 So the first item on the agenda, welcome everyone, first of all. The first item on the agenda is the Executive Director's Report. Thank you Chair Mullen. Two brief updates. First remind folks that next Monday we do have a board meeting November 22nd. That will start at 1 p.m. And the topic of the meeting is the 2020 ACO quality and financial performance. In addition, we have two ongoing public comment periods. The first is related to today's item of discussion, which is the state's the Vermont Health Information Exchange Plan. And that public comment period is open through November 25th. I'm sure we will hear more from the presenters today on next steps there. And then I just want to highlight related to the One Care Vermont FY22 budget. We have, we still have open public comment. We're asking folks to submit their comments by December 1st in order to be considered ahead of the Green Mountain Care Board staff presentation, which is on December 8th. Or by December 17th to be considered ahead of the potential Green Mountain Care Board vote, which is tentatively scheduled for December 22nd. We heard from some folks that they wanted a little more time for comments to be considered by the board. So we just wanted to, I wanted to point that out for the board and for the public. And that is all I have to report. I'll turn it back to you, Mr. Chair. Thank you, Susan. Next item on the agenda are the minutes of Friday, November 5th, Monday, November 8th, Wednesday, November 10th, and Friday, November 12th. Is there a motion? So moved. All four of them. Second. It's been moved and seconded to approve all four minutes without any additions, deletions, or corrections. Is there any further discussion? Hearing none. For the motion, please signify by saying aye. Aye. Any opposed? Please signify by saying nay. Let the record indicate that it was unanimous approval of the minutes. So next, we're going to the main purpose of today's meeting. And that is the health information exchange strategic plan and 2022 connectivity criteria. And for the purposes of that, I'm going to turn it over to Kate O'Neill, who will tee things up and then we'll introduce our presenters. So thank you, Kate. Yeah. Thank you. I'm getting my slides up. You can see them hopefully. We can. So good afternoon. I'm Kate O'Neill and I'm on staff at the Green Mountain Care Board. And I serve as the director of data management analysis and data integrity. So to start, I'll do just a very quick introduction today to cover the statutory authority for the board. And then I'll hand it over to the presenters from AHS and Vital to present on the plan itself. And then after that, I'll come back and share with you the staff review of the update to the HIE plan and the 2022 connectivity criteria. So today we'll be talking about the two responsibilities that the board has related to HIT and health information exchange. And first, it's reviewing and approving the state HIT plan. We now call it the HIE plan. And the board's authority is focused on whether or not the plan will support achieving the principles for health care reform and the HIE plan statute in Section 9351 outlines a variety of features the HIE plan must address or include. The Department of Vermont Health Access within the Agency of Human Services is required to revise the HIE plan annually with a comprehensive update every five years. And currently, we, so the current HIE plan was approved originally in 2018 and then there were annual updates in 2019 and 2020 and now this is the 2021 update. That's before the board today. And then second, the board is required to review connectivity criteria for providers connecting to the Vermont Health Information Exchange or the VI. The board's HIE plan review is required to present criteria for approval annually before March 1st. But since 2019, we've been reviewing those criteria for the coming year in conjunction with the board's HIE plan review. And so we're going to be doing the same thing today. So that's why you're reviewing both of them at the same time. So that just sets it up and now I will turn it over to Emily Richards and our colleagues at Vital and to do the presentation and then I'll return after they're done and I'll walk through the staff analysis. Great. I'm just going to share my slides here. We'll just take me a moment. Sorry, trying to get all the screens right so I can see you and the slides at the same time. And everybody see the slides okay? We can. Okay. Great. Thank you. I'm going to get started, introduce us in the presentation and yeah, thank you, Emily. Good afternoon, everyone. My name is Ina Vakis. I'm the director of health reform and I've been having discussions with the board lately on other topics, but I'm excited to be here today to be sharing the health information exchange strategic plan 2021 update. And I know that this board has received this plan update in past years and a particular difference with the update this year is that I am accompanying Emily in providing this update. And that is because the health information exchange group has joined in the office of health reform and the secretary's office at the agency of human services. I know that you're familiar with this arrangement of activities within AHS because it was a part of our strategic plan for improving our overall performance and health reform and engagement with the all payer model agreement. And as a part of this plan, I have been serving as the chair for the health information exchange steering committee and this all represents a significant difference from, again, last year's update where the HIE program sat with the department of Vermont health access. And this update is in service of truly aligning our health reform initiatives, including HIE as the backbone for payment and delivery system reform as a critical and key partner for our blueprint for health as it long has been and working with the Vermont chronic care initiative all together and moving health reform forward. So again, thank you for having us today and I'll ask Emily to introduce herself now. Thanks, I'm Emily Richards and the director of the health information exchange program at AHS and we're also joined by Beth Anderson and Carolyn Stone from vital. I'd like to thank them for being online and available to answer any questions about vital's progress and at the end of this presentation, Carolyn will walk us through the update to the the state's connectivity criteria for the V high. So to jump right in. So today we're going to review the core concepts underpinning the HIE plan in Vermont. As a reminder, I know of course the board has reviewed this plan for a number of years, but those core concepts really fuel our trajectory in terms of health information exchange progress. So we want to make sure that sort of what's driving strategic planning is well understood. So we'll walk through those first. Then we'll jump into what's been accomplished in 2021 with a brief overview and a look ahead to 2022 plans and then jump back to that to the ecosystem or component parts that allow us that allow us to progress health information exchange efforts in Vermont and take those one by one and look at accomplishments and what's ahead. OK, so the core planning concepts of the strategic plan. So as Kate mentioned, this plan is called for in title 18. AHS and consultation with the HIE Steering Committee comes together every year to administer the plan, evaluate and update each year and with a real focus on integrating electronic health information infrastructure to support sharing of electronic health information. So the plan itself covers three essential elements, Vermont specific vision and goals for the exchange of health data, which we'll look at again today. The HIE ecosystem or the environment required for HIE to effectively function and clear objectives and tactical plans for achieving progress towards this vision. And as everyone remembers, the reinvigration of this plan a few years ago was really focused on a transparent and accountable path towards progress. So we're continuing to focus on that as we look ahead. So considering our goals statewide, a few years ago, we looked across use cases or the ways in which users would benefit from health data and the access to health data and the action of exchanging health data and realize that really sort of all of those married use cases roll up into three universal goals that can act as our North Star for planning. So we continue to look towards these and drive towards these in our activities, which are detailed in the strategic plan. The first goal is to create one health record for every person. And the idea here is to support optimal care delivery and coordination by ensuring access to complete and accurate health records. In the last couple of years, we've talked about an increased access, patient access to health records. So this is also in service of optimal care delivery and care coordination by having patients really empowered to participate in their care. Having one record serves multiple parties. Second goal here is to improve health care operations. So enriching health care operations through data collection and analysis to support quality improvement and reporting, basically making sure that health care operations can be data informed. Putting the appropriate data in the arms of folks to understand how performance management and improvement. And the use of data to enable investment and policy decisions is our final goal here. So this is a look at bolstering the health system's ability to learn and improve by using accurate comprehensive data to guide investment of time, labor and capital and informed policymaking and program development. Which I think the audience here can really understand. So looking at our next core concept here, the HIE ecosystem or again the environment required to progress HIE activities. So when we started strategic planning a few years ago with the HIE steering committee, we acknowledged that there had been this sort of myopic focus on technology as the singular approach to advancing health data exchange. When in reality we need this sort of marriage of financing our resources to support activities, policies and processes that enable data exchange and an effective governance model all to work in concert with technical capabilities. And so the strategic plan really acknowledges that and takes apart each component of the HIE ecosystem and looks at how it would need to be advanced to further our goals. So this kind of shootout of technology is also acknowledging that our technology to enable health data exchange is modular and it begins at a foundation with a foundation. So I often use the metaphor of a house. You have to build the foundation of the house before you can pick out the curtains or the paint color. And it's sort of the same concept here. Public investment is really focused on ensuring that we have core technical capabilities to collect and safely exchange health data. And once those core capabilities are in place, we can do things like extract data for analysis, support coordination of care, provide data for our consumer tools and all the sort of data uses that you might think of when you think of health data. So all these concepts are important to our strategic planning so that we're focusing our efforts on building foundational services to enable the use cases that are clearly out there. So moving on to who develops the plan itself. So in late 2017, we pulled together, we at HHS pulled together the Health Information Exchanger HIE Steering Committee, our diligent, passionate and small group to pull together an HIE strategic plan to really get our HIE efforts back on track on the state and again to provide an accountable and transparent look at progress ahead. So this is how the group has evolved to date. These are the members of the group. Still a relatively small group, but the idea is a way of representatives from across the continuum of care who can reflect different perspectives on the strategic planning process and also who can act as liaisons to their own groups to further help data exchange goals statewide. So moving on and just sort of a final core concept here that I wanted to go over was kind of the structure of governance of Health Information Exchange here in Vermont. So if we start at the top, where do stakeholders convene to discuss HIE matters, set priorities and propose policy? That's the HIE Steering Committee. This group develops, executes and evaluates the HIE plan, which we're discussing today and monitors performance and operational administrative support with, excuse me, with operational administrative support from the HIE unit. Where do decisions makers go for support? And decision makers, we're talking about the Steering Committee. We're going to subcommittees here. So we use subcommittees to really gather technical insights and expertise on particular topics and feed up into the Steering Committee. And sometimes those are short-term groups and some of the Steering Committee, the subcommittees we've had for a long time, who's responsible for oversight. Of course, that's the thing. Emily, can I just jump in here for just a second? Just to observe here that the subcommittees are very active and are deeply engaged in a number of topic areas, which we'll elaborate on, but that they really drive a lot of the priorities for the Steering Committee. And I just have observed, since I have been the chair for only so long, I've observed the great amount of work that the subcommittees are churning out, in particular, related to projects like claims and clinical data integration. That's a really great point. And I think that's a great way to point out kind of this relationship between strategic planners at sort of the macro level and the folks who are looking at really specific topics and doing sort of timely work to advance health information exchange strategies. That's a good point. Hey, how's it going, Ben? So looking at oversight, of course, of your mountain care board's role, Kate pointed out the statutory authority to approve the statewide HIE plan and vitals budget annually. Those who provide HIE services include vital and other HIE service vendors like by state primary care and one care who are providing services related to health data exchange in the state and how our service providers held accountable. And so we've talked about this over the past few years, but the state's contractual relationship with vital has evolved and now really reflects how we hold vital accountable for performance in service of advancing the strategies that we've articulated in the HIE plan. And for those not presenting, if you don't mind putting yourself on mute. Thank you. All right, so those are sort of the core concepts that underpin planning and really allow us to create a framework for thinking about how we'll advance health information exchange in the state before I move on to 2021 progress and how we're thinking about next year. Any questions on this? Everyone sort of old hat at those. So thanks for letting me review them. Okay, so let's jump into a couple of things that have advanced this year and how we're thinking about next year. So first wanted to start by saying health tech solutions which is a known group to us, they came to the state in 2017 and 2017, or excuse me, 2018 to evaluate our health information exchange efforts, governance model framework that we're using to articulate our needs and advance our health information exchange journey. They've come here and they've done comprehensive evaluation and we asked them to come back this past year to again look at our HIE plan to ensure we're on track, that we're in alignment with national initiatives and sort of market evolutions and to do a gap analysis for us to help us continually improve. And to kind of summarize their findings, they concluded that our health information exchange strategy is in direction, excuse me, are correct for accomplishing the goals as we've set out in the HIE plan. The health data architecture and the VHIE data model which we'll talk more about today are appropriate for what we're trying to accomplish meaning that we've got the appropriate core, a technical infrastructure to further our goals. And finally stakeholder alignment is critical for success. And I don't want to say more about that one. But before I turn it over, the final thing here I'll just point out is that they were really key in helping us articulate this sort of transition that Vermont's in from a first generation HIE model to a second generation model. And so what they're saying is that the VHIE is rapidly transitioning from a first generation HIE based on the sharing of clinical information from and to the point of care. So thinking about how HIE would support direct care to a second generation HIE which with a much more robust assortment of data types and services offered. So in a way, we're at a pivotal point where the technologies that we have are really allowing us to do what we had envisioned in terms of health data exchange and service of care delivery. And now we can think about new uses of data services and health data itself. But you know, I'll turn it over to you to think to expand on how stakeholder alignment is critical for our success. Thanks Emily. The second generation HIE concept really is about a unified place for health data, integrating different types of health data and strengthening the tools that we have by bringing more types of data together that are complementary and inform one another. That can't be accomplished without stakeholder alignment, without stakeholder participation. Certainly we are all working in that spirit together in the HIE Steering Committee. But we know that there is work to continue to do to ensure that we are all working towards this unified health data space that we see the value that we are testing with integrated claims and clinical information. For instance, and that as an example, commercial payers are in alignment with this vision and contributing potentially claims data to the health information exchange. We have brought claims data forward and into the health information exchange through the Department of Vermont Health Access and we'd like to see the same in the commercial payers space and that's a place for work and advancement as we move forward together. Okay, thanks. So moving on to look at 2021 major changes in accomplishments. There's two really key things that we wanted to point out. One, in this past year, well, I'll remind you of what the Collaborative Services Project is before I jump in. So the Collaborative Services Project as a reminder was this idea that there was a sort of fractured development in health data exchange technologies. And if we came together on a unified look at how we'd like to aggregate and exchange health data, we can reduce duplication of services and ensure that we are working towards this creation of one unified longitudinal health record for each Vermonter to enable again, care delivery, care coordination, population health management, the myriad use cases that we think about when we think about health data exchange. So for this past year, Vital has made significant progress and technical implementation of this project, meaning that now they've launched new capabilities to match patient records across a diversity of systems. There are new master patient index, the completed terminology services, which standardized code sets into a terminology that's useful or language that's useful to the end user of health data. They've deployed an integration engine, a platform for routing data to appropriate users and most recently launched a new data platform, a consolidated data system relying on its standard data model to enable consistent data sharing and use. And that's what HealthTech Solutions is pointing to as the technology, the technical capabilities that are appropriate for what we're trying to achieve here in Vermont in terms of our vision for health data exchange. Because of all of that work that Vital has done over the last few years to implement the collaborative services project technologies, Medicaid is now able to share claims data on the VHI. And we are now able to get a linked clinical and claims data set, which will ultimately help us manage performance for the Medicaid plan and for associated healthcare reforms. So a lot of technical progress there. And the other major change in 2021 was the expiration of the High Tech Act funding, which we anticipated and we talked about last time when we were in front of the Green Mountain Care Board. But we have in the last year much more information about what this means in terms of federal investment and health information exchange has been uncovered. So as a reminder of what the US High Tech Act did, which is basically it's sort of stimulus money and started under the Obama administration. It allowed Vermont to support Medicaid providers in purchasing electronic health record technologies. That was the Medicaid EHR incentive payment program. Some people call it meaningful use. It allowed us to develop and enhance the VHI, the health information exchange, including these collaborative services technologies that I just pointed to. It allowed us to develop care coordination and analytics capacities at OneCare Vermont and to maintain and enhance public health registries and data capabilities. So that was system and staff and to bolster the public health, or excuse me, blueprint for health operations with data and data services. So initially providing analytic services, support for their clinical registry and now use of data directly from the VHI to support program implementation and evaluation. So since that expired in September, we've secured ongoing system development funding, but at a lower match rate. And so we've been able to do this because CMS or the Center for Medicare and Medicaid Services has basically said we are committed to the idea that states need the capacity to collect and exchange health data in service of the Medicaid health plan, Medicaid operations, Medicaid providers and Medicaid patients. So with a really specific focus on Medicaid that is contrasting with the High Tech Act which was stimulus money to be used more broadly to benefit the healthcare system. So those two concepts are being confronted but what we know now is that CMS is committed to continuing this work. Why it comes in at a lower match rate is because we have to cost allocate to the benefit of Medicaid. So as an important component of this, we have begun a process for certifying the VHI system through a process that CMS calls outcomes-based certification. This was an opportunity previously only available to things that CMS would consider part of the Medicaid enterprise. So now they have enveloped the idea that health data exchange is part of the Medicaid enterprise. And we, by obtaining certification we're doing two things financially. We're opening the door to ongoing perpetual sustained funding for operations of the VHI modules or VHI system at a 75-25 match rate which is cost allocated to Medicaid. So it will look something probably in the end like a 50-50 match rate. And it also means that we can request enhanced funding for development activities. So those previously either came in at a 90% in federal match rate or something close to it cost allocated for the entirety of the system. Once where we've requested a new federal match rate or expecting something closer to a 65% federal investment ratio. So the certification process which we talked a little bit about last year has been really sort of, we've been seeing to it sort of intensively for over a year at this point. So we started with a subcommittee of the Steering Committee who helped us develop measures and those outcome measures are how we based certification of the system and ongoing funding. So CMS is basically saying we don't wanna focus on the fact that your widget does X and Y. We wanna focus on the fact that you built a widget to support Medicaid in some way and we are going to measure your progress through an outcome measure. So how do you support direct care, care coordination, enable public health, support AHS's health reform priorities, things like that. And so we went through a multi-month process to propose these outcomes measures to CMS. It's a new process for them so they were learning like we were and we are one of the first states to go through it, perhaps the third at this point. And so ultimately they accepted our proposal of outcome measures and we in partnership with Vital began reporting our collecting data to report that we are meeting the measures in May of 2021. Just seven days ago, so just this last week, we did our final certification review with CMS which was a four-hour process of presenting the outcome measures back to CMS and showing them how the VI system enables that measurement. We got very positive feedback from that certification review. So we are optimistic in the fact that we will receive approval. CMS has a couple of months to do this so any time between tomorrow and the next 90 days certified VI and once we do receive certification we'll begin to start the process for obtaining that ongoing maintenance funds for the VI system which is retroactive as well as proposing an enhanced federal match rate for the system enhancement work that we have planned for 2021. So I feel like I just said a lot so why don't I pause for a second before I jump into 2022 activities. And Susan, I assume this is okay to stop partway through and ask for questions but you tell me if you want me to wait till the end. Mr. Chair, what do you think? Usually we wait till the end Emily if that's okay. We wait till the end. Okay. Emily, I can just jump in and give you a break if you'd like. Sure. Give you a moment to catch your breath. I just can't underscore enough the work that Emily and the team did in this new process of the outcomes based certification. It is a new process with CMS as Emily mentioned we're among some of the first states to go through this process. It's a totally different model than what we've been working with to date. And I think it's taken a lot of work and creativity as well as persistence to get through this kind of evolving and new program with CMS. And I think that they've done a fabulous job with the team in navigating this new area. And I just want to give them praise where praises do in that regard. And of course, we're very hopeful that we get the information back soon and that it is positive for the state of Vermont and the HIE. Thanks for saying that, I would be remiss if I didn't point out vital enormous role here in particular Carolyn Stone's team. They did a great job presenting the system to CMS and the feedback we heard was Vermont's demonstrating best practice. We're gonna show other states here what you've done. We wanna create the model based on what you've presented and that was doing a large part to how Carolyn's team presented the system which was really exciting to see. Okay, so I'm gonna jump into 2022 activities to look at the year ahead. So these are kind of broken down into different parts but I'll say there's a nuance to each. And as you all are well aware, we are working towards sort of moving towards the goalpost each year further and further. So we will do in part some work to progress our efforts each year. So when we think about 2022, first step is governing use of expanded health records on the beehive. So as we've talked about for the last couple of years, we've had the intention of using the beehive or this sort of central key health data repository that's central to our unified health data space to begin to aggregate additional data types that would constitute factors that influence our people's health and wellbeing. So we are talking about expanding the sort of traditional clinical health record to include social determinants of health data claims records, mental health and substance use disorder services data. And so those are left out of the health records for various reasons which are articulated in the HIE plan but we can go more into that if that's of interest. And so by doing this, by expanding the health records and adding these additional data types that sort of fall out of the traditionally regulated clinical data, we are acknowledging that there's a need for more formalized robust data governance to ensure the security and usability of health records on the system. So the HIE steering committee is committed to continually supporting development of functional data governance that aligns stakeholders and ensures that we are safeguarding new types of data in alignment with stakeholder preference and federal and state statute. So that's something that will really kick off in earnest in this coming year and it's going to be a new partnership and a new way of thinking about health data. So there's, this is the beginning of an evolution it's a of how we are sort of formalizing data governance it won't finish this year, we will kick it off. So that's one concept is thinking about how we are appropriately protecting and using health data on the VHIE as it expands and another sort of concept under our need for governing the health records on the VHIE is just this idea that the VHIE system has recently upgraded and offers an incredible service now that potentially was underutilized before or not available before which positions vital to offer more data services to additional customers. And so that shift in the business model means that we need to keep our eye on how AHS and vital governance relationship exists and how just generally the governance of the system is transparently articulated to the public and how the system is used generally. So the steering committee will continue to evaluate its role as it relates to governance on sort of both of these fronts and think about its relationship with the Vital Board of Directors and Vital itself. So next up here thinking about 2022 planned activities. So last year we talked a lot about public health integration with the VHIE because Vital and the Department of Health did such an exceptional job in partnering in response to the COVID-19 pandemic. So of course that work has continued and evolved and become more sophisticated over time. There's some examples listed here I won't go through them and there's more in the HIE plan itself but catalyzing on this momentum and making sure that we are picking up on kind of this national push towards leveraging HIEs and service of public health management. We're gonna be using 2022 to develop a public health and VHIE integration strategy. So this will think about the public health our goals towards to our goal to create one longitudinal health record for each Vermonter on the VHIE including maximizing public health data to do that and also the fact that the VHIE has new robust data service capabilities and how the Department of Health can be leveraging those data capabilities to support public health management. So looking at it from both of those frames and we hope to next year come back with a more specific look at sort of our path ahead in terms of public health's use of the VHIE system and data and how Vital will be leveraging the data aggregated at the Department of Health. So next year we'll also be thinking about leveraging the unified health data space to support Medicaid operations. And by this we again mean Vital as the VHIE as the central health data repository feeding it into and out to different health data systems. So we're thinking about this on sort of two fronts. First generally just to support Medicaid performance management because we understand that to manage risk and overall performance of the Medicaid health plan including associated health reforms we need linked clinical and claims data. And as I talked about we are now submitting claims data to the VHIE and benefiting from a linked clinical and claims and benefiting from linked clinical and claims data on the VHIE. Specifically Vital will also be transmitting a clinical data feed back to Medicaid to ensure that Medicaid can comply with the new federal interoperability rules for patient access so that if an individual asks for their healthcare encounter data or their claims data from their Medicaid health plan through a 30-party application on their phone they can get the full record from Medicaid directly. So when we think about preparing Medicaid providers to participate in value-based purchasing models first and foremost they need the ability to collect data and to exchange it across provider networks using the health information exchange. And unfortunately because the Medicaid meaningful use program was a bit restrictive not all Medicaid providers are able to do that. So the federal government has provided us the opportunity to continue an EHR incentive program but run it as we see fit with federal investment. And so we're going to be looking into designing a program in this coming year that really targets Medicaid providers particularly those that are participating in our near-term value-based purchasing models. And so really what we'll first be doing is looking across the system and seeing where their data collection gaps and where the needs are. Do folks need referral tools or care coordination tools or electronic health records? What is the data collection capacity that they need? And then we'll look at actually incentivizing folks providing money to purchase these tools and a means to connect to the health information exchange. And we'll use a subcommittee of the health information exchange steering committee to design this program. So we really have a cross-sector perspective on the program's design. Okay. So moving on, the final thing here for thinking about 2022, this is not new. This was brought up last year but just really wanted to highlight sort of the shift in the health data access environment or landscape that really kicked off in earnest with a launch of the federal patient access and interoperability rules. So these first and foremost, next slide, just go to this next slide. So these are two rules that have brought together a technical framework from the office of the national coordinator and a regulatory framework from CMS to really put patients at the center of their healthcare by driving systems that make their data more accessible to them. So this is happening in a lot of different ways but the easiest sort of one I think to understand is now patients are able to use third party apps on their phone to request their health records from HIEs, from payers and from some providers. It also, these rules are also driving payers to interact more effectively so that they save costs and they reduce sort of administrative burdens that can hinder care. So these rules aren't new. Like I said, to this year, they didn't kick off in the previous year where we'll likely start to see more of an evolution of how patients are using their data and that really impacts how we're thinking about how to evolve the health data system so it supports all of its users because patients are a real user now. As part of sort of this concept of improving access, MITLE will also be launching a new provider portal and the idea here is just to continually improve how health records are accessed and used and made meaningful to support care delivery. So that's a sort of a brief summary of 2022. And as I mentioned, we wanted to kind of launch back into the HIE ecosystem. And again, this is the environment required to advance health data exchange efforts. So previously we had this really myopic focus just on technology and the HIE Steering Committee through the HIE plan is really acknowledging that we need to advance multiple fronts, financing, policy and process, governance in addition to technology in order to advance health data exchange in the state. So we're gonna take these piece by piece. Okay, so, yeah, I should be showing you that there's the triangle of our HIE ecosystem. So let's talk about governance first or the structure that we would need to govern the security and accessibility of data itself. So from the vantage point of the Steering Committee and the subcommittees who informed them in 2021, we continued the Collaborative Services subcommittee. This was a group that was formed to provide strategic insight to vital as they selected the technologies for the Collaborative Services project and they implemented them and then provided an assessment back to the Steering Committee itself as the sort of technical advisors to determine if the system would appropriately meet their needs which they did determine and which is included in the HIE plan. The Connectivity Criteria subcommittee and Carolyn's gonna talk more about this is a group that will continue year over year to support vital and reviewing and updating the connectivity criteria or the standards for exchanging data with the HIE. The Interface Prioritization subcommittee is a group that we launched a couple of years ago so that there's a group of a variety of stakeholders who are providing insights on how public dollars are used to advance connections between data collection systems and the HIE and helping us prioritize those. Of course, because of the pandemic, really the focus of connectivity the last couple of years has really been labs or systems that are collecting COVID results to ensure that the Department of Health and healthcare providers have needed data for COVID response. So that's really been the thrust of connections over the last couple of years, but we expect to sort of get back to relatively normal terms in terms of progressing connections between electronic health records or care coordination tools and the HIE. The Claims subcommittee with me this year and because of our ability now to integrate claims data onto the VI. So this was a group who came together to begin articulating these cases for our linked clinical and claims data set to really help vital understand how the system could be used with claims data on it. So this group did an incredible amount of work which is all on the website. If anybody's interested in looking at these cases and sort of a deep dive into how claims data could advance work from this variety of perspectives and they'll continue next year to articulate and oversee how claims data on the VI can support these mirrored use cases. And finally, the part two group is on new groupie there, their group run by Vital to bring together stakeholders around the development of universal policies and procedures for sharing data that we'd call clinically sensitive, substance use disorder data, mental health data, women's health data, other behavioral health data to ensure that one federal rules allow the policies and procedures for aggregating these new data types on the VI or our stakeholder informed and endorsed. So that's a look at this past year. So looking ahead at what these groups will do in terms of our governance structure. So we'll be combining the interface prioritization subcommittee and the connectivity criteria subcommittee which are both groups that provide insights on connections to Vital. So they'll continue their great work and we'll continue to update the connectivity criteria year over year which lives in the HIE plan. We'll be introducing a new subcommittee the population health subcommittee. So this is where we'll be thinking about how social determinants of health data can be aggregated onto the VI from the perspective of how we'd govern uses of this new data type as well as how we'd prioritize projects or data aggregation efforts onto the VI. So a lot of great work I'm sure is anticipated for this group in the year ahead. The part two plus group will continue as we await federal rules regarding sharing of data governed by 42 CFR part two. They'll continue to engage substance use disorder data sources and other producers of clinically sensitive data in what it might mean to share data through the VI. We'll continue our claims subcommittee. I guess we shouldn't call it pilot anymore just the claims subcommittee to guide implementation of efforts to aggregate and utilize claims data produced by the VI or excuse me provided by the VI. And we'll introduce this new group the Medicaid data aggregation and access program. This is the group that's gonna be looking at designing an EHR incentive program for Medicaid providers to be able to collect data from their own facility and to exchange data through the VI. So that's a look at governance to jump into another facet of the HIE ecosystem policy. So here you're seeing the HIE policy and process maturity model. So when we thought about strategic planning a few years ago, you know, we knew that Rome couldn't be built in a day and so there was going to be an evolution of each of these facets of the ecosystem. So when we thought about policy and processes that we need to enable data exchange, we conceived that it began with sort of an organizational focus or individuals data sharing preferences managed in each care setting all the way to the ideal scenario, which is that sharing of data sources that constitute an individual's entire health profile or be supported by state and federal policy. So we feel like we're somewhere in the middle here, of course, with a shift in the consent policy in 2019 that was in that went into effect in 2020, feel like we're closer to the statewide consent management model, excuse me, but our needs will continue to evolve and as we add new data types, we're going to be thinking of new means for consent. So in this past year, Vermont's law and immunization records was amended to allow for bi-directional exchange from the state's immunization registry to the VHI, which is huge, a huge milestone because now it allows data, immunization record data to populate the longitudinal health records on the VHI and it will allow the VHI to ensure that the immunization registry has the most up-to-date immunization records. So great progress there. We expect that the actual technology for bi-directional exchange will be implemented next year. Of course, we talked about the federal laws directing patient access and health record exchange through the patient access and interoperability rules. A lot of that framework has not been produced yet and we expect that it will continue at CMS and the ONC will continue to provide sort of a framework around that. So there's more to come on that and more to see in terms of patient use of their data. And as I noted, we're thinking about the policies and processes that are needed to enable the aggregation in exchange of clinically sensitive data, social determinants of health data and I'd add to that claims data. Okay, so looking at how the resources we use to support our health information exchange efforts and on the right here you're seeing, again, a look at how we think the HIE financing model would mature over time. We think we're somewhere in the middle here where we've evolved from just this concept that public funds are the sole source of funding to the idea that we're thinking about diversifying revenues for our HIE systems, working towards sort of that long-term goal of something that looks like a more sustainable relationship between public and private investment. So we've gone over some of this on the left here with the US High Tech Act funding expired in 2021 and what that means. I noted that CMS continues to offer states the opportunity to fund health information exchange efforts but with a different funding model. We're pursuing outcomes-based certification to obtain ongoing maintenance funds and the ability to request and for enhanced federal matrates for development work of HIE systems. And let's see here. So that's kind of the federal look, the steering committee itself notes in the HIE plan that we need sustained public funding in order to advance our work, are the vision articulated in the HIE plan here over year and that sustained funding comes from the HIT fund which is a portion of the state's tax on commercial claims. And so they are suggesting that we extend that every year right now it's extended through 2023. And finally, the final consideration here is that the Collaborative Services Project is expected to position the VI to provide demand driven services. This means that the system itself can meet users data needs and data services needs outside of what the public, sort of the public good HIE infrastructure might look like which is positive in terms of supporting a sustainability model that relies on both public and private investment but we are just at the beginning stages of this. So that business model is not totally known to us yet. Okay. And I think we've gone over data governance here but just one more note just on the importance of thinking about the steering committee's role and thinking about how we govern and manage data exchanged through the VI and the population health subcommittee will really be focusing on this in the year to come as it relates to the exchange and aggregation of social determinants of health data. The part two group will be thinking about universal policies and processes for enabling aggregation and exchange of clinically sensitive data and the claims subcommittee will think about how legislative changes may be required and policy and processes are needed to enable or really maximize this data service of linking clinical and claims data through the VI. So all those fronts. And finally, a look at technology. So I keep pointing to this idea of Vermont's unified health data space. If you see the gray box in the center that's the health information exchange. So this is our data repository that can match records across a diversity of systems making them accessible for a variety of users and ensure security and do consent management on a variety of fronts and then push data out depending on user need. So this is perhaps a more simple look at at kind of the system that we aim to build. Some of these things are in place now like most of the gray, what's in gray now is exists today. Some of these other things exist in part like bi-directional exchange with public health registries is coming soon or pushing VI data out to the Medicaid care coordination tool for example exists today but other things are envisioned in terms of creating the appropriate technical architecture just to realize the goals that we've set forth in the HIE plan. So that is, those are all of my slides. So I'm gonna, you know, any final thoughts before we turn it over to Vital for the presentation on connectivity criteria. I think before we turn it over to Vital we might wanna ask you questions. So, Ina, did you have some final thoughts or do you want us to just jump in? Jump in, please. Okay. So I'll start, Emily, you talked about one of the goals in 2022 is really a new provider view and what's different? What will the provider see in this new provider view? Yeah, Beth or Carolyn, I'd love to turn that one to you because they'll be launching the new provider portal and I think they can provide a great perspective on that. Yeah, I'll start, Carolyn, if you wanna add in. So the new provider portal, our goal is to make it a more user-friendly interface one which I think we don't have. I think the new portal will present the data really in a French sheet in a more holistic, maneuverable way is the language I might use to get a view of what the patient's data and what's available. We will be able to expose more of the patient's data than we have been in the existing provider portal. So there'll be some important data made available to providers that I think is really important. But one thing I will say and Maureen is on the call and I know she may wanna jump in as well is we intend to continue enhancing this portal. So in a lot of ways, we'll be replacing and somewhat enhancing what we have now but then Maureen will be leading a really good pilot and then ongoing process of stakeholder engagement to understand what else they might want to see. So what other functionality would be helpful for them to have in the portal and then we will continue to enhance it from there. And this new portal will allow us a lot of flexibility to be able to do that which we don't have with the current portal. So if they wanna see data presented in a certain way or be able to check panels of patients we'll have some flexibility to create that capability in it. So you may wanna pass my second question to Beth too Emily but that really is you were focusing on the transition of the financing. And my question is, when do we get to the point where providers across the state see so much value in front of them that they would be willing to pay for each time there's a click or what have you? Yeah, I mean, I would love Beth's insights but I just, I do wanna say that the steering committee continues to kind of grapple with the concept of what is a public good as it pertains to the health information exchange infrastructure and then what would be a demand driven service is what would demand driven service, excuse me, what can someone buy? And I don't think we've come to a final definition on that. I don't know that we, I mean, it's sort of a live discussion. So, obviously Beth, please weigh in on the value proposition of the VHI but just to say that I think we're on the precipice of this conversation and it's, the steering committee is interested in getting to a more concerted definition around public good so they can support the state in investing in something that has the broadest benefit. Yeah, Emily, I think I agree with what Emily said and I think that's a really important point is we wanna develop kind of the perspective of what the foundational kind of the, to ensure equity and availability for everyone, what that kind of baseline service is. I know then as there are additional services and capabilities we can offer, but I think we'll have significant value to providers, payers, things like that and that's also where we're looking at potentially charging for services where we're adding on to that foundation and providing additional value and capabilities to them likely leading to operational savings or improved efficiencies, things like that. Okay, so we'll go in alphabetical order of the board members starting with board member Holmes, Jessica. Okay, well, thank you for the presentation. I guess I just have a couple of questions. As you think about moving to adding more clinically sensitive data and the social determinants of health data, it seems really critical to have a consumer voice on that steering committee and I noticed that's still vacant. So I wanted to hear a little bit more about why it's still vacant on the steering committee and what the plans were to fill that position. Well, first of all, it's a great and important question and I think there's kind of, there's a couple of ways to look at it. Of course, the consumer voice best steering committee which has been a struggle to fill because it's really such a, it's a position that requires a lot of dedicated time and not everybody's gonna have the interest and the time to give to the group. So it's certainly a gap there and something that needs to be filled in the steering committee absolutely recognizes that. The other thing that is on the forefront of the steering committee's mind is thinking about how to better engage existing stakeholder groups and reach out to gain insights from providers, consumers from those impacted by changes in the data exchange models. So I think both of those things are really important consideration to be around like sort of how we get more of a voice into the development of policies and processes that are impacting, how we're exchanging new types of data and Maureen from Vital has done a great job of engaging the substance use disorder community around how new data can be exchanged and using them as gatekeepers to their constituents to really understand how new policies would impact folks and how folks would feel about new data sharing arrangements which was sort of building off our shift in the consent model in March of 2020. But we're gonna need to do something similar every time we add new data or we shift the consent model or anything changes. And so I'm just not really answering your question but just pointing out that it's really important. Thank you. Well, I hope you do continue that work because I think it really is an important voice to have. And I guess my second question really is about if you could talk a little bit more about what you mean by social determinants of health data, like what specific fields you're thinking about adding. And then with that, who will be using it? How will it be used to help us better understand some of the, an act on some of the health inequities that we suspect are out there but this data will help us really evaluate. So wondering what the fields are, who's gonna use it? How it will be used to help us understand health inequities. So the first part of the question is the easiest to answer which is like how do we define social determinants of health? And as what's probably underscoring your question is the fact that like when you say this term social determinants of health people think of lots of different things, homelessness or food insecurity, transportation issues, lots of different things that could impact someone's health and well-being. Thankfully the ONC third project called the gravity project has begun to standardize data terminology for exchange in clinical settings that could be couched as social determinants of health data. So we can start there with those standards and I think that they call them domains but they're the domain areas are sort of generally what people would think of when they think of social determinants of health including the examples that I've provided. So that's a starting place for us. And at AHS this past year what we've begun doing is aggregating data that falls within those domains so that we are able to use the VHOT to collect social determinants of health data produced by the agency. So that's in that practice that's provided a good framework for us to at least begin this project. What we, the latter parts of your question are a little bit harder to answer because I think the population health subcommittee is really gonna help us define new sources of data for social determinants of health, how that data is gonna be used by whom, when sort of the whole framework for data sharing and their work hasn't kicked off yet. Okay, great. Well, thank you. Those are my questions, appreciate it. Thanks Jess. Next we'll move to board member Launge Robin. Thank you and thank you, Ina and Emily for the presentation. So I was, I have a bunch of questions. I was wondering if you could talk a little bit more about the governance issues that you're talking about in terms of the focus for 2022. Are you speaking specifically to, for example, membership or purview of the HIE Steering Committee? Are you speaking to like the vital board, both? Could you just be a little more concrete about what that work entails in terms of defining the expanded governance? So yeah, there's a lot of considerations here under a broad umbrella of governance. So one is this idea of sort of more traditional data governance, which is policies and processes that allow for the appropriate and secure, you know, use of data that would be aggregated through the VHI. And so when we talk about data governance specifically, we're talking about, you know, adding these new data types, how do we ensure that they are appropriately, the new data is appropriately used, right? So that's one piece of it that will be seen to by the population health subcommittee. The part two group is thinking about those policies and potentially proposing a consent model to reflect politically sensitive data. And then the claims subcommittee ultimately will need to think about that as claims data uses potentially expand through the VHI. So that's the kind of like the part of it that's data governance. In terms of this steering committee's relationship with the vital board that needs to evolve and focus on the fact that vital will be offering expanded data services to groups outside of state government or not on behalf of state government. And so what that looks like will really be contingent on how vital evolves its business model. Okay, I'll turn your question. Yeah, no, that's very helpful. In terms of the ladder piece, that's an area that I think, and I'll just tell you my opinion as a Green Mountain Care Board member is it seems to me like that ladder piece about the external stakeholders in the overall direction is part of what the HIE plan is meant to address is to ensure that not just state government actors but the whole HIE space private and public is rowing in the same direction so that we don't have an HIE that's being, for example, creating multiple care coordination technology systems that don't necessarily enhance moving one set of care coordination processes forward. So I'll just, that I was part of why I asked the question is because I would be concerned about having the overall strategic direction be diluted and potentially sort of pulled in different directions. So I'll just make that as a comment. Thank you for extending on that. In the funding area, I am also, I was in follow up to Kevin's question, I am very interested in this definitional issue around public good versus the end user services and how those sort of connect. In the plan, it seemed to indicate that the public good components might be in your three tiers, the first two tiers, the foundational and the exchange services. And I was wondering if that was driven by the CMS Medicaid enterprise system criteria and rules versus which to your point about funding would kind of essentially limit how much of the total cost that Medicaid could support because it does need to be focused on Medicaid patients, understandably. Or if there was something, some other considerations that maybe I didn't pick up on in reading the report. Yeah, so I think it's a conversation that started with the steering committee that's not yet well articulated in the plan. It's the fact that the HIE services model, like what you're saying, that there's three tiers, that each of the parts of those tiers, the blocks of those tiers is nuanced. So for example, we have data aggregation as a foundational service or an exchange service kind of at the bottom, but data aggregation sort of in general terms means connecting data collection systems with the HIE. So then the question becomes, this is just an example, is the public's responsibility to pay for all connections from electronic health record systems, the HIE. So there are nuances in each of those sort of blocks of foundational services. Some are easier, like providing a master patient index that allows you to match records across a diversity of systems. That's one system that state government can sustain in service of this goal of having a longitudinal health record for each promoter. So there are more conversations, I think that need to happen. And Beth's talking about the provider portal, even the provider portal, what is the line between equitable access to health data and providing kind of built-in whistle services that a healthcare organization might buy from Vital. And those are all things that need to be better defined. Okay, thank you. So I did take a look at the metrics that you mentioned that were the outcome metrics that were in the appendix of the plan that you and Vital will be reporting on to the Feds. And one of the questions that raised for me is whether there needs to be alignment in Vital's reporting as part of their budget to those metrics. And so I don't think anybody has to necessarily answer that now, but it might make sense for us to think about the metrics we currently get and how to align that on a broader basis. So it's not just Medicaid focused moving forward. So you're welcome to comment, but also if folks wanna think about that, I'm happy to get feedback on that at a later time. I mean, I think it's a great idea and Beth, I think it looks like you wanna add too. Yeah, I think that's a good point is as we go forward into next year, I think we wanna have some conversations with you or Vital wants to have some conversations with our board team about what goes into our regular packet because we have had some shifts and we do wanna represent the current work. So I think that's a great time to start those conversations. Great, thank you. My last question is about, you had mentioned that the claims subgroup would be identifying potential legislative changes needed to further that work. And I was curious when you would expect that work to be completed. Inna, do you wanna weigh in on that one? I don't think that we would expect that to necessarily be completed in advance of this legislative session if that's what you're asking. Yeah, I just wasn't sure how far along it was if this was a stream of work that really needs to start at some point in 2022 or if there'd already been some thinking. So that's what I was trying to suss out. And that's it for me, Kevin, thank you. Thanks so much, Robin. And next we're gonna turn to board member Pelham, Tom. Well, thank you all for a very thorough and intense presentation. This is very complicated stuff and it's hard to keep track of it. And I appreciate all the work that has gone in in my experience going back to opt in and opt out which seemed like a pretty simple thing to grapple with. This is very, very dense stuff. My first question has to do, I think with your first goal which was the one record per patient or per person here. I see that patients and people, I'll try to use the current terminology, one person per people. One is you said because of the collaboration project that you were at 95%. So I'm just asking, so if this is your top goal but your experience now is a 95% unity between looking somebody up and getting the right person is how much farther is there to go? Well, I think it's a really important thing which is that VITAL's new master patient index is doing incredible work to match records across systems and it's doing exactly what it's supposed to do. It's having a really high success rate and doing that matching. Whoa, we need to do now I think is add records. So add more information to the VHI that would go through the master patient index be matched so successfully and add to the longitudinal health record. So on patient matching, definitely hitting that one out of the park. VITAL's doing a great job and that new technical service is working exactly as planned the next step there is adding more information. So you're building on the 95%, it's not getting to the 95% anymore. Yeah, we'll just continue to use that system. So add more records and continue to use the great system to match them to one patient. So my second question has to do with the issue of bringing commercial payers of more engaged with this process. And I'm just wondering if there's anything as anything that you see or anticipate where the board might be helpful in that regard in terms of our authorities relative to regulating private insurance companies. You know, do you have anything to add to that? There isn't something that I can identify at this point but I think it's a conversation that we should certainly continue to have as we move forward. And so I appreciate the question. I don't have an answer off the top of my head. But again, I think it's an important question, important topic for continued discussion. I mean, I ask that because of my observation, I'm just obviously speaking for myself is that, you know, the commercial carriers are happy to say they're all in on healthcare reform. But when you look at the change in the payment system, you know, they're down at one to 2% in terms of their true fixed perspective payments. And so I just, so, you know, if there's something where we can do and be helpful, we should at least make sure the door's open. Maybe we can't be, but you know, the door should be open at that level. I do share the concerns. I think that both Robin and Jess were referencing in terms of the consumer rep, you know, on the steering committee, especially as we go down the road toward bringing more definition to what is a social determinant of health and try to integrate into more individual access into having access to their own information. That at some point in time, there might be some tensions there. And I think that as we, the sooner we get engaged in those tensions, the better off we will be in bringing advocates for privacy to the table in a way that doesn't undermine what we've accomplished to date. So that's that observation. I think there was one more, or there was one more, you may remember that we had a, I think it was a primary care advisory committee member and part of the topic had to do with the V-HI. And the folks at the meeting or advisory committee meeting, primary care advisory committee were the principals in there, in their, what do I wanna call it, in their, blanking on the word, in their business. They were the principals. And they didn't, when we asked them or they were asked, you know, how much they used to sit the vital system, they basically said they didn't. And some of them said they still get their information from the hospital, et cetera, et cetera. And after that got scrubbed a little bit, not at that meeting, but after, you know, Beth was concerned about it, rightfully so. It was basically that the people in the back office are the ones that use the system and it's not necessarily the physicians themselves. So if they're asking for a test result, they're not quite sure they don't have current knowledge as to where it's coming from in some cases. So I just wanna emphasize that that was a little snafu that popped up. And so it's just important to get the right people in the room, you know, when you're trying to sort through some of these integration issues so that you have the right people in the room. So other than that, I'm advantaged today by going last. And as we all recognize here, that's an easier task to do. I didn't wanna talk more about social determinants of health and what that means and what that's gonna mean when it hits the street and people start to say, well, you know, this record or that record is now gonna be out there, you know, on the, on vital. So, but we're all aware of that concern and let's, those are the areas that I was interested in. Thank you. Thank you, Tom. So next we'll have the best presentation, Beth. I'm actually gonna pass this to Carolyn who is our expert at connectivity criteria. Thank you. Carolyn Stone from Vital. So what we're gonna walk you through as Emily mentioned is just our annual update to the connectivity criteria. This criteria is a tiered system that kind of establishes standards for connecting and meeting the data quality goals, not only of the VHI, but of our downstream stakeholders. And, you know, we've tried to base these connectivity criteria on the federal standards and this, you know, that are part of the ON Secures Act and it includes the US core data for interoperability or the US CDI. And what we've been doing is we meet with the subcommittee and annually we review the existing criteria and then, you know, we've added in the one new piece that we've added in this year is the claims data. And we based a lot of our work and expertise on the data currently being collected by the Medicaid Agency for this year with the other stakeholders in the group who were there. And we tried to base that on existing data submission formats for the professional claims. So that as a baseline to say, okay, you know, this is what we think we'll do for this year as we start to utilize that data in 2022, we'll just be reevaluating this as a part of our annual go around. We reviewed the mental health, behavioral health and claims and physical health data as well this year. And everyone agreed that we think that that's working fairly well. The mental health and behavioral health, we haven't had a chance to put into use. We're all still waiting for that SAMHSA guidance on how to handle that data correctly. So we're gonna leave it as we defined it originally. The one thing that we did update is we did add in some, the COVID-19 test results into kind of known data that everyone wants to get. The reason we're just adding this at this late date is over the past year, there's lots of in-house testing machines now that are available to providers across the state to do testing in many different care settings now, not just sending, originally when the pandemic started, it was just labs doing these tests. But now there's widespread machines being deployed to specialty practices, primary care practices, all aspects of the continuum. And we're trying to capture that data now from everyone if they have it. If they're doing that type of testing, then we would expect them to be able to transmit that. And those are pretty much the updates for this year. Clearly, we continue to work with healthcare organizations to ensure compliance with these criteria and weave that into all of our processes. Okay, board members, do you have questions on the connectivity criteria update? Thank you. Thank you, Carolyn. So next, unless you have anything further you wanna say, Emily, I'm gonna open it up to public comment. Is that okay? That's great, thank you. Okay, so any member of the public who wishes to comment on the presentation today about the health information exchange strategic plan and the 2022 connectivity criteria, please raise your hand or if you're just on the phone, please speak up. And Walter, I see you're first, so I'll call on you. God, I get to be first, wow. A couple of shout outs to Jessica, Robin and Tom for their mentioning of the no patient or on the steering committee. Another shout out to Tom for saying, not mentioning patients as consumers that we are people. And then a couple of questions. Exactly what is patient-centered? And when you say measuring Medicaid claims, exactly what does that mean? And a note that if you start subscribing or start having subscription services for data, those costs will inevitably be passed on to us patients. So that is something to think about. And if you bring private insurance into that, the same thing's gonna happen. So I'll take a crack at the question about patient-centered Walter and Emily and Ena and Beth and Carolyn can tell me how that fits into the way they perceive it on the health information exchange. But to me, if something is patient-centered, the patient is the most important part of the system. And so everything should be looked through the lens of how it affects the patient and how does it make it easier for the patient and better for the patient. But people from the IT world may have a different definition. So I'll pass it over to them to see if they have anything to add. I think we're with you, Chair Mullen, in terms of that perspective and the same vein of sort of what the vital does. And maybe to Tom's earlier point, they have a behind the scenes service to support patients and providers and ensuring high quality care on behalf of the health and well-being of the population. So when we talk about claims on the VHI, we're not talking about measuring the claims themselves, we're talking about using claims data linked with clinical data to understand the patient's experience. So we're able to improve healthcare programming and curb costs. I think of the VHI as providing information so others can do their work. And Walter, I didn't quite get your second piece. I think you said Medicaid, but I'm not positive. Measuring Medicaid claims. And when I think of the word patient-centered, patient-centered has often meant specifically in healthcare terms where the patient suddenly is uninsured or has, what's the word I wanna use? But anyway, high deductibles and stuff like this, they call it choice, but what it really is the patient goes from one plan to another of high deductible. So that's where I was thinking on my patient-centered idea. Of course it should be the patient. So let's follow this up. I as a patient sitting in an orthopedic office in Copley Hospital or at the Mansfield Orthopedic Center, can I type in my own data or figure out how to get my own data to that physician? Cause there was a slight problem. This was a few months ago of actually getting data. So that's another question. Where was the correction there, Walter, in accessing the data? Can I access my own data? How's that? As a patient, how's that? It's a great question. I know that, for example, I can access my patient portal, both at my primary care provider and at my local hospital, but how does that work for VitalBeth? Can a patient access anything? Yes, currently you can request to have a complete copy of your records that we have on the VHI. There's a process, happy to follow up with you on how to get that information. So you can have a copy for yourself. Part of what Emily talked about in her presentation was for next year, we will be creating these, what's called an API. And it's a very technical term I realized, but basically that allows for an electronic interface for you. So if you wanted to use an application such as I'm going to say an Apple Health type application, just because that's something people commonly are familiar with to get your data from the VHI and to see it in an app and have access to it. So right now it's more of a, you request it from us and we can send you a file, a print out. We work with you to understand how you want that data. But in the future it will be more technically supported for you to have access to the data. Could that address your question? Well, not really, but we'll go on. When you say measuring Medicaid claims, what does measuring, I think I heard that word measuring in there. What exactly does that mean? Well, again, we're talking about using the HIE as a way to collect information and provided in a meaningful way. So not measuring Medicaid claims, but using claims and clinical information to measure healthcare performance and to understand costs and effectiveness of care delivery. So not measuring the claims themselves, but using that as information for measurement. Okay, next I'm going to call on Dr. Rick Hildebrandt. Thanks, I just have a couple of comments. First of all, I think someone had mentioned that this was dense. I'm the Chief Medical Information Officer here around the regional. This is an incredibly complicated topic and you guys did a phenomenal job explaining it to light people. So really well done. HIEs are really complex technology and I think you did a really excellent job at explaining that to the group here. So thank you for that. Beth, you had mentioned API integration. I think that's really important. When it comes to a patients or a, I'm sorry, I've referred to people as patients, so I'm sorry, part of my nature, but our consumers perspective, they're going to want to control their information they want to, not the way we want to, and that's going to be via APIs, whether it's Apple Health or some other app. They don't want to have to go to 14 different portals, I can promise you, they want it in one spot and that API integration is really important, specifically with Apple Health, which is probably the most uniformly known. And the second thing I would say is patient and consumer voice is important, provider voice is also very, very important and I think that was mentioned once, having the voice of your healthcare providers is incredibly important to make sure that we're hitting this right. I know there's not a provider on your steering committee, Frank, I don't know that many providers would have the ability given the time commitments, but finding a way to incorporate that voice. Nancy, we're volunteering, Rick. Yeah, I don't know that I have the time, but I do think it's a really important thing because when it comes down to a need to engage both your consumers and your providers in this process to make sure you have seamless communication. Thank you. May I? Sure, go ahead, Beth. So that, Rick, I appreciate your comments and I think you've heard some of this, but just for the benefit of others on the call. I mean, that is something we are trying to do as vital going forward too. And we've created a position internally to do some more of that engagement and conversation to really get feedback and input. We want to build tools and functionality and capabilities that meet the needs of the people who are going to use it, not just what we think is right and good. So we do, and you will be someone we contact as you know we have already, but we will be reaching out and wanting to do that more. Okay, is there other public comment? Is there other public comment? Seeing no hands raised and hearing none. I wish to thank everyone for very comprehensive presentation. I think that anyone following the presentation today will have learned a great deal. And so thank you. And with that, is there any old business to come before the Green Mountain Care Board? Kevin, were you going to go back to Kate O'Neill? Because I've seen she had preliminary staff. She had staff recommendations, yep, yep. I do. And I will try to be very efficient with the time here. I'm pulling up my slides again. And you should see my slide that says process area. Okay, so yeah, so big thanks to everyone who presented. I'll just quickly walk through the process and then the principles that were developed. Sarah Kinsler was very instrumental in having done that with the board last year, maybe even the year before. And so because we have principles that we use to review the HIE plan and the connectivity criteria, I'm just going to run through those. This is more kind of a sort of a general, does the HIE plan address these principles? Whereas the presentation you just heard was much more specific to the plan and planned activities going forward. But in terms of the process, HSE submitted the HIE plan on November 1st. We're currently in the middle of a special public comment period that ends on November 25th. And then following that, we will incorporate any comment that we receive in our staff recommendation to the Green Mountain Care Board on the HIE plan and the connectivity criteria. And then there will be a potential vote on December 1st. So you're not voting today. So to support the board's review of the HIE plan and the connectivity criteria, we're working with the same four proposed principles that were developed a couple of years ago and they can be summarized as alignment with statute. That's first and second, whether the HIE plan meets the goals of other recent relevant legislation and whether the HIE plan incorporates national best practice and stakeholder input. So to address principle number one, the statute describes requirements for the plan, including supporting effective, efficient statewide use of electronic health information for a variety of purposes, educating providers in the public, supporting interoperability, proposing strategic investments in technology and infrastructure, recommending funding mechanisms, incorporating existing initiatives wherever possible and integrating technologies wherever possible and then addressing issues related to governance and security. You heard a lot about that in the presentations today. So we do find that this 2021 update to the HIE plan meets these criteria. The updated plan also describes the technologies in place in the foundational phase one of the collaborative services project and describes activities underway in phase two of the new platform, infrastructure and implementation. And so they talked much about the outcomes they anticipated in this implementation and I just wanted to share them here. For principle number two, Act 48 established the 14 principles for healthcare reform and in its decision to approve the HIE plan, originally the board found that the plan spoke to several of these principles and these areas remain core to the 2021 update and this update is consistent with these principles. The HIE plan describes the focus for 2022 including the development of governance structures for expanded health records collection and data integration into the VHIE, improving public health capabilities through data integration, refining the conceptual IT services model, leveraging the unified health data space to support Medicaid operations and improving access to health information for people, for consumers and for providers and those who care for them. So the third principle focuses on alignment with other relevant legislation. This plan does integrate and build on recent legislation in 2021. Vermont's law on immunization records was amended to allow immunization record sharing from the Department of Health's registry to the VHIE. Vermont's Act 53 of 2019 prompted the change to Vermont's HIE Consent Policy. In 2021, the HIE Steering Committee and the subcommittees began to contemplate changes to the state's protocols for access to protected health information on the VHIE to enable aggregation and exchange of additional data sources such as social determinants of health and we talked a lot about that. So in 2022, AHS in partnership with Vital and the HIE Steering Committee will work to articulate how public health operations can be enhanced through integration and the effort will include an analysis of policy and legislative changes that may be required for additional data sharing or data access arrangements between the Department of Health and the VHIE and that's articulated within the plan and additionally the state and the HIE Steering Committee will work to further design consent and data governance processes that are needed for sharing and accessing claims social determinants of health and the clinically sensitive data as was discussed. Finally, the fourth principle is does the plan incorporate best practices and expertise as well as feedback from stakeholders. So the HIE plan approved in 2018 built on national standards and since then Vermont with guidance from the Steering Committee has taken strides in both developing and executing IT strategies that improve redundancies and inefficiencies that align with the state introduction of new federal rules that drive interoperability and the growth in the HIE marketplace. In terms of feedback from Vermonters, you certainly talked a lot about that and I know that there will be more work done there in the HIE Steering Committee to include stakeholders from a variety of constituencies. Most importantly, the public and consumers and then on the HIE plan and technical roadmap, the HIE Steering Committee and its subcommittees include stakeholders representing hospitals, FQHCs, one care designated agencies, payers, et cetera. Integrating new data on the VHI policies and processes that govern how data in the VHI is sourced, accessed and managed are essential to respecting privacy and supporting effective care coordination and the HIE plan incorporates the intent to involve stakeholders in the development of the data management process and I'm confident you'll be hearing more about that as certainly in December and then as 2022 moves forward in terms of operating or operationalizing this plan. So moving to the connectivity criteria, here there are two principles for your review and they focus on alignment with the HIE plan goals and clarity of the criteria themselves since they're really an operational tool. So are the proposed connectivity criteria in alignment with the goals and will they support implementation at the HIE plan? We believe the answer is yes. This year's connectivity criteria remain aligned with the HIE plan's goals and structure and will support increased availability of and usability of the data which is critical to the achievement of Vermont's health reform goals. The connectivity criteria made minor adjustments with the physical health criteria included in tiers two and three adding mental health and behavioral health data elements to support data exchange with designated agencies and other mental health and behavioral health providers and these new data elements will continue to support the plan. And then two, are the proposed connectivity criteria sufficiently clear to be operationalized by vital? And we find yes, these criteria were developed to expand providers ability to submit and receive structured data from the VHI in part providing specific standards and requirements to support Vermont's providers and contract negotiations with the HR vendors. And that is all from me. If you have any questions for me or the A team as staff having reviewed this, let me know. Thank you, Kate. You did a great job in your first year taking this over from Sarah and we really appreciate all your hard work. Do any board members have questions for Kate? See some shaking heads so I don't think there are any questions, Kate. So thank you very much. Okay, so I'll just remind you that you and all the special public comment period is open now and it goes through November 25th and you could go right to the Green Mountain Care Board website front page and to click on the opportunity to provide comment. And the final staff recommendation to the board on the plan and the connectivity criteria will be on December 1st where the board will potentially vote on the plan. And it's hard to believe that December is only two weeks away. Thank you very much. Okay, at this point in time, is there any old business to come before the board? Is there any new business to come before the board? Hearing none, is there a motion to adjourn? Some moved. Second. It's been moved and seconded to adjourn. All those in favor of the motion, please signify by saying aye. Aye. Aye. Any opposed, signify by saying nay. Let the record show it was unanimous vote. Thank you everyone and have a great rest of the day.