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:
Jim Bracher, representing State Treasurer/Insurance Commissioner
Dr. Robert Brooks, representing the Department of Health
Dr. Michael Graven, representing University of South Florida, College of Public Health
Cretta Johnson, representing of the Florida Association of Counties
William P. “Bud” Johnston, representing the Department of Elder Affairs
John Laney, representing the Agency for Health Care Administration
Cheryll Lesneski, representing Putnam County Health Department
Becky Lyons, representing the Department of Children and Families
Jane McNeely, representing the Department of Juvenile Justice
Rod Westall, representing the Department of Corrections

Council Members Absent:
Robert Anderson, representing the Office of the Attorney General
Lee Cornman, representing the Department of Business and Professional Regulation
Dr. John Heilman, representing Pinellas County Health Department
Linda Keen, representing the Correctional Medical Authority
Rose Naff, representing Florida Healthy Kids Corporation
Commissioner of Education

Others in Attendance:

Wayne McDaniel, DOH
Carol McNally, Healthy Families Florida
Marie Melton, DOH
Allen Pearman, DOH
Linda Rackleff, BOR
Richard Schmitt, TRW
Rhonda White, DOH
Noel Witt, DOEA

I. Call to Order and Welcome: Dr. Robert Brooks called the Florida Health Information Systems Council meeting to order and welcomed participants.

II. Roll Call: In lieu of roll call, 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 July 28, 1999 were adopted with a correction to reflect Becky Lyons as the representative for the Department of Children and Families.

IV. Review Process to Ensure Cooperative Planning Among Agencies Collecting or Maintaining Health-related Data:

Dr. Brooks, in his introduction to this agenda topic, thanked the members of the FHISC workgroup who had participated in the development of the proposed review process for cooperative planning.

Allen Pearman provided background and summary information on the draft review process being presented to the council for approval. He noted that the proposed FHISC review process was developed as the result of two meetings of the workgroup established by the Council in July of this year. The process developed reflects the specific statutory language mandating the Council to establish a review process. The process reflects the “voluntary” nature of participation in the Council’s activities and relies on the continued commitment of staff resources by member agencies to the review process in order to meet the objective of facilitating the identification, collection, standardization, sharing, and coordination of health-related data activities.

It was further noted that Council needed to vote to accept workgroup recommendations or amend and then accept a review process, which will then be forwarded to the Legislature and Governor. The due date for the report on the review process is January 1, 2000.

Dr. Brooks opened the floor for questions and comments. During the discussion, Mr. Johnson emphasized the importance of developing data standards to support data sharing. Dr. Graven supported the importance of data standards in data sharing efforts but also emphasized the importance of data security and confidentiality issues as well. Efforts and development at the federal level were specifically noted as having significant impact on both data standards and data sharing efforts. There developed a general consensus that the issues identified during this discussion were best addressed in the Council’s strategic plan. Based upon issues raised during the discussion, the Chair directed that steps be taken to invite Roy Cales, the statewide Chief Information Officer, to the next Council meeting to seek his insight into the role of the Council in the development of an enterprise wide information technology strategy.

A discussion of the role in the Council in the review of budget proposals and monitoring of health-related bills filed in the legislature followed. The Council agreed, through a formal motion, that the Council Chair seek further guidance as to its role in providing useful input to the legislative process. Specifically, the Council Chair will have staff prepare for his signature a letter providing background information on the council and its activities and possible roles that the Council might play in support of the legislative process. The letter would then be sent to the chairman of the major budget and substantive health related committees of the House and Senate.

Discussions of the draft review process resulted in the adoption through consensus of three modifications to the document as originally presented. The first modification is to the introductory portion of the document and would explicitly acknowledge that the primary focus of the council is on health-related data collection and sharing. The council considers technology issues only to the extent that they positively or negatively support health-related data. The second modification would explicitly acknowledge that other governmental agencies might forward planning and budget related documents to the Council as part of the effort to ensure cooperative planning among agencies. The final modification would specifically note that the Council’s chair has the prerogative to appointment ad hoc workgroups to address cooperative planning issues in addition to those resulting from a member request.

A unanimous vote adopted the Florida Health Information Systems Council review process as amended. Staff was directed to incorporate the changes adopted, formally format the report, and prepare a transmittal letter for Dr. Brooks signature by January 1, 2000.

V. FHISC Strategic Plan:

Mr. Pearman noted that the revised FHISC Strategic Plan is due March 1, 2000. He stated workgroup participants have been identified and meetings will be scheduled for January and February The Strategic Planning Workgroup will meet during the second week of January and the first week of February. A Council meeting will be scheduled for the week of February 14, 2000. Additional volunteers are encouraged and welcomed to attend these workgroup meetings.

VI. Status Reports on Specific Data Sharing Efforts Between State Agencies :

Department of Children and Families & Department of Health (CMS)

Marie Melton presented a status report on steps taken to reduce barriers that exist at State level that hampered coordination and integration of Healthy Start and Healthy Families client information at the local level. Steps have been successfully taken to permit the sharing of screening information between the two programs. (A written report, which served as the basis for Ms. Melton’s comments, is included as an attachment to these minutes.)

Board of Regents & Department of Health (MQA)

Allen Pearman reported that as directed, Council staff has taken steps to assist BOR obtaining certain information on licensed physicians and their training background (including specialties). A number of issues related to completeness, accuracy, confidentiality, and integrity of data have been identified. Additional technical issues are in the process of being addressed by DOH staff.

During discussion of this topic, Dr. Brooks asked that Linda Rackleff forward three basic questions that the Board of Regents is seeking to answer with licensure data to Wayne McDaniel, Deputy Secretary for the Department of Health. The ability of the DOH to respond to these requests will serve as a test of existing systems. Results of this “test” will be reported back to the council.

VII. FHISC Web Page Status: Mr. Pearman reported on recent updates to the FHISC web page. He specifically noted that the “links” section has been updated to include results from the Robert Wood Johnson Foundation’s project on improving the use of data in state health policymaking (with discussion of specific experiences of the states of California, North Carolina and New York). The link reports on an independent evaluation of the RWJF Information for State Health Policy project, which was a six-year effort to help states strengthen their health data systems.

A current copy of section 381.90, Florida Statutes has also been added to the FHISC web site.

Finally, Mr. Pearman requested that new members provide written permission or authorization to use their agency logo and mission statement on the FHISC web site

VIII. Final Business:

Dr. Brooks requested that staff present a status report on the federally mandated health practitioner integrity data bank at the next Council meeting.

There being no further business, the meeting was adjourned.

Summary of Action Items:

1. Forward the Council’s report on the development of the proposed review process for cooperative planning among state agencies to the Governor and Legislature.
2. Prepare and adopt revisions to the Council’s strategic plan (due March 1, 2000).
3. Invite Roy Cales, statewide Chief Information Officer, to next Council meeting in order to seek his insight into the role of the Council in implementing an enterprise-wide information technology policy.
4. Prepare letters to the chairs of designated Legislative committees for the Chairman’s signature seeking guidance regarding possible assistance the Council might provide in support of the legislative process.
5. Report on status of BOR request for certain information from the Department of Health on licensed physicians and their training background.
6. Schedule staff presentation on status of the federally mandated health practitioner integrity data bank for next Council meeting.

Report to the Florida Health
Information Systems Council
December 13, 1999

Earlier this year, FHISC was requested to facilitate the sharing and coordination of health related data between Healthy Start (HS) and Healthy Families Florida (HFF).

Background Information:

F.S. 409.153 established Healthy Families Florida. The goal of HFF is to promote positive parent child interactions and healthy child growth and development, thereby reducing child abuse and other poor childhood outcomes. The entry point to HFF is by screening families for potential eligibility for HFF, then offering a voluntary assessment, which further determines the need for intensive home visiting services for up to 5 years. 1998 was the first year of operation for HFF. In 1999, HFF has grown to 37 project sites, and is projected to serve more than 6000 families in targeted geographic areas over a 12 month period. DCF contracts with the Ounce of Prevention Fund of Florida to administer HFF. Ounce of Prevention awards grant money to community based organizations to implement local HFF projects.

F.S. 383.14 established the Healthy Start system. The goal of HS is to reduce infant mortality, reduce the number of low birth weight babies and improve health and developmental outcomes. HS was initiated in 1992, and is established statewide through community based prenatal and infant healthcare coalitions. The entry point into the HS system is through universal risk screening of pregnant women and newborn infants by healthcare providers and birthing facilities. In 1998, 141,137 pregnant women were offered HS risk screening, with 99,245 women consenting to screening. Pregnant women and infants screened at risk for adverse outcomes are notified of their risk factors and referred to voluntary HS care coordination services to assist in reducing their risks for adverse outcomes.

As the HS program has developed, DOH legal services determined the need to modify the client release of information consent on the current HS risk screening form. The release statement wording was modified to include release of sensitive information that may be noted on the form, and release of client specific screening information to Healthy Start coalitions. This release statement was still in the review process when work began between HFF and HS to develop a combined prenatal screening tool that would meet the needs of both programs. HFF and HS have the charge to coordinate with existing programs and in April of 1999 an interagency workgroup was convened to work toward developing a combined prenatal screening tool.

Issue:

Healthy Start has an established system for prenatal and infant risk screening. HFF has an established hospital based infant screening system. At issue was the ability to share confidential Healthy Start prenatal risk screening information with Healthy Families Florida projects at screening form intake to provide HFF early access to potential prenatal clients.

Confidential Information:

Although F.S. 381.0022 allows for sharing of information between DOH and DCF on clients who are, or have been, the subject of a program within the jurisdiction of each agency, staff was unable to identify by statute the ability to directly share information between DOH and a subcontract of DCF.

DOH legal counsel directed us to contact Florida Health Information Systems Council for assistance, citing a reference to F.S. Chapter 163, Intergovernmental Programs, Part VI, Collaborative Client Information Systems.

Discussions were held with Lisa Cook to provide background information and to discuss the proposed request for guidance to the Florida Health Information Systems Council. Due to key staff changes and the programmatic decision to pursue other avenues to share information, the sharing of confidential information was later withdrawn as a FHISC agenda item.

Problems:

· Developing a release statement that would protect the client and the agency, yet would not deter potential clients from signing up for these beneficial voluntary programs.
· Developing a release statement suitable for both a statewide program and a program available in specific geographic areas that will change as the program grows.
· Sharing of confidential information at screening form intake, prior to additional client contact by care coordination providers.

After multiple consultations between HFF, HS, and DOH legal services, a release of information statement for placement on the combined HFF/HS screening tool was agreed upon by all parties. This release statement, if signed by the client, will allow the sharing of risk screening information between the HS care coordination providers, HS coalition, and HFF.

The issue regarding sharing of confidential information will become more common as agencies contract with community based coalitions who in turn contract with local providers to deliver services.

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