The meeting was called to order at 9 AM by Chairman of the NM Telehealth Alliance & Director of SDCCHP, Dr. Arturo Gonzales. Thank you to the Con Alma Foundation for helping to fund this get together. This meeting is critical to our state at this time. NM has recently developed very vibrant Telehealth programs. A descriptive detail is enclosed in your packet for review of these programs.
Sustainability is the key. How do programs work together to create the best network of healthcare. Recognition to attendees. We are here to take everyone’s expertise in the healthcare field and try to bring it all together to have a statewide vision. Goal to identify to agree to come to some common ground by the end of the day.
Joie Glenn, Vice Chairman of the NM Telehealth Alliance presented the logistics of the day’s meeting. She introduced Dr. Alverson and Jeff Blair.
A PowerPoint presentation was shown to the group. The packet contains a list of definitions that were reviewed by Dr. Alverson and Mr. Blair. The following were reviewed by Jeff Blair:
Basic Definitions were reviewed.
Personal Health records.
Electronic health record (EHR)
Health Information Exchange (HIE) Network
E-Prescribing Network (Sure scripts)
The Payer-Provider/Reimbursement Network (HIPPA transaction standards)
Personal Health Record (PHR) Networks
Dr. Alverson then presented information on the Telehealth Network and Defining Telemedicine and Telehealth. A handout entitled, “Telehealth and HIT Definitions,” is contained in your packet for review. Discussion included:
Healthcare at a distance.
More than healthcare, can be training, exchange of information, etc.
Use of technology to provide healthcare at a distance.
More than just video conferencing.
Also educational.
Store and Forward.
Comments and questions from the group were answered by Dr. Alverson and Mr. Blair. A question was asked regarding the broad use of terms. Dr. Alverson stated that our goal was to come to some commonality on the use of terms.
It’s the use of these tools to effectively provide care to our patients to develop a system that is a model to the nation.
Thank you’s from Joie Glenn recognizing individuals that helped put this day
together. Dan Jaco, NNMRA, was introduced. Mr. Jaco gave guidelines on how we
were to proceed with the discussion. Scribes are sitting at each table.
Spokesperson needs to be designated. Packet has information on programs that can
be referred to during your discussions. Open format.
Table 1. Spokesperson Steve Kanig. Julie – scribe.
Historical concerns on both sides based on specific use of technology.
Form follows function.
Working together vs. coming together
Communication of information and data across shareholders
Legislative - confusion re: Programs
Avoiding and reducing redundancy.
Need coordination
Cross fertilizing boards of directors
Structure Public/Private collaboration
Graphical model of evolution of
organizational collaboration and structure
Summary:
• Overlapping individual silos
• Umbrella structure around this allowing also for individual interests
• More commonality than diversified interests
• Kumbaya!
• Organizational structure that will help us do that
Table 2
Competition & trust are the hurdles
We are a transitional generation
Privacy – confidentiality
Trust huge – national competitive entities – sharing information
Patient expectations – having information available
Information (Data) is an “asset” and must be shared
Consumer (patient) benefits the most – concerned with Privacy – not public
information
Content and Distribution challenges
Lay a framework that will accomplish this in the best possible manner
Let’s at least set the foundation and guidelines for the next generation
Cost not the major issue – is burden but not major issue
Government helps promote dissemination of information
Integration interoperability – is happening
Standards – not robust
IT is the “easy” part
*Trust is huge because
challenging because of competition,
Competing entities
competition and priority issue therefore a barrier to moving in this direction
“Their Data” is viewed as “Their Asset”
Patient/consumer benefits the most
On the other side
Competition can make this happen because consumers want it
BUT: They are afraid of privacy issues
They (the patient) want their records with them
Back to the question:
“Yes” but need to lay out framework
Part of framework
Content Distribution
Where is it stored? How
How is it stored?
• Advances in technology applications will enable consumer to take the steps
and accept trade-offs
• Next generations are using technology day-to-day
• “Our generation will want to take baby steps” and are skeptical about this but
we are still interested in the benefits
• Example: email w/primary care physician
Practitioners
• create a model
• cost not an issue if it is perceived as a benefit rather than a burden
• stark rules
• integration - interoperability
• certification standards loose
Who is doing this?
• Feds setting underpinnings
• CMS
• SAMSA
Working close to standards and therefore connectivity
Table 3 – Spokesperson – Patricio Larragoite
Developing and setting standards
Transcend turf issues and duplication
Leader in standardization in NM and maybe globally
Utilize this summit i.e., press conference
Take leadership from the State of NM
Develop good business model/plan that goes with standardization for coordination
and
Sustainability
Eliminate silo issues
Legislative process – key legislators need to be educated
Tie in Utilization of e-records with health information technology
Legislature – confusion – similar summit with key legislators.
Conclusions
a) HIT & TH work together? YES
b) How work together
1. Standards/interoperability critical
2. Coordinated approach message to key audiences
1. legislators/staff – funding entities
2. Providers
3. public/consumers
Table 4
Multi-level synergy that happens between HIT
Are not sustainable alone without that synergy
The Pipes are needed
Security and communication standards
Need buy-in from user groups
Technical - cultural – legal buy-in
Table 5
Culture change to patient focus not organization
Fully leveraging technologies
Change how we deliver care and interact
Standardization i.e., physician licensing, data access, authentication,
automating reporting
Infrastructure – As a state building as a WHOLE Automate Reporting
Master personal index for entire state
Tele IT – use Telehealth technology due to barriers on IT.
Standardization – Federal HIPPA
Questions & Answers:
Move towards legislation that is already in place in terms of Patient ID.
Health care – only 1 component of all of E-government i.e., property taxes
We don’t need to reinvent the standards – lets agree and fast track these
What is the best way to interact with the state on these standards?
Reza Ghadimi introduced Dr. Alfredo Vigil. Dr. Vigil addressed the group reiterating his passion for Telehealth and HIT.
HIT key in how health care can get better
Importance that we are dealing with a bottleneck of human feelings and
perceptions
Summit proves we understand Telehealth and HIT
Legislative sessions made little progress
Need to overcome working in silos and get connected
Frontline clinicians – their interest and perception to get on board –
problematic
Need to reduce information errors – in changes to care – immediate information –
accuracy/speed
Tolerance
Manual vs. automated – what is/isn’t?
Security vs. insecurity – automated vs. manual systems
Manipulate system as it is moving
Legislative Session - Privacy Bill - attitudinal issue
Laws that affect medical information
Time waiting for medical care reduced? What does it really affect?
How do translate how this is affecting the people in the street? How does it
help the average?
person in their healthcare environment?
Care and learning – where is healthcare system – where could it be?
Start thinking of who/when/what we are going to present to our legislators
Questions & Answers?
This morning we were identifying how we could get the buy-in – standards came up. Dr. Sange talked about perhaps the DOH, Human Services Dept, Ray Soto’s Dept – and not reinventing the wheel. How can we approach you or how do you see it happening?
Structural issue. Define role of alliance and commission and how we create collaborations. Get primary structure down. It then becomes natural and logical into what we call specialized areas. The world deals with this and some group tells us what we need to do. You need to narrow down and work on individual components. Need a standards group who only discusses these areas.
Jeff Blair – take advantage of all standards and initiatives available in the public sector. These vary. Sharing data between healthcare systems - interoperability. Help those who are purchasing electronic health records to help them so they purchase one with the capabilities that they will be requiring in the future. Balance in enabling and facilitating treatment.
Ray Soto – working group counties, states, title companies, attorneys, etc. We are going to pass e-standards that we agree on for the counties.
What can and should be done at the Federal level, given what the local level can do. Need steady stream of information.
How can those involved work towards appropriate collaboration
of entities/resources of these technologies?
How can we deal with individual interests, resources, and control issues to have collaboration?
Dr. Stephen Burd, Webmaster of NM Telehealth Alliance, Anderson School of Management was introduced by Dr. Gonzales. Dr. Burd introduced the second topic for discussion by going over his handout included as part of these minutes. (Identify possible partnerships and/or joint efforts in Telehealth and Health Care Information Technology).
Infrastructure issue: What are we talking about to support Telehealth and heath information exchange. Handout reviewed. Physical layer.
What about us as a group putting together a web site that addresses Telehealth so that there is information out there about what exists. Rio Grande Health Information
Table 1
Create a web site that agendas news, etc. could be consolidated and brought
together.
NM RHIO Grande? Forum structure on web site
Vote to break into small groups or stay as one large group? We will stay together as a large group.
Role of such an entity
Developing a communication clearinghouse on line is an important function that is important to us right now.
Dale felt strongly that there ought to be a merger of some fashion. Form to
follow function.
RHIO can perform that function. Maybe the alliance dissolves into RHIO. Form
central resource center whether it is the Alliance or RHIO.
Telehealth is important in HIT. Distinctive pieces of Telehealth coordinated under some umbrella. What are the distinctive parts?
Strategy for communicating with Legislators. Need to communicate with legislature with what we are trying to do. Having a web site that is neutral for the public. Communicate with those legislators sooner rather than later.
Volunteer staff – not FTEs
Killed applications that could be ruled out?
Focusing on Technology too much
Benefit working together – have self interest.
What are the clues?
LCF - NMHIC - RHIO Grande
Incorporated 50l(c)3 incorporated but waiting
for 501(c)3 status
Community Wide Response for Community Wide Priorities
Certain autonomy may be needed
Common interests - operate as a whole
Requirement for sustainable business model
Who are the different organizations?
I don’t know how to do this but there must be some way to do it right with
impact
Can we show immediate impacts – on patient care, access, quality
“A quality health network”
RHIO Grande - governance role
Dr. Gonzales asked what is meant by governance. Look at RHIO to be proactive and get it going by hooking up with correct resource. Don’t need to loose corporate automony to do that. Telehealth can be support organization supporting use of Telehealth and health information.
Bob Mayer (DOH) role of commission not structured to play this role of
governance. Provides coordination. Does not necessarily reflect what is going on
today. Appointed by the governor.
Need plan for HIT in general. Plan for the State of NM to have HIT. What is
that? By the time you develop plan, world has moved on.
Dale Alverson – vision – use tools to improve the wellness and healthcare of the people we serve. It would be nice if I knew I have a place to go to to contact key stakeholders. Immediate addressing of what organization is the governance organization.
RHIO – umbrella - ???
Resource Center – point of contact. Need to evolve silos chart
What do these different organizations do? Summary from RHIO, Alliance, etc. what they are doing? What are the commonalities? Representatives summarized their activities.
NM Chili
NNMRA – NM Medical Review Association – EMR physician’s offices; 35 Quality
Improvement; diabetes prevention; e prescribing;
Lovelace Clinic Foundation – Maggie & Jeff – Health/Info Network/Population
outcomes
Telehealth Alliance – Dr. Gonzales – coordinating Telehealth in the state – take
role on of
providing technical assistance for rural providers i.e., writing proposals to
Feds; equipment
RHIO – working closely with Lovelace Clinic physician survey as well as to
health care decision
Makers (i.e., insurance companies) regarding need for network services; Lab –
radiology –
\ medications, patient record tools, Advanced directors, immunizations, quality
reporting
PHS present outcomes based information for legislative presentation - true value
HSD – Lowell – focus on Medicaid – health information exchange – HSD is
supportive.
Nitty Gritty Work – who’s doing it? Do we have the staff?
David Roddy - information in your own system vs. really wanting to help. Need health resources to provide services. Telehealth, HIT, and exchange of that information. Need technology. Duplication?
Jeff: Impediments: Different perceptions of the value of that single entity to us. We all have constraints and limitations on the degree of our autonomy.
Identify what value we want from an umbrella organization. Develop limits and constraints. Third piece is principle.
Focus on quality of care for the community. Have to try to construct an overall umbrella organization. We don’t pull it one way or another based on our funding. Look at value we want to receive,
Ernest Colletta, UNM Psychiatry – From program side, as we do more Telehealth, we are bumping into issues of information sharing.
Governance seems like the entities want to be governed. There needs to be some rules of participation. Governance as Shared Leadership – a book referred to by Liz Stefanics that may be the model we want to look at.
Dr. Gonzales asked if we could review Mr. Blair’s idea of value, constraints, limitations and principle. Other dimensions: Answer those questions in the context of the next 18 months only. Bring example of project and how it would relate. Governance? Look at association model. Entities doing some common things together, but doing their own thing individually.
Business goal – bring something tangible to the legislature. Look at
governance then.
Identify what you want governed.
Distinct next steps identified to address:
1) Have individual organizations address questions, Codify questions, put on
RHIO
Website. RHIO/NM Telehealth Alliance
2) Develop goals, i.e., plan a legislative summit to educate them, publication, etc. Educating the legislators – joint activity
a. How do we communicate and educate together
b. What is content
3) Legislative
RHIO Board get together to develop model for this umbrella organization. This
group meets again as a membership. Is the RHIO taking the leadership role? Need
to get permission and then come back.
Create umbrella entity first.
April 18th 9 AM – 1 PM next meeting after boards have met and gotten permission to participate in new entity. Focus will be to answer questions Jeff expressed regarding value, constraints, limitations and principle(s).
Any documentation regarding past collaboration efforts will be disseminated.
Dale – if we reached this kind of level does it need to be facilitated by third party. Only if it’s useful.
Liz Stefanics will try to find a summary of the book, Governance as Shared
Leadership.
Liz could also serve as the facilitator. You can meet with chairs of different
groups to see how it will work.
Meeting adjourned at 3:46 PM.