Project Proposal - HLN

®

Development of the Vermont Health Information Technology

Strategic Plan

Project Proposal

October 11, 2006

HLN Consulting, LLC 7072 Santa Fe Canyon Place

San Diego, CA 92129 858/538-2220 (Voice) 858/538-2209 (FAX)

[email protected] http://www.hln.com/

Development of the Vermont Health Information Technology Plan – Project Proposal

HLN Consulting, LLC 10/11/2006 2

Table of Contents

1 INTRODUCTION............................................................................................................................... 3

1.1 COMPANY BACKGROUND............................................................................................................. 3 1.2 HEALTH INFORMATION TECHNOLOGY EXPERTISE ....................................................................... 4

2 PROJECT BACKGROUND.............................................................................................................. 9 3 PROJECT PROPOSAL ................................................................................................................... 11 4 PARTNERSHIP PLAN .................................................................................................................... 16 5 PROJECT TIMELINE .................................................................................................................... 18 6 PROJECT STAFFING..................................................................................................................... 19

6.1 PROJECT MANAGEMENT ............................................................................................................ 19 6.2 BIOGRAPHIES OF KEY STAFF...................................................................................................... 20 6.3 PROJECT COMMUNICATION AND COLLABORATION.................................................................... 23

7 PROJECT BUDGET........................................................................................................................ 25 8 REFERENCES.................................................................................................................................. 26 9 APPENDIX A: SCOPE DISCUSSION ........................................................................................... 27 10 APPENDIX B: GANTT CHART .................................................................................................... 31



1 Introduction

1.1 Company Background Founded in 1997, HLN Consulting, LLC is a health information technology services company whose mission is to:

♦ Provide a wide range of technology consulting services to public health agencies and their not-for-profit partners.

♦ Develop and support robust technical solutions addressing pressing public health needs.

♦ Facilitate the collaboration between health care and public health communities necessary to successfully exchange data and use information technology to support each other’s missions.

♦ Support national health policy and program initiatives and promote the use of standards for systems interoperability.

We are actively and continuously engaged with the public health and healthcare community on a local, regional, and national level. In addition to ongoing client work, our staff members speak frequently at national conferences, including the American Public Health Association (APHA) annual meeting, National Immunization Conference (NIC), Immunization Registry Conference (IRC), and many regional events. We attend relevant industry meetings, sometimes with our clients, to stay up-to-date on important technical and health policy developments. As a company we provide institutional support to the American Immunization Registry Association (AIRA sustaining member), the Public Health Data Standards Consortium (PHDSC), the National Association for Public Health Information Technology (NAPHIT), and HL7. We worked specifically with PHDSC on a detailed response to the HL7 Electronic Health Record proposed ballot to ensure that a public health perspective was infused into this standard, and we participated in the HIMSS EHR Working Group. We also contribute to the community by writing articles and white papers that both summarize project findings and best practices, and conceptualize emerging issues. See attachments to this document for examples. We also have presented at recent health information technology conferences including the Connecting Communities for Better Health conference in May 2005. We are results-oriented. Our goal is to satisfy our customers’ needs, large or small. Deliverables must be useful to clients. We work with material until it’s right. We strive to complete projects on time and within budget. Our staff members are diversely skilled to provide flexible, versatile solutions. They thrive on new challenges. HLN has a cadre of over 30 professionals who come from diverse backgrounds, including traditional consulting, academia, government service,



health plans, and commercial industry. Our staffing model allows us to assemble the best team for a project, drawing upon a wide range of affiliated consultants and specialists to meet a client’s specific needs. The HLN experience is one of collaboration and cooperation. Consultants seek to engage fully with client organizations to understand the larger organizational, political and financial frames within which they work. Long-term relationships allow clients and consultants to leverage earlier experiences to achieve more efficient and informed partnerships for sustained high-quality outcomes. HLN consultants work well with others – be they clients, standards groups, project stakeholders (inside and external to the organization), and especially other vendors. In 2003 HLN received the annual Partnership Award from the American Immunization Registry Association (AIRA). Core values bind us together. Service to our clients. Intellectual Rigor. Collaboration. Social Consciousness. Trust and Respect. These are the values that drive us to excellence and govern our relationships to each other and our clients.

1.2 Health Information Technology Expertise

HLN has extensive experience developing and supporting health information systems. More than 90% of HLN’s business is connected with public health, which encompasses a wide array of functions that interact with the healthcare delivery system, including surveillance, quality assurance, health access, insurance, regulation and evaluation. Through our work with health departments and through other direct engagements, HLN also has experience working with the private sector: hospitals and hospital systems, hospital associations, health plans, universities, quality organizations and other non-profit healthcare organizations. The following table summarizes HLN’s recent work in the knowledge areas relevant to this project:

Knowledge Area HLN Experience

Strategy and Business Planning

HLN consults with public health, non-profit and academic institutions to develop strategic and business plans for the development and deployment of technology. HLN uses a number of methodologies. Our work with public agencies (including New York City, Los Angeles County, Rhode Island, Washington State, and California) involves working closely with staff from all levels of the organization to perform needs assessments, systems assessments, and develop strategic plans. We use onsite interviews and discussions, conduct research, monitor and participate in national forums, and communicate regularly via electronic means to provide advise on developing a business case, funding and budgeting alternatives for IT, IT organization and staffing, business process improvement, as well as a wide variety of technical subjects.




National Health Information Network/ Regional Health Information Organization (NHIN/RHIO)

HLN is a leading consultant to NHIN/RHIO projects, with special emphasis on ensuring public health’s role in these emerging phenomena. HLN submitted a distinguished response to the January 2005 HHS ONCHIT RFI focused on models for RHIO implementation, which was used to inform the architecture models of the Vermont Blueprint project which commenced later that year. HLN recently worked with the Arizona HealthQuery project, a health services data exchange collaborative. We continue to participate in a number of RHIO planning efforts, including in New York City and Rhode Island.

Issues Regarding Medication History and Data Exchange

HLN's experience with immunization registries, where the history of vaccine administration, the concomitant complexity of the immunization schedule and forecasting requirements, and the functionality of vaccine inventory management, provides a strong foundation for additional work in this area required by this project. Our work on creating and supporting systems to manage the dispensing of medications as part of mass campaigns in the context of bio-terrorism preparedness has extended our capability in this area. We have done extensive work related to issues of system-to-system data transfer that includes medication and vaccine transmission. These activities fall squarely within the AHIC focus area of Biosurveillance.

Stakeholder Engagement Needs Assessment

HLN is made up of professionals who have wide ranging backgrounds working with providers, patients and payers, state and local health departments, health plans, hospitals, provider practices, and community and rural health centers and related non-profit agencies. We have experience working with HRSA in Maternal and Child Health (MCH), genetic screening and primary care, with CMS working with Medicaid and Medicare, and with CDC working on immunization registries, implementations of Public Health Information Network (PHIN), bioterrorism preparedness and response, and the collaboration of hospital and reference laboratories with public health laboratories. We have collaborated heavily with public/private coalitions, consulting on their organizational structures, developing their charters and providing advice and education. We have contracted with public health clients to assist them with planning and implementing the movement of work from government to private organizations. These clients and organizations include hospital research entities, foundations, non-profits and businesses. HLN works extensively to evaluate systems needs and requirements, and prepare detailed documentation (including use narratives, use cases, process flows, and other documenting techniques). Using a requirements management software product, DOORS (by Telelogic), we maintain repositories of user requirements that can be accessed and managed throughout a project to ensure that the end result matches the desired functionality.




Health Information Exchange Health Level 7 (HL7) Messaging Technologies

Many of HLN’s public health projects involve submission, processing, consolidation, and display/query of healthcare data from disparate sources. Whether using standards-based approaches (like HL7) or other file formats, HLN initiates and supports semi-automated to fully-automated solutions depending on client needs and specifications. In NYC, HLN supports a sophisticated immunization data submission and processing system. For the State of California, HLN enabled HL7 2.n messaging in the California Automated Immunization Registry (CAIR) software. In Los Angeles, HLN is participating in the development of a comprehensive PHIN-compliant data exchange architecture using HL7 3.0 messaging. In Rhode Island, HLN is building HL7 data exchanges with McKesson, Polaris, and eClinicalWorks systems.

Integration of multiple information systems Public Health Information Network (PHIN) Master Patient Index (MPI) Strategies

Duplicate record identification and resolution (Deduplication)

HLN was one of three vendors contracted to develop, as a team, an integrated Master Child Index (MCI) for NYC. HLN provided the leadership from this project’s inception, and served as the prime contractor for one of the other two companies. This system (deployed successfully in January 2004) allows for the registration of clients in a central database, and the use of a sophisticated matching engine accessible through a set of core services (written by HLN). There are currently more than 3 million child records in this database. Significant work was also done on modifying existing tools and software to make use of these new features. HLN is currently participating in the design of a set of integrated public health applications for Los Angeles. In Rhode Island, HLN provides technical support and development for KIDSNET, a comprehensive child health system for the state. Besides developing a new web client for RI, HLN has implemented a set of de-duplication and client merge tools that enable more records to be accurately absorbed into the shared database. HLN is also involved with several Public Health Integration Network (PHIN) planning and implementation projects, one in Los Angeles and one in Rhode Island. In Los Angeles, HLN is enhancing the patient matching/merging capabilities of the county’s immunization registry system to support bio-terrorism preparedness. HLN consultants also played an active and leading role in the activities, analysis and presentation of the Public Health Informatics Institute’s Unique Records Workgroup culminated in the publication in April 2006 of the Unique Records Portfolio, a Guide to Resolving Duplicate Records in Health Information Systems, including principles and concepts, metrics, case examples from child health integrated information systems, a profile questionnaire, and self-assessment tools. Recently, HLN completed an assessment for the WA State DOH to establish a Record Matching Service. HLN presented a seminar and two workshops in record matching and provided configurations for three programs including the Trauma Registry.




The development, implementation, and evaluation of distributed systems

Secure web-based file management

As a leading Open Systems vendor, HLN has had extensive experience in the development, implementation, and evaluation of distributed systems. The NYC MCI project is first and foremost about integrating disparate systems that are scattered in various locations in the agency. A good portion of our work involves linking different sub-systems together to create a seamless, smoothly-operating installation. One area of particular interest is the integration of a subsystem called Web File Repository (WFR), an HLN-developed product for HIPAA-compliant web-based secure file management into the NYC immunization registry web client for the purpose of automating the collection of patient and immunization data submission files from providers.

Public heath registry systems

HLN is one of the pre-eminent immunization registry system services vendors in the country, specializing in project evaluation and continuing development of custom systems. Over the past several years, HLN has conducted major registry strategic evaluations in New Hampshire, Rhode Island, Philadelphia, Kentucky, Washington, and California. HLN currently provides technical support and software development for immunization registries in New York City, Rhode Island, and Philadelphia. Because of continuing work developing and support both Microsoft-based (in CA and PA) and non-Microsoft-based (in NYC and RI) registries, HLN hosts a unique software test bed which can be leveraged (with client permissions) as a testing ground for new concepts and interfaces. No other immunization registry developer operates such a diversity of registry products and architectures. This diverse environment of production public health systems benefits patient-centered non-registry projects as well.




Hospital systems

Health Plans

HLN consultants have conducted assessments in hospitals in several states. In 2001, HLN assisted the NYC health department in designing a survey to assess the readiness of hospitals to provide communicable disease reports electronically and to participate in syndromic surveillance activities. In depth interviews including hospital management, clinicians, especially with infection control, legal counsel, safety personnel and laboratorians were conducted in representative public and private hospitals. Additionally, HLN is consulting with the NYC immunization registry to develop an HL7 interface to the 13 hospitals in the NY Health and Hospitals System electronic health record system (Misys). In NH, HLN consultants conducted an assessment of the Capitol Health System and the Concord Hospital (Logician); and in KY, with the Baptist Health System Hospitals (McKesson) and the University of Kentucky Medical Center; and with the Philadelphia Health Department and Children’s Hospital of Philadelphia (EPIC). HLN has worked with hospital associations as conveners for hospital stakeholders or representatives of hospital issues in AZ for St. Luke’s Health Initiative (SLHI), in NYC, KY, CA, and in connection with ambulatory practices in NJ, Philadelphia, NH, KY and WA. As a participant in the Public Health Data Standards Consortium (PHDSC), HLN contributes to standards development for the exchange of surveillance data between hospitals, laboratories and public health departments, and for the emergency room syndromic surveillance functions. HLN has experience in several states with hospitals vis-à-vis electronic birth reporting, newborn screening and early hearing detection. We have experience with the Certificate of Need (CON) process both in NJ and in KY where hospitals sought CONs for technology; and with the licensing of hospitals and health care facilities. We have worked with hospital discharge data in AZ and RI and through our affiliation with the National Association of Health Data Organizations (NAHDO). We have extensive experience working with public and private health plans and their organizations in CA and NY. HLN consultants have also worked on projects which involve billing and encounter systems. We have been involved with Medicaid fee for service and managed care billing systems in immunization registry projects in CA, NY, NH, KY and RI as much of our work has been in child health integration systems and some maternal and child health systems. Our work with CalOptima health plan in CA centered around the use of the Medi-Cal PM 160 claims document. We worked with the Medi-Cal eligibility system and have worked on formatting claims data from Medicaid and commercial plans for use in public health data bases.



2 Project Background The Vermont Information Technology Leaders (VITL) is tasked with the development of a statewide health information technology plan as described in 18 V.S.A. § 9417. The statute calls for a plan with eight requirements:

1. Support the use of electronic health information (EHI) 2. Educate providers and the public on electronic health infrastructure issues 3. Promote the use of national standards for electronic health information

infrastructure 4. Propose strategic investments in EHI 5. Recommend EHI funding mechanisms 6. Incorporate existing health care information technology initiatives 7. Integrate the technical components of four ongoing EHI initiatives and any other

relevant initiatives 8. Address privacy, confidentiality, ownership, and governance issues related to

EHI. Based on the legislation, VITL has developed a draft outline of the technology plan with a goal statement, a statement of purpose, and eight specific sections that can be mapped to the goals in the statute. The four major health IT initiatives highlighted by the legislature for inclusion in the plan are:

1. The Blueprint for Health project in the Department of Health (VDH), and the associated Chronic Care Information System (CCIS)

2. The Global Clinical Record (GCR) and all other Medicaid management information systems being developed by the office of Vermont Health Access

3. Information Technology components of the Quality Assurance System 4. The program to capitalize electronic medical record systems in primary care

practices with loans and grants The legislation also calls for VITL to deploy a pilot project to conduct electronic health information exchange between at least two hospitals in order to develop EHI strategies and to determine “whether and how” to expand the initiative statewide. The coordination and inclusion of these five IT projects into the plan will be critical to the adoption of the plan. VITL’s challenge is to develop a health information technology plan that is in line with national standards and efforts in other states but also takes into account the current landscape and provides leadership that is relevant to the ongoing initiatives and legislative priorities. VITL has a diverse and talented set of individuals among its directors and advisory board members. A number of well qualified individuals have volunteered to assist with the



development of the plan. The challenge for VITL is to manage this development and to make the best use of contributors’ efforts without losing track of the deliverable timeline and requirements, the incorporation of the five IT initiatives, and the appropriate national context. HLN is uniquely positioned to assist VITL in this effort. In February, 2006, HLN completed a technical architecture planning project for the Blueprint for Health project. Two months later, HLN conducted a follow-up assessment to assist in the selection and configuration of vendors for the VITL pilot and the Blueprint CCIS. As part of these projects, HLN consultants developed relationships with a number of key VITL stakeholders, including staff of VITL, VDH, the Vermont Program for Quality in Health Care (VPQHC), GCR team members, hospitals and insurers. After the completion of our Blueprint engagement, VDH extended our contract on a time-and-materials basis for ad-hoc consulting needs, and HLN continues to keep abreast of Vermont Health IT developments through contacts at VDH and VITL. HLN also monitors legislative activities related to the Commission on Health Care Reform. Our intimate knowledge of the Blueprint CCIS project will enable us to engage the Blueprint in the development of the plan and ensure the appropriate tie-in that the legislature requires. Meanwhile, our EHI and RHIO work in other states enables us to bring the national perspective to the planning process.



3 Project Proposal HLN proposes to provide the following consulting services to VITL related to the development of the Vermont Health Information Technology Strategic Plan:

• Strategic direction and leadership

Provide appropriate context, ensuring that the development of the Plan is in line with stated goals and consistent with existing initiatives, national standards, stakeholder interests, and legislative mandates. Assist VITL in setting the scope for each section of the Plan.

• Project management

Organize and manage resources to develop the Plan. Develop a project plan, implement the project plan, and monitor progress and adherence to timelines. Assign work to VITL committee members and other content volunteers, review submissions, and perform consolidation and editing. Provide an electronic environment that facilitates stakeholder participation and collaborative authoring.

• Content production

Create an initial outline and base content for each section of the Plan from which collaborators will build upon. Create Plan content in areas not covered by volunteer submissions, conducting the necessary research and interviews and allowing for input from the appropriate VITL stakeholders.

The goal is to establish a partnership between HLN and VITL, making the development of the plan as collaborative as possible, with HLN as project leader and major contributor. The current legislative deadlines related to the development of the plan are:

• January 1, 2007 – Update to Legislature and Preliminary Technology Plan • July 1, 2007 – Final Technology Plan

Therefore, we propose a phased engagement, with two deliverable time periods:

• Phase 1: To December 31, 2006 o Organize Project / Kickoff o Initial Site Visit o Develop project plan o Achieve consensus on Plan scope o Work on Plan content o Submit preliminary report to the legislature



• Phase 2: From January 1, 2006 to June 30, 2007 o Incorporate feedback into the Plan o Continue development of Plan content o Completion of the final Plan

The amount of written content that will be developed by HLN will depend on the level of participation from VITL volunteers and the scope of each section of the Plan. HLN proposes to conduct the project on a time-and-materials basis, invoiced monthly with a status report of progress. Site visits will be provided for the purpose of achieving consensus on scope, soliciting volunteers, presenting progress to stakeholders, evangelizing Plan concepts, performing on-site interviews, meeting with legislative contacts, and attending VITL committee meetings. Specific deliverables in the three project areas follow. Strategic direction and leadership

• Deploy and maintain project website for documents, status, resources, and content • Provide relevant references and Strategic Technology Plan examples • Conduct at least two on-site visits and participation in committee meetings via

teleconference • Develop scope document • Interview stakeholders and representatives of relevant projects such as Hans

Kastensmith, Blueprint, Medicaid GCR, VPQHC Project management

• Develop and maintain project plan • Deploy web-based collaborative authoring environment • Solicit contributors via on-site visits and website; publish open assignments,

assigned content, dates and project milestones • Monthly progress reports to VITL leadership

Content production

• 10-15 page legislative report at the end of Phase 1 • Base outline and section content • Final plan, including an introduction and 8 sections, to be divided up into four

categories of work based on the sections in the statute (See Page 9):

Report Sections Strategy

Sections 1, 3, 8

Topics related to security, privacy and confidentiality, standards, and promotion of EHI infrastructure. These sections will draw from work at the national level and in other states. Drafts of these sections will be written early in the project and



Report Sections Strategy Sections 1, 3, 8 (continued)

posted to the website for the team to review and enhance throughout the duration of the project. Some of the topics in this category will require decision making in both scope and content which may require participation from stakeholders to reach a consensus. Options will be explored, especially through the presentation of examples from other states, and agreement will be reached via committee meetings and electronic collaboration. For example, in the August, 2006 VITL Standards and Architecture Committee meeting, Mike Berry listed four challenges in the area of privacy and security from the Arizona Health-e Connection Roadmap1:

1. consumer control 2. confidentiality protection 3. how to handle minors 4. who will have access and for what purpose.

The decisions made in Arizona can help inform the Vermont team as to the set of options in these areas. Vermont may have different goals and needs than some of the examples that will be reviewed, particularly in the area of making the Plan “patient-centric” – a feature that has been identified as a priority by VITL. (Also see Section 9, Appendix A for a discussion of the RTI security/privacy collaborative and its impact on the Plan).

Sections 2, 4

Sections that require strategic analysis such as governance, education, investment and infrastructure recommendations. These will be written in a more iterative fashion, with discussion beginning at the first site visit. Substantial input on Section 2 will be solicited from the Education and Awareness Committee. Some recommendations in these sections will defer to the state plan for telecommunications. The three ONC (Office of the National Coordinator for Health IT) projects currently underway will also inform these sections:

ONCHIT 1: Standards harmonization. ONCHIT 2: EHR compliance and certification. ONCHIT 3: Prototypes.

1 St. Luke’s Health Initiatives and BHHS Legacy Foundation. “Arizona Health-e Connection Roadmap.” http://gita.state.az.us/tech_news/2006/Arizona%20Health-e%20Connection%20Roadmap.pdf



Report Sections Strategy

Sections 6,7

Sections that require more detailed information gathering, analysis, interviews, and review such as those related to Medicaid/GCR and Blueprint harmonization. Research for these sections will be conducted in the first phase of the project and the content will be written in the second phase. Work on these sections will also involve the development of a proposed architecture for integrating the technical components of the systems highlighted for inclusion in this section.

Section 5

Content related to value of investment, financial projections, and funding models. The legislature has called for the Plan to recommend funding mechanisms to promote capital investments in health information technology infrastructure. Building a statewide health information infrastructure as described in the Plan will require significant investment from virtually all entities in health information exchange:

• Hospitals • Laboratories • Pharmacies • Payors • Ambulatory • Physicians • Public Health / Surveillance

A major focus will be EHR adoption among physician practices. A survey conducted by the Bi-State Primary Care Association2 found that 67% of practices identified cost as the largest barrier to EHR adoption. Sustainability is a key issue – training, hardware, productivity effects, and support are identified as barriers in addition to initial costs. Funding will be needed to assist in the adoption of EHR technology, especially in smaller, rural practices. In addition to the legislature, funding sources include foundation grants and contracts as well as federal grants and contracts from such agencies as AHRQ, ONC, NIH, and NLM. EHR and EHI infrastructure require substantial investments: at startup, during phased implementation, and for ongoing operational

2 Health Information Technology & Primary Care in Rural Vermont: An Assessment and Resource Inventory. Bi-State Primary Care Association, December 2005. http://www.bistatepca.org/Bi-State%20Reports.htm



Report Sections Strategy Section 5 (continued)

activities. Project benefits do not always accrue to the participants in proportion to their investment. The Plan will 1) communicate the value of investment to the provider, and 2) propose financial incentives that bridge the value gap and promote the adoption of technology consistent with Plan standards and architecture. We will draw partly on efforts in other states such as Rhode Island where network models are applied to EHR deployment, and we will establish principles for public financing designed to direct funding to projects based on need, value, likelihood of success and adherence to Plan concepts. The scope of the funding mechanisms detailed in the Plan must be limited to include targeted investments and cannot include financial projections for all systems in the covered in the Plan such as the GCR. Contributions to this Plan section are an optional component of the proposal and are included in the second cost proposal on p. 25.

As we draw on strategic planning efforts at the national level and in other states, we expect to include content in the Plan that is not limited to the specific eight areas described in the legislation. The overarching national health information technology goals of informing clinical practice, interconnecting clinicians, personalizing care, and improving population health3 call upon the health care community to implement a large set of changes necessary to accompany the full use of information technology. In addition to the national strategic plan, health information technology plans from states such as Arizona, Minnesota, Rhode Island and Utah will be used to help define the scope of the Plan beyond the letter of the legislation. Some additional topics may include:

• Methods and architecture to uniquely identify patients • Methods and architecture to uniquely identify providers, including standards for

the use of the National Provider Identifier (NPI) • Methods to securely authenticate providers and other authorized users • Methods to manage privacy and consent • Priorities for interconnection with public health in areas such as surveillance and

emergency preparedness and response • Goals for the adoption of Personal Health Records (PHRs) • Promoting the use of telehealth systems • Developing measurable outcome goals

3 The Decade of Health Information Technology: Delivering Consumer-centric and Information-rich Health Care, Tommy Thompson and Dr. David Brailer, Department of Health and Human Services, July 21, 2004.



4 Partnership Plan One of HLN’s first tasks will be to work with VITL to further define the scope of the document on a section-by-section basis. Depending on the degree to which VITL stakeholders volunteer to produce content, the scope will be limited to the funding level provided. For the sections relating to IT project harmonization, an HLN software architect will be engaged early in the project to examine the technical architecture of the relevant projects and to propose a level of scope that is appropriate for the level of funding. The software architect will connect with technical staff working on Blueprint, GCR, and other initiatives and incorporate their perspectives into the proposal. Higher levels of funding will allow for us to incorporate technical architecture directly into the Plan, whereas less funding may limit us to high-level discussion of the concepts. Throughout the project, HLN will work closely with VITL staff, stakeholders, and leadership to develop the Plan. HLN will also reach out to clients and associates in other states for feedback and suggestions, particularly in areas such as public and provider education. The HLN project website and other electronic tools (See Section 6.3) will be utilized to facilitate collaboration in a cost-effective manner. Costs can be further minimized by relying on VITL staff to organize and conduct regular meetings to solicit feedback on HLN-produced content. The major steps of the project are:

OrganizeProject Site Visit Project Plan Develop

Content Draft Plan Final Plan

IncorporateFeedback

These steps are described in the following section: Organize Project: In this step, we will perform the following tasks:

Establish Project Team – We will work with VITL staff to determine who the members of the project team will be. This core group will work together to manage the project and make sure it stays on track. We would expect the core group to meet every one to two weeks, usually via conference call. Deploy Project Website – The project website and other electronic collaboration tools will be deployed. Options for collaborative authoring will be discussed, ranging from a simple website maintained by an editor to a Wiki will full editing privileges granted to all team members and contributors.



Conduct Project Kickoff Meeting – HLN expects that the project team will meet with VITL team members via conference call during the first week of the project to accomplish the following objectives:

Define Specific Goals and Objectives – The first task of the project team will be to clearly and carefully define and validate the goals and objectives of the project, as well as review the deliverables for both the HLN team and VITL team. Develop Preliminary Project Plan – An outcome of this first phase needs to be a more detailed work plan, with assigned responsibility, for moving forward.

Site Visit: HLN expects to conduct a one to two day site visit early in the project. The primary purpose of this site visit is to meet with VITL staff, present the project to the appropriate VITL committees, discuss scope, collect detailed input from stakeholders on the sections of the Plan, and identify potential contributors. Interviews will be conducted to inform the development of the project plan and the project harmonization work. The specific individuals to be consulted will be identified in the initial project stage, but HLN expects six to eight individuals to be interviewed individually or in small groups during this site visit. Detailed field notes will be taken by HLN, and a summary will be provided to the project team for each meeting. Project Plan: After the site visit, the preliminary project plan will be revised to incorporate details related to the development of each section of the Plan. Develop Content: During this phase, HLN will implement the project plan, engaging VITL contributors and conducting research to inform its own contributions. Draft content will be edited and posted to the project website in real-time, as it is created, and VITL staff will be kept up-to-date by the HLN project manager via bi-weekly conference calls. Periodically, VITL staff will facilitate meetings to review draft content and provide feedback to HLN. Draft Plan and Feedback: As drafts of Plan sections are produced they will be presented via website to team members and feedback will be solicited. Final Plan: The final Plan will be presented to the legislature at the conclusion of this project.



5 Project Timeline The proposed schedule for the project assumes a September start date and a site visit scheduled during September or October. There are three widely attended health information technology conferences towards the end of September (NAPHIT, PHIN, and eHI), at which HLN consultants are attending and/or presenting, and the full HLN team is not available for a site visit September 14-29 and October 6-20. This provides only a few limited windows during which a site visit could occur before mid-October. If it is not possible to schedule the initial visit until late October, a series of conference calls will be proposed to get the project started prior to the visit, and the initial site visit will occur after October 20.

Sep Oct Nov Dec Jan Feb Mar Apr May Jun JulOrganize ProjectFirst Site VisitProject PlanDevelop Content - Phase 1Report to LegislatureIncorporate FeedbackDevelop Content - Phase 2Final PlanFollowup

2006 2007

A proposed schedule of tasks is detailed in the Gantt chart attached to the end of this proposal.



6 Project Staffing The organizational chart below identifies the key personnel who shall be assigned to accomplish the work required by this project and the lines of authority.

Noam H. ArztProject Director

Michael BerryProject Manager

Susan SalkowitzSenior Analyst

Ken LarsenSenior Architect

Additional Analystas required

SystemsProgrammer as

required

6.1 Project Management Dr. Arzt will serve as project director, responsible for all contract issues and ultimately for the quality and completeness of the deliverables. Michael Berry will manage the project team and be responsible for the day to day activities of the project team as well as the project schedule. As project manager, Mike is responsible for completing all administrative activities under this contract, including: ♦ Provide written, monthly status reports transmitted via e-mail and posted to the

project website. ♦ Participate in project status meetings (via conference call) to ensure that activities are

coordinated and proceeding on schedule. ♦ Ensure that all interviews and discussions are conducted in an appropriate manner,

and are documented as required. ♦ Ensure that all written deliverables and reports are prepared properly and circulated in

a timely manner. ♦ Ensure the overall quality and timeliness of all products, materials, and services

produced or delivered under this contract. Quality is of paramount importance to us. All design documents we prepare are reviewed by multiple individuals, including the project manager and company president.



6.2 Biographies of Key Staff The following are brief biographical sketches of the project team members and their roles on the project. The proposed team has worked together on a number of health information technology projects including the Blueprint CCIS Architecture project for the Vermont Department of Health. Noam H. Arzt, Ph.D., Project Director

A graduate of the University of Pennsylvania three times over, Noam brings a wide variety of skills and experience to bear on issues of technology in organizations. Through more than fifteen years of progressive management experience at the University of Pennsylvania, Noam understands how to develop, deploy and support systems on any scale. As a Senior Fellow and active researcher at Penn, Noam has served as principal investigator and senior investigator on Federal, state and foundation grants and contracts, including a current research contract in tele-dentistry funded by the National Library of Medicine, and a TOP (Technologies Opportunity Program, formerly TIIAP) grant funded by the Federal Department of Commerce. In 1997 Noam launched his consulting company, HLN Consulting, LLC, which has provided services and support to numerous public health agencies around the country, including the California Department of Health Services, the New York Citywide Immunization Registry, the New Jersey Department of Health and Senior Services, the Minnesota Department of Public Health, and the Rhode Island Department of Health. Dr. Arzt is a member of HIMSS, APHA, NAPHIT, HL7, and AMIA. He is actively involved in the Electronic Health Record (EHR) and National Health Information Network (NHIN) initiatives. A frequent speaker at national conferences on healthcare informatics and PHIN, Dr. Arzt brings a national leadership perspective to HLN’s work on this project.

Michael Berry, BSE, Senior Project Manager

A member of HLN’s management team since 2001, Mike Berry has led numerous consulting engagements related to health systems integration and emergency preparedness, communications, and response; as well as Regional Health Information Organization (RHIO) and Public Health Information Network (PHIN) architecture. His role as a health information technology consultant is built on a technical foundation of creating successful systems for public health clients. He has staffed and managed information systems projects for HLN in three states, ranging from web-based portals, to child health registries, to electronic health information exchange applications. He also created HLN's web-based project tracking and survey analysis software, proprietary tools used extensively across both public health and non-profit client engagements. Mike’s public health informatics work includes a special focus on systems integration and person-matching technologies for immunization registries and other public health



systems. He has presented on these topics to the National Immunization Conference, the Immunization Registry Conference, and to the members of the Integrated Child Health Information Systems Community of Practice. He has been actively involved with Public Health Informatics Institute (PHII) initiatives since 2005. In the private sector, Mike is consultant to Women and Infants Hospital of Rhode Island, advising and managing software development for the Early Hearing Detection and Intervention program there. He is also relationship manager for HLN projects at the University of Pennsylvania. Mike brings a deep technical understanding, as well as crisp written and oral expression skills to any project he undertakes. He holds a B.S.E. in Computer Science Engineering from the University of Pennsylvania.

Susan Salkowitz, MGA, Principal

Sue has a career of over 40 years in public service and consulting, having served for 32 years with the City of Philadelphia in various information technology roles, including Director of Health Information Systems, Philadelphia Department of Public Health: 1986 to 1993. Subsequently, she formed Salkowitz Associates, LLC and has consulted extensively in developing comprehensive business plans, including business systems planning and organizational and governance planning and financial forecasting in many program areas in non profit and public agencies. She has specific and current experience conducting business planning related to the assessment, operations and deployment of immunization information systems and is considered a national expert in this subject matter.

During the last 8 years, Sue has been principal consultant and subject matter expert for HLN Consulting, LLC immunization registry assessment and business planning projects for the California Department of Health Services, Kentucky Department for Public Health, Washington State and Seattle/King County Health Departments, the Philadelphia Department of Public Health, and the New Hampshire Health Department. In addition, she served as senior consultant to the VDH Blueprint Project. In all of these projects, she has drafted the recommendations and plans for deployment in public health and private provider settings, defining roles and responsibilities of various stakeholder groups including the health departments, health insurance plans, hospitals, various non-profit organizations and professional societies, coalitions and consumers. She has worked on plans for incorporating registries into other public and private health information systems, including those of other vendors working in this space and university and foundation supported systems. In WA, she also coordinated the deployment planning with an outside marketing company contracted with the state. Since the beginning of 2004, Sue is also assisting the NYC Immunization Program in updating their strategic plan for their registry with specific emphasis on activities with health systems and provider offices.



Sue is an Adjunct Senior Fellow, Leonard Davis Institute of Health Economics, University of Pennsylvania, and an active member of APHA, AMIA, and HIMSS. She is a Board Member ex officio of the American Immunization Registry Association, where she served on the Programmatic Registry Operations Workgroup (PROW) and is also serving on the steering committee and as subject matter expert on the AIRA Modeling IZ Registry Operations Workgroup (MIROW). She serves as the AIRA representative to the Public Health Data Standards Consortium Board and the National Health Information Infrastructure and Electronic Health Record initiatives and was co-author of the October 2004 AIRA Snapshots special edition, A Perspective on the Next Generation of Connecting for Health - Immunization Information Systems and Electronic Health Records Initiatives Sue has presented widely on immunization registries and maternal and child health case management systems and record matching. As a consultant to the Public Health Informatics Institute Connections Community of Practice, Sue was the project manager of the Unique Records Workgroup which published the Unique Records Portfolio- A Guide to Resolving Duplicate Records in Health Information Systems, (PHII April 2006).

Ken Larsen, BS, MCSE, Solution Architect

Ken is a seasoned information technology professional and leader with over twenty years experience managing and supporting information technology projects. Ken has extensive experience working with managed care organizations (15 years with U.S. Healthcare and Aetna in IT as Project Manager, Director, Software Architect and Developer), which included a consortium of health plans exploring a nationwide health information exchange. As a senior IT consultant, Ken has successfully designed and implemented large scale distributed software systems for Health Maintenance Organizations, Health Plans, Defense Contractors, Pharmaceutical Informatics organizations, and Property and Casualty Insurance companies. Ken has managed multi-million dollar project budgets for Fortune 100 companies and is known for delivering cost effective, successful software solutions that streamline operations and increase revenue. Clients include Aetna Inc., Lockheed Martin Corporation, IMS Health, U.S. Healthcare Inc., and Reliance Insurance Company. Most recently, Ken was lead architect on HLN’s Vermont Blueprint engagement, and has led the technical development for a variety of projects related to Rhode Island KIDSNET, an integrated child health information system. He also served as technical lead on the All Kids Count PDA Application, developed to support immunization registries in six jurisdictions. Ken has a proven ability to excel as a solution architect, a programmer, and an analyst, with skills from requirements solicitation to programming to deployment.

In addition to the core project staff, HLN will supplement the team with additional consultants as needed. Ruth Gubernick, for example, has served as a subject matter expert on HLN projects for nearly ten years, utilizing her experience with technology in



provider settings, her laboratory background, and her involvement in health initiatives spanning public health, hospitals, and private providers.

Ruth Gubernick, MPH, BS MT (ASCP), Specialist

Ruth’s consulting work with the American Academy of Pediatrics (AAP), National office and the NJ Chapter’s Pediatric Council on Research and Education (PCORE), has focused on office-based system changes, including the successful integration of technology in the primary care setting. As a Program Director and Quality Improvement Advisor, Ruth works closely with both private and public pediatric and family medicine health care providers, both physicians and their staff, to improve their delivery of preventive child health care and chronic care management in their practice. She has also worked as a consultant with the NY State TIPPs (Target Improvement in Immunization Practices) staff and their participating offices, hospital-based ambulatory care practices and community health centers. Ruth has both public health and clinical laboratory experience. She began her career as a clinical Microbiology Technologist at the Hospital of the University of Pennsylvania (HUP) and while Section Chief for Antimicrobial Susceptibility Testing, she instituted the first automated testing system. She later worked as the Supervisor of the Diagnostic Lab in the Health Services Dept. at Perdue Farms, Inc., Salisbury, MD, where she supervised all laboratory procedures. At the Camden County (NJ) Dept. of Health and Human Services, Ruth worked in the Communicable Disease Unit, conducting investigations, inspections and surveys pertaining to disease reporting, control and prevention. She later served as the Dept.’s MCH Unit Director for the Immunization, WIC and Improved Pregnancy Outcome programs. Working part-time, she became the County’s Program Coordinator for NJ LINCS (Local Information Network and Communications System), as well as NJ FamilyCare (SCHIP). While the LINCS Coordinator, she organized and chaired the first countywide emergency preparedness planning committee. A graduate of the University of Pennsylvania and Rutgers University/UMDNJ, School of Public Health, Ruth is also licensed as a NJ Registered Environmental Health Specialist and a Health Officer. She is active in numerous local and national organizations; a member of AIRA and APHA (American Public Health Association), an Executive Board member of NJPHA, a Board member of the Southern NJ Perinatal Cooperative, a regional MCH Consortium.

6.3 Project Communication and Collaboration HLN fosters a collaborative environment both within its own project team and with clients. We believe strongly in the appropriate use of technology to enable collaboration and support team activities in our busy professional lives. For this project, HLN will manage collaboration and communication through the use of the tools described below:



Email Distribution Lists: We will create a series of distribution lists, hosted on an HLN server, to support project collaboration. We encourage all project participants to use the email lists to ensure that the right information gets to the right people. The HLN team will use these lists to actively disseminate information to the appropriate groups even in cases where the information is posted on the project website from which individuals can pull down information at their convenience. We find that using a combination of “push” and “pull” techniques ensures that project participants have all the information when they need it and when they want it. Archives of messages that are sent to the email distribution lists can be maintained on a secure, password-protected website so that individuals never have to worry if they have difficulty locating a message that they received in the distant past. Project Website: The project manager will maintain a password-protected project website as a repository of all relevant project materials. This will include project management materials (e.g., project schedule, meeting agendas, meeting notes), project deliverables (e.g., visioning documents, assessment reports), and links to other resources. The project website will evolve as the project progresses and will be accessible to all individuals whom VITL chooses to give access to. Attachments that are distributed via email distribution lists, and documents that are utilized during web conferences or referred to in the project tracking system, are very often posted on the project website. Web Conferencing and Teleconferencing: HLN hosts a web conferencing service which can be used to conduct stakeholder meetings and is encouraged for use in conjunction with all teleconferences during which it may be helpful to visually share documents during a meeting. This enables all web conference participants to literally be on the same page at the same time. This service provides the full range of standard web conferencing features such as desktop sharing, application sharing, white-boarding, polling, etc. Secure Web-Based File Sharing: For secure file exchange between HLN staff and client staff we provide a web-based file repository for team members. This repository allows secure file transfer using a simple web browser, encrypted using SSL, and storage of the files on an HLN server. User accounts are secured by username/password authentication, and users can be authorized for individual or group (shared) folders. Collaborative Authoring: HLN has experience with web-based collaborative authoring solutions ranging from a simple website maintained by an editor, to a Wiki, which is a website that allows users to edit content. Specifically, HLN has experience with MoinMoin4 Wiki software, which can be deployed on an HLN server for VITL’s use.

4 http://moinmoin.wikiwikiweb.de/



8 References Amy Zimmerman Branch Chief Rhode Island Department of Health Children’s Preventive Services Providence, RI Voice: 401/222-5942 Email: [email protected] Amy Metroka Director, Citywide Immunization Registry New York City Department of Health and Mental Hygiene Bureau of Immunization New York, NY Voice: 212/676-2319 Email: [email protected] David Ross Director Public Health Informatics Institute/Taskforce for Childhood Survival and Development Decatur, Georgia Voice: 800/874-4338 Email: [email protected] Arthur J. Limacher, Jr. Chief of Information Technology & Services Vermont Department of Health Agency of Human Services 108 Cherry St. Burlington VT 05402 Voice: (802)863-7294 Email: [email protected]



9 Appendix A: Scope discussion Some preliminary thoughts on the scope questions raised by Jim Hester are listed below. This content is based on a conversation between Mike Berry and Greg Farnum on September 6, 2006 which was conducted to explore our ideas related to the scope of the Plan and get feedback from VITL. Ultimately the decisions related to these scope questions will be made with group input as part of the project itself.

1) Time frame: short term (1 yr.), intermediate term (3-5 yr.), long term (10 year), or some mix of the three?

We expect the plan to be relevant for the intermediate term (3-5 years), keeping in mind that the level of technical detail must be managed in order for the plan to stay relevant beyond a short timeframe. As Andrea Lott mentioned, a plan with too much technical detail will need to be constantly revised as the technical detail stales.

2) Geographic detail: Will the plan look only at the state as a whole, or will it have

some geographic detail? If the latter, what basis will we use for dividing up the state, e.g., hospital service area, county, other?

The Plan will be Statewide in scope, though some geographic focus may be present especially related to projects in Sections 6 and 7, such as sites for the VITL Medication Pilot and provider sites involved in the Blueprint. Specific investments in local communities will likely not be a part of the Plan and instead relegated to the state Department of Information and Innovation (DII).

3) Health care sectors: What specific health care sectors will the plan focus on? Beyond the obvious – acute care, physician, diagnostic, medications – will it include sub-acute services such as nursing home and long term care, the full range of behavioral health services, home health?

We see the Plan as evolving over time to be applicable to all the sectors mentioned without getting bogged down in detail within those sectors. We want to preserve our investments in technology today and support migration efforts over time. As systems are replaced, the goal is to have standards in place that should be adopted. It is important for the Plan to consider legislative priorities, especially chronic care, Medicaid, and the adoption of electronic medical records for the purpose of reducing costs and medical errors.



One component of the Plan that we expect to resonate well with VITL participants and the legislature is the concept of a patient centric plan – IT-focused, but patient centric – and in any one of those settings (acute care, physician, diagnostic, etc.) the things that are important to make it patient centric are similar.

4) Baseline assessment: will we attempt some form of current inventory health information technology and capabilities in the state? If so, what kind of geographic detail

A full assessment of the state of Vermont Health IT would extend the scope of the Plan to the point where the level of effort to conduct the assessment may dwarf that of the rest of the Plan. We also feel that it is important to not begin the development of the Plan on an assessment footing, which may alienate some stakeholders fearing a critical evaluation. On the other hand, some level of assessment is needed to provide recommendations, and will also feed any financial model forecasts which the legislature may be seeking. Our strategy is to leverage the assessment work currently being done by Hans Kastensmith to provide this basis in our Plan. HLN will meet with Mr. Kastensmith early in the project to understand the scope of his assessment and to explore the degree to which it could be referenced in the Plan.

5) Benchmarking with other states/regions: to what degree will we put Vermont’s

status/issues in a regional/ national context?

Exploring planning efforts in other states will be a part of the process to develop the Plan. The degree to which implementations in other states are used as benchmarks and written into the Plan is yet to be discussed with VITL.

6) Classes of health information infrastructure to be included a. Telecommunication capability: T-1, high speed internet? b. Data standards and protocols c. Database architecture and standards d. Other

Database architecture and operating system standards are typically not within scope of an HIT plan. One of the goals of health information exchange is that organizations with differing standards in this area can communicate with one another because of common data standards and protocols. For this reason, data standards and protocols are firmly within scope. Telecommunications capability



is likely to be a part of any discussion related to the deployment of electronic medical records (See #7, below), but we expect any recommendations in this area to be high level, deferring to the state plan for telecommunications and DII for low-level recommendations.

7) Diffusion of electronic medical records: will we address the issue of how to

accelerate the diffusion of EMR into hospital and physician practices in the state? For example, identifying barriers, recommending goals and strategy by geographic area? Will it address options to practice based EMR, such as individual ‘smart cards’?

Our expectation based on discussions with VITL leadership is that this is a part of the plan that would be handled primarily by VITL, with some input from HLN.

8) Privacy issues and approaches

As mentioned in the proposal, some of the topics related to privacy and confidentiality will require decision making in both scope and content which may require participation from stakeholders to reach a consensus. Options will be explored, especially through the presentation of examples from other states.

Vermont is an RTI state (meaning that it has signed an agreement with RTI International to join a national effort – under the ONC umbrella – to address privacy and security issues related to health information exchange), and an important part of the Plan development process will be to determine where the plan and the RTI efforts intersect. State-level interim assessments are due to be completed by Fall, 2006, and the RTI project completion is targeted for March, 20075. HLN will ensure that the Plan is developed in collaboration with the RTI efforts.

9) Education plan

Discussion related to whether the development of the Plan would include educational and outreach efforts occurred during the VITL Standards and Architecture meeting in August, 2006. The consensus of the group was that the Plan would propose educational efforts but that the implementation of those efforts is out of scope for this project. As for the Plan, HLN expects that substantial input on Section 2 will be solicited from the Education and Awareness Committee.

5 RTI International News Release. August 2, 2006. "34 States, Territories Join National Health Information Security and Privacy Collaboration." http://www.rti.org/newsroom/news.cfm?nav=7&objectid=BCE53731-9277-4FF2-B3A70BBBAB6B1E82



10) Implementation plan and structure: Phasing/priorities for implementation. Role of VITL relative to other organizations in the state for actually implementing the plan and creating the infrastructure? Role of regulators, e.g. CON process and possible new legislation.

11) Financial plan: For example, business model for sustained financing of operations and projected capital needs for development over short, medium and long time frame.

Based on discussions with VITL, implementation planning seems to be divided into two categories: one for the EMR deployment (#7, above), and another for the rest of the components of the Plan. By the same token, a financial plan may be divided into “funded” and “unfunded” plans. One idea that has been discussed is to have a financial model that is incremental. For example, a model that proposes a certain percentage of the practices across the state will be up and running by a certain date. This way we can present a set of finite numbers incremental to the needs of the legislature.



10 Appendix B: Gantt Chart (See following page)

ID Task Name Finish

1 Organize Project Fri 9/29/06

2 Contracting Fri 9/22/06

3 Conduct kickoff teleconference Mon 9/25/06

4 Establish project team Fri 9/29/06

5 Deploy project website Fri 9/29/06

6 Site Visit and Followup Tue 10/31/06

7 Site visit Tue 10/31/06

8 Deploy web-based collaboration solution Fri 10/6/06

9 Conduct interviews Tue 10/31/06

10 Revise project plan Mon 10/2/06

11 Monthly Status Report Mon 6/4/07

21 Develop Content - Phase 1 Tue 12/26/06

22 Create scope document Fri 10/6/06

23 Develop base outline Fri 10/20/06

24 Make preliminary assignments Tue 10/24/06

25 Base section content Tue 11/21/06

26 Introduction and Background draft Tue 11/21/06

27 Category 1 (Sec 1,3,8) presentation and discussion Tue 11/28/06

28 Category 2 (Sec 2,4) presentation and discussion Tue 11/28/06

29 Category 3 (Sec 6,7) research Tue 12/19/06

30 Category 1 draft Tue 12/26/06


32 Report to Legislature Tue 1/2/07

33 Develop Content - Phase 2 Tue 4/17/07

34 Category 1 final Tue 2/6/07


36 Category 3 presentation and discussion Tue 1/16/07


38 Category 4 draft (Sec 5) Tue 2/27/07



41 Final Plan Fri 6/29/07

8/13 9/10 10/8 11/5 12/3 12/31 1/28 2/25 3/25 4/22 5/20 6/17 7/15September 1 November 1 January 1 March 1 May 1 July 1

Task

Split

Progress

Milestone

Summary

Project Summary

External Tasks

External Milestone

Deadline

Page 1

Project: VITL - HIT Plan (Draft)Date: Tue 9/12/06

Project Proposal - HLN

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