Florida Health Information Systems Council

Minutes, May 22, 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:

Linda Nelson, representing the Department of Health
JoeAnne Hart, representing Florida Association of Counties
Debra Gressel, representing the Agency for Health Care Administration
Dr. Michael Graven, representing University of South Florida, College of Public Health
Rich Robleto, representing the Department of Insurance
Lori Schultz, representing Department of Children & Families

Council Members Absent:

Rod Westall, representing the Department of Corrections
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
Lee Cornman, representing the Department of Business and Professional Regulation
Lisa Gill representing the Florida Healthy Kids Corporation 
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)
Allen Pearman(DOH)
Kathy Reep (Florida Hospital Association)
Richard Schmitt (Technology Review Workgroup)
Kim Streit (Florida Hospital Association)
Becky Lyons (Department of Children and Families)

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. A quorum was not established. Attendance is reflected above.

III. Approval of Minutes: The minutes of the Florida Health Information Systems Council meeting held March 29, 2002 were reviewed. Approval of the minutes was tabled until the next meeting due to lack of a quorum.

Allen Pearman determined that SB 1276 and HB 1679 needed to be distributed to members. For purposes of this meeting we will carry Action Item Number 3 until the next meeting.

IV. FHISC Strategic Plan Revisions and Update: Council Review and Approval – Allen Pearman 

Linda Nelson presented the revision and the changes adopted for the Strategic Plan and a staff summary of the changes. Linda Nelson also proposed two technical changes that provided language that is more consistent with the language that has just emerged out of this Legislative session.

Allen Pearman then reviewed proposed modifications and referenced page numbers on what he called “the unmarked up copy” of the Strategic Plan that includes some additions that were not in earlier versions. The first of two additions had to do with the addition of the summary of the changes to the Strategic Plan that are proposed The second addition was a technical change to the endnotes to give proper credit to quotations that were added with respect to the impact of bio-terrorism on the sharing of health information system security. Instructions that have been provided by the State Technology Office were also included in the packet. The basic changes that were proposed begin in the Executive Summary (marked up copy) with changes to update the period of time that the Plan is to address. It added language with respect to the addition of a third Strategic Issue that had been previously discussed for inclusion in the Strategic Plan. 

In further reference to the “marked up” version, Mr. Pearman stated that he included the Performance Review Standards on a section-by-section basis. These are the standards that the State Technology Office will utilize in reviewing the Strategic Plan. There are ten (10) items that were identified as major or significant changes to the Strategic Plan. 

Strategic Issue number 3 has been added to the Table of Contents. 

The first changes, in terms of language, would begin on page 7 of the unmarked copy, page 6 of the copy with strikethroughs and underlines. This is additional language with respect to the impact of bio-terrorism threats on data standardization, collection, and sharing. In particular, observations made by Dr. Claire Bloom, Senior Advisor to the Director of the Center for Disease Control and Prevention, Department of Health and Human Services are being used. 

On page 9 of the unmarked copy and page 8 of the marked copy, language with respect of the extension of the HIPAA transaction deadline is explicitly acknowledged in this background information.

The next change on page 10 of the unmarked copy and page 9 of the marked copy which is to modify Strategic Objective to reflect the extension of the HIPAA standards. This is the emphasize meeting the October 16 deadline or having filed for a timely extension of the deadline for compliance with the standards.

On page of 10 and 14 of the unmarked copy, changes note that the Agency for Health Care Administration has established a HIPAA Web site which is consistent with or supports the previously identified council goal of trying to have a single site established for HIPAA. It was noted that this is a beginning and focal point for the sharing of information for HIPAA compliance.

The next item, which is on page 11, is an acknowledgement of the development of the State Health Data Catalog by ACHA’s State Center for Statistics. It is noted that this action helps to support the Council goals with respect to data sharing. 

The next item, on page 11, is a discussion of the impact of bio-terrorism on data sharing and coordination efforts. Again, this relies on some observations made by Dr. Claire Bloom.

The next item is the addition of the Strategic Issue regarding the sharing and coordination of use of analytic data tool systems and expertise.

On pages 13 and 14, and this is something that is continuously reviewed, statutory references have been updated to reflect current statutory languages on pages 16 and 17.
The effective date for compliance with the HIPAA privacy standards has been corrected, in two places, to April 14, 2003.

Debra Gressel pointed out that it should list Secretary rather than Director for AHCA on the Executive Summary page.

Linda Nelson proposed the following specific changes. On page 6, Introduction section, paragraph beginning, “In a memorandum to Vice President Al Gore…”, Dr. Agwunobi requests that it might be moved to the section speaking to Strategic 1, Trends and Conditions Analysis, page 7. This might be more appropriately a trending condition as it speaks to the beginning of these initiatives under the prior administration. On page 8, under the section Governor Jeb Bush, 1999, it speaks to the Chief Information Officer as opposed to the role and responsibility of the State Technology Office. Current legislative proviso speaks to coordinating with the State Technology Office. The recommendation is that the document references the State Technology Office in lieu of a reference to specific individuals. The proposal is to change references to the Chief Information Officer to State Technology Office whenever it occurs in this document.

Linda Nelson made reference to the table, Information on Related IT Projects, which is at the back of the document. She referred to the section on the table indicating Project Name. At the last council meeting, agencies spoke to what they were doing with regard to the HIPAA compliance. Shell language has been added that speaks to the Health Information Portability and Accountability Act of 1996 compliance, coordination of other agencies (such as AHCA, DOH, Department of Children and Families), and work towards strategic goal advocacy for state agency actions necessary to meet the HIPAA standards. It was suggested that there be some feedback through e-mail for inclusion in this table. The second project name refers to the passing into statute during the last session of the Legislature of Senate Bill 1276. This was the result of a direct work product of a request from Senator Silver. Multiple agencies worked together through the summer and fall to produce the recommendation that produced this legislation. This initiative was for eligibility and data sharing and should be reflected as a tremendous effort for computer data sharing.

Becky Lyons and Lori Schultz, Department of Children and Families, commented by telephone, that they agree that SB 1276 should be included. 

Linda Nelson stated that we are at a point where there are two things that must be done. We must identify the process whereby this document is accepted. Possibly a phone call should be scheduled as we must have a quorum to accept this document. Linda Nelson asked by affirmation whether or not there is agreement on these changes that she raised on behalf of Dr. Agwunobi. An official vote was not taken but there was agreement to proceed with the previously discussed modifications. 

Linda Nelson stated that scheduling a second meeting should be for the purpose of taking a formal vote to approve the modified Strategic Plan. 

Allen Pearman stated that we might schedule it as a telephone conference call, but it will be necessary to do appropriate notice. According to statute, the Strategic Plan is due June 1, 2002 and the schedule was to meet the June 1 deadline. Because of the delay in the distribution of the instructions for the preparation of the Strategic Plan, the State Technology Office expects the Strategic Plan on July 15, 2002. Linda Nelson wants the draft to be sent to the STO pending formal approval by the council, rather than acting upon a memorandum to supercede statutes. 

Lori Schultz and Becky Lyons commented that they are in agreement with this direction. They suggested a vote by e-mail if it does not violate any laws. 

Linda Nelson stated that by agreement and consent, if not by formal action, we agree to take the necessary steps to have a formal vote approving proposed changes. We will also prepare the draft so that it is in the hands of the State Technology Office by June 1, 2002. 

Allen Pearman confirmed that we would forward material to the STO that will be labeled “Pending Formal Approval by the Council.” Linda Nelson commented that this is technically appropriate, as we have had other examples of this proceeding in other councils.

Allen Pearman will attempt to schedule the conference call as soon as possible, but he will also try to poll the members to determine some alternative dates in order to assure a quorum so that we can take the final action that is needed.

Linda Nelson stated that we would make the technical corrections that are needed and conduct a final technical review before we submit the Strategic Plan on behalf of the council as an official draft on June 1, 2002.

Allen Pearman commented that consistent with the terms of Florida Statutes, we are now submitting a draft document. STO will review and comment and forward comments back to the council for consideration and possible action. There is the possibility that upon review by STO there could still possibly be further modification of the Plan. 

Linda Nelson stated the change in format triggered reorganizing the document. 

Absent a vote and quorum, the Agenda moved forward.

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

Linda Nelson commented that everyone had been asked to give a status and update of progress on these activities.

Allen Pearman mentioned that Debra Gressel had presented a handout. For those on the phone, Allen Pearman stated that he would forward a copy of the material that she has distributed to us. 

Debra Gressel identified herself as Administrator of the Office of Data Collection. She stated that she was asked to give an update on the Medicaid status regarding the HIPPA Rule. For compliance purposes, an Implementation Advance Planning document is in its final stages in the agency review process before being submitted to the federal government for approval. They have requested sole source approval to utilize ConsulTech, who is now ACS State Health Care, to minimize the remediation and to use their clearinghouse as the HIPAA translator solution. They are developing access databases for the EDIX 12 transactions. Members of Medicaid are participating in various workgroups of the National Medicaid HIPAA Group as well as other national projects. They have done many different things for the privacy rule-- completed a draft of recipient rights and information policy notice which is preparatory to the rulemaking process. They have completed an analysis of the state law and HIPAA and an analysis of state law regarding minors and HIPAA for MediKids. They have a contract with the language and tracking process for business associate contract amendments. They are working a lot with the privacy rule which is going into effect next April. They have also developed a HIPAA Policy and Procedures as well as developed consent and authorization forms. They have established a project management office. They have work plans, communication plans, and other issue plans. They have also completed staff awareness training within the agency which includes Medicaid and all of the area offices. The new employee orientation as been modified to include HIPAA. Additional funding was granted this past Legislative session. There will be $800,000 and an additional $800,000 at the 90/10 federal match for continuing the Medicaid Project Management office as for the special project monitoring assigned to the Legislature’s technical review workgroup. There will be three fulltime people who will be working with the privacy officer.

Regarding the extension for the transaction portion of HIPAA, Medicaid is planning to submit a compliance plan to the federal government as required for the deadline extension to October 2003. Because of this year’s size and complexity of the task to make the information system that Medicaid uses compliant, the need to develop workarounds to handle the omissions in the EDI transactions and codes as they relate to Medicaid business needs and the test and coordination with 80,000 providers and the convoluted nature of the privacy rule requirements. The additional time is crucial to successful implementation. 

Ms. Gressel then commented on other agency issues related to HIPAA. The data collection area that Ms. Gressel supervises will also be affected by HIPAA. It will be one to two weeks before her area will know exactly what their duties will be regarding this. Legal advice has indicated that they are not a covered entity, however, to do good business practices, they will be complying with privacy and security regulations. The depth of this compliance is still to be determined but should be determined within the next month. If any rule needs to be changed, the process can begin. 

Debra Gressel and Linda Nelson then asked for questions. Allen Pearman stated that what AHCA has decided to do with respect to hospital discharge data is one that may face other agencies. The agency or the particular program may not be a covered entity as far as HIPAA is concerned, but then there is the issue of dealing with confidential information or highly personal, sensitive information that is protected by statute. You may have issues in terms of how the information is released and whether or not it has, and this is HIPAA terminology, been
“de-identified” sufficiently for release. This may be an issue to be faced even if the conclusion is reached that the program is not a covered entity or that a particular set of activities are not covered by HIPAA; there are still issues that need to be addressed. 

Linda Nelson commented that specifically the question would be whether you are a covered entity or not, may not be the only issue to be addressed. It may be simply a “best” practice to implement the HIPAA privacy and security rules just for good measure.

Linda Nelson queried the council as to whether anyone else interpreted a more global position on the privacy and security issues. She commented that she thought that she had read that one of the agencies, possibly DCF, had made the decision that each were being taken individually and applying the rules. 

Linda asked Lori Schultz for confirmation as to whether or not this is the case. Ms. Schultz stated that they have received an interpretation on the status of their covered entities from the DCF legal counsel, but unfortunately, Mike Gardner (who has lead on this issue for DCF) could not be present at the meeting today.

Linda Nelson then requested information as to what other agencies are taking a more pro-active approach to interpreting the privacy and security rules.  Ms. Nelson addressed the Association of Counties as to how they have interpreted this compliance.  JoeAnne Hart commented that she has not dealt directly with any programs that they may have under compliance of HIPAA, but she is sure that there are some.

VI. Status report on the first meeting of the council’s informal workgroup to address issues related to data extraction and merging for state sponsored projects – Allen Pearman

Allen Pearman stated that there were a number of participants at the initial conference call meeting. He stated that they began to lay out the issues with respect to the possible need for analytic data sets that would help ease the process of data extraction in cases where we are engaged in state sponsored research or state sponsored program evaluations. Dr. Graven indicated that in terms of an action step that one of the issues that the group needs to consider is an actual process by which state agencies, in one sense, were surveyed with respect to their data structure, and how they were related to their need for analytic data. Dr. Graven had some thoughts on an education role. Dr. Graven observed his comments on the issue of analytic data structures and the need for review of the current agency data sets for all the agencies that have health related data came out of experiences as an academic type who was hired by contract by several of the state agencies to produce these periodic external review type reports for many of the federal programs. 

Dr. Graven stated that it takes time and research to determine what data are available and what could be done to convert available data to an analytical data structure. There are many assets available, but few that can be allocated to this task. He believes that Strategic Issue 3 is also important, and that a survey provides a basis for recommendation for some additional data structures that might be considered for some of the data that is housed in all of the state agencies. However, unless there are specific resource commitments by member agencies nothing will happen to address this issue.

Dr. Graven stated that his specific recommendation is that it needs allocated resources and commitment from the agencies before it can be done. Linda Nelson questioned as to whether we should be tasked as the council to develop a strategic effort and identify the resources and intended outcomes from that. Dr. Graven affirmed and again commented that in its absence means that it will not happen. 

As a result of previous discussion, Linda Nelson requested that council members look at Strategic Issue 3 and see if there is an actionable item that should be included; how it would be included in the document as it stands, or if modification of the document is needed to meet this recommendation.

Linda Nelson stated that it might be helpful to look within the council member’s agency and your entity to see if there are any metadata activities going on. The metadata is what is really needed as a first task; not the data. She stated that we should table this discussion and bring it up in a subsequent meeting. From there we can operationalize what we are going to do with this knowledge of our data that we have. What this element essentially raises is the issue of creating metadata tables at each of the agencies, entities, and associations for further use.

VII. Health Data Reports

Status Report on Specific Data Sharing Efforts between State Agencies

 Linda Nelson asked for updates on any new initiatives that are ensuing. Linda Nelson asked if any members are sharing data that is not obligated data sharing, such as reporting to the federal government. Our statutory charge includes addressing data sharing at state, local, and federal levels. The council has yet to address issues of vertical data sharing. 

JoeAnne Hart responded that she is not aware of any, but she believes that the Florida Association of Counties will be involved in SB1276 because they do have information referrals and group setups with existing counties. 

Linda Nelson asked that JoeAnne Hart report on data sharing between and amongst counties, county to state, and county to private entity at the next meeting.

Dr. Graven commented that there has been some sharing with federal agencies. There have been several efforts to coordinate with the Southern Command that is located in Tampa in order to compile a series of things, especially disease surveillance data.

Linda Nelson asked that Dr. Graven send information via, perhaps, e-mail as to whom we could contact for the purpose of getting information to the council. 

Debra Gressel commented that AHCA is mandated to give data to the cancer registry and the birth defect registry. AHCA also gives data to The Agency for Health Care Research and Quality in Washington. Recently, data has begun to be shared with the Department of Health for their Injury Surveillance project. A lot of the data sharing in the recent past and last six months has been with universities. Medicaid contracts with the University of Florida and University of South Florida look at pregnancy outcomes. Florida State University is looking at breast and prostate cancer. They are preparing a report to submit in Norway in July. USF has not gotten approved yet, but they are looking at mental health. 

Debra Gressel stated that they, the Office of Data Collection (AHCA), does a great deal of data sharing, but it must go through a confidential data committee and through the Secretary. Very few people will actually get confidential data. 

Linda Nelson inquired as to whether the formal committee reviews all of the AHCA data. Debra Gressel responded that it is just for their hospital, inpatient and ambulatory patients. 

Linda Nelson inquired as to whether other agencies have formal structures for data review for sharing. Dr. Graven commented that the Department of Heath has Vital Statistics. 

Lori Schultz mentioned FLORIDA and the data exchanges on that as an example. DCF has a FLORIDA management team of the agencies that are members of the FLORIDA environment. It is more of a case-by-case basis. There is the Investment Control Board that deals with the big issues when new things are being built that might consider information sharing. Sometimes this is a preemptive strike. 

Linda Nelson asked Rich Robleto, Department of Insurance, whether they have a formal process for data sharing for review. Mr. Robleto stated they have certain information that is shared with AHCA as part of some of the reports that they do such as consumer inquiries. There as just been a study as to what confidential information they have, and the accessibility of it. He has responded to a survey by the Inspector General regarding this.

Linda Nelson then asked Mr. Robleto whether they have a formal structure for review when a request comes in for granting. He responded that anyone can make a public records request for the files, and they do have an office for responding to those requests. 

Linda Nelson stated that there is another question that might be considered during one of the workgroup calls or at this actual forum. The question is how to approach the HIPAA requirement as to whether this becomes part of IRB request for waivers to Health and Human Services or under the auspices of our existing laws in Florida. At this point none of us are prepared to answer this, but it may be a question for future discussions or agendas. Reference was made to the comments of Amy Jones at our last meeting regarding these issues. Ms. Jones stated that even if we have a waiver for an exemption in the law, we still must submit for formally invoking that waiver to HHS.

In closing, Linda Nelson encouraged Dr. Graven to join the council in its endeavors.

At this point, Linda Nelson asked Dr. Agwunobi to join the meeting.

Dr. Agwunobi identified himself and noted that Linda Nelson is the formal Department of Heath designee and thereby Chair of the Council. He stated that he had been briefed by Linda Nelson today and in the past on the activities of this group and on the work on the Strategic Plan, and he sees that it has been the hard work of many people. He expressed his appreciation, and pledged his support for our council. 

VIII. Other Business: There were no other items to bring to the attention of the council

IX. 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:

1. Schedule 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 July 15, 2002. [Note: A draft Florida Health Information Systems Council Strategic Plan for Fiscal Years 2003-2004 through 2007-2008 was forwarded to the State Technology Office on May 31, 2002, to technically comply with the statutory deadline for submission of June 1. It was noted that due to an absence of a quorum, the council was not able to formally approve the revised strategic plan at the meeting held on May 24, 2002. Finally, it was noted that a telephone conference call had been scheduled for June 26, 2002 during which the council is expected to formally approve the draft forwarded to the State Technology Office.] 

2. Distribute copies of SB 1276 and HB 1679 (previously incorrectly identified as SB 668) with associated legislative staff analysis to council members and interested parties. [Note: Copies of the referenced material were sent (via e-mail) to council members and interested on April 11, 2002 and again on May 24, 2002]

3. The chair requested that council members look at Strategic Issue 3 and see if there is an actionable item that should be included in the strategic plan; how it would be included in the document as it stands, or if modification of the document is needed to meet this recommendation.

4. The chair requested that a representative of the Florida Association of Counties report on data sharing between and amongst counties, county to state, and county to private entity at the next regular council meeting.

5. The chair requested the each member agency review status of metadata activities within their respective agencies and report back to the council in a subsequent meeting.