WYHIO (Wyoming Health Information Organization) Board Meeting

Oct. 6, 2005

7:30 a.m.

Attendance:

Carol Jenkins, WHCC ex officio; Emily Genoff, WHCC staff; Dana Barnett, Outreach and Business Development Director, United Medical Center; Larry Madsen, Vice President, Black Hills Bentonite; Lee Clabots, Wyoming Department of Health; Lisa Dolan Branson, Adil Moidduden, AHRQ; Steve Chasson, Wyoming Primary Care Association Director; Dr. Robert Fagnant, representing Wyoming Medical Society; Andrew Fisher, Vice President, Great West Healthcare; and Dr. Geoff Smith, Interim WyHIO Chair.

Meeting called to order

Dr. Smith called the meeting to order and started with introductions of those in attendance and reviewed the agenda.

Subgroups

Dr. Smith said the amount of work required in a short time period to complete the electronic health records network study necessitated small group breakouts and task assignments. He anticipates similar groups to be created within the WyHIO with specific areas of focus.

IT2 plan and recommendations to Wyoming state Legislature

The Legislature mandated creation of an Information Technology Technical Management Committee of the Healthcare Commission to provide oversight to the electronic medical records study and plan drafting. That group, also known as the IT2, has for all intents and purposes dissolved. The report and plan developed went to the Healthcare Commission, which is in the final stages of drafting a set of recommendations that will be sent to the Legislature’s Labor, Health and Social Services Committee on or before Oct. 15. Dr. Smith will present the study and report and the Commission will discuss its attached recommendations to the LHSS on Oct. 17 in Casper. Discussion followed regarding the ability of WyHIO Board members to advocate for the passage of ensuing legislation. Dr. Smith encouraged the Medical Society to amplify the pro-electronic health record sentiment of patients to its members.

Grants

Two grants were written this fall requesting funding for WyHIO Board staffing. One grant proposal was submitted to the Robert Wood Johnson Foundation and the other went to the U.S. Department of Health and Human Services. The grant proposal sent to HHS’s HRSA was actually submitted by Sweetwater County Memorial Hospital because a rural grantee was required. Ms. Genoff said notification of whether the Robert Wood Johnson grant has been awarded will come in within the month and involves $100,000, while the Rural Health Network Development Planning Grant notification will not come until late in the year. Unless those grants are funded and/or the Legislature sets aside funding for WyHIO activities, there are no other potential sources of money pending at this time for WyHIO staff.

Staffing

The Healthcare Commission has donated some staffing to the WyHIO pending the acquisition of money in the form of grants or an allocation from the Legislature to hire and pay professionals to provide structure to the organization. Mr. Clabots asked if there is a detailed description or workplan for staff; Traci Lindsten, the CIO in WDH, may be able to accomplish some of the work. Dr. Fagnant said he does not think the WMS will contribute funding at this time. A survey will go out soon to WMS members which could address funding for an electronic medical records network. Mr. Barnett said when information is available about the specific needs of the WyHIO, United Medical Center will be willing to contribute. Mr. Chasson said the PCA may be able to lend some staff support, as well. Word has been received from the leadership of WyNETTE – an emerging telemedicine network being built in the state – that collaboration with that organization is possible and potentially beneficial, Dr. Smith said.

AHRQ

Ms. Dolan Branton said AHRQ does not know at this time what future funding will be available from her agency. However, they can provide technical assistance and share information about what is happening in other states as requested by the WyHIO.

Meeting structure

Mr. Barnett said the Hospital Association can poll or survey its members regarding grants tapped for electronic medical records locally and networks being built. Discussion followed regarding setting up a statewide confab to share information about the WyHIO and gather information about what hospitals and medical providers are doing with electronic health records. Mr. Chasson just attended the rural health communities’ electronic medical records conference in Butte, Mont. The information disseminated there will be emailed to WyHIO Board members soon; it is obvious Wyoming as not as far ahead as a lot of other states in the region, he said. Dr. Smith asked Mr. Chasson to do a presentation at the statewide gathering using the conference handouts. Mr. Madsen said it is premature to consider inviting the business community to a meeting about electronic health records – information about how the network is of benefit to employers must be packaged. Mr. Fisher proposed meeting quarterly together and bi-weekly via telephone. There was a consensus that a face-to-face meeting needs to be set up as soon as possible; most Board members were agreeable to meeting in Casper or Cheyenne.

Tax exempt status

Mr. Fisher provided a detailed statement of the differences between tax exempt statuses available from the IRS. Dr. Fagnant has experience with 501(c)3’s and supports pursuit of that status. Mr. Fisher said a 501(c)3 is harder to implement and has categories the WyHIO does not fit into, as well as restricting the opportunities for the WyHIO to lobby. Lobbying can only be an ancillary activity for 501(c)3 organizations. The 501(c)4 option, however, would prevent tax deductible donations from being received and prevents receipt of many grants, according to the discussion. Dr. Fagnant will find out about challenges of accounting 501(c)3’s face. Dr. Smith said the WyHIO does not fall in the categories of a 501(c)3 unless it were defined as “scientific� or “educational� in nature. A membership model where fees are charged would be difficult under 501(c)3, Dr. Smith said, and deliver services. Other states with regional health information organizations (RHIOs) have classified them as 501(c)3’s. Mr. Madsen said he is a CPA and he does not think there has a been a lot of work done in the area of determining which is better – a (c)3 or (c)4. He does not think the paperwork is onerous. He does not know whether charitable contributions are going to be a large part of the WyHIO’s budget. Dr. Smith said his medical group has lawyers and accountants and he will find out whether there is an expert in the arena of tax exempt classifications and the revenue sources impacted by the different models. Ms. Jenkins has an article about RHIOs written by a legal firm that she will circulate. Dr. Fagnant also will do some research on tax exempt statuses. Ms. Jenkins suggested the WyHIO could set up multiple entities with different tax statuses under its umbrella. Discussion followed regarding the benefits and challenges of having multiple organizations.

Next steps:

1) Setting up a face to face meeting

2) Formation of a detailed work plan

3) Planning for a statewide meeting

4) Tax exempt status

5) Pursuit of funding opportunities arising continuously (grants), and

6) Presentation of the report and plan to the Legislature.

Discussion followed regarding the availability of grantwriting services. Montana Dakota Utilities is donating their grantwriters to communities, Ms. Jenkins said. She will give them a call. Mr. Barnett, Dr. Fagnant and Dr. Smith will speak with their communities’ hospitals about the availability of donated grantwriting services. The PCA may be able to help. Ms. Genoff will check with the Rural Development Council, which is a stakeholder and has provided communities with grantwriting services in the past. The WHCC can assist with many WyHIO Board activities – meeting logistics and minutes, for example – but more intensive activities like grantwriting will have to be allocated elsewhere because the Commission does not have enough staff to provide that level of assistance, Dr. Smith said. Mr. Clabots will be contacted by Dr. Smith about what specifically WDH can do to help with the WyHIO’s work. Dr. Smith will send an email polling for times when Board members can meet by telephone and in person, with the goals being to set out a prioritized workplan.

Other business:

Mr. Barnett would like a directory of the group. Dr. Smith will email it.