Florida Health Information Systems Council

Minutes, March 29, 2002

Membership: (§381.90, F.S.) 
The council shall be composed of the following members or their senior executive-level designees:
Secretary of the Department of Health (DOH) 
Director of the Agency for Healthcare Administration (AHCA) 
Attorney General (AG) 
Secretary of the Department of Business and Professional Regulation (DBPR) 
Secretary of the Department of Children and Families (DCF) 
Secretary of the Department of Corrections (DC) 
Commissioner of Education (DOE) 
Secretary of the Department of Elder Affairs (DOEA) 
State Treasurer/Insurance Commissioner (DOI) 
Secretary of the Department of Juvenile Justice (DJJ) 
Executive Director of the Correctional Medical Authority (CMA) 
Two Representatives of County Health Departments (CHD) 
A Representative of Florida schools of public health chosen by the Board of Regents (BOR) 
A Representative of the Florida Association of Counties (FAC) 
A Representative of the Florida Healthy Kids Corporation

Council Members in Attendance:

Robert Anderson, representing the Attorney General’s Office
Donald Bennett, representing the Correctional Medical Authority
Gary Bunt, representing Putnam County Health Department 
George Hinchliffe, representing the Department of Juvenile Justice
William P. “Bud” Johnston, representing the Department of Elder Affairs
Linda Nelson, representing the Department of Health
Rich Robleto, representing the Department of Insurance
Lori Schultz, representing Department of Children & Families
Carolyn Turner, representing the Agency for Health Care Administration
Rod Westall, representing the Department of Corrections

Council Members Absent:

ee Cornman, representing the Department of Business and Professional Regulation
Lisa Gill representing the Florida Healthy Kids Corporation 
Dr. Michael Graven, representing University of South Florida, College of Public Health
Dr. John Heilman, representing Pinellas County Health Department 
Cretta Johnson, representing the Florida Association of Counties
Ron McCord, representing the Commissioner of Education

Others in Attendance: 

Linda Brady (DOH)
Mike Gardner (DCF)
Amy Jones (DOH)
Becky Lyons (DCF)
Allen Pearman(DOH)
Kathy Reep (Florida Hospital Association)
Kim Shafer (DOH)
Andrea Slapion (DOH)
Kim Streit (Florida Hospital Association)

 

I. Call to Order and Welcome: 
Linda Nelson called the Florida Health Information Systems Council meeting to order at 2:00 pm and welcomed participants.

II. Roll Call: 
A formal roll call was conducted and attendees identified themselves and the organization they represented. Attendance is reflected above.

III. Approval of Minutes:  The minutes of the Florida Health Information Systems Council meeting held December 17, 2001 were reviewed. Upon a formal motion and second, the minutes were approved as presented.

Allen Pearman commented that members reviewing the action items should note that we talked about preparation of a side-by-side comparison of statutory provisions for this council and the State Technology Office. This is not viewed as part of the meeting minutes just approved but to direct attention to the comparison.
note that we talked about preparation of a side-by-side comparison of statutory provisions for this council and the State Technology Office. This is not viewed as part of the meeting minutes just approved but to direct attention to the comparison.

 IV. Bio-terrorism Planning: Agency coordination and information requirements: 
Linda Nelson presented a brief summary prior to the arrival of our guest presenter, Rhonda White. The Governor, FDLE, DOH and other agencies have charged Dr. Agwunobi with the health portion of state’s bio-terrorism planning. The Department of Health has contracted with a third party to go into the field, at the local level, and do a needs assessment and develop regional plans. $46 million dollars has been allocated to the state.

Upon her arrival, Rhonda White commented on activities related to bio-terrorism planning and preparedness. The first activity involves domestic security planning with the other agencies in Florida and our community partners through the domestic security task force and the seven regional task force under the direction of FDLE that were established after September 11, 2002. Each regional task force has a health and medical subcommittee; and six of the seven subcommittees is chaired by public health department directors and co-chaired with a sheriff in the regions. Happenings with health and medical have taken the lead on pulling together the state plan for domestic security. The Department of Health has contracted with the University of South Florida and Deloitte Consulting; and together they have done a needs assessment with health partners, hospitals, physician groups, and other community health partners who would participate with DOH in any response. The regional planning process is actually larger than bio-terrorism; it is terrorism in general. The Department of Health has the lead on bio-terrorism. 

The second activity that is happening simultaneously is that the federal government has awarded the first portion of grants to the states for domestic security that is to be used for public health preparedness and hospital preparedness for biological events. The Department of Health (DOH) is working on the grant applications for this money. The Center for Disease Control (CDC) has the lead for public health preparedness, and they awarded Florida $40.5 million dollars. DOH has also been granted access to $6.6 million of this funding. DOH will use the “Regional Needs Assessment” funding to assess the regional needs and roll those into the categories of allowable funding in the grant. In the CDC application process, the Department of Health will present the two applications to the Governor his required endorsement. The applications are due to CDC and Health Resources & Services Administration (HRSA) on April 15, 2002. Final awards are expected by May 15, 2002. The Department of Health will be developing information sharing components in the CDC grant. The department’s focus is to be able to recognize a biological agent, ability to report it, ability to respond to it, and ability to mitigate any type of public health implications that it might have. Significant portion of the funding is earmarked for the training component for DOH staff and public health provider partners. The other important part is ability to share critical confidential health information in a predetermination phase. 

A major initiative focuses on developing the ability to connect directly to our hospital providers, emergency room physicians, and infection control staff. Allowing them to report a pre-validated event that is suspect to them and ability to connect by telephone 24-hours of the day is important. EpiCom is modeled after the national system, Epidemic Information Exchange (Epi-X) that connects all of public health nationally to the state level. EpiCom will move the department from the state level of connectivity to the individual provider level of connectivity within Florida. As a provider in a hospital or physician’s office in this system, there is ability to report and share information back and forth as the lab work is completed and information is received. This connectivity will allow reporting of diseases electronically. There is also some funding for pilot projects for communication across providers.

At this time reportable diseases are sent to us in a variety of ways, none of which are electronic. The electronic lab reporting project will allow private labs to submit reportable diseases electronically, and will reduce the follow-up time from the point at which a lab is confirmed and when the investigation is done.

Currently laboratories report to the county health department in the jurisdiction of the provider. At this time, labs are sending hard copy information as opposed to sending a file once a day. Confidential information cannot be sent by e-mail unless it is encrypted on both ends. Department of Health does not have this capability with lab reports. 

The standard concerning security was discussed. Our internal Department of Health 

V. HIPAA Status Report and Update: Privacy Regulations: 
Linda Nelson presented a brief summary before our guest, Amy Jones, arrived. There have been some changes regarding the privacy rule. Amy Jones, Director of Medical Quality Assurance, has put the side-by-side together of Florida Rules versus HIPAA compliance. Allen Pearman addressed the 40- page briefing. The rule changes consisted of 41 pages in the Federal Register published March 27, 2002. The link sent out would take you to the page that had a press release from the HHS secretary and a link the 41- page publication of the changes. The change would eliminate the need of written patient consent for providers when they need to share protected health information for treatment, payment and operations. There were issues in terms of the administrative difficulty in the way the rule was previously drafted. This is a loosening of the previously published rule in terms of that requirement. The rule also appears to provide greater latitude in giving payers and providers the ability to share health information for payment and operations.

Linda Nelson then recognized Amy Jones. Ms Jones is currently the Director of Medical Quality Assurance. She briefed us on the HIPAA issues and their alignment for privacy that is key to information sharing within our agencies. She discussed confidentiality issues in the private sector and HIPAA. After that comparison, a great number of statutes and functions were identified that Department of Health perform that were exempt from HIPAA. Department of Health is in the process of drafting exemption requests for HHS. The proposed privacy rule changes that came out this week may require that the department’s exemptions request be modified. An example of one of these exemptions is recording diseases for public health surveillance. This exemption would be applicable to both public health providers and all the private sector providers who are required to report occurrence of disease. It is the intent of the Department of Health to share the exemption request with the representatives of the private sector who have an interest in this issue. Ms Jones further committed that specific efforts will be made to share the exemption request with industry representatives such as the Florida Hospital Association prior to submission.

Linda Nelson then moderated questions from callers.

Will Department of Health be able to maintain quality assurance efforts and programs at the state level? Yes.

How is this being coordinated at the state level, such as with the state legislative budget commission? The bulk of the health information is in the Department of Health and in the Agency for Health Care Administration and to a lesser extent in Juvenile Justice, Department of Children and Families and some other agencies. Under current state law agencies may share confidential information without special consent or permission when it is within the same treatment protocol or to ensure continuity of care. This change in HIPAA privacy rule makes HIPPA regulations more consistent with state law. 

When does the Department of Health plan submit the exemptions request? The original plan was forward the request to the Governor’s Office in April. These changes HIPPA privacy rule may require modifications in the exemptions request.

Linda Nelson asked whether or not we are asking for a waiver for an extension for a year on transaction codes, and whether the chief executive officer of the state needs to make this request on behalf of everybody? Ms Jones indicated that each agency is on its own. All requests, however, must be made through the Governor’s office

Linda Nelson asked if the changes in the relaxation of the privacy rules affected the privacy regulations implementation date? No, and no modifications in effective dates are anticipated at this time.

Extent to which Correction Departments are exempt from HIPAA regulations was discussed. It is unknown as to whether privacy modification will effect Corrections unless it is with other agencies after inmates move out of correctional facilities and into care situations with the Department of Health. It will simplify exchanges like this. There is no determination that Correctional Departments are exempt.

Kathy Reep of the FHA commented they have just completed preemption analysis of all of the Florida Statutes and regulations relating to confidentiality and patient record. They did analysis on provisions relating to the Department of Corrections. In most instances we found that the current guidelines are not preempted. She offered to share more detail of the analysis with the council staff. Ms Jones indicated willingness to share the DOH analysis with others to facilitate a comparison of results.

VI. FHISC Strategic Plan Revisions and Update:
Allen Pearman introduced this topic by noting that the FHISC is required to review and revise the Strategic Plan annually. The deadline for the revision is June 1, 2002. The submission is made to the State Technology Office. The State Technology Office is also the body that, in consultation with the Governor’s Office, as well as certain legislative committees, develops the requirements in terms of format, content, and etc. The key point is that we will need to proceed with the review and revision process on a timeframe that would permit the council to meet the June 1, 2002 deadline. At this point, there is no information that there will be a delay in that deadline. There are a few issues that need to be addressed such as the bio-terrorism issue and sharing of information under that set of conditions. Some developments over the past year need acknowledgement in the report such as the actions that AHCA had taken to develop a catalog of health information sources, and the fact that the information is available online for the public and other members of state government.

Linda Nelson recommended that weekly conference calls on strategic plan revision be scheduled. Upon a formal motion and second, a scheduling of weekly conference calls was approved.

VII. Summary on Status of the HIPAA Rule Adoption and Implementation of Agency Plans: 

Allen Pearman asked participants about status or comments regarding steps being taken by agencies to meet HIPPA requirements. George Hinchliffe from the Department of Juvenile Justice commented that his department has setup an interdepartmental team to oversee the implementation of the HIPAA requirements. Their contract documents regulate providers, as they do not do rules. They do not regulate people outside of the department. The provider is the department’s agent, and the department is the covered entity. The obligation falls to the Department of Juvenile Justice to ensure that the standard is met.

Mike Gardner (DCF), another participant, stated that the General counsel of his department has interpreted a covered entity as that, within the department, any program funded by Medicaid in whole or part that provides medical care would be considered a covered entity. A request for the information he referenced was made.

Allen Pearman asked Carolyn Turner (AHCA) to follow-up with someone in AHCA on the status of steps being taking by Medicaid and review of HIPAA impacts on the activities of the State Center for Health Statistics. 

VIII. Review and discussion of charge to council informal workgroup to address issues related to data extraction and merging for state sponsored projects: 
Allen Pearman noted that the first meeting of the previously authorized informal workgroup had yet to be scheduled. The chair suggested that meeting locations for the workgroup rotate among member locations. Volunteers were solicited and Bud Johnston offered to host the first meeting of the workgroup at the Department of Elder Affairs.

IX.  Health Data Reports
Status Report on Specific Health Data Sharing Efforts between State Agencies
(Open Discussion)

Bud Johnston (DEA) reported that the Department of Elder Affairs and the Department of Children and Families deal with adult protective service referrals. There is a requirement to track referrals and provide services within a certain timeframe. There have been many problems over the years as it is a manual process. There is now a data sharing process between the two departments. 

Allen Pearman stated that information on Bill 1276 would be shared with the council members. Another bill (SB 668) that passed created a study commission on public records. It focused on the counties and their release of public records. When records are recorded it is common that personal identifying information gets on the documents. 

Linda Nelson commented that there is a need to review data sharing at the federal level and local and private sectors consistent with the statutory charge made to the council by statute.

X. Other Business: 
There being no other items to bring to the attention of the council. 

XI.  Adjournment:  A motion was made and seconded to adjourn.  Without objection, the meeting was adjourned at 4:00 p.m.

Summary of Pending Action Items:

Summary of Pending Action Items:

1. Take steps necessary to schedule initial meetings of FHISC workgroup to address issue related to data extraction and merging for state sponsored projects and similar issues that might be addressed by formally establishing and maintaining health related analytical data sets. Coordinate with the Department of Elder Affairs to schedule first meeting at their work site.

2. Schedule weekly conference calls to consider revisions to the FHISC strategic plan. Revisions are to be completed, approved by the council, and forwarded to the State Technology Office on or before June 1, 2002

3. Distribute copies of SB 1276 and SB 668 with associated legislative staff analysis to council members and interested parties