Final Report And Recommendations Of The Governance Design Grup
FINAL REPORT ANDRECOMMENDATIONS OF THEGOVERNANCE DESIGN GRUPContributors:Bruce Adams, JDRoderick BrembyAugust 21, 2018Report prepared for:Connecticut HealthIT Advisory CouncilPat Checko, DrPHBill Roberts, JDJake StarLisa Stump, MS, RPhPrepared by:Jennifer Richmond, Connecticut Health IT Program Management OfficeMichael Matthews, CedarBridge GroupChris Robinson, CedarBridge GroupCedarBridge Group LLC515 NW Saltzman Rd. #661CedarBridgePortland, OR97229 Group LLCwww.cedarbridgegroup.com1
Governance Design Group Final Report and RecommendationsTable of ContentsAcknowledgements . 3Executive Summary and Overview of Recommendations. 4Project Structure and Process . 6Governance Design Group Project Charter .7Stakeholder Representation of Governance Design Group Members .7Governance Design Group Process .8Governance Building Blocks .9Background . 10Components of Governance . 10Models of Data Sharing and Exchange. 12Trusted Exchange Framework and Common Agreement (TEFCA) . 14Design Group Recommendations and Considerations . 19Recommendation 1: Mission, Vision, and Values . 19Recommendation 2: Critical Success Factors . 20Recommendation 3: Characteristics of Neutral and Trusted Entity . 20Recommendation 4: Relationship of the State of Connecticut, HIE Entity, Office of Health Strategy,and Health IT Advisory Council . 21Recommendation 5: Considerations for Designation of Existing Entity vs. Creation of New Entity. 26Recommendation 6: Data Governance as Component of Corporate Governance . 27Recommendation 7: Elements of Trust Agreement . 28Recommendation 8: Table of Contents for Policies and Procedures . 29Recommendation 9: Conformance with TEFCA . 30Closing Thoughts . 31Appendix . 32Select National and State Legislation Reviewed by the Design Group . 32Additional Considerations . 332
Governance Design Group Final Report and RecommendationsAcknowledgementsOn behalf of the State of Connecticut, the Executive Director of the Office of Health Strategy, and theHealth Information Technology Officer express their sincerest gratitude to all those who participated inthe Governance Design Group. A sound governance structure and trust framework provide a criticalfoundation for successful data sharing and health information exchange in the state. Your insights,perspectives, and wisdom were invaluable in the development of these recommendations and are atestament of your desire to help improve the health and wellbeing of the citizens of Connecticut.3
Governance Design Group Final Report and RecommendationsExecutive Summary and Overview of RecommendationsRecognizing that successful and sustainable data sharing initiatives are built upon solid foundations ofgovernance and trust, the Health IT Advisory Council chartered a Governance Design Group to develophigh-level recommendations for how to best establish an overall health information exchange (HIE)governance framework for Connecticut. Such recommendations were prepared over the course of fivemeetings of the Governance Design Group from May through July of 2018. The recommendations werepresented to the Health IT Advisory Council on July 19, 2018. The Council unanimously approved theserecommendations and commended the group for its outstanding work.The implementation of a governance structure for health information exchange and data sharingrequires time, effort, and resources beyond the scope of this Design Group. Rather, this Design Groupembraced its charge to provide baseline recommendations and principles from which a more detailedaction plan could be developed. This Final Report and Recommendations of the Governance DesignGroup represents the fulfillment of this phase of governance construction.Guidance regarding the governance of HIE in the state was provided in Public Act No. 17-2 (as amendedby Public Act No. 18-91), stating the roles of the executive director of the Office of Health Strategy(OHS), the health information technology officer (HITO), and the Health IT Advisory Council. By law, theSecretary of the Office of Policy and Management (OPM), in collaboration with the executive director ofOHS, is empowered to establish or incorporate an entity to implement and operate the Statewide HIEprogram, as defined by statute.As a result of this legislative directive, the HITO, with the support of the Health IT Advisory Council,specifically requested the Governance Design Group address the following:1. Relationship of the State of Connecticut, the HIE entity, OHS, and the Health IT Advisory Council;2. Pros and cons of establishing a new HIE entity or designating an existing entity to oversee HIEoperations;3. Baseline elements of a trust agreement;4. Table of contents for HIE policies and procedures; and5. Critical success factors in HIE governance.The Governance Design Group, with support and facilitation from CedarBridge Group and the HealthInformation Technology Program Management Office (HIT PMO), produced high-level governancerecommendations based on the following objectives:1.2.3.4.5.Develop high-level requirements for the Connecticut HIE governance structure;Define attributes of a “neutral and trusted entity”;Review models of governance used successfully by other state HIEs;Review state and national legislation and regulations that should inform HIE governance; andReview existing trust frameworks and trust agreements commonly used for interoperability andHIE initiatives.Through the detailed discussion of the Governance Design Group, and facilitated exercises designed byCedarBridge Group, recommendations were developed in nine separate categories that are discussed in4
Governance Design Group Final Report and Recommendationsmore detail throughout this document. The categories of recommendations, considered “buildingblocks” by the Governance Design Group, are as follows: Mission, vision, and valuesCritical success factorsCharacteristics of a neutral and trusted entityRelationship of the State of Connecticut, the HIE entity, OHS, and the Health IT Advisory CouncilConsiderations for the creation of a new entity or the designation of an existing entity tooversee HIE operationsData governance as a component of corporate governanceElements of a trust agreementTable of contents for policies and proceduresConformance with the Trusted Exchange Framework and Common Agreement (TEFCA)This Final Report and Recommendations of the Governance Design Group represents the conclusionof the Governance Design Group’s work. However, the Design Group foresees continued refinement ofthe governance framework, in support of the statewide HIE and the creation or designation of an entityto oversee HIE operations. The work of this Governance Design Group is a positive step forward inachieving the goal of delivering high-value data sharing services that meet the needs of Connecticut’sdiverse stakeholder community.5
Project Structure and ProcessThe Office of Health Strategy (OHS) is legislatively charged with the planning, design, implementation,and oversight of health information exchange (HIE) services for the State of Connecticut. As prescribedin Public Act No. 16-771:There shall be established a State-wide Health Information Exchange to empower consumers to makeeffective health care decisions, promote patient-centered care, improve the quality, safety, and value ofhealth care, reduce waste and duplication of services, support clinical decision-making, keep confidentialhealth information secure and make progress toward the state’s public health goals. [Sec. 6, § 17-b-59d(a)]During special session in June 2017, Public Act No. 17-22, was passed, and further amended by Public ActNo. 18-913 in May 2018, establishing OHS and the following responsibilities:(1) Developing and implementing a comprehensive and cohesive health care vision for thestate, including, but not limited to, a coordinated state health care cost containmentstrategy;(2) Promoting effective health planning and the provision of quality health care in the state in amanner that ensures access for all state residents to cost-effective health care services,avoids the duplication of such services, and improves the availability of financial stability ofsuch services throughout the state;(3) Directing and overseeing the State Innovation Model (SIM) Initiative and related successorinitiatives;(4) (A) Coordinating the state's health information technology initiatives, (B) seeking funding forand overseeing the planning, implementation and development of policies and proceduresfor the administration of the all-payer claims database (APCD) program, (C) establishing andmaintain a consumer health information Internet web site, and (D) designating anunclassified individual from the office to perform the duties of a health informationtechnology officer (HITO);(5) Directing and overseeing the Health Systems Planning Unit under, and all of its duties andresponsibilities as set forth in chapter 368z; and(6) Convening forums and meetings with state government and external stakeholders,including, but not limited to, the Connecticut Health Insurance Exchange, to discuss healthcare issues designed to develop effective health care cost and quality strategies.As a result, the HITO and the HIT PMO formerly under the Office of Healthcare Advocate (OHA) havebeen reassigned to OHS as of February 1st, 2018.Guidance regarding the governance of HIE in the state was provided in PA 17-2, as amended by PA 1891, re-stating the role of the executive director of OHS, the HITO, and the Health IT Advisory Council. Inaddition, the statute empowers the Secretary of the Office of Policy and Management, in -PA.pdf3 1-R00HB-05290-PA.pdf2CedarBridge Group LLC6
Governance Design Group Final Report and Recommendationswith the executive director of OHS, to establish or incorporate an entity to implement and operate theState-wide HIE program, as defined in the statute.To develop high-level considerations for how to best establish an overall HIE governance framework andstructure in Connecticut, the HITO with the support of Health IT Advisory Council commissioned theformation of a time-limited, multi-stakeholder Governance Design Group.Governance Design Group Project CharterBuilding upon previous planning and analysis, including the Environmental Scan4 and HIE Use CaseDesign Group recommendations5, the HITO and the Health IT Advisory Council formally chartered 6 theformation of the Governance Design Group to address the following:1.2.3.4.5.Relationship of the State of Connecticut, the HIE entity, OHS, and the Health IT Advisory Council;Pros and cons of either establishing or designating an entity to oversee HIE operations;Baseline elements of a trust agreement;Table of contents for HIE policies and procedures; andCritical success factors in HIE governance.By addressing the above topics, Connecticut will have a “starter-set” of governance considerationsavailable that supports the delivery of high-value data sharing services operating within a soundgovernance and trust framework that meet the needs of Connecticut’s diverse stakeholder community.Stakeholder Representation of Governance Design Group MembersThe Governance Design Group was commissioned by the HITO, overseen by the Health IT AdvisoryCouncil, and supported by the HIT PMO and CedarBridge Group. The list of Governance Design Groupmembers, and the description of their stakeholder representation, can be seen in Table 1 below.Table 1: Governance Design Group MembersNameRole and Stakeholder RepresentationBruce Adams, JDGeneral Counsel in the Office of the Lieutenant General; represents theperspectives of the state and serves as a legal subject matter expert.Roderick BrembyCommissioner of the Department of Social Services; represents the perspectivesof the state and the Medicaid population.Commissioner Bremby was supported by Joe Stanford (DSS) and Polly Bentley(HealthTech Solutions).Patricia Checko,DrPHCo-chair of SIM Consumer Advisory Board and Health IT Advisory CouncilMember; represents the views and needs of consumers and patients and as anadvocate for public T-Advisory-Council/Reports/Environmental Scan Summary Findings FINAL 20170523.pdf?la sory-Council/Design-Groups/HIE/HIE Use Case DG Final Report 20171101.pdf?la en6 ojectCharterV10-52118003.pdf?la en57
Governance Design Group Final Report and RecommendationsBill Roberts, JDPartner at Shipman & Goodwin LLP, on assignment to the Office of the AttorneyGeneral; represents the perspective of the Office of the Attorney General andserves as a legal subject matter expert, specifically in regard to privacy andsecurity.Jake StarChief Information Officer of VNA Community Healthcare and Health IT AdvisoryCouncil Member; represents the perspectives of non-hospital and non-physicianstakeholders in the larger healthcare team and advises on the needs andchallenges of long-term post-acute care providers.Lisa Stump, MS,RPhSenior Vice President and Chief Information Officer of Yale New Haven Healthand Health IT Advisory Council Member; represents the perspective of a largehealth system and advises on the needs of academic medical centers.Governance Design Group ProcessThe Governance Design Group consisted of five meetings from May through July of 2018. The first twomeetings provided Design Group members with background information and helpful context toestablish a common understanding of goals, objectives, terminology, best practices, and relevantinformation. Over the course of the remaining meetings, CedarBridge Group led Design Group membersthrough nine separate "building block” exercises in which background materials and presentations wereused to inform and frame discussions. Each exercise, and the associated outcome, were captured asinitial recommendations and considerations and were re-validated amongst Design Group members atthe following meeting. The Design Group meeting schedule is detailed in Table 2 below.Table 2: Design Group Meeting ScheduleMeetingsMeeting 1May 23, 2018Meeting 2June 6, 2018Meeting 3June 14, 2018Meeting 4June 20, 2018Topics and Exercises Background and OverviewBest Practices Background and OverviewBest PracticesBuilding Block Exercise: Critical success factorsConfirm outcome of exercise from June 6 meetingBuilding Block Exercise: Characteristics of a neutral and trusted entityBuilding Block Exercise: Elements of a trust agreementBuilding Block Exercise: Table of contents for policies and proceduresConfirm outcomes of exercises from June 14 meetingBuilding Block Exercise: Relationship of the State of Connecticut, theHIE entity, OHS, and the Health IT Advisory CouncilBuilding Block Exercise: Data governance as a component of corporategovernanceBuilding Block Exercise: Considerations for the creation of a new entityor the designation of an existing entity to oversee HIE operations 8
Governance Design Group Final Report and RecommendationsMeeting 5July 11, 2018Health IT AdvisoryCouncil Meeting Confirm outcomes of exercises from June 20 meetingBuilding Block Exercise: Mission, vision, and valuesBuilding Block Exercise: Conformance with TEFCAValidation of all recommendations before presentation to Health ITAdvisory Council (July 19, 2018)Presentation of recommendations (unanimously approved)July 19, 2018Governance Building BlocksRecognizing the enormity of the challenge of developing recommendations for governance and trust, a“building block” approach was undertaken by the Design Group to address various aspects ofgovernance. These building blocks would then be melded together into a comprehensive set ofrecommendations and considerations.As displayed in Diagram 1, the Governance Design Group considers mission and vision to be of highestconsideration in the creation of a governance and trust framework. Likewise, critical success factorsmust be identified and embraced to ensure the organization responsible for data sharing and healthinformation exchange can bring tangible and sustainable value to Connecticut’s diverse stakeholders. Inbetween the mission and vision and the critical success factors building blocks lie important strategicand tactical considerations, such as the characteristics of the HIE entity, elements of the trust agreementthat establishes common “rules of the road” for exchange, and robust policies and procedures thatguide the organization’s day-to-day operations.Each meeting, the Governance Design Group addressed several building blocks and developedrecommendations and considerations for each. These recommendations and considerations arediscussed in detail later in the document.Diagram 1: GovernanceBuilding Blocks9
Governance Design Group Final Report and RecommendationsBackgroundComponents of GovernanceIn May of 2013, the Office of the National Coordinator forHealth Information Technology (ONC) released the GovernanceFramework for Trusted Health Information Exchange.7 Theintention of this document was to serve as ONC’s guidingprinciples on HIE governance and to provide a “commonconceptual foundation applicable to all types of governancemodels.” ONC organized their guiding principles into fouroverarching categories: organizational principles, trustprinciples, business principles, and technical principles.Diagram 2: ONCGovernance PrinciplesThese ONC principles were reviewed as part of the GovernanceDesign Group process in order to provide background andcontext regarding the federal government’s perspective of HIEgovernance, and the key principles that should be consideredwhen establishing a governance framework. The following ONCprinciples were reviewed with Design Group members:Organizational Principles: The entity that
This Final Report and Recommendations of the Governance Design Group represents the conclusion of the Governance Design Group’s work. However, the Design Group foresees continued refinement of . Building upon previous planning and analysis, including the Environmental Scan 4 and HIE Use Case Design Group recommendations 5, .
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ART 224 01 05/01 04:00 PM AAH 208 ART 231 01 05/02 04:00 PM AAH 138 . Spring 2019 Final Exam Schedule . BIOL 460 01 No Final BIOL 460 02 No Final BIOL 460 03 No Final BIOL 491 01 No Final BIOL 491 02 No Final BIOL 491 03 No Final BIOL 491 04 No Final .
ME 2110 - Final Contest Timeline and Final Report Preparation March 31, 2014 C.J. Adams Head TA . Agenda 2 Overview of this week Final Contest Timeline Design Review Overview Final Report Overview Final Presentation Overview Q&A . MARCH Monday Tuesday Wednesday Thursday Friday .
ANTH 330 01 No Final Spring 2020 Final Exam Schedule . ART 221 01 No Final ART 223 01 No Final ART 224 01 05/11 04:00 PM AAH 208 . BIOL 693 01 No Final BIOL 696 01 No Final BLBC 518 01 05/12 04:00 PM CL 213 BLBC 553 01 No Final CEP 215 01 05/12 06:00 PM G303 CEP 215 02 05/11 10:30 AM WH106B .
recommendations can be found on the following pages: 67-68, 126-128 TCFD recommendations DRAFT - FOR DISCUSSION PURPOSES ONLY Recommendations of the Task Force on Climate-related Financial Disclosures i Final Report Recommendations of the Task Force on Climate-related Financial Disclosures June 2017 A4S TCFD top tips and practical examples
ii MENDING THE WALL The recommendations of this report are lengthy and highly detailed. Many of the recommendations of the report address the organizational structure of the Senate itself. The overall tenor of the recommendations may be summarized by a few recurring themes. As with all campus activities, implementing these recommendations will .
A Summary of the Final Report 1.1 Introduction This Volume 1 provides an overview of Volumes 2 and 3 of our Final Report and of our special report on COVID-19, and details our approach to our inquiry. It contains a complete list of our recommendations. Volume
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