 will really inform with whom you need to 22 collaborate to, again, advance 23 interoperability. And once projects are 24 awarded then there will be some early 25 deliverables around thinking about that 20 1 collaboration process. So if you're a CHITA 2 and you're doing an electronic record 3 project, when we kick off the collaboration 4 process when the grants are awarded, there 5 will be early deliverables about discussing, 6 well, with which RHIO would you like to work, 7 to talk about things that you'll need to talk 8 about during your project. So again that 9 will be an early deliverable and a part of 10 the collaboration process that we facilitate 11 through the New York e-Health Collaborative. 12 And then just two more points where 13 applicants are required to allocate five 14 percent of their project funds to support the 15 collaboration process, and the source of 16 funds can either be reimbursable funds from 17 the grant or matching funds. And you 18 certainly are welcome to ask questions about 19 that when we're at the question and answer 20 period. 21 And then also when you read Section 4 22 and you're really thinking about the approach 23 to your project, plan and think about how the 24 collaboration process will impact your work, 25 and it will be important to think about that 21 1 as you put together your project application 2 and your project plans. 3 Oh, right, eligible applicants. We 4 have two. The first is the RHIO, the 5 Regional Health Information Organization, and 6 it's outlined in Section 3.1. And then we 7 have the CHITAs, or the Community Health 8 Information Technology Adoption 9 collaboration, and they are described in 10 Section 3.2. 11 The RHIOs have discussion around the 12 definition of a RHIO which gets to the lead 13 applicant and the not-for-profit status, 14 multi-state or participation. Mission to 15 improve health care quality efficiency, 16 etcetera, through advancement of 17 Interoperable Health Information Technology. 18 The stakeholder section, there was a 19 list of, I think, 12 stakeholder types. 20 We're requiring you to have at least six of 21 them included as part of your RHIO. We want 22 to see a matrix or a table that lists your 23 stakeholders today, and it includes specifics 24 about their name and other items that we 25 included in the application, but also your 22 1 future plans and the new stakeholders that 2 you'll be bringing in as part of this matrix 3 to make it very clear who is participating 4 now, who the new stakeholders are, so it's 5 very easy for us to see how you are thinking 6 about growing the RHIO and covering the 7 stakeholders that are listed in the RGA. 8 We also included a section on service 9 area, to do a summary -- to really just try 10 to describe the service area, and hopefully 11 that's really straight forward. The scope of 12 services for the RHIO are important and will 13 be evaluated as to how you first describe 14 what types of services you provide today and 15 then again your plans to enhance those 16 services as part of your grant application. 17 And these services are, in essence, what a 18 RHIO is and why RHIOs need to exist. They're 19 of and for the providers and the doctors, 20 right? And that's -- you know that's really 21 their purpose in life, to enable the kinds of 22 collaboration and other activities we need to 23 advance interoperable health information 24 technology to improve quality and reduce 25 health care costs. So those services are 23 1 related to all of the things that I think a 2 lot of you are doing related to privacy and 3 security and governance, and having good 4 governance processes, having a lot of 5 clinical discussions, keeping clinical 6 priorities at the forefront, addressing the 7 business model complexity of all this. So 8 those services are really important. Again, 9 I think we ask for a matrix, talking about 10 which services you provide today and then 11 what services you will be providing as part 12 of your two-year grant project. And then I 13 think there are a few other criteria listed 14 there. One is that if you're A RHIO applying 15 for an electronic health record project in 16 category 3, you also have to satisfy the 17 Health IT adoption and support services that 18 are specified in Section 3.2 under the CHITA 19 section. 20 So moving to the CHITAs quickly. In 21 contrast, CHITAs are community 22 collaborations. They don't have to be a 23 separate not-for-profit organization. They 24 are meant to comprise clinicians and 25 clinically affiliated providers, again in the 24 1 spirit of care coordination and emphasizing 2 care coordination and the scale that we need 3 to have in place to adopt electronic health 4 records in the best way that we can, again to 5 realize value, and to have that value result 6 in patient care improvements. 7 So the participants are listed in 8 Section 3.2. One of those participants -- 9 there is a list of participants, and then 10 there is, I think, a subset that lists those 11 that can be the lead applicant. And the lead 12 applicant has to enter into the contract with 13 New York, and those can be physician groups, 14 and community health center consortiums, and 15 hospitals, and long-term care providers, 16 rural health networks. I think I covered 17 them all, but if you have questions about who 18 can lead just ask during the Q and A. 19 And then I think I talked about the 20 care coordination zones -- try to say that 21 fast three times -- and how important that is 22 again to emphasize the value that we want to 23 result from electronic health record 24 adoption, getting to the information and how 25 that benefits patient care, and really 25 1 needing the right providers and the scale of 2 those providers to realize the benefit. And 3 that, in essence, is why we define that care 4 coordination zone. And again you have to 5 define that as part of your grant 6 application. And we really didn't put any 7 requirements on the size or the type other 8 than saying you have to follow the 9 requirements about who can participate in 10 one; that's defined in Section 3.2. 11 And then the Health IT adoption and 12 support services are very important also as a 13 key component of advancing electronic health 14 record adoption related to the "soup to nuts 15 services," as we say, that clinicians need in 16 their quest to implement electronic health 17 records and again realize patient care 18 improvement. It's everything from readiness 19 assessments to work flow, to project 20 management, to supporting product selection, 21 all the way to ongoing process and quality 22 improvement services, again a really 23 important part of the electronic health 24 record adoption equation and why the CHITAs 25 are so important. 26 1 Okay, so evaluation quickly. There 2 is a project evaluation, and that is in 3 Section 5.1.4. And then there is how we will 4 review and score and evaluate the grants to 5 make awards, and that is in Section 5.2. So 6 I'll go to the project evaluation first. And 7 essentially this is saying that a project 8 evaluation, the HEAL New York Phase 5 Program 9 will be evaluated, all of the projects, by a 10 third-party evaluation team; that's to be 11 determined. And applications must be 12 allocate five percent of their project funds 13 to support the project evaluation. The 14 source of funds can either be reimbursable 15 grant funds or matching funds, and that 16 anticipate planning for participation in the 17 evaluation as part of your application. So 18 again to be determined, but a very, very 19 important part of this, and we will want you 20 to be prepared to participate in that as we 21 kick it off as part of the start of the grant 22 projects. 23 So the grant -- turning to how we 24 will review and score the grants and make the 25 awards, and I'm just going to say a little 27 1 bit about this. There are two parts. There 2 is a technical application, and there is a 3 financial application, and Laurie will talk 4 about the critical parts of that. I just 5 wanted to emphasize that as part of the 6 technical application there are the following 7 parts. The organizational plan, the 8 technical plan, the clinical plan, leadership 9 and personnel qualifications and project 10 management. I think the financial plan 11 actually doesn't go there. There's a 12 business model discussion that should be 13 included in the organizational plan, and that 14 is indicated in Section 5.2 where it talks 15 about the organizational plan. So that's an 16 extra bullet there. So not only is this the 17 format with which your application should be 18 in -- and Laurie will talk about this -- but 19 these are the sections, these are the parts 20 that you will be evaluated on as we score and 21 then award your grant projects, very 22 important. And again we listed the criteria 23 in Section 5.2. 24 And then with the financial 25 application there is the project budget, a 28 1 discussion of cost effectiveness, 2 sustainability, project sustainability, and 3 applicant sustainability, and Laurie will go 4 through and mention the format and some of 5 the components to that. But again the 6 technical and the components of the technical 7 application and the financial application, 8 two pieces. I think you guys really know 9 that from the rounds that we've been through. 10 So I'm going to stop there and hand 11 it over to Laurie to go through the 12 application process. 13 MS. FAZIOLI: Okay, I'm going to 14 go through the application process. I work 15 in the HEAL office and wanted to bring to 16 your attention some basic points to have you 17 avoid -- sorry, I'm short -- having your 18 application eliminated from further review. 19 We find with every RGA deadline we're going 20 through and doing the initial screening 21 process and some basic information will be 22 missing, and after all the work you've put 23 into these applications, you can have your 24 application disqualified. I'll also be 25 referencing some sections of the RGA that I 29 1 think are helpful in making sure you have 2 completed and packaged your applications 3 properly. 4 I'd like to begin with one of the 5 most important points that the deadline is 6 November 19 by 3 p.m. at the Hedley Building 7 in Troy. Please do not send your 8 applications to the Albany office. And if 9 you're going to hand deliver your 10 applications, make sure you have enough 11 travel time to reach the Troy office because 12 no applications will be accepted after 3 p.m. 13 Section 6.5, "How to File an 14 Application," this guides you through the 15 appropriate number of copies, signatures. A 16 common mistake is there are two original 17 applications required, both need to be 18 signed. Many times we'll see the first 19 original application signed and the second 20 original application is not signed, and these 21 are really simple things that can lead to 22 your application being disqualified. Please 23 include two copies, either two CDs or two USB 24 drives, and please quality assure those 25 copies. Many times we'll get CDs and they're 30 1 blank. So these are real basic things, but 2 if you just take these steps -- you put so 3 much work into these. If you take these 4 steps before the final submission, it will 5 save your application from being 6 disqualified. 7 One last point, no cost figures in 8 your technical application. 9 Section 9 includes all of the forms 10 and checklists. This is a very important 11 section, again, in packaging your 12 applications to us. Please use the checklist 13 provided. This will ensure complete 14 submissions. If you go through every point 15 there, you will have everything you need in 16 your package to make sure there is no 17 disqualification. Make sure you identify 18 your lead applicant, identify the category 19 you're applying for, the region. Please note 20 that the RHIOs and the CHITAs have separate 21 sections for forms, and also in the financial 22 section there is a different cover page for a 23 RHIO or a CHITA, so just make sure as you're 24 going through your packages you are using the 25 correct forms. 31 1 Again, I want to stress, incomplete 2 submissions may be eliminated from further 3 review. 4 Another important section is your 5 minimum requirements, which is Section 7.4. 6 This describes the initial screening process 7 for completeness. Again, your sections, 8 forms, format, copies, this is where we'll 9 also do an initial review for eligible 10 applicant, that your stakeholder requirements 11 have been met. We'll review for match 12 requirements being met, and also that your 13 project is not in conflict with Commission 14 mandates. Again, this document, 7.4, is very 15 important, because again any missing critical 16 elements may result in the elimination of 17 applications. I hate to see all the work go 18 into these and have them eliminated for a 19 basic reason. 20 Just to touch on a few points for the 21 award process. Section 5.3 describes the 22 award process. Separate applications must be 23 submitted for each grant category. You 24 cannot apply more than once per category. If 25 you apply for multiple categories, the 32 1 applicant needs to describe the 2 interrelationship between the projects. If 3 an applicant is applying for multiple 4 categories, the total requested funding 5 cannot exceed 15 million. I know I'm going 6 fast, so questions and answers, feel free. 7 And again this was stated previously, 8 but we expect to make awards in three grant 9 categories; our Statewide Health Information 10 Network for New York, or our SHIN-NYs; 11 Clinical Informatic Services, our CIS; and 12 Electronic Health Records, EHRs. 13 Section 5.3.6 is a very important 14 section. It details 55 percent of the total 15 available funds, or 58 million, is expected 16 to be available for the SHIN-NY category in 17 step one of the award process. The remaining 18 45 percent of the total available funds, or 19 47 million, is expected to be available for 20 the CIS and EHR categories in step 2 of the 21 award process. Applications meeting a 22 minimum score will be -- and awards made 23 using the 4-step award process which is 24 detailed in Section 5.3.6. It goes into 25 every step of the award process in that 33 1 section; 5.3.6 is very important to review. 2 It lists your regional allocations and how we 3 will proceed through the four steps of the 4 award process. 5 Joe LeDuc of our HEAL staff is going 6 to take you through the rest of the awards 7 and reporting and contract processing. And 8 thank you, and feel free to ask questions at 9 the end. 10 MR. LEDUC: The first category 11 of awards is going to be in the SHIN-NY 12 category. We're expecting an award up to 13 eight awards. It's going to use the 14 Commission mandates, the Commission on Health 15 Care Facility in the 21 century regions, and 16 so awards based on a single-commission region 17 is expected to be the lesser of the regional 18 allocation, or up to 10 million, and this is 19 again in Section 5.3 in further detail. 20 For co-applying RHIOs, serving more 21 than one commissioned region, the maximum 22 award amount is expected to be the sum of the 23 regional allocations but not to exceed 15 24 million. 25 The second category is the CIS, and 34 1 we're expecting a minimum of two awards and 2 up to a maximum of four. The maximum award 3 amount is expected to be 5 million or the 4 lesser of the regional allocation. 5 And the third category is the 6 Electronic Health Records, the EHRs, and 7 we're expecting to make up to eight awards in 8 this category. The maximum award is expected 9 to be 8 million dollars, or the lesser of the 10 regional allocation, and again this is in 11 Section 5.3.6. 12 Section 6.6 describes the New York 13 State Reserve Rights, and too I wanted to 14 point out related to the award process. We 15 reserve the right to reject any or all 16 applications, and to adjust or correct costs 17 for errors of concurrence of the applicant if 18 errors exists. And there are more rights 19 reserved in Section 6.6, so you should review 20 those, that section further. 21 Contracts are expected to start in 22 the first quarter of 2008, and they're going 23 to be for an initial term of two years. 24 We're going to have the option to renew the 25 contracts for up to two one-year periods to 35 1 ensure completion of the projects with no 2 additional funding, so you'll have extra time 3 to finish. Any renewal must be approved by 4 the State Attorney General and the Office of 5 the State Comptroller. 6 During the two-year period, you're 7 going to be required to submit quarterly 8 vouchers to the Department of Health based 9 upon eligible expenses actually incurred by 10 the grantee, and you're also going to be 11 required to submit quarterly reports on the 12 project itself. And written questions based 13 on anything in the RGA will be accepted 14 through October 12 at the e-mail address here 15 and in the RGA. 16 And now Keegan is going to talk about 17 allowable costs. 18 MR. BAILEY: I just have a few 19 slides on allowable costs. And so primarily 20 to start off, up to 75 percent of the 21 application -- the application's total 22 project costs will be covered by HEAL NY 23 Phase 5 or, in other words, reimbursable. In 24 addition, it is required that at least 25 25 percent of the application's total project 36 1 costs be matching funds, and also all 2 applications that include the 10 percent cash 3 as part of, or in addition to, the 25 percent 4 match will be evaluated more favorably than 5 applications that do not include the 10 6 percent match. 7 It's important to refer to sections 8 934 through 936 for information in how the 9 applicant should allocate funds in the 10 budget. These documents can be found in 11 Section 93, Financial Form for RHIOs and 12 CHITAs. 934, HEAL New York, Phase 5, Health 13 IT Allowable Costs provides a definition of 14 capital, explaining the difference between 15 non-capitalizable expense capitalizable 16 expense and provides guidance in how the 17 applicant should allocate the expenses. And 18 so total capitalizable expenses must not 19 exceed 40 percent of total reimbursable 20 expenses. And also there is the 21 responsibility of applicant to allocate at 22 least 60 percent of all reimbursable expenses 23 as capitalizable. 24 In addition, applicant project 25 expenses have been broken down into four 37 1 phases that are listed here on the slide. 2 Just for the purposes of qualifying what is 3 matching and what is reimbursable, and those 4 phases are planning, implementation, 5 post-implementation and evaluation 6 collaboration. And I'll go through really 7 quickly what those are. Again, this is in 8 Section 934. So under "planning" we have 9 expenses related to developing organizational 10 strategy, developing technical strategy which 11 includes your five-minute use cases, 12 technical requirements, and architectural 13 requirements, and developing clinical 14 strategy. Under "implementation", expenses 15 related to personal services, executive 16 director, project director, other staff, 17 software licenses, hardware and installation, 18 implementation integration services, testing, 19 quality assurance training, Health IT and 20 adoption support services, administration 21 pools and real-estate services. And for 22 post-implementation it's basically the same 23 list with hardware and software maintenance 24 included. And then for evaluation and 25 collaboration we have evaluation and then 38 1 participation in the statewide collaboration 2 process. And there is a grade in this 3 attachment that kind of explains this, just 4 to kind of lay this out for you a little more 5 clearly. 6 And then finally for the purposes of 7 the RGA, matching funds can be used for 8 planning implementation or 9 post-implementation phases and reimbursable 10 funds for all expenses listed under 11 implementation, post-implementation and 12 evaluation collaboration phases, and that's 13 subject to limits in 935. 14 I'm going to turn it back over to 15 Lori to lead into the Q and A section. 16 MS. EVANS: All right, well, 17 thank you, Laurie, and Joe and Keegan. When 18 we started I failed to introduce Steve Smith 19 over here. He's the director of operations 20 in my office, which is the Office of Health 21 Information Technology Transformation. So 22 sorry, Steve, we forgot to introduce you. 23 All right, so who wants to go first? 24 MR. HATCH: I'm representing a 25 group of 12 community-based chemical 39 1 dependency providers in Rochester, and one of 2 the standards -- we'll be looking at the EHR 3 section. One of the standards says that the 4 software that's being used has to be CCHIT 5 certified. Now, my understanding is that 6 right now CCHIT certification is only 7 available for ambulatory physical health 8 care, and that the CCHIT standards for 9 behavioral health are nearing completion and 10 may be adopted as early as late October or 11 November. And clearly nothing is going to be 12 certified until some period of time after 13 that. Can you help sort out what we can do? 14 MS. EVANS: Yes. Good question. 15 I think what makes the most sense is to do 16 what we did I think in the -- or what the 17 Department did in the first round of HEAL, 18 which is say that when certification is 19 available then the applicant has six months 20 after that time to submit it for 21 certification to become certified. So that 22 would depend on -- once it becomes available, 23 you have six months to apply, and there will 24 be some dependencies with when they 25 facilitate that time, but that's what we can 40 1 do for that. 2 Can you repeat your name please for 3 our transcriptionist? 4 MR. HATCH: Sure. Carl Hatch, 5 H-A-T-C-H. 6 MS. EVANS: Okay. How does that 7 sound? 8 MR. HATCH: That's terrific. 9 MS. EVANS: Great. And, sorry, 10 please say your name and where you're from 11 before your question and also wait for a 12 microphone. 13 MR. CAPPONI: Hi, I'm Lou 14 Capponi, New York City Health and Hospice 15 Corporation. I have several questions. The 16 first one is regarding Section 3.2, the lead 17 applicant, you point out hospitals. What 18 about public benefit corporations that are 19 overseeing hospitals, would those be included 20 under that umbrella, or could a public 21 benefit corporation apply on behalf of 22 hospitals? 23 MS. EVANS: One sec. Okay, we 24 will talk about that after the meeting and 25 get back to you with the answer via the 41 1 website. 2 MR. CAPPONI: My second question 3 is regarding the participants, Section 3.2, 4 talked about small practices, and in 5 parenthesis there is 1 to 5. Is that meant 6 to define small practices 1 to 5 providers? 7 MS. EVANS: It is. 8 MR. CAPPONI: Okay, and in that 9 same section regarding the small practices 10 you say hospital-based practice ambulatory 11 care is not included. What about practices 12 that are in the community but under a 13 hospital's license? 14 MS. EVANS: Wouldn't that be the 15 same? 16 MR. CAPPONI: Not physically in 17 the hospital. 18 MS. EVANS: If they're still 19 under the hospital's corporate umbrella, then 20 you can't use grant funds for those. 21 MR. CAPPONI: Okay, those are 22 considered hospital? 23 And then the third question is on 24 page 9 and slide 5 of this presentation, the 25 diagram has some lines going through it. I'm 42 1 just wondering if it was deliberate to have 2 the lines go through the left part of the 3 diagram for any particular emphasis or -- 4 MS. EVANS: No. 5 MR. CAPPONI: Just Power Point? 6 MS. EVANS: Yeah, just trying to 7 emphasize the cross-section and the 8 importance of advancing each in the building 9 blocks together. 10 MR. CAPPONI: Thank you very 11 much. 12 MS. EVANS: You're welcome. 13 MR. HEIMAN: Jim Heiman from 14 LIPIX RHIO. I have a couple questions about 15 the stakeholder requirements, Section 16 3.1.2.1. In a couple of instances for 17 stakeholders the word "end" is used. So, for 18 example, in Part H it says data suppliers 19 including pharmacies and webs and music 20 centers. Are you implying that all three 21 must be included as a stakeholder? 22 MS. EVANS: No. It could be 23 four. It depends on your needs, the scope of 24 your project, what's happening in your 25 community, but it could be more. 43 1 MS. HIGGINS: Kelly Higgins from 2 the Center of Excellence in Buffalo. Can a 3 state university medical school be considered 4 the lead applicant for a CHITA since it's a 5 legally constituted network function with 6 other community providers advancing Health 7 IT? 8 MS. EVANS: One sec. Can you 9 repeat the question? 10 MS. HIGGINS: Can a state 11 university medical school be considered the 12 lead applicant for a CHITA, since it's a 13 legally constituted network functioning with 14 other community providers advancing Health 15 IT? 16 MS. EVANS: Are you delivering 17 the health care services? Are you delivering 18 care? No? 19 MR. VEINO: It doesn't appear to 20 be in one of the categories. It's a legal 21 entity. You can have a contract, but it 22 doesn't appear to be among the legal 23 categories. 24 MS. EVANS: Okay. I think the 25 answer is no. Marybeth? A tentative no. 44 1 We'll look into it, but probably not. 2 MS. SWAIN: Hi. Elizabeth Swain 3 from the Community Health Center Association. 4 I have a couple of questions. I'd just read 5 them. In the category of community-wide HR 6 limitation, Section 2.3.3, the RGA says that 7 the majority of grant funds are required to 8 be spent on, quote, ambulatory physician 9 office space, EHR implementation and solo 10 small physician practices, including those 11 that serve Medicaid beneficiaries. Is this 12 definition inclusive of the community health 13 centers? 14 MS. EVANS: Yes. 15 MS. SWAIN: The second question, 16 referring to the lead applicant list for 17 CHITAs, quote, legally constituted network or 18 consortium of community health centers, end 19 quote, and diagnostic and treatment centers, 20 does this mean that a D and TC that is also 21 an FQAC must be part of a network in order to 22 serve as a lead applicant but a regular D and 23 TC can serve as a lead applicant on its own? 24 MS. EVANS: Both can serve as 25 lead applicants on their own. 45 1 MS. SWAIN: Okay, thanks. 2 MS. EVANS: Yup. 3 MR. McHUGH: Patrick McHugh 4 representing Columbia University, health 5 sciences. This might be a redundant question 6 but perhaps I could get a little more 7 guidance on it, so specifically a faculty 8 practice organization at a medical school 9 cannot serve as the lead agency? Is that 10 what I'm hearing, or shall I wait for 11 consideration? 12 MS. EVANS: We'll post a 13 response. 14 MR. McHUGH: Thank you. 15 MR. TURNER: Benny Turner with 16 Bronx RHIO, four quick questions. Just for 17 clarification on the grant funding and the 18 matching funds, if an applicant is in 19 category 1 and has a strong application that 20 takes it to the maximum limit on the grant 21 funding, does that mean it would be a 10.33 22 million dollar total project cost with 10 23 million dollars in grant funding coming from 24 the State and 333,000 in matching funds? Is 25 that the maximum award? In other words, the 46 1 total project costs, to realize a 10 million 2 dollar grant from the State, the total 3 project costs would be 10.33 million? 4 MS. EVANS: That's my 5 understanding. 6 MS. HEFNER: Yes, the 10 million 7 is the amount that would be reimbursed 8 under -- 9 MR. TURNER: For a total project 10 cost, 10.33. 11 The financial plan, there was some 12 question about where the financial plan fits 13 into the application. Is that in the 14 technical application or in the financial? 15 MS. EVANS: As part of the 16 organizational plan in the technical 17 application there are a few bullets about 18 business, a business model, so you should 19 address those bullets as part of the 20 organizational plan in the technical 21 application, but the financial application 22 includes the budget and the other elements 23 that are required as part of the financial 24 application. 25 MR. TURNER: But on page 26 in 47 1 the RGA, Section 5.2.6, there is a whole 2 section on the financial plan. 3 MS. EVANS: Right. 4 MR. TURNER: And so numerous 5 points that have to be addressed in the 6 financial plan. 7 MS. EVANS: Yes. 8 MS. RALEIGH: That is the 9 financial application. 10 MR. TURNER: That goes into the 11 financial application. 12 MS. EVANS: Yeah, right. There 13 is no financial plan. There is just the 14 financial application, and then it includes, 15 you know, those five areas as part of the 16 financial application. 17 MR. TURNER: Respond to all of 18 those points in the financial plan. 19 MS. EVANS: Yes. 20 MR. TURNER: Letters of 21 commitment, there is one called for in the 22 financial plan and one called for in the 23 technical plan. And the technical plan is 24 focused on governance, and of course in the 25 financial plan it's about financial 48 1 commitment from the stakeholders. Can those 2 be combined into one letter and then put the 3 same letter in both parts? 4 MS. EVANS: Yes. 5 MS. HEFNER: No. 6 MS. EVANS: No? 7 MS. HEFNER: I'm sorry. You 8 could, but you would have to redact the 9 component of that that discussed the dollars 10 that would be part of that relationship. 11 MR. TURNER: So really it should 12 be two letters. 13 MS. HEFNER: It should be two 14 letters, yes, but it could be one letter as 15 long as the dollars don't appear in the 16 technical side. So if you redacted that so 17 it was clear to the technical reviewers what 18 those costs were, then that would be fine. 19 MR. TURNER: In terms of getting 20 signatures on letters, I really have to have 21 two letters. 22 MS. HEFNER: Yes. 23 MS. EVANS: If you don't include 24 specific dollars amounts, then you can have 25 one letter. If you want to include specific 49 1 dollar amounts, then you have to have two 2 letters, because you can't have dollar 3 amounts in your technical applications. 4 MR. TURNER: But you do require 5 dollar amounts. 6 MS. HEFNER: Correct. 7 MR. TURNER: So that's two 8 letters signed separately. 9 MS. HEFNER: That's fine. 10 MR. TURNER: Regarding the 11 required service area analysis, will the 12 State be able to provide any data sources to 13 do that analysis? A lot of different things 14 in that analysis. 15 MS. EVANS: No. 16 MR. TURNER: Okay, thank you. 17 MS. KING: Barbara King, 18 Continuum Partners. I was wondering if a 19 project or applicant did not receive funding 20 in HEAL 1, does that impact at all whether or 21 not you could receive funding in HEAL 5? 22 MS. EVANS: No. 23 MS. KING: No, okay. 24 MS. FYFE: Dorothy Fyfe from 25 SUNY Downstate, Brooklyn. I have a quick 50 1 question. Matching funds, can TELP 2 (phonetic) outpatients be included as a 3 matching fund? 4 MS. HEFNER: Can what? 5 MS. RALEIGH: That's the 6 Dormitory Authority tax exempt leasing 7 program? 8 MS. FYFE: Yes. 9 MS. RALEIGH: If I understand, 10 that's a source of borrowing. 11 MS. FYFE: Right. 12 MS. RALEIGH: I would say yes. 13 MS. EVANS: Can you repeat the 14 question please? 15 MS. FYFE: Yes. In terms of 16 matching funds for the stakeholders, I was 17 inquiring whether TELP (phonetic) funded 18 equipment, capital equipment could be 19 included as a matching fund. 20 MS. RALEIGH: And that's 21 borrowing, so I would say yes. 22 MR. HEIMAN: Jim Heiman 23 from LAPIX RHIO. I have a question. As we 24 are -- we're kind of leading the way in most 25 of the software development from our software 51 1 vendor side, and as our software vendors 2 actually develop the technology that fits one 3 of these use cases and we're actually paying 4 for it, we actually own that software as the 5 RHIO, and you're saying that we can't turn 6 around and sell that build that we didn't 7 buy -- we didn't -- we actually gave it to -- 8 the software is developing that software for 9 us, so we technically own that particular 10 part of the software. Can we then in turn 11 sell that build to other people? 12 MS. EVANS: So you're asking if 13 LIPIX can sell software? 14 MR. HEIMAN: Specific aspects of 15 the software, not selling the whole software. 16 MS. EVANS: Well, you know, I 17 think that raises a lot of different 18 questions. One of the things that I talked 19 about in the RGA related to RHIOs is how 20 important they are as an organization that's 21 building trust and collaboration and dealing 22 with privacy issues and engaging New Yorkers 23 as consumers, dealing with some of the 24 business issues, and that in fact in our view 25 RHIOs enable the development and 52 1 implementation of Health IT because those 2 services are so important to realizing those 3 goals, but in fact RHIOs are not technology 4 organizations. They're not developing 5 software. They're not turning into sort of 6 physical proprietary health information 7 exchange networks because again we want to 8 drive -- try and drive common approaches 9 across the State in a nervous system type of 10 fashion. So based on what we've included as 11 this point, I would say no, you know, based 12 on that definition that's included in Section 13 3.1. I don't know if you're getting into 14 sort of intellectual property issues that are 15 very different -- 16 MR. HEIMAN: Yes. 17 MS. EVANS: -- than what I'm 18 saying. And I don't know if there's a 19 section in here related to intellectual 20 property. 21 MR. HEIMAN: Intellectual 22 property is pretty much what we're referring 23 to. 24 MS. EVANS: Okay, we'll talk 25 about it and provide a written response back, 53 1 and if you can sort of tease out, perhaps, 2 the question a little bit more, that would 3 be -- in an e-mail. 4 MR. VEINO: Yes, that would be 5 helpful. 6 MS. EVANS: That would be 7 helpful also. 8 MR. HEIMAN: But just one 9 question. You say 5 percent goes to NYeC and 10 you say matching funds or reimbursable funds. 11 Is that supposed to be end? 12 MS. EVANS: It's 5 percent of 13 the total, but you can reimbursable funds or 14 you can use grant funds to satisfy that 5 15 percent. 16 MR. HEIMAN: So it's 5 percent 17 of the total project costs. 18 MS. EVANS: Yup. 19 MR. HEIMAN: I just have one 20 last question. You say that after a CHITA 21 gets granted an award they're going to 22 actually come and pick the RHIO that you're 23 going to be working with. Is that for 24 integration into the RHIO? And if so who is 25 going to be paying for that after the fact if 54 1 it's not included in anybody's application? 2 MS. EVANS: Well, I think if you 3 should -- if you're a CHITA you should 4 include the scope of work in your 5 application, at least in terms of what it's 6 going to look like from a development point 7 of view. There will be instructions -- there 8 will be specifications between the Electronic 9 Health Record and the health information 10 exchange capability of their Statewide Health 11 Information Network for New York, so we want 12 you guys to be able to collaborate on those 13 components and to be able to sort of talk 14 about what makes the most sense after the 15 grants are awarded. So if you're applying as 16 a CHITA in that application, you should 17 contemplate that and consider that in your 18 proposal. And whether you want to end up 19 paying for it but actually ask the RHIO to do 20 it, or whether you want to do it in 21 partnership with the RHIO because you need 22 the specifications, it's up to you. You 23 should put what you want to do in the 24 application. 25 MR. AMRHEIN: I'm Scott Amrhein, 55 1 and I'm with the Continuing Care Leadership 2 Coalition, and this is also a question about 3 CHITA lead applicants. I see in the list of 4 long-term care organizations are listed as 5 potential lead applicants. Can consortia of 6 long term care organizations be lead 7 applicants, multiple organizations coming 8 together? 9 MS. EVANS: Yes. 10 MR. AMRHEIN: And could such a 11 consortia be organized, for example, as a 12 preexisting trade organization that 13 represents -- 14 MS. EVANS: No. 15 MR. AMRHEIN: Okay, so it would 16 have to be a newly formulated consortium of 17 long-term care organizations. 18 MS. EVANS: Well, you could have 19 one entity be the -- you know, one of the 20 consortium take the lead if you're not a 21 formal consortium, but it's sort of up to 22 you. I mean you'll still satisfy it if there 23 was one entering into the contract with New 24 York State on behalf of the group. 25 MR. AMRHEIN: Thank you. 56 1 MR. VEINO: Emphasize, it has to 2 be -- the key issue there, it has to be a 3 legally -- entity capable of entering into a 4 formal contract. 5 MS. DePERRIOR: Dawn DePerrior 6 from the Rochester RHIO today. A couple 7 questions. The first one is really easy, and 8 that is on page 24 of the RGA, 5.11. It says 9 that costs incurred after October can be used 10 for matching funds. Does that mean after 11 October 1 or after -- starting November 1? 12 MS. EVANS: October 1. 13 MS. DePERRIOR: October 1, okay, 14 thank you. 15 The second question is really related 16 to the slide that we're looking at now, and 17 the slide on page 23. And the question is 18 for -- 19 MS. EVANS: Sorry, what's on 20 page 23? 21 MS. DePERRIOR: Page 23 refers 22 to -- if an applicant applies for multiple 23 categories, the applicant should describe the 24 interrelationship between each category. So 25 if the Rochester RHIO is looking at use cases 57 1 that really cross-section each of these 2 different categories, and it's a project that 3 has a budget, and so we're thinking through 4 how we present that budget across three 5 separate category applications. 6 MS. EVANS: Well, I would focus 7 on the use case. If a use case is on one 8 category, you can address it in one category. 9 You don't have to address it across other 10 categories. 11 MS. DePERRIOR: Okay, so that 12 would be the preferred. 13 MS. EVANS: Right, that would be 14 the preferred. 15 MS. DePERRIOR: And this 16 description of the interrelationship between 17 the three applications should be probably an 18 executive summary of all three, I would 19 imagine. 20 MS. EVANS: Yes. 21 MS. DePERRIOR: Okay, thank you. 22 And then the next question is can a RHIO 23 supply corps services to another community's 24 CHITA as a service provider? So the 25 Rochester RHIO has a vendor which we are 58 1 using as an application service provider. We 2 do not own software or hardware. And if a 3 CHITA was interested in using the Rochester 4 RHIO services but not intellectual property 5 would that be allowable? 6 MS. EVANS: Yes. 7 MS. DePERRIOR: Okay, thank you. 8 That's all for now. Thank you. 9 MR. GILBERT: Hi, I'm Jeff 10 Gilbert from New York State Affiliates of 11 Planned Parenthood. I have two questions. 12 One relates to the regional structure of the 13 program. Does that preclude an application 14 from a statewide network of providers? 15 MS. EVANS: No, it doesn't. We 16 would just have to figure out -- you would 17 have to -- you would have to suggest how the 18 allocation would work across the regions 19 based on which clinics are where and tell us 20 as part of your application. 21 MR. GILBERT: Okay, and then the 22 second question is regarding the provider 23 makeup of the CHITA. Do you require some 24 sort of a provider mix? To be specific to 25 Planned Parenthood, what I'm thinking about, 59 1 does a network of diagnostic and treatment 2 centers operate on Planned Parenthood 3 Affiliates, can they in and of themselves 4 form a CHITA, or would we have to -- other 5 types of providers? 6 MS. EVANS: One second. Well, I 7 think for the -- depending upon your grant 8 category, what you're proposing, the clinical 9 affiliation of other providers that are 10 listed is important because you'll want to 11 drive the results into the record. So for 12 the purposes of successful EHR adoption and 13 those interfaces from the clinical affiliate 14 providers, that's really important to have as 15 part of it. 16 MR. VEINO: Also, there's also a 17 reference here. On page 21, CHITAs are 18 required to include ambulatory care 19 clinicians and solo and small physician 20 offices, including those that have contracts 21 with and serve Medicaid beneficiaries and 22 provide care in long-term care facilities. 23 MS. EVANS: So you would need to 24 include -- 25 MR. GILBERT: If a CHITA is an 60 1 applicant, then that mix has to be included 2 as the applicant as opposed to an applicant 3 that has associations with other types of 4 providers. 5 MS. EVANS: No. I mean your 6 applicant is going to be one entity, and you 7 need to include the others as part of the 8 project as part of the -- I mean one 9 organization enters into the contract with 10 New York as part of the CHITA. The others 11 are participants. So there is a difference 12 between -- I mean you can select from that 13 list which participants you want to be 14 included. 15 MR. VEINO: We assume that 16 CHITAS will not themselves be legally 17 constituted organizations that enter into a 18 contract themselves. They're made up more 19 loosely organized, so somebody has got to be 20 the lead contractor. 21 MS. SCAMURRA: Hi, I'm Sue 22 Scamurra, and I'm from Western New York RHIO, 23 and I've got some questions from a large 24 group of physicians that have been working 25 concurrently with the RHIO over, probably, 61 1 two years, so it's a lot of cross-over, and 2 they're written by e-mails, so I can't 3 explain them any further. But the questions 4 were, first, is there a preferred 5 organizational structure for a 6 private-practice-physician-driven CHITA? 7 MS. EVANS: No. 8 MS. SCAMURRA: Okay. Related to 9 that, would a CHITA -- could it be a 501C3 if 10 they were to formally organize a much larger 11 group of independents as a consortium similar 12 to the way we formulated a RHIO in Western 13 New York? 14 MS. HEFNER: I think that's 15 okay. 16 MS. EVANS: Yeah, it's fine. We 17 would have to make an adjustment to who can 18 be a lead applicant. 19 MS. SCAMURRA: Okay. 20 MS. EVANS: Are they already a 21 501 -- is it DASNY? 22 MS. SCAMURRA: Yeah. 23 MS. EVANS: Are they already a 24 501C3? 25 MS. SCAMURRA: No. We are 62 1 probably at an organizational stage now to 2 decide, in terms of business' state ability, 3 you know, there are a lot of options open to 4 us in Western New York, because we've had 5 physicians involved so long. So then the 6 third question would be, could the lead 7 applicant for a CHITA be the RHIO? 8 MS. EVANS: It depends on the -- 9 I mean RHIOs can be the lead applicants for 10 each of the categories. It depends on what 11 they're doing. 12 MS. SCAMURRA: So that would be 13 pretty much explained out and, say, that the 14 business model or the relationship -- 15 MS. EVANS: Well, if they're 16 applying for the Electronic Health Record 17 category, RHIOs are allowed to lead that in 18 addition to CHITAs. I'm not sure what you're 19 getting at, but -- 20 MS. SCAMURRA: Well, it's just, 21 you know, understanding, you know, the lead 22 concept in being able to explain that back to 23 them. 24 The last part is the idea of direct 25 accountability for groups of physicians that 63 1 come together as a CHITA. So the 2 accountability would then fall financially 3 and project wise on the lead applicant, so 4 the governance structure would have to be 5 built around that to ensure the 6 accountability across all the members. 7 MS. EVANS: Yeah, I think the 8 governance structure of a CHITA includes all 9 of the participants as a steering committee. 10 It has one RHIO leader, but it should include 11 the participants, but the lead -- you know, 12 the leader is entering into the contract but 13 I think the broad participation, through a 14 steering committee or any similar body, is 15 important. It's noted in the application. 16 MS. HEFNER: I think the RGA, it 17 lists entities that can be the lead on a 18 RHIO -- or on a CHITA, and a RHIO is not 19 listed. 20 MR. VEINO: Right. This is on 21 page 203.2.1.1. 22 MS. HEFNER: I mean we can 23 certainly look into it, but as it stands 24 right now it's not allowed. 25 MS. EVANS: Yeah, I think it's 64 1 sort of -- I would say it really gets back to 2 what the project is, because I think if you 3 go back and look at what project they want to 4 do, then it can be the RHIO or the CHITA 5 doing that, so I guess I would go back and 6 ask that question to the group. 7 MS. SCAMURRA: Like I said, I 8 just have an e-mail back and forth at this 9 point, but it's good to ask while I have the 10 audience. So what you're saying basically is 11 the accountability is developed within your 12 local governments or on the regional level. 13 There's no -- other than the State 14 accountability of a signed contract by a lead 15 organization, that subdivision of 16 accountability then falls within the 17 governance of that local organization, 18 whatever it is. 19 MS. HEFNER: Yeah. From our 20 perspective, the accountability is going to 21 be with the lead applicant because that's who 22 we have a contract with. 23 MS. SCAMURRA: Okay, that's it. 24 Thank you. 25 MS. SMITH: I have three 65 1 questions. One, could answers to questions 2 that are critical in making decisions who's 3 lead applicant and who can and cannot 4 partner, can those be answered sooner than 5 October 26? 6 MS. EVANS: Yes. 7 MS. SMITH: That would be, I 8 think, helpful for those of us who are 9 trying -- 10 MS. EVANS: Yes, we'll answer 11 them as quickly as we can, as they come in. 12 Nancy Smith. 13 MS. SMITH: The second 14 question -- 15 MS. EVANS: So, Nancy, which are 16 you coming in on -- 17 MS. SMITH: With Health -- of 18 New York. 19 MS. EVANS: No, I'm sorry, just 20 with your first question are you -- what 21 exactly -- are you referring just to the 22 questions that have been asked to date or do 23 you have -- 24 MS. SMITH: No. My point is 25 that in making -- in building the plans among 66 1 different organizations you need to know 2 early on some core questions about 3 eligibility, who can be a lead applicant; 4 otherwise, we're going to be really late in 5 just getting to the writing of the grant. 6 MS. EVANS: Do you have a 7 question about that right now or do you -- 8 MS. SMITH: No. It's a question 9 whether or not you can post the answers to 10 those questions as soon as possible versus 11 October 26. 12 MS. EVANS: Right, we can. I 13 was just going to see if I could answer it 14 now versus -- 15 MS. SMITH: I do have two 16 questions. Thank you, Laurie. Under 17 Category 3 is an eligible applicant a medical 18 society? 19 MS. EVANS: No. 20 MS. SMITH: Under category 1, 2 21 and 3, could an eligible applicant be an 22 organization that has a mission for 23 controlling costs, quality and safety, and is 24 doing like planning around RHIO activities -- 25 MS. EVANS: Yes. 67 1 MS. SMITH: -- but is in itself 2 not a RHIO? It has a broader mission. In 3 its mission is not the word "RHIO." 4 MS. EVANS: Well, the mission -- 5 if your mission statement is to advance 6 interoperable health information technology 7 to approve quality, if that's part of your 8 mission, you can apply. 9 MS. SMITH: But if -- it's not 10 in the mission statement. The mission 11 statement is to improve quality, control 12 costs and improve safety, but activities 13 include, but are not limited to, 14 interoperability. 15 MS. EVANS: Well, if you include 16 that, then it's part of your mission, so I 17 would say yes. 18 MS. SMITH: No, I'm saying it's 19 not in the mission. It becomes an activity 20 not in the mission statement -- the by-laws 21 of the organization. 22 MR. VEINO: It's something your 23 organization is doing legally? It's not 24 precluded from doing it? It's committed to 25 making that part of its operation? 68 1 MS. SMITH: Correct, but if the 2 IRS asked if we were a RHIO, we would say no. 3 MS. EVANS: I think if your 4 mission -- if it's part of -- if your answer 5 to Bob's question was yes, then I would say 6 that you should apply. 7 MS. SMITH: So we're not 8 precluded from doing activity. 9 MS. EVANS: Right. 10 MS. SWAIN: I'm Elizabeth Swain 11 again from CHCANYS. Based on the way a 12 couple of other questions were answered, I 13 wanted to ask that if the Community Health 14 Care Association of New York State, which is 15 a primary care association, is a legally 16 instituted network or a consortium of 17 community health centers, are we legally -- 18 are we legal lead applicant, the Primary Care 19 Association of Community Health Centers? 20 MR. VEINO: It's like a 21 preexisting organization or association made 22 up of these entities. 23 MS. SWAIN: Yeah. Our members 24 are community health centers, so we would not 25 be eligible to be an applicant. 69 1 MS. EVANS: You would not. 2 MS. SWAIN: But legally 3 constituted networks of community health 4 centers or legally constituted consortium. 5 By legally constituted you mean already 6 existing incorporated bodies -- 7 MR. VEINO: Capable of entering 8 into a contract. 9 MS. SWAIN: Right. 10 MR. VEINO: Legal entities. 11 MS. SWAIN: Right. 12 MR. VEINO: Established for the 13 purpose -- 14 MS. EVANS: It could be a 15 community health center. 16 MS. SWAIN: Right. 17 MS. EVANS: One community health 18 center could support a broader network if the 19 network isn't yet its own entity. 20 MS. SWAIN: Right. 21 MS. EVANS: I might want to go 22 back to Nancy's question. One second. Can 23 you wait one second? 24 So, Nancy, we just want you to -- can 25 you put that question in writing and have us 70 1 respond in a written format so everyone can 2 benefit? And we'll do that quickly. Okay, 3 thanks, that will be great. 4 MS. GALANIS: Christina Galanis, 5 Southern Tier Health. We've received a lot 6 of inquiries since it was released pretty 7 much around the same question I think I heard 8 other people ask. There's a possible 9 impression that anyone who is awarded a HEAL 10 1 contract is a RHIO, and we know that -- so 11 we looked at the definition of a RHIO and 12 tried to pick through that and figure it out. 13 It doesn't actually say that a RHIO is 14 currently engaged or will at some point in 15 some timeframe engage in actually creating a 16 data exchange. Was that your intent? 17 MS. EVANS: I'm not -- I'm not 18 understanding what you mean. Sorry. 19 MS. GALANIS: You can be formed 20 as a RHIO and not actually be down the path 21 of creating a data exchange, apparently. 22 MS. EVANS: So like a new -- so 23 you're saying that someone who's younger 24 that's -- that that's perfectly fine. If 25 those are your goals -- if your goals are to 71 1 advance, you know, interoperable health 2 information technology health information 3 exchange, that's great. If you're just 4 starting out, that's fine, if that's what 5 you're getting at. 6 MS. GALANIS: Right. In this 7 grant process you can form yourself legally 8 as a RHIO and then apply for grant funding to 9 actually do the technology. 10 MS. EVANS: Sure. 11 MS. GALANIS: That's helpful, 12 because we had that question asked a few more 13 times. Okay, thank you. 14 MS. EVANS: Yup. 15 MS. JOHNSON: Hi, I'm Natasha 16 Johnson from NYCLIX, and I have a question 17 about the use cases. For the quality use 18 case, if an organization wants to create a 19 quality report of clinical and other data, 20 does that report actually have to be 21 implemented, or can it just create a report 22 that can be used? 23 MS. EVANS: I'm not sure I 24 understand the difference. 25 MS. JOHNSON: With quality use 72 1 cases, what I'm trying to find out is if the 2 quality report has to be implemented within 3 that period. 4 MS. EVANS: We would like to 5 have demonstration of -- yes, yes. 6 MS. JOHNSON: Okay. 7 MS. O'CONNOR: Hi, I'm Heather 8 O'Connor. I'm with ARCHIE. Many of the 9 practices in our organization applied for the 10 MSSNY grant, and they're still waiting to 11 hear about that award. Does that preclude 12 them? Okay, and then what are the 13 implications if, by chance, they do get an 14 award? 15 MS. EVANS: No implications. 16 MS. O'CONNOR: So they can 17 withdraw from -- 18 MS. EVANS: Pardon? 19 MS. O'CONNOR: They can withdraw 20 their application from the HEAL 5? 21 MS. EVANS: Sorry, can you start 22 over? 23 MS. O'CONNOR: I'm just 24 wondering if, by chance, they received a 25 MSSNY award after submitting for a HEAL 5, 73 1 what would be the implications to the HEAL 5 2 application? 3 MS. EVANS: They're totally 4 separate. 5 MS. HEFNER: It wouldn't be the 6 same project under the 2, right? 7 MS. EVANS: Are you saying -- 8 MS. HEFNER: If it's the same 9 project we're not going to fund the same 10 thing twice. 11 MS. O'CONNOR: But the other 12 practices who might not have applied for 13 MSSNY who applied for HEAL 5, would that 14 jeopardize their chances with HEAL 5? 15 MS. EVANS: No. 16 MS. HEFNER: The evaluations are 17 separate from each other, but, you know, if 18 one occurs first in time, we won't duplicate 19 that same project and award it in the other. 20 We would not do that. 21 MS. O'CONNOR: Thank you. 22 MS. HAWKS: Hi, Christina Hawks, 23 Continuing Care Health Information Exchange. 24 Can a non-profit organization, which consist 25 of entities that could be considered a CHITA 74 1 also be considered a CHITA, the non-profit? 2 MS. EVANS: It gets back to 3 whether CHITAs can be not-for-profits. Is 4 that -- 5 MS. HAWKS: Yes. 6 MS. EVANS: If they satisfy the 7 requirements in the lead applicant and 8 participant section, then they could -- I 9 mean if they happen to be a not-for-profit 10 also. 11 MS. HAWKS: But if that 12 organization is not the type of entity that 13 participants in the CHITA are, it's not a 14 health care. 15 MS. EVANS: Can you give an 16 example? 17 MS. HAWKS: Just a 18 non-for-profit that supports collaboration 19 and exchange of information from 20 organizations. 21 MR. VEINO: But it's not among 22 the organizations listed there as a potential 23 lead applicant for CHITA; is that what you're 24 saying? 25 MS. HAWKS: Right. 75 1 MR. VEINO: Well, they have to 2 be one of those categories in order to be a 3 lead applicant for a CHITA. 4 MS. HAWKS: Okay, thank you. 5 MR. BROGAN: My name is Barry 6 Brogan. I'm with the North Care Behavioral 7 Healthcare Network, and I'm thrilled to see 8 that some other behavioral health care 9 providers are interested in linking up with 10 primary care amongst themselves. My question 11 is from page 24, Section 5141 -- I'm sorry, 12 5142, where it talks about the matching 13 funds, and specifically we, as a rural health 14 network, receive funds from New York State, 15 and we have for the last four years had 16 budget items to support the development of 17 IT. We would like to use that budget line to 18 support the matching funds part. Is there 19 any restriction based on this section that 20 would preclude us from using DOH funds as 21 part of our match? 22 MR. VEINO: Only the non-state 23 share of matching funds or services may be 24 counted towards the match requirement. 25 MS. HEFNER: We sort of consider 76 1 that to be also our share, so we would expect 2 that your share would come from other than 3 state grant sources. 4 MR. BROGAN: Okay. That's 5 disappointing for rural health networks. 6 MS. HEFNER: Sorry. 7 MR. BROGAN: It's primarily 8 running on a single grant that comes from the 9 New York State Department of Health -- 10 MS. HEFNER: You're talking 11 about the funds from the State that are grant 12 funds, not Medicaid reimbursement type funds 13 or anything like that? 14 MR. BROGAN: Correct. These are 15 contract -- these rural health networks -- 16 there are 35 of them across the State -- are 17 under contract with the State to provide 18 various coordination and program development 19 services. 20 MS. HEFNER: Right. We wouldn't 21 expect that those funds would count as a 22 match for the HEAL 5 program. 23 MR. BROGAN: Okay, leave it at 24 that. And then the other area I was 25 wondering with regards to the regions that 77 1 have been designated by the Berger Commission 2 report -- although, they see the North 3 Country as two regions, we don't. And I was 4 wondering if you could highlight any specific 5 issues that we're going to need to address 6 when we put forth a proposal that includes 7 three counties -- six counties, three from 8 two different territories. Are there any 9 specific issues that we need to address? 10 MS. EVANS: I think there is 11 just one which is the -- just make sure you 12 explain how you're allocating -- you know, 13 based on the regional allocations, how you're 14 summing those and what your rationale is, 15 because if you're covering more than one 16 region you'll pull funds from each region. 17 You'll just tell us how you've done that. 18 MS. HEFNER: There is a section 19 in the financial forms that asks you to do 20 just that, to take your costs and divide them 21 among the regions based on where the cost 22 will actually go. 23 MR. BROGAN: Thank you. 24 MS. STUARD: Susan Stuard, New 25 York Presbyterian. With regard to an 78 1 application in category 3, when the CHITA is 2 contemplating its sort of later integration 3 with a RHIO, just to sort of scope that out, 4 certainly some of that integration is corps 5 services, but you wouldn't necessarily have 6 to do all of the corps services to achieve 7 that level of integration. Is that sort 8 of -- 9 MS. EVANS: Yeah. 10 MS. STUARD: Great. So in terms 11 of scoping that out, just the ones necessary 12 to achieve the integration. 13 MS. EVANS: Right. 14 MS. UPADAHAY: Hi. I'm Asha 15 from the THINC RHIO. I just have a couple of 16 questions here. How many applications can a 17 RHIO apply as a partner? 18 MS. EVANS: As a partner. 19 MS. UPADAHAY: In any form, 20 which no limit? 21 MS. EVANS: No limit. 22 MS. UPADAHAY: Okay. And would 23 the State please clarify your expectations of 24 CHITA applicants in the region already served 25 by RHIOs, existing RHIOs. 79 1 MS. EVANS: Depending on the 2 goal the RHIO or the CHITA can apply. 3 MS. UPADAHAY: Any specific 4 expectations they have on CHITAs or -- 5 MS. EVANS: Well, I think that, 6 you know, CHITAs are about -- you know, 7 they're really the adoption champions. 8 They're about the clinician at the point of 9 care and really supporting that need. There 10 is a need to collaborate closely with the 11 RHIO when you get to the interoperability 12 components that are so important. Can they 13 exist in the same area? Of course. Do they 14 need to work harmoniously? Yes. Hopefully, 15 that helps a little bit? 16 MS. UPADAHAY: Yeah, it does. 17 And then just one more question. Would a 18 CHITA have to get documented letters of 19 support from a RHIO, or would a CHITA have to 20 define a plan of how to work with a RHIO? 21 MS. EVANS: We talked about -- 22 in certain parts of the application, we 23 talked about sort of describing the working 24 relationship, but we stopped short of 25 requiring letters of support between RHIOs 80 1 and CHITAs because we wanted that to be 2 addressed as part of the kick-off of the 3 projects, and then people would be convened, 4 and we would talk about what would make the 5 most sense based on what awards were made. 6 So there may be -- let me point to -- let me 7 just find the one section. So I think the 8 discussion about the collaboration is 9 important, and we sort of drew the line with 10 respect to letters of support because we 11 wanted that to be an already deliverable of 12 the grant award. Does that make sense? 13 MS. UPADAHAY: Thank you. 14 MS. DePERRIOR: Dawn DePerrior 15 again from the Rochester RHIO. Three 16 additional questions. The first for the 17 Rochester RHIO. How does the co-applicant 18 process work with two RHIOs? Can you confirm 19 one application or two? 20 MS. EVANS: One application, one 21 application and one of the RHIOs has to step 22 up and enter into the contract. Both RHIOs 23 can't enter into the contract if there are 24 two. One can, but we really feel like it's a 25 partnership, and it's really a co-activity, 81 1 but again somebody has to step up to enter 2 into the contract with the State. 3 MS. DePERRIOR: So then if two 4 RHIOs are working on similar projects it's 5 beneficial to apply as co-applicants with the 6 one grant application. 7 MS. EVANS: Yes. Sorry. 8 MS. DePERRIOR: The second 9 question is from page 27 of the RGA, Section 10 5.2.1.13D, and it states, "What is 11 envisioned -- oh, the question is, "What is 12 envisioned in a plan" -- and I quote -- "a 13 plan for providing incentives for 14 participation by New Yorkers and supporting 15 electronic communication with clinicians?" 16 MS. EVANS: I think we wanted to 17 start to get your ideas around how to engage 18 patients. 19 MS. DePERRIOR: We weren't sure. 20 You were looking for incentives for patients 21 and clinicians or just -- 22 MS. EVANS: This is under the 23 patient engagement section? 24 MS. DePERRIOR: Right. That's 25 what I thought, okay. 82 1 MS. EVANS: And I think 2 financial incentives for clinicians can be 3 discussed under the business model component 4 if you so choose. 5 MS. DePERRIOR: Okay, and then 6 the last question is would it be possible to 7 have additional sessions of the RGA provided 8 in Word format? Because a lot of the 9 checklists, we could save ourselves some time 10 if they were in Word format rather than the 11 PDAs. It just would be administratively a 12 little helpful to us. 13 MS. EVANS: PDF, you mean? 14 MS. DePERRIOR: Yeah. 15 MS. EVANS: Sure. 16 MS. DePERRIOR: PDF, yup. 17 MR. MURPHY: Ray Murphy, HIXNY. 18 With regard to the satisfaction of 19 qualifications for RHIO, the six categories, 20 do they need to be six separate members, or 21 can a single member qualify in multiple 22 categories if in fact they fit? 23 MS. EVANS: I don't know how 24 that would work. It has to be six different 25 types. 83 1 MR. MURPHY: Six. 2 MS. EVANS: Types. 3 MR. MURPHY: But does that mean 4 six different members? 5 MS. EVANS: Can you give me an 6 example? 7 MR. MURPHY: You have large 8 organizations that provide -- 9 MS. EVANS: Let's say hospitals. 10 If you have eight hospitals that's the 11 hospital type. 12 MR. MURPHY: Okay. 13 MS. EVANS: You need to go -- 14 you need to satisfy another type. 15 MR. MURPHY: Okay, a hospital 16 that has a lab in it doesn't satisfy the lab 17 documents essentially. 18 MS. EVANS: If that's the only 19 lab, I mean I would sort of go to -- that's 20 why we listed, I think, 12 or 13, and you 21 have six, because there's going to be some 22 differences. And if that's the only lab 23 around, you know, I would then go look to -- 24 you know, for the purposes of evaluation, you 25 know, going through that process, I would try 84 1 and cover the six types without having to do 2 the lab inside the hospital. Of course, it 3 depends on the region. If it's the only lab 4 and it's a more rural place, that's fine, but 5 you know, try and make sure you check off the 6 six. 7 MR. HATCH: Carl Hatch again 8 from Recovery Net. Excuse me. For a CHITA 9 could the lead agency be an Article 31 or 32? 10 MR. VEINO: No. Well, not 11 unless it also has an Article 28 license. 12 Some of them do, but, you know, diagnostic 13 and treatment center we define as being an 14 Article 28 licensed entity. 15 SPEAKER: Would you repeat the 16 last part? We didn't hear that. 17 MR. VEINO: The term in the 18 definition of lead applicants for CHITAs in 19 reference to a diagnostic and treatment 20 center, for us that is a term of art within 21 the Public Health Law, meaning an entity 22 licensed under Article 28 of the Public 23 Health Law. It can't be just licensed under 24 Article 31; though some entities are dual 25 licensed. 85 1 MS. GARCIA: Hi. My name is 2 Arlene Lozano Garcia from the Primary Care 3 Development Corporation. I had a question 4 about the contracting and DOH's option to 5 renew the contract without additional 6 funding, if necessary. Something like a 7 category 3 application from a CHITA where 8 part of the members don't have the EHR yet 9 and part of the project is to implement that 10 and that could cause delays, are you going to 11 look at, at the end of the two-year project, 12 if there were a particular circumstance that 13 would cause the project to last longer than 14 two years, or is it simply okay to put in a 15 really ambitious project in two years and 16 know that it's okay if it goes beyond that 17 time? 18 MS. HEFNER: I would certainly 19 not rely on getting any extensions to the 20 contract. We're putting it in there pretty 21 much as a fail-safe in case we need it, but 22 at this point we're hoping not to use it at 23 all. 24 MS. GARCIA: Okay, so at what 25 point, though, within the project if that 86 1 consideration needs to be taken? 2 MS. HEFNER: Do you mean at what 3 point would you begin to seek an extension? 4 MS. GARCIA: Yes. 5 MS. HEFNER: Well, as soon as 6 you know you'll need it, I suppose. 7 MR. HALL: John Hall from the 8 INSNC RHIO and Southern New York Association. 9 Expanding upon the stakeholders of a RHIO, 10 whatever function and stakeholders you have 11 as members of your RHIO apply towards the 12 two, or does it have to be additional six 13 stakeholders -- 14 MS. EVANS: No, no, it's six, 15 but what we did ask is for a real -- we 16 emphasized growth and inclusion and giving us 17 a table that says here are current members, 18 here's our plan to embrace new members and to 19 really spell that out and talk about how 20 you're going to get there. 21 MR. HALL: Thank you. 22 MS. FLOCK: My name is Deborah 23 Flock. I'm with CVPH Medical Center. For an 24 application for where the hospital is the 25 lead applicant, are we able to include 87 1 emergency room physicians as part of the 2 application in working with community 3 physicians to advance the health -- 4 MS. EVANS: Yeah, as long as you 5 include those other physicians. 6 MS. TYLER: Virginia Tyler with 7 Tyler Consulting. I have three questions. 8 They're all fairly technical. The first one 9 is there is a 30 page maximum. I'm wondering 10 does that apply to the financial and the 11 technical application, or is it 30 pages for 12 each? 13 MS. EVANS: No, we decided 30 14 pages for the technical. 15 MS. TYLER: Okay. 16 MS. EVANS: And -- one sec. 17 SPEAKER: The checklist says 30 18 pages. The checklist for each section says 19 30 pages. 20 MS. HEFNER: It says it twice? 21 I think it's intended to be 30 each. 22 MS. EVANS: Thirty each. 23 MS. TYLER: Thank you. The 24 second question pertains to the match. If 25 applicants are able to get a match greater 88 1 than 25 percent, will you view that more 2 favorably than if they only get the 25? 3 MS. EVANS: Yes, of course. 4 MS. TYLER: The third one has to 5 do with care coordination zones. In very 6 rural areas with low population density, 7 would you be willing to look at the total 8 geographic region or the percent of 9 population covered? 10 MS. EVANS: Of course. 11 MS. TYLER: Thank you. 12 MS. EVANS: Going once -- darn. 13 MS. FOULGER: Judy Foulger from 14 CDPHP. Is a health plan eligible to serve as 15 a lead applicant for a CHITA? 16 MS. EVANS: No, but we strongly 17 encourage participation and equal 18 partnerships. 19 MR. AMRHEIN: Scott Amrhein 20 again. Three quick questions. Could you 21 clarify what a standardized electronic 22 approach to aggregating and presenting 23 clinical information to improve coordination 24 of care, or care outcomes, qualify as a 25 clinical decision support in an 89 1 HIV environment -- or HIE environment under 2 category 2? 3 MS. EVANS: Sorry. Would 4 that -- yeah, yes. 5 MR. AMRHEIN: Okay. It doesn't 6 have to be analytic software, per say. It 7 could be a different approach. 8 MS. EVANS: Just explain it, and 9 you'll be evaluated accordingly. 10 MR. AMRHEIN: Very good. 11 Secondly, also category 2, does the clinical 12 decision support in an HIE environment use 13 case approach need to include measurement and 14 reporting on physician quality, or is that 15 more related to the quality reporting for 16 outcomes use case? 17 MS. EVANS: The latter. 18 MR. AMRHEIN: The latter. And 19 then this is a category 3 question. Would a 20 CHITA, working to implement community-wide 21 Electronic Health Records under category 3, 22 qualify if it offered support across several 23 care coordination zones if it were more than 24 just one zone? 25 MS. EVANS: Yeah. Just define 90 1 the big zone or the zones in the big zone. 2 MR. AMRHEIN: Great, thanks. 3 MS. GALANIS: Christina Galanis 4 again from Southern Tier Health Link. To 5 follow up on the rural health question, can 6 they receive grant funding, and can county 7 health departments receive grant funding as 8 part of a project; for example, a county 9 health department that wants to put in a 10 CCHIT certified EMR in their free clinic? 11 MS. EVANS: Yes. 12 MS. GALANIS: And the same for 13 rural health, if they wanted to assist either 14 a CHITA or a RHIO in supporting rural health 15 doctors for some of the EHR support 16 functions? 17 MS. EVANS: Yes. 18 MS. GALANIS: Thank you. One 19 more question. Has any thought been given to 20 extending the duty? I'm only asking because 21 we have a lot of collaboration to do. 22 MS. HEFNER: We did give it some 23 thought. 24 MS. GALANIS: Okay, and you're 25 still thinking? 91 1 MS. HEFNER: No, we're done 2 thinking. I don't think we can extend the 3 due date at this point. 4 SPEAKER: You can or you can't? 5 MS. HEFNER: No, we can't. 6 MR. MARINO: Al Marino, Queens 7 Network. On page 20 on the participants in a 8 CHITA it says the participants have to be 9 from a separate corporate structure. Does 10 that imply that all the participants have to 11 be from separate corporate structures, or can 12 you have a hospital and a nursing home from 13 the same structure? 14 MS. EVANS: You need to make 15 sure you satisfy all of the other 16 requirements for the physician outside of the 17 structure. 18 MS. SMITH: Nancy Smith again 19 with Health Advancement Project. Under 20 category 1 you state that look more favorably 21 if RHIOs collaborate, which I understand in 22 terms of the ultimate goal. In the case 23 where you have a significant region that at 24 this point is absent in a RHIO HIT ground 25 work, does that still apply? 92 1 MS. EVANS: I think it's up to 2 you and what you think is best for the 3 region. I'm not sure I -- sorry, Nancy. 4 MS. SMITH: I like that answer, 5 but in the RG it's really clear that there 6 will be -- that there is a preference for 7 collaboration. So I'm asking is that also 8 the case in an area where there is really an 9 absence of beginning work. 10 MS. EVANS: I think -- I think 11 it's up to you and what you think is going to 12 be best for the project and the region and 13 what you're trying to accomplish. 14 MS. ESPOSITO: Marybeth 15 Esposito, Mather Hospital, and my question is 16 how would an EHR for a hospital as a project 17 expense be viewed? 18 MS. EVANS: We -- not favorably. 19 We want the electronic health record adoption 20 to be focused in the ambulatory environment. 21 The hospital participation is important 22 because you want to get results from the 23 hospital integrated into the electronic 24 health record. And to the extent that the 25 hospital needs funds to do that in 93 1 participation of the project, then funds can 2 be used for that integration but not for the 3 electronic health record for the hospital 4 itself. 5 SPEAKER: Could you repeat that, 6 please? 7 MS. EVANS: She asked if funds 8 could be used to implement an electronic 9 health record in a hospital. The answer is 10 no. If a hospital is participating -- 11 leading or participating in an electronic 12 health record adoption, the electronic health 13 record adoption should be focused on the 14 ambulatory care environment, but to drive 15 adoption and interface results from a 16 hospital, for example, into the office-based 17 electronic health record, that's a really 18 important component, because that's going to 19 drive successful adoption and effective use 20 of the electronic health record. So the 21 funds that would be required to build that 22 interface for the hospital are allowable. 23 Does that make sense? 24 MR. GOIOIA: Phillip Goioia from 25 the Cayuga Community Health Network, Rural 94 1 Health Network. You're thinking about -- 2 community CHITA with integrating electronic 3 records with third-party administration is a 4 community health plan, would the 5 administrative cost for the payment be part 6 of the grant or it would just be the payment 7 for performance or payment for outcomes part 8 be part of the -- 9 MS. EVANS: I'm sorry. 10 MR. GOIOIA: The system of the 11 integrated financial -- 12 MS. EVANS: This is -- 13 MR. GOIOIA: -- health records 14 so. 15 MS. EVANS: So you want to 16 integrate the practice management health 17 system with the Electronic Health Record? 18 MR. GOIOIA: With the community 19 basis. 20 MS. EVANS: Yeah. I think 21 that's an important part of the Electronic 22 Health Record adoption, so to interface the 23 two could be included, yes. 24 MR. GOIOIA: Would the 25 third-party payment administration be part of 95 1 the grant, or would that be separate, just 2 the evaluation for the payment for 3 performance or payment for outcomes would 4 just be more -- 5 MS. EVANS: I'm sorry, I'm 6 not -- 7 MR. GOIOIA: So there's like a 8 financial administration system which you 9 would be using for getting payments from 10 local chamber of commerce and small 11 businesses to the health care providers, and 12 part of it would be a quality part, part of 13 it would be administrative costs for 14 developing -- 15 MS. EVANS: Paying for the 16 quality part would be preferable. 17 MR. GOIOIA: Okay. The 18 administrative costs for financials -- 19 MS. EVANS: What exactly would 20 the administrative costs be? 21 MR. GOIOIA: Well, it's a 22 question of developing software and hardware 23 to create a system where people could -- 24 community people could pay to the community 25 pool -- 96 1 MS. EVANS: Yeah, I would leave 2 that out, that part out of the budget. 3 MR. GOIOIA: But the integration 4 part and the quality part -- 5 MS. EVANS: Yeah. 6 MR. GOIOIA: -- would be 7 important? 8 MS. EVANS: Yeah. 9 MR. TURNER: Benny Turner, Bronx 10 RHIO. It's a question about getting cost 11 information or helping us develop cost 12 information on two use cases -- immunization 13 in accord with the EHRs and the 14 interoperable EHRs for Medicaid. Is there 15 anyone we can contact at the State so we can 16 talk with to get a more intelligible cost 17 estimate? 18 MS. EVANS: Correct me if I'm 19 wrong, Marybeth. I think the process would 20 be e-mail, and we'll use the team to respond 21 through e-mail. Does that work, or is that 22 right? 23 MR. VEINO: No private 24 questions. 25 MS. EVANS: No private 97 1 questions. 2 MR. TURNER: Thank you. 3 MR. HEIMAN: Jim Heiman from 4 LIPIX RHIO. Two questions. One, the CHITA 5 certification, 2006 versus 2007, is that an 6 issue? 7 MS. EVANS: Oh, good point. 8 MR. HEIMAN: There are only 9 nine -- that are 2007. 10 MS. EVANS: Only nine so far? 11 MR. HEIMAN: Yes. 12 MS. EVANS: You know, we'll 13 provide a written response. I think it's 14 more the expectation that that will happen 15 within X number of months in terms of having 16 a feasible approach to submitting -- I mean 17 it's important if you're certified to stay 18 certified, so we'll just allow time to allow 19 that to happen in a reasonable way. But if 20 your vendors aren't getting recertified, you 21 should ask them to get recertified. And I 22 think, while we're on the vendor topic, I 23 would just encourage everyone to really talk 24 to your vendors and have conversations about 25 what they want to be when they grow up and 98 1 how they view -- and I mean that in a way 2 that the environment is changing rapidly. 3 Health IT is still a new area. We're all 4 learning. We have a lot to learn. We're 5 going to have course corrections along the 6 way, and being able to really talk to your 7 vendors about how they view themselves in 8 this field over time is really, really 9 important. I mean there is a big difference 10 between facilitating results delivery into an 11 Electronic Health Record and clinical 12 messaging. That's very different from health 13 information exchange and being able to think 14 about health information exchange in a way 15 that not just, I think, allows information to 16 be shared in your community but that can 17 really support clinical informatic 18 capabilities for quality reporting and public 19 health surveillance reporting and for 20 supporting interoperable EHR adoption. Those 21 are critical components of health information 22 exchange, and those capabilities are critical 23 to driving the corps services and this common 24 health information exchange protocol that 25 we've addressed as part of what it means to 99 1 do health information exchange. So just, you 2 know, ask the hard questions, and it's -- you 3 know, you may need a few vendors, and one of 4 reasons why we included a health information 5 service provider committee as part of the 6 statewide collaboration process is because we 7 want the projects and your vendor. We want 8 you to bring your vendors along, and we want 9 to really start to talk about some of the 10 things that we should be talking about to 11 drive these corps services. And I'll stop 12 there. I just wanted to emphasize and 13 encourage you to have those conversations. 14 And, you know, we're going to take, which has 15 always been the case -- the vendor 16 responsibility questionnaires from the 17 vendors are a really important part of the 18 process, as it always has been. 19 MR. HEIMAN: My other question 20 was, quickly, can you just give us a little 21 more understanding of what NYeC is going to 22 be doing with the money, the 10 million 23 dollars? 24 MS. EVANS: They are going to 25 be -- they are going to be -- hang on. It's 100 1 actually -- it's 5 percent of the 105, so 2 it's 5 million, and -- 3 MS. HEFNER: Up to. 4 MS. EVANS: Pardon? 5 MS. HEFNER: Up to. 6 MS. EVANS: So I think the key 7 role for NYeC is to be able to convene, and 8 basically it's a home for collaboration and 9 convening all of the projects in each of the 10 gray categories and to drive -- especially 11 with the Statewide Health Information Network 12 for New York projects, there's a lot of 13 discussing and thinking we want to do around 14 health information exchange, getting back to 15 the point that we don't want to do this in a 16 way where in two years or three years or four 17 years we have to do inter RHIO 18 interoperability. We want to try and have 19 successes in the region and drive health 20 information exchange but do it in a way where 21 we are doing some things exactly the same. 22 So NYeC's role is to convene the projects and 23 the vendors, especially in that category, to 24 drive corps services and to drive this common 25 health information exchange protocol. So as 101 1 I was saying in the beginning, that process 2 will be determined and worked out. Once the 3 awards are made, the group will come 4 together; we'll have a kick-off meeting; 5 we'll talk about what makes sense in terms of 6 the working sessions and the series of 7 meetings and so forth. But, you know, you 8 need to think about that and anticipate it in 9 your applications. And then the other key 10 pieces will be based on which project -- 11 which use cases are selected and then the key 12 intersection points between some of the grant 13 categories. You know, if a CHITA is doing an 14 electronic health record project, we really 15 want to have that collaboration happen with 16 the RHIO and be able to facilitate those 17 discussions. So we're really trying to use 18 the convening and the collaboration process 19 so all of you can benefit and all of your 20 projects can benefit, but also for us to be 21 part. We want to be a part of helping and 22 supporting and providing technical assistance 23 and using our knowledge to support the 24 projects as well, so it's a real home to be 25 able to have that be a part of the process. 102 1 MR. HEIMAN: So it's going to be 2 5 percent of the total dollars of the 3 reimbursable -- 4 MS. EVANS: Yes. 5 MR. HEIMAN: -- dollars then, 6 correct? 7 MS. EVANS: Yes. Well, you can 8 use matching dollars but it's the 75 percent. 9 MR. HEIMAN: Yes. 10 MS. EVANS: Yeah, sorry, 11 clarification. 12 MS. SMITH: Just to clarify, 13 because you said before that it would be of 14 the total project. You're saying it's just 15 the -- 16 MS. EVANS: Well, it's the 17 total, the reimbursable. The total -- 18 MS. SMITH: And that's the same 19 for the evaluation? Five percent? 20 MS. EVANS: Yes. 21 MS. SMITH: My question was if 22 an applicant is not currently working a 23 vendor or wants to consider working with a 24 different vendor for a project, does that 25 vendor have to be identified in the grant, or 103 1 can that vendor selection process be part of 2 the two-year request? 3 MS. EVANS: Nancy, if you don't 4 think you have time to interview or decide on 5 a vendor now, I would just tell us how you're 6 going to do that, but be very clear about 7 what your goals are and what you need and how 8 you're going to do it, because I think it's 9 something that has to happen really fast once 10 the awards are made. You know, you can even 11 bring it down to some choice and options and 12 put that in the application and say how 13 you're going to select the final choice upon 14 grant award. 15 MS. KOCH: Irene Koch from 16 Brooklyn Health Information Exchange. We 17 talked about it a couple of times today, but 18 I think it might be worth while to just have 19 clarified on the website the interpretation 20 of the last sentence in the first paragraph 21 of Section 4.2 about 5 percent of the funds 22 going for the collaboration process and, 23 additionally, 5 percent of the funds going 24 for evaluation and 5.1.4.1 because there 25 seems to be some ongoing confusion about the 104 1 total project cost. 2 MS. EVANS: Right. So just to 3 be clear, it's 5 percent of -- it's 5 percent 4 of the hundred and 5.75, so it's the 75 5 percent side -- is that clear? -- for both 6 the statewide collaboration and the 7 evaluation. 8 MR. HALL: Right, and the text 9 of the RGA says allocate 5 percent of 10 reimbursable funds or matching funds, so I 11 think that's leading to some confusion. 12 MS. EVANS: Yes, and I think the 13 point there, for the 75, the source of funds 14 could be reimbursable or in kind or matching, 15 but it's still coming from the 75 percent 16 denominator. Does that make sense? We'll 17 make sure it's clear in the writing, but it 18 is based on the 75 percent denominator. 19 MS. GARCIA: Arlene Garcia again 20 from Primary Care Development Corporation. 21 Two quick questions. One, can a 501C3 that 22 provides EHR adoption services to community 23 health centers be part of the CHITA as long 24 as they're not the lead applicant? 25 MS. EVANS: If the participants 105 1 of a CHITA want to work with you to satisfy 2 the goals of their project, that's up to 3 them. 4 MS. GARCIA: Okay, so that leads 5 up to my second question. In 3.223, the HIT 6 Adoption and Support Services, is it expected 7 that the CHITA members provide those 8 services, or are those to be contracted out? 9 MS. EVANS: They can decide how 10 they're going to provide those services. 11 MS. GARCIA: Thank you. 12 MS. SCAMURRA: Susan Scamurra 13 from Western New York again. One more 14 clarification on the evaluation process. If 15 a third-party is hired by the State to go out 16 and do an independent evaluation and they 17 come back to each of the projects and want 18 information or work done by the projects to 19 gather the information or whatever, do we 20 have to worry about additional costs on our 21 part, or would that be considered all 22 inclusive in what they receive money on? For 23 instance, if they wanted us to conduct 24 surveys -- 25 MS. EVANS: Who is the they, and 106 1 who is the us? 2 MS. SCAMURRA: Well, you're 3 talking about an independent third-party 4 evaluator. 5 MS. EVANS: We'll put it in 6 writing. 7 MS. SCAMURRA: Okay. That's one 8 of the issues that's going on with the HEAL 1 9 now is just, you know, information or pieces 10 of information that are needed, we have to 11 now find people to gather that information, 12 so we need to know whether we need to include 13 those costs as well. 14 MS. EVANS: Going once, going 15 twice -- 16 MR. VEINO: Lora, I would like 17 to make one thing. Earlier on, a question 18 was raised as to whether or not, as I 19 understood the question at that time, a 20 faculty practice could be a lead applicant 21 for a CHITA. I would ask the person who has 22 that question to follow that up with an 23 e-mail, and when you do, focus please on the 24 issue of how or if that faculty practice is 25 separately organized as an entity separate 107 1 from its sponsoring medical school or 2 hospital. 3 MS. HEFNER: Now you can clap. 4 MS. EVANS: Thank you so much. 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 108 1 C E R T I F I C A T E 2 3 I, Kyle Alexy, a Shorthand Reporter and Notary 4 Public in and for the State of New York, do hereby 5 certify that the foregoing record taken by me is a 6 true and accurate transcript of the same, to the best 7 of my ability and belief. 8 9 10 ___________________ 11 Kyle Alexy 12 13 DATE: October 1, 2007 14 15 16 17 18 19 20 21 22 23 24 25