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									         New Mexico
 Health Information Exchange
Strategic and Operational Plans




                Contact:
                   Jeff Blair
                (505) 938-9904
         Jeff.Blair@LCFresearch.org

         Submitted October 14, 2009
          Updated January 22, 2010
                    New Mexico Health Information Exchange Strategic Plan



Table of Contents – Strategic Plan


S.1. Introduction to Strategic Plan .......................................................................... 6

S.2. Environmental Scan ......................................................................................... 6
         S.2.1     Clinical Network Readiness ........................................................................................... 6
         S.2.2     Administrative Readiness .............................................................................................. 8
         S.2.3     E-prescribing Readiness ................................................................................................ 8
         S.2.4     Other Statewide Readiness .......................................................................................... 10

S.3. Health Information Exchange (HIE) Development and Adoption ................ 10
         S.3.1 HIE Vision, Mission, and Goals .................................................................................... 10
         S.3.2 HIE Strategies ................................................................................................................ 11

S.4. Health Information Technology (HIT) Adoption Across New Mexico ......... 18
         S.4.1 EHR Adoption ................................................................................................................ 18
         S.4.2 E-Prescribing Adoption ................................................................................................ 19
         S.4.3 Medicaid's Claims-Based Web Portal ......................................................................... 19

S.5. Medicaid Coordination ................................................................................... 20

S.6. Coordination of Medicare and Federally Funded, State Based Programs . 22

S.7. Participation with Federal Care Delivery Organizations .............................. 23

S.8. Coordination of Other ARRA Programs ........................................................ 24

S.9. Governance ..................................................................................................... 25
         S.9.1     Building a History of Collaborative Governance ....................................................... 25
         S.9.2     Governance Model: Membership Representation and Structure ............................ 25
         S.9.3     Governance Model: Decision Making Authority ....................................................... 27
         S.9.4     Alignment with Emerging NHIN Governance ............................................................. 29
         S.9.5     New Mexico HIT Coordinator ....................................................................................... 29
         S.9.6     Accountability and Transparency ............................................................................... 29
         S.9.7     Activities to strengthen New Mexico HIE Governance .............................................. 30

S.10. Finance ........................................................................................................... 31
         S.10.1 Sustainability ............................................................................................................... 31

S.11. Technical Infrastructure ................................................................................. 33
         S.11.1     Interoperability ............................................................................................................ 33
         S.11.2     Technical Architecture / Approach ............................................................................. 33
         S.11.3     Master Patient Index (MPI) Management                                                                                         37
         S.11.4     Technical Relationships Between NMHIC, HealthXnet and Sure Scripts                                                            38
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        S.11.5 New Mexico and the Nationwide Health Information Network (NHIN)                                                                 38



S.12. Business and Technical Operations ............................................................. 40
        S.12.1 Implementation………………………………………………………………………………..40
        S.12.2 Project Management .................................................................................................... 41
        S.12.3 Leveraging Existing HIE Capacities and Services                                                                         42


S.13. Legal / PolicyTechnical Infrastructure .......................................................... 42
        S.13.1    Privacy and Security .................................................................................................... 42
        S.13.2    State Laws ................................................................................................................... 45
        S.13.3    Policies and Procedures .............................................................................................. 46
        S.13.4    Trust Agreements ......................................................................................................... 47
        S.13.5    Oversight of Information Exchange and Enforcement ............................................. 47




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Table of Contents - Operational Plan


O.1. Introduction to Operational Plan .................................................................. 49

         O.1.1 Detailed Project Schedule ............................................................................................ 49
         O.1.2 Issues, Risks, Dependencies ....................................................................................... 57

O.2. Coordinate with ARRA Programs ................................................................. 60

         O.2.1 New Mexico Regional Extension Center .................................................................... 60
         O.2.2 Workforce Development............................................................................................... 60
         O.2.3 Availability of Broadband............................................................................................. 61

O.3. Coordination with Other States .................................................................... 61

O.4. Governance .................................................................................................... 62

         O.4.1 Governance and Policy Structures ............................................................................. 62
         O.4.2 Evolving to Production Use of NMHIC (Organizational Structure and Staffing) .... 63

O.5. Finance ........................................................................................................... 67

         O.5.1 Cost Estimates and Staffing Plans ............................................................................. 67
         O.5.2 Controls and Reporting ................................................................................................ 68

O.6. Technical Infrastructure ................................................................................ 68

         O.6.1 Standards and Certifications ........................................................................................ 68
         O.6.2 Technical Architecture .................................................................................................. 70
         O.6.3 Technology Deployment ............................................................................................... 73

O.7. Business and Technical Operations ............................................................ 75

         O.7.1 Current HIE Capacities .................................................................................................. 75
         O.7.2 State Level Shared Services and Repositories........................................................... 75
         O.7.3 Standard Operating Procedures for HIE ...................................................................... 77

O.8. Legal / Policy .................................................................................................. 77

         O.8.1 Establish Requirements .............................................................................................. 77
         O.8.2 Privacy and Security Harmonization (due 9/25) ......................................................... 78
         O.8.3 Federal Requirements .................................................................................................. 78




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Appendices – Strategic and Operational Plans


Appendix A: Glossary of Terms ................................................................................. 80

Appendix B: NMHIC Stakeholders by Type ........................................................... 88

Appendix C: Summary of New Mexico EMR Act of 2009 ........................... 90

Appendix D: New Mexico EMR Act of 2009 ................................................. 91

Appendix E: Southwest Telehealth Access Grid (New Mexico) .............. 103

Appendix F: SW Telehealth Access Grid (Arizona and New Mexico) ..... 104

Appendix G: NMHIC Subscription Agreement .......................................... 105

Appendix H: NMHIC Business Plan                                                                             121

Appendix         I: New Mexico State Designation Letter                                                     185




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              New Mexico Health Information Exchange Strategic Plan




      STRATEGIC PLAN

S1.   Introduction to Strategic Plan

      The Governor of New Mexico has appointed a Health Information Technology
      Coordinator for the state. In addition, the Governor has selected the New Mexico
      Health Information Collaborative (NMHIC) as the State Designated Entity (SDE) to
      coordinate HIE activities and continue the development and expansion of health
      information exchange (HIE) capacity among providers (hospitals and medical
      practices) in New Mexico. NMHIC is the state‘s growing health information
      exchange network, as well as the community collaborative that has supported HIE
      development with time and funding. The collaborative includes New Mexico
      stakeholders representing health care providers, payers, employers, state agencies
      and consumers. NMHIC was created in 2004, and continues to be fully staffed and
      operated by the Lovelace Clinic Foundation (LCF). NMHIC will continue to
      collaborate to implement technical assistance, guidance and information on best
      practices to support and accelerate health care providers‘ efforts to become
      meaningful users of Electronic Health Records (EHRs) to enhance delivery, quality,
      and value of health care.

S2.   Environmental Scan

      The environmental scan discusses HIE readiness within the State of New Mexico.
      The scan discusses the readiness of the clinical network, New Mexico Health
      Information Collaborative (NMHIC), to support clinical summary exchange, clinical
      laboratory ordering and results delivery, public health reporting (i.e., immunizations,
      notifiable laboratory results), and quality reporting; the readiness of the
      administrative network, HealthXnet, to support eligibility and claims transactions;
      and the readiness of New Mexico Medical Review Association/New Mexico
      Prescription Improvement Coalition (NMMRA/NMPIC)/SureScripts to support
      electronic prescribing and refill requests, and prescription fill status and/or
      medication fill history. The subsections below that discuss each of the HIE
      networks in the state cover the network services they currently provide; the level of
      network usage; the health care providers, payers, and/or state agencies that use or
      support each network; and the human capital for each network.

      Health Information Technology (HIT) resources that are currently being used in New
      Mexico are discussed in the HIT Adoption section of the Strategic Plan within the
      New Mexico HIE Plan.

      S.2.1 Clinical Network Readiness

      Until now, the development of the NMHIC clinical network services has focused on
      providing clinical summary exchange, clinical laboratory results delivery, and public

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health reporting. To accomplish this, Lovelace Clinic Foundation (LCF/NMHIC) has
established operating interfaces with Presbyterian Healthcare Services (the largest
health care provider in the state, with seven metropolitan and rural hospitals and the
largest medical group), TriCore Reference Laboratories (the largest clinical testing
and pathology reference laboratory in the state), and rural Holy Cross Hospital in
Taos. From April 2008, to December 2009, NMHIC processed over 25 million
transactions from these organizations, with more than 1,035,000 unique patient
identities. NMHIC also demonstrated that it can share standards-compliant
summary patient records, lab results, and emergency responder information as part
of the Nationwide Health Information Network (NHIN) Trial Implementations in 2008.
NMHIC has just completed establishing interfaces to ABQ Health Partners (the
second largest medical group in the state).

NMHIC is in the process of establishing interfaces to Lovelace Health Systems (the
second largest hospital system in the state) and SED Labs (the second largest
clinical laboratory in the state), and expects to have these interfaces completed by
March 2010. NMHIC plans to establish clinician user access to the NMHIC Portal
by June 2010, including interactions with HealthXnet and SureScripts. In addition,
NMHIC and the State Department of Health are working together to provide
laboratory results for notifiable conditions and emergency department visit data for
situational awareness to DOH with a planned go live date of June 2010. NMHIC
has demonstrated its ability to forward reportable conditions to the New Mexico
DOH as part of NHIN Trial Implementations. The state‘s Medical Assistance
Division of the Human Services Department is considering how it might be able to
provide access to Medicaid health claims to NMHIC clinician users and how NMHIC
might be able to provide access to clinical data for the Medicaid program.

 The American Recovery and Reinvestment Act (ARRA) calls for New Mexico HIE
networks to enable quality reporting. ONC and CMS have been working together to
define the quality measures for quality reporting. At the end of December 2009,
ONC published the Interim Final Rule (IFR) and CMS published the Notice of
Proposed Rulemaking (NPRM). NMHIC has reviewed these documents and also
participated in the processes initiated by several health IT professional associations
to provide feedback on the IFR and NPRM. The federal government has indicated
that it will probably be Spring 2010 before the requirements for quality reporting for
2011 and 2012 will be published as a final rule. NMHIC will then incorporate this
information in its plans to help New Mexico health care providers demonstrate
meaningful use of health IT in those cases where quality measures could be
electronically sent through the HIE and the NHIN to CMS.

LCF staffs and operates NMHIC. This staff has a history of success developing
NMHIC HIE functionality, collaborating with major stakeholders in the private sector
of health care delivery, and working closely with the Department of Health within the
State. However, NMHIC‘s designation as the SDE for New Mexico and LCF‘s
position as the non-profit entity that will provide leadership for the development of
the HIT Regional Center will clearly require additional resources. The current staff
of LCF/NMHIC that can be dedicated full time to the development of the New
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Mexico HIE and the HIT Regional Center includes the CIO, Director of Health
Informatics, four project management/technical staff, one full time technical project
manager from our technology partner (MedPlus), and two administrative support
staff. Part time availability includes the President, Director of Clinical Informatics,
CFO, legal counsel, human resources, and three research/project management
staff. Other part time resources include consultants and community stakeholders
from the public and private sectors of health care.


S.2.2 Administrative Readiness

HealthXnet has been assisting healthcare providers in New Mexico with
administrative and revenue cycle efficiencies since 1999. Healthcare providers
today can perform various transactions, including eligibility inquiries and electronic
claims submissions, using a fully web-browser-based service. There are currently
30 hospitals in New Mexico and 193 other provider organizations in New Mexico
using HealthXnet. These include physician offices, surgery centers, DME suppliers,
home health, billing services, and various other provider types. There are also 19
additional provider organizations outside of New Mexico that use HealthXnet. Over
8.4 million transactions were performed on HealthXnet during 2009 and year-to-
year transaction growth has averaged 66% over the past five years. Approximately
90% of transactions performed using HealthXnet during 2009 were eligibility
inquiries. Electronic claims submissions are offered through a partnership with
ZirMed, Inc., based in Louisville, KY. Electronic claims is a newer service for
HealthXnet and accounted for 1.9% of its 2009 volume.

Blue Cross Blue Shield of New Mexico, Lovelace Health Plan, Molina Healthcare of
New Mexico, and Presbyterian Health Plan are all ―Pa     rtner‖ health plans in the
HealthXnet program and help cover the costs of running the service. HealthXnet
has been a MEVS vendor for New Mexico‘s Medical Assistance Division since 2001
and is an established trading partner of CMS for Medicare transactions. HealthXnet
offers connectivity to other key health plans, including Aetna, Cigna, Humana,
Tricare, UnitedHealth, and others via a partnership with Ingenix.

HealthXnet is a subsidiary of Hospital Services Corporation, which is a subsidiary of
the New Mexico Hospital Association. HealthXnet has four full-time staff and is
currently recruiting for a fifth staff member. It has had an ongoing relationship with
APP Design, Inc. for five years and they provide a significant portion of its software
and interface development work. APP Design has many years of experience
developing healthcare interfaces and exchanges.

S.2.3 E-Prescribing Readiness

E-prescribing adoption will be promoted by NMMRA/NMPIC and NMHIC will add an
e-prescribing function by 2011 that will enable clinician users to prescribe
seamlessly from the NMHIC web portal through SureScripts to retail and
commercial pharmacies.
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NMMRA has staffed and facilitated NMPIC for the last several years. SureScripts
provides prescription benefit information and e-prescribing services in New Mexico
and virtually all other states. The readiness of NMMRA/NMPIC/SureScripts to
support electronic prescribing and refill requests is described below.

NMPIC is a statewide group effort aimed at reducing the negative health
outcomes/adverse drug events associated with inappropriate drug treatment. This
Collaborative serves New Mexico‘s community interest through implementation and
evaluation of e-prescribing education for providers and beneficiaries, development
of clinical guidelines for potentially inappropriate medications in the elderly and
educational medication therapy management modules for clinical providers for the
major chronic disease/conditions, as well as improvement of drug utilization,
medication and reduction of potentially inappropriate medication.

NMPIC involves health care providers, pharmacies, and health plans to improve
prescribing, with particular emphasis on assisting physician practice sites that use
or are adopting e-prescribing technology. Two phases are planned for this coalition:
the first phase provided full sponsorship to include hardware, software and
subscription fees for two years for providers implementing e-prescribing if they meet
established reporting requirements. The second phase will provide up to $1,000
per physician for implementation. Initial funding was provided by major prescription
drug plans (PDPs) in New Mexico, and Human Services Department Medical
Assistance Division (Medicaid). NMPIC is working to increase available funding for
the project and is working with major PDPs in New Mexico based on PDP
enrollment data provided by CMS.

NMPIC Mission: To improve safety in delivery of prescription drugs in New Mexico.

NMPIC Goals:
 To promote best practices in prescribing and medication management therapies
 To share data on prescription management and choose appropriate
  interventions
 To establish clinical guidelines for better management of chronic disease
  populations
 To promote and assist in the implementation of e-prescribing with
  comprehensive decision support tools
 To educate providers and beneficiaries on safety in delivery of prescription drugs

The SureScripts network reports that New Mexico had 134,320 electronic
prescription transactions during 2008, with 316 active prescribers and 219
participating pharmacies as of May 2009. Statistics for prescription refills and
requests/responses for medication history information are available only for
physicians from the first phase of the e-prescribing pilot project. NMPIC is working
with SureScripts to establish a data use agreement and provide prescription fill
status and/or medication history for all e-prescribing providers in New Mexico as
well as prescribing patterns by pharmacy location in New Mexico.
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      NMMRA currently has 2.5 FTEs to staff NMPIC. Other resources to support the
      expansion and operation of e-prescribing in New Mexico include the New Mexico
      Medical Assistance Division (Medicaid) of the Human Services Department e-
      prescribing pilot that is being carried out as a part of the NMPIC e-prescribing pilot.

      S.2.4 Other Statewide Readiness

      NMHIC will collaborate with users of the expanding statewide telehealth network of
      networks information communications infrastructure being developed by the Center
      for Telehealth at the University of New Mexico as part of the Southwest Telehealth
      Access Grid (Appendices E-F) being supported by the Federal Communications
      Commission Rural Health Care Pilot Program. This Grid will help provide the
      necessary security, reliability, and disaster recovery needed for HIE transactions
      among the participants.

      In addition, LCF/NMHIC participates in the Robert Wood Johnson Foundation
      (RWJF) Aligning Forces for Quality (AF4Q) initiative and was recently awarded a
      RWJF contract to measure physician adoption and benefits of the health information
      exchange related to reduction of duplicate laboratory and radiology procedures for
      2010 to 2012.

S3.   Health Information Exchange (HIE) Development and Adoption

      S.3.1 HIE Vision, Mission, and Goals and Objectives

      The New Mexico Health Information Collaborative‘s (NMHIC‘s) vision is to provide
      a statewide HIE network that enables the transformation of health care by improving
      quality of care, patient safety, efficiency, and outcomes in a manner that is
      sustainable.

      NMHIC‘s mission (overall purpose) is to create a statewide HIE network that is
      sufficiently trusted and valued by all stakeholders (employees / patients, employers,
      physicians, health systems and health plans) so that it will improve care
      coordination and create a foundation for sustainability.

      NMHIC‘s goals and objectives associated with HIE capacity development and use
      among all health care providers in, and potentially external to, New Mexico
      (including meeting meaningful use criteria) are:
         Improve statewide benefits, such as continuity of care and lower costs, by
          providing rapid access to patient health care information from multiple health
          care facilities across the community.
         Provide additional cost savings for the community by reducing redundant clinical
          tests and results reporting for the same patient
         Secure the trust of consumers, patients and providers by providing strong
          privacy and security safeguards for health care information
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   Obtain HIE certification for NMHIC through certifying organizations that may be
    designated by HHS, by implementing appropriate interoperability, privacy, and
    security capabilities.
   Provide the ability to share patient information with all providers in the country
    through the Nationwide Health Information Network
   Facilitate improved public health services by providing health data for mandatory
    reporting, monitoring of health status, and emergency responder information to
    the New Mexico Department of Health
   Empower consumers to actively manage their own health by providing access to
    their health information in an understandable format.
   Improve health care services to rural and underserved populations by providing
    health care information through HIE and telehealth
   Encourage the adoption of electronic health records systems in New Mexico by
    making it easier and less costly to securely share information over electronic
    networks
   Facilitate public reporting of patient outcomes and quality measures by enabling
    communication of this information for meaningful use of health IT as may be
    required by ONC

Note: HIT, including the HIE network, should be considered an enabler of improved
healthcare quality, efficiency, and costs, rather than a goal in itself.

S.3.2 HIE Strategies

Build on Strategies from NMHIC Business Plan

New Mexico‘s HIE Plan builds upon the strategies developed in the comprehensive
NMHIC Business Plan that was first reviewed with the New Mexico community and
ONC in October, 2008. The NMHIC Business Plan has been updated several times
to reflect progress with network implementation activities and evolving community
priorities and needs. Although the NMHIC Business Plan, Version 3, was
distributed on March 11, 2009, a great deal of the information in the plan is still
relevant because it shows how we identified the community priorities for network
services and how we constructed a business plan that focused on meeting the
needs of health care providers, payers, patients, consumers, and employers. Below
are the major sections in the NMHIC Business Plan, Version 3, from March 2009.
The complete NMHIC Business Plan is in the Appendix for your reference.

Executive Summary
Background
     NMHIC Perspective
     Problem to be Solved
     NMHIC Solution
     NMHIC History and Future
     NMHIC Governance
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NMHIC Network Services
      Criteria for Selecting Network Services
      Description of Network Services
      Community Readiness for Network Services
      Availability of Network Services
      Time Frame for Data Suppliers
Business Assessments
      Total Market Opportunity
      Factors Supporting Adoption of Network Services
      Factors supporting Successful Operations
      Factors Mitigating Success
Summary of Financial Projections
      (The information in this section is out of date and the current information is
      included in this New Mexico HIE Strategic and Operational Plan document.)
Financial Benefits to NMHIC Stakeholders
Conclusions and Recommendations
Appendix

The strategies for NMHIC in the New Mexico HIE Plan have been revised to reflect:

1. The expanded role of NMHIC as the State Designated Entity (SDE) with
   coordinating responsibility for New Mexico‘s administrative network
   (HealthXnet), and e-prescribing initiatives – New Mexico Medical Review
   Association (NMMRA), New Mexico Prescription Improvement Coalition
   (NMPIC), NMHIC, and SureScripts
2. The key HIE milestones (network service capabilities in 2011, 2013 and 2015)
   set forth by the New Mexico HIE Collaborative Agreement Program
3. The health outcomes policy priorities and measures for meaningful use of HIT
   identified by the HIT Policy Committee
4. ONC budget allocations for New Mexico plus available funding from the
   community.

The New Mexico strategy builds upon the HIE network infrastructure for clinical,
administrative and e-prescribing information that will be in place by the end of 2009
as described in the Environmental Scan of our New Mexico HIE Plan.

Strategy for Coordination and Expansion of HIE Networks

Coordination between the Medical Assistance Division (Medicaid program) of the
New Mexico Human Services Department (HSD) and NMHIC has already begun.
The coordination will take place in several areas, including governance, finance,
and expansion of network services. This is described in more depth in the Medicaid
Coordination section of the New Mexico HIE Strategic Plan. An important element
of this coordination will be access to Medicaid‘s claim and encounter information
over the NMHIC HIE network to support meaningful use of Medicaid providers as
early as 2011.

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       The plan for 2010 is to provide clinician access to the NMHIC Web Portal in June
       with 600 physicians in the state‘s two largest medical groups. NMHIC will also
       expand to cover all hospitals in Albuquerque and Santa Fe, and begin to connect to
       rural hospitals and medical practices. During 2010, NMHIC will also establish close
       collaboration and technical integration with HealthXnet which already provides
       eligibility and claims network services. E-prescribing adoption will be promoted by
       NMMRA/NMPIC and NMHIC will add an e-prescribing function that will enable
       clinician users to prescribe seamlessly from the NMHIC web portal through
       SureScripts to retail and commercial pharmacies. The strategy will also involve
       close coordination with the New Mexico HIT Regional Extension Center, so HIE
       network services to medical practices that serve rural and underserved populations
       will include HIE capabilities in 2011. This will enable these medical practices to
       demonstrate care coordination over the HIE, and therefore meet the requirements
       for meaningful use of HIT.

       The strategy for 2011 also includes establishing care coordination through the NHIN
       to local Veterans Administration Health facilities, the Indian Health Service, and the
       military health system of the Department of Defense. This will close a major gap in
       coordination of care for patients flowing between the VA, IHS, DOD, and private
       sector health facilities within New Mexico.

       The objectives for each year generated by this strategy are shown in Table 1.

              Table 1. Expansion of New Mexico HIE Network Capabilities
Date    Implementation      Hospitals        Medical Practices    Other Organizations
                                   2 largest hospital
                                                             Data provided from the 2     2 largest reference /
2009   NMHIC Interfaces            systems (12 urban and
                                                             largest medical groups       clinical labs
                                   rural hospitals)
                                   30 urban and rural                                     4 major health plans,
       HealthXnet                                            Over 150 medical practices
                                   hospitals                                              Medicaid and Medicare
                                                                                          More than 200
       E-prescribing               Not applicable            More than 300 physicians
                                                                                          pharmacies
                                                                                          New Mexico Department
                                                                                          of Health, HSD Medical
       Clinician access to                                   Clinical usage begins with   Assistance Division
                                   Access available to all
2010   NMHIC Portal;                                         600 physicians from 2        (Medicaid), and five major
                                   interfaced hospitals
       including e-prescribing                               largest medical groups       health plans, expand e-
                                                                                          prescribing to 250
                                                                                          pharmacies
                                                             Add interfaces to medical
                                   Expand to 20 urban and                                 Expand to 4 reference /
       NMHIC Interfaces                                      practices in collaboration
                                   rural hospitals                                        clinical laboratories
                                                             with HIT Regional Center
                                                             Expand to 250 medical        5 major health plans,
       HealthXnet                  Expand to 40 hospitals
                                                             practices                    Medicaid and Medicare
       Clinician access to
       NMHIC Portal
       E-prescribing
       Medicaid claim and                                                                Expand to 5 labs and 5
                                   Expand to 30 urban and
2011   encounter information
                                   rural hospitals
                                                             Expand to 1200 physicians    radiology/imaging centers,
       Begin sending patient                                                             expand to 270 pharmacies
       info directly to provider
       EHR systems
       New interfaces


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                  New Mexico Health Information Exchange Strategic Plan

              Table 1. Expansion of New Mexico HIE Network Capabilities
Date    Implementation      Hospitals        Medical Practices    Other Organizations
                                                           Expand to 350 medical       6 major health plans,
       HealthXnet                 Expand to 45 hospitals
                                                           practices                   Medicaid and Medicare
       Clinician access to
       NMHIC Portal
       E-prescribing
                                                                                       Expand to receive data
       Medicaid claim and
                                  Expand to 45 urban and                               from 12 labs and 8
2012   encounter information                               Expand to 1800 physicians
                                  rural hospitals                                      radiology/imaging centers,
       Expand sending
                                                                                       expand to 282 pharmacies
       patient info directly to
       provider EHR systems
       New interfaces
                                                           Expand to 450 medical       7 health plans, Medicaid
       HealthXnet                 Expand to 50 hospitals
                                                           practices                   and Medicare
       Clinician access to
       NMHIC Portal
       E-prescribing
       Medicaid claim and                                                             Expand to 20 labs and 12
                                  Expand to 50 urban and
2013   encounter information
                                  rural hospitals
                                                           Expand to 2400 physicians   radiology/imaging centers,
       Sending patient info                                                           and 282 pharmacies
       directly to provider EHR
       systems
       New interfaces
                                  Expand to all 60                                     8 health plans, Medicaid
       HealthXnet                                          450 medical practices
                                  hospitals                                            and Medicare




       Strategy to Address Meaningful Use of HIT

       The New Mexico strategy, as indicated in Table 2, below, expects to support all four
       ONC network service objectives for meaningful use by 2011, as well as meet one of
       the 2013 network service objectives (registry reporting) also in 2011. The reason
       we expect to meet these objectives is the reality that New Mexico has been building
       HIE capacity for the last five years.




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                                   Table 2. Meaningful Use of Services

 Objectives Set Forth in Cooperative Agreement                       New Mexico HIE Plan
                                                      HIE Network Service              HIE
HIE Network Service                       Year
                                                          Availability           Network Initiative
Lab results delivery                      2011               2010           NMHIC
                                                                            NMMRA/NMPIC/
E-prescribing                             2011               2010
                                                                            NMHIC/SureScripts
Claims and eligibility checking           2011               2010           HealthXnet
Quality and immunization
                                          2011                 2011            NMHIC
reporting, if available
Patient summaries for continuity
                                          2013                 2010            NMHIC
of care
Registry reporting and reporting
to public health – for EHR                2013                 2011            NMHIC
practices only



New Mexico‘s strategy also includes closely monitoring the discussions and
recommendations regarding policies, measures, and standards for meaningful use
of HIT from the HIT Policy Committee, the HIT Standards Committee, the Interim
Final Rule, and the Notice of Proposed Rule Making. As of January 2010, we have
identified 16 candidate meaningful use measures from the NPRM (Table 2) that
may require some form of HIE network service in 2011 or 2012. They are:

                                    Table 3. Measures of Meaningful Use

     Health Outcomes Policy Priorities            Candidate Meaningful Use Measures for Support by HIE
A. Improve quality, safety, efficiency, and      1.Communicate orders from CPOE
reduce health disparities                        2. Route e-prescribing messages
                                                 3. Transmit lab results back to clinicians
                                                 4. Transmit quality measures to CMS or other payers
                                                 5. Facilitate verification of patient eligibility
                                                 6. Route health claims electronically

B. Engage patients and families                  7. Provide patients with timely electronic access to their health
                                                 information
                                                 8. Provide clinical summaries for patients for each office visit

C. Improve care coordination                     9. Facilitate exchange of key clinical information (i.e.; problem
                                                 list, medication list, allergies, diagnostic test results)
                                                 10. Enable medication reconciliation at relevant encounters
                                                 and each transition of care
                                                 11. Provide summary care record for each transition of care
                                                 and referral

D. Improve population and public health          12. Report immunizations to public health agencies
                                                 13. Transmission of reportable conditions to public health
                                                 agencies
                                                 14. Transmit electronic syndromic surveillance data to public
                                                 health agencies

E. Ensure adequate privacy and security          15. Full compliance with HIPAA Privacy and Security Rules
protections for personal health information      16. Conduct or update a security risk assessment and
                                                 implement security updates as necessary
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        New Mexico Health Information Exchange Strategic Plan



New Mexico believes that we are well positioned to support all transactions that
may be required to support the meaningful use measures in the table above
because of our experience exchanging lab results, summary patient records, and
emergency responder information during the ONC-sponsored NHIN Trial
Implementations in 2008. The Trial Implementations also gave us the opportunity to
demonstrate that we could comply with the standards for interoperability, privacy,
and security that are described in Tables 2a and 2b in the Interim Final Rule (HIT:
Initial Set of Standards, Implementation Specification sand Certification Criteria for
EHRs). In addition, if some of the quality measures are to be communicated via the
HIE and the NHIN, we will be able to accommodate this communication using the
same CCD required standards that we used during the NHIN Trial Implementations.

New Mexico expects to update its HIE plan after HHS publishes the final rule for
meaningful use in late Spring, 2010. These updates will include more detail
regarding New Mexico HIE network support of meaningful use measures for 2011,
and the plans to provide new network services for 2013 and 2015 (if they are
designated in the Final Rule), and as defined by the New Mexico HIE Cooperative
Agreement.

Strategy for Continuous Quality Improvement of Care Coordination
and Meaningful Use of HIT

In New Mexico, we believe that the concept of a HIE network that complies with
interoperability, privacy, and security standards identified by the NHIN project is
inherently a system that will facilitate continuous quality improvement (CQI). It does
this because it is conceptually designed as an enabler for the health care process,
rather than a solution in itself. This topic relates to health information exchange
networks in two ways:

   1. Narrow application: The use of CQI principles to improve the processes of
      the HIE network.
   2. Broad application: The role that the HIE plays by providing information that
      enables medical practices, hospitals, public health, and consumer
      information services to evaluate and improve their processes to achieve CQI.

NMHIC will develop the operating processes to support the HIE network before
going into production in June 2010 in a manner that will enable the narrow definition
of CQI. We are familiar with CQI principles set forth by Joseph Juran. We also
have the business background and experience to employ them.

The NMHIC network provides information to health care providers that enables
them to evaluate and improve their administrative and clinical processes (broad
definition of CQI), but NMHIC does not expect to be part of using CQI within health
care provider facilities to achieve higher levels of meaningful use of HIT.


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        New Mexico Health Information Exchange Strategic Plan


Strategies for Serving Health Care Providers, Public Health, and Consumers

The principal strategy for the HIE network to serve health care providers is to
enable care coordination. This strategy was set forth during the earlier
development of NMHIC in the NMHIC Business Plan. It involves the use of the
Master Person Index to uniquely identify a patient, the record locater service to
locate that patient‘s records across multiple health care facilities, and the NMHIC
Clinician Portal to display that patient‘s health care information in the form of a
summary patient record that complies with the interoperability, privacy and security
standards set forth by the NHIN. This includes the use of the continuity of care
document (CCD) and the HITSP C32 construct to define content. It also includes
the use of interoperability standards to display and/or send laboratory and radiology
results to the NMHIC portal and provider EHRs respectively. Eligibility verification
and claims processing is already in production in New Mexico via HealthXnet.
LCF/NMHIC and HealthXnet plan to work collaboratively to make these network
services as seamless to clinical users as possible. Clinician use of e-prescribing
will be promoted by NMMRA and NMPIC. Clinician access to e-prescribing
functions will be provided through several different sources, including NMHIC, EHR
vendors, and stand-alone e-prescribing devices. Communication to and from
prescription benefit organizations and retail and commercial pharmacies will be
provided by SureScripts. These functions are already in operation in New Mexico,
but the HIE Strategic Plan calls for better coordination among all of these e-
prescribing network services.

The state has decided to use the New Mexico Health Information Exchange
(operated by LCF/NMHIC) as the official agent for all public health reporting. The
current contract between the state and NMHIC covers reporting from all emergency
departments across the state and from labs and providers for syndromic
surveillance. NMHIC already has experience with this type of network scenario
because it demonstrated sending summary patient record information to public
health facilities as part of the Emergency Responder demonstration over the NHIN
in 2008. In addition, the exchange will include an interface with the electronic
medical record system used at all public health clinics.

The principal strategy for the HIE network to provide information to organizations
offering data services for patient engagement (PHR system vendors) is to continue
evaluating approaches and select the approach/vendor that would best meet the
needs of New Mexico patients/consumers. NMHIC has already conducted market
research evaluating several different patient health record alternatives. Some
alternatives obtain data from health care provider EHRs and offer them as tethered
records to consumers. Others offer data from health claims and are offered by
health care payers. Still others offer patients the ability to create personal health
records on web sites, or within secure independent databases and expect to draw
upon patient information from health care providers. One of the major impediments
to the growth of this marketplace is that not all solutions comply with interoperability,
privacy, and security standards that have been set forth by the NHIN and ONC.
The research that we conducted indicated that the marketplace for patient health
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              New Mexico Health Information Exchange Strategic Plan


      record services is just beginning to emerge and the best approach to serve this
      market is not yet clear. The choice of a Personal Health Record (PHR) system
      approach/vendor is strategic because the PHR will draw information from existing
      health organizations for several years but, in the long term health care providers
      might be receiving patient information from PHR systems for patient care purposes.
      Therefore, NMHIC will continue to carefully evaluate alternatives before we decide
      upon a specific approach.

      Strategies for Managing, Updating, and Integrating the Strategic and
      Operational Plans The strategy is to be responsive to both federal health policies
      and local stakeholder priorities. The response to the State HIE FOA from Section
      3013 of the American Recovery and Reinvestment Act of 2009 (ARRA) addresses
      federal health care policies. On the other hand, the NMHIC Business Plan Version
      3 was developed in response to community priorities for HIE network services.
      Although there was not enough time for LCF/NMHIC to integrate both of these plans
      and meet the deadlines set forth by ARRA and ONC, New Mexico‘s strategy is to
      integrate both of these plans. This strategy involves the development of a draft
      integrated New Mexico HIE Plan, review of the draft plan with HIE stakeholders in
      New Mexico, and distribution of the integrated plan by May 1, 2010.

      Detailed work plans for coordination of the above topics will be developed by
      December 2010.

S4.   Health Information Technology (HIT) Adoption Across New Mexico

      S.4.1 EHR Adoption

      The New Mexico Department of Health (DOH) has deployed Electronic Health
      Record (EHR) systems in all New Mexico public health facilities. To facilitate
      physician adoption of EHR systems, DOH has made available a reduced pricing
      EHR model to the general provider populace.

      The New Mexico Primary Care Association (NMPCA) has also been actively
      supporting the implementation of EHR systems among its members. NMPCA is a
      statewide membership organization representing 20 organizations with over 150
      medical, dental, and school-based clinical sites in 90 communities throughout New
      Mexico. Fifteen of these organizations are Federally Qualified Health Centers and
      receive federal funding through HRSA. One-third (74 of 222) of the FQHC medical
      providers in New Mexico have implemented and are utilizing Electronic Health
      Records (EHRs) and an additional 50% are expected to complete implementation in
      the next 12 months. Implementers have utilized a combination of Federal and State
      funding to purchase and implement their EHRs. NMPCA operates a Health Center
      Controlled Network and works with five member organizations in the areas of
      integrated practice management and HIT.

      The five non-FQHC organizations operate eight clinical sites with 22 medical
      clinicians. Six providers at one site currently utilize EHRs and an additional seven
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        New Mexico Health Information Exchange Strategic Plan


are projected to implement in the next 12 months. NMPCA members have identified
HIT support as a priority service they would like to see NMPCA provide and
discussions are ongoing to expand network services to support additional EHR
systems.

The New Mexico Medical Review Association (NMMRA) conducted the Doctors
Office Quality through Information Technology (DOQ-IT) program helping 48
medical practices select, implement and effectively use EHR systems during the
period August 2007 to July 2009. NMMRA continues to work with physician
practices that have EHRs on using their systems for care management and
development of reporting capability.

In early 2008, LCF/NMHIC and the New Mexico Health Policy Commission (HPC)
coordinated separate surveys about HIT adoption in New Mexico using most of the
same questions and wording for the questions. The LCF/NMHIC survey was
distributed by email to members of the New Mexico Medical Society and to the
physicians in a large medical group in Albuquerque, while the HPC survey was
distributed to a separate group of physicians and physician assistants in the state.
The first question in the survey asked whether the respondents have an Electronic
Health Record (EHR) system with the ability to capture clinical information. There
were 423 respondents that reported that they have EHR systems that are
implemented and in use out of a total of 1,084 respondents to these surveys. This
represents 39% of the respondents to these surveys. We believe that the actual
percentage of EHR implementation and use for all physicians in the state is
probably somewhat lower. Nevertheless, we are including this information since it
does represent a serious effort to determine the level of HIT adoption in New
Mexico.

S.4.2 E-Prescribing Adoption

Beginning in 2008, the New Mexico Prescription Improvement Coalition (NMPIC)
conducted an e-prescribing pilot program to incent provider adoption and produce
clinical champions. The initial incentive program recruited 59 physicians and a
second, ongoing phase has 40 physicians committed to adopt e-prescribing. NMPIC
also performed outreach and education efforts hosting e-prescribing forums in
September 2006 and February 2008. The members of NMPIC have actively
engaged independent physician associations, conducted regional education
meetings, and presented at conferences statewide. Concurrent with these efforts,
the New Mexico Medical Assistance Division (MAD) influenced e-prescribing use
through a Medicaid Transformation Grant facilitating the adoption of e-prescribing
by rural non-profit providers. Electronic prescription volume in the state increased
from 5,453 in 2006 to 134,320 transactions. Physician participation between 2006
and 2009 increased from 6 providers to 316 providers. In that same time span, the
number of New Mexico community pharmacies capable of routing e–prescriptions
increased from 153 to 220 locations.

S.4.3 Medicaid’s Claims-Based Web Portal
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              New Mexico Health Information Exchange Strategic Plan



      In the area of EHR adoption, MAD introduced a claims-based web portal to deliver
      Medicaid patient information to providers in 2008. The project provided insight to the
      motivation and level of effort necessary to encourage provider adoption.

S5.   Medicaid Coordination

                                                                   The
      According to Julie Weinberg, Deputy Director of the NMHSD, ― New Mexico
      Human Services Department (HSD), Medical Assistance Division (MAD) is currently
      seeking approval of its Planning-Advance Planning Document from the Centers for
      Medicare and Medicaid Services (CMS) in order to proceed with the development of
      HSD‘s State Medicaid HIT Plan (SMHP). Until the SMHP is developed and
      approved by CMS, we cannot address how, specifically, the State HIE will be
      integrated with Medicaid. We can, however, discuss how this integration will occur
      in general terms.

       The
      ― SMHP‘s primary goal will be promoting and achieving widespread adoption
      and meaningful use of HIT, including the exchange of health information, using New
                                                            p
      Mexico Medicaid providers as an effective way to ―jum start‖ the HIT adoption and
      use process. Because the New Mexico Medicaid program currently covers nearly
      25% of the New Mexico population we are certain that Medicaid can help lead the
      way to widespread HIT adoption in New Mexico. A robust and viable HIE is
      essential to the success of the SMHP and, given the penetration of Medicaid in the
      New Mexico health care system, the SMHP‘s success in HIT adoption and use
      within the Medicaid provider community is part of creating a robust and viable state
      HIE.

      ―Because HSD needs a robust and viable state HIE, our SMHP will include a yet-to-
      be-determined level of funding for the state HIE, subject to CMS guidance expected
      to be released in February. The exact level of funding and the mechanics of the
      funding will depend largely upon the aforementioned CMS guidance as well as our
      FY11 budget. In addition, HSD will consult with the New Mexico Health Information
      Collaborative (NMHIC) on the mechanics and level of funding during our SMHP
      planning process. HSD has included a minimum of $150,000 in the administrative
      portion of our state FY11 budget request in anticipation of the 90/10 federal match
      for implementation of the SMHP. Even if our budget is scaled back during the
      current legislative session, we are committed to at least $150,000 for the SMHP
      implementation work in state FY11.

      ―Table 4, below, lists activities that HSD currently anticipates will be in the SMHP
      that will integrate the HIE and NM Medicaid program and is not intended to be a
      complete listing of activities that the program will engage in once the SMHP is
      developed and implemented. HSD has submitted a Planning-Advance Planning
      Document (P-APD) to the Center for Medicaid State Operations (CMSO) requesting
      funding to develop the SMHP.‖



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                  New Mexico Health Information Exchange Strategic Plan


                       Table 4. Current and Expected Medicaid Coordination with HIE
 Current Medicaid
     Activity                         Interdependency                                  Integration
Member of NMHIC         This is the key interdependency that           Helps ensure NMHIC‘s HIE supports
General Steering        underlies all others in the relationship       Medicaid‘s needs in terms of the program‘s
Committee               between the New Mexico HIE                     activities promoting HIT adoption and
                        development effort and Medicaid‘s HIT          meaningful use, administering the
                        adoption and meaningful use efforts            Medicaid HIT incentive program, improving
                        under its future SMHP. The New Mexico          care quality and health outcomes, and
                        Medicaid program and other medical             achieving more cost effective approaches
                        assistance programs run by HSD serve 1         to health care delivery.
                        in 4 New Mexicans. Medicaid‘s successful
                        promotion of HIT adoption and meaningful
                        use will be a significant contributor to the
                        success of New Mexico HIE development
                        efforts. Conversely, the success of
                        Medicaid‘s adoption and meaningful use
                        efforts are largely dependent upon having
                        a fully functional, sustainable and widely
                        used HIE with the network services and
                        functionality to support the measurement
                        of meaningful use as required by section
                        4201 of the Recovery Act.
Expected Medicaid
    Activities                      Interdependency                                     Integration
Member of               See above                                      Provides the Medicaid agency the
Executive Steering                                                     opportunity to participate in oversight of in
Committee                                                              order to promote the long term
                                                                       sustainability of NMHIC and the New
                                                                       Mexico HIE.
Financial Support of    Reliable funding for the New Mexico HIE        Medicaid becomes a key stakeholder in
NMHIC HIE               is part of creating a sustainable HIE,         the New Mexico HIE.
                        which Medicaid needs in order to
                        successfully implement its SMHP. HSD
                        expects to be able to provide some
                        financial support to the HIE as part of its
                        SMHP, although current budget
                        constraints and constraints going forward
                        will limit just how supportive we can be in
                        this area.




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                 New Mexico Health Information Exchange Strategic Plan

Make Medicaid          The HIE will be able to supply more                                       node‖ in the
                                                                       Medicaid agency becomes a ―
claims and             complete information about Medicaid             New Mexico HIE network.
encounters available   members through its CCDs because not
to HIE and             all providers will be participating in health
information from       information exchange, particularly in the
non-Medicaid           early years. This in turn will also benefit
providers available    the Medicaid program and its members by
to Medicaid            making otherwise unobtainable health
                       information available to Medicaid
                       providers who are participating in health
                       information exchange. Medicaid will rely
                       on the HIE to supply health information to
                       Medicaid providers from non-Medicaid
                       providers who currently serve or who
                       have served Medicaid enrollees in the
                       recent past.
Offer a low-cost or    To meet statewide adoption goals and for        Links Medicaid providers into the New
no-cost, web-based     overall Medicaid program improvement,           Mexico HIE who might not otherwise invest
EMR product for        Medicaid needs as many of its providers         in and use EHR.
Medicaid providers.    as possible to adopt and meaningfully use
                       HIT. The low-cost or no-cost EMR product
                       will benefit NMHIC by adding more
                       doctors into the EHR network.

Administer Medicaid    Medicaid will need to collect EHR               Medicaid‘s HIT incentive program will
HIT adoption and       information from the New Mexico HIE in          promote HIT adoption and meaningful use
meaningful use         order to determine meaningful use by            and link providers into the New Mexico
incentive program      those providers participating in the            HIE.
                       Medicaid HIT inventive program. NMHIC
                       is planning to support at least 13
                       meaningful use measures in 2011, based
                       on information released by the HIT
                       Standards and HIT Policy Committees to
                       date. Participants in the Medicaid
                       incentive program will enhance the ability
                       of the HIE to meet its meaningful use
                       goals in the Cooperative Agreement.




S6.    Coordination of Medicare and Federally Funded, State Based Programs

       LCF/NMHIC as the SDE for Health Information Exchange in New Mexico has a
       strong history of collaboration across the state and nationally. Some of the federally
       funded state-based programs we have collaborated with to date have been:

       NHIN Gateway Web Services for SSA Use Case
       Work is underway to define and establish a standards-based request and receipt
       process which will streamline the disability claims development process for the
       Social Security Administration. This SSA Use Case will utilize the existing NHIN
       Gateway Web Services at the NMHIC HIE network. NMHIC, an original NHIN
       Awardee, is actively participating in the NHIN Option Year One Specification
       Factory and Testing Infrastructure Work Groups, and their Sub-Groups, to define
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                                                                                                           22
              New Mexico Health Information Exchange Strategic Plan


      the NHIN specifications. Fully implemented, these specifications will provide the
      backbone for the SSA Use Case. The NHIN Testing Infrastructure will provide the
      mechanism to prove a state of NHIN production worthiness at NMHIC, and as such,
      readiness to participate in the SSA Use Case in the year 2010.

      SSA Electronic Determination of Patient Disability over Regional HIE Networks and
      the NHIN
      This pilot will use New Mexico‘s health information exchange (HIE) network to allow
      electronic submission of medical information from health providers to the SSA using
      NMHIC to streamline the SSA disability claims application process. This will
      shorten the lengthy disability claims request process for applicants and will reduce
      the burden on health care organizations to provide the needed medical information.
      LCF‘s primary partners in the SSA project are Presbyterian Healthcare Services
      and Albuquerque Health Partners Medical Group.

      Coordination with Indian Health Service (IHS)
      NMHIC actively interacted with IHS during the past few years, planning IHS
      involvement, yet with the advent and progress of NHIN, IHS has requested
      interaction solely though the NHIN for data exchange. No date has been set for this
      implementation.

      Southwest Telehealth Access Grid (SWTAG) Project (Appendices E-F) – We have
      had seats on both the Engineering Committee and the Governance Committee for
      this project, sponsored by the Federal Communications Commission (FCC) and
      managed by the University of New Mexico. This project will facilitate broadband
      network capabilities for Telehealth purposes across the Southwest. We are working
      closely with all of the stakeholders in this project to assure that Health Information
      Exchange exists to support Telehealth activities.

      Electronic Reporting to the New Mexico Department of Health – LCF/NMHIC is
      planning to facilitate electronic reporting of reportable laboratory conditions and
      emergency department encounters from New Mexico health care organizations to
      the New Mexico Department of Health and the CDC. As part of our NHIN project
      activities in 2008 we created and demonstrated the technology to filter and report
      the information from the HIE network. In January, 2010, NMHIC signed a contract
      with the New Mexico Department of Health for e-reporting of state-identified
      reportable conditions from reference labs and emergency departments to the New
      Mexico Department of Health. This contract represents the first ongoing source of
      revenue for NMHIC network services. In addition, we are working closely with the
      CDC to include national reporting through the NHIN using the GIPSE standard.

S7.   Participation with federal care delivery organizations

      Nationwide Health Information Network (NHIN) Trial Implementation Project – As a
      participant in the NHIN project, NMHIC has had ongoing interaction with several
      Federal Agencies, such as the Veterans‘ Administration, the Indian Health Service,
      and the Department of Defense. In the 2008 NHIN Demonstration in Washington
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              New Mexico Health Information Exchange Strategic Plan


      DC, we served as a data provider across the NHIN in the Wounded Warrior
      demonstration to the HHS Secretary. In 2009 at the Health Information
      Management Systems Society (HIMSS) Conference in Chicago, we worked with the
      VA, DOD, and Kaiser Permanente to demonstrate the exchange of HITSP standard
      patient summary records over the NHIN. We have participated in all aspects of the
      NHIN project since October 1, 2007.

S8.   Coordination with Other ARRA Programs

      The stakeholders involved in building the New Mexico Health Information
      Collaborative (NMHIC) since 2004 will carry those cooperative and coordinating
      approaches into their work involving various ARRA federal initiatives. NMHIC has
      demonstrated its willingness and ability to forge cooperative relationships across
      different organizations and domains of interest in order to accomplish efficient
      outcomes in a state with constrained resources.

      The New Mexico Regional Extension Center (NMREC) is led by the same LCF
      staff that leads NMHIC. The NMREC proposal involves staff which participates in
      technical and governance functions of the Southwest Telehealth Access Grid
      (SWTAG, an initiative funded by the FCC outside ARRA). Regional Center staff will
      support Meaningful Use EHR adoption by performing outreach, education, workflow
      analysis, project management, privacy and security training, and IT infrastructure
      support. Because NMREC and NMHIC staff already work together, our teams will
      coordinate EHR adoption with simultaneous NMHIC expansion efforts, so primary
      care practitioners implementing EHRs will maximize their opportunities to
      demonstrate Meaningful Use of summary document exchange, e-prescribing, care
      coordination and public health participation through HIE. Participation in the
      SWTAG will ensure coordination of both non-ARRA funded broadband expansion
      initiatives, and those funded under ARRA. This coordinated effort will provide
      support for EHR and HIE adoption in our rural state. Our state agency partners,
      including NM Department of Health, are also members of SWTAG.

      State LCF/NMHIC leadership includes the director of New Mexico Primary Care
      Association (NMPCA), who coordinates federal funding opportunities for Health
      Resources and Services Administration (HRSA) support to Federally Qualified
      Health Centers and Health Center Control Networks. The many New Mexico
      physicians who participate in these federal initiatives receive IT support from
      NMPCA, so NMHIC technical and leadership collaboration can be accomplished
      when new initiatives are offered.

      Community-Based Quality Initiatives LCF/NMHIC is also actively engaged in two
      additional initiatives that relate to improving the quality of health and health care
      through community collaboration and through health information technology. The
      Robert Wood Johnson Foundation has given an Aligning Forces for Quality award
      to an AF4Q community coalition representing health care organizations in the
      Albuquerque area (Bernalillo County). The AF4Q community coalition is led by the
      New Mexico Medical Review Association (NMMRA), which is a CMS-recognized
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              New Mexico Health Information Exchange Strategic Plan


      quality improvement organization. The President of LCF, Maggie Gunter, and the
      Director of Clinical Informatics, Dr. Robert White, serve on the leadership council of
      the AF4Q community coalition. The Robert Wood Johnson Foundation has also
      given an award to LCF to evaluate and quantify the benefits of NMHIC network
      services (including reduction of redundant laboratory and radiology tests) to health
      care providers and payers in New Mexico.

      The State is working with the institutions of higher learning to pursue workforce
      development opportunities. The community college system in New Mexico has
      pledged the use of their statewide distance learning network to support expanded
      training for workers in the healthcare industry. The University of New Mexico
      supports workforce development through its medical school and school of nursing.
      Our hospital partners have also offered the use of their training facilities to provide
      physicians with a local option for hands on training. We have also approached a
      large, temporary employment agency as a partner in retraining and recruiting
      personnel to assist physicians with the task of implementing electronic medical
      records technology.

      Our workforce will be deployed through local community hubs at our hospitals and
      through statewide organizations like the Primary Care Association. Our providers
      will be offered training through similar channels and through our statewide distance
      learning network.

      A recent survey found that many healthcare providers in New Mexico already have
      access to broadband. New Mexico‘s plan for broadband expansion through the
      funding available in ARRA will build connections to all major public facilities as well
      as hospitals around the state. This hub and spoke arrangement envisions local
      providers connecting through their community centers, whether they are public hubs
      or central sites provided by community-based institutions like community colleges or
      hospitals. The State already supports broadband to all of the Department of
      Health‘s public health clinics and its school-based health centers.

S9.   Governance

      S.9.1 Building Upon a History of Collaborative Governance

      The governance of NMHIC (New Mexico‘s HIE and SDE) has been based upon
      broad and diverse community participation since its inception. In 2004, LCF/NMHIC
      established the NMHIC Steering Committee. By 2007, the Steering Committee
      grew to more than 30 community organizations including state government, health
      care providers, payers, professional associations, employers, public schools, and
      consumer representatives.

      S.9.2 Governance Model: Membership Representation and Structure

      As the role of NMHIC in New Mexico has grown, the governance structure and
      community representation for NMHIC continues to evolve. In 2009, Lovelace Clinic
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        New Mexico Health Information Exchange Strategic Plan


Foundation, the non-profit 501(c)(3) applied health research organization that
created, staffs and operates NMHIC, decided to escalate governance from the level
of the NMHIC Steering Committee to the level of the LCF Board of Directors. Now
community governance will preside over LCF/NMHIC, not just NMHIC. The new,
expanded Board of Directors held its first meeting on January 19, 2010. The new
Board of Directors strengthens the multi-disciplinary, multi-stakeholder governance
model in two ways:

   The new LCF Board of Directors includes the State HIT Coordinator and CIO of
    the New Mexico Department of Health; the Deputy Director of the Medical
    Assistance Division (Medicaid); four directors representing medical practices
    (one independent, one from a rural IPA, one from the New Mexico Medical
    Association, and one from a Federally Qualified Health Clinic); five directors
    from a large medical group; five directors from hospitals (one from the Hospital
    Association, two from urban hospitals, and two from rural hospitals); seven
    directors from health plans (mostly physician executives); one director from the
    Quality Improvement Organization; four directors from the University of New
    Mexico (one from Biomedical Informatics, one from research and the VA, one
    from pediatrics/telehealth, and one from health policy); two from clinical and
    reference laboratories; two directors from major community employers; one
    director from wellness and preventive education; one director (chair) from
    applied health research; one director representing consumers; and one director
    representing rural telehealth. Many of the directors on this Board actually
    represent more than one stakeholder group. For example, some of the health
    plan and health system executives are physicians as well as administrators. In
    addition, the director representing the Hospital Association also represents New
    Mexico‘s administrative HIE network (HealthXnet), and the director for the QIO
    also represents e-prescribing initiatives as the sponsoring organization for the
    New Mexico Prescription Improvement Coalition (NMPIC).

   The new LCF Board will then choose the committee members that will provide
    more direct governance over the two major LCF divisions (NMHIC and the
    Health Research Division). The governance committee that will directly preside
    over NMHIC is expected to have between eight and sixteen members, and meet
    on a monthly or quarterly basis. All division committee members must also be
    members of the large community LCF Board.

    HIT Coordinator and CIO for NM Dept. of Health
    Deputy Director, Medical Assistance Division, NM Human Services Division
    CEO, Presbyterian Health Plan
    CEO, Lovelace Health Plan
    CEO, United Healthcare, NM Division
    CEO, Molina Healthcare Services
    Medical Director-Quality, Blue Cross and Blue Shield of New Mexico
    CEO, ABQ Health Partners (large medical group)
                                                                             02-26-10
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        New Mexico Health Information Exchange Strategic Plan


   Director, UNM Center for Teleheatlh
   Director, UNM Library and Informatics Division
   CEO, TriCore Reference Labs
   CEO, SED Labs
   Practicing physicians (2), ABQ Health Partners
   Physician/researcher, VA Medical Center
   CEO, NM Hospital Association
   Physician representative, NM Medical Society
   CEO, NM Medical Review Association (state‘s CMS-designated QIO)
   CEO, NM Primary Care Association (safety net providers)
   CIO, ABQ Health Partners
   Endocrinologist (Board Chair), ABQ Health Partners
   VP Quality, Lovelace Health Plan
   Chair, NM Telehealth Alliance Board
   Practicing physician (independent—not part of large ABQ systems)
   Vice Chair, Century Bank
   Software Engineer, Intel/Digital Health
   COO/CNO, Lovelace Westside Hospital
   Medical Director, Process Excellence, Presbyterian Healthcare Services
   CIO, CHRISTUS St. Vincent Hospital (Santa Fe)
   CIO, Gila Regional Medical Center (Silver City)
   CEO, Holy Cross Hospital (Taos)
   CEO, San Juan IPA (Farmington)
   Physician Founder of NMHIC (now CEO, Alegent Medical Group, Omaha)
   Consumer representative (retiree)
   CEO, LCF Research

Despite several discussions with and invitations to the Indian Health Service for
representation on past and current governance bodies for NMHIC, this
representation has not yet occurred. We will continue to encourage IHS
representation on the governance body for NMHIC.

S.9.3 Governance Model: Decision-Making Authority

The role of the NMHIC Steering Committee has been to provide advice, guidance,
and oversight for the development of the health information exchange. This
collaborative decision-making model has proved to be very productive. For
example, in addition to the regular NMHIC Steering Committee meetings, in early
2008 several members of the NMHIC Steering Committee volunteered to help
NMHIC identify community priorities for HIE network services. A comprehensive
survey of more than 1,000 potential network users was conducted. It identified the
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        New Mexico Health Information Exchange Strategic Plan


top community priorities for network services. The top nine network services are
clinician access to: (1) laboratory results; (2) Summary Patient Records; (3)
medication lists; (4) radiology and imaging reports; (5) discharge summaries; (6)
progress notes; (7) eligibility; (8) referrals; and (9) e-Prescribing.

These community priorities provided strategic direction for the development of the
New Mexico Health Information Collaborative (NMHIC) comprehensive Business
Plan. (See Appendix H) The plan has also provided a foundation to support
ongoing discussions with and feedback from the NMHIC Steering Committee and
other community stakeholders (Figure 1 and Appendix B). As such, the NMHIC
Business Plan has served as an important vehicle to support and facilitate
meaningful advice and guidance from the NMHIC Steering Committee.



                                              Healthcare
                                              Providers

                                                                     Patient &
                  Healthcare                                        Consumer
                 Purchasers &                                      Organizations
                  Employers




                                                                                   Health Plans
       Other HIT                        New Mexico
      Users & Care
        Agents
                                         Statewide
                                      Health Information
                                         Exchange


                                                                                Health
                                                                             Professions,
                                                                               Schools,
                                                                             Universities,
                 Clinical                                                     Colleges
               Researchers



                                   Health                  Public Health
                                Information                 Agencies
                                Technology
                                  Vendors




                        Figure 1. NMHIC Community Stakeholders




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        New Mexico Health Information Exchange Strategic Plan


S.9.4 Alignment with Emerging Nationwide Health Information Network
Governance

New Mexico‘s governance model is well-positioned to be compatible with the
emerging Nationwide Health Information Network governance principles and
functions. The Director of Health Informatics for LCF/NMHIC served on the NHIN
Governance Work Group during the first six months of 2009. The Work Group
defined and described the key principles and functions for NHIN governance. The
major NHIN governance functions include: (1) Development of the Strategic
Direction; (2) Development and Maintenance of the NHIN Policies, Procedures,
Reference Materials and Support Services; (3) Development of the Legal
Infrastructure; (4) Management of Participation in the NHIN; (5) Dispute Resolution;
(6) Governance of NHIN Support Services; and (7) Managing Risks to the
Confidentiality, Privacy and Security of Information. In addition, LCF/NMHIC
continues to participate in the NHIN Trial Implementation contract Option Year One
and the no-cost contract extension until it concludes.

S.9.5 New Mexico HIT Coordinator

The New Mexico HIT Coordinator, Robert Mayer, has overall responsibility for
ensuring that state agencies and their federal partners fully cooperate in the effort to
move providers to meaningful use of electronic medical records systems. The
Coordinator has been designated by the Governor‘s Office as the key liaison in this
effort. With roles in both the Governor‘s Office and the New Mexico Office of
Recovery and Reinvestment, the Coordinator is in a position to drive the integration
of initiatives relating to electronic medical records, as well as related projects funded
under ARRA including the EHR/EMR projects and the federal broadband projects.
The Coordinator also chairs the Governor‘s Telehealth and Health Information
Technology Commission.

The New Mexico HIT Coordinator will regularly meet with the Cabinet Secretaries
from all agencies engaged in promoting the adoption of electronic medical records
systems. The Coordinator will assist with the internal use of electronic medical
records at the Department of Health, the Human Services Department (including the
Medicaid program), the Children Youth and Families Department, and the
Department of Corrections. Working with the Department of Indian Affairs, the
Coordinator will meet with tribal leaders to ensure their participation, both through
the Indian Health Services and local tribal providers. The Coordinator is also a
member of the joint agency team working with the US Department of Veterans‘
Affairs to link the federal medical records for veterans with the records used by local
health care providers.

S.9.6 Accountability and Transparency

Accountability and transparency for the development and operation of the New
Mexico HIE will build upon the practices used by LCF/NMHIC during the past five
years. New Mexico HIE accountability and transparency practices will include:
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         New Mexico Health Information Exchange Strategic Plan


   Regular status reports to the governing body. NMHIC provided status reports to
    the NMHIC Steering Committee on a quarterly basis for several years. During
    the last two years of rapid growth, directed by federal contracts, these quarterly
    status meetings were interrupted by definitive monthly status reports that were
    required by the federal government. Since ARRA expands the network services
    included under the term ―HIE‖, and since it calls for more oversight by state
    government, NMHIC meetings will be expanded to include:
         Status activities of clinical network services (clinical summary exchange
           for care coordination, lab orders and results, quality reporting, public
           health reporting) provided by NMHIC, administrative network services
           (eligibility and health claim transactions) provided by HealthXNet, and e-
           prescribing network services (prescribing, refills, fill status notifications
           and medication history) that utilize the SureScripts/RxHub network
         These status meetings will be conducted on a quarterly basis to the
           NMHIC Oversight Committee within the overall LCF/NMHIC Board of
           Directors
         New Mexico HIE status will also be presented to the LCF/NMHIC Board
           of Directors each time they meet (once or twice per year).
   The information that is planned for periodic, publicly available, NMHIC reports,
    and for review in the quarterly NMHIC Committee meetings, includes:
         The number and type of healthcare organizations that are providing data
           for access by the New Mexico HIE network
         The number and type of users that access the New Mexico HIE network
         The number of user accesses for each type of network service (volume)
         The number and type of privacy or security incidents that may have
           occurred
         Which network services are planned for future availability
         A summary of development and operating costs
         A summary of development and operating revenue, including whether the
           source of revenue is from federal or state grants or contracts; how much
           of the funding is derived from user fees or subscriptions; and how much is
           derived from other sources
         A review of the New Mexico HIE goals and objectives, and the status of
           New Mexico HIE progress to meet goals and objectives
         A review of New Mexico HIE network challenges, risks, and risk mitigation
           initiatives

S.9.7 Activities to Strengthen New Mexico HIE Governance

The full LCF Research Board of Directors met on January 19, 2010, and the second
meeting of the full Board is scheduled for April 20, 2010. We hope to establish the
membership of the NMHIC Oversight Committee, which will provide direct oversight
for the state HIE network, during the April 20, 2010, LCF Research Board meeting.
By the Fall of 2010, we plan to establish a process so that we can provide
appropriate status reporting (discussed in section S.9.6 above) to the NMHIC
Oversight Committee and to the full LCF Research Board.

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             New Mexico Health Information Exchange Strategic Plan


S10. Finance

     S.10.1 Sustainability

     NMHIC, with the benefit of federal and state funding, developed a comprehensive
     Business Plan during 2008. One of the major objectives of the NMHIC Business
     Plan was to support discussions with key stakeholders that would lead to funding
     commitments for ongoing sustainability of NMHIC. The sustainability model in the
     Business Plan has undergone several versions:

     1. The original business model scenario assumed that some funds would come
        from transaction revenue and the rest would come from health plans.
     2. During the summer of 2008, executives from two large health plans suggested
        that we create some new scenarios that would show what it would cost the
        health plans if they were to assume the entire cost of supporting NMHIC. They
        explained that if we charged the hospitals, the cost would only be passed on to
        the health plans anyway; and if we charged the users, it might discourage rapid
        clinician adoption. The new scenarios were created, distributing the annual cost
        to each of the health plans based on a single rate per member per month
        (pmpm).
     3. Since then, the financial summary from the NMHIC Business Plan has been
        reviewed with key stakeholders, including the presidents of the five major health
        plans and the Medical Assistance Division (Medicaid program) of the Human
        Services Department. Some of these payers have indicated that they ―int   end‖ to
        provide enough funds to cover the matching fund requirements for the HIE and
        for the HIT Regional Extension Center, but not all payers have agreed yet and
        we have still not received written commitments for specific amounts of funding.

     New Mexico has developed a budget for the HIE Cooperative Agreement but the
     sustainability plan is different. LCF/NMHIC projects that it will take approximately
     $15M to completely fund the expansion of HIE network services throughout the
     state. The state HIE cooperative agreement grant goes a long way to help cover
     this funding, because it will provide $7.07M from 2010 through 2013. Before New
     Mexico can create new scenarios for ongoing sustainability for the New Mexico HIE
     Plan, several new areas of expenditures and funding opportunities will need to be
     better defined:

     1. Now that the role of NMHIC has been expanded to include network services for
        eligibility, health claims and e-prescribing, how much will the cost of providing
        these services during and beyond the four years of the State HIE Cooperative
        Agreement affect funding requirements for sustainability?
     2. Will the New Mexico community (including the State of New Mexico) be able to
        provide all of the matching funds for the New Mexico HIE network for 2011,
        2012, and 2013, as required by the State HIE Cooperative Agreement grant?
     3. In addition to matching funds for the State HIE grant, how much funding should
        NMHIC plan on during the next several years from various community sources?


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        New Mexico Health Information Exchange Strategic Plan


When there is greater clarity about the three issues mentioned above, NMHIC will
be able to construct a number of new scenarios (Scenarios were developed during
2008 and 2009 in the NMHIC Business Plan, but they no longer apply.) for ongoing
sustainability. We expect to have enough clarity to create the New Mexico HIE Plan
by the end of 2010.

The issue of financial long term sustainability is one that we have identified as a
high risk. The plan to address this risk has four aspects:

1. The President of LCF has been meeting with the presidents of the major health
   plans in New Mexico to obtain commitment to provide matching funds for both
   NMHIC and the New Mexico HIT Regional Extension Center for 2010 and 2011.
   The presidents of two leading health plans have now taken leadership roles to
   obtain the needed financial commitment from the other health plans. The
   agreement is based on the proposition that the five major health plans would all
   contribute based on a per-member-per-month construct. At this time, three of
   the five largest health plans have agreed to provide the necessary funding, one
   is providing a lesser amount, and one is still pursuing approvals to provide the
   necessary funding. Discussions continue to bring these agreements to a final
   commitment. The major health plans have not yet agreed to a financial
   construct for ongoing sustainability of NMHIC beyond 2011. However, it is
   encouraging that four of the five health plan presidents have agreed to
   personally serve on the expanded LCF Research Board of Directors.
2. Despite the budget deficits that are projected for the State, the Medical
   Assistance Division (Medicaid) in New Mexico is still trying to allocate some
   funding for NMHIC.
3. To address the need for long term sustainability, New Mexico continues to study
   other states‘ approaches to providing ongoing sustainable funding for health
   information technology. We have spoken with a vice president of the Vermont
   Information Technology Leaders (VITL) initiative and reviewed the two state
   laws they have passed that add a small fee to each health care claim to
   generate sustainable funding for health IT in Vermont. If New Mexico health
   plans and other NMHIC stakeholders consider this to be an option for New
   Mexico, LCF/NMHIC would work with the health plans and the LCF Research
   Board of Directors to develop any such legislation.
4. New Mexico is also considering whether we should charge annual or monthly
   subscription fees or transaction fees to users of the HIE network. Before we
   move forward on this approach, we need to have a better understanding of how
   this might impact user adoption and utilization. This assessment should take
   place after we have a body of users that can give informed answers to the
   question of how much they are willing to pay for network services, based on the
   value they are receiving from these services. If we adopt methods to charge
   providers or users for the network services, the total revenue it will generate will
   probably be about 1/3 of the total annual requirement for ongoing sustainability.
   Therefore, this approach is not likely to solve the long term sustainability issue
   by itself.

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              New Mexico Health Information Exchange Strategic Plan



S11. Technical Infrastructure

      S.11.1 Interoperability

      Participation in NHIN
      NMHIC successfully demonstrated sharing of standards-compliant summary patient
      records, lab results, and emergency responder information as part of the
      Nationwide Health Information Network (NHIN) Trial Implementations in 2008.
      NMHIC also demonstrated its ability to forward reportable conditions to the New
      Mexico DOH as part of NHIN Trial Implementations. NMHIC plans to continue its
      participation in NHIN in 2011 by sharing patient information over the NHIN for care
      coordination with local Veterans Administration Health facilities, Indian Health
      Services, and the military health system of the Department of Defense. This will
      close a major gap in coordination of care for patients flowing between the VA, IHS,
      DOD, and private sector health facilities within New Mexico.

      Adoption of HHS standards and certification for HIE
      We have demonstrated the adoption of HHS standards through our participation
      and demonstrations within the NHIN project. Through integration of data within our
      community, we have determined that our local healthcare providers have not
      adopted HHS standards and in some cases do not have CCHIT certified EHRs in
      place. Our role in NHIN has been to incorporate data from many sources in different
      formats and create the ability to transform that information to meet national
      standards.

      In terms of HIE standards, we have been involved extensively in the NHIN Testing
      Workgroup which is defining the process for testing compliance with NHIN
      standards. We anticipate that when an NHIN certification program exists we will be
      well positioned to achieve that certification. In addition, we have reviewed the
      CCHIT requirements that have been published in regard to HIE certification and
      plan to pursue that certification as soon as it is made available.

      Planning and accounting for meaningful use criteria.
      New Mexico will update its HIE Plan when the final rule for meaningful use is
      published in late Spring, 2010. The updates will include more detail regarding New
      Mexico HIE network‘s support of meaningful use measures for Stage 1 (2011 and
      2012), and the plans to provide new network services for Stage 2 and Stage 3 (if
      the final rule provides more information about meaningful use requirements for 2012
      – 2015).

      S.11.2 Technical Architecture / Approach
      NMHIC utilizes a federated architecture of independent (decentralized) databases
      that are connected to share and exchange information. The federated architecture
      provides a means to share data and transactions using messaging services,
      combine information from several components and coordinate activities among
      autonomous components.

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                         New Mexico Health Information Exchange Strategic Plan



NMHIC System Architectural Overview
LCF/NMHIC has deployed the MedPlus Centergy suite of products to support HIE
across the state of New Mexico. Centergy is a web enabled, n-tier, thin client
solution based on a federated data model (Figure 2).
Centergy‘s implementation of a federated model is done through the Vlink™ engine.
Vlink‘s architecture deploys an instance of a database and interface engine on a
server behind the firewall of each organization – this is referred to as an edge
server or service. The edge service captures data by tapping into a site‘s existing
electronic data streams. This data flows into and is permanently stored on the
organization‘s edge server. While we store the clinical information at the edge,
specific demographic data elements are sent for processing to the centralized
master person index.
When a user logs into the NMHIC Clinician Portal and selects a patient, the clinical
data service (CDS) is called and a query is sent to the sites containing patient data.
The patient data is gathered and returned in an encrypted XML format. The
multiple messages are then organized into a single document and sent to the
application and web servers. Once formatted, it is forwarded to the requestor‘s
desktop.

                          Clinical Portal


                                                    SSL HTTPS                                                                  RLS
                                                     Request
                                                                                                                          Security/              Patient
                                                                                                                          Privacy                Index
     Other NHIEs              NM DOH         NMEMSTARS

                                                                           Firewall                    XML



                                                                                                         Clinical Data
                                                                                                              Service                   EMPI Server
                                                                                         Web Servers
                                                                                                          Application
                                   XML                                                                         Server
                                 Or HTTPS                                                                                                                        Clinic A
                                 Request




                                                                                                         XML



                                      Facility                                          Facility          Facility                              Facility
                HL7                                               HL7
Point of Service                    Interface &   Point of Service                    Interface &       Interface &                           Interface &
  System(s)                          Database       System(s)                          Database          Database                              Database
                                       Edge                                              Edge              Edge                                  Edge
                                      Server                                            Server            Server                                Server

                                                                                                                                  LIS                                   ChartWriter
                            Facility                                         Facility                              Facility                                 Facility
                   HL7     Data Store                                HL7    Data Store                            Data Store                               Data Store


Point of Service                                  Point of Service
  System(s)                                         System(s)
                   Presbyterian Health                               Taos Holy Cross                          TriCore Reference                   Albuquerque Ambulance
                        Services                                        Hospital                                 Laboratories                            Service


                                                                       Figure 2 – NMHIC Architecture




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        New Mexico Health Information Exchange Strategic Plan


Components of the NMHIC System
The NMHIC System is comprised of the following components:
      NMHIC Clinician Portal (web based viewer)
       o String Templates (web screen customization tool)
       o Home Page Content Manager (web site content customization tool)
      Vlink (edge services):
       o Clinical Data Store (relational database Data Repository)
       o Integration Engine (interface engine)
      Vlink (central services)
       o Patient Identification – Initiate Master Patient Index (MPI) and Record
         Locator Service (RLS)
       o Web and Application Server (processing and formatting data requests
         and responses)
       o Auditing Services (logging of data requests, user activity and events)
       o Security Service (authorization and authentication services)
       o Clinical Data Service (accepts the clinical data requests, traverses the
         federated architecture and returns the appropriate data)

NMHIC System Data Flow
Figures 3a and 3b illustrate the high level data flow for the NMHIC System. Figure
3a shows the data flow for data acquisition. This diagram uses one edge server
and one central service. Figure 3b shows the data flow for data request from a
user. Similar to Figure 3a, this diagram uses one edge server and one central
service. These data flows for acquisitions and requests will work in a significantly
similar fashion at all NMHIC constituents.




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             New Mexico Health Information Exchange Strategic Plan


                                Data Center

                                                                          XML
                                                            Central
                                                          Integration
                                                            Engine
                                Database
                                 Server
                                                                                                                                 VPN tunnel
                                                                                                                               To Data Center
                                                                                                                               (using Internet)

                                                   EMPI




                                                                                                                                                             XML
                                         Centergy Defined
Site‘s ADT System                        Message Format



                            Centergy Defined
                            Message Format                                                                                      XML                                        Firewall
                                                                                                  Vlink
   Site‘s Other System                                                                      Integration
                                                          Site’s Internal                       Engine
                                                             Network
                                                                                                             St
                                                                                                                 or
                                                                                                                    e   dP
                          Centergy Defined                                                                                ro
                          Message Format                                                                                       ce
                                                                                                                                    du
                                                                                                                                       reC
                                                                                                                                             all
     Site‘s LIS                                                                                                                                    s
                                                  Centergy Defined
                                                  Message Format




                                                                                                                                                         Vlink
       Site‘s Transcription System                                                                                                                     Data Store




                                                  Figure 3a – Data Acquisition Data Flow

                                                                                                   HTTPS
                                                                                                                                                                Data Center
                                                                                 Web                                                 Security
                                                                                Server                                                Server


                                                                                                           XML
                              NMHIC Clinician                                             App
                                 Portal                                                  Server                                                                 Database
                                                                                                                                 Central
                               Web-Based                                                                                                                         Server
                                                                                                                 XML           Integration
                                 Viewer
                                                                                                                                 Engine




                                                                                                                                                         EMPI




                                 XML                                 Firewall
         Vlink                                                                                             Public Internet
   Integration
       Engine

                  St
                     ored
                            Pr
                              oc
                                ed
                                  ure
                                        Ca
                                          lls




                                                  Vlink
                                                Data Store


                                                    Figure 3b – User Request Data Flow


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        New Mexico Health Information Exchange Strategic Plan


Scalability – HIE capacity development
NMHIC is building the Health Information Exchange for scalability. This means that
adding users will not require much increase of absolute cost. The infrastructure
hardware and software is architected to enable storage and other technical
components to be added at small incremental cost and will not require costly
wholesale change-out. While the HIE is designed for scalability, adding data
providers to the exchange will require additional expense to develop data exchange
interfaces.


S.11.3 Master Patient Index (MPI) Management

NMHIC has a community MPI which is used to conduct patient matching both when
the data is populated into the exchange and when the end user does a patient
search. When patient information is added to NMHIC the MPI logic determines
whether the patient already exists in the HIE or whether a new patient record needs
to be created. When an end user enters information to search for a patient in the
NMHIC Clinician Portal the MPI is used to find the patient or list of patients that
match the information used in the search.

NMHIC uses the Initiate MPI software which is a very robust commercial product.
This MPI technology has been integrated into our Medplus application and conducts
all of the patient matching functions for NMHIC. One of the requirements of this
technology is the constant monitoring and tuning of the system. The day to day
monitoring is done by NMHIC staff and the tuning is done every six months with the
support of Medplus subject matter experts.


We plan to provide easier clinician access to NMHIC and HealthXnet by using
single sign on functions which will make it possible for end users to move freely
between clinical and administrative functions of each application. With this model,
both applications will maintain separate patient registries requiring the end user to
ensure the correct patient is matched in each application. NMHIC and the corporate
parent of HealthXnet (the New Mexico Hospital Association) have conceptually
agreed on this first collaboration step and to further discuss and create a plan of
future activities that would be appropriate and useful for the users of NMHIC by the
end of 2010. If we later agree to combine the core infrastructures of these networks,
we will carefully plan how the patient registries and functions will interact.


We also plan to offer electronic prescribing capabilities through the NMHIC Clinician
Portal. In order to accomplish this, we plan to use Medplus Corporation‘s existing
interfaces to the SureScripts network. In that case, the patient matching and
demographics will be communicated from the NMHIC Clinician Portal application to
the pharmacies via Medplus to SureScripts. No central registry will be required
between NMHIC and SureScripts.

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        New Mexico Health Information Exchange Strategic Plan


In terms of other registries associated with the New Mexico HIE it is important to
note that there will be no proprietary provider directories in place.

S.11.4 Technical Relationships Between NMHIC, HealthXnet and Sure Scripts
As described in the Environmental Scan section of the Strategic Plan, New Mexico
currently has separate networks that provide clinical information, administrative
transactions, and e-prescribing transactions. When ONC published the State HIE
FOA, NMHIC and HealthXnet agreed to work together to provide all seven network
services identified in the FOA to health care providers in New Mexico. The first step
of working together will be to provide the HealthXnet capabilities seamlessly to end
users by using a single sign technology. Next, we will add e-prescribing capabilities
to the NMHIC Clinician Portal by utilizing the Medplus integration with Surescripts.

The organizations also agreed that NMHIC would assume responsibility for planning
and coordination to migrate the HIE services provided by the different organizations
into a construct that would best serve the clinical users in New Mexico. NMHIC
plans to convene additional meetings among all of the parties during the first half of
2010 to explore the best way to harmonize and/or integrate these HIE network
services.

S.11.5 New Mexico and the Nationwide Health Information Network (NHIN)

In early February, 2010, NMHIC will be among the first HIEs utilizing the Federal
Health Architecture‘s (FHA) NHIN testing infrastructure to validate the newest
release of our NHIN Gateway. We will be deploying the latest NHIN interface
specifications which include the following:

Messaging Platform: The NHIN is a Web Services based, service oriented
architecture using Simple Object Access Protocol (SOAP) messages over HTTP
and Health Level 7 (HL7 – ver. 3.0). Public Key Infrastructure (PKI) is used to
                                                                 ust
establish data integrity and non-repudiation which supports a ―tr fabric‖ among
participants. The Web Services use the WS-I Basic Profile ver. 2.0 and the WS-I
Security Profile ver. 1.1.

Services Registry: Describes how participants in the NHIN will use the Universal
Description Discovery and Integration (UDDI - Ver. 3.0.2) registry. The NMHIC
services will be populated into this registry prior to production use (see below for
timing).

Patient Discovery: This is the first step in a 3 step process of retrieving data on a
patient. It describes how patient demographics will be communicated between
NHIN participants for the purpose of determining a positive match. It allows for an
immediate match or a request for more demographics to complete a match. If a
match is found, a participant specific ID is sent for use in further queries.


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        New Mexico Health Information Exchange Strategic Plan


Query for Documents: Step two of the patient data retrieval process. Using the ID
returned by a Patient Discovery, a query is sent to a participant to ask what
information (in the form of document IDs and descriptions) is available for that
patient.

Retrieve Documents: This is the third step in the patient data retrieval process. It
describes how to retrieve some or all of the documents returned in the Query for
Documents and how to interpret the metadata for the received documents for
display.

Access Consent Policies: This describes how Access Consent Polices will be
constructed and how to share them between participants. It is up to each participant
to author their own policies and determine how they will respond to policies they
receive from others. NMHIC will construct these policies prior to production use of
the NHIN.

Authorization Framework: Different types of users will have different access
privileges and this specification describes how to communicate those privileges. It
describes who the user is, their role, how they were authenticated, etc. The
referenced lower level specifications are: OASIS Security Access Markup Language
(SAML) ver. 2.0.

In addition to the above specifications are a set of profiles describing various
business cases and how to implement them over the NHIN. These include:

Health Information Event Messaging (HIEM): Describes how one participant may
publish content or subscribe to content from another. Related documents include:

Geocoded Interoperable Population Summary Exchange (GIPSE): The Center for
Disease Control (CDC) has created a format for creating GIPSE in order to monitor
public health events. This profile defines how these files may be sent over the
NHIN.

                                                                         ush‖
Document Submission: This profile describes how an NHIN participant can ―p
data for a given patient to another participant without a subscription.

CMS Care: Defines the profile for the exchange of Continuity Assessment Record
and Evaluation (CARE) data between Centers for Medicare and Medicaid Services
(CMS) and health care providers.

We plan to deploy NHIN future functions as follows:

1. The Social Security Administration disability claims processing project is
   expected to start in the first half of 2010. The SSA will be able to request patient
   data by providing an SSA-827 Authorization Form (as a PDF document) with an
   NHIN Patient Discovery message over our NHIN Web Services Gateway. After
   validating the 827, NMHIC will respond to further Document Query and
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             New Mexico Health Information Exchange Strategic Plan


        Document Retrieve messages for that patient from the SSA. NMHIC will start by
        providing patient records from two of our provider organizations (PHS and ABQ
        HP) to SSA via the NHIN before the end of this 12 month project. We plan to
        incorporate other providers in subsequent years.

     2. NMHIC will connect to the NHIN for the purpose of exchanging patient
        information to support Care Coordination by the end of 2010. The key benefit of
        this exchange will be making Federal Agencies‘ (VA, IHS, DOD) information
        available to the healthcare organizations within New Mexico. Physicians will use
        the NMHIC NHIN Portal to send Patient Discovery messages to participating
        agencies. Upon receipt of a patient demographic match, physicians will be able
        to determine what documents are available (Query for Documents) for that
        patient and retrieve the appropriate documents (Retrieve Documents) for the
        current care episode.

     3. Electronic Reporting to the CDC will commence in test during 2010. NMHIC is
        going live with local reporting of lab and ED reportable conditions to the NM
        DOH in June 2010. NMHIC will work with the CDC and NHIN Specification
        Factory to deliver GIPSE formatted files of syndromic surveillance information to
        the CDC using the NHIN Health Information Event Messaging protocol.
        Production reporting over the NHIN to CDC may be ready to commence by the
        end of 2010.

S12. Business and Technical Operations

     S.12.1 Implementation

     New Mexico‘s strategy for statewide HIE implementation is to designate NMHIC to
     provide coordination for all HIE network services and continue the expansion of
     these technology infrastructures across the remainder of the state. Since 2004,
     NMHIC‘s HIE capabilities have progressed through a strong community
     representation (including state representatives) that has evolved into the
     public/private partnership that exists today. LCF/NMHIC and key individuals from
     the State of New Mexico have also participated on the HISPC project which has
     worked through many of the privacy and security issues resulting in legislation such
     as the New Mexico EMR Act of 2009 (see Appendix C).

     The expansion of NMHIC network services across the state will be focused on
     hospitals as technology infrastructure hubs. Our intent is to leverage these hospitals
     to host the technology required to support physicians across that community. Given
     our role as the lead of the NM Health Information Technology Regional Extension
     Center (NMREC) initiative, we will have the opportunity to help physicians deploy
     EHR systems in a manner that will integrate centrally with the statewide HIE.

     NMHIC is also the key facilitator of public health reporting for the state. The
     interfaces built to share information to support coordination of care will also be used
     to electronically send reportable laboratory conditions and emergency room
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        New Mexico Health Information Exchange Strategic Plan


encounters to the state‘s public health department. These two capabilities are key
for providers to demonstrate meaningful use through health information exchange.
These capabilities were demonstrated by NMHIC in the NHIN project in 2008 and
are planned for production by the end of the second quarter of 2010. At that time,
we will inventory all health information being reported to state/federal agencies and
work to transition them to NMHIC as soon as practical.

Since September 2007, LCF/NMHIC has been one of the participating members of
the NHIN Trial Implementations Project. During that time, LCF/NMHIC has
developed all of the required technology/interfaces, created HITSP standard
summary patient records, and worked on the many privacy and security issues
associated with health information sharing. Given this, we expect to be among the
early HIEs ready to participate in production use of the NHIN. In January 2010,
LCF/NMHIC was awarded an SSA Disability Determination grant to process
disability claims over the NHIN. We also expect to participate with the VA, IHS, and
DOD information systems to support our significant New Mexico population
represented by those agencies.

S.12.2. Project Management

LCF/NMHIC has a comprehensive approach to project management based on
industry best practices and Project Management Institute’s (PMI) methodologies.
We start by creating a comprehensive project plan including the project charter, our
approach to scope management, a detailed work breakdown structure, a
comprehensive schedule, risks/mitigation strategies, and definitions of project
processes. We start the project with a kick-off meeting and then conduct weekly
project status meetings. Our reporting process provides monthly reporting of
progress based on a detailed Microsoft Project schedule that will be updated at
least monthly. This schedule will be imported into our Deltek accounting and time
management system to generate reports of project status and financial comparisons
in relation to the budget.

For this project, we have identified the following key project management resources:

Project Lead, Jeff Blair – High level project leadership and accountability. Jeff will
serve as the single point of contact for communication with ONC.

Project Manager, Dave Perry – Day to day project management, coordination, and
project leadership. Dave will be responsible for all LCF/NMHIC resource
management and will be the key point of contact for our technology partner,
MedPlus. Dave will negotiate agreements with MedPlus and hold them accountable
for meeting deliverables as defined.

Finance Lead, Don Nettles – Don will be responsible for creating the project
accounting structure in our accounting and time management system.



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              New Mexico Health Information Exchange Strategic Plan


      Project Administrator, Mark Butler – Schedule management, weekly/monthly
      progress reporting, and financial reporting.

      MedPlus Project Manager, Bob Meyer – Day to day project management and
      coordination of all MedPlus resources and activities.

      For more information see the NMHIC Business Plan Version 3 (appendix H).


      S.12.3 Leveraging Existing Capacities and Services

      NMHIC is the HIE network selected by the Governor as the state designated entity
      (SDE) to plan and coordinate the development of HIE network services statewide.
      The network currently has a community master patient index (MPI) with 880,000
      unique identities within a state population of 2 million people. We anticipate the MPI
      will grow to nearly the full state population before the end of the second year of the
      project. NMHIC also has been processing transactions from the largest delivery
      system and the largest laboratory in the state and has processed over 25 million
      HL7 messages from those systems from April 2008 thru December 2009. These
      volumes represent approximately half of the healthcare provided in New Mexico.

      Over the next twelve months, NMHIC plans to connect to the second largest
      integrated delivery system and laboratory and several other key hospitals. In
      addition, we will connect with communities across the state where information
      sharing and exchange exists at any level (i.e. disease registries, tumor registries,
      immunizations, etc.). At that time we expect the patient index and data available in
      the HIE will represent more than 60 percent of the physicians practicing in the state.


S13. Legal / Policy

      S.13.1 Privacy and Security

      NMHIC has identified the significant legal issues affecting in-state and out-of-state
      disclosures of electronic health information through the NMHIC health information
      exchange. LCF, through its participation in the Health Information Security and
      Privacy Collaborative, undertook a detailed analysis of New Mexico law as it affects
      health information exchange and utilized the results of that review to: first,
      participate in the drafting and passage of the New Mexico Electronic Medical
      Records Act; and second, determine the appropriate policy response of the NMHIC
      health information exchange to state law requirements.

      New Mexico, like many other states, has state laws that provide heightened privacy
      protection for certain types of health information. Specifically, New Mexico, by
      statute, imposes specific consent requirements with respect to the disclosure of
      health information dealing with sexually transmitted diseases, HIV/AIDS test results,
      viral hepatitis, genetics, children‘s mental health and developmental disabilities, and
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        New Mexico Health Information Exchange Strategic Plan


adult mental health and developmental disabilities (―Specially-protected
information‖). Because these statutes impose higher privacy standards than those
imposed by the HIPAA Regulations, the New Mexico statutory consent
requirements must be complied with even when the disclosure of information would
otherwise be permitted under the HIPAA Regulations without patient consent or
authorization. For example, although under the HIPAA Regulations disclosure of
health information that included HIV/AIDS test results would be permitted without a
patient consent or authorization for treatment, payment, or operations purposes, the
disclosure of such information in New Mexico must be based upon a patient
consent.

To clarify state law and to provide state-law recognition of health information
exchange, LCF worked with the New Mexico Department of Health to draft and
pass the New Mexico Electronic Medical Records Act. Among other things, the act,
which became effective in June of 2009, provides for: (i) legal recognition of
electronic medical records; (ii) disclosure of health information (including specially
protected information) to a health information exchange for the development and
operation of the health information exchange; (iii) disclosure of health information
(including specially protected information) to a provider to treat a condition that
poses an immediate threat to the life of any individual and that requires immediate
medical attention; and, (iv) out-of-state disclosures on the same basis as in-state
disclosures. A copy of the New Mexico Electronic Medical Records Act is attached
as Appendix D.

While the passage of the New Mexico Electronic Medical Records Act provided
significant and important reform, it did not resolve the barrier that results from the
existence of two legal standards for the disclosure of health information in New
Mexico; namely, the HIPAA Regulation standards of treatment, payment, and
operations for the disclosure of most health information and the higher, state-law,
consent-based standard for the disclosure of specially protected information.
Likewise, a higher, consent-based standard also exists under 45 CFR Part 2 with
respect to the confidentiality of medical records of alcohol and drug abuse patients.

At the present time, a technical solution does not exist that will identify, segregate,
and protect the confidentiality of specially protected information within an
individual‘s electronic medical record (a.k.a. masking or sequestration) in
compliance with New Mexico law. The existence of two standards for permitted
disclosure and the inability to differentiate between information subject to the
respective standards requires that all disclosures be based upon the higher, more
restrictive standard. Consequently, NMHIC adopted a policy that disclosures of
health information through the NMHIC health information exchange may be made
only: (1) with the written consent of the individual; (2) to a provider who has a need
for the information to treat a condition that poses an immediate threat to the life of
any individual and that requires immediate medical attention (as permitted under the
New Mexico Electronic Medical Records Act); (3) as required by law; or (4) as
specifically directed by the covered entity that controls the information. Permitting
disclosures of health information under (1) and (2) above ensures that disclosures
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         New Mexico Health Information Exchange Strategic Plan


of health information to requestors through the health information exchange will be
in compliance with state and federal laws.

The HHS Privacy and Security Framework for Electronic Exchange of Individually
Identifiable Health Information sets out eight principles to guide the actions of
health-care related persons and entities that participate in health information
exchange. NMHIC, as the operator of the health information exchange, will
encourage adoption by its participants of the principals outlined in the HHS Privacy
and Security Framework, and will itself comply with those principles related to
NMHIC‘s role in health information exchange.

Specifically, the eight principles are: (1) individual access; (2) correction; (3)
openness and transparency; (4) individual choice; (5) collection, use, and disclosure
limitation; (6) data quality and integrity; (7) safeguards; and, (8) accountability.

The first two principles, individual access to health information and providing an
individual with the ability to correct errors in the individual‘s information will be the
responsibility of the participants in the NMHIC health information exchange. At the
present time, NMHIC does not contemplate direct individual (patient or consumer)
access to the NMHIC health information exchange. With respect to the remaining
six principles:

Openness and Transparency: NMHIC will be governed by a community board that
includes broad community representation. NMHIC intends to provide education for
both users of the NMHIC health information exchange and for individuals whose
information may be the subject of disclosure through the NMHIC health information
                                                                                 t-
exchange. Education will include explanations of the right of an individual to ―op
out‖ of the system and the consent requirement.

Individual Choice: The NMHIC health information exchange provides individuals
with the ability to decide whether or not their information may be disclosed. Within
the NMHIC Clinician‘s Portal we have the ability to designate a patient who has as
opted out, in which case their information is not shared with anyone on the network.
This technical solution was created to allow NMHIC the ability to meet this
requirement of the New Mexico Medical Records Act. Given this, we must ensure
that the patient‘s right to opt out has supporting processes to facilitate that right. We
are planning to create the policies and procedures to afford this right to individuals
by the end of June, 2010. We will also determine the best methods to communicate
the information but at a minimum will include the information on our NMHIC web
site.

Collection, Use, and Disclosure Limitation: The NMHIC Subscription Agreement
(Appendix G) will contractually prohibit use of the NMHIC health information
exchange except for purposes permitted under the agreement, which in most cases
will be limited to emergency situations, or cases where the individual has consented
to the disclosure.

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         New Mexico Health Information Exchange Strategic Plan


Data Quality and Integrity: Data quality concerns the accuracy, currency, and
precision of specific data. Integrity relates to how data maintains its conformity to
rules and constraints over time. NMHIC will manage data quality and integrity on a
prospective basis as follows:

   NMHIC will implement a proactive, ongoing data quality strategy;
   Data will be managed according to institutionalized rules, policies, constraints,
    and continual monitoring;
   Processes by which data is created, transformed, and used, will be streamlined
    and optimized to provide transparency and eliminate unnecessary wastage;
   Published information will be entirely accurate and clear with a demonstrable
    audit trail relating to the source of the data and calculations performed on it, and;
   Problems, when identified, will be rectified at the source to eliminate the
    underlying problem.

Safeguards: A detailed description of the privacy and security safeguards is
included in Section O.6.2 of the Operational Plan.

Accountability: The NMHIC Subscription Agreement will contractually bind
participants to compliance with its terms and conditions. As a result of stakeholder
input, the NMHIC Subscription Agreement will be revised to provide enhanced
obligations upon participants and the NMHIC health information exchange, including
encryption and breach notification requirements.

S.13.2 State Laws

While the review and analysis of existing state law is an ongoing process, NMHIC
believes that it has identified the significant state-law issues affecting health
information exchange within the State. There are currently no plans to attempt
additional modifications to state law. NMHIC participated in the NHIN DURSA
workgroup, and has signed the test data DURSA. NMHIC expects to sign the
limited production version of the DURSA.

Requirement for Written Patient Consent: New Mexico‘s state privacy law
requires that specially-protected patient information (e.g., sexually transmitted
diseases, human immunodeficiency virus tests, viral hepatitis, genetic information,
children‘s mental health and developmental disabilities, and adult mental health and
developmental disabilities) cannot be shared with other health care providers
without written patient consent. Since we are not aware of nor have we been able
to develop a technical method to mask or sequester this type of specially protected
patient information at a level that would meet the privacy expectations of local or
national privacy advocates (virtually 100% assurance that their information is not
disclosed), we have had to adopt a privacy policy in our state that requires written
patient consent for all disclosures of patient information. This also means that
written patient consent is required for any request to access patient information that
comes from outside of New Mexico over the NHIN.

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        New Mexico Health Information Exchange Strategic Plan


When NMHIC reviewed the DURSA for limited production use, we escalated this
issue to ONC (by email on September 10, 2009). We were told that other states
including New York and Minnesota also have this same issue regarding
communications over the NHIN.
Possible Technical Solution: The SSA Disability Determination contract appears
to have established a method to provide written patient consent over the NHIN, but
we are not aware that this method has been adopted or implemented by other
health care organizations that might request patient information over the NHIN.

No Discrimination for Out-of-State Access: Rather than imposing a barrier to
interstate exchange and participation in the NHIN, Section 8 of the EMR Act was
specifically included in the act to facilitate the appropriate disclosure of electronic
medical records to out-of-state providers in accordance with state law. It provides
as follows:

       OUT-OF-STATE DISCLOSURES. A disclosure otherwise permissible under
       the Electronic Medical Records Act may be made to providers, health care
       group purchasers, health care institutions, health information exchanges or
       record locator services located or operating outside of the state.

This section of the Act was intended to make it clear that if a disclosure is otherwise
permissible under state law, it doesn‘t matter that the disclosure is made to an out-
of-state recipient. Provided the disclosure was permissible to an in-state recipient
under state law, it would not be prohibited simply because the recipient was located
out-of-state.


S.13.3 Policies and Procedures

The policies and procedures to support the production use of NMHIC will address:
 Governance processes including support for the new governance model with
   expanded responsibilities; compliance with any state regulations that may now
   need to be considered; development of administrative processes to support
   public meeting notices, agendas, minutes, rules, and other requirements for
   accountability and transparency.
 Administrative processes including user licensing, accounting, billing,
   management controls, scheduling, insurance, and other processes. It would be
   desirable if the administrative processes for the clinical network (NMHIC) are
   consistent with the administrative processes for the administrative network
   (HealthXnet) and HSD Medical Assistance Division (Medicaid) HIT initiatives.
 Privacy and security processes including privacy policies, user authentication,
   user authorization, and network security methods. NMHIC has already done a
   great deal of work to establish consensus-based privacy policies in New Mexico,
   but now it becomes appropriate to assess whether the NMHIC privacy policies
   are also appropriate for the administrative network and e-prescribing initiatives.


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         New Mexico Health Information Exchange Strategic Plan


   User support processes including installation, education, help desk, and others.
    From a user perspective, it would be desirable if the user support processes for
    the clinical, administrative, and e-prescribing networks are consistent.
   Compatibility and / or consistency with the governance and policy framework
    developed by the Nationwide Health Information Network (NHIN) and
    documented within the Data Use and Reciprocal Support Agreement (DURSA).
   Development to enable and promote information exchange within New Mexico
    and between states.


S.13.4 Trust Agreements

Over the past four years, NMHIC has developed and circulated among stakeholders
various versions of an agreement designed to serve as the trust agreement among
                                                                 M
the participants in the NMHIC health information exchange (the―N HIC
Subscription Agreement). The NMHIC Subscription Agreement is to be signed
between LCF (the legal entity that staffs and operates NMHIC) and individual
Participants. A copy of the current version of the NMHIC Subscription Agreement is
attached as Appendix G.

In October 2009, LCF/NMHIC conducted a series of meetings with our stakeholder
community to elicit feedback on the then current version of our production Network
Subscription Agreement (NSA). Those meetings were attended by a good
representation of stakeholders across the healthcare community and a significant
amount of feedback was received. LCF/NMHIC is using the feedback to make
changes to the NSA and plans to have a draft ready for circulation by the end of
February, 2010, and an improved version completed by the end of March 2010.

The new version of the NSA will be used to create a specific version for each of our
current participants and each of the participants planned to be connected to NMHIC
in 2010. Those stakeholder-specific NSA documents will be distributed and
individual review processes will be conducted in parallel, with the expectation that
our core group of production participants will have their NSAs fully executed before
the end of May 2010, in order for production use of NMHIC for Care Coordination to
commence in June. The project plan will be updated to document the NSA review
process, define resources, and align timing with the objective that each stakeholder
will have the NSA fully executed one month prior to their planned NHIN production
date.

S.13.5 Oversight of Information Exchange and Enforcement

Oversight for the exchange of health information will be provided through a variety
of channels. The State of New Mexico has a comprehensive Electronic Medical
Records Act that details the roles and responsibilities of health information
exchanges, and the privacy protections afforded individuals, including the right to
opt out of the exchange. This state law will be enforced by the Attorney General‘s

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        New Mexico Health Information Exchange Strategic Plan


Office which also has authority under the new privacy regulations in ARRA to
monitor data security for medical records.

For day to day oversight of the health information exchange, the New Mexico Health
Information Collaborative Committee will represent major stakeholders and be
responsible for ensuring the exchange is operating effectively and within the
appropriate regulatory environment. The NMHIC Oversight Committee will operate
under the aegis of the new LCF Research Board of Directors which was described
earlier in the Governance Section.




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              New Mexico Health Information Exchange Operational Plan


       OPERATIONAL PLAN

O.1.   Introduction to Operational Plan

       The New Mexico Health Information Collaborative (NMHIC) recognizes the need to
       continue in a leadership role to determine the path and optimize the model for
       exchange of health information in New Mexico and nationwide.
       The New Mexico HIE Strategic Plan will be implemented through this Operational
       Plan that outlines a corresponding and comprehensive set of activities to achieve
       statewide HIE. Execution of this Plan will enable and support New Mexico‘s
       providers to achieve and demonstrate meaningful use of Health Information
       Technology (HIT) to enhance delivery, quality, and value of health care.
       New Mexico, through NMHIC, plans to continue our practice of sharing information
       and coordinating with the HIE initiatives in other states, as well as supporting the
       NHIN initiatives to coordinate the development and interoperability of HIEs
       nationwide. Coordination with other states through the NHIN is included in this
       Operational Plan.

       O.1.1 Detailed Project Schedule

       The Project Schedule below describes the tasks and subtasks that will be
       completed over the next four years to enable and implement statewide Health
       Information Exchange.




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New Mexico Statewide HIE Project Plan 2009-2013                                                                                                           Thu 2/25/10

 ID     Task Name                                                                                Duration        Start         Finish    PredeceResource Names

 1      Statewide HIE Strategic & Operational Plan Development                                     222 wks      Thu 10/1/09    Fri 2/7/14
 2          Update Strategic & Operational Plan per State HIE Requirements                            3 wks      Mon 2/8/10   Fri 2/26/10
 3               Update Governance Requirements                                                       3 wks      Mon 2/8/10   Fri 2/26/10      NMHIC
 4               Update Finance Requirements                                                          3 wks      Mon 2/8/10   Fri 2/26/10      NMHIC
 5               Update Technical Infrastructure Requirements                                         3 wks      Mon 2/8/10   Fri 2/26/10      NMHIC
 6               Update Business & Technical Operations Requirements                                  3 wks      Mon 2/8/10   Fri 2/26/10      NMHIC
 7               Update Legal/Policy Requirements                                                     3 wks      Mon 2/8/10   Fri 2/26/10      NMHIC
 8          Align State Medicaid HIT Plan with State HIE Plan                                       7.8 wks      Mon 2/8/10   Thu 4/1/10       NMHIC
 9          Align State Public Health Requirements with State HIE Plan                              7.8 wks      Mon 2/8/10   Thu 4/1/10       NMHIC
 10         Consolidate Statewide HIE Strategic & Operational Plan and the NMHIC Business Plan        8 wks      Mon 3/1/10   Fri 4/23/10      NMHIC
 11         Obtain Endorsement of Strategic & Operational Plan from LCF Board & Stakeholders            1 wk    Mon 4/26/10   Fri 4/30/10 10   NMHIC
 12         Submit Updated Strategic & Operational Plan to ONC                                         1 day     Fri 4/30/10  Fri 4/30/10      NMHIC
 13         Obtain Endorsement of Statewide Policy Framework from LCF Board & Stakeholders          8.4 wks      Mon 5/3/10  Wed 6/30/10 11    NMHIC
 14         Continue to Update Strategic & Operational Plan                                        222 wks      Thu 10/1/09     Fri 2/7/14     NMHIC
 15         Submit Updated Strategic & Operational Plan to ONC                                         1 day    Mon 1/31/11  Mon 1/31/11       NMHIC
 16     State HIE Program Reporting                                                               39.6 wks       Thu 4/1/10  Mon 1/10/11
 17         Submit ARRA Reports Quarterly at Federalreporting.gov                                    7 days      Thu 4/1/10     Fri 4/9/10     NMHIC
 18         Submit ARRA Reports Quarterly at Federalreporting.gov                                    7 days      Thu 7/1/10     Fri 7/9/10     NMHIC
 19         Submit ARRA Reports Quarterly at Federalreporting.gov                                    6 days      Fri 10/1/10  Fri 10/8/10      NMHIC
 20         Submit ARRA Reports Quarterly at Federalreporting.gov                                    6 days      Mon 1/3/11  Mon 1/10/11       NMHIC
 21         Submit Financial Status Reports Quarterly to ONCGrants@hhs.gov                           7 days      Thu 4/1/10     Fri 4/9/10     NMHIC
 22         Submit Financial Status Reports Quarterly to ONCGrants@hhs.gov                           7 days      Thu 7/1/10     Fri 7/9/10     NMHIC
 23         Submit Financial Status Reports Quarterly to ONCGrants@hhs.gov                           6 days      Fri 10/1/10  Fri 10/8/10      NMHIC
 24         Submit Financial Status Reports Quarterly to ONCGrants@hhs.gov                           6 days      Mon 1/3/11  Mon 1/10/11       NMHIC
 25         Submit ONC Program Progress Reports Semi-Annually                                        7 days      Thu 7/1/10     Fri 7/9/10     NMHIC
 26         Submit ONC Program Progress Reports Semi-Annually                                        6 days      Mon 1/3/11  Mon 1/10/11       NMHIC
 27     State HIE Program Meetings & Training                                                      0.6 wks     Mon 5/10/10 Wed 5/12/10
 28         Attend Kick-Off Summit & Leadership Training                                             3 days     Mon 5/10/10  Wed 5/12/10       NMHIC
 29     New Mexico HIE Marketing and Promotion Activities                                          222 wks      Thu 10/1/09    Fri 2/7/14
 30         Market and Promote the State HIE Plan & NMHIC HIE Services                             222 wks      Thu 10/1/09     Fri 2/7/14     NMHIC Marketing
 31         Integrate ePrescribing & HealthXnet Integration into End User Training                    2 wks    Wed 7/21/10    Tue 8/3/10 54    NMHIC HelpDesk
 32         Promote ePrescribing & HealthXnet Integration Network Services                        29.8 wks     Wed 7/21/10    Fri 2/18/11 54   NMHIC Marketing
 33     HITREC Primary Care Physician Deployment/HIE Integration                                    89 wks       Mon 4/5/10  Fri 12/30/11
 34         Determine EHR Interface Requirements for each EHR system                                 89 wks      Mon 4/5/10  Fri 12/30/11      NMHIC & Provider
 35         Develop EHR Interface for each EHR system                                                89 wks      Mon 4/5/10  Fri 12/30/11      NMHIC & MedPlus
 36         Deploy EHR Interface for each EHR system                                                 89 wks      Mon 4/5/10  Fri 12/30/11      NMHIC & Provider
 37     HIE Evaluation Activities                                                                209.3 wks       Mon 1/4/10    Fri 2/7/14
 38         State HIE Program Evaluation                                                         204.3 wks       Mon 2/8/10     Fri 2/7/14     NMHIC
 39         Robert Wood Johnson AF4Q HIE Evaluation Grant                                          153 wks       Mon 1/4/10 Mon 12/31/12
 40              Evaluate 2009 Lab & Radiology Claims Data to 2011Claims Data                      153 wks       Mon 1/4/10 Mon 12/31/12       NMHIC
 41     Upgrade NMHIC Health Information Exchange Infrastructure                                 149.6 wks       Mon 3/1/10    Fri 2/1/13
 42         Upgrade NMHIC Data Center Servers - Hardware                                              4 wks      Mon 3/1/10   Fri 3/26/10      NMHIC IT
 43         Upgrade NMHIC HIE Software Infrastructure                                            149.6 wks       Mon 3/1/10    Fri 2/1/13
 44              Upgrade Centergy Data Exchange License (750K to 1250K)                                 1 wk     Mon 4/5/10     Fri 4/9/10     MedPlus & NMHIC
 45              Upgrade Centergy Clinical Portal License (750K to 1250K)                               1 wk     Mon 4/5/10     Fri 4/9/10     MedPlus & NMHIC
 46              Upgrade Initiate Identity Hub MPI License (750K to 1250K)                              1 wk     Mon 4/5/10     Fri 4/9/10     MedPlus & NMHIC
 47              Perform MPI Tuning                                                                   2 wks     Mon 4/12/10   Fri 4/23/10 46   MedPlus & NMHIC
 48              HealthXnet Integration - Single Sign On Capabilities                               43 wks       Mon 3/1/10 Thu 12/30/10
 49                   Development (Build, Configuration, Installation)                                6 wks      Mon 3/1/10     Fri 4/9/10     MedPlus & NMHIC
 50                   Implementation (Testing, Validation, Go-Live)                                   6 wks     Mon 4/12/10   Fri 5/21/10 49   NMHIC & MedPlus
 51                   HealthXnet Integration - further integration                                   31 wks     Mon 5/24/10 Thu 12/30/10 50    NMHIC & MedPlus
 52              Install Centergy ePrescribing Solution                                          141.6 wks     Mon 4/26/10     Fri 2/1/13
 53                   Development (Build, Configuration, Installation)                                6 wks     Mon 4/26/10   Mon 6/7/10 47    MedPlus & NMHIC
 54                   Implementation (Testing, Validation, Go-Live)                                 6.2 wks      Tue 6/8/10  Tue 7/20/10 53    NMHIC & MedPlus
 55                   Setup Initial 60 Physician Users (Setup, Test, Go-Live)                         4 wks    Wed 7/21/10   Tue 8/17/10 54    NMHIC & Provider
 56                   Setup Next 60 Physician Users (Setup, Test, Go-Live)                            4 wks     Mon 1/10/11     Fri 2/4/11     NMHIC & Provider
 57                   Setup Next 60 Physician Users (Setup, Test, Go-Live)                            4 wks      Mon 1/9/12     Fri 2/3/12     NMHIC & Provider
 58                   Setup Next 60 Physician Users (Setup, Test, Go-Live)                            4 wks      Mon 1/7/13     Fri 2/1/13     NMHIC & Provider
 59              Install Centergy EMR/EHR Gateway                                                     4 wks    Mon 5/10/10    Mon 6/7/10
 60                   Development (Build, Configuration, Installation)                                2 wks     Mon 5/10/10   Fri 5/21/10      MedPlus & NMHIC
 61                   Implementation (Testing, Validation, Go-Live)                                   2 wks     Mon 5/24/10   Mon 6/7/10 60    NMHIC & MedPlus
 62              Install Centergy Nomenclature Mapping System                                       12 wks     Mon 8/30/10 Mon 11/22/10
 63                   Development (Build, Configuration, Installation)                                6 wks     Mon 8/30/10 Mon 10/11/10       MedPlus & NMHIC
 64                   Implementation (Testing, Validation, Go-Live)                                   6 wks    Tue 10/12/10 Mon 11/22/10 63    NMHIC & MedPlus
 65     NMHIC Pre-Production Pilot Activities                                                     37.6 wks      Thu 10/1/09  Mon 6/28/10
 66         Complete Privacy and Security policies to Support Trust Framework                        17 wks      Mon 3/1/10  Mon 6/28/10       NMHIC
 67         Develop Patient Opt-Out Policies & Procedures                                            17 wks      Mon 3/1/10  Mon 6/28/10       NMHIC
 68         Obtain HIE/Security Certification                                                        17 wks      Mon 3/1/10  Mon 6/28/10       NMHIC
 69         Comply with Standards to Support Meaningful Use                                          17 wks      Mon 3/1/10  Mon 6/28/10       NMHIC
 70         Develop Process to capture HIE Status & Metrics                                         0.2 wks     Thu 10/1/09  Thu 10/1/09


                                                                                 Page 1
New Mexico Statewide HIE Project Plan 2009-2013                                                                                                  Thu 2/25/10

 ID     Task Name                                                                      Duration        Start         Finish    PredeceResource Names

 71     NM Department of Health e-Reporting Project (Notifiable Conditions)             54.6 wks     Thu 10/1/09 Tue 10/26/10
 72         Contracting                                                                   12 wks     Thu 10/1/09 Mon 12/28/09         NMHIC & DOH
 73         Requirements Analysis                                                          8 wks     Mon 11/2/09 Wed 12/30/09         NMHIC & DOH
 74         System Design                                                                  8 wks      Mon 1/4/10   Fri 2/26/10        NMHIC & DOH
 75         System Build & Setup                                                           8 wks      Mon 2/1/10   Fri 3/26/10        NMHIC IT
 76         System Development, Testing, Go-Live                                          12 wks      Mon 3/1/10   Fri 5/21/10        NMHIC & DOH
 77         Add e-Reporting Capability for new HIE Provider Interfaces                    21 wks      Tue 6/1/10 Tue 10/26/10         NMHIC IT
 78     NMHIC Production Pilot Activities                                                9.6 wks      Wed 6/2/10    Fri 8/6/10
 79         Setup End Users on NMHIC Portal                                                  1 wk     Wed 6/2/10   Tue 6/8/10         NMHIC HelpDesk
 80         Train End Users on NMHIC Portal                                                2 wks      Wed 6/9/10  Tue 6/22/10 79      NMHIC HelpDesk
 81         End User Privacy & Security Training                                             1 wk    Wed 6/23/10  Tue 6/29/10 80      NMHIC & Provider
 82         Production Pilot Go-Live                                                         1 wk    Wed 6/30/10   Tue 7/6/10 81      NMHIC & Provider
 83         Production Go-Live with Initial Set of Data Partners                           4 wks     Mon 7/12/10     Fri 8/6/10       NMHIC & Provider
 84     NHIN Production Activities                                                        44 wks    Wed 3/10/10   Tue 1/18/11
 85         Implement Updated NHIN Specifications & Gateway                                9 wks    Wed 3/10/10   Tue 5/11/10
 86              Update interface specifications & Gateway software                        6 wks     Wed 3/10/10  Tue 4/20/10         MedPlus & NMHIC
 87              Test with NIST & ONC Testing Tools                                        3 wks     Wed 4/21/10  Tue 5/11/10 86      NMHIC & MedPlus
 88         NHIN Production with SSA                                                      16 wks      Thu 6/3/10  Thu 9/23/10         NMHIC & Fed Partn
 89         NHIN Production with VA, IHS, & DOD                                            6 wks     Mon 12/6/10  Tue 1/18/11         NMHIC & Fed Partn
 90     Add Additional NMHIC Exchange Providers                                        214.2 wks     Mon 11/2/09 Wed 1/15/14
 91         Lovelace Health System (4 hospitals)                                          41 wks     Mon 11/2/09   Fri 8/20/10
 92              Network Subscription Agreement Review & Signature                         4 wks     Mon 11/2/09 Mon 11/30/09         NMHIC & Provider
 93              Interface Requirements Gathering                                          3 wks    Mon 11/23/09 Mon 12/14/09         NMHIC & Provider
 94              Install NMHIC Edge Server Hardware & Software                             2 wks     Mon 1/11/10   Fri 1/22/10        NMHIC IT
 95              Interface Development (Build, Configuration, Installation)                5 wks    Mon 12/21/09   Fri 1/22/10        MedPlus & NMHIC
 96              Interface Implementation (Testing, Validation, Go-Live)                   5 wks     Mon 1/25/10   Fri 2/26/10 95     NMHIC & MedPlus
 97              Setup End Users on NMHIC Portal                                             1 wk     Mon 8/2/10     Fri 8/6/10       NMHIC HelpDesk
 98              Train End Users on NMHIC Portal                                             1 wk     Mon 8/9/10   Fri 8/13/10 97     NMHIC HelpDesk
 99              End User Privacy & Security Training                                        1 wk    Mon 8/16/10   Fri 8/20/10 98     NMHIC & Provider
100         SED Medical Laboratories                                                      41 wks     Mon 11/2/09   Fri 8/20/10
101              Network Subscription Agreement Review & Signature                         4 wks     Mon 11/2/09 Mon 11/30/09         NMHIC & Provider
102              Interface Requirements Gathering                                          3 wks    Mon 11/23/09  Fri 12/11/09        NMHIC & Provider
103              Install NMHIC Edge Server Hardware & Software                             2 wks     Mon 1/11/10   Fri 1/22/10        NMHIC IT
104              Interface Development (Build, Configuration, Installation)                5 wks    Mon 12/21/09   Fri 1/22/10        MedPlus & NMHIC
105              Interface Implementation (Testing, Validation, Go-Live)                   5 wks     Mon 1/25/10   Fri 2/26/10 104    NMHIC & MedPlus
106              Setup End Users on NMHIC Portal                                             1 wk     Mon 8/2/10     Fri 8/6/10       NMHIC HelpDesk
107              Train End Users on NMHIC Portal                                             1 wk     Mon 8/9/10   Fri 8/13/10 106    NMHIC HelpDesk
108              End User Privacy & Security Training                                        1 wk    Mon 8/16/10   Fri 8/20/10 107    NMHIC & Provider
109         Christus St. Vincent Regional Medical Center                                31.8 wks     Mon 1/11/10   Fri 8/20/10
110              Network Subscription Agreement Review & Signature                         8 wks     Mon 1/11/10     Fri 3/5/10       NMHIC & Provider
111              Interface Requirements Gathering                                            1 wk     Mon 3/8/10   Fri 3/12/10 110    NMHIC & Provider
112              Install NMHIC Edge Server Hardware & Software                             2 wks     Mon 3/15/10   Fri 3/26/10 111    NMHIC IT
113              Interface Development (Build, Configuration, Installation)                4 wks     Mon 3/15/10     Fri 4/9/10 111   MedPlus & NMHIC
114              Interface Implementation (Testing, Validation, Go-Live)                   4 wks     Mon 4/12/10     Fri 5/7/10 113   NMHIC & MedPlus
115              Setup End Users on NMHIC Portal                                             1 wk     Mon 8/2/10     Fri 8/6/10       NMHIC HelpDesk
116              Train End Users on NMHIC Portal                                             1 wk     Mon 8/9/10   Fri 8/13/10 115    NMHIC HelpDesk
117              End User Privacy & Security Training                                        1 wk    Mon 8/16/10   Fri 8/20/10 116    NMHIC & Provider
118         University of New Mexico Hospital                                           28.8 wks      Mon 2/8/10   Fri 8/27/10
119              Network Subscription Agreement Review & Signature                         8 wks      Mon 2/8/10     Fri 4/2/10       NMHIC & Provider
120              Interface Requirements Gathering                                            1 wk     Mon 4/5/10     Fri 4/9/10 119   NMHIC & Provider
121              Install NMHIC Edge Server Hardware & Software                             2 wks     Mon 4/12/10   Fri 4/23/10 120    NMHIC IT
122              Interface Development (Build, Configuration, Installation)                4 wks     Mon 4/12/10     Fri 5/7/10 120   MedPlus & NMHIC
123              Interface Implementation (Testing, Validation, Go-Live)                   4 wks     Mon 5/10/10   Mon 6/7/10 122     NMHIC & MedPlus
124              Setup End Users on NMHIC Portal                                             1 wk     Mon 8/9/10   Fri 8/13/10        NMHIC HelpDesk
125              Train End Users on NMHIC Portal                                             1 wk    Mon 8/16/10   Fri 8/20/10 124    NMHIC HelpDesk
126              End User Privacy & Security Training                                        1 wk    Mon 8/23/10   Fri 8/27/10 125    NMHIC & Provider
127         UNM Medical Group                                                           28.8 wks      Mon 2/8/10   Fri 8/27/10
128              Network Subscription Agreement Review & Signature                         8 wks      Mon 2/8/10     Fri 4/2/10       NMHIC & Provider
129              Interface Requirements Gathering                                            1 wk     Mon 4/5/10     Fri 4/9/10 128   NMHIC & Provider
130              Install NMHIC Edge Server Hardware & Software                             2 wks     Mon 4/12/10   Fri 4/23/10 129    NMHIC IT
131              Interface Development (Build, Configuration, Installation)                4 wks     Mon 4/12/10     Fri 5/7/10 129   MedPlus & NMHIC
132              Interface Implementation (Testing, Validation, Go-Live)                   4 wks     Mon 5/10/10   Mon 6/7/10 131     NMHIC & MedPlus
133              Setup End Users on NMHIC Portal                                             1 wk     Mon 8/9/10   Fri 8/13/10        NMHIC HelpDesk
134              Train End Users on NMHIC Portal                                             1 wk    Mon 8/16/10   Fri 8/20/10 133    NMHIC HelpDesk
135              End User Privacy & Security Training                                        1 wk    Mon 8/23/10   Fri 8/27/10 134    NMHIC & Provider
136         Heart Hospital of New Mexico                                                25.8 wks      Mon 3/8/10  Mon 9/6/10
137              Network Subscription Agreement Review & Signature                         8 wks      Mon 3/8/10   Fri 4/30/10        NMHIC & Provider
138              Interface Requirements Gathering                                            1 wk     Mon 5/3/10     Fri 5/7/10 137   NMHIC & Provider
139              Install NMHIC Edge Server Hardware & Software                             2 wks     Mon 5/10/10   Fri 5/21/10 138    NMHIC IT
140              Interface Development (Build, Configuration, Installation)                4 wks     Mon 5/10/10   Mon 6/7/10 138     MedPlus & NMHIC


                                                                              Page 2
New Mexico Statewide HIE Project Plan 2009-2013                                                                                              Thu 2/25/10

 ID     Task Name                                                                     Duration      Start        Finish    PredeceResource Names

141             Interface Implementation (Testing, Validation, Go-Live)                   4 wks    Tue 6/8/10   Mon 7/5/10 140    NMHIC & MedPlus
142             Setup End Users on NMHIC Portal                                             1 wk  Mon 8/16/10   Fri 8/20/10       NMHIC HelpDesk
143             Train End Users on NMHIC Portal                                             1 wk  Mon 8/23/10   Fri 8/27/10 142   NMHIC HelpDesk
144             End User Privacy & Security Training                                        1 wk  Mon 8/30/10   Mon 9/6/10 143    NMHIC & Provider
145        NM Heart Institute                                                          25.8 wks    Mon 3/8/10   Mon 9/6/10
146             Network Subscription Agreement Review & Signature                         8 wks    Mon 3/8/10   Fri 4/30/10       NMHIC & Provider
147             Interface Requirements Gathering                                            1 wk   Mon 5/3/10    Fri 5/7/10 146   NMHIC & Provider
148             Install NMHIC Edge Server Hardware & Software                             2 wks   Mon 5/10/10   Fri 5/21/10 147   NMHIC IT
149             Interface Development (Build, Configuration, Installation)                4 wks   Mon 5/10/10   Mon 6/7/10 147    MedPlus & NMHIC
150             Interface Implementation (Testing, Validation, Go-Live)                   4 wks    Tue 6/8/10   Mon 7/5/10 149    NMHIC & MedPlus
151             Setup End Users on NMHIC Portal                                             1 wk  Mon 8/16/10   Fri 8/20/10       NMHIC HelpDesk
152             Train End Users on NMHIC Portal                                             1 wk  Mon 8/23/10   Fri 8/27/10 151   NMHIC HelpDesk
153             End User Privacy & Security Training                                        1 wk  Mon 8/30/10   Mon 9/6/10 152    NMHIC & Provider
154        San Juan Regional Medical Center                                            22.8 wks    Mon 4/5/10  Mon 9/13/10
155             Network Subscription Agreement Review & Signature                         8 wks    Mon 4/5/10   Fri 5/28/10       NMHIC & Provider
156             Interface Requirements Gathering                                            1 wk  Mon 5/31/10   Mon 6/7/10 155    NMHIC & Provider
157             Install NMHIC Edge Server Hardware & Software                             2 wks    Tue 6/8/10  Mon 6/21/10 156    NMHIC IT
158             Interface Development (Build, Configuration, Installation)                4 wks    Tue 6/8/10   Mon 7/5/10 156    MedPlus & NMHIC
159             Interface Implementation (Testing, Validation, Go-Live)                   4 wks    Tue 7/6/10   Mon 8/2/10 158    NMHIC & MedPlus
160             Setup End Users on NMHIC Portal                                             1 wk  Mon 8/23/10   Fri 8/27/10       NMHIC HelpDesk
161             Train End Users on NMHIC Portal                                             1 wk  Mon 8/30/10   Mon 9/6/10 160    NMHIC HelpDesk
162             End User Privacy & Security Training                                        1 wk   Tue 9/7/10  Mon 9/13/10 161    NMHIC & Provider
163        San Juan Regional Rehabilitation Hospital                                   22.8 wks    Mon 4/5/10  Mon 9/13/10
164             Network Subscription Agreement Review & Signature                         8 wks    Mon 4/5/10   Fri 5/28/10       NMHIC & Provider
165             Interface Requirements Gathering                                            1 wk  Mon 5/31/10   Mon 6/7/10 164    NMHIC & Provider
166             Install NMHIC Edge Server Hardware & Software                             2 wks    Tue 6/8/10  Mon 6/21/10 165    NMHIC IT
167             Interface Development (Build, Configuration, Installation)                4 wks    Tue 6/8/10   Mon 7/5/10 165    MedPlus & NMHIC
168             Interface Implementation (Testing, Validation, Go-Live)                   4 wks    Tue 7/6/10   Mon 8/2/10 167    NMHIC & MedPlus
169             Setup End Users on NMHIC Portal                                             1 wk  Mon 8/23/10   Fri 8/27/10       NMHIC HelpDesk
170             Train End Users on NMHIC Portal                                             1 wk  Mon 8/30/10    Fri 9/3/10 169   NMHIC HelpDesk
171             End User Privacy & Security Training                                        1 wk   Mon 9/6/10  Mon 9/13/10 170    NMHIC & Provider
172        Rehoboth McKinley Christian HCS                                               17 wks   Mon 5/17/10  Tue 9/14/10
173             Network Subscription Agreement Review & Signature                         8 wks   Mon 5/17/10  Mon 7/12/10        NMHIC & Provider
174             Interface Requirements Gathering                                            1 wk  Tue 7/13/10  Mon 7/19/10 173    NMHIC & Provider
175             Install NMHIC Edge Server Hardware & Software                             2 wks   Tue 7/20/10   Mon 8/2/10 174    NMHIC IT
176             Interface Development (Build, Configuration, Installation)                4 wks   Tue 7/20/10  Mon 8/16/10 174    MedPlus & NMHIC
177             Interface Implementation (Testing, Validation, Go-Live)                   4 wks   Tue 8/17/10  Tue 9/14/10 176    NMHIC & MedPlus
178             Setup End Users on NMHIC Portal                                             1 wk  Tue 8/17/10  Mon 8/23/10 176    NMHIC HelpDesk
179             Train End Users on NMHIC Portal                                             1 wk  Tue 8/24/10  Mon 8/30/10 178    NMHIC HelpDesk
180             End User Privacy & Security Training                                        1 wk  Tue 8/31/10   Tue 9/7/10 179    NMHIC & Provider
181        Miners' Colfax Medical Center                                                 17 wks   Mon 5/17/10  Tue 9/14/10
182             Network Subscription Agreement Review & Signature                         8 wks   Mon 5/17/10  Mon 7/12/10        NMHIC & Provider
183             Interface Requirements Gathering                                            1 wk  Tue 7/13/10  Mon 7/19/10 182    NMHIC & Provider
184             Install NMHIC Edge Server Hardware & Software                             2 wks   Tue 7/20/10   Mon 8/2/10 183    NMHIC IT
185             Interface Development (Build, Configuration, Installation)                4 wks   Tue 7/20/10  Mon 8/16/10 183    MedPlus & NMHIC
186             Interface Implementation (Testing, Validation, Go-Live)                   4 wks   Tue 8/17/10  Tue 9/14/10 185    NMHIC & MedPlus
187             Setup End Users on NMHIC Portal                                             1 wk  Tue 8/17/10  Mon 8/23/10 185    NMHIC HelpDesk
188             Train End Users on NMHIC Portal                                             1 wk  Tue 8/24/10  Mon 8/30/10 187    NMHIC HelpDesk
189             End User Privacy & Security Training                                        1 wk  Tue 8/31/10   Tue 9/7/10 188    NMHIC & Provider
190        Gila Regional Medical Center                                                  17 wks   Mon 6/14/10 Mon 10/11/10
191             Network Subscription Agreement Review & Signature                         8 wks   Mon 6/14/10    Fri 8/6/10       NMHIC & Provider
192             Interface Requirements Gathering                                            1 wk   Mon 8/9/10   Fri 8/13/10 191   NMHIC & Provider
193             Install NMHIC Edge Server Hardware & Software                             2 wks   Mon 8/16/10   Fri 8/27/10 192   NMHIC IT
194             Interface Development (Build, Configuration, Installation)                4 wks   Mon 8/16/10  Mon 9/13/10 192    MedPlus & NMHIC
195             Interface Implementation (Testing, Validation, Go-Live)                   4 wks   Tue 9/14/10 Mon 10/11/10 194    NMHIC & MedPlus
196             Setup End Users on NMHIC Portal                                             1 wk  Tue 9/14/10  Mon 9/20/10 194    NMHIC HelpDesk
197             Train End Users on NMHIC Portal                                             1 wk  Tue 9/21/10  Mon 9/27/10 196    NMHIC HelpDesk
198             End User Privacy & Security Training                                        1 wk  Tue 9/28/10  Mon 10/4/10 197    NMHIC & Provider
199        HSD Medicaid Claims Data Interface                                            17 wks    Tue 7/6/10  Tue 11/2/10
200             Network Subscription Agreement Review & Signature                         8 wks    Tue 7/6/10  Mon 8/30/10        NMHIC & Provider
201             Interface Requirements Gathering                                            1 wk  Tue 8/31/10   Tue 9/7/10 200    NMHIC & Provider
202             Install NMHIC Edge Server Hardware & Software                             2 wks    Wed 9/8/10  Tue 9/21/10 201    NMHIC IT
203             Interface Development (Build, Configuration, Installation)                4 wks    Wed 9/8/10  Tue 10/5/10 201    MedPlus & NMHIC
204             Interface Implementation (Testing, Validation, Go-Live)                   4 wks Wed 10/6/10    Tue 11/2/10 203    NMHIC & MedPlus
205             Setup End Users on NMHIC Portal                                             1 wk Wed 10/6/10 Tue 10/12/10 203     NMHIC HelpDesk
206             Train End Users on NMHIC Portal                                             1 wk Wed 10/13/10 Tue 10/19/10 205    NMHIC HelpDesk
207             End User Privacy & Security Training                                        1 wk Wed 10/20/10 Tue 10/26/10 206    NMHIC & Provider
208        NM Department of Health Clinics                                               17 wks    Tue 7/6/10  Tue 11/2/10
209             Network Subscription Agreement Review & Signature                         8 wks    Tue 7/6/10  Mon 8/30/10        NMHIC & Provider
210             Interface Requirements Gathering                                            1 wk  Tue 8/31/10   Tue 9/7/10 209    NMHIC & Provider


                                                                             Page 3
New Mexico Statewide HIE Project Plan 2009-2013                                                                                               Thu 2/25/10

 ID     Task Name                                                                    Duration      Start         Finish     PredeceResource Names

211            Install NMHIC Edge Server Hardware & Software                             2 wks    Wed 9/8/10    Tue 9/21/10 210    NMHIC IT
212            Interface Development (Build, Configuration, Installation)                4 wks    Wed 9/8/10    Tue 10/5/10 210    MedPlus & NMHIC
213            Interface Implementation (Testing, Validation, Go-Live)                   4 wks Wed 10/6/10      Tue 11/2/10 212    NMHIC & MedPlus
214            Setup End Users on NMHIC Portal                                             1 wk Wed 10/6/10    Tue 10/12/10 212    NMHIC HelpDesk
215            Train End Users on NMHIC Portal                                             1 wk Wed 10/13/10   Tue 10/19/10 214    NMHIC HelpDesk
216            End User Privacy & Security Training                                        1 wk Wed 10/20/10   Tue 10/26/10 215    NMHIC & Provider
217        Eye Associates of NM                                                         17 wks   Mon 8/23/10   Tue 12/21/10
218            Network Subscription Agreement Review & Signature                         8 wks   Mon 8/23/10   Mon 10/18/10        NMHIC & Provider
219            Interface Requirements Gathering                                            1 wk Tue 10/19/10   Mon 10/25/10 218    NMHIC & Provider
220            Install NMHIC Edge Server Hardware & Software                             2 wks Tue 10/26/10     Mon 11/8/10 219    NMHIC IT
221            Interface Development (Build, Configuration, Installation)                4 wks Tue 10/26/10    Mon 11/22/10 219    MedPlus & NMHIC
222            Interface Implementation (Testing, Validation, Go-Live)                   4 wks Tue 11/23/10    Tue 12/21/10 221    NMHIC & MedPlus
223            Setup End Users on NMHIC Portal                                             1 wk Tue 11/23/10   Tue 11/30/10 221    NMHIC HelpDesk
224            Train End Users on NMHIC Portal                                             1 wk Wed 12/1/10     Tue 12/7/10 223    NMHIC HelpDesk
225            End User Privacy & Security Training                                        1 wk Wed 12/8/10    Tue 12/14/10 224    NMHIC & Provider
226        Southwest Medical Associates                                                 17 wks   Mon 8/23/10   Tue 12/21/10
227            Network Subscription Agreement Review & Signature                         8 wks   Mon 8/23/10   Mon 10/18/10        NMHIC & Provider
228            Interface Requirements Gathering                                            1 wk Tue 10/19/10   Mon 10/25/10 227    NMHIC & Provider
229            Install NMHIC Edge Server Hardware & Software                             2 wks Tue 10/26/10     Mon 11/8/10 228    NMHIC IT
230            Interface Development (Build, Configuration, Installation)                4 wks Tue 10/26/10    Mon 11/22/10 228    MedPlus & NMHIC
231            Interface Implementation (Testing, Validation, Go-Live)                   4 wks Tue 11/23/10    Tue 12/21/10 230    NMHIC & MedPlus
232            Setup End Users on NMHIC Portal                                             1 wk Tue 11/23/10   Tue 11/30/10 230    NMHIC HelpDesk
233            Train End Users on NMHIC Portal                                             1 wk Wed 12/1/10     Tue 12/7/10 232    NMHIC HelpDesk
234            End User Privacy & Security Training                                        1 wk Wed 12/8/10    Tue 12/14/10 233    NMHIC & Provider
235        Renal Medicine Associates                                                    17 wks   Mon 10/4/10     Wed 2/2/11
236            Network Subscription Agreement Review & Signature                         8 wks   Mon 10/4/10   Mon 11/29/10        NMHIC & Provider
237            Interface Requirements Gathering                                            1 wk Tue 11/30/10    Mon 12/6/10 236    NMHIC & Provider
238            Install NMHIC Edge Server Hardware & Software                             2 wks   Tue 12/7/10   Mon 12/20/10 237    NMHIC IT
239            Interface Development (Build, Configuration, Installation)                4 wks   Tue 12/7/10     Wed 1/5/11 237    MedPlus & NMHIC
240            Interface Implementation (Testing, Validation, Go-Live)                   4 wks    Thu 1/6/11     Wed 2/2/11 239    NMHIC & MedPlus
241            Setup End Users on NMHIC Portal                                             1 wk   Thu 1/6/11    Wed 1/12/11 239    NMHIC HelpDesk
242            Train End Users on NMHIC Portal                                             1 wk  Thu 1/13/11    Wed 1/19/11 241    NMHIC HelpDesk
243            End User Privacy & Security Training                                        1 wk  Thu 1/20/11    Wed 1/26/11 242    NMHIC & Provider
244        Southwest Gastroenterology Associates                                        17 wks   Mon 10/4/10     Wed 2/2/11
245            Network Subscription Agreement Review & Signature                         8 wks   Mon 10/4/10   Mon 11/29/10        NMHIC & Provider
246            Interface Requirements Gathering                                            1 wk Tue 11/30/10    Mon 12/6/10 245    NMHIC & Provider
247            Install NMHIC Edge Server Hardware & Software                             2 wks   Tue 12/7/10   Mon 12/20/10 246    NMHIC IT
248            Interface Development (Build, Configuration, Installation)                4 wks   Tue 12/7/10     Wed 1/5/11 246    MedPlus & NMHIC
249            Interface Implementation (Testing, Validation, Go-Live)                   4 wks    Thu 1/6/11     Wed 2/2/11 248    NMHIC & MedPlus
250            Setup End Users on NMHIC Portal                                             1 wk   Thu 1/6/11    Wed 1/12/11 248    NMHIC HelpDesk
251            Train End Users on NMHIC Portal                                             1 wk  Thu 1/13/11    Wed 1/19/11 250    NMHIC HelpDesk
252            End User Privacy & Security Training                                        1 wk  Thu 1/20/11    Wed 1/26/11 251    NMHIC & Provider
253        Mountain View Regional Medical Center                                        17 wks   Mon 2/14/11    Mon 6/13/11
254            Network Subscription Agreement Review & Signature                         8 wks   Mon 2/14/11      Fri 4/8/11       NMHIC & Provider
255            Interface Requirements Gathering                                            1 wk  Mon 4/11/11     Fri 4/15/11 254   NMHIC & Provider
256            Install NMHIC Edge Server Hardware & Software                             2 wks   Mon 4/18/11     Fri 4/29/11 255   NMHIC IT
257            Interface Development (Build, Configuration, Installation)                4 wks   Mon 4/18/11     Fri 5/13/11 255   MedPlus & NMHIC
258            Interface Implementation (Testing, Validation, Go-Live)                   4 wks   Mon 5/16/11    Mon 6/13/11 257    NMHIC & MedPlus
259            Setup End Users on NMHIC Portal                                             1 wk  Mon 5/16/11     Fri 5/20/11 257   NMHIC HelpDesk
260            Train End Users on NMHIC Portal                                             1 wk  Mon 5/23/11     Fri 5/27/11 259   NMHIC HelpDesk
261            End User Privacy & Security Training                                        1 wk  Mon 5/30/11     Mon 6/6/11 260    NMHIC & Provider
262        Memorial Medical Center                                                      17 wks   Mon 3/28/11    Tue 7/26/11
263            Network Subscription Agreement Review & Signature                         8 wks   Mon 3/28/11     Fri 5/20/11       NMHIC & Provider
264            Interface Requirements Gathering                                            1 wk  Mon 5/23/11     Fri 5/27/11 263   NMHIC & Provider
265            Install NMHIC Edge Server Hardware & Software                             2 wks   Mon 5/30/11    Mon 6/13/11 264    NMHIC IT
266            Interface Development (Build, Configuration, Installation)                4 wks   Mon 5/30/11    Mon 6/27/11 264    MedPlus & NMHIC
267            Interface Implementation (Testing, Validation, Go-Live)                   4 wks   Tue 6/28/11    Tue 7/26/11 266    NMHIC & MedPlus
268            Setup End Users on NMHIC Portal                                             1 wk  Tue 6/28/11     Tue 7/5/11 266    NMHIC HelpDesk
269            Train End Users on NMHIC Portal                                             1 wk   Wed 7/6/11    Tue 7/12/11 268    NMHIC HelpDesk
270            End User Privacy & Security Training                                        1 wk Wed 7/13/11     Tue 7/19/11 269    NMHIC & Provider
271        Rehabilitation Hospital of Southern New Mexico                               17 wks    Mon 5/9/11     Wed 9/7/11
272            Network Subscription Agreement Review & Signature                         8 wks    Mon 5/9/11     Tue 7/5/11        NMHIC & Provider
273            Interface Requirements Gathering                                            1 wk   Wed 7/6/11    Tue 7/12/11 272    NMHIC & Provider
274            Install NMHIC Edge Server Hardware & Software                             2 wks Wed 7/13/11      Tue 7/26/11 273    NMHIC IT
275            Interface Development (Build, Configuration, Installation)                4 wks Wed 7/13/11       Tue 8/9/11 273    MedPlus & NMHIC
276            Interface Implementation (Testing, Validation, Go-Live)                   4 wks Wed 8/10/11       Wed 9/7/11 275    NMHIC & MedPlus
277            Setup End Users on NMHIC Portal                                             1 wk Wed 8/10/11     Tue 8/16/11 275    NMHIC HelpDesk
278            Train End Users on NMHIC Portal                                             1 wk Wed 8/17/11     Tue 8/23/11 277    NMHIC HelpDesk
279            End User Privacy & Security Training                                        1 wk Wed 8/24/11     Tue 8/30/11 278    NMHIC & Provider
280        Horizon Specialty Hospital of Albuquerque                                    17 wks    Mon 6/6/11    Tue 10/4/11


                                                                            Page 4
New Mexico Statewide HIE Project Plan 2009-2013                                                                                               Thu 2/25/10

 ID     Task Name                                                                    Duration      Start         Finish     PredeceResource Names

281            Network Subscription Agreement Review & Signature                         8 wks    Mon 6/6/11     Mon 8/1/11        NMHIC & Provider
282            Interface Requirements Gathering                                            1 wk   Tue 8/2/11     Mon 8/8/11 281    NMHIC & Provider
283            Install NMHIC Edge Server Hardware & Software                             2 wks    Tue 8/9/11    Mon 8/22/11 282    NMHIC IT
284            Interface Development (Build, Configuration, Installation)                4 wks    Tue 8/9/11     Tue 9/6/11 282    MedPlus & NMHIC
285            Interface Implementation (Testing, Validation, Go-Live)                   4 wks    Wed 9/7/11    Tue 10/4/11 284    NMHIC & MedPlus
286            Setup End Users on NMHIC Portal                                             1 wk   Wed 9/7/11    Tue 9/13/11 284    NMHIC HelpDesk
287            Train End Users on NMHIC Portal                                             1 wk Wed 9/14/11     Tue 9/20/11 286    NMHIC HelpDesk
288            End User Privacy & Security Training                                        1 wk Wed 9/21/11     Tue 9/27/11 287    NMHIC & Provider
289        HealthSouth Rehabilitation Hospital                                          17 wks   Mon 7/11/11    Mon 11/7/11
290            Network Subscription Agreement Review & Signature                         8 wks   Mon 7/11/11      Fri 9/2/11       NMHIC & Provider
291            Interface Requirements Gathering                                            1 wk   Mon 9/5/11    Mon 9/12/11 290    NMHIC & Provider
292            Install NMHIC Edge Server Hardware & Software                             2 wks   Tue 9/13/11    Mon 9/26/11 291    NMHIC IT
293            Interface Development (Build, Configuration, Installation)                4 wks   Tue 9/13/11   Mon 10/10/11 291    MedPlus & NMHIC
294            Interface Implementation (Testing, Validation, Go-Live)                   4 wks Tue 10/11/11     Mon 11/7/11 293    NMHIC & MedPlus
295            Setup End Users on NMHIC Portal                                             1 wk Tue 10/11/11   Mon 10/17/11 293    NMHIC HelpDesk
296            Train End Users on NMHIC Portal                                             1 wk Tue 10/18/11   Mon 10/24/11 295    NMHIC HelpDesk
297            End User Privacy & Security Training                                        1 wk Tue 10/25/11   Mon 10/31/11 296    NMHIC & Provider
298        Gerald Champion Regional Medical Center                                      17 wks    Mon 8/8/11    Tue 12/6/11
299            Network Subscription Agreement Review & Signature                         8 wks    Mon 8/8/11    Mon 10/3/11        NMHIC & Provider
300            Interface Requirements Gathering                                            1 wk  Tue 10/4/11   Mon 10/10/11 299    NMHIC & Provider
301            Install NMHIC Edge Server Hardware & Software                             2 wks Tue 10/11/11    Mon 10/24/11 300    NMHIC IT
302            Interface Development (Build, Configuration, Installation)                4 wks Tue 10/11/11     Mon 11/7/11 300    MedPlus & NMHIC
303            Interface Implementation (Testing, Validation, Go-Live)                   4 wks   Tue 11/8/11    Tue 12/6/11 302    NMHIC & MedPlus
304            Setup End Users on NMHIC Portal                                             1 wk  Tue 11/8/11   Mon 11/14/11 302    NMHIC HelpDesk
305            Train End Users on NMHIC Portal                                             1 wk Tue 11/15/11   Mon 11/21/11 304    NMHIC HelpDesk
306            End User Privacy & Security Training                                        1 wk Tue 11/22/11   Tue 11/29/11 305    NMHIC & Provider
307        Eastern New Mexico Medical Center                                            17 wks Mon 10/31/11    Wed 2/29/12
308            Network Subscription Agreement Review & Signature                         8 wks Mon 10/31/11    Tue 12/27/11        NMHIC & Provider
309            Interface Requirements Gathering                                            1 wk Wed 12/28/11     Wed 1/4/12 308    NMHIC & Provider
310            Install NMHIC Edge Server Hardware & Software                             2 wks    Thu 1/5/12    Wed 1/18/12 309    NMHIC IT
311            Interface Development (Build, Configuration, Installation)                4 wks    Thu 1/5/12     Wed 2/1/12 309    MedPlus & NMHIC
312            Interface Implementation (Testing, Validation, Go-Live)                   4 wks    Thu 2/2/12    Wed 2/29/12 311    NMHIC & MedPlus
313            Setup End Users on NMHIC Portal                                             1 wk   Thu 2/2/12     Wed 2/8/12 311    NMHIC HelpDesk
314            Train End Users on NMHIC Portal                                             1 wk   Thu 2/9/12    Wed 2/15/12 313    NMHIC HelpDesk
315            End User Privacy & Security Training                                        1 wk  Thu 2/16/12    Wed 2/22/12 314    NMHIC & Provider
316        New Mexico Rehabilitation Center                                             17 wks Mon 12/12/11     Tue 4/10/12
317            Network Subscription Agreement Review & Signature                         8 wks Mon 12/12/11      Tue 2/7/12        NMHIC & Provider
318            Interface Requirements Gathering                                            1 wk   Wed 2/8/12    Tue 2/14/12 317    NMHIC & Provider
319            Install NMHIC Edge Server Hardware & Software                             2 wks Wed 2/15/12      Tue 2/28/12 318    NMHIC IT
320            Interface Development (Build, Configuration, Installation)                4 wks Wed 2/15/12      Tue 3/13/12 318    MedPlus & NMHIC
321            Interface Implementation (Testing, Validation, Go-Live)                   4 wks Wed 3/14/12      Tue 4/10/12 320    NMHIC & MedPlus
322            Setup End Users on NMHIC Portal                                             1 wk Wed 3/14/12     Tue 3/20/12 320    NMHIC HelpDesk
323            Train End Users on NMHIC Portal                                             1 wk Wed 3/21/12     Tue 3/27/12 322    NMHIC HelpDesk
324            End User Privacy & Security Training                                        1 wk Wed 3/28/12      Tue 4/3/12 323    NMHIC & Provider
325        Lea Regional Medical Center                                                  17 wks   Mon 1/23/12     Fri 5/18/12
326            Network Subscription Agreement Review & Signature                         8 wks   Mon 1/23/12     Fri 3/16/12       NMHIC & Provider
327            Interface Requirements Gathering                                            1 wk  Mon 3/19/12     Fri 3/23/12 326   NMHIC & Provider
328            Install NMHIC Edge Server Hardware & Software                             2 wks   Mon 3/26/12      Fri 4/6/12 327   NMHIC IT
329            Interface Development (Build, Configuration, Installation)                4 wks   Mon 3/26/12     Fri 4/20/12 327   MedPlus & NMHIC
330            Interface Implementation (Testing, Validation, Go-Live)                   4 wks   Mon 4/23/12     Fri 5/18/12 329   NMHIC & MedPlus
331            Setup End Users on NMHIC Portal                                             1 wk  Mon 4/23/12     Fri 4/27/12 329   NMHIC HelpDesk
332            Train End Users on NMHIC Portal                                             1 wk  Mon 4/30/12      Fri 5/4/12 331   NMHIC HelpDesk
333            End User Privacy & Security Training                                        1 wk   Mon 5/7/12     Fri 5/11/12 332   NMHIC & Provider
334        Union County Hospital                                                        17 wks   Mon 2/27/12    Mon 6/25/12
335            Network Subscription Agreement Review & Signature                         8 wks   Mon 2/27/12     Fri 4/20/12       NMHIC & Provider
336            Interface Requirements Gathering                                            1 wk  Mon 4/23/12     Fri 4/27/12 335   NMHIC & Provider
337            Install NMHIC Edge Server Hardware & Software                             2 wks   Mon 4/30/12     Fri 5/11/12 336   NMHIC IT
338            Interface Development (Build, Configuration, Installation)                4 wks   Mon 4/30/12     Fri 5/25/12 336   MedPlus & NMHIC
339            Interface Implementation (Testing, Validation, Go-Live)                   4 wks   Mon 5/28/12    Mon 6/25/12 338    NMHIC & MedPlus
340            Setup End Users on NMHIC Portal                                             1 wk  Mon 5/28/12     Mon 6/4/12 338    NMHIC HelpDesk
341            Train End Users on NMHIC Portal                                             1 wk   Tue 6/5/12    Mon 6/11/12 340    NMHIC HelpDesk
342            End User Privacy & Security Training                                        1 wk  Tue 6/12/12    Mon 6/18/12 341    NMHIC & Provider
343        Los Alamos Medical Center                                                    17 wks    Mon 4/9/12     Tue 8/7/12
344            Network Subscription Agreement Review & Signature                         8 wks    Mon 4/9/12     Mon 6/4/12        NMHIC & Provider
345            Interface Requirements Gathering                                            1 wk   Tue 6/5/12    Mon 6/11/12 344    NMHIC & Provider
346            Install NMHIC Edge Server Hardware & Software                             2 wks   Tue 6/12/12    Mon 6/25/12 345    NMHIC IT
347            Interface Development (Build, Configuration, Installation)                4 wks   Tue 6/12/12    Tue 7/10/12 345    MedPlus & NMHIC
348            Interface Implementation (Testing, Validation, Go-Live)                   4 wks Wed 7/11/12       Tue 8/7/12 347    NMHIC & MedPlus
349            Setup End Users on NMHIC Portal                                             1 wk Wed 7/11/12     Tue 7/17/12 347    NMHIC HelpDesk
350            Train End Users on NMHIC Portal                                             1 wk Wed 7/18/12     Tue 7/24/12 349    NMHIC HelpDesk


                                                                            Page 5
New Mexico Statewide HIE Project Plan 2009-2013                                                                                                 Thu 2/25/10

 ID     Task Name                                                                    Duration        Start         Finish     PredeceResource Names

351            End User Privacy & Security Training                                        1 wk    Wed 7/25/12    Tue 7/31/12 350    NMHIC & Provider
352        Kindred Hospital                                                             17 wks     Mon 5/14/12   Wed 9/12/12
353            Network Subscription Agreement Review & Signature                         8 wks     Mon 5/14/12    Tue 7/10/12        NMHIC & Provider
354            Interface Requirements Gathering                                            1 wk    Wed 7/11/12    Tue 7/17/12 353    NMHIC & Provider
355            Install NMHIC Edge Server Hardware & Software                             2 wks     Wed 7/18/12    Tue 7/31/12 354    NMHIC IT
356            Interface Development (Build, Configuration, Installation)                4 wks     Wed 7/18/12    Tue 8/14/12 354    MedPlus & NMHIC
357            Interface Implementation (Testing, Validation, Go-Live)                   4 wks     Wed 8/15/12    Wed 9/12/12 356    NMHIC & MedPlus
358            Setup End Users on NMHIC Portal                                             1 wk    Wed 8/15/12    Tue 8/21/12 356    NMHIC HelpDesk
359            Train End Users on NMHIC Portal                                             1 wk    Wed 8/22/12    Tue 8/28/12 358    NMHIC HelpDesk
360            End User Privacy & Security Training                                        1 wk    Wed 8/29/12     Wed 9/5/12 359    NMHIC & Provider
361        Mimbres Memorial Hospital                                                    17 wks     Mon 5/14/12   Wed 9/12/12
362            Network Subscription Agreement Review & Signature                         8 wks     Mon 5/14/12    Tue 7/10/12        NMHIC & Provider
363            Interface Requirements Gathering                                            1 wk    Wed 7/11/12    Tue 7/17/12 362    NMHIC & Provider
364            Install NMHIC Edge Server Hardware & Software                             2 wks     Wed 7/18/12    Tue 7/31/12 363    NMHIC IT
365            Interface Development (Build, Configuration, Installation)                4 wks     Wed 7/18/12    Tue 8/14/12 363    MedPlus & NMHIC
366            Interface Implementation (Testing, Validation, Go-Live)                   4 wks     Wed 8/15/12    Wed 9/12/12 365    NMHIC & MedPlus
367            Setup End Users on NMHIC Portal                                             1 wk    Wed 8/15/12    Tue 8/21/12 365    NMHIC HelpDesk
368            Train End Users on NMHIC Portal                                             1 wk    Wed 8/22/12    Tue 8/28/12 367    NMHIC HelpDesk
369            End User Privacy & Security Training                                        1 wk    Wed 8/29/12     Wed 9/5/12 368    NMHIC & Provider
370        Cibola General Hospital                                                      17 wks      Mon 6/4/12    Tue 10/2/12
371            Network Subscription Agreement Review & Signature                         8 wks      Mon 6/4/12    Mon 7/30/12        NMHIC & Provider
372            Interface Requirements Gathering                                            1 wk    Tue 7/31/12     Mon 8/6/12 371    NMHIC & Provider
373            Install NMHIC Edge Server Hardware & Software                             2 wks      Tue 8/7/12    Mon 8/20/12 372    NMHIC IT
374            Interface Development (Build, Configuration, Installation)                4 wks      Tue 8/7/12     Tue 9/4/12 372    MedPlus & NMHIC
375            Interface Implementation (Testing, Validation, Go-Live)                   4 wks      Wed 9/5/12    Tue 10/2/12 374    NMHIC & MedPlus
376            Setup End Users on NMHIC Portal                                             1 wk     Wed 9/5/12    Tue 9/11/12 374    NMHIC HelpDesk
377            Train End Users on NMHIC Portal                                             1 wk    Wed 9/12/12    Tue 9/18/12 376    NMHIC HelpDesk
378            End User Privacy & Security Training                                        1 wk    Wed 9/19/12    Tue 9/25/12 377    NMHIC & Provider
379        Radiology Associates of NM                                                   17 wks      Mon 7/2/12   Tue 10/30/12
380            Network Subscription Agreement Review & Signature                         8 wks      Mon 7/2/12    Mon 8/27/12        NMHIC & Provider
381            Interface Requirements Gathering                                            1 wk    Tue 8/28/12     Tue 9/4/12 380    NMHIC & Provider
382            Install NMHIC Edge Server Hardware & Software                             2 wks      Wed 9/5/12    Tue 9/18/12 381    NMHIC IT
383            Interface Development (Build, Configuration, Installation)                4 wks      Wed 9/5/12    Tue 10/2/12 381    MedPlus & NMHIC
384            Interface Implementation (Testing, Validation, Go-Live)                   4 wks     Wed 10/3/12   Tue 10/30/12 383    NMHIC & MedPlus
385            Setup End Users on NMHIC Portal                                             1 wk    Wed 10/3/12    Tue 10/9/12 383    NMHIC HelpDesk
386            Train End Users on NMHIC Portal                                             1 wk   Wed 10/10/12   Tue 10/16/12 385    NMHIC HelpDesk
387            End User Privacy & Security Training                                        1 wk   Wed 10/17/12   Tue 10/23/12 386    NMHIC & Provider
388        X-Ray Associates of NM                                                       17 wks     Mon 8/13/12   Tue 12/11/12
389            Network Subscription Agreement Review & Signature                         8 wks     Mon 8/13/12    Mon 10/8/12        NMHIC & Provider
390            Interface Requirements Gathering                                            1 wk    Tue 10/9/12   Mon 10/15/12 389    NMHIC & Provider
391            Install NMHIC Edge Server Hardware & Software                             2 wks    Tue 10/16/12   Mon 10/29/12 390    NMHIC IT
392            Interface Development (Build, Configuration, Installation)                4 wks    Tue 10/16/12   Mon 11/12/12 390    MedPlus & NMHIC
393            Interface Implementation (Testing, Validation, Go-Live)                   4 wks    Tue 11/13/12   Tue 12/11/12 392    NMHIC & MedPlus
394            Setup End Users on NMHIC Portal                                             1 wk   Tue 11/13/12   Mon 11/19/12 392    NMHIC HelpDesk
395            Train End Users on NMHIC Portal                                             1 wk   Tue 11/20/12   Tue 11/27/12 394    NMHIC HelpDesk
396            End User Privacy & Security Training                                        1 wk   Wed 11/28/12    Tue 12/4/12 395    NMHIC & Provider
397        Artesia General Hospital                                                     17 wks    Mon 10/29/12   Wed 2/27/13
398            Network Subscription Agreement Review & Signature                         8 wks    Mon 10/29/12   Mon 12/24/12        NMHIC & Provider
399            Interface Requirements Gathering                                            1 wk   Tue 12/25/12     Wed 1/2/13 398    NMHIC & Provider
400            Install NMHIC Edge Server Hardware & Software                             2 wks      Thu 1/3/13    Wed 1/16/13 399    NMHIC IT
401            Interface Development (Build, Configuration, Installation)                4 wks      Thu 1/3/13    Wed 1/30/13 399    MedPlus & NMHIC
402            Interface Implementation (Testing, Validation, Go-Live)                   4 wks     Thu 1/31/13    Wed 2/27/13 401    NMHIC & MedPlus
403            Setup End Users on NMHIC Portal                                             1 wk    Thu 1/31/13     Wed 2/6/13 401    NMHIC HelpDesk
404            Train End Users on NMHIC Portal                                             1 wk     Thu 2/7/13    Wed 2/13/13 403    NMHIC HelpDesk
405            End User Privacy & Security Training                                        1 wk    Thu 2/14/13    Wed 2/20/13 404    NMHIC & Provider
406        Carlsbad Medical Center                                                      17 wks    Mon 12/10/12     Tue 4/9/13
407            Network Subscription Agreement Review & Signature                         8 wks    Mon 12/10/12     Tue 2/5/13        NMHIC & Provider
408            Interface Requirements Gathering                                            1 wk     Wed 2/6/13    Tue 2/12/13 407    NMHIC & Provider
409            Install NMHIC Edge Server Hardware & Software                             2 wks     Wed 2/13/13    Tue 2/26/13 408    NMHIC IT
410            Interface Development (Build, Configuration, Installation)                4 wks     Wed 2/13/13    Tue 3/12/13 408    MedPlus & NMHIC
411            Interface Implementation (Testing, Validation, Go-Live)                   4 wks     Wed 3/13/13     Tue 4/9/13 410    NMHIC & MedPlus
412            Setup End Users on NMHIC Portal                                             1 wk    Wed 3/13/13    Tue 3/19/13 410    NMHIC HelpDesk
413            Train End Users on NMHIC Portal                                             1 wk    Wed 3/20/13    Tue 3/26/13 412    NMHIC HelpDesk
414            End User Privacy & Security Training                                        1 wk    Wed 3/27/13     Tue 4/2/13 413    NMHIC & Provider
415        Physicians Medical Center                                                    17 wks     Mon 1/28/13     Fri 5/24/13
416            Network Subscription Agreement Review & Signature                         8 wks     Mon 1/28/13     Fri 3/22/13       NMHIC & Provider
417            Interface Requirements Gathering                                            1 wk    Mon 3/25/13     Fri 3/29/13 416   NMHIC & Provider
418            Install NMHIC Edge Server Hardware & Software                             2 wks      Mon 4/1/13     Fri 4/12/13 417   NMHIC IT
419            Interface Development (Build, Configuration, Installation)                4 wks      Mon 4/1/13     Fri 4/26/13 417   MedPlus & NMHIC
420            Interface Implementation (Testing, Validation, Go-Live)                   4 wks     Mon 4/29/13     Fri 5/24/13 419   NMHIC & MedPlus


                                                                            Page 6
New Mexico Statewide HIE Project Plan 2009-2013                                                                                                  Thu 2/25/10

 ID     Task Name                                                                     Duration        Start         Finish     PredeceResource Names

421             Setup End Users on NMHIC Portal                                             1 wk    Mon 4/29/13      Fri 5/3/13 419   NMHIC HelpDesk
422             Train End Users on NMHIC Portal                                             1 wk     Mon 5/6/13    Fri 5/10/13 421    NMHIC HelpDesk
423             End User Privacy & Security Training                                        1 wk    Mon 5/13/13    Fri 5/17/13 422    NMHIC & Provider
424        Alta Vista Regional Hospital                                                  17 wks     Mon 3/11/13    Tue 7/9/13
425             Network Subscription Agreement Review & Signature                         8 wks     Mon 3/11/13      Fri 5/3/13       NMHIC & Provider
426             Interface Requirements Gathering                                            1 wk     Mon 5/6/13    Fri 5/10/13 425    NMHIC & Provider
427             Install NMHIC Edge Server Hardware & Software                             2 wks     Mon 5/13/13    Fri 5/24/13 426    NMHIC IT
428             Interface Development (Build, Configuration, Installation)                4 wks     Mon 5/13/13   Mon 6/10/13 426     MedPlus & NMHIC
429             Interface Implementation (Testing, Validation, Go-Live)                   4 wks     Tue 6/11/13    Tue 7/9/13 428     NMHIC & MedPlus
430             Setup End Users on NMHIC Portal                                             1 wk    Tue 6/11/13   Mon 6/17/13 428     NMHIC HelpDesk
431             Train End Users on NMHIC Portal                                             1 wk    Tue 6/18/13   Mon 6/24/13 430     NMHIC HelpDesk
432             End User Privacy & Security Training                                        1 wk    Tue 6/25/13    Mon 7/1/13 431     NMHIC & Provider
433        Nor Lea General Hospital                                                      17 wks      Fri 4/19/13  Mon 8/19/13
434             Network Subscription Agreement Review & Signature                         8 wks      Fri 4/19/13   Fri 6/14/13        NMHIC & Provider
435             Interface Requirements Gathering                                            1 wk    Mon 6/17/13    Fri 6/21/13 434    NMHIC & Provider
436             Install NMHIC Edge Server Hardware & Software                             2 wks     Mon 6/24/13    Mon 7/8/13 435     NMHIC IT
437             Interface Development (Build, Configuration, Installation)                4 wks     Mon 6/24/13   Mon 7/22/13 435     MedPlus & NMHIC
438             Interface Implementation (Testing, Validation, Go-Live)                   4 wks     Tue 7/23/13   Mon 8/19/13 437     NMHIC & MedPlus
439             Setup End Users on NMHIC Portal                                             1 wk    Tue 7/23/13   Mon 7/29/13 437     NMHIC HelpDesk
440             Train End Users on NMHIC Portal                                             1 wk    Tue 7/30/13    Mon 8/5/13 439     NMHIC HelpDesk
441             End User Privacy & Security Training                                        1 wk     Tue 8/6/13   Mon 8/12/13 440     NMHIC & Provider
442        Roosevelt General Hospital                                                    17 wks      Fri 5/31/13  Mon 9/30/13
443             Network Subscription Agreement Review & Signature                         8 wks      Fri 5/31/13   Fri 7/26/13        NMHIC & Provider
444             Interface Requirements Gathering                                            1 wk    Mon 7/29/13      Fri 8/2/13 443   NMHIC & Provider
445             Install NMHIC Edge Server Hardware & Software                             2 wks      Mon 8/5/13    Fri 8/16/13 444    NMHIC IT
446             Interface Development (Build, Configuration, Installation)                4 wks      Mon 8/5/13    Fri 8/30/13 444    MedPlus & NMHIC
447             Interface Implementation (Testing, Validation, Go-Live)                   4 wks      Mon 9/2/13   Mon 9/30/13 446     NMHIC & MedPlus
448             Setup End Users on NMHIC Portal                                             1 wk     Mon 9/2/13    Mon 9/9/13 446     NMHIC HelpDesk
449             Train End Users on NMHIC Portal                                             1 wk    Tue 9/10/13   Mon 9/16/13 448     NMHIC HelpDesk
450             End User Privacy & Security Training                                        1 wk    Tue 9/17/13   Mon 9/23/13 449     NMHIC & Provider
451        Guadalupe County Hospital                                                     17 wks      Fri 7/12/13   Fri 11/8/13
452             Network Subscription Agreement Review & Signature                         8 wks      Fri 7/12/13     Fri 9/6/13       NMHIC & Provider
453             Interface Requirements Gathering                                            1 wk     Mon 9/9/13    Fri 9/13/13 452    NMHIC & Provider
454             Install NMHIC Edge Server Hardware & Software                             2 wks     Mon 9/16/13    Fri 9/27/13 453    NMHIC IT
455             Interface Development (Build, Configuration, Installation)                4 wks     Mon 9/16/13   Fri 10/11/13 453    MedPlus & NMHIC
456             Interface Implementation (Testing, Validation, Go-Live)                   4 wks    Mon 10/14/13    Fri 11/8/13 455    NMHIC & MedPlus
457             Setup End Users on NMHIC Portal                                             1 wk   Mon 10/14/13   Fri 10/18/13 455    NMHIC HelpDesk
458             Train End Users on NMHIC Portal                                             1 wk   Mon 10/21/13   Fri 10/25/13 457    NMHIC HelpDesk
459             End User Privacy & Security Training                                        1 wk   Mon 10/28/13    Fri 11/1/13 458    NMHIC & Provider
460        NM Department of Corrections                                                  17 wks      Fri 8/23/13 Mon 12/23/13
461             Network Subscription Agreement Review & Signature                         8 wks      Fri 8/23/13  Fri 10/18/13        NMHIC & Provider
462             Interface Requirements Gathering                                            1 wk   Mon 10/21/13   Fri 10/25/13 461    NMHIC & Provider
463             Install NMHIC Edge Server Hardware & Software                             2 wks    Mon 10/28/13    Fri 11/8/13 462    NMHIC IT
464             Interface Development (Build, Configuration, Installation)                4 wks    Mon 10/28/13 Mon 11/25/13 462      MedPlus & NMHIC
465             Interface Implementation (Testing, Validation, Go-Live)                   4 wks    Tue 11/26/13 Mon 12/23/13 464      NMHIC & MedPlus
466             Setup End Users on NMHIC Portal                                             1 wk   Tue 11/26/13   Mon 12/2/13 464     NMHIC HelpDesk
467             Train End Users on NMHIC Portal                                             1 wk    Tue 12/3/13   Mon 12/9/13 466     NMHIC HelpDesk
468             End User Privacy & Security Training                                        1 wk   Tue 12/10/13 Mon 12/16/13 467      NMHIC & Provider
469        Sierra Vista Hospital                                                         17 wks     Mon 9/16/13 Wed 1/15/14
470             Network Subscription Agreement Review & Signature                         8 wks     Mon 9/16/13    Fri 11/8/13        NMHIC & Provider
471             Interface Requirements Gathering                                            1 wk   Mon 11/11/13   Fri 11/15/13 470    NMHIC & Provider
472             Install NMHIC Edge Server Hardware & Software                             2 wks    Mon 11/18/13   Mon 12/2/13 471     NMHIC IT
473             Interface Development (Build, Configuration, Installation)                4 wks    Mon 11/18/13 Mon 12/16/13 471      MedPlus & NMHIC
474             Interface Implementation (Testing, Validation, Go-Live)                   4 wks    Tue 12/17/13   Wed 1/15/14 473     NMHIC & MedPlus
475             Setup End Users on NMHIC Portal                                             1 wk   Tue 12/17/13 Mon 12/23/13 473      NMHIC HelpDesk
476             Train End Users on NMHIC Portal                                             1 wk   Tue 12/24/13 Tue 12/31/13 475      NMHIC HelpDesk
477             End User Privacy & Security Training                                        1 wk     Wed 1/1/14    Wed 1/8/14 476     NMHIC & Provider




                                                                             Page 7
                                 New Mexico Health Information Exchange Operational Plan


O.1.2 Issues, Risks, Dependencies

       The major risks, and our plans to address these risks, are:

                                           Potential
          Risks                Level                                              How Risk Will be Addressed
                                            Impact
                                                         The plan to mitigate this risk has four aspects:
                                                            1. Build upon the deep knowledge of health care privacy and security within
                                                                NMHIC from our experience with HIT privacy and security
                                                                recommendations from the National Committee on Vital and Health
                                                                Statistics (NCVHS), leading the Health Information Security and Privacy
                                                                Collaborative (HISPC) project in New Mexico, the development and
                                                                passage of the State EHR law defining privacy requirements for EHRs
Despite the fact that
                                                                and HIEs, and our active participation in the development of the Data Use
providers have signed the
                                                                and Reciprocal Support Agreement (DURSA) for the NHIN.
development / testing level              Possible
                                                            2. Continue engaging individual health care organizations to understand
NMHIC Network                            delay in plan
                                                                and resolve privacy and security issues that are specific to their
Subscription Agreements,                 for
                                High                            organizations. The most recent example of this approach is the detailed
privacy/security concerns                production
                                                                negotiation with Presbyterian Healthcare Systems to meet their new,
continue to delay signing of             use by June
                                                                higher level requirements for data security.
the production level                     2010.
                                                            3. Continue to integrate the wording from negotiations with individual
Network Subscription
                                                                organizations into a single production-level NMHIC subscription
Agreements.
                                                                agreement that will meet the needs of all NMHIC data suppliers and
                                                                users. This approach was initiated in September 2009 when we
                                                                convened a series of community meetings to move closer to general
                                                                consensus on a single production-level NMHIC subscription agreement.
                                                            4. The draft of a single, consensus-based production-level NMHIC
                                                                subscription agreement is expected by the end of January, and the final
                                                                version of the NSA is planned for the end of March 2010.




                                                                                                                              02-26-10
                                                                                                                                    57
                             New Mexico Health Information Exchange Operational Plan

                                     Potential
          Risks             Level                                               How Risk Will be Addressed
                                      Impact
                                                     The plan to address this risk has four aspects:
                                                     1. The president of LCF has been meeting with the presidents of the major health plans
                                                        in New Mexico to obtain commitment to provide matching funds for both NMHIC and
                                                        the New Mexico HIT Regional Extension Center for 2010 and 2011. The presidents
                                                        of two leading health plans have now taken leadership roles to obtain the needed
                                                        financial commitment from the other health plans. The agreement is based on the
                                                        proposition that the five major health plans would all contribute based on a per-
                                                        member-per-month construct. At this time, four of the five largest health plans have
                                                        agreed to provide the necessary funding and the fifth has agreed to provide a lesser
                                                        amount. Discussions continue to bring these agreements to a final commitment.
                                                        The major health plans have not yet agreed to a financial construct for ongoing
                                    May affect
Despite ongoing support                                 sustainability of NMHIC beyond 2011. However, it is encouraging that four of the five
                                    ability to          health plan presidents have agreed to personally serve on the expanded LCF
and some expressions of
                                    provide             Research Board of Directors.
willingness to provide
                                    matching         2. Despite the budget deficits that are projected for the State, the Medical Assistance
funds for NMHIC, the
                                    funds for           Division (Medicaid) in New Mexico is still trying to allocate some funding for NMHIC.
health plans and other
                                    2011 and         3. To address the need for long term sustainability, New Mexico continues to study
stakeholders in the         High                        other states‘ approaches to providing ongoing sustainable funding for health
                                    beyond, and
community have not yet                                  information technology. We have spoken with a vice president of the Vermont
                                    may affect
committed to provide                                    Information Technology Leaders initiative and reviewed the two state laws they have
                                    ongoing
matching funds or ongoing                               passed that add a small fee to each health care claim to generate sustainable
                                    funding for
sustaining funds to                                     funding for health IT in Vermont. This approach is an option for New Mexico;
                                    sustainability
NMHIC.                                                  however, we would not move forward with this approach unless we had support from
                                    .                   the major health plans in the state.
                                                     4. New Mexico is also considering whether we should charge annual or monthly
                                                        subscription fees or transaction fees to users of the HIE network. Before we move
                                                        forward on this approach, we need to have a better understanding of how this might
                                                        impact user adoption and utilization. This assessment should take place after we
                                                        have a body of users that can give informed answers to the question of how much
                                                        they are willing to pay for network services, based on the value they are receiving
                                                        from these services. If we adopt methods to charge providers or users for the
                                                        network services, the total revenue it will generate will probably be about 1/3 of the
                                                        total annual requirement for ongoing sustainability. Therefore, this approach is not
                                                        likely to solve the long term sustainability issue by itself.




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                               New Mexico Health Information Exchange Operational Plan

                                       Potential
          Risks              Level                                              How Risk Will be Addressed
                                        Impact
Business reasons
preventing data providers
from interfacing to NMHIC.
These reasons include:
                                      May delay
1. Concern about other
                                      NMHIC
    health care providers
                                      ability to       For the first two business concerns, continuing relationship-building meetings to
    (perceived as
                                      accelerate       address concerns usually leads to success. For the third concern, lack of
    competitors) having
                                      expansion of     resources / funding to work with NMHIC to establish the interfaces to the edge
    access to their data     Medium
                                      the HIE, and     server, once NMHIC has sufficient funding we can provide the necessary
2. Other high-priority HIT
                                      may affect       resources in special cases.
    projects within their
                                      value of HIE
    organizations that are
                                      to clinician
    more urgent
                                      users.
3. The cost of providing
    resources to establish
    the interfaces to the
    NMHIC edge servers
                                      May delay
                                      NMHIC
                                      ability to
Legal reasons preventing              accelerate
healthcare providers from             expansion of     Continue discussions and negotiations to identify specific impediments and
                             Medium
signing the Network                   the HIE, and     develop legally appropriate wording to address them.
Subscription Agreements               may affect
                                      value of HIE
                                      to clinician
                                      users.
Ability of the Medical
Assistance Division                   May affect
                                                       Since we know that MAD (Medicaid) would like to provide funding to us if they
(Medicaid) to provide                 ongoing
                             Medium                    can, we will continue to work with them so that they have whatever supportive
funding at a time when the            funding for
                                                       information they need to allocate some funds for NMHIC.
state budget for Medicaid             sustainability
is being cut



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              New Mexico Health Information Exchange Operational Plan



O.2.   Coordinate with ARRA Programs

       NMHIC is one of the essential enablers that will help practitioners adopting EHRs to
       demonstrate meaningful use of health IT, because practitioners must be able to
       exchange summary patient documents with other health care sites or practitioners.
       They must also obtain and use information outside their EHR sphere in order to
       coordinate patient care. Thus, the NMHIC team‘s approach to coordination will be
       to deploy NMHIC connections in concert with EHR adoption support activities
       funded by the New Mexico Regional Extension Center. NMHIC will be equipped to
       provide technical assistance for both EHR and HIE from one organization and
       coordinated contact point. LCF staff participates in technical and governance
       activities of New Mexico‘s broadband initiative the Southwest Telehealth Access
       Grid, and leaders of SWTAG participate in NMHIC governance. Therefore,
       leadership and technical coordination is assured.

       NMHIC governance includes the director of New Mexico Primary Care Association
       (NMPCA), who coordinates federal funding opportunities for Health Resources and
       Services Administration (HRSA) support to Federally Qualified Health Centers and
       Health Center Control Networks. The many New Mexico physicians who participate
       in these federal initiatives receive IT support from NMPCA, so NMHIC technical and
       leadership collaboration can be accomplished when new initiatives are offered.

       O.2.1 New Mexico Regional Center

       LCF/NMHIC is the lead organization submitting a proposal to be the HIT Regional
       Center that will provide support for the state. EHR adoption will be facilitated and
       supported by the New Mexico HIT Regional Center (NMRC), so HIE network
       services to medical practices that serve rural and underserved populations will
       include HIE capabilities in 2011.

       Regional Center staff will support Meaningful Use EHR adoption by performing
       outreach, education, workflow analysis, project management, privacy and security
       training, and IT infrastructure support. Because NMRC and NMHIC staff work
       together already, our teams will closely coordinate EHR adoption with NMHIC
       expansion efforts, so primary care EHR practitioners maximize their opportunities to
       demonstrate meaningful use of summary document exchange, e-prescribing, care
       coordination and public health participation through HIE. This will enable medical
       practices to demonstrate care coordination over the HIE, and therefore meet the
       requirements for meaningful use of HIT.

       O.2.2 Workforce Development

       The State is working with the institutions of higher learning to pursue workforce
       development opportunities. The community college system in New Mexico has
       pledged the use of their statewide distance learning network to support expanded
       training for workers in the healthcare industry. The University of New Mexico
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              New Mexico Health Information Exchange Operational Plan


       supports workforce development through its medical school and school of nursing.
       Hospitals across the state have agreed to support state HIT initiatives by offering
       the use of their training facilities to provide physicians with a local option for hands
       on training. Similar collaborations have been offered by a large, temporary
       employment agency which is willing to be a partner in retraining and recruiting
       personnel to assist physicians with the task of implementing HIT. Other avenues for
       collaboration will involve professional organizations like the New Mexico Primary
       Care Association, New Mexico Medical Review Association (QIO), and professional
       societies, as well as training through the statewide distance learning network.

       O.2.3 Availability of Broadband

       A recent survey found that many healthcare providers in New Mexico already have
       access to broadband. New Mexico‘s plan for broadband expansion through the
       funding available in ARRA will build connections to all major public facilities as well
       as hospitals around the state. This hub and spoke arrangement envisions local
       providers connecting through their community centers, whether they are public hubs
       or central sites provided by community-based institutions like community colleges or
       hospitals. The State already supports broadband to all of the Department of
       Health‘s public health clinics and its school-based health centers.

       The broadband mapping funds requested by New Mexico will not be available in
       time to assist us with addressing gaps in the existing broadband coverage.
       However, in the process of assembling the ARRA grant application, the State
       collected maps from each of the telecommunications providers operating in the
       state, showing their coverage and service offerings. These maps will be used until
       an updated map is available.


O.3.   Coordination with Other States

       During the last 24 months, LCF/NMHIC staff has played significant roles in national
       workgroups related to Nationwide Health Information Network Trial Implementations
       and to Health Security and Privacy. These experiences will be carried over into
       HITREC efforts to leverage individual state or community experiences and
       accomplishments to the national and inter-state arena, thereby collectively
       enhancing EHR and HIE education, policy, technical, governance, and privacy or
       legal practices. It is expected that LCF/NMHIC staff will participate in HITREC
       national task forces or work groups to accomplish better health IT adoption and
       better patient care outcomes, locally and nationally.

       New Mexico has a history of sharing HIE information and coordinating HIE
       implementations with other states. For example, LCF/NMHIC has:

       1. Coordinated with 18 other health care organizations (private, state, and federal)
          that are participating in the Nationwide Health Information Network (NHIN) Trial
          Implementations project. This coordination has taken place in multiple areas,
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               New Mexico Health Information Exchange Operational Plan


            including agreement on interoperability standards, where New Mexico served as
            the Co-chair of the Core Services Content Workgroup for the NHIN during 2008,
            as well as actively participating in the Leadership and Communications
            Workgroup, the Data Use and Reciprocal Support Agreement Workgroup, the
            Testing Workgroup, and the Security and Technical Core Services Workgroup;
       2.   Shared its comprehensive business plan with many other HIEs through the State
            Level HIE Consensus Project;
       3.   Shared the results from the Health Information Security and Privacy
            Collaborative (HISPC) initiative in New Mexico related to health information
            privacy and security policy variations with more than 30 other states;
       4.   Coordinated with ONC in the development of the NCVHS recommendations for
            the functional requirements of the NHIN. The current Director of Health
            Informatics at LCF / NMHIC served as the Vice Chair of the NCVHS workgroup
            that developed these recommendations;
       5.   Shared HIE information with the e-Health Collaborative including responding to
            their annual RHIO Survey and presenting at their conferences and webinars;
       6.   Shared thoughts and information with the HIE Steering Committee of the Health
            Information and Management Systems Society (HIMSS). The current Director of
            Health Informatics at LCF / NMHIC was appointed by HIMSS to this Steering
            Committee;
       7.   Shared and received many types of HIE network information directly with other
            states including Colorado, Utah, Iowa, New York, Indiana, Massachusetts, and
            North Carolina; and
       8.   Coordinated with Arizona, Southwest IHS, and New Mexico as part of the
            Southwest Telehealth Access Grid (SWTAG).

       New Mexico plans to continue our practice of sharing information and coordinating
       with the HIE initiatives in other states, as well as the national initiatives to support
       and coordinate the development of HIEs nationwide.


O.4.   Governance

       O.4.1 NMHIC Selected as the State Designated Entity (SDE)

                                                                    M
       According to Robert Mayer, New Mexico HIT Coordinator, ―N HIC was designated
       by Governor Richardson as the statewide health information exchange on May 27,
       2009, indicating his and the state‘s commitment to focus on the resources of the
       Collaborative in order to further the goal of seamless exchange of health
       information. The state has subsequently contracted with NMHIC to facilitate public
       health reporting, including emergency department encounters and ongoing
       syndromic surveillance.‖

       The letter from the Governor selecting NMHIC as the SDE, is included as Appendix
       ----.



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      New Mexico Health Information Exchange Operational Plan


O.4.2 Governance and Policy Structures

The governance model for NMHIC HIE is described in Section S.9 of the Strategic
Planning Section of this document. Until now, the NMHIC Steering Committee has
provided advice, guidance, and oversight for the development of the HIE network.
During the next six months, the governance and policy structure within the
Operational Plan will reflect several major changes:
 Many governance and policy topics will evolve from the further development and
   production use of the NMHIC network, which is planned for June of 2010. Both
   HealthXnet and SureScripts are already in production.
 NMHIC will have expanded responsibilities as the HIE and SDE for New Mexico,
   including Electronic Reporting to NM DOH (See S.9.5), coordination with MAD
   (Medicaid project - See S.5), technical integration with the administrative
   network (HealthXnet – Paragraph 3, S.11.3 and S.11.4), and inclusion of e-
   prescribing initiatives (NMMRA / NMPIC / SureScripts – S.11.4).
 The coordination responsibilities of NMHIC will also expand to include the HIT
   initiatives within the state government of New Mexico and the HIT Regional
   Center activities.

O.4.3 Evolving to Production Use of NMHIC – Organizational Structure and
      Staffing

The governance and policy structure for production use will build upon the current
NMHIC organization and the roles of the staff within this organization. The
organization chart appears below in Figure 4:




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           New Mexico Health Information Exchange Operational Plan




                                        Figure 4.


Key functional roles include:

   President and Executive Director: This position serves as the chief executive officer
    of NMHIC. Utilizes the NMHIC advisory steering committee to obtain key input
    regarding the direction and strategy of the NHIN initiative, oversight, strategic
    guidance, leadership representing LCF/NMHIC to key stakeholders, and fiduciary
    responsibility.
   Director of Health Informatics: This position serves as lead for the NHIN initiative,
    and is responsible for the strategy and business plan.

   Medical Director of Clinical Informatics: This position serves as the chief medical
    officer for NMHIC and the liaison coordinator for working with physicians, clinical
    practices and other stakeholder groups on the NHIN programs and services. This
    position will be extremely important in providing thought leadership and relationship
    management with physicians and medical groups; physicians are more receptive to
    and more likely to consult with other physicians about issues of technology and
    business management, workflow issues, and information seeking.

   Chief Financial Officer: This position provides the key financial expertise to ensure
    the financial aspects of the business plan are identified and addressed in order to
    create a sustainable operation for health information exchange.

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           New Mexico Health Information Exchange Operational Plan


   Marketing: This position is responsible for outreach and marketing of the health
    information exchange (HIE) to the healthcare community in New Mexico. The
    person in this position will spend significant time with healthcare providers and
    payers to explain the benefits of participation as a data provider and/or user. This
    person will raise awareness and enthusiasm within the state for the HIE, leading to
    expanded adoption beyond the pilot participants. It is critical that this position be
    staffed by a physician who is highly knowledgeable in the national HIT and HIE
    initiatives.
   Legal Officer: This position serves to assure that all legal aspects regarding the
    implementation and operation of the health information exchange are identified and
    addressed.
   Director of Human Resources: This position provides human resource and
    administrative support for the health information exchange. As new positions are
    needed, this position assures the market assessment is performed to attract and
    recruit qualified candidates. This position also is responsible for ongoing programs
    to ensure that qualified staff is retained as well as to ensure staff issues are
    addressed in a timely and appropriate manner. This position is also responsible for
    ensuring general administrative support is provided for NMHIC/NHIN staff activities.
   Chief Information Officer: This position serves as the combination chief technology
    operating-information officer and overall NHIN project manager with prime
    responsibility for leading the technology staff, managing the programmatic and
    contractual relationship with the supporting vendors, and implementation of the
    health information exchange services with the participating organizations.
   IT and Data Security Analyst: This position is responsible for assuring the security
    and integrity of the technical environment and data managed by the NMHIC
    network. The individual filling this position has extensive security expertise,
    including CISSP certification.
   Applications and Interface Support Analysts: These positions are responsible for
    managing the various components of the NMHIC network, including application
    servers, internet portals, databases, data supplier interfaces, etc. Responsibilities
    also include front line support for subscribers, with additional support provided by
    MedPlus as required.
   Admin and IT: This position is responsible for administration of the various
    components of the NMHIC environment.
   Project Managers: These positions are responsible for the development and
    management of the various project use cases and/or phases required for the
    implementation of NMHIC. The individuals in these roles ensure that the projects
    follow Project Management Institute concepts and principles.
   Subscriber Support: These positions are responsible for the day to day support of
    the subscriber community, responding to technical problems, providing training, and
    providing go-live assistance when new data providers or data users subscribe to
    NMHIC.

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          New Mexico Health Information Exchange Operational Plan


The governance and policy structure for the operational activities of the new expanded
NMHIC HIE SDE will be developed during the first half of 2010 in a series of meetings
among all of the key stakeholders. The first meeting of the new expanded Board of
Directors took place on January 19, 2010.




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             New Mexico Health Information Exchange Operational Plan



O.5.   Finance

       O.5.1 Cost estimates and staffing plans

       Cost estimate for implementation of the NMHIC strategic plan over four years.




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              New Mexico Health Information Exchange Operational Plan


       O.5.2 Controls and Reporting

       LCF will establish and maintain a project financial and reporting structure which will
       mirror the financial plan and budget created for the State Health Information
       Exchange Cooperative. That structure will be implemented within the Deltek
       software suite (accounting, time keeping, and project management applications)
       which are designed to meet the requirement for GAAP and DCAA. In addition, LCF
       operates and accounts for its activities according to OMB Circular A-122 and
       Circular A-133 which dictate that a CPA firm audit and certify that LCF‘s financial
       policies, procedures and controls are maintained in compliance with GAAP and
       relevant OMB guidelines. LCF will serve as a single point of contact to submit
       NMHIC progress and spending reports periodically to ONC.

O.6.   Technical Infrastructure

       O.6.1 Standards and Certifications

       Interoperability Standards
       The Office of the National Coordinator has created a portfolio of interoperability
       standards as part of the Nationwide Health Information Network (NHIN) Trial
       Implementations. This portfolio includes message format standards such as HL7;
       terminology standards such as ICD, CPT, NDC, LOINC, RxNorm, and SNOMED;
       document standards such as the CCD; and HITSP constructs such as C32, C37,
       etc. NMHIC, as a participant in the NHIN Trial Implementations, demonstrated its
       ability to exchange health care information with other HIE networks using these
       interoperability standards over the NHIN in 2008. HealthXnet exchanges patient
       eligibility and health claim information among New Mexico‘s providers and payers
       using ASC X12N message format standards. SureScripts sends e-prescribing
       transactions between prescribers, pharmacies and PBM‘s using NCPDP script and
       ASC X12N message format standards.

       Data Use and Reciprocal Support Agreements (DURSA) define policies for
       interactions among HIE networks over the NHIN. NMHIC has signed the test data
       NHIN DURSA and expects to sign the limited production version.

       The mechanisms that LCF/NMHIC will rely upon to continue our commitment to
       using and helping local providers migrate to health IT standards include:
          1. Facilitation of the care coordination and quality reporting components of
              meaningful use.
                 a. NMHIC, along with our technology partner, MedPlus, has been
                    reviewing the Interim Final Rule from ONC and the NPRM from CMS
                    to update our understanding of the standards that will be required to
                    support our care coordination responsibilities as part of meaningful
                    use of health IT. We believe that the three stages that span 2011
                    through 2016 in the IFR and NPRM define the long-term framework
                    for health IT standards.

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       New Mexico Health Information Exchange Operational Plan


         b. NMHIC and MedPlus will be convening meetings in June (after ONC
             publishes the final rule in late Spring) to review these standards
             requirements and develop/share our plans to comply with them for
             Stage One of the evolution toward meaningful use.
         c. NMHIC and HealthXnet will convene a meeting in the March-April
             timeframe to discuss technical methods (such as single sign-on) to
             allow access to NMHIC and HealthXnet, and identify specific
             standards coordination requirements to support our common set of
             users in New Mexico.
         d. Since LCF is also the state lead for the New Mexico Regional
             Extension Center, NMHIC is becoming thoroughly familiar with the
             standards requirements to support meaningful use of electronic health
             records and we plan to use this knowledge to ensure that the NMHIC
             HIE network is using the standards to provide care coordination for
             healthcare providers that want to qualify for meaningful use incentives.
   2. The standards requirements of the SSA Disability Determination through the
      NHIN contract which we plan to implement during 2010 and 2011.
   3. The standards requirements (including GIPSE) that are part of the no-cost
      extension to the NHIN Option Year One contract related to public health
      reporting.

NMHIC, like many other HIE networks, faces the challenge of supporting advanced
healthcare informatics standards required to support care coordination as part of the
meaningful use of health IT and communication over the NHIN and, at the same
time, providing network services within our community to many providers that have
not yet migrated to the required standards. Supporting this spread of standards
versions will probably call for mechanisms to manage this environment as efficiently
as possible. It is not yet clear whether the methods of management will require
mapping or translation or some other method. Since NMHIC may be one of the
leading edge HIE networks, we would like to work closely with ONC to identify these
requirements and determine if methods developed by or with NMHIC could be
generalized to help all other HIE networks.

NMHIC would like to continue to provide feedback to ONC regarding health IT
standards. It would be helpful if ONC provides a structure or method to facilitate
such feedback as it did for the NHIN Trial Implementation contract.

Certifications
At this time, ONC has not set forth the criteria to certify HIE networks. When the
criteria are set forth, NMHIC will apply for HIE certification. Given the active
participation of NMHIC in the NHIN, and the preliminary certification criteria
established by CCHIT in early 2009, NMHIC is optimistic that it will probably meet
the criteria to be set forth by ONC.




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      New Mexico Health Information Exchange Operational Plan


O.6.2 Technical Architecture

NMHIC utilizes a federated architecture of independent (decentralized) databases
that are connected to share and exchange information. The federated architecture
provides a means to share data and transactions using messaging services,
combine information from several components, and coordinate activities among
autonomous components. Refer to section S.11.2, Technical Architecture, for more
information.

Statewide Availability of HIE
NMHIC has adopted a standards-based shared services model that enables the
integration of state and community level efforts. Since New Mexico is relatively
small (in terms of population) and NMHIC has been evolving since 2004, our state
has a relatively consistent approach to Health Information Exchange. State-level
shared services that exist today (within NMHIC) are:
     o     Master Person Index (MPI)
     o     Record Locator Service
     o     Terminology Services
     o     Electronic Claims Management
     o     Eligibility Verification
     o     Electronic Claims Status
     o     NMPIC / Electronic Prescribing
These services are described in section O.7.2, State Level Shared Services and
Repositories.

Based on federal standards and the NHIN implementation platform, New Mexico
Health Information Exchange enables an environment of interoperable services that
are both flexible and adaptable. Its architecture ensures statewide availability of
HIE among healthcare providers, public health and those offering service for patient
engagement and data access, as shown in Figure 5.




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       New Mexico Health Information Exchange Operational Plan


                                                               Delivery Systems,
                                                               Medical Groups,
                                                                     IPA‘s

                            State Agencies




Hospitals -
Metropolitan
 and Rural



                               Standards Based - NHIN, HITSP                              Service
                               New Mexico HIE Services                                   Availability

                               NMHIC Interface Connectivity                                 2009
                               Master Person Index & Record Locator Service                 2009
                               HealthXnet Eligibility Checking & Claims Processing          2009
                               Clinician Access to NMHIC Web Portal                         2010
                               E-prescribing                                                2010
                               Patient Summary for Continuity of Care                       2010
                               NM Regional Center / HITREC Technology Transfer              2010
                               Medicaid Claim & Encounter Information                       2011
                               Registry Reporting to Provider EHR's                         2011
                               Reporting to Public Health (EHR pactices only)               2011
                               Care Coordination via NHIN to VA, IHS, DoD                   2011


  Health Plans




                                                                               Regional Health
                 Ambulatory - EHR                                                Information
                  Meaningful Use                                                Organization
                    Adoption
                                                  Consumer - PHR
                                                       TBD




                            Figure 5. New Mexico HIE Services

Protection of Health Data
NMHIC, as the operator of the New Mexico Health Information Exchange, will
encourage adoption by its participants of the principals outlined in the HHS Privacy
and Security Framework for Electronic Exchange of Individually Identifiable Health
Information. These eight principles are set out to guide the actions of health-care
related persons and entities that participate in health information exchange. NMHIC
will comply with those principles that relate to NMHIC‘s role in health information
exchange. See section S.13.1, Privacy and Security, for a detailed description of
these principles.
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       New Mexico Health Information Exchange Operational Plan



NMHIC will apply the following safeguards to protect health data:

   All health care organizations who participate in the NMHIC network are required
    to sign a network subscription agreement that specifies their responsibilities as
    users and data providers, and the health information organization‘s
    responsibilities to protect the privacy and security of electronic health
    information.

    The NMHIC Subscription Agreement will contractually bind participants to
    compliance with its terms and conditions. As a result of stakeholder input, the
    NMHIC Subscription Agreement will be revised to provide enhanced obligations
    upon participants and the NMHIC health information exchange, including
    encryption and breach notification requirements.

   The NMHIC health information organization will be a business associate to
    covered entities that are participants in the NMHIC network, requiring the
    NMHIC health information organization to meet privacy and security standards
    for business associates as set out in the HIPAA regulations.
   Before an individual‘s electronic health information may be accessed on the
    NMHIC network, the user must be authorized (registered as a qualified user on
    the network) and then authenticated (verified that the users are who they say
    they are).
   The NMHIC authorized user may access an individual‘s electronic health
    information under only two circumstances:
       1. The user has acknowledged that the individual has given written consent
          to that health care provider to access the individual‘s electronic health
          information. (Duration of validity of consent to be determined)
       2. The user makes a representation of the existence of a medical
                                                 ak
          emergency. (Referred to as the ―bre the glass‖ process)
   The health information organization will maintain a record of each access to an
    individual‘s electronic health information to support investigation of improper
    access.
                                                        ak
    The network is able to support the emergency ―bre the glass‖ process only
    because all patient health records of participating health care providers are
    made available to the network by placing them on a secure computer that is
    located within the health care data provider‘s physical location.
   The NMHIC health information organization will require that all employees,
    contractors, and service providers adhere to the organization‘s policies on
    privacy and security. LCF will provide annual HIPAA Privacy and Security
    training to employees.
   NMHIC will have a policy and/or procedure indicating that LCF IT staff regularly
    review the audit logs for potential breaches of security or possible unauthorized
    access.
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       New Mexico Health Information Exchange Operational Plan


   A key part of our trust framework is the information technology in place to
    support privacy and security. Our privacy and security policies are supported
    within our NMHIC Clinician Portal application with comprehensive audit trails,
    attestment (and audit trails) of written patient consent, support for complex
    passwords with expiration periods, and required challenge questions for end
    users who are not on a trusted IP network. In addition, we will work with our
    partners to ensure comprehensive authorization of users prior to administration
    of user accounts.
   We have also implemented information security technologies including dual
    Cisco firewalls with intrusion prevention, Cisco‘s automated Monitoring and
    Reporting System (MARS), Cisco encrypted Virtual Private Networks (VPN) for
    connections with partners, Encryption of data at rest, access control audit
    systems for data center access auditing, Symantec End Point Protection for
    virus and spyware prevention, backup and recovery procedures with offsite
    storage, and robust physical security to protect our data processing equipment.


Business and clinical requirements determined via a multi-stakeholder
planning process

The New Mexico Health Information Collaborative includes stakeholders
representing health care providers, payers, employers, state agencies and
consumers. NMHIC collaborates with its stakeholders through scheduled meetings
to define and implement technical assistance, guidance, and information on best
practices to support and accelerate health care providers‘ efforts to become
meaningful users of Electronic Health Records (EHRs) to enhance delivery, quality,
and value of health care.

To date, the NMHIC Steering Committee, comprised of more than 30 community
organizations including state government, health care providers, payers, employers,
professional associations, public schools, and consumer representatives (refer to
Appendix B), was responsible for ensuring the exchange is operating effectively and
within the appropriate regulatory environment. Also, the Steering Committee
provided advice, guidance, and oversight for the development and operation of the
health information exchange.

By April 2010, the LCF/NMHIC Board of Directors will meet to establish criteria for
selection, and select Board members to form a NMHIC Oversight Committee to
provide direction for continuing development and operation of the New Mexico HIE,
with emphasis that HIE processes are business process and use-case driven, with
decision making that considers the needs of all NHIN stakeholders.

O.6.3 Technology Deployment

NMHIC will continue to identify and deploy shared services aggressively in
alignment with ―m eaningful use‖ as defined by the federal government. New Mexico
has substantial capabilities based on investments already made, and these
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investments will be leveraged into shared services available on a statewide basis.
See Figure 5, New Mexico HIE Services. Priority will be given to those services
identified in the ONC State HIE Cooperative Agreement Program: eligibility and
claims, electronic prescribing and medication history, laboratory results delivery,
public health reporting, quality reporting, and summary exchange.

Solutions to Develop HIE Capacity within New Mexico

The plan for 2010 is to provide clinician access to the NMHIC Web Portal in June
with 600 physicians in the state‘s two largest medical groups. NMHIC will also
expand to cover all hospitals in Albuquerque and Santa Fe, and begin to connect to
rural hospitals and medical practices. The expansion of NMHIC network services
across the state will be focused on hospitals as technology infrastructure hubs. Our
intent is to leverage these hospitals to host the technology required to support
physicians across that community. Given our role as the lead of the NM Health
Information Technology Regional Center (NMRC) initiative, we will have the
opportunity to help physicians deploy EHR systems in a manner that will integrate
centrally with the statewide HIE.

During 2010, NMHIC will establish close collaboration and technical integration with
HealthXnet which already provides eligibility and claims network services. E-
prescribing adoption will be promoted by NMMRA/NMPIC and NMHIC will add an e-
prescribing function that will enable clinician users to prescribe seamlessly from the
NMHIC web portal through SureScripts to retail and commercial pharmacies. The
strategy will also involve close coordination with the New Mexico HIT Regional
Center, so HIE network services to medical practices that serve rural and
underserved populations will include HIE capabilities in 2011. This will enable these
medical practices to demonstrate care coordination over the HIE, and therefore
meet the requirements for meaningful use of HIT.

Coordination between the Medical Assistance Division (Medicaid program) of the
New Mexico Human Services Department (HSD) and NMHIC has already begun.
The coordination will take place in several areas, including governance, finance,
and expansion of network services. This is described in more depth in Medicaid
Coordination, section S.5 of the New Mexico HIE Strategic Plan. An important
element of this coordination will be access to Medicaid‘s claim and encounter
information over the NMHIC HIE network to support meaningful use of Medicaid
providers as early as 2011.

The plan for 2011 also includes establishing care coordination through the NHIN to
local Veterans Administration Health facilities, the Indian Health Service, and the
military health system of the Department of Defense. This will close a major gap in
coordination of care for patients flowing between the VA, IHS, DOD, and private
sector health facilities within New Mexico

Compliance with HHS Standards and Implementation Specifications


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              New Mexico Health Information Exchange Operational Plan


       NMHIC has demonstrated the adoption of HHS standards through our participation
       and demonstrations within the NHIN project. Also, we have been involved
       extensively in the NHIN Testing Workgroup which is defining the process for testing
       compliance with NHIN standards. We anticipate that when an NHIN certification
       program exists we will be well positioned to achieve that certification. As soon as
       ONC establishes the criteria for HIE certification, selects an organization to perform
       the certification, and the certification process is tested and approved, NMHIC will
       apply for certification.


       New Mexico plans to continue our practice of sharing information and coordinating
       with the HIE initiatives in other states, as well as the national initiatives to support
       and coordinate the development of HIEs nationwide.

O.7.   Business and Technical Operations

       O.7.1 Current HIE Capacities

       NMHIC is the HIE network selected by the Governor as the state designated entity
       (SDE) for coordination of HIE networks statewide. The network currently has a
       community master patient index (MPI) with over one million unique identities within
       a state population of 2 million people. We anticipate the MPI will grow to nearly the
       full state population before the end of the second year of the project. NMHIC also
       has been processing transactions from the largest delivery system and the largest
       laboratory in the state and has processed over 25 million HL7 messages from those
       systems between April 2008 and December 2009. These volumes represent about
       half of the healthcare provided in New Mexico.

       Over the next twelve months, NMHIC plans to connect to the second largest
       integrated delivery system and laboratory and several other key hospitals. In
       addition, we will connect with communities across the state where information
       sharing and exchange exists at any level (i.e. disease registries, tumor registries,
       immunizations, etc.). At that time we expect the patient index and data available in
       the HIE will represent more than 80 percent of the physicians practicing in the state.

       O.7.2 State level shared services and repositories

       State-Level Shared Services
       We anticipate creating/enhancing several state-level shared services during the
       next four years. Since New Mexico is relatively small (in terms of population) and
       NMHIC has been evolving since 2004, our state has a relatively consistent
       approach to Health Information Exchange. The shared services that exist today
       (within NMHIC) are as follows:

       Statewide Master Person Index (MPI) – The NMHIC MPI has been populated since
       April of 2008 and as of December 2009 represents nine New Mexico hospitals, a
       400-physician medical practice, and the largest laboratory in the state. The MPI

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currently has over one million unique patient identities compared to the state
population of 2 million residents. In early 2010 we are adding four additional
hospitals, a 200-physician medical practice, and the second largest laboratory in the
state and expect the number of unique patients in the MPI to exceed 1.5 million by
the end of 2010.

Statewide Record Locator Service – The NMHIC Record Locator Service is the
NMHIC technology that locates all available records in the network for every patient
in the MPI. This information is then presented in the NMHIC Clinician Portal
(available in June 2010) or can be integrated into a physician‘s Electronic Medical
Record system (planned to be available in 2011).

NMHIC Terminology Services – one of the significant challenges in state/nationwide
health information exchange will be ensuring the adherence to national terminology
standards. The majority of today‘s healthcare organizations are using non-standard
terminology. NMHIC and others participating in the NHIN Trial Implementations
Project have been required to accumulate non-standard data across a community
and translate and consolidate that into data that meets national standards. As we
progress, it is expected that NMHIC will facilitate translation at the various source
systems across the state.

HealthXnet – NMHIC will leverage this existing statewide web portal for electronic
eligibility, claims status and claims transactions. Mechanisms will be developed
collaboratively between NMHIC and HealthXnet to enable users of both systems to
easily access appropriate functionalities on either system.

NMPIC / Electronic Prescribing – The New Mexico Medical Review Association
(NMMRA) is an Albuquerque-based, non-profit, physician-sponsored organization.
NMMRA has served continuously as the state‘s only federally contracted Medicare
Quality Improvement Organization (QIO) since 1984. NMMRA also serves as the
state‘s Medicaid External Quality Review Organization.
In 2006, NMMRA created the New Mexico Prescription Improvement Coalition
(NMPIC), which began with 28 organizations and currently involves 185
stakeholders including the New Mexico Pharmacists Association; the University Of
New Mexico College Of Pharmacy; major health plans; the New Mexico Human
Services Department, Medical Assistance Division; New Mexico Department on
Aging and other health care providers. The coalition‘s work has focused on four
major areas affecting the Medicare population: e-prescribing; drugs to be avoided in
the elderly; annual monitoring for patients on persistent medications; and
medication therapy management to expand pharmacist activities in providing face-
to-face information and education to patients about their medications.
NMPIC‘s e-prescribing project promotes the adoption of e-prescribing to enhance
medication management and patient safety in participating locations. In its first
phase, which involved more than 100 physicians practicing in 19 communities
throughout the state, there was success both in numbers of active e-prescribers and
data reporting. Participating sites are actively using their e-prescribing solutions to
track and report data on patient eligibility, medication history, drug utilization, drug-
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       to-drug interactions, prevented/reversed prescriptions as a result of drug alerts, and
       dispensing errors detected by the e-prescribing solutions. Based on the success of
       phase1, phase 2 was launched July 1, 2009 and involves an additional 90
       providers. A Phase 2 added activity involves NMMRA evaluating participants‘
       efficiency in using their e-prescribing solutions, looking at changes in prescribing
       patterns and focusing on utilization and patient safety.

       O.7.3 Standard Operating Procedures for HIE

       Standard Operating Procedures for health information exchange will be required
       across the continuum. Policies and procedures will be needed within user
       healthcare organizations to define acceptable use, patient consent, and workflow
       within the environment. As data providers there will be required Network
       Subscription Agreements (NSAs) and Data Use and Reciprocal Support
       Agreements (DURSAs) that will be translated into policies and procedures to ensure
       appropriate use and compliance. In addition, NMHIC has many policies and
       procedures that will define the day to day operations as well as compliance and
       facilitation of everything included above.

       Since LCF has existed since the 1990s and NMHIC since 2004, many of the
       policies and procedures needed to operate our business reliably and securely
       already exist. We have worked actively to create additional HIE specific policies and
       procedures over the last few years and plan to continue in the coming years. In
       addition, we will collaborate and synchronize procedures with HealthXnet as we
       work to include their administrative functions within the statewide HIE network.

O.8.   Legal / Policy

       O.8.1 Establish Requirements

       The NMHIC Privacy and Security Officer will have primary responsibility for
       compliance by the NMHIC health information exchange with federal and state legal
       and policy requirements. The NMHIC Privacy and Security Officer will be an
       individual with the appropriate knowledge and training to assess and implement
       policies and procedures that are in compliance with state and federal laws. To the
       extent necessary, the NMHIC Privacy and Security Officer will engage the NMHIC
       legal officer for assistance and guidance.

       The NMHIC Privacy and Security Officer will develop policies and procedures to
       ensure legal compliance by the NMHIC health information exchange, including
       policies and procedures related the operation of the system and the monitoring of
       the system for compliance by participants. The Privacy and Security officer will
       report on a regular basis to the President and Executive Director of the NMHIC
       health information exchange, as well as to the governing board.




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O.8.2 Privacy and Security Harmonization

The work previously done by LCF in analyzing state laws affecting in-state and out-
of-state disclosures of electronic health information through a health information
exchange, in assisting in the passage of the New Mexico Electronic Medical
Records Act, and in collaborating with stakeholders across the state in the
development of the NMHIC health information exchange has significantly
contributed to an increased understanding by stakeholders of privacy and security
requirements. While there is no quantifiable data available to support the
conclusion, LCF believes that the efforts to establish an electronic health
information exchange have resulted in a re-examination by stakeholders of their
existing policies and procedures, both with respect to compliance with the HIPAA
Regulations and with respect to more stringent state law requirements related to
specially-protected health information such as HIV/AIDs and mental health
information. Consequently, LCF believes that the level of awareness of privacy and
security issues by stakeholders statewide has already been significantly improved
and, in addition, that the policies and procedures of the stakeholders are becoming
more standardized across stakeholders.

Each Participant in the NMHIC health information exchange will be required to
execute a standardized NMHIC Subscription Agreement. Under the NMHIC
Subscription Agreement, Participants will be required to utilize the NMHIC health
information exchange in compliance with federal and state laws related to the
privacy and security of health information and the policies and procedures of the
health information exchange. As more Participants become a part of the health
information exchange, awareness of and compliance with privacy and security
requirements will become more standardized.

NMHIC intends to include provisions in the NMHIC Subscription Agreement and to
adopt policies and procedures that will foster standardization of privacy and security
policies across participants. For example, as a result of comments received at
recent stakeholder meetings, NMHIC is considering requiring that all participants
meet the federal encryption standards with respect to their electronic health
information.

With respect to coordination and consistency on an interstate basis, LCF intends to
continue to participate in the development of the NHIN.

O.8.3 Federal Requirements

New Mexico has a high concentration of federal health facilities for the state's
population because several military bases reside in New Mexico; the VA and its
rural clinics are essential safety net care in underserved counties and the state has
a high proportion of veterans; and Indian Health Services facilities provide care
across a wide geographic area which includes many Indian tribal lands and pueblo
organizations. For these reasons, NMHIC activities during NHIN involved several
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collaborations and demonstrated exchanges with federal entities. That participation
fostered technical, organizational and legal practices that will speed HIE between
federal facilities and other medical care systems in New Mexico. Two LCF
individuals participated in Data Use and Reciprocal Services Agreement (DURSA)
development over the last 24 months, and the NMHIC Director of Medical
Informatics was a career VA employee before joining the LCF team, so the issues
faced by federal health care practitioners and HIE advocates will receive
appropriate attention.




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                                         Appendix A:
                                   Glossary of Terms

American Recovery and Reinvestment Act of 2009 (ARRA) – A $787.2 billion stimulus
measure, signed by President Obama on February 17, 2009, that provides aid to states
and cities, funding for transportation and infrastructure projects, expansion of the Medicaid
program to cover more unemployed workers, health IT funding, and personal and business
tax breaks, among other provisions designed to ―stim    ulate‖ the economy.

Centers for Medicare and Medicaid Services (CMS) – A federal agency within the
United States Department of Health and Human Services that administers the Medicare
program and works in partnership with state governments to administer Medicaid, the
State Children‘s Health Insurance Program (SCHIP), and health insurance portability
standards.

Certification Commission for Healthcare IT (CCHIT) – A recognized certification body
(RCB) for electronic health records and their networks. It is an independent, voluntary,
private-sector initiative, established by the American Health Information Management
Association (AHIMA), the Healthcare Information and Management Systems Society
(HIMSS), and The National Alliance for Health Information Technology.

Confidentiality – The obligation of a person or agency that receives information about an
individual, as part of providing a service to that individual, to protect that information from
unauthorized persons or unauthorized uses. Confidentiality also includes respecting the
privacy interest of the individuals who are associated with that information.

Consent – The permission granted by an authorized person that allows the provider,
agency or organization to release information about a person. The authorized person
may be the subject of the information or they may be a designated representative such as
a parent or guardian. Law, policy and procedures, and business agreements guide the use
of consent.

Covered Entity – As defined by HIPAA Privacy/Security/Enforcement regulations: a
                      h
covered entity is ―a ealth plan; healthcare clearinghouse; a healthcare provider who
transmits any health information in electronic form in connection with a transaction covered
by HIPAA.‖

Data Use Agreement – An agreement between a health provider, agency or organization
and a designated receiver of information to allow for the use of limited health information
for the purpose of research, public health or health care operations. The agreement
assures that the information will be used only for specific purposes.

Data Use and Reciprocal Support Agreement (DURSA) – a mutiparty agreement
around rights and responsibilities in a health information exchange; a comprehensive
agreement that would govern the exchange of health data through the Nationwide Health
Information Network.
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Doctor's Office Quality Information Technology (DOQ-IT) – Promotes the adoption of
electronic health record (EHR) systems and information technology (IT) in small-to-
medium sized physician offices with a vision of enhancing access to patient information,
decision support, and reference data, as well as improving patient-clinician
communications.

Electronic Health Record (EHR) – A real-time electronic record of health-related
information on an individual that conforms to nationally recognized interoperability
standards and that can be created, managed, and consulted by authorized clinicians and
staff across more than one health care organization – a patient health record with access
to evidence-based decision support tools that can be used to aid clinicians in decision
making. The EHR can automate and streamline a clinician's workflow, ensuring that all
clinical information is communicated. It can also prevent delays in response that result in
gaps in care. The EHR can also support the collection of data for uses other than clinical
care, such as billing, quality management, outcome reporting, and public health disease
surveillance and reporting.

Electronic Medical Records (EMR) – Electronic records of health-related information on
an individual that can be created, gathered, managed, and consulted by authorized
clinicians and staff within one health care organization.

Electronic Prescribing (e-Prescribing) – A type of technology with which physicians use
handheld or personal computer devices to review drug and formulary coverage, and to
transmit prescriptions to a printer or a local pharmacy. E-prescribing software can be
integrated into existing clinical information systems to enable physician access to patient-
specific information to screen for drug interactions and allergies.

Federal Communications Commission (FCC) – The United States government agency
charged with regulating interstate and international communications by radio, television,
wire, satellite and cable.

Federally-Qualified Health Center (FQHC) – A ―sa net‖ provider such as community
                                                       fety
health center, public housing center, or outpatient health program funded by the Indian
Health Service, and programs serving migrants and the homeless. FQHCs provide their
services to all persons regardless of ability to pay, and charge for services on a community
board approved sliding-fee scale that is based on patients‘ family income and size.
FQHCs are funded by the federal government under Section 330 of the Public Health
Service Act.

Health and Human Services (HHS), U.S. Department of – The federal government
agency responsible for protecting the health of all Americans and providing essential
human services. HHS, through CMS, administers the Medicare (health insurance for
elderly and disabled Americans) and Medicaid (health insurance for low-income people)
programs, among others.


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Healthcare Provider – A person or organization that furnishes, bills, or is paid for
healthcare in the normal course of business.

Health Insurance Portability and Accountability Act (HIPAA) – Enacted by Congress in
1996 Title I of HIPAA protects health insurance coverage for workers and their families
when they change or lose their jobs. Title II of HIPAA, known as the Administrative
Simplification provisions, requires the establishment of national standards for electronic
health care transactions and national identifiers for providers, health insurance plans, and
employers. The Administration Simplification provisions also address the security and
privacy of health data. The standards are meant to improve the efficiency and
effectiveness of the nation‘s health care system by encouraging the widespread use of
electronic data interchange in the U.S. health care system.

Health Information for Economic and Clinical Health (HITECH) Act – Refers
collectively to the health information technology provisions included in Title XIII of Division
A and Title IV of Division B of the ARRA.

Health Information Exchange (HIE) – The electronic movement of health-related
information among organizations according to nationally recognized standards.

Health Information Organization (HIO) – An organization that oversees and governs the
exchange of health-related information among organizations according to nationally
recognized standards. Research Triangle Institute International (RTI) is under contract
from the U.S. Department of Health and Human Services (HHS) to work with the Office of
the National Coordinator (ONC) for Health Information Technology to implement this
national collaborative effort.

Health Information Security and Privacy Collaboration (HISPC) – A national
collaborative effort to address privacy and security policy questions affecting interoperable
health information exchange (HIE).

Health Information Technology (HIT) – The application of information processing
involving both computer hardware and software that deals with the storage, retrieval,
sharing, and use of health care information, data, and knowledge for communication and
decision making.

Health Information Technology Regional Extension Center (HITREC) – The Health
Information Technology Extension Program provides grants for the establishment of
Health Information Technology Regional Centers that will offer technical assistance,
guidance and information on best practices to support and accelerate health care
providers‘ efforts to become meaningful users of Electronic Health Records (EHRs). The
consistent, nationwide adoption and use of secure EHRs will ultimately enhance the
quality and value of health care.

Healthcare Information Technology Standards Panel (HITSP) – A multi-stakeholder
coordinating body designed to provide the process within which stakeholders identify,
select, and harmonize standards for communicating and encouraging broad deployment
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and exchange of healthcare information throughout the healthcare spectrum. The Panel‘s
processes are business process and use-case driven, with decision making based on the
needs of all NHIN stakeholders. The Panel‘s activities are led by the American National
Standards Institute (ANSI), a not-for-profit organization that has been coordinating the U.S.
voluntary standardization system since 1918.

HL7 (Health Level Seven) – American National Standards Institute (ANSI) accredited
standards for the exchange, management and integration of electronic healthcare
information. HL7 is the most widely used messaging standard and includes fields for:
diagnostic results, notes, referrals, scheduling information, nursing notes, problems, and
clinical trials data.

Independent Practice Association (IPA) – An association of independent physicians, or
other organization that contracts with independent physicians, and provides services to
managed care organizations on a negotiated per capita rate, flat retainer fee, or negotiated
fee-for-service basis. The IPA assembles physicians in self-directed groups within a
geographic region to invent and implement healthcare solutions, form collaborative efforts
among physicians to implement these programs, and to exert political influence upward
within the medical community to effect positive change.

Informatics – The application of computer science and information science to the
management and processing of data, information, and knowledge.

Interface – A means of interaction between two devices or systems that handle data.

Interoperability – Interoperability is the ability of health information systems to work
together within and across organizational boundaries, in order to advance the effective
delivery of health care for individuals and communities, i.e., a property referring to the
ability of diverse systems and organizations to inter-operate. The term is often used in a
technical ‗sy stems engineering sense‘, or alternatively in a broad sense, taking into
account social, political, and organizational factors that impact system to system
performance. Process, policy, and technology in transition. Current electronic health
record usage is primarily centered on the needs of authorized clinicians and staff for
information regarding the patients treated within their organization. However, individuals
seeking health care services typically go to many care providers who are not affiliated with
one another. Each provider organization creates a separate record for the patient‘s care
experiences. Without the ability to view multiple records on an individual from the multiple
places where records are created, clinicians have an incomplete view of the available
information that could well influence diagnosis, prevention and treatment. The solution
being pursued in health care is to enable the aggregation of health-related information into
one record focused around a person‘s comprehensive health history rather than around
one provider‘s limited view of that history, and to authorize access to that record wherever
and whenever a person receives care. To accomplish this higher level of information
aggregation and sharing, all the contributing organizations must be able to send and
receive information using standards that facilitate the interoperable exchange of health-
related information. Electronic records capable of employing such standards for
interoperability, therefore, are pivotal to achieving patient-focused organization of health-
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related information. Electronic records that do not have this capability will be limited in their
ability to keep pace with the future direction of health care.

Lovelace Clinic Foundation (LCF) – The 501(c)(3) non-profit health research
organization that created, staffs, and operates the New Mexico Health Information
Collaborative.

Master Patient Index (MPI) – An accurate master patient (person) index, in electronic
format, may be considered the most important resource in a Health Information Exchange
(HIE) because it is the link for positively tracking patient, person, or member activity within
an organization, or across organizations, and across patient care settings. The MPI
identifies all patients who have been treated in a facility or across facilities and lists a
unique medical record or identification number associated with each individual.

Meaningful EHR User – As defined in the ARRA, a Meaningful EHR User meets the
following requirements: (i) use of a certified EHR technology in a meaningful manner
which includes the use of electronic prescribing; (ii) use of a certified EHR technology that
is connected in a manner that provides for electronic exchange of health information to
improve the quality of health care; and (iii) use of a certified EHR technology to submit
information on clinical quality and other measures as selected by the Secretary of HHS.

National Committee for Quality Assurance (NCQA) – NCQA is a private not-for-profit
organization dedicated to improving health care quality. Employers and consumers use
quality information provided by the NCQA to make more informed health care choices.
Physicians, health plans and others use the NCQA information to identify opportunities for
improvement and make changes that enhance the quality of patient care.

National Committee on Vital Health Statistics (NCVHS) – NCVHS is an external
advisory committee to the Secretary of the Department of Health and Human Services and
to the DHHS Data Council. It has developed vital records reporting systems, uniform data
sets, and it was tasked with oversight under HIPAA. In 1996, the committee was re-
chartered to include more direct focus on data standardization and privacy.

Nationwide Health Information Network (NHIN) – The NHIN is a secure backbone
concept that links existing regional HIEs through a standard set of "core services" that
allows one HIE to share data with another HIE. This effectively creates a "network of
networks" that spans the Nation and provides stakeholders (payers, consumers, providers,
policymakers, and administrators) with the ability to access data from across institutions,
States, and repositories.

New Mexico Health Information Collaborative (NMHIC) – The name of the Health
Information Exchange network for New Mexico, and the name of the collaborative that
supports the development of the network.

New Mexico Primary Care Association (NMPCA) – A statewide membership
organization representing 20 organizations with over 150 medical, dental, and school-
based clinical sites in 90 communities throughout New Mexico. Fifteen of these
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                    New Mexico HIE Strategic and Operational Plans


organizations are Federally Qualified Health Centers and receive federal funding through
HRSA.

New Mexico Regional Extension Center (NMREC) – The proposed HIT Regional
Extension Center for the State. LCF/NMHIC has been invited by the Office of the National
Coordinator for Health Information Technology to submit a full application in response to
the FOA "Health Information Technology Extension Program: Regional Centers
Cooperative Agreement Program."

Office of the National Coordinator (ONC) – Serves as principal advisor to the Secretary
of HHS on the development, application, and use of health information technology;
coordinates HHS‘s health information technology policies and programs internally and with
other relevant executive branch agencies; develops, maintains, and directs the
implementation of HHS‘ strategic plan to guide the nationwide implementation of
interoperable health information technology in both the public and private health care
sectors, to the extent permitted by law; and provides comments and advice at the request
of OMB regarding specific Federal health information technology programs. ONC was
established within the Office of the Secretary of HHS in 2004 by Executive Order 13335.

Opt in / Opt out – The provision or removal of consent or authorization that a patient
provides regarding the use of their health information

Public Health Information Network (PHIN) – A national initiative of the Centers for
Disease Control and Prevention (CDC) to enable real-time data exchange between
organizations for the promotion of interoperability, collaboration, rapid dissemination of
critical information, and computer statistical analysis in the many organizations that
participate in public health.

Personal Health Record (PHR) – An electronic record of health-related information on an
individual that conforms to nationally recognized interoperability standards. An ideal PHR
would provide a complete and accurate summary of the health and medical history of an
individual by gathering data from many sources and making this information accessible
online to anyone who has the necessary electronic credentials to view the information.

Portal – A point of access to information on the World Wide Web. Portals present
information from diverse sources in a unified way. Popular portals include MSN, Yahoo
and AOL. Aside from the search engine standard, Web portals offer other services such as
news, stock prices, infotainment and various other features. Portals provide a way for
enterprises to provide a consistent look and feel with access control and procedures for
multiple applications, which otherwise would have been different entities altogether.

Quality of Care – The degree to which health services for individuals and populations
increase the likelihood of desired health outcomes and are consistent with current
professional knowledge. Quality can be defined as a measure of the degree to which
delivered health services meet established professional standards and judgments of value
to consumers.


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Quality Improvement Organization (QIO) – An entity that works with consumers,
physicians, hospitals and other caregivers to monitor the appropriateness, effectiveness,
and quality of care provided to Medicare beneficiaries. QIOs are private contractor
extensions of the federal government that work under the auspices of the U.S. Centers for
Medicare and Medicaid Services (CMS). In recent years, QIOs have undertaken to
facilitate continual improvement of health care services within their constituent
communities in addition to their original and ongoing statutory audit/inspection role of
medical peer review.

Record Locator Service (RLS) – Part of an infrastructure that might be used in an
interoperable health information environment. The RLS enables patient authorized
information to be found, but does not allow access to the actual information the records
may contain. This allows records to be located and transferred (if authorized), while
preserving the security, privacy, and the autonomy of the participating entities.

Regional Health Information Organization (RHIO) – A health information organization
that brings together health care stakeholders within a defined geographic area and
governs health information exchange among them for the purpose of improving health and
care in that community.

State-Designated Entity (SDE) – As defined in the ARRA, a State-Designated Entities
(SDE) may be designated by a State as eligible to receive grants under Section 3013 of
the ARRA. To qualify as an SDE, an entity must be a not-for-profit entity with broad
stakeholder representation on its governing board; demonstrate that one of its principal
goals is to use information technology to improve health care quality and efficiency through
the authorized and secure electronic exchange and use of health information; adopt
nondiscrimination and conflict of interest policies that demonstrate a commitment to open,
fair, and nondiscriminatory participation by stakeholders; and conform to other
requirements as specified by HHS.

Telehealth – The use of telecommunications technologies and electronic information to
support long-distance clinical health care, patient and professional health-related
education, or public health and health administration.

U.S. Department of Health and Human Services (HHS) – The federal government
agency responsible for protecting the health of all Americans and providing essential
human services. HHS, through CMS, administers the Medicare (health insurance for
elderly and disabled Americans) and Medicaid (health insurance for low-income people)
programs, among others.

Use Case – A technique to identify, clarify, and organize requirements of a new system or
software change. Each use case provides one or more scenarios that convey how the
system should interact with the end user or another system to achieve a specific business
goal. The use case should contain all system activities that have significance to the users.
A use case can be thought of as a collection of possible scenarios related to a particular
goal.


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XML (eXtensible Markup Language) – A general purpose markup language adaptable to
many different kinds of data. XML is a set of rules for encoding documents electronically,
used extensively in modern solutions to transfer health data between different and
incompatible computer systems. XML‘s design goals emphasize simplicity, generality, and
usability over the Internet. Although XML‘s design focuses on documents, it is widely used
for the representation of arbitrary data structures, for example in web services.




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                                       Appendix B:
NMHIC Stakeholders by Type and NMHIC Steering Committee Members
                                                                               Steering
                            NMHIC Stakeholders                                Committee
                                                                               Member
 Healthcare Purchasers & Employers:
        Albuquerque Hispano Chamber of Commerce
        Association of Commerce and Industry of NM
        Bank of Albuquerque
        Don Chalmers Ford                                                       Yes
        First Community Bank                                                    Yes
        Four Thought Group                                                      Yes
        Greater Albuquerque Chamber of Commerce
        HealthXnet
        Intel Corporation                                                       Yes
        Johnson Associates (consulting firm)                                    Yes
        Public Service of New Mexico (PNM)
        Sandia National Laboratories                                            Yes
        Semantic Mesa Technology
        Technology Ventures Corporation
        Wells Fargo Bank
 Healthcare Providers:
        Albuquerque Indian Health Center
        First Choice Community Healthcare (safety net provider)                 Yes
        Heart Hospital of New Mexico
        Holy Cross Hospital (Taos)                                              Yes
        Lovelace Health Systems                                                 Yes
        New Mexico Veterans Affairs Health Care System
        New Mexico Heart Institute
        (cardiology specialty physician group)
        NM Primary Care Association (rural safety net provider association)     Yes
        Presbyterian Healthcare Services                                        Yes
        SED Laboratory                                                          Yes
        Taos Medical Group
        TriCore Laboratory                                                      Yes
        UNM Center for Telehealth                                               Yes
        UNM Hospital
 Health Plans:
        Blue Cross/Blue Shield                                                  Yes
        Lovelace Health Plan
        Molina Health Care of NM (Medicaid insurer)                             Yes
        New Mexico Mutual
        Presbyterian Health Plan                                                Yes
        United Healthcare                                                       Yes
 Professional Associations:
        Greater Albuquerque Medical Association                                 Yes
        New Mexico Medical Society                                              Yes

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                                                                              Steering
                            NMHIC Stakeholders                               Committee
                                                                              Member
       NM Coalition for Health Information Leadership Initiatives               Yes
       New Mexico Hospital Association                                          Yes
       NM Takes on Diabetes (cooperative alliance of insurers and health
                                                                               Yes
       plans)
       NM Telehealth Alliance                                                  Yes
       RIOSNET (physician primary care alliance)
       Sangre de Cristo Community Health Partnership                           Yes
Health Professions, Schools, Universities, Colleges:
       Albuquerque Public Schools (secondary schools)                          Yes
       Project ECHO – University of New Mexico
       Rio Rancho Schools                                                      Yes
       UNM Health Sciences Center                                              Yes
       UNM School of Management                                                Yes
Public Health Agencies:
       Health Policy Commission (state body to collect health service and
                                                                               Yes
       policy information)
       New Mexico Department of Health                                         Yes
       NM State Legislature
       Office of Governor Bill Richardson
Consumer/QIO Organizations:
       New Mexico Retiree Health Care                                          Yes
       New Mexico Medical Review Association                                   Yes
Charitable Organizations:
       McCune Charitable Foundation
       United Way
Clinical Researchers:
       Lovelace Clinic Foundation                                              Yes
Other HIT Users and Care Agents:
       Support and clerical staff of providers
       Patient eligibility verification and health claims processing staff
Health Information Technology Vendors:
       MedPlus




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                                        Appendix C:
       Summary of New Mexico Electronic Medical Record Act of 2009

Proposal – February 2009

New Mexico Governor Bill Richardson proposed an initiative to promote the use of
electronic medical records (EMR) and electronic health information exchange (HIE), and
institute new privacy protections over the use of electronic health care information. The
EMR Act of 2009 (New Mexico Senate Bill 278) allows individuals to opt-out of HIE and
to request a log indicating who has accessed their medical record and for what purpose.
Upon passage, the bill is designed to:

      Establish EMRs as the legal equivalent of existing paper-based records;
      Prohibit a provider, health care institution, HIE or health care purchaser from using
       or disclosing health care information in an individual's EMR to another person
       without the consent of the individual;
      Prohibit access to demographic information, information about the location of the
       individual's EMR or information in an individual's EMR except in connection with the
       treatment of the individual or as permitted by the consent of the individual;
      Require a HIE maintaining a record locator service to maintain an audit log of
       persons obtaining access to information in the record locator service and make it
       available on the request of an individual whose health care information is the
       subject of the audit log;
      Allow individuals to exclude their demographic information and information about
       the location of their EMR; and
      Protect record locator services, HIEs, health care institutions and providers from
       liability for any harm to the individual caused by the exclusion of an individual's
       information if the individual requests to exclude all of their information.

The intent of the legislation is to encourage health care providers to use EMRs knowing
that their patients‘ information will remain confidential.

Passage into Law – April 2009

The New Mexico Electronic Medical Records Act (Senate Bill 278 or the Act) was
introduced, passed, and signed into law on April 2, 2009. As proposed, the Act:

       Provides for the use, disclosure, and protection of electronic medical records;
       Provides that electronic medical records and the electronic signatures therein
        satisfy any requirements for written medical records, signatures pertaining to
        medical records, or the retention of medical records;
       Prohibits the use and disclosure of healthcare information in a person's electronic
        medical record without the consent of the individual except as authorized by state
        or federal law; and
       Addresses the disclosure of information to a record locator service as defined by
        the Act.

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                     Appendix D:
New Mexico Electronic Medical Records Act of 2009




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Appendix D cont’d: New Mexico Electronic Medical Records Act of 2009




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Appendix D cont’d: New Mexico Electronic Medical Records Act of 2009




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Appendix D cont’d: New Mexico Electronic Medical Records Act of 2009




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Appendix D cont’d: New Mexico Electronic Medical Records Act of 2009




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Appendix D cont’d: New Mexico Electronic Medical Records Act of 2009




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Appendix D cont’d: New Mexico Electronic Medical Records Act of 2009




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Appendix D cont’d: New Mexico Electronic Medical Records Act of 2009




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Appendix D cont’d: New Mexico Electronic Medical Records Act of 2009




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Appendix D cont’d: New Mexico Electronic Medical Records Act of 2009




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Appendix D cont’d: New Mexico Electronic Medical Records Act of 2009




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Appendix D cont’d: New Mexico Electronic Medical Records Act of 2009




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        New Mexico HIE Strategic and Operational Plans


                                   Appendix E:

                  New Mexico House Bill 229 / Senate Bill 199


   Southwest Telehealth Access Grid
 Conceptual Network Map for New Mexico

    Shiprock                                                         Raton

                  Farmington
                                  Holy Cross
                                   Hospital                     Christus St. Vincent
                                                              Regional Medical Center

   NM Primary Care
     Association
                                                               Santa Fe

                                                                          Presbyterian Medical
                                                                               Services

                                                Albuquerque


Lovelace Clinic
 Foundation
                          CHECSNet
                                                                         State of NM
                                                                       GSD Fiber and
                                                                      Digital Microwave
                                              Soccoro




    Sangre de Cristo
      Community
   Health Partnership                                          UNM/NMIMT/NMSU
                                                                 Fiber Network

                                            Las Cruces



                                               El Paso




                               Internet 2
                                 National Lambda Rail

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                                                    Appendix F:



      SWTAG is a “Network of Networks”
Southwest Telehealth Access Grid, an FCC Rural Healthcare Pilot Program
project, is a collaborative project that includes Arizona and the Southwest IHS
Area Offices; Albuqerque, Navajo, Phoenix, and Tucson, and several New
Mexico stakeholders. SWTAG is being designed to support HIE and
development of a model for the NHIN/PHIN.


                                                   Southwest Telehealth Access Grid
                                                       Conceptual Network Map



                                                                   Shiprock                                           Raton
                                               Navajo Area IHS                              Holy Cross
                                                                              Farmington
                                                                                             Hospital


                                Flagstaff                                                                                     Presbyterian Medical
                                                                                                                                   Services

                                                                        Albuquerque                              Santa Fe
                                                         Navajo
                                                          Area
                                                                          Area IHS
          Phoenix Area
              IHS                                        Office
                                                                                                    Albuquerque
                                                                                                                 State of NM
                                                                                                                   Fiber and
                                                                                                              Digital Microwave
                                                                       CHECSNet                                                        NM Dept of
                    Phoenix                                                                                                             Health
                              Arizona Telemed Program
                                                                                                   Soccoro
                                                                                                                                 NM Dept of
                                                                                                                                 Corrections
                     Tucson                                          Sangre de
     Tucson Area
         IHS                                                           Cristo
                                                                      Health
                                                                                                                 UNM/NMIMT/NMSU
                                                                                                 Las Cruces        Fiber Network


                                                                                                    El Paso




                                                                                       Regional Backbone Providers

                                  Internet 2
                                  National Lambda Rail                                     Telehealth Service/Network Providers




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                                            Appendix G:
                       NMHIC HIE Subscription Agreement
                                          (DRAFT 8-21-2009)

                              New Mexico Health Information Collaborative
                                    Health Information Exchange
                                       Subscription Agreement

   This New Mexico Health Information Collaborative Health Information Exchange Subscription
   Agreement (this "Agreement") is made between Lovelace Clinic Foundation, a New Mexico
   nonprofit corporation, with a principal place of business located at 2309 Renard Place SE, Suite 103,
   Albuquerque, New Mexico 87106 (“LCF”) and the following Person (the “Participant”):


               Participant:




               Type of Person:
               (i.e. corporation, individual, etc.)


               Address:




       Effective on the date that the last of LCF and Participant sign this Agreement, in consideration of
   the mutual promises, covenants, and agreements contained herein, LCF and Participant agree:


       1. Definitions. Capitalized words and phrases used in this Agreement shall have the meaning
   ascribed to them in the attached Glossary.


         2. Background. Using the NMHIC Information System, LCF has developed and operates a
Health Information Exchange in New Mexico, known as NMHIC. NMHIC has been designated by the
State of New Mexico as the New Mexico Health Information Exchange. Participant desires to utilize the
NMHIC Information System to improve the quality and cost-effectiveness of Health Care in New
Mexico, all in accordance with the terms and conditions of this Agreement.

       3. LCF as Business Associate of Participant. With respect to the performance of its duties and
   obligations under this Agreement, LCF is a Business Associate of the Participant and LCF agrees as
   follows:
                      New Mexico HIE Strategic and Operational Plans

                  (a) LCF shall not Use or Disclose Protected Health Information other than as permitted or
required by this Agreement or as Required By Law. LCF shall implement administrative, physical, and
technical safeguards that reasonably and appropriately protect the confidentiality, integrity, and
availability of the Electronic Protected Health Information that it creates, receives, maintains or transmits
as required by the HIPAA Regulations. LCF shall immediately document and report to Participant any
Security Incident of which it becomes aware in accordance with the NMHIC Policies and Procedures.

               (b) LCF shall use appropriate safeguards to prevent Use or Disclosure of any Protected
Health Information other than as provided for under this Agreement.

                (c) LCF shall immediately document and report to Participant any Use or Disclosure of
Protected Health Information not permitted by this Agreement of which it becomes aware.

                (d) LCF shall ensure that any agent, including a subcontractor, to whom it provides
Protected Health Information, agrees to the same restrictions and conditions that apply through this
Agreement to LCF with respect to such information.

                 (e) LCF shall make any amendments or corrections to any Protected Health Information
created or received by it from or on behalf of Participant that the Participant directs or agrees to pursuant
to the HIPAA Regulations.

                (f) LCF shall make available to Participant any Protected Health Information received
from, or created or received by it on behalf of the Participant, necessary for Participant to respond to a
request by an Individual for access to, inspection and for a copy of Protected Health Information of the
Individual in compliance with the HIPAA Regulations.

                 (g) LCF shall make available internal practices, books and records, including policies and
procedures relating to the Use and Disclosure of Protected Health Information received from, or created
or received by it on behalf of the Participant to the Participant, or to the Secretary, for purposes of the
Secretary determining the Participant’s compliance with the HIPAA Regulations.

                (h) LCF agrees to document such disclosures of Protected Health Information and
information related to such disclosures as would be required for the Participant to respond to a request by
an Individual for an accounting of disclosures of Protected Health Information in accordance with the
HIPAA Regulations and the provisions of the HITECH Act.

                 (i) Upon termination of this Agreement, LCF shall return or destroy all Protected Health
Information received from, or created or received by LCF on behalf of the Participant that LCF maintains
in any form, and retain no copies of such information, or to the extent that such return or destruction is not
feasible, LCF shall extend the protections of this Agreement to the information and limit further Uses and
Disclosures to those purposes that make the return or destruction of the information infeasible.

                (j) LCF shall comply with all duties and obligations imposed upon LCF as a Business
Associate under the provisions of the HIPAA Regulations and the HITECH Act.

                  (k) In addition to the foregoing, if requested by Participant, LCF and Participant shall
enter into Participant’s form business associate agreement.

        4. Subscription License. For the Term and subject to the terms and conditions of this Agreement,
    LCF grants to Participant a nonexclusive license to access and Use the NMHIC Information System
    from one or more Workstations, through the internet, for the purposes of: (a) making Disclosures to


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                     New Mexico HIE Strategic and Operational Plans

    LCF as described in Section 5 of this Agreement; and, (b) retrieving Information from the Electronic
    Medical Records of Individuals maintained by third parties in accordance with the provisions of
    Section 6 of this Agreement.

        5. Disclosure of Participant EMR Information to LCF.


                (a) Disclosure. For the purposes of the development and operation of the NMHIC
    Information System, and subject to the terms and conditions of this Agreement, Participant shall
    Disclose Participant EMR Information to LCF on a real time basis and in an Electronic form
    acceptable to Participant and LCF.


                 (b) Uses and Disclosures of Participant EMR Information. LCF shall Use the Participant
    EMR Information Disclosed to it under this Agreement and Information Disclosed to LCF by other
    NMHIC Participants in accordance with the terms and conditions of this Agreement and for the
    development and operation of the NMHIC Information System. Use by LCF may include Use for
    system administration, assessment, testing, and problem identification and the creation of reports
    related to the usage of the NMHIC Information System and compliance with Applicable Law. LCF
    shall also Use the Participant EMR Information to make Disclosures permitted under Section 6 and
    Section 10 of this Agreement.


                (c) Restrictions and Limitations. The Disclosure of Participant EMR Information to LCF
    under this Agreement is permitted pursuant to the Electronic Medical Records Act and the HIPAA
    Regulations, and the Participant EMR Information Disclosed to LCF shall not be Used or further
    Disclosed by LCF except as permitted under this Agreement, the Electronic Medical Records Act, the
    HIPAA Regulations and Applicable Law. LCF may Disclose Participant EMR Information to its
    employees or contractors, provided that each such employee or contractor to whom Participant EMR
    Information is Disclosed: (i) has a need to access the Participant EMR Information as a part of such
    employee’s or contractor’s job duties related to the development or operation of the NMHIC
    Information System; and, (ii) is subject to written confidentiality obligations under which such Person
    agrees to protect the privacy and the security of the Participant EMR Information in accordance with
    the terms and conditions of this Agreement and Applicable Law. In addition to all other obligations
    imposed upon LCF under this Agreement, the Electronic Medical Records Act, the HIPAA
    Regulations, and Applicable Law, LCF shall make reasonable efforts to limit its access to and Use of,
    and the access to and Use of by its employees and contractors of, the Participant EMR Information to
    the minimum necessary for the development and operation of the Record Locator Service and the
    Health Information Exchange.


                 (d) Specially Protected Information. Disclosure to and access by LCF of Specially
Protected Information included in Participant EMR Information shall not require a Consent from the
Individual who is the subject of the Specially Protected Information to the extent the Specially Protected
Information is only Used by LCF for the purposes of the development and operation of the Record
Locator Service and the Health Information Exchange; however, the Disclosure to other Persons,
including other NMHIC Participants, by LCF of Specially Protected Information under Section 6 and
Section 10 of this Agreement shall be made only in compliance with this Agreement, the Electronic
Medical Records Act, the HIPAA Regulations, the state and federal laws governing the disclosure of the
Specially Protected Information, and Applicable Law. Specially Protected Information is subject to all of



                                                   107
                     New Mexico HIE Strategic and Operational Plans

the security and protective protocols outlined in Section 3 of this Agreement. Further, with respect to
Specially Protected Information:

                         (i) LCF acknowledges and agrees that the confidentiality of Specially Protected
Information is protected by New Mexico state law and Federal law which requires the Consent of the
Individual who is the subject of the Specially Protected Information for Disclosure and Use by other
NMHIC Participants and the Disclosure of Specially Protected Information by Participant to LCF is made
pursuant to the Electronic Medical Records Act solely for the purpose of the development and operation
of the Record Locator Service and the Health Information Exchange. LCF further acknowledges that any
Use or Disclosure by LCF of Specially Protected Information except for purposes of the development and
operation of the Record Locator Service and the Health Information Exchange is prohibited by state or
federal law which prohibits the further Disclosure of such information without the Consent of the
Individual who is the subject of the Specially Protected Information or as otherwise permitted Applicable
Law. LCF acknowledges that under New Mexico state law, a Person that makes an unauthorized
Disclosure of such Specially Protected Information is guilty of a petty misdemeanor and shall be
sentenced to imprisonment in the county jail for a definite term not to exceed six months or the payment
of a fine of not more than five hundred dollars, or both and may be subject to further monetary, criminal
or civil penalties.

                        (ii) LCF shall ensure that any employee or contractor having access to Participant
EMR Information agrees to the same restrictions and conditions applicable to LCF with respect to
Specially Protected Information.

        6. Disclosures to Third Parties Through NMHIC Information System. As the Business Associate
    of Participant and in accordance with the terms and conditions of this Agreement, the Electronic
    Medical Records Act, the HIPAA Regulations, and Applicable Law, LCF may Disclose Participant
    EMR Information using the NMHIC Information System to other Persons only as follows:


               (a) to a Provider who has a need for such Information to treat a condition that poses an
    immediate threat to the life of any individual and that requires immediate medical attention;


                (b) to a Person who warrants that he or she has the Consent of the Individual who is the
    subject matter of the Participant EMR Information for access to such Information;


                (c) as Required by Law; or,


                (d) as directed in writing by the Participant from time to time.


         7. Reliance Upon Third Party Warranty. In making a Disclosure to a Person under Section 6(a)
    or (b) or Section 10 of this Agreement, Participant and LCF may rely upon the warranty of the Person
    making the request that the request is, respectively, either: (a) from a Provider who has a need for
    such Information to treat a condition that poses an immediate threat to the life of any individual and
    that requires immediate medical attention; or, (b) that the Person has the Consent of the Individual
    who is the subject matter of the Participant EMR Information for access to such Information.




                                                   108
                 New Mexico HIE Strategic and Operational Plans

    8. Maintenance of Audit Log. In addition to the requirements of Section 3(h) and (j) of this
Agreement, in accordance with the Electronic Medical Records Act, LCF shall maintain an audit log
of Persons obtaining access to Information in the Record Locator Service, which shall include, at the
minimum:


            (a) the identity of the Person obtaining access to the Information;


            (b) the identity of the Individual whose Information was obtained;


            (c) the location from which the Information was obtained;


            (d) the specific Information obtained; and,


            (e) the date the Information was obtained.


    LCF shall make a copy of the audit log available upon the request of the Individual whose Health
Care Information is the subject of the audit log; however the audit log made available to an Individual
shall include only information related to that Individual. The audit log shall be made available to the
requesting Individual annually for a fee not to exceed twenty-five cents ($.25) per page, or such other
amount as permitted by Applicable Law.


    9. Opt-Out Provisions. LCF shall provide a mechanism by which Individuals who make an
Exclusion Request may exclude their Demographic Information and Information about the location of
their Electronic Medical Records from the Record Locator Service. Each party shall promptly notify
the other in writing upon receipt of an Exclusion Request from an Individual and upon receipt of an
Exclusion Request: (a) Participant shall, if Participant’s Electronic Medical Record has such
functionality, cease to Disclose to LCF Information from such Individual’s Electronic Medical
Record under Section 5 of this Agreement; and, (b) LCF shall cause all Information in such
Individual’s Electronic Medical Record to cease to be accessible to NMHIC Participants through the
Record Locator Service and the Health Information Exchange.


    10. Out-of-State Disclosures. LCF may make Disclosures to Providers, Health Care Group
Purchasers, Health Care Institutions, Health Information Exchanges and Record Locator Services
located or operating outside the State of New Mexico if such Disclosure would otherwise be
permissible under the Electronic Medical Records Act and the terms and conditions of this
Agreement.

    11. Identification of Authorized Users; Use of NMHIC Information System, and NMHIC EMR
Information by Authorized Users of Participant.


            (a) Participant, through its Principal Contact, shall provide in writing to LCF the names
of Authorized Users. LCF shall assign each such Authorized User his or her Authentication


                                               109
                      New Mexico HIE Strategic and Operational Plans

    Information, which will allow the Authorized User access to the NMHIC Information System, and
    deliver in writing the Authentication Information to the Participant’s Principal Contact. The
    Participant’s Principal Contact shall advise each Authorized User of his or her Authentication
    Information. Participant shall immediately notify LCF in writing of any Authorized User who is no
    longer authorized by Participant to access and Use the NMHIC Information System and LCF will
    promptly terminate such Authorized User’s access to the NMHIC Information System.


                (b) Authorized Users may access and Use the NMHIC Information System only in
    accordance with the terms and conditions of this Agreement, the Electronic Medical Records Act, the
    HIPAA Regulations, the laws and regulations governing the Use and Disclosure of Specially
    Protected Information, and Applicable Law. Participant shall implement policies and procedures to
    require and insure compliance by Authorized Users with the requirements of this Agreement,
    including the requirements of this Section 11(b). Participant and its Authorized Users shall access
    NMHIC EMR Information utilizing the NMHIC Information System only as follows:


                        (i) as a Provider to treat a condition that poses an immediate threat to the life of
    any individual and that requires immediate medical attention; or,


                        (ii) with the Consent of the Individual who is the subject of the NMHIC EMR
    Information requested.


                 (c) Prior to each access or Use of the NMHIC Information System, an Authorized User
shall be required to enter his or her Authentication Information, and to acknowledge that access to, and
the receipt and Use of NMHIC EMR Information utilizing the NMHIC Information System is subject to
the terms and conditions of this Agreement, the Electronic Medical Records Act, the HIPAA Regulations,
the laws and regulations governing the Use and Disclosure of Specially Protected Information, the
policies and procedures of the Participant, and Applicable Law. Participant and its Authorized Users shall
retain reasonable documentation of the basis for each access made to NMHIC EMR Information, which,
if access is based upon the Consent of an Individual, shall include a copy of such Consent. Participant
shall make available to LCF copies of such documentation upon request, including the Consent, for
purposes of determining the compliance with this Agreement by Participant and its Authorized Users.

                 (d) To the extent that NMHIC Participant EMR accessed by Participant and its
Authorized Users includes any Specially Protected Information, Participant, for itself and on behalf of its
Authorized Users, acknowledges and agrees that the confidentiality of Specially Protected Information is
protected by New Mexico state law and federal law which requires the Consent of the Individual that is
the subject of the Specially Protected Information for Disclosure and Use and the Disclosure of Specially
Protected Information in NMHIC EMR Information by LCF and other NMHIC Participants is made
based upon the warranty by the Participant and its Authorized Users that it has a Consent authorizing such
Disclosure or that the Disclosure is to a Provider to treat a condition that poses an immediate threat to the
life of any individual and that requires immediate medical attention. Participant acknowledges that the
further Disclosure of Specially Protected Information by Participant or its Authorized Users is prohibited
absent the Consent of the Individual who is the subject of the Specially Protected Information, and that
under New Mexico state law, a Person who makes an unauthorized Disclosure of such Specially Protected
Information is guilty of a petty misdemeanor and shall be sentenced to imprisonment in the county jail for
a definite term not to exceed six months or the payment of a fine of not more than five hundred dollars, or
both and may be subject to further monetary, criminal or civil penalties.


                                                    110
                      New Mexico HIE Strategic and Operational Plans


                 (e) Participant, for itself and its Authorized Users, represents and warrants to LCF and to
each of the other NMHIC Participants that any request for access to NMHIC EMR Information by
Participant or any of its Authorized Users will be made only in accordance with the requirements of
Section 11(b), above.

                 (f) Participant shall be responsible for all acts and omissions of Authorized Users and all
other Persons who access the NMHIC Information System, and NMHIC EMR Information through the
Participant or by Use of any Authentication Information received or obtained by Participant from LCF.

        12. Site Equipment. LCF will provide, install, and maintain the Site Equipment at Participant’s
    Facility. LCF shall install and maintain the necessary NMHIC Software Applications on the Site
    Equipment and provide such connections between the Site Equipment and the Participant’s computer
    network(s) required for the Disclosure of Participant EMR Information to the Site Equipment.
    Participant shall provide connectivity from the Site Equipment to the internet. The Site Equipment
    shall be owned by [LCF] [Participant]. LCF may, during the Term, replace or modify the Site
    Equipment. Participant shall implement and maintain administrative, physical, and technical
    safeguards that reasonably and appropriately protect the Site Equipment. Participant shall not remove
    the Site Equipment from the Participant’s Facility, or move the Site Equipment from the installed
    location at the Participant’s Facility to another location within the Participant’s Facility, without the
    prior written consent of LCF.

         13. Host. LCF shall provide all equipment, software, and services necessary for the operation and
maintenance of the Host and an internet connection for the Host. Participant is responsible for providing
Authorized Users with internet connections for communication with Host via the internet. LCF agrees to
install, operate, and maintain the NMHIC Software Applications on the Host. LCF agrees to allow
Authorized Users to access and Use the NMHIC Information System via the internet in accordance with
the terms and conditions of this Agreement.

         14. Restrictions on Use of NMHIC Information System. Participant agrees not to sublicense,
    license, rent, sell, loan, give or otherwise distribute all or any part of the NMHIC Information System
    to any third party. Participant agrees not to reverse engineer, disassemble, decompile, modify, or
    alter the NMHIC Software Applications, or any copy thereof, in whole or in part. Participant agrees
    to comply with the general terms and conditions of use of the NMHIC website as the same are posted
    on the NMHIC website from time to time.


        15. Training. LCF may from time to time provide group-training sessions for NMHIC
    Participants on the use of the NMHIC Information System. At the request of Participant, LCF will
    provide training to Participant and Authorized Users for such charges and costs as agreed to between
    LCF and Participant.


        16. Fees. There shall be no fees or payments required from either party under this Agreement,
unless otherwise agreed to in writing by LCF and the Participant.

        17. Confidential Information. During the term of this Agreement the parties may, but shall not be
    required to, exchange information which may represent confidential and proprietary trade secrets of
    the disclosing party, and which may include, but not be limited to, business plans, product
    applications, studies, reports, methods, processes, software designs, and other technical and business


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                      New Mexico HIE Strategic and Operational Plans

    information which by its nature is deemed confidential, (hereinafter referred to as “Proprietary
    Information”). Each party agrees to hold all Proprietary Information of another party disclosed to it
    under this Agreement in trust and confidence and not disclose or use such Proprietary Information
    except for the purposes of carrying out obligations under this Agreement. This Agreement shall not
    restrict disclosure or use of Proprietary Information that is:

                 (a) already known to the recipient as evidenced by the records of the recipient; or

                (b) obtained without restriction as to further disclosure from a source other than the other
party, which source is under no obligation (written or otherwise) of confidentiality to the party claiming
the information to be its Proprietary Information; or

                 (c) generally available to the public when received, or thereafter becomes generally
available to the public through no fault of the recipient; or

                (d) developed independently by the recipient without access to the Proprietary
Information of the other party.

As used in this Agreement, Participant EMR Information shall not be Propriety Information that is subject
to the restrictions contained in this Section 17.

        18. Steering Committee. LCF shall establish and maintain a Steering Committee consisting of
representatives of the NMHIC Participants. LCF shall hold regular meetings of the Steering Committee.
The Steering Committee shall review, consider, and provide advice to LCF with respect to all aspects of
the Record Locator Service and the Health Information Exchange, including, but not limited to: (i)
technical, administrative, and security matters; (ii) matters related to privacy and legal issues; and (iii) the
scope of information available through the Record Locator Service and the Health Information Exchange.


        19. Warranties/Indemnification.

                  (a) LCF will hold Participant harmless from any damages or liabilities resulting from
third-party claims that the NMHIC Information System, or its use infringes U.S. patents, copyrights or
similar intangible rights, provided that Participant will promptly notify LCF of the matter, cooperate with
LCF as requested, and permit LCF to control the investigation, defense, and disposition of the same. LCF
does not warrant that operation of the NMHIC Information System shall be uninterrupted or error free or
that it shall meet Participant's needs or the needs of other NMHIC Participants.

                  (b)(i) If a liability related to the performance of this Agreement is established against
Participant based wholly or in part upon the negligence, malpractice, breach of contract, or comparative
fault of LCF, LCF employees, or LCF's contractors, including subcontractors, LCF shall indemnify
Participant for that portion of Participant’s liability, as established by agreement among the parties at
settlement or established by judgment, and that portion of Participant’s defense costs, including attorney's
fees, which is attributable solely to the percentage of fault of LCF, LCF's employees, or LCF’s
contractors, including subcontractors.

                 (ii) If a liability related to the performance of this Agreement is established against LCF
based wholly or in part upon the negligence, malpractice, breach of contract, or comparative fault of
Participant, Participant’s employees, or Participant’s contractors, including subcontractors, Participant
shall indemnify LCF for that portion of LCF’s liability, as established by agreement among the parties at


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                      New Mexico HIE Strategic and Operational Plans

settlement or established by judgment, and that portion of LCF’s defense costs, including attorney's fees,
which is attributable solely to the percentage of fault of Participant, Participant’s employees, or
Participant’s contractors, including subcontractors.

EXCEPT AS EXPRESSLY PROVIDED IN THIS SECTION 19, NO WARRANTY OR ASSURANCE,
EXPRESS, IMPLIED, OR STATUTORY, IS GIVEN BY LCF WITH RESPECT TO THE NMHIC
INFORMATION SYSTEM OR ANY OTHER MATTER, INCLUDING, WITHOUT LIMITATION
(AND LCF SPECIFICALLY DISCLAIMS) ALL WARRANTIES OF TITLE, MERCHANTABILITY
OR FITNESS FOR A PARTICULAR PURPOSE.

      20. Limitation of Liability. IN NO EVENT SHALL A PARTY BE LIABLE TO THE OTHER
PARTY, WHETHER IN CONTRACT OR IN TORT OR UNDER ANY OTHER LEGAL THEORY
(INCLUDING, WITHOUT LIMITATION, STRICT LIABILITY AND NEGLIGENCE) FOR LOST
PROFITS OR REVENUES, LOSS OR INTERRUPTION OF USE, LOST OR DAMAGED DATA,
REPORTS, OR DOCUMENTATION, OR SIMILAR ECONOMIC LOSS, OR FOR ANY INDIRECT,
SPECIAL, INCIDENTAL, CONSEQUENTIAL, PUNITIVE OR SIMILAR DAMAGES, ARISING
OUT OF OR IN CONNECTION WITH THE PERFORMANCE OR NON-PERFORMANCE OF THIS
AGREEMENT, EVEN IF THE PARTY HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH
CLAIM.

        21. Term and Termination.


                (a) The term of this Agreement shall commence on the Effective Date and shall continue
until this Agreement is terminated by a party under subsection (b) or (c) below.

                (b) Either LCF or Participant may terminate this Agreement at any time for no reason or
for any reason upon thirty (30) days written notice to the other.

                 (c) Either LCF or Participant may terminate this Agreement immediately upon written
notice to the other party upon a material breach by the other party of any term or condition of this
Agreement.

               (d) Upon the termination of this Agreement, regardless of the reason, Participant and its
Authorized Users shall: (i) immediately cease use of the NMHIC Information System; and (ii) LCF shall
promptly comply with the requirements of Section 3(i), above.

                  (e) The words “termination” and cognate words such as “term” and “terminate” as used
in this Agreement are to read as omitting from their effect the following rights, powers, duties, and
obligations of the parties which shall survive any termination to the degree necessary to complete their
full fulfillment or discharge:

                          (i) the obligations of LCF to comply with the provisions of this Agreement for
the protection of the privacy and security of any Participant EMR Information retained by LCF following
termination;

                         (ii) the obligations of LCF under Section 3 and Section 8 of this Agreement;

                         (iii) the rights, powers, duties, and obligations of the parties under Sections 17,
19, 20, 22, 23, and 24 of this Agreement; and,



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                      New Mexico HIE Strategic and Operational Plans

                         (iv) any cause of action or claim of a party accrued, or to accrue, because of a
breach or default by the other party.

        22. Electronic Transactions and Signatures. For any purpose under this Agreement, the parties
agree that: (a) in accordance with the Electronic Medical Records Act, electronic signatures shall satisfy
any law or rule requiring a signature pertaining to a medical record; and (b) transactions conducted under
this Agreement may be conducted by electronic means and such transactions shall be governed by the
New Mexico Uniform Electronic Transactions Act.

        23. Miscellaneous.

                (a) LCF may refer to Participant as a NMHIC Participant in any advertising, publicity, or
marketing materials and Participant may reference its participation as a NMHIC Participant in the Record
Locator Service and the Health Information Exchange in any advertising, publicity, or marketing
materials.

               (b) The terms and conditions of this Agreement may not be amended, waived, or
modified, except in a writing signed by the party to be charged therewith.

                 (c) No failure or delay of either party to exercise any rights or remedies under this
Agreement shall operate as a waiver thereof, nor shall any single or partial exercise of any rights or
remedies preclude any further or other exercise of the same or any other rights or remedies, nor shall any
waiver of any rights or remedies with respect to any circumstances be construed as a waiver thereof with
respect to any other circumstances.

                (d) If any provision of this Agreement is held invalid or unenforceable in any
circumstances by a court of competent jurisdiction, the remainder of this Agreement, and the application
of such provision in any other circumstances, and in any other jurisdiction, shall not be affected thereby.

                 (e) All notices and other communications under this Agreement shall be in writing and
shall be delivered to a party’s Principal Contact.

                  (f) Neither party shall be responsible for failures or interruptions of communications
facilities or equipment of third parties, labor strikes or slowdowns, shortages of resources or materials,
natural disasters, world events, delay or disruption of shipment or delivery, trespass or interference of
third parties, or similar events or circumstances outside its reasonable control.

                 (g) This Agreement shall be governed by and construed and enforced in accordance with
the laws of the State of New Mexico, excluding its principles of conflicts of law.

                (h) This Agreement may be executed in one or more counterparts.

                (i) This Agreement is binding upon and shall inure to the benefit of the respective
successors and permitted assigns of the parties. Neither party may assign its rights, powers, duties, or
obligations under this Agreement without the written consent of the other party, except in the case of a
merger, acquisition of substantially all of the assets of a party, or by operation of law.

                (j) This Agreement sets forth the entire and only agreement among the parties relative to
the subject matter hereof. Any representation, promise, or condition, whether oral or written, not
incorporated herein shall not be binding on the parties.



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                       New Mexico HIE Strategic and Operational Plans

                  (k) The parties are independent contracting entities. Nothing in this Agreement shall be
construed to create a partnership, agency relationship, or joint venture between the parties. Neither party
shall have any authority to bind or make commitments on behalf of the other party for any purpose, nor
shall either party hold itself as having any such authority.

                (l) With the exception of the parties to this Agreement, there shall exist no right of any
Person to claim beneficial interest in this Agreement or any rights accruing by virtue of this Agreement.

                 (m) In this Agreement, words of inclusion shall not be construed as terms of limitation so
that references to “included” shall be regarded as nonexclusive, noncharacterizing illustrations.

        24. Principal Contacts. The Principal Contacts of the parties for purposes of this Agreement are:

                Participant:

                Name:                             [INDIVIDUAL NAME]

                Address:

                Telephone:
                Facsimile:
                Unsecured Email:



                LCF:

                Name:
                Address:                          Lovelace Clinic Foundation
                                                  2309 Renard Place, SE, Suite 103
                                                  Albuquerque, NM 87106

                Telephone:                        (505) 938-9900
                Facsimile:                        (505) 938-9940
                Unsecured Email:                  [to be added]

        A party may, from time to time, by written notice to the other party, change its Principal Contact.

         25. Operational Date(s). Notwithstanding any other provision of this Agreement, the Disclosure
of Participant’s EMR Information under Section 6 and Section 10, and Participant’s access to and use of
the NMHIC Information System under Section 11will not occur until such date(s) as LCF determines that
the NMHIC Information System and Participant’s connectivity to the NMHIC Information System
become operational. LCF shall provide Participant with written notice at such time as the NMHIC
Information System becomes functional with respect to Participant.

Lovelace Clinic Foundation,                               Participant:
a New Mexico nonprofit corporation


By:                                                       By:
_____________________________________                     _____________________________________


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                 New Mexico HIE Strategic and Operational Plans

Name:                                         Name:
_____________________________________         _____________________________________
Title:                                        Title:
_____________________________________         _____________________________________




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                       New Mexico HIE Strategic and Operational Plans

                                                 GLOSSARY

“Applicable Law” shall mean: (i) for Participants that are not federal entities, all applicable statutes and
regulations of the State of New Mexico, as well as all applicable Federal statutes, regulations, and policy
requirements; and, (ii) with respect to Participants that are federal entities, all applicable Federal statutes,
regulations, and policy requirements.

“Authentication Information” shall mean a User’s unique username, password, and other information that
may be required from time to time by NMHIC to identify a User.

“Authorized User” shall mean each Individual authorized by Participant in accordance with Section 11 of
this Agreement to access and Use the NMHIC Information System.

“Business Associate” shall have the same meaning as the term “business associate” under the HIPAA
Regulations.

“Consent” shall mean the written permission of the Individual who is the subject of the Information that
meets the requirements of an authorization under the HIPAA Regulations, a consent under the
requirements of 42 CFR Part II, and that also meets the requirements of a consent or authorization under
New Mexico law for the release of Specially Protected Information.

“Covered Entity” shall have the same meaning as the term “covered entity” under the HIPAA
Regulations.

“Demographic Information” shall mean information that identifies the Individual who is the subject of the
health care information, including the Individual’s name, date of birth and address and other information
necessary to identify the Individual or that associates the individual with the Individual’s Electronic
Medical Record.

“Disclose” shall mean to release, transfer, provide, give access to or otherwise divulge in any other
manner information outside of the Person holding the information.

“Effective Date” shall mean the date of the last signature of LCF and Participant on this Agreement.

“Electronic” shall mean relating to technology having electrical, digital, magnetic, wireless, optical,
electromagnetic or similar capabilities.

 “Electronic Medical Record” shall mean an electronic record of an Individual patient’s Health Care
Information that may include Demographic Information.

“Electronic Medical Records Act” shall mean the New Mexico Electronic Medical Records Act, New
Mexico Laws 2009, Ch. 69.

“Electronic Protected Health Information” shall have the same meaning as the term “electronic protected
health information” under the HIPAA Regulations.

“Exclusion Request” shall mean a request by an Individual in accordance with the Electronic Medical
Records Act to exclude such Individual’s Demographic Information and Information about the location of
the Individual’s Electronic Medical Records from the Record Locator Service.




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                      New Mexico HIE Strategic and Operational Plans

“Health Care” shall mean care, services, or supplies related to the health of an Individual and includes: (1)
preventative, diagnostic, therapeutic, rehabilitative, maintenance or palliative care and counseling; (2)
services, assessments or procedures that are concerned with the physical or mental condition or functional
status of an individual or that affect the structure of function of the body of an individual; and, (3) the sale
or dispensing of a drug, device, a piece of equipment or other item in accordance with a prescription.

“Health Care Group Purchaser” shall mean a Person who is licensed, certified or otherwise authorized or
permitted by the New Mexico Insurance Code to pay for or purchase Health Care on behalf of an
identified Individual or group of Individuals, regardless of whether the cost of coverage or services is paid
for by the purchaser or the persons receiving coverage or services.

“Health Care Information” shall mean any Information, whether oral or recorded in any form or medium,
related to the past, present or future physical or mental health or condition of an Individual; the provision
of Health Care to an Individual; or the past, present or future payment for the provision of Health Care to
an Individual.

“Health Care Institution” shall mean an institution, facility or agency licensed, certified or otherwise
authorized or permitted by Applicable Law to provide Health Care in the ordinary course of business.

“Health Information Exchange” means an arrangement among Persons participating in a defined secure
electronic network service, such as a regional health information organization, that allows the sharing of
Health Care Information about individual patients among different Health Care Institutions or unaffiliated
Providers.

“HIPAA Regulations” means the Standards for Privacy of Individually Identifiable Health Information
and the Security Standards for the Protection of Electronic Protected Health Information [45 C.F.R. Parts
160 and 164] promulgated by the U.S. Department of Health and Human Services under the Health
Insurance Portability and Accountability Act (HIPAA) of 1996, as in effect on the date of this Agreement
and as may be amended, modified, or renumbered.

“HITECH Act” shall mean the Health Information Technology for Economic and Clinical Health
(HITECH) Act, Title XIII of Division A and Title IV of Division B of the American Recovery and
Reinvestment Act of 2009 (ARRA), Pub. L. No. 111-5 (Feb. 17, 2009), and regulations promulgated
thereunder.

“Host” means the host computer system maintained and operated by LCF at LCF’s Facility on which
LCF has installed the NMHIC Software Applications.

“Individual” shall have the same meaning as the term “individual” under the HIPAA Regulations.

“Information” shall mean data, including text, images, sounds and codes and computer programs,
software and databases.

“LCF’s Facility” shall mean the physical premises of LCF located at 2309 Renard Place SE, Suite 103,
Albuquerque, New Mexico 87106.


“NMHIC” shall mean New Mexico Health Information Collaborative, the New Mexico Health
Information Exchange.




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                      New Mexico HIE Strategic and Operational Plans

“NMHIC EMR Information” shall mean Information from the Electronic Medical Records of Individuals
made available to LCF by NMHIC Participants for the development and operation of the NMHIC
Information System.

“NMHIC Information System” shall mean the NMHIC Software Applications, the Record Locator
Service, the Health Information Exchange, the Host, the Site Equipment, and all related hardware and
software.

“NMHIC Participant” shall mean the Participant and each other Person who has signed a New Mexico
Health Information Collaborative Health Information Exchange Subscription Agreement with LCF on
terms and conditions that are substantially the same as this Agreement.

“NMHIC Policies and Procedures” shall mean the policies and procedures adopted by NMHIC from time
to time related to the operations of NMHIC.


“NMHIC Software Applications” shall mean one or more of the software applications utilized by LCF to
operate the NMHIC Information System.

“Participant” shall mean the Person identified on the first page of this Agreement who is a party to this
Agreement.

“Participant EMR Information” shall mean Information from Electronic Medical Records created or
maintained by Participant, which may include information that pertains to: patient encounters (i.e.
registrations, hospitalizations and visits); tests (i.e. laboratory and imaging); conditions (i.e. diagnoses and
allergies); treatments (i.e. procedures, services and medications); and, dispositions (admission, discharge,
transfer and death). The specific Information Disclosed by Participant to LCF shall be determined from
time to time by Participant and LCF.

“Participant’s Facility” shall mean the physical premises of Participant located at the Participant’s address
as shown on the first page of this Agreement.

“Person” shall mean any of an Individual, a partnership, a corporation, limited liability company, or other
entity recognized by Applicable Law.

“Principal Contact” shall mean the person identified in Section 24 of this Agreement, who shall serve as
the person responsible for interactions between LCF and the Participant with respect to this Agreement.

“Protected Health Information” shall have the same meaning as the term “protected health information”
under the HIPAA Regulations.

“Provider” shall mean an Individual who is licensed, certified or otherwise authorized or permitted by
Applicable Law to provide Health Care in the ordinary course of business or practice of a profession.

“Record Locator Service” shall mean an information service that contains Demographic Information and
the location of Health Care Information of a specified Individual across different Health Care Institutions
or unaffiliated Providers that participate in the service.

“Required By Law” shall have the same meaning as the term “required by law” under the HIPAA
Regulations.



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                     New Mexico HIE Strategic and Operational Plans

“Secretary” shall have the same meaning as the term “secretary” under the HIPAA Regulations.

“Security Incident” shall have the same meaning as the term “security incident” under the HIPAA
Regulations.

“Site Equipment” shall mean the computer hardware and other equipment provided by LCF and
maintained at Participant’s Facility.

“Specially Protected Information” shall mean Participant EMR Information that consists of Information
subject to the provisions of:

        (a) NMSA 1978 §§ 24-1-9.4 and 24-1-9.5 [sexually-transmitted diseases]
        (b) NMSA 1978 §§ 24-2B-6 and 24-2B-7 [human immunodeficiency virus tests]
        (c) NMSA 1978 §§ 24-2E-2 and 24-2E-3 [viral hepatitis]
        (d) NMSA 1978 24-21-1, et. seq. [genetic information privacy]
        (e) NMSA 1978 § 32A-6A-24 [children’s mental health and developmental disabilities]
        (f) NMSA 1978 § 43-1-19 [mental health and developmental disabilities]
        (g) 42 C.F.R. Part II [confidentiality of alcohol and drug abuse patient records]

“Term” shall mean the period from the Effective Date of this Agreement through its termination in
accordance with Section 21 of this Agreement.

“Use” shall mean the sharing, employment, application, utilization, examination, or analysis of such
information within an entity that maintains such information.

“Workstation” shall mean an Electronic device by which an Authorized User may access the NMHIC
Information System through the internet.




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          New Mexico HIE Strategic and Operational Plans


                       Appendix H:
                    NMHIC Business Plan




New Mexico Health Information Collaborative (NMHIC)

                  Business Plan
                         Version 3.0




                           Contact:
                             Jeff Blair
                          (505) 938-9904
                   Jeff.Blair@LCFresearch.org

                         March 11, 2009




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                          New Mexico HIE Strategic and Operational Plans


Table of Contents
 S.14. Executive Summary .......................................................................................... 1

 S.15. Background ....................................................................................................... 3
          NMHIC Perspective ..................................................................................................................... 3
          Problem to be Solved ................................................................................................................. 3
          NMHIC Solution .....3
          NMHIC History and Future ......................................................................................................... 3
          NMHIC Governance .................................................................................................................... 5

 S.16. NMHIC Network Services ................................................................................. 5
          Criteria for Selecting Network Services ................................................................................... 5
          Description of Network Services ............................................................................................... 8
          Community Readiness for Network Services .......................................................................... 9
          Availability of Network Services ............................................................................................. 11
          Time Frame for Data Suppliers ................................................................................................ 12

 S.17. Business Assessments .................................................................................. 13
          Total Market Opportunity ......................................................................................................... 13
          Factors Supporting Adoption of Network Services .............................................................. 14
          Factors Supporting Successful Operations .......................................................................... 18
          Factors Mitigating Success ..................................................................................................... 23

 S.18. Summary of Financial Projections ................................................................ 25
          Summary of NMHIC Expenditures .......................................................................................... 25
          Summary of NMHIC Revenue .................................................................................................. 26
          Financial Projection Scenarios ............................................................................................... 27

 S.19. Financial Benefits to NMHIC Stakeholders ................................................... 29

 S.20. Conclusions and Recommendations ............................................................ 31

 S.21. Acknowledgements ........................................................................................ 33

 S.22. Appendices...................................................................................................... 34
          Appendix A: Philosophy ......................................................................................................... 34
          Appendix B: NMHIC Stakeholders by Type and NMHIC Steering Committee Members .. 80
          Appendix C: NMHIC Staff Biographies .................................................................................. 37
          Appendix D: Privacy Policies ................................................................................................. 41
          Appendix E: Administrative and Technical Operations Approach ..................................... 42
          Appendix F: HIE Network Technologies/Capabilities .......................................................... 46
          Appendix G: Assumptions Regarding Network Availability ............................................... 49
          Appendix H: National Savings Estimate Table ..................................................................... 50
          Appendix I: Total Annual Benefit to Payers Table ............................................................... 51
          Appendix J: Savings to NMHIC Stakeholders Based on Local Estimates ........................ 52
          Appendix K: Scenarios 1 through 6 from Versions 1 and 2.2 ............................................. 58
          Appendix L: Scenario Analysis By Health Plan .................................................................... 61


                                                                      i
                    New Mexico HIE Strategic and Operational Plans

Executive Summary

The New Mexico Health Information Collaborative (NMHIC) is the name of New Mexico‘s
growing health information exchange (HIE) network, as well as the community collaborative that
has supported its development with time and funding. The collaborative includes New Mexico
stakeholders representing health care providers, payers, employers, state agencies and
consumers. NMHIC was created in 2004, and continues to be fully staffed and operated by the
Lovelace Clinic Foundation (LCF).

Objective: The objective of this report is to provide the business and financial information
necessary for key stakeholders, in particular the health plans and HSD Medicaid, to decide to
fully fund NMHIC for 2010 and beyond.

Summary of Financial Scenarios
Although the limited federal funding for NMHIC in 2009 reduced the rate of growth for new
interfaces, new network services, and user adoption rates, the scenarios in this report are still
able to support the critical goals for 2009 of adding the largest health care providers to the
network, providing commercial availability of the NMHIC network portal, and retaining the
nationally recognized NMHIC staff. In addition, the projections of NMHIC expenditures for 2010,
2011, and 2012 reflect a better understanding of network costs.

This report includes the following three new scenarios:
 The Baseline Scenario includes all of the feedback from NMHIC stakeholders generated by
    Versions 1 and 2.2, and more accurate funding information from the federal government for
    2009. It assumes that all payers (health plans) in New Mexico will provide approximately
    $3.01M per year to fund NMHIC for 2010, 2011, and 2012. It also assumes that the funding
    provided by each health plan will be based on a $0.201per member per month rate.
 The Baseline Plus $500K Additional Federal Funding Scenario describes the effect on
    health plan funding for NMHIC if federal funding from the American Recovery and
    Reinvestment Act (ARRA) becomes available to NMHIC for 2010.
 The Baseline Plus $1M Additional Federal Funding Scenario describes the effect on health
    plan funding for NMHIC if federal funding from the American Recovery and Reinvestment
    Act (ARRA) becomes available to NMHIC for 2010.
An analysis of projected funding from each of the five major health plans in New Mexico for the
three scenarios above is shown in Appendix L. All previous scenarios from Versions 1 and 2.2
are included in Appendix K for your reference.

Overview of the Business Plan Report: This report describes how NMHIC has been developing
a strong foundation to meet community health information needs in New Mexico:
 It begins with a description of how NMHIC has been guided by the priorities of the NMHIC
    stakeholders. A key example has been the selection of NMHIC network services based on
    a comprehensive survey of potential network users.
 It goes on to describe how NMHIC has developed a solid network technical infrastructure
    that will enable clinicians to import clinical data directly into their electronic health record
    (EHR) systems, or – if they do not have an EHR – still make full use of the NMHIC Clinician
    Portal.
 In addition to the benefits provided by access to clinical information from local New Mexico
    healthcare providers, NMHIC will also be able to access patient information from the
    Veterans‘ Health Administration, the Military Health Service of the DoD, and the Indian
    Health Service, through the Nationwide Health Information Network (NHIN). NMHIC is able
    to do this because it complies with the standards for interoperability required by the NHIN.

                                                 1
                   New Mexico HIE Strategic and Operational Plans

   The report describes how LCF has built a strong and effective NMHIC executive /
    management / technical team.
   It also includes a candid summary of the factors that are likely to support and mitigate
    success of the network.
   The report then integrates all of the benefits, the costs and the risks presented so far and
    expresses them in the form of financial scenarios.
   All scenarios described in the Business Plan show that the benefits to the community
    (especially the payers) significantly exceed the cost of developing and operating the NMHIC
    network. To be specific, the savings and/or cost avoidance to payers is very conservatively
    estimated to vary from $ 6-11 M per year, while the annual cost to both operate and expand
    NMHIC is only $3 M per year.

Federal Recognition and New Funding: The federal government has recognized NMHIC‘s
strong foundation and its capabilities by prominently featuring NMHIC during the live
demonstrations of the Nationwide Health Information Network (NHIN) Trial Implementations in
2008 in Washington, DC. Moreover, NMHIC capabilities and accomplishments were explicitly
recognized by the federal government in its decision to provide funding to NMHIC for 2009.

Supporting documents for this report include:
 Survey of Potential Network Users
 Environmental Scan
 NMHIC Network Subscription Agreement
 Financial Pro Forma Software Tool (available in electronic form only)




                                               2
                   New Mexico HIE Strategic and Operational Plans

Background

NMHIC Perspective

Vision: To provide a sustainable statewide health information exchange network that transforms
health care quality, patient safety, efficiency, and outcomes.

Health Information Technology, including the HIE network, should be considered an enabler
rather than a goal in itself.

Problem to be Solved

Every day, New Mexico doctors make decisions without access to all the necessary patient
information because this information is often scattered among different healthcare organizations
that are not connected. Scattered information wastes precious physician time, causes
unnecessary ordering of repeat laboratory and radiology tests, reduces the accuracy of
diagnoses, and contributes to medical errors that may harm or even kill the patient.

NMHIC Solution

NMHIC will enable doctors to electronically locate, connect to, and review patient information
scattered across multiple health care organizations. This patient information may include
previous medical events, diagnoses, tests, medications, and relevant documents. Doctors will
be able to access this information via a web portal or receive it directly into their computers
and/or electronic health record (EHR) systems. Physicians do not need to have EHR systems
to make full use of the NMHIC Clinician Portal. The organizations that participate in the NMHIC
network have agreed to make that information accessible by building secure electronic
connections to NMHIC. Whenever clinicians request access to information about individual
patients for whom they are responsible, the NMHIC HIE network will authenticate that they are
who they claim to be and provide privacy protections that comply with federal and state
regulations. Across the nation, similar HIE networks are developing in almost every state
because these networks enable communications that are faster, more current, more complete,
more private, and less costly than phone, fax, or postal mail. These networks also can be used
by any doctor with a computer and internet access, even if their medical practice does not have
an EHR system or they are located in a rural area.


NMHIC History and Future

Phase 1 – Foundation building – 2004-2006. NMHIC was created in 2004 by the non-profit
Lovelace Clinic Foundation (LCF) in Albuquerque, New Mexico. It began with $1.5 million in
federal funding, matching funds from community stakeholders and $447,000 from the State.
The initiative:
 brought together 33 public and private New Mexico health organizations and non-medical
   employers in a community collaborative to develop the network that now connects sources
   of scattered medical information;
 designed a federated network architecture that leaves patient information on the originating
   organization‘s computers, thereby avoiding a central data warehouse or repository; and
 built a secure, privacy-protected network prototype to exchange medical information.



                                               3
                   New Mexico HIE Strategic and Operational Plans

Phase 2 – Conducted demonstration projects – 2006-2007. NMHIC piloted three demonstration
projects:
 In 2006, NMHIC conducted a test that successfully matched individual patient identities
    across multiple healthcare facilities using 4 million patient identity entries contributed by
    eight different New Mexico healthcare organizations.
 On November 1, 2006, Taos doctors and nurses used the NMHIC exchange for the first time
    to coordinate medication, education, and dietary care for patients with diabetes.
 In 2007, Taos Holy Cross Hospital staff demonstrated that it could report abnormal hearing
    screening tests for newborns to the New Mexico Department of Health using the NMHIC
    network.

In addition, in March 2007, the New Mexico State Legislature approved funding of more than
$600,000 to continue development and expansion of NMHIC.

Phase 3 – NMHIC chosen to participate in the Nationwide Health Information Network - 2007-
2008. The NMHIC successes in Phase 1 and Phase 2 led to the award of a federal contract for
more than $3.5 million from the Office of the National Coordinator for Health Information
Technology (ONC) to participate in the base year of the Nationwide Health Information Network
(NHIN) Trial Implementations. The NHIN contract provides funds for NMHIC to:
 accelerate development and expand its network services within New Mexico, and
 participate as one of the nine HIE networks across the country in a trial implementation of
   the NHIN. This trial included:
   o the exchange of summary patient records plus other clinical information among the nine
       HIE networks (as well as several federal and private sector health networks which joined
       the demonstration in mid-2008) ;
   o testing of standards and connections for accurately, securely, and privately moving
       information between regional HIE networks; and
   o demonstration of the benefits provided by the NHIN (e.g., patients temporarily needing to
       have their medical information available to doctors in a community other than their
       home).

Phase 4 – Becoming self-sustaining – 2009 and beyond. The funds from Phase 3 are enabling
NMHIC to strengthen its infrastructure, provide additional network services, and extend these
services to more New Mexico hospitals, laboratories, and doctors. However, federal and state
funding for the development of the network may only be available for the next few years. Now,
while we still have the support of state and federal funding, is the time for us to develop the
sustainable business plan for the future. In order for NMHIC to become self-sustaining, it must:
 clearly understand which network services have the highest priority within the New Mexico
    community; and
 demonstrate that the value of the network services it offers will more than justify user fees,
    and/or annual contributions from the NMHIC stakeholders (providers, payers, employers and
    public health) who benefit from these services.




                                               4
                     New Mexico HIE Strategic and Operational Plans

NMHIC Governance

The New Mexico Health Information Collaborative (NMHIC) is a statewide effort that engages
stakeholders from all sectors of the community. In establishing the initial infrastructure for the
HIE, Lovelace Clinic Foundation (LCF) convened leaders from all possible community
organizations or groups which could benefit from NMHIC and established a Stakeholder group
and a Steering Committee.

The NMHIC Steering Committee represents 33 organizations. The Steering Committee
provides community input from the constituents who contribute either data and/or funds to the
exchange; who use exchange data; or who represent important employer, professional, or state
government groups. The Steering Committee votes on issues needing community consensus
or response because it includes every constituency. Various work or advisory groups have
been formed to address specific exchange topics over the course of NMHIC‘s existence.
Membership has increased over the project duration. Attendance at the Steering Committee
meetings remains high, reflecting continuing community support and commitment to
establishing an HIE in New Mexico. NMHIC stakeholders and Steering Committee members
are shown in Appendix B.


NMHIC Network Services
The network services subsection includes four topics:

1.   Criteria for Selecting Network Services
2.   Descriptions of Network Services
3.   Community Readiness for Network Services
4.   Availability of Network Services

Criteria for Selecting Network Services

Health Information Exchanges around the country have developed a variety of services for their
users. These services are typically referred to as network services. The selection of network
services provided by our HIE network is influenced by four major factors:

    a comprehensive survey that has identified which network services are considered to have
     the highest priority by the potential users of the network within the New Mexico community,
    the network services (use cases) that have already been implemented and tested as part of
     the base year of the NHIN contract,
    market or technical issues related to providing certain network services, and
    willingness/ability of health care organizations to supply data for different network services.

The first factor influencing the selection of network services is the result of a comprehensive
survey. The Community-wide Survey of Potential Network Users was designed from January
through March of 2008 and conducted from March 24 through April 27, 2008. Invitations to take
this survey were emailed to more than 1,700 Medical Doctors, Doctors of Osteopathy, and
practice managers throughout the State of New Mexico. Invitations were sent to members of
the New Mexico Medical Society, physicians practicing at ABQ Health Partners, physicians
practicing at the University of New Mexico Hospital, and practice managers identified by the
Medical Group Management Association. In total, 513 potential users completed this survey.


                                                  5
                         New Mexico HIE Strategic and Operational Plans

The following table displays the priority rankings of the network services from the Survey of
Potential HIE Network Users. Column 2, Priority Ranking, shows the percentage (in bold) and
actual number of survey respondents who indicated that the network service was either their
―                      very
 highest priority‖ or ― important‖. Column 3, Network Interfaces Implemented, identifies the
dates when the interfaces to support the network service have been, or will be, implemented
and tested. Column 4, Commercial Service Available, identifies the dates when the network
service will be fully supported for commercial availability.

                                                Table 1

                           Highest Priority      Network     Commercial
  Network Service                and            Interfaces     Service             Comments
                           Very Important     Implemented     Available
                                                                          Lab Results will be available
                               85.4%                                      to view on a portal by
Receive Lab Results                            July 2008      July 2009
                                438                                       7/2009, and received as a
                                                                          message by 9/2009
                                                                          A continuity of care record
View or Update
                               84.8%                                      summarizes the significant
Summary Patient                                July 2008      July 2009
                                435                                       parts of a patient‘s medical
Record
                                                                          record
Access Medication                                                         Medication lists from
List from pharmacy              83%            September     November     commercial and retail
benefit managers                426              2009          2009       pharmacies via connection
(PBMs)                                                                    to RxHub

Receive Radiology              82.5%
                                               July 2008      July 2009
and Imaging Reports             423
Receive Hospital                                                          This need will be met by the
                               70.7%
Discharge                                      July 2008      July 2009   Summary Patient Record in
                                363
Summaries                                                                 some cases
View Routine                                                              This need will be met by the
                               70.3%
Progress Notes and                                                        Summary Patient Record in
                                361
Consultation Reports                                                      some cases
Verify Patient
                                                                          This data would be obtained
Eligibility and                 69%           March 2010
                                                             June 2010    from payers (insurance,
Authorization for               354
                                                                          Medicaid, Medicare)
Care
Verify Whether a
Provider Can Accept
a Patient‘s Insurance,         64.3%                                      Service availability to be
and Receive                     330                                       determined
Authorization for
Referral
                                                                          This will require contract
Send Prescriptions
                               61.6%                         September    arrangements with
Electronically (e-                             April 2010
                                316                            2010       SureScript and RxHub
Prescribing)
                                                                          networks
Send and Receive               59.5%                                      Service availability to be
Patient Referrals               305                                       determined
Order Radiology /               58%                                       Service availability to be
Imaging                         298                                       determined




                                                    6
                      New Mexico HIE Strategic and Operational Plans

                        Highest Priority      Network     Commercial
    Network Service           and            Interfaces     Service              Comments
                        Very Important     Implemented     Available
                            57.9%                                       Service availability to be
Order Lab Tests
                             297                                        determined
View Immunization           45.6%                                       Service availability to be
Records                      234                                        determined
Record or View              39.4%                                       Service availability to be
Advanced Directives          202                                        determined
Send Mandatory
Public Health               36.9%           November                    Mandatory reporting is a part
                                                          March 2010
Reporting                    189              2009                      of biosurveillance
(Biosurveillance)

The complete survey results are available in a separate supporting document, Survey of
Potential HIE Network Users in New Mexico.

The second factor that influences the selection of network services is that some use cases
have already been implemented as part of the base year of the NHIN contract. These include:

    Summary Patient Record (part of the core implementation)
    EHR-Lab Results
    Emergency Responder

Consequently, these three network services have fewer barriers to becoming commercial
network services than other services.

The third factor that influences the selection of network services is market or technical issues.
For example, the New Mexico Department of Health has expressed interest in receiving
mandatory public health reports, emergency responder reports, and other public health
situational awareness reports through the HIE network. Other than mandatory reporting, these
network services were not included in the Survey of Potential HIE Network Users. However,
these services are important to the New Mexico Department of Health.

Another example, e-prescribing, is identified as a network service that has a high priority within
the New Mexico community. In order to provide this service, NMHIC would probably need to
secure agreements with other networks, such as SureScripts/RxHub. The SureScripts network
provides links to local and commercial pharmacies throughout the United States. SureScripts
was founded by the National Association of Chain Drug Stores (NACDS) and the National
Community Pharmacists Association (NCPA). It has become the network of choice for e-
prescribing because it is efficient and uses national standards for interoperability when it sends
prescriptions to pharmacies. RxHub was created by the three leading pharmacy benefit
management companies. RxHub provides three network services to prescribers: eligibility
benefits, formulary information, and medication history. RxHub and SureScripts are merging to
provide full service e-prescribing.

The fourth factor that influences the selection of network services is the willingness/ability of
health care organizations to supply data for specific network services. This issue can affect the
ability of the network to provide complete data, facilitate continuity of care, or even make it
impractical to provide a network service.



                                                 7
                    New Mexico HIE Strategic and Operational Plans


Description of Network Services

   NMHIC Clinician Portal – Community Patient Healthcare Record. The Clinician Portal will
    include the following clinical data:
    o   Summary Patient Record: Access to a patient‘s Summary Patient Record, also referred
        to as a Continuity of Care Record, portable among different health care systems and
        providers, for key patient data. This data would usually include: problem list/diagnoses,
        medication list, allergy list, test results, immunizations, procedures, and dates of service
        and names of providers, viewed through the NMHIC Clinician Portal.
    o   Lab Results: Access to a patient‘s laboratory results, from multiple laboratories, viewed
        through the NMHIC Clinician Portal.
    o   Radiology and Imaging Reports: Access to a patient‘s radiology and imaging reports
        from multiple radiology providers, viewed through the NMHIC Clinician Portal.
    o   Discharge Summaries: Access to a patient‘s discharge summaries from multiple
        hospitals, viewed through the NMHIC Clinician Portal.
    o   Access to patient record information via the Nationwide Health Information Network
        (NHIN). NMHIC users will also be able to access patient record information from other
        organizations that are connected to the NHIN, including the Veterans‘ Health
        Administration, the Department of Defense Military Health System, the Indian Health
        Service, Kaiser-Permanente, Cleveland Clinic, etc.
   Emergency Responder: Electronic reporting of emergency responder and emergency
    department notifiable diseases or conditions, adverse events, and situational awareness
    data to the New Mexico Department of Health and CDC.
   Lab Results – Message: Transmission of a patient‘s laboratory results, through the HIE
    network, into the EHR system operated by the physician that ordered the laboratory tests.
    The laboratory results will be communicated within a standard HL7 message format.
   Medication History from RxHub: Access to a patient‘s list of medications paid for by
    pharmacy benefit managers (PBMs) and dispensed by commercial and retail pharmacies,
    viewed through the NMHIC Clinician Portal.
   e-Prescribing: Send prescriptions electronically via computer to commercial/retail
    pharmacies (without using paper or fax), through the NMHIC HIE network. This will require a
    business agreement with the SureScript network to route and distribute prescriptions to
    commercial and retail pharmacies. It may also require a business arrangement with RxHub
    to provide information about patient eligibility, formulary limitations, and medication history.
   Quality: Using the functions of the HIE to help improve health care of an individual, as well
    as improving health care of the participating community. Improving the health care of an
    individual occurs by: improving continuity of care (identifying potential adverse events such
    as drug-to-drug interactions, reducing redundant lab tests, avoiding medical errors) and
    lowering the cost of care. Improving health care for the community occurs by: 1)
    aggregating health care information, comparing provided care against best practices, and
    reporting this information back to health care facilities and medical practices so that they can
    take action to improve their clinical processes and patient outcomes; and 2) reporting the
    results of the comparison of performance with best practices to health plans and the public.
   Biosurveillance: Electronic reporting of required Laboratory Results for Notifiable Diseases
    or Conditions, from multiple laboratories, to the New Mexico Department of Health.


                                                  8
                     New Mexico HIE Strategic and Operational Plans

   Insurance Eligibility: Verify a patient‘s insurance eligibility and authorization for care,
    procedures, medications, etc., through the NMHIC Clinician Portal.
   Health Plan Claims Data: If a patient covered by a health plan decides to see a new
    physician/health care provider, this network service will provide health claim data from
    previous patient visits to the new health care provider for patient care purposes. The
    previous health claims data (ICD9 codes, CPT codes and NDC codes for prescribed
    medications) will be viewed on the NMHIC Clinician Portal.


Community Readiness for Network Services

The following table shows statistics that can serve as indicators of potential user readiness to
begin to use the NMHIC HIE network. Column 2 shows the responses of 548 potential users
(mostly physicians) who addressed these questions online. The online Survey of Potential HIE
Network Users was conducted March 24 through April 27, 2008, by the RHIO Grande and
LCF/NMHIC. Column 3 shows the responses of 563 potential users (mostly physicians) who
answered these questions via postal mail. The postal mail survey was conducted by the New
Mexico Health Policy Commission in May and June of 2008. Since the survey sent by postal
mail specifically excluded the 548 email respondents, it enables us to combine the results of
both surveys in the fourth column of the table (Combined Results).


                                                 Email              Mail
                                                                                   Combined Results
         Readiness Indicator                  Responders         Responders
                                                                                         (n=1111)
                                                (n=548)             (n=563)
                                              No.        %       No.          %       No.           %
Access to Internet in Office                 536        99.1%    522     95.4%      1,058         97.2%
Access to Broadband Internet                 401        73.6%    439     81.1%       840          77.3%
EHR Systems:
              Implemented and in Use        255        46.7%    168     31.2%       423          39%
              Being Implemented Now          91        16.7%    81      15.1%       172          15.9%
              Planned Implementation
                                              86        15.8%    92      17.1%       178          16.4%
               Next Year
              No Plans for EHR in Near
                                             114        20.9%    197     36.6%       311          28.7%
               Future



In order for a potential user to be considered ―ready‖ to use HIE network services, they must, at
a minimum, have access to the Internet in their office. The email survey and the postal mail
survey tell us that there are at least 1058 potential users that have Internet access in their office
today. If we use other indicators, such as access to Broadband, then the data tells us that there
are at least 840 potential users today. EHR systems are not a prerequisite for a medical
practice to connect and receive the benefits from an HIE network. However, the information
about the number of respondents who have EHR systems implemented and the number of
respondents who plan to implement EHR systems is provided as an indicator that the New
Mexico clinician population is moving forward to implement health information technology.



                                                    9
                    New Mexico HIE Strategic and Operational Plans

Although there may be an inclination to extrapolate the percentages of the NMHIC and HCP
survey results to the total population of 4312 practicing physicians in the State, it is likely that
the respondents to these two surveys are not representative of the total population. That is, it is
likely that the survey respondents are more computer-literate and more likely to work in
organizations that have implemented EHR systems than are New Mexico physicians as a
whole. However, if the respondents to these surveys tend to be more computer-literate than
other respondents, the survey results might be a good reflection of the priorities of the early
adopters. It also appears that having 840 potential users that are ― ready‖ is sufficient to move
forward.




                                                10
                                      New Mexico HIE Strategic and Operational Plans
Availability of Network Services

The following tables show the estimates for when data suppliers will make patient information available to the network, when the
network will be technically available, and when the network services will be commercially available.




                                                                 11
                                New Mexico HIE Strategic and Operational Plans
Time Frame for Data Suppliers




                                                     12
                      New Mexico HIE Strategic and Operational Plans


Business Assessments

This section presents essential information that will be needed for an informed business assessment
by NMHIC Stakeholders. It includes:
 Total Market Opportunity
 Factors Supporting Adoption of Network Services
 Factors Supporting Successful Operations
 Factors Mitigating Success

Total Market Opportunity

                                                                                 ceiling‖ for business
The following information defines the total market opportunity (i.e., maximum or ―
estimates) for the NMHIC Business Plan. This information has been extracted from the New Mexico
Health Care Environmental Scan, which is a companion document to the NMHIC Business Plan.

Potential Patients and Consumers (Total Population and Covered Lives)
The total population in New Mexico as of 2005-2006 data is 1.932 million.
The total number of individuals:
 Covered by all types of health insurance                  1.513 million          (78%)
       o Covered by plans paid for by employers                 835,514            (43%)
       o Covered by health plans paid for by individuals         77,510             (4%)
       o Covered by Medicaid                                    318,596            (16%)
       o Covered by Medicare                                    250,039            (13%)
       o Covered by Other Public Agencies                        31,684             (2%)
       o Not covered by insurance                               419,227            (22%)

Potential Users (Total Number of Clinicians, etc.)
The total number of:
 Licensed physicians practicing in state in 2008:      4,312
 Licensed physicians‘ assistants in state in 2008:       485
 Advanced practice nurses in 2006-2007:                  634

Potential Data Suppliers (Total Number of Health Care Providers and Payers)
 Total number of hospitals in New Mexico:                59
 Major group practices (10 or more physicians):          10
 Major laboratories serving New Mexico:                   4
 Major radiological/imaging centers in New Mexico:        7
 Physicians practicing in New Mexico as of 2008:      4,312

Potential Beneficiaries (Health Plans, Medicare, Medicaid and Employers)
 Major health plans
   o Presbyterian Health Plan (418,000 members)
   o Blue Cross and Blue Shield of New Mexico (270,000 members)
   o Lovelace Health Plan (190,000 members)
   o Molina Healthcare of New Mexico (76,000 members)
 Medicare (250,000 members)
 Medicaid (319,000 members)
 Other Public Agencies (32,000 members)
 The total health care expenditures for New Mexico were $7.93 billion as of 2004


                                                                                                     13
                      New Mexico HIE Strategic and Operational Plans



Factors Supporting Adoption of Network Services

The factors that support adoption of network services include:
 Momentum created by recent NMHIC activities
 National HIE network trends
 Benefits by type of network service
 Benefits to community stakeholders
 The NMHIC marketing plan
 Projection of Clinician User Adoption

Momentum Created by Recent NMHIC Activities
 NMHIC achievements during AHRQ grant (October 2004 – September 2007)
  o Garnered support from NMHIC Steering Committee and Stakeholders
  o Developed and tested prototype network components
 NMHIC achievements from Health Information Security and Privacy Collaborative (HISPC)
  contract (May 2006 – present)
  o Provided leadership to identify variations in privacy and security policies throughout the state
  o Introduced draft legislation to define HIT privacy laws for New Mexico
 NMHIC achievements during Nationwide Health Information Network (NHIN) Trial Implementation
  contract (October 2007 – present)
  o Strengthened NMHIC management and staff;
  o Implemented robust network infrastructure (MPI, Record Locator Service, portal, interfaces,
     edge servers, security, etc.);
  o Established and tested interfaces with Presbyterian Healthcare Services and TriCore
     Reference Laboratories;
  o Developed and signed Network Subscription Agreements (NSAs) with partners,
  o Exchanged Summary Patient Records with more than a dozen other networks during the
     NHIN demonstration in September, 2008;
  o Conducted a live demonstration of the Emergency Responder Use Case at the NHIN Forum
     with Albuquerque Ambulance, Presbyterian Healthcare Services Emergency Department, and
     the New Mexico Department of Health on December 15, 2008;
  o Was selected by ONC to participate in the NHIN governance workgroup which will define
     NHIN legal, business, and technical functions.

National HIE Network Trends
 The Fifth Annual Survey of Health Information Exchange at the State and Local Levels, conducted
   by eHealth Initiative for 2008, reports the following:
   o The number of operational health information exchange initiatives has increased from 32 in
       2007 to 42 in 2008, which is an increase of 31%.
   o A majority of fully operational exchange efforts (29/42) report reductions in health care costs.
       Sixty-nine percent of 2008 respondents say health information exchange allows them to
       decrease dollars spent on redundant tests; reduce the number of patient admissions to
       hospitals for medication errors, allergies, or interactions; decrease the cost of care for
       chronically ill patients; or reduce staff time spent on administration.
   o For the first time, a majority (69%) of operating HIE networks (29 of 42) report a positive
       financial return on their investment.




                                                                                                  14
                         New Mexico HIE Strategic and Operational Plans

Benefits by Type of Network Service

                      NMHIC DATA SUPPLIERS, USERS & BENEFICIARIES
                               Data
     Network Service                           Benefits to Users        Types of Users      Beneficiaries
                             Suppliers

                                            * Reduces redundant
                                            lab test.
                                                                                           * Data Suppliers
                                            * Faster results to
                                                                        * Clinicians and   * Health Plans
   Lab Results on Portal   * Laboratories   clinicians
                                                                        their assistants   * Medicaid
                                            * Improves continuity of
                                                                                           * Employers
                                            care
                                            * Less costly
                           * Medical                                                       * Data Suppliers
                                            * More complete
                           Practices                                                       * Health Plans
                                            information to clinicians
   Summary Patient         * Hospitals                                  * Clinicians and   * Medicaid
                                            * Improves continuity of
   Record on Portal        * ER on site                                 their assistants   * Employers
                                            care
                           * Emerg. Dept                                                   * Dept, of
                                            * Less costly
                           Hospital                                                        Health
                                            * Reduces redundant
                                            image services
                                                                                           * Data Suppliers
                                            * Faster results to
   Radiology & Image       * Radiology                                  * Clinicians and   * Health Plans
                                            clinicians
   Reporting on Portal     facilities                                   their assistants   * Medicaid
                                            * Improves continuity of
                                                                                           * Employers
                                            care
                                            * Less costly
                                            * More complete
                                                                                           * Data Suppliers
                                            information to clinicians
   Discharge Summaries                                                  * Clinicians and   * Health Plans
                           * Hospitals      * Improves continuity of
   on Portal                                                            their assistants   * Medicaid
                                            care
                                                                                           * Employers
                                            * Less costly
                                            * Saves lives
                           * ER on site
   Emergency                                * Less costly               * Department of    * All citizens
                           * Emerg. Dept.
   Responder                                * Improves efficiency of    Health             * State Govt.
                           * Hospital
                                            mandatory reporting

                                            * Reduces redundant
                                            lab tests
                                                                                           * Data Suppliers
                                            * Faster results to
   Lab Results                                                          * Clinicians and   * Health Plans
                           * Laboratories   clinicians
   Messages                                                             their assistants   * Medicaid
                                            * Improves continuity of
                                                                                           * Employers
                                            care
                                            * Less costly




                                                                                                              15
                        New Mexico HIE Strategic and Operational Plans


                   NMHIC DATA SUPPLIERS, USERS & BENEFICIARIES
                              Data
  Network Service                                Benefits to Users        Types of Users      Beneficiaries
                            Suppliers

                          * Healthcare
                          facilities
                          operated by
                          the VA
                          * Healthcare
                          facilities
                                                                                             * Data Suppliers
                          connected to        * More complete
Access to the                                                                                * Health Plans
                          IHS                 information to clinicians
Nationwide Health                                                         * Clinicians and   * Medicaid
                          * Healthcare        * Improves continuity of
Information Network                                                       their assistants   * Employers
                          facilities          care
(NHIN)                                                                                       * Dept, of
                          operated by         * Less costly
                                                                                             Health
                          the DoD
                          * All healthcare
                          facilities in the
                          private sector
                          that are
                          connected to
                          NHIN
                                              * Faster medication
                                              history to clinicians
                                                                                             * Data Suppliers
Medication History        * RxHub             * Improves continuity of
                                                                          * Clinicians and   * Health Plans
on Portal                 * Hospital          care
                                                                          their assistants   * Medicaid
(from RxHub)              * Pharmacies        * Improves patient
                                                                                             * Employers
                                              safety
                                              * Less costly
                          * Health Plans
                                              * Clinician payment
                          * Medicare                                      * Clinicians
Insurance Eligibility                         * Clinician time                               None
                          * Medicaid                                      * Office staff
                                              * Lower cost
                          * PBMs
                                              * Improves patient
                                              safety                                         * Health Plans
e-Prescribing                                                             * Clinicians
                          * Clinicians        * Less costly                                  * Medicaid
(Gateway)                                                                 * Pharmacies
                                              * Less time for refills                        * Employers
                                              and renewals
                          * Hospitals         * Improves clinical
                                                                          * Hospitals        * Consumers
                          * Medical           processes
Quality Measurement                                                       * Clinicians       * Health Plans
                          Practices           * Improves patient
and Reporting                                                             * Health plans     * Medicaid
                          * Laboratories      safety
                                                                          * Other payers     * Employers
                          * Health Plans      * Less costly
                          * ED Hospitals      * Saves lives
                          * Laboratories      * Less costly               * Department of    * All citizens
Biosurveillance
                          * Medical           * Improves efficiency of    Health             * State Govt
                          Practices           reporting
                          * Health Plans      * Continuity of care        * Clinicians
                                                                                             * Health Plans
Claims Information        * HSD               * Patient safety            * Office staff
                                                                                             * Medicaid
                          Medicaid            * Less costly               * Patients
Other Network
Services TBD




                                                                                                                16
                      New Mexico HIE Strategic and Operational Plans

Benefits to Community Stakeholders
The New Mexico Health Information Collaborative (NMHIC) HIE network will provide benefits to
physician practices, hospitals, health plans, Medicare, Medicaid, employers and patients.
 Benefit to Physician Practices
       o Prompt access to information from other healthcare providers (including medical practices,
            hospitals, Veterans Health Administration, IHS, etc.).
       o Better clinical decisions and care with access to more complete data.
       o Able to provide care with fewer delays.
       o Avoid rework - repeating taking of histories.
       o Better access to current medications lists.
       o Less time collecting or getting information, more time using available information.
       o There may be less liability risk exposure with improved information access.
 Benefit to Hospitals
       o Prompt access to patient information from other health care facilities.
       o Expedite patient information to Emergency Departments.
       o Minimize unnecessary/avoidable services.
       o Reduce expensive manual information processing costs, especially for non-routine
            requests.
 Benefit to Laboratories and Imaging Centers
       o Prompt access to information from other providers.
       o Reduce expensive manual information processing costs, especially for non-routine
            requests.
       o Capability to use the NMHIC for report distribution functions instead of building new
            interfaces.
       o Opportunity to reduce lost revenue from lab orders that lack complete patient billing
            information.
 Benefit to Health Plans
       o Reduction of redundant lab and radiology tests will lower costs.
       o Faster clinician access to more complete patient information improves efficiency and
            lowers costs across the entire health care community.
       o Potential use of clinical data for quality reporting and for pay-for-performance.
 Benefit to Employers / Purchasers
       o Reduction of redundant lab and radiology tests will lower costs.
       o Faster clinician access to more complete patient information improves efficiency and
            lowers costs across the entire health care community.
       o Potential use of clinical data for quality reporting and for pay-for-performance.
       o Lower absenteeism and higher productivity for employers as employee health improves.
 Benefit to Patients
       o Continuity of care across health care providers will be dramatically improved.
       o Patients can avoid both the time and expense involved with redundant laboratory and
            radiology tests.
       o Patients will experience less frustration caused by providing information again and again.
       o Patients will know that they are receiving higher quality care because physicians will have
            access to all of their health records without delays even when their records are scattered
            across multiple health care facilities.
 Benefit to the Community as a Whole
       o Improved continuity of care between the health care facilities operated by the VA, the
            Indian Health Services (IHS), the Department of Defense (DoD), and the private sector
            healthcare facilities enabled by access to the Nationwide Health Information Network
            (NHIN).



                                                                                                    17
                       New Mexico HIE Strategic and Operational Plans

       o   Decreased escalation of health care costs for the state of New Mexico.
       o   Healthier community members, allowing increased productivity and freeing financial
           resources for other needs.
       o   Increased economic development, since employers seek to relocate in areas with high
           quality health care.
       o   It should, however, be noted that the savings from avoidable services represent a loss of
           revenues to the organizations and practices that would have provided those services.


NMHIC Marketing Plan
The purpose of the marketing plan is to ensure that the revenue goals for NMHIC are achieved. The
marketing plan for NMHIC will be developed by February 28, 2009. Marketing plans traditionally
include five elements: product, packaging, price, place, and promotion. This Business Plan will
provide the foundation for several elements of the marketing plan. For example: the product portion
of the marketing plan will be based upon the information within the Network Services section;
packaging and pricing will be based upon the Revenue Generated by User Subscriptions section; and
place can either be considered to be the NMHIC network portal or the user‘s computer monitor.

The promotion plan has not been addressed within this Business Plan. The promotion plan will
include the names of key individuals and organizations that should participate in the HIE network.
This includes the data suppliers (hospitals and medical practices), potential users (clinicians), the
payer beneficiaries (health plans, Medicaid, and employers), the State of New Mexico, and
consumers. NMHIC has already conducted interviews with executive decision makers of the
hospitals, medical practices, and health plans that will become the data suppliers, users, and payer
beneficiaries of the network.

Projection of Clinician User Adoption
Based on the Availability of Network Services, the Time Frames for Data Suppliers, and the factors
above, NMHIC projects the following rate of clinician user adoption.

                                          2008     2009     2010    2011     2012
                      New Users              0      600     1360     690      220
                      Total Users            0      600     1960    2650     2870

This projection indicates that 66.5% (2870 of 4312) of licensed physicians practicing in New Mexico
would be users of the NMHIC network by the end of 2012. The clinician adoption rate is skewed
toward the earlier years, because that is when the largest health care providers and medical groups in
the state are expected to sign NMHIC network subscription agreements. The only reason that 2009
does not show the largest number of new clinician users is that commercial availability of NMHIC will
not occur until October of 2009.


Factors Supporting Successful Operations

The factors in this section that support successful operations are discussed in the following
subsections:
 Organization Structure
 Staffing
 Exchange Operations
 Exchange Partners and Their Roles


                                                                                                        18
                       New Mexico HIE Strategic and Operational Plans


Organization Structure
The health information exchange (HIE) network in New Mexico is called the New Mexico Health
Information Collaborative (NMHIC). NMHIC is a community collaborative that has been initiated,
developed, operated, and staffed by Lovelace Clinic Foundation (LCF). LCF is a 501(c)(3), non-profit,
tax-exempt applied health research organization. The NMHIC organization chart is shown below.
Please refer to Appendix C for the biographies of the NMHIC staff.




Staffing
Staff functions required for NMHIC include: project management, generalists, facilitation,
communications/communicators, product management, and administrative leadership. Maximum
leverage of limited but adaptable resources is required in order to achieve the vision and mission of
the NHIN project.

Key functional roles include:
   President and Executive Director: This position serves as the chief executive officer of NMHIC and
    co-lead for the NHIN initiative. Utilizes the NMHIC advisory steering committee to obtain key input
    regarding the direction and strategy of the NHIN initiative.
   Director of Health Informatics: This position serves as lead for the NHIN initiative, and is
    responsible for the strategy and business plan.




                                                                                                        19
                       New Mexico HIE Strategic and Operational Plans

   Medical Director of Clinical Informatics: This position serves as the chief medical officer for
    NMHIC and the liaison coordinator for working with physicians, clinical practices and other
    stakeholder groups on the NHIN programs and services. This position will be extremely important
    in providing thought leadership and relationship management with physicians and medical groups;
    physicians are more receptive to and more likely to consult with other physicians about issues of
    technology and business management, workflow issues, and information seeking.
   Chief Financial Officer: This position provides the key financial expertise to ensure the financial
    aspects of the business plan are identified and addressed in order to create a sustainable
    operation for health information exchange.
   Marketing: This position is responsible for outreach and marketing of the health information
    exchange (HIE) to the healthcare community in New Mexico. The person in this position will
    spend significant time with healthcare providers and payers to explain the benefits of participation
    as a data provider and/or user. This person will raise awareness and enthusiasm within the state
    for the HIE, leading to expanded adoption beyond the pilot participants. It is critical that this
    position be staffed by a physician who is highly knowledgeable in the national HIT and HIE
    initiatives.
   Legal Officer: This position serves to assure that all legal aspects regarding the implementation
    and operation of the health information exchange are identified and addressed.
   Director of Human Resources: This position provides human resource and administrative support
    for the health information exchange. As new positions are needed, this position assures the
    market assessment is performed to attract and recruit qualified candidates. This position also is
    responsible for ongoing programs to ensure that qualified staff is retained as well as to ensure
    staff issues are addressed in a timely and appropriate manner. This position is also responsible
    for ensuring general administrative support is provided for NMHIC/NHIN staff activities.
   Chief Information Officer: This position serves as the combination chief technology operating-
    information officer and overall NHIN project manager with prime responsibility for leading the
    technology staff, managing the programmatic and contractual relationship with the supporting
    vendors, and implementation of the health information exchange services with the participating
    organizations.
   IT and Data Security Analyst: This position is responsible for assuring the security and integrity of
    the technical environment and data managed by the NHIN initiative. The individual filling this
    position has extensive security expertise, including CISSP certification.
   Applications and Interface Support Analysts: These positions are responsible for managing the
    various components of the NMHIC network, including application servers, internet portals,
    databases, data supplier interfaces, etc. Responsibilities also include front line support for
    subscribers, with additional support provided by MedPlus as required.
   Admin and IT: This position is responsible for administration of the various components of the
    NHIN environment.
   Project Managers: These positions are responsible for the development and management of the
    various project use cases and/or phases required for the implementation of the NHIN initiative.
    The individuals in these roles ensure that the projects follow Project Management Institute
    concepts and principles.
   Subscriber Support: These positions are responsible for the day to day support of the subscriber
    community, responding to technical problems, providing training, and providing go-live assistance
    when new data providers or data users subscribe to NMHIC.



                                                                                                          20
                       New Mexico HIE Strategic and Operational Plans


Other positions will be added as the buildup of NHIN operations occurs. These positions will provide
expanded support for help desk services, end-user training, system administrative functions, etc.

Exchange Operations
Privacy Policies
 It is essential that individuals trust that their electronic health information is kept private and secure
    by the NMHIC health information organization. It is also essential that the methods used to
    protect privacy and maintain the security of the electronic health information are not so
    burdensome as to deter clinician use and health information exchange. As a result, LCF
    developed NMHIC Privacy Policies to address the balance between these two objectives, and to
    ensure patient consent is obtained by the provider prior to accessing patient information on the
    NMHIC network. Please refer to Appendix D for a list of the Privacy Policies.

Expectations of Data Users and Providers
 All NMHIC data users and providers are required to sign the NMHIC Subscription Agreement,
   which provides details regarding requirements and expectations for participation in the network.
 Data Providers are expected to allow NMHIC servers within their network environments to enable
   access to patient information. Additionally, Data Providers are expected to work with LCF staff to
   ensure the continuous operation of the NMHIC data exchange, including operations monitoring,
   incident management, problem management, configuration management, change management,
   service management, etc.
 Data Users are expected to contact LCF operations staff in the event of issues with accessing
   NMHIC supplied information.
 Both Data Providers and Data Users are expected to immediately report any patient information
   security or privacy breaches, or inappropriate disclosures. The LCF help desk and service
   support staff are the primary points of contact for ongoing operations management of the NMHIC
   network.

Security Practices and Technology
 LCF implemented the latest in best practices for information security technology and information
   security to ensure protection of individual health information accessed by the NMHIC network. The
   formal security policy and Standard Operating Procedures (SOPs) are patterned after industry
   best practices that meet or exceed all of the HIPAA security requirements.
 LCF understands that NMHIC security crosses all levels of the service model, including physical
   access systems and SOPs, as well as SOPs governing network access, directory access, system
   access, database access, and applications.
 LCF is responsible for the installation, upgrade, maintenance, and change management
   associated with all aspects of information security infrastructure hardware and system software for
   NMHIC.

Administrative and Technical Operations
 NMHIC‘s administrative and technical operations are conducted in secure facilities within the LCF
  offices in Albuquerque, New Mexico. To support the NHIN Trial Implementation contract, LCF
  upgraded the facilities to provide enhanced support, including privacy protection, data security,
  availability, and reliability, and backup recovery.
 LCF provides all NMHIC data center services including operations, technical support, monitoring,
  and system administration. LCF personnel have extensive experience in healthcare technology
  and have implemented a full suite of advanced solutions that enable optimal operations in the
  NMHIC environment. LCF‘s approach is flexible, customizable, and responsive to changing


                                                                                                         21
                       New Mexico HIE Strategic and Operational Plans

   needs. NMHIC‘s maintenance and implementation control policies and standard operating
   procedures (SOPs) ensure that maintenance--installations, upgrades, patches, and functionality
   changes--are properly approved, tested, implemented, and documented in accordance with
   service center standards. For more details regarding Administrative and Technical Operations, as
   well as the NMHIC technical architecture, please refer to Appendices E and F.

Facility and Infrastructure Requirements
 The NMHIC staff occupies offices at 2309 Renard Place SE in Albuquerque, New Mexico. The
   current facility provides the necessary space to accommodate existing and near-term anticipated
   staff for the NHIN initiative. Additional office space may be required as the NHIN initiative
   approaches the full realization of its potential. The infrastructure equipment required for current
   and anticipated NHIN requirements will be housed within the existing NMHIC facility. This
   equipment is scalable to the needs of the NHIN initiative, and is configured to be easily moved if
   the need arises. Edge servers required at data provider sites will be installed by NMHIC staff.
   The space required for this equipment is minimal and should not pose any challenges at provider
   facilities.

Exchange Partners and Their Roles
The NMHIC partners consist of data providers and data users. Data providers are those healthcare
systems (hospitals, health plans, government entities, physician clinics) that subscribe to the network
with the purpose of sharing patient care information with subscribing data users. Data users access
patient care information from NMHIC in order to gain a more complete picture of the history of care
given to their patient.

LCF has spent a number of years building positive relationships with healthcare providers across the
state. As a result, LCF has been able to obtain signed subscriber agreements with four organizations
as the initial NMHIC data providers for the NHIN Trial Implementations. These organizations include
Presbyterian Healthcare Services, TriCore Reference Laboratories, Albuquerque Ambulance Service,
and Taos Holy Cross Hospital. In addition, LCF signed a NMHIC subscriber agreement with the New
Mexico Department of Health, as a data user.

LCF continues to work with other healthcare organizations, in order to meet their needs with NMHIC
services. The LCF goal is to add at least 12 subscribers to NMHIC within the next 36 months.
Potential candidates to become new NMHIC subscribers include Lovelace Health System, ABQ
Health Partners, Heart Hospital of New Mexico, UNM Hospital System, New Mexico Heart Institute,
Eye Associates of New Mexico, Presbyterian Health Plan, Lovelace Health Plan, Blue Cross Blue
Shield of New Mexico, United Healthcare, Molina and RxHub.

The specific data provided may vary slightly from one subscriber to the next. However, most hospital
organizations will provide ADT, clinical notes, medication history, laboratory results and orders,
radiology reports, allergy history, immunization history, and EKG/cardiology reports. Most health plan
organizations will provide eligibility information and healthcare information from claims history.




                                                                                                     22
                       New Mexico HIE Strategic and Operational Plans


Factors Mitigating Success

Partnership Risks and Constraints
 Some healthcare providers may take more time than planned before they agree to provide data
   and/or become a user of the NMHIC network.
   Risk Mitigation: The NMHIC team plans to engage all potential data suppliers and users as early
   as possible, so that there is sufficient time for these partners to plan, budget, test, and implement
   their interfaces to the NMHIC network.
 If one or more major healthcare providers do not participate in the NMHIC network, it will degrade
   the value of network services for all other users.
   Risk Mitigation: The NMHIC team plans to engage potential partners on both a collective and an
   individual basis in order to encourage all partners to participate.

Technical Risks and Constraints
 While the network infrastructure is robust and scalable, every new supplier of patient data for the
   network will require the installation of an interface and, in many cases, an Edge Server. This will
   take time and resources.
   Risk Mitigation:
   o The Business Plan has projected adoption rates over the next several years and included the
        resources to support these adoption rates in the plan.
   o NMHIC has contracted with a technology partner, MedPlus, which has years of experience
        implementing HIE networks.
   o NMHIC has hired a technical staff with the skills and experience that are appropriate for
        managing and installing network interfaces. This team has demonstrated its capabilities
        during the test and demonstration of the NHIN trial Implementation.
 Every new user on the network will require authorization, authentication, education and technical
   support.
   Risk Mitigation: The NMHIC team plans to establish a comprehensive marketing plan and update
   the privacy and security plan by the end of December, 2008. The marketing plan and the privacy
   and security plan will identify the specific actions necessary to address these requirements.
 After the network is commercially operational and interfaces to the data suppliers and users are in
   place, there will continue to be operational risks including maintaining network availability and
   reliability, and recovering quickly from network interruptions.
   Risk Mitigation: Operations risk has been mitigated by implementing accepted practices for
   continued operations in the event of failure, data backup and recovery processes, and subscriber
   support processes.

Competitive Risks and Constraints
 In other parts of the country, employers, health plans, and private initiatives are developing
  personal health record (PHR) networks. If PHR networks are implemented in New Mexico, they
  might be installed in a manner that uses the patient data provided by NMHIC (which will be
  complementary to NMHIC), or they may attempt to obtain patient information from the same data
  suppliers as NMHIC (which would be directly competitive to NMHIC, as well as being redundant
  and a waste of community resources).
  Risk Mitigation: the NMHIC team plans to address this risk in two ways:
  o Move as quickly as possible to implement the NMHIC network with our local partners so that
      NMHIC will be the de facto source of provider data for patient care throughout the state. If we
      do this in a manner that provides good value to our partners and users, it is less likely that
      another network will be able to compete with us.




                                                                                                      23
                       New Mexico HIE Strategic and Operational Plans

    o    The NMHIC team will be exploring the emerging PHR marketplace to better understand the
         requirements for this market and the business and technical options available. This
         knowledge should put us in a better position to recommend, select, or partner with a PHR
         solution that will best meet the needs of the New Mexico community.
   Payers (health plans and Medicaid) are offering, or planning to offer, physicians access to health
    claims data for a patient at the time of patient care. This service is not as comprehensive or timely
    as the Summary Patient Record, but it does present some degree of competition.
    Risk Mitigation: The NMHIC team plans to discuss this with the health plans to identify the best
    way for NMHIC and the health plans to work together to provide an information solution that gives
    the greatest value to health care providers and consumers.
   If several of the beneficiaries (health plans, Medicare, or Medicaid) decline to contribute to the
    network on a per member per month basis, that might delay the development of the network.
    Risk Mitigation: There are many reasons why a good solution like NMHIC may take time to
    receive full community support. The NMHIC Business Plan has attempted to recognize this reality
    by projecting support from health plans and other payers over a period of years.

Financial Risks and Constraints
 If the payers in New Mexico do not agree to provide adequate funding for NMHIC, beginning in
   2010, that will impact the rate of growth of the NMHIC HIE network.
   Risk Mitigation: NMHIC is working with the health plans and Medicaid individually and as a group
   to arrange for adequate funding for MNMHIC starting in January 2010. BCBS of New Mexico has
   volunteered to convene a meeting of all of the payers with the intent of obtaining a commitment to
   fund NMHIC at a single PMPM rate for all payers.

Legal Risks and Constraints
 At this time, neither the nation nor the state of New Mexico has come to a consensus regarding
   the policies and practices to protect the privacy of healthcare information. This lack of legal
   consensus leaves HIE networks like NMHIC in a vulnerable position until consensus is reached.
   While NMHIC can be developed to support most of the privacy policies and practices being
   considered, NMHIC will remain vulnerable to a redesign of its network if federal or state privacy
   laws are adopted that vary too far from those being considered today.
   Risk Mitigation:
   o The NHIN Trial Implementation contract calls for NMHIC to support a basic level of patient
       preferences regarding the privacy protections of their health care information. In addition, the
       NMHIC Business Plan includes funding to support additional types of patient preferences
       when they arise.
   o Privacy/security risks have been mitigated by implementation of NMHIC subscriber
       agreements and the execution of appropriate liability insurance policies. The NMHIC
       subscriber agreement ensures that each subscriber understands and complies with data use
       privacy and security requirements. The liability insurance policies mitigate risk and provide
       coverage necessary for an entity that is involved in providing electronic access to protected
       health information.




                                                                                                      24
                       New Mexico HIE Strategic and Operational Plans


Summary of Financial Projections

The intent of this section is to complement the business information from the previous sections with
financial information that will enable NMHIC stakeholders to continue discussions that will lead to
stakeholder decisions regarding the financing for NMHIC.

The tables in this section were generated by the Financial Pro Forma software tool which was
developed specifically for HIE networks by the e-Health Initiative. This software tool is intended to
help HIE networks determine when they will achieve financial self-sufficiency.

Summary of NMHIC Expenditures

The NMHIC expenditures shown below have been developed by the NMHIC staff based on the
following:
 Actual NMHIC expenditures to develop and implement the HIE network infrastructure during the
     base year, and the extension to the base year, of the NHIN contract, from October 2007 through
     December 2008. Funding for this infrastructure was provided primarily by the federal government
     via the NHIN Trial Implementations contract, and by the State of New Mexico.
 Priorities and time frames for the availability of NMHIC network services were derived from the
     results of the Survey of Potential Network Users and careful business and technical assessment
     of how quickly NMHIC can provide each new network service.
 Interviews with executive decision makers and stakeholders representing the medical practice
     community, the hospital community, the health plan community, the State of New Mexico
     Department of Health, and the New Mexico Human Services Department (Medicaid).
 Business and technical experience of the NMHIC staff.

The following table shows significant changes from the same table in Version 1 of the NMHIC
Business Plan. These changes have occurred because the NMHIC staff is now aware of the actual
federal funding that will be available to NMHIC for 2009 and has more information about the costs of
providing network services. Total NMHIC expenditures have been reduced for 2009 from $3.24M in
Version 1 of the Business Plan to $1.78M in Version 3 of the Business Plan, in response to the limited
funding that will be available for 2009. The reduction in expenditures occurred in the following areas:
 New software license costs to support additional patient identities in the MPI are deferred to 2010.
 The number of new network interfaces for 2009, along with the associated vendor implementation
   costs, is reduced.
 New NMHIC staff hires planned for 2009 are deferred.
 LCF executive time budgeted for NMHIC is reduced.
 Date for commercial availability slips from August 1, 2009 to October 1, 2009.
 Commercial availability for network services for medication history and laboratory messages slips
   from late 2009 into 2010.

Although Version 3 of the NMHIC Business Plan reduces the rate of growth of new interfaces, new
network services, and user adoption rates projected in Version 1 in order to stay within the limited
funding for 2009, it still supports the 2009 goals of adding major health care providers to the network,
providing commercial availability of the NMHIC network portal, and retaining the nationally recognized
NMHIC staff. In addition, the projection of NMHIC expenditures for 2010, 2011, and 2012 reflects a
better understanding of network costs than in Version 1.




                                                                                                        25
                      New Mexico HIE Strategic and Operational Plans

                         Projection of NMHIC Expenditures (in millions)
                                    2004 -        2008         2009       2010       2011       2012
      Type of Expenditure
                                     2007        Year 1       Year 2     Year 3     Year 4     Year 5
COST OF REVENUE                              -            -       0.28       0.38       0.43      0.46
  MINUS DEPRECIATION                         -            -          -          -          -          -
  SUBTOTAL -
                                             -            -       0.28      0.38       0.42       0.46
  COST OF REVENUE

OPERATING EXPENSES                     2.85          3.02         1.64       2.31       2.49       2.45
  MINUS DEPRECIATION                   0.00         -0.15        -0.16      -0.25      -0.29      -0.33
  SUBTOTAL -
                                       2.85          2.87         1.48      2.06       2.20       2.12
  OPERATING EXPENSES

CAPITAL INVESTMENTS                    1.05          0.77         0.02      0.44       0.20       0.20

        TOTAL EXPENDITURES             3.90          3.64         1.78      2.88       2.82       2.78




Summary of NMHIC Revenue

The revenue projections in Version 3 of the NMHIC Business Plan reflect feedback from NMHIC
stakeholders and information from the federal government regarding funding for 2009. As a result,
the revenue projections in Version 3 include four changes:
 The two largest health plans in New Mexico suggested that the revenue model should not include
    subscription fees for clinical users, but that this revenue should instead be included within the
    revenue expected from the health plans.
 The health plans also suggested that the revenue model should include all payers (health plans
    and Medicaid) and that the amount of revenue expected from each payer should be based on a
    single per member per month (PMPM) rate.
 NMHIC has been informed by several health plans that Version 1 of the Business Plan was
    published too late (the end of September) to be included in their budgets for 2009.
 During 2009 (Year Two) NMHIC expects to receive approximately $1.78 M from the federal
    government. This amount is comprised of $ 0.38 M in carryover funds for January and February,
    2009; and approximately $1.5 M for March 1, 2009, through February 28, 2010. (We are
    estimating that only $1.4 M is likely to be received within the 2009 calendar year.) NOTE: The
    Office of the National Coordinator (ONC) refers to the $1.5 M as the funding for Option Year One
    of the NHIN Trial Implementation contract.




                                                                                                   26
                        New Mexico HIE Strategic and Operational Plans


                               Summary of NMHIC Revenue Projections
                                           2008    2009      2010                       2011          2012
                                               Year 1   Year 2        Year 3           Year 4     Year 5
 Revenue from Clinician Users of
 the Network                                     -          -             -              -             -
 (Network Subscription Agreements – NSAs)
 Revenue from Payers
 ▪ Number of Covered Lives                       -          -         1.25 M           1.25 M     1.25 M
 ▪ Rate Per Member Per Month                     -          -         $0.201           $0.201     $0.201
 ▪ Total Revenue from Payers                     -          -        $3.01 M          $3.01 M     $3.01 M
 Revenue from Government
 ▪ State of New Mexico                      $0.58 M         -             -              -             -
 ▪ Federal
   ▪ Base Year 2008                         $3.06 M        -            -                -           -
   ▪ Carry Over to 2009                        -        $0.38 M         -                -           -
   ▪ Option Year One - 2009                    -        $1.40 M         -                -           -
   ▪ Total Funds from Government            $3.64 M     $1.78 M         -                -           -
 Total Revenue                              $3.64 M     $1.78 M      $3.01 M          $3.01 M     $3.01 M



Financial Projection Scenarios

Scenarios 1 through 6 were presented in Versions 1 and 2.2 of the NMHIC Business Plan. These
scenarios are included in this version of the Business Plan as Appendix K for your historical
reference. These scenarios generated constructive feedback from both NMHIC stakeholders and the
federal government. The scenarios below reflect this feedback, plus the possibility of additional
federal funding for 2010 from the American Recovery and Reinvestment Act (ARRA). An analysis of
projected funding from each of the five major health plans in New Mexico for the three scenarios
below is shown in Appendix L.

The information in the tables below was generated by the Pro Forma Software Tool developed by the
e-Health Initiative. Please note that this software tool recognizes start-up funding from federal and
state contracts and grants as part of cash flow, but it does not recognize these funds as revenue. By
using this approach NMHIC will not show a positive net income until NMHIC revenue exceeds the
costs of providing network services (financial self-sufficiency). The net income for each year is shown
as the bottom line of each scenario.

Baseline Scenario
The assumptions for this scenario are described under the subsections Summary of NMHIC
Expenditures and Summary of NMHIC Revenue above. This Baseline Scenario does not include
any federal funding from ARRA.

                                            Baseline Scenario
                                      2004 -      2008      2009               2010            2011           2012
     Revenue/Expense
                                       2007      Year 1     Year 2            Year 3         Year 4          Year 5
Costs:
Total NMHIC Development
                                     $3.90 M      $3.64 M       $1.78 M       $2.88 M        $2.82 M         $2.78 M
and Operating Costs


                                                                                                                 27
                      New Mexico HIE Strategic and Operational Plans



Revenue:
Revenue From User
                                     -            -           -          -            -           -
Subscriptions
Revenue from Payers                  -            -           -       $3.01 M     $3.01 M     $3.01 M
 ▪ Number of Covered Lives           -            -           -        1.25 M      1.25 M      1.25 M
 ▪ Rate Per Member Per
                                     -            -           -       $0.201       $0.201      $0.201
Month
▪ Total Operating Revenue            -            -           -       $3.01 M     $3.01 M     $3.01 M
Funding From Federal, State
                                  $3.45 M     $3.64 M     $1.78 M        -            -           -
and Stakeholders
Total Operating and Funding
                                  $3.45 M     $3.64 M     $1.78 M     $3.01 M     $3.01 M     $3.01 M
Revenue

Financial Summaries:
Cash Flow (+/-)                  -$0.45 M         -           -       $0.12 M     $0.18 M     $0.22 M
Net Earnings (+/-)                   -            -           -       $0.30 M     $0.09 M     $0.09 M


Baseline Plus $500K Additional Federal Funding Scenario
          What if … ?‖ scenario. It shows the effect if $500,000 in additional federal funds becomes
This is a ―
available for 2010 as a result of ARRA.

                  Baseline Plus $500K Additional Federal Funding Scenario
                                2004 -     2008      2009       2010       2011                 2012
      Revenue/Expense
                                 2007     Year 1     Year 2     Year 3     Year 4              Year 5
Costs:
Total NMHIC Development
                               $3.90 M   $3.64 M    $1.78 M    $2.88 M    $2.82 M             $2.78 M
and Operating Costs

Revenue:
Revenue From User
                                     -            -           -          -            -           -
Subscriptions
Revenue from Payers                  -            -           -       $2.51 M     $3.01 M     $3.01 M
 ▪ Number of Covered Lives           -            -           -        1.25 M      1.25 M      1.25 M
 ▪ Rate Per Member Per
                                     -            -           -       $0.167       $0.201      $0.201
Month
▪ Total Operating Revenue            -            -           -       $2.51 M     $3.01 M     $3.01 M
Funding From Federal, State
                                  $3.45 M     $3.64 M     $1.78 M     $0.50 M         -           -
and Stakeholders
Total Operating and Funding
                                  $3.45 M     $3.64 M     $1.78 M     $3.01 M     $3.01 M     $3.01 M
Revenue

Financial Summaries:
Cash Flow (+/-)                  -$0.45 M         -           -       $0.13 M     $0.18 M     $0.22 M
Net Earnings (+/-)                   -            -           -          -        $0.09 M     $0.09 M

Baseline Plus $1M Additional Federal Funding Scenario




                                                                                                      28
                       New Mexico HIE Strategic and Operational Plans

This is another ―What if … ?‖ scenario. It shows the effect if $1 M in additional federal funds becomes
available for 2010 as a result of ARRA.

                    Baseline Plus $1M Additional Federal Funding Scenario
                                 2004 -     2008      2009       2010      2011                  2012
      Revenue/Expense
                                  2007     Year 1     Year 2    Year 3     Year 4               Year 5
Costs:
Total NMHIC Development
                                $3.90 M   $3.64 M    $1.78 M   $2.88 M    $2.82 M              $2.78 M
and Operating Costs

Revenue:
Revenue From User
                                      -            -           -          -            -           -
Subscriptions
Revenue from Payers                   -            -           -      $2.01 M      $3.01 M     $3.01 M
 ▪ Number of Covered Lives            -            -           -       1.25 M       1.25 M      1.25 M
 ▪ Rate Per Member Per
                                      -            -           -       $0.134      $0.201       $0.201
Month
▪ Total Operating Revenue             -            -           -      $2.51 M      $3.01 M     $3.01 M
Funding From Federal, State
                                  $3.45 M      $3.64 M     $1.78 M      $1 M           -           -
and Stakeholders
Total Operating and Funding
                                  $3.45 M      $3.64 M     $1.78 M    $3.01 M      $3.01 M     $3.01 M
Revenue

Financial Summaries:
Cash Flow (+/-)                   -$0.45 M         -           -      $0.13 M      $0.18 M     $0.22 M
Net Earnings (+/-)                    -            -           -         -         $0.09 M     $0.09 M



Financial Benefits to NMHIC Stakeholders
A quantification of the benefits to stakeholders is shown below.

The first perspective to help us quantify the benefits to NMHIC stakeholders is derived from a study
of nationwide HIE savings performed by the Center for Information Technology Leadership (CITL),
The Value of Healthcare Information Exchange and Interoperability. This perspective takes the
savings generated by HIEs and interoperability at the national level and projects these savings to New
Mexico based upon the percentage of national versus state expenditures on health care. Since the
national savings estimates assume an advanced level of interoperability, and since many
health care organizations in New Mexico do not yet have EHR systems with advanced levels of
interoperability, it was decided to use only 10% of the projected savings from HIE networks in
this report. This perspective shows the following annual financial benefits (mostly cost avoidance)
for New Mexico.

                Projected Savings (and/or Cost Avoidance) from HIE Networks
                                                   Annual Savings      Annual Savings to
                Source of Savings
                                                     New Mexico       New Mexico Payers
 Outpatient Providers & Laboratories                                              $2.07 M
         Reduced Tests                                     $ 2.62 M
         Efficiencies on Remaining Tests                  $ 16.94 M


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                      New Mexico HIE Strategic and Operational Plans

 Outpatient Providers & Radiology Centers                                                    $4.42 M
          Reduced Tests                                          $ 5.61 M
          Efficiencies on Remaining Tests                       $ 10.50 M
 Providers Communicating with Other Providers                                                $5.41 M
          Physicians                                              $ 5.45 M
          Hospitals                                               $ 2.68 M
 Providers & Public Health Departments                                                           N/A
          Physicians                                             $ 0.07 M
          Public Health Departments                              $ 0.07 M
 Total Interoperability Savings                                  $ 43.94 M                 $11.90 M

For more details on these savings (cost avoidance), please refer to Appendix H.

The second perspective to help us quantify the benefits to NMHIC stakeholders uses local examples
and local data. We have chosen to draw primarily upon data from Albuquerque-based medical
institutions for the second perspective because Albuquerque: (1) has more available information on
which to base estimates, (2) is the state‘s tertiary care center, (3) accounts for a much higher volume
of medical activity than its population would dictate, and (4) is the physical location of the initial
NMHIC data providers.

This analysis is based on local demographics, statistics, workload, and insights gained from current
health information exchange activities, but does not include all areas of potential savings or cost
avoidance. All benefits are based on extremely conservative estimates. Measures of improved
health care quality are only assessed in relation to adverse drug events (ADEs). Measures of savings
to patients and consumers from their reduced work in exchanging or tracking their health information
were not included.

The following table includes estimates of potential savings and/or cost avoidance from eight
examples. The assumptions that were used to estimate these savings are described in Appendix J.

                                                                                       Estimate of
                   Areas of Savings and/or Cost Avoidance
                                                                                     Annual Savings
Avoiding unnecessary ambulatory visits caused by missing patient data                     $1,509,200
Avoiding unnecessary referrals to Emergency Departments (other than ADEs)
                                                                                             $576,000
caused by missing patient data
More efficient information sharing within Emergency Departments                              $686,400
Reduced number of adverse drug events (ADEs) which require Emergency
                                                                                             $365,000
Department visits
Reduction in redundant laboratory testing                                                  $1,000,000
Reduction in redundant imaging services                                                      $280,500
Improved lab and imaging staff efficiency                                                    $180,000
Improved staff efficiency by electronic sharing of patient records among hospitals            $59,059
                                           Total Annual Savings for Albuquerque            $4,656,159
  Savings from the rest of the state (estimated to be 30% of Albuquerque savings)          $1,396,848
                           Total Annual Savings/Cost Avoidance in New Mexico               $6,053,007

Whether we use very conservative (only 10%) estimates from the national studies for the first
perspective, or very conservative estimates from the eight local examples in the second perspective,




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                      New Mexico HIE Strategic and Operational Plans

both perspectives show savings/cost avoidance that significantly exceeds the $3.01M annual cost for
NMHIC.



Conclusions and Recommendations
Conclusions

   NMHIC has assembled the resources, technologies, and community stakeholders to develop an
    HIE network to solve the problem of scattered patient information. Scattered information wastes
    precious physician time, causes unnecessary ordering of repeat laboratory and radiology tests,
    reduces the accuracy of diagnoses, and contributes to medical errors that may harm or even kill
    the patient. NMHIC will solve this problem by enabling physicians to have rapid access to this
    critical information when making decisions about patient care. NMHIC has already established a
    strong foundation to achieve this, including:
    o Developing broad community support among NMHIC stakeholders
    o Identifying network service priorities from a comprehensive survey of potential network users
    o Demonstrating a prototype HIE network in 2006-2007
    o Establishing a robust technical platform and strong executive and management team to
         operate the HIE
    o Demonstrating the ability to communicate with other networks as part of the Nationwide Health
         Information Network in 2008
   NMHIC has developed revenue and cost models to help assess options for expansion of high
    priority network services over a five year period. Scenarios 1 through 6 were presented in
    Versions 1 and 2.2 of the Business Plan. Version 3 includes new information from the federal
    government regarding funding for 2009 and feedback from NMHIC stakeholders.
   The health information exchange network is a critical component of a health information
    infrastructure for New Mexico. The development of this health information infrastructure is
    necessary for improving quality and lowering costs, and therefore an essential component of all
    proposals for universal access to health care.


Recommendations

The following recommendations were presented in Version 1 of the NMHIC Business Plan. They are
still relevant for Version 3, with a few minor edits.

Recommendations for NMHIC Stakeholders
 NMHIC and the community should view the development of the HIE network as if it were the
   development of a non-profit public utility.
 Version 1 of the NMHIC Business Plan was presented to the NMHIC Steering Committee and
   RHIO Grande Board on Tuesday, October 21, 2008. This review began the process of community
   discussions that are intended to lead to stakeholder decisions regarding the financing for NMHIC.
   Version 3 of the NMHIC Business Plan includes feedback from NMHIC stakeholders and federal
   funding sources, and is intended to continue this process.
 Since the benefits of sharing patient information to improve quality of care, patient safety, and
   lower costs must be balanced by the need to ensure that patient protected health information



                                                                                                 31
                       New Mexico HIE Strategic and Operational Plans

   (PHI) is safeguarded, the initiatives to build community consensus for financial support of NMHIC
   must move forward in parallel with forums to develop community consensus to protect PHI.

Recommendations for Payers (Health Plans and Medicaid)
 Since the scenarios in this report reveal that most of the cost to support the HIE network will be
   directly or indirectly covered by the payer community, the forums to develop community
   consensus for the financial support of NMHIC should be led by the payer community.
 Since the New Mexico Human Services Department (Medicaid) will benefit from the lower
   community healthcare costs provided by NMHIC (e.g., significant improvements in continuity of
   care and reduced duplication of health care services) it should consider covering the cost of
   access to NMHIC for physicians caring for Medicaid patients.
 The New Mexico Human Services Department (Medicaid) can also directly improve the quality
   and lower the cost of health care in the state by making Medicaid health claim information
   accessible to physicians throughout the state via NMHIC.

Recommendations for Health Care Providers
 Since the success of the NMHIC HIE is dependent on data supplied by health care providers and
   the use of the network by clinicians, there should also be an initiative to promote clinician review of
   the network services as they are being developed to provide feedback to maximize the ease of
   use and benefits to clinicians.

Recommendations to New Mexico Department of Health
 The relationship of the New Mexico Department of Health (DOH) to NMHIC should shift from that
   of a benefactor to that of a customer of HIE network services. In addition to the transfer of
   medical information about DOH clients, these network services should include mandatory
   reporting of notifiable diseases and conditions, Biosurveillance, Emergency Responder, and other
   network services for safety net providers operated by the DOH.

Recommendations to Employers
 Since the benefits of the Health Information Network will accrue to the entire New Mexico
   community, employers who provide health benefits for their employees will also realize
   savings (and/or cost avoidance). For this reason, employers should consider paying for
   their share of the annual costs of NMHIC. Employers‘ shares of NMHIC costs might be
                                                per
   determined using an algorithm similar to the ― member per month‖ construct used by
   health plans.




                                                                                                       32
                       New Mexico HIE Strategic and Operational Plans



Acknowledgements
The LCF and NMHIC staff would like to thank:

   Dr. Robert Kolodner of the Office of the National Coordinator of Health Information Technology
    (ONCHIT) for providing financial support for the development of this Business Plan as a
    deliverable under the NHIN Trial Implementation contract.

   Robert Mayer and the New Mexico Department of Health for their support in the development of
    this Business Plan.

   The 2007 New Mexico State Legislature for its generous appropriation that supported the
    development of the Interim Report of the NMHIC Business Plan.

   The NMHIC Steering Committee that has provided advice and support to NMHIC over the past
    four years.

   The RHIO Grande Task Force, including Steven Kanig, M.D.; Jeff Dye; Steve Burd, Ph.D.;
    Dorothy Ball; and Robert Mayer, for their participation in the development of the Survey of
    Potential Network Users.

   Thomas A. MacLean, Vice President Health Care Management, Blue Cross Blue Shield of New
    Mexico, and Dennis Angellis, M.D., Chief Medical Officer, Presbyterian Health Plan, for their
    ongoing support of NMHIC, and for their review and feedback to Version 1 of the Business Plan,
    which has shaped many of the updates in Version 2.2.




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                         New Mexico HIE Strategic and Operational Plans


Appendices

Appendix A: Philosophy
   Mission
    To create a statewide health information exchange network that is sufficiently trusted and valued by
    all stakeholders (employees/patients, employers, physicians, health systems and health plans) so
    that it will improve care coordination and create a foundation for sustainability.
   Goals
      o   Improve statewide benefits, such as continuity of care and lower costs, by providing rapid
          access to patient health care information from multiple health care facilities across the
          community.
      o   Provide additional cost savings for the community by reducing redundant clinical tests and
          results reporting for the same patient
      o   Secure the trust of consumers, patients and providers by providing strong privacy and
          security safeguards for health care information
      o   Implement appropriate interoperability, privacy and security capabilities so that NMHIC can
          be certified by the Certification Commission for Health Information Technology (CCHIT)
      o   Interoperate with other NHIE‘s within the Nationwide Health Information Network
      o   Facilitate improved public health services, including mandatory reporting, monitoring of
          health status, and the ability to respond more quickly to health emergencies
      o   Empower consumers to understand and access personalized health information to facilitate
          active management of their health
      o   Utilize health information technology to provide health care services to rural and
          underserved populations
      o   Encourage the adoption of electronic health records systems in New Mexico by making it
          easier and less costly to securely share information over electronic networks
      o   Facilitate public reporting of patient outcomes and quality measures


   Guiding Principles
      o   The priorities of potential network users and stakeholders in the community should drive the
          selection of network services offered by the HIE
      o   The HIE should be developed and operated for the benefit of all users and stakeholders; that
          is, as if it is a public utility
      o   Since the use of HIE network services may require user acceptance of new processes,
          policies and culture, the HIE may need to set forth realistic expectations by providing
          appropriate user and community education
      o   The business model of the HIE network should lead toward financial self-sufficiency as soon
          as possible




                                                                                                       34
                  New Mexico HIE Strategic and Operational Plans


Appendix B: NMHIC Stakeholders by Type and NMHIC Steering Committee Members

                                                                 Steering
                          NMHIC Stakeholders                    Committee
                                                                 Member
         Business Organizations:
               Albuquerque Hispano Chamber of Commerce
               Association of Commerce and Industry of NM
               Bank of Albuquerque
               Don Chalmers Ford                                   Yes
               First Community Bank                                Yes
               Four Thought Group                                  Yes
               Greater Albuquerque Chamber of Commerce
               Health Extranet (provides patient eligibility
               information)
               Intel Corporation                                   Yes
               Johnson Associates (consulting firm)                Yes
               Public Service of New Mexico (PNM)
               Sandia National Laboratories                        Yes
               Semantic Mesa Technology
               Technology Ventures Corporation
               Wells Fargo Bank
         Healthcare Providers:
               Albuquerque Indian Health Center
               First Choice Community Healthcare (safety net
                                                                   Yes
               provider)
               Heart Hospital of New Mexico
               Holy Cross Hospital (Taos)                          Yes
               Lovelace Health Systems                             Yes
               New Mexico Veterans Affairs Health Care System
               New Mexico Heart Institute
               (cardiology specialty physician group)
               NM Primary Care Association (rural safety net
                                                                   Yes
               provider association)
               Presbyterian Healthcare Services                    Yes
               SED Laboratory                                      Yes
               Taos Medical Group
               TriCore Laboratory                                  Yes
               UNM Center for Telehealth                           Yes
               UNM Hospital
         Professional Associations:
               Greater Albuquerque Medical Association             Yes
               New Mexico Medical Society                          Yes
               NM Coalition for Health Information Leadership
                                                                   Yes
               Initiatives
               NM Hospital and Health System Association           Yes
               NM Takes on Diabetes (cooperative alliance of
                                                                   Yes
               insurers and health plans)
               NM Telehealth Alliance                              Yes


                                                                              35
         New Mexico HIE Strategic and Operational Plans

                                                          Steering
                  NMHIC Stakeholders                     Committee
                                                          Member
       RIOSNET (physician primary care alliance)
       Sangre de Cristo Community Health Partnership       Yes
Healthcare Payers:
       Blue Cross/Blue Shield                              Yes
       Lovelace Health Plan
       Molina Health Care of NM (Medicaid insurer)         Yes
       New Mexico Mutual
       Presbyterian Health Plan                            Yes
       United Healthcare                                   Yes
Educational Institutions:
       Albuquerque Public Schools (secondary schools)      Yes
       Project ECHO – University of New Mexico
       Rio Rancho Schools                                  Yes
       UNM Health Sciences Center                          Yes
       UNM School of Management                            Yes
Government:
       Health Policy Commission (state body to collect
                                                           Yes
       health service and policy information)
       New Mexico Department of Health                     Yes
       NM State Legislature
       Office of Governor Bill Richardson
Consumer/QIO Organizations:
       New Mexico Retiree Health Care                      Yes
       New Mexico Medical Review Association               Yes
Charitable Organizations:
       McCune Charitable Foundation
       United Way




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                    New Mexico HIE Strategic and Operational Plans



Appendix C: NMHIC Staff Biographies

     Margaret J. Gunter, PhD, a health services researcher and medical sociologist, is the
      Project Co-Lead for the NHIN Trial Implementation contract. She is President and
      Executive Director of the Lovelace Clinic Foundation (LCF), a non-profit health research
      institute in Albuquerque, NM. LCF's primary purpose is to develop interventions and
      conduct outcomes and healthcare delivery research to improve the quality, availability, and
      cost effectiveness of healthcare in the United States. Dr. Gunter was instrumental in the
      development of Lovelace Health System‘s nationally recognized Episodes of Care® (EOC)
      Disease Management Program. From 2004-2008, Dr. Gunter served as Principal
      Investigator for the AHRQ-funded New Mexico Health Information Collaborative (NMHIC)
      project, which is developing a statewide health information exchange network. Dr. Gunter
      has been responsible for developing broad community participation in NMHIC with a very
      participatory governance model. Dr. Gunter is also Senior Project Manager for New
      Mexico‘s ONC-funded Health Information Security and Privacy Collaborative (HISPC),
      which has identified key privacy and security barriers to implementing a health information
      exchange in New Mexico, and is currently working to pass new updated state privacy
      legislation to address these barriers. Dr. Gunter holds a PhD in medical sociology from the
      University of Pittsburgh.
     Jeff Blair, MBA, is the Director of Health Informatics for the New Mexico Health Information
      Collaborative (NMHIC) at Lovelace Clinic Foundation. He currently serves as the Lead for
      the Nationwide Health Information Network (NHIN) Trial Implementation contract that was
      awarded to NMHIC in September 2007. During 2005, Mr. Blair served as the facilitator for
      the development of the New Mexico Regional Health Information Organization (NM RHIO).
      During 2006, Mr. Blair was the Technical Manager for the AHRQ / RTI-funded Health
      Information Privacy and Security Collaborative (HISPC) project. The objective of this
      project was to identify variations in privacy and security policies and develop solutions for
      these variations that may create impediments to interoperable health information exchange
      in New Mexico. He was appointed by the U.S. House of Representatives to the National
      Committee on Vital and Health Statistics (NCVHS) in 1997 and is currently in his third four-
      year term with NCVHS, serving as Co-Chair of the Subcommittee on Standards and
      Security. During the last ten years, Mr. Blair has played a leadership role in almost every
      standards recommendation and task that has been directed to the NCVHS by Congress or
      the Secretary of HHS. These include the HIPAA transaction standards, the standards for
      EHR functionality, and the e-prescribing standards. Virtually all of the NCVHS
      recommendations on these topics have been adopted as federal regulations. In 2006 the
      Office of the National Coordinator of Health Information Technology (ONCHIT) asked the
      NCVHS to recommend the minimal but essential functional requirements for the Nationwide
      Health Information Network (NHIN). Mr. Blair was Vice Chair of the NCVHS Task Force
      that set forth the minimal but inclusive set of functional requirements for the NHIN. Mr. Blair
      held a variety of management and staff positions during his 30-year career with IBM. Mr.
      Blair has his Bachelor of Management Engineering from Rensselaer Polytechnic Institute,
      and his MBA from Northwestern University. Mr. Blair has been elected a Fellow of the
      American College of Medical Informatics (ACMI) and the Health Information and
      Management Systems Society (HIMSS).


     Robert E. (Bob) White, MD, MPH, is the Medical Lead for the NHIN Trial Implementation
      contract. He is Director of Medical Informatics and Senior Research Scientist for Lovelace
      Clinic Foundation (LCF), and is also Professor Emeritus, Department of Medicine,

                                                                                                  37
                 New Mexico HIE Strategic and Operational Plans

    University of New Mexico School of Medicine. Prior to joining Lovelace Clinic Foundation
    full-time in September 2006, Dr. White practiced general internal medicine at the New
    Mexico Veteran's Administration Health Care System. He was an academic generalist at
    the VA and the University of New Mexico beginning in 1979. His academic focus was using
    electronic medical databases for research and quality improvement projects. Dr. White is
    very familiar with the use and applications of EHRs from his years of experience using the
    VA VISTA EHR system. Dr. White currently works on four funded projects at Lovelace
    Clinic Foundation and the VA, and he is the Director of Medical Informatics for the New
    Mexico Health Information Collaborative (NMHIC). Since May 2006, Dr. White has also
    been a testing juror of ambulatory electronic record software with the national Certification
    Commission for Health Information Technology.
   Dave Perry is the Chief Information Officer for Lovelace Clinic Foundation. He has over 25
    years of information technology experience and expertise. Mr. Perry was the Director of IT
    Infrastructure for Presbyterian Healthcare Services (New Mexico‘s largest healthcare
    integrated delivery system) from 1998 to 2006 and was responsible for their state-wide
    telecommunications network, information security, and computer support. He has run his
    own successful technology business in New Mexico and has also worked for other large
    technology vendors, gaining experience in many industries. He is now focused on building
    NMHIC and supporting the technology requirements of Lovelace Clinic Foundation. Mr.
    Perry received an Electronics Technician Diploma from DeVry Institute of Technology in
    1980.
   Donald L. Nettles, MBA, CPA is LCF‘s Chief Financial Officer. He has extensive
    experience with financial accounting, financial operations and auditing at the public and
    federal level. Retiring after 25 years with Standard Oil holding down financial management
    and operating positions in the research, law, pension administration and accounting policy
    departments, Don operated his own accounting firm and has been employed by the DOD
    as an auditor with the DCAA. As Controller of the Research Dept of Standard Oil, he was
    responsible for budgeting and controlling the costs for on average about 1100 research
    projects with a $300 million dollar budget.
   Shelley Carter is Lovelace Clinic Foundation‘s (LCF) Director of Research and Educational
    Services, a senior research associate and project manager. Ms. Carter is currently serving
    as the Clinical and Community Coordinator for the New Mexico Health Information
    Collaborative (NMHIC). Ms. Carter is also project lead for New Mexico‘s Health Information
    Security and Privacy Collaborative (HISPC) project. The HISPC contract is addressing
    privacy and security issues in New Mexico that relate directly to the development of the HIE
    Network and the NHIN Trial Implementation contracts. Ms. Carter has extensive
    experience designing and managing programs to improve the health of New Mexico
    communities. In her work with the New Mexico Primary Care Association (NMPCA), Ms.
    Carter oversaw the data collection and analysis of the impact of health care on 117
    Federally Qualified Community Health Centers statewide. As the NMPCA‘s Community
    Planner/Developer and Clinical Analyst, she facilitated analysis of a health care/Medicaid
    utilization report to HRSA. At LCF, Ms. Carter is the Director of Research and Education.
    Over the last five years, she has been involved in a ten-site HMO Research Network‘s
    Center for Education and Research on Therapies (CERT) Prescribing Safety project. Ms.
    Carter served as project manager for the CMS-funded Medicare Case Management
    Demonstration for Congestive Heart Failure and Diabetes Mellitus, whose objective was to
    assess the cost-effectiveness of case management. She is currently involved in a project
    with Centers for Disease Control and Prevention (CDC)/Battelle Seattle Research Center to
    implement and evaluate interventions to increase colorectal cancer screening in primary
    care clinics. Ms. Carter is coordinating a project with ORC Macro and CDC to conduct a

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                  New Mexico HIE Strategic and Operational Plans

    clinical trial of the impact of a prostate cancer screening decision aid (brochure) on such
    issues as provider practice style and patient-provider shared decision making.
   Randall McDonald is part-time in-house legal counsel to LCF and a practicing attorney in
    Albuquerque, New Mexico. Mr. McDonald received his B.A. in 1974 from Montana State
    University, his J.D. from the University of Montana School of Law in 1978, and his LL.M. in
    Taxation from Boston University in 1981. His practice areas include business and
    commercial transactions, computer and technology law, and tax-exempt organization law.
    He also represents numerous New Mexico technology companies and provides legal
    assistance with respect to issues regarding the formation, financing, operation, and the sale
    of technology companies and the licensing of technology, both with respect to private
    licensing transactions and transactions with federal and state institutions. Mr. McDonald
    has extensive experience in issues related to HIPAA and health information exchange. Mr.
    McDonald has provided legal counsel to LCF for the past ten years and is the lead legal
    and privacy consultant for the New Mexico Health Information Collaborative. He also
    chaired the Legal Working Group and the Implementation Plan Working Group of the
    AHRQ / RTI-funded Health Information Security and Privacy Collaborative project for New
    Mexico, and is currently involved in the HISPC , Harmonizing State Laws Collaborative and
    in the NHIN Project DURSA Workgroup. Mr. McDonald has an AV rating from Martindale
    Hubbell, and is listed in the 2007 edition of The Best Lawyers in America in the areas of
    Corporate Law and Mergers and Acquisition Law, is listed in Chambers USA, America‘s
    Leading Business Lawyers in the area of Corporate/M and A, and is listed by Southwest
    Super Lawyers, in the area of Intellectual Property.
   Kent R. Langsteiner, BSCS, CISSP, CHFI, MCP has over 26 years of experience in
    computer application, database analysis, design and development as well as network and
    applications security. This experience has been gained in many different computing as well
    as business environments. Mr. Langsteiner initially started in the Health Care Insurance
    industry, working on system processing regular business as well as Medicare and Medicaid
    claims. Most recently, Mr. Langsteiner has been involved in the development of a
    distributed patient medical information system for the New Mexico Health Information
    Collaborative (NMHIC). In this role, he has developed the data engine which builds virtual
    health information records from distributed databases residing at client locations. In
    addition, he was involved in the development of the Master Patient Index (MPI) for the
    NMHIC system. The MPI implements a deterministic patient record matching algorithm
    which employs several industry standard methods for comparing patient records and
    selecting those which apply to a single individual. Mr. Langsteiner‘s other duties have
    included coordinating the implementation of interface standards with client institutions for
    the purpose of providing data to the NMHIC system, reviewing security policies and
    procedures related to the LCF computing environment, serving on the Technology and
    Security Working Group for the National Health Information Network Trial Implementation.
    He has provided consulting services for various other projects within LCF as well as
    providing oversight and supervision of the expansion of the LCF datacenter.
   Mark Butler is the IT Project Manager for the Laboratory Results Use Case as part of the
    NHIN Trial Implementation Project. Mark has over 27 years of healthcare experience
    including over 20 years of healthcare IT experience. Mr. Butler was the Information
    Systems Director for SED Medical Laboratories, a regional reference laboratory in New
    Mexico, from 1991-2007. Mr. Butler was responsible for providing strategic oversight and
    management for the organization‘s clinical and financial information systems. He directed
    complex projects relating to the technologic support of the laboratory‘s business and
    technical operations. Mr. Butler directly managed all hardware infrastructure, software
    systems, and IT support. Mr. Butler was a member of the New Mexico Health Information

                                                                                                  39
             New Mexico HIE Strategic and Operational Plans

Collaborative (NMHIC) Clinical Council and Steering Committee from 2005-2007, assisting
in the development of NMHIC‘s HIE network.




                                                                                     40
                      New Mexico HIE Strategic and Operational Plans


Appendix D: Privacy Policies

   All health care organizations who participate in the NMHIC network are required to sign a
    network subscription agreement that specifies their responsibilities as users and data
    providers, and the health information organization‘s responsibilities to protect the privacy and
    security of electronic health information.
   The NMHIC health information organization will be a business associate to covered entities that
    are participants in the NMHIC network, requiring the NMHIC health information organization to
    meet privacy and security standards for business associates as set out in the HIPAA
    regulations.
   Before an individual‘s electronic health information may be accessed on the NMHIC network,
    the user must be authorized (registered as a qualified user on the network) and then
    authenticated (verified that the users are who they say they are).
   The NMHIC authorized user may access an individual‘s electronic health information under
    only two circumstances:
    o   The user has acknowledged that the individual has given written consent to that health
        care provider to access the individual‘s electronic health information. (Duration of validity
        of consent to be determined.)
    o   The user makes a representation of the existence of a medical emergency. (Referred to as
             reak the glass‖ process)
        the ―b
   The health information organization will maintain a record of each access to an individual‘s
    electronic health information to support investigation of improper access.
   The network is able to support the emergency ―    break the glass‖ process only because all
    patient health records of participating health care providers are made available to the network
    by placing them on a secure computer that is located within the health care data provider‘s
    physical location.
    The NMHIC health information organization will require that all employees, contractors, and
    service providers adhere to the organization‘s policies on privacy and security. LCF will
    provide annual HIPAA Privacy and Security training to employees.
   NMHIC will have a policy and/or procedure indicating that LCF IT staff regularly review the
    audit logs for potential breaches of security or possible unauthorized access.




                                                                                                        41
                     New Mexico HIE Strategic and Operational Plans


Appendix E: Administrative and Technical Operations Approach
The LCF approach to NMHIC client services blend MedPlus‘ advanced toolsets, NMHIC‘s
seasoned healthcare professionals, and MedPlus‘ industry best practices approach to deliver a
seamless customer support framework. We optimize this approach to suit the needs of the network
subscriber.
Through the provision of a single point of contact for all IT services, and direct access to our
centralized customer service center, NMHIC and MedPlus are positioned to offer a greatly
enhanced spectrum of application and technical support services. We believe this will have a
positive impact on the network subscribers‘ user satisfaction. Our Help Desk solution includes the
best technology set available in the market today, healthcare domain-experienced support
professionals and years of operational proficiency that position NMHIC and MedPlus to efficiently
effect positive improvement in the network subscribers‘ IT domain. An overall understanding of the
uniqueness associated with a large healthcare environment enables NMHIC and MedPlus to
provide excellent support services in an industry focused on providing world-class care and
support.
NMHIC provides comprehensive 24X7 Help Desk services that offers a single point of contact for
all IT problems and inquiries. An efficient and effective problem management process is used for
the tracking and reporting of all problems. A full communication model is used to provide
information to network subscribers/users regarding IS activities. Our approach to comprehensive
Help Desk and dispatch services includes, but is not limited to, hardware and software
troubleshooting from a command center facility, diagnostics, installation support, and application
support.
By leveraging our best practice toolsets, NMHIC and MedPlus manage all network subscriber IS
problems through our centralized customer service center, utilizing our combined automated call
distribution (ACD), Help Desk, and knowledgebase systems. This consolidated single point of
contact supports provision of a consistently high service offering to all network subscribers/users.
Within our centralized service center, NMHIC and MedPlus leverages our broad skill base to
achieve a high level of first call resolution. This promotes increased problem resolution timeframes
across the full spectrum of issues, including clinical and financial application support. Escalations
are used to intensify the attention and expertise given to a particular event, based on severity and
time elapsed since the trouble ticket was created. The escalation level is used to communicate
clearly the stage of the escalation over technical bridges and in communications about an
escalation. This notification process continues during the event until the trouble ticket is resolved.
The software provides the functionality that alerts management when a Service Level Agreement
(SLA) is in danger of being missed. With a built-in escalation process, the software lets us create
milestones or thresholds to trigger actions such as notifications, escalations, and reassignments
that are initiated when service standards and commitments are at risk. NMHIC specifies when to
escalate an issue, to whom, and how frequently notifications should be delivered. These actions
can be performed discretely or in a recurring manner until appropriate actions are taken to make
sure that the commitments are met.

       Ticket Tracking
       The end-user support environment involves three core technologies for service delivery:
        Interaction Management
        Service Management
        Knowledge Management.



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              New Mexico HIE Strategic and Operational Plans

MedPlus provides NMHIC with best-of-breed technologies to address each of those
segments of the support model.
Interaction Management means the capture and presentation of all forms of end-user
communication in a single interface for the NMHIC/MedPlus staff. MedPlus presents these
communications seamlessly to the NMHIC/MedPlus staff. Voice calls, voicemail messages,
e-mail messages, web chats, web call-backs, and faxes are presented through a single
queue structure to NMHIC/MedPlus professionals.
Interactions are then be translated into new or existing service requests in the help desk
system. This facilitates the logging and tracking of all forms of service requests, and will
allow for each support group participating in the system to track their efforts and others‘
efforts to achieve end-user resolution. NMHIC/MedPlus will facilitate escalation procedures,
manage asset information, track SLA performance, and generate a wealth of reporting
information.
The solutions entered in help desk system for each incident will ultimately be entered and
reused through NMHIC‘s utilization of knowledge base tools. This will provide a repository
for solutions presented to clients. The knowledge base tools capture information through
the workflow by the staff providing the end-user solutions. The entire process of information
capture, approval, improvement, use, and reuse is tracked within the tool, which will enable
NMHIC and MedPlus to measure all aspects of its utilization. Further, we will be able to run
reporting on solutions used to provide our clients with specific issues within the environment
to best target organizational improvements.

Level 1 Support
Each Level 1 transaction can be received via telephone, e-mail, fax, or web chat. The Level
1 support team will document the problem the user is experiencing in the ticketing system
and then proceed to troubleshoot and resolve the problem. The Level 1 support team will
leverage knowledge base(s), remote control tools, and other customer-provided tools to
resolve the problem. If the problem cannot be resolved, it will be escalated as appropriate
to Level 2, Desktop Support Area, or other appropriate customer groups.
As transactions are received, we will perform the following required steps:
 Document problem in ticketing system
 Troubleshoot and document troubleshooting
 Use knowledge base to identify solution
 Resolve and document solution
 Escalate and document as appropriate
The call handling process assists in defining the time taken by Level 1 support before
escalation. The Level 1 analyst first confirms the end user's information and opens a new
ticket in help desk system for the incident. The analyst then asks the end user to describe
the reason for their call and enters this information into the ticketing system. The
information describing the problem is then linked into the knowledge base system and
begins to immediately search for a solution. While often the analyst might already know the
solution or know the issue needs to be escalated, our support capabilities are always
evolving, and issues that once needed escalation can, with documentation, be resolved on
the initial call.
We will enter both technical support solution information, as well as process-specific
information into the knowledge base system. Therefore, if certain applications or systems
are defined as ―Level 2 only‖ issues, the knowledge base system will quickly respond to the

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              New Mexico HIE Strategic and Operational Plans

analyst with the appropriate escalation instructions. Otherwise, once the knowledge base
system has presented its first selection of potential solutions, the analyst continues to ask
some basic troubleshooting questions of the end user to refine the search. The analyst
works through the existing solutions to attempt resolution. If there are no knowledge base
system solutions available at this point in the search to resolve the issue, then our process
will direct the analyst to escalate the issue to the appropriate next level of support.
Our approach works best when a feedback loop can be established between all support
elements. That feedback loop becomes our knowledge base toolset. Whenever another
group resolves an issue for an end user, that group should document the resolution into the
knowledge base. By doing so, it further enables the Help Desk staff to resolve issues at the
front lines, and allows all aspects of the support team to procedurally improve the quality
and speed of support.
In addition, we will also work through our transition process to identify and classify each
application within the environment. That process will examine the current environment, the
processes in place, the escalation procedures, the current sources of support information,
and the support resources to populate the knowledge base and to establish the specific
client procedures. This information will be documented in our knowledge base for all
elements of the support organization to leverage and maintain.
Level 2 and Level 3 Support
Each Level 2 transaction can be received via ticketing system or transferred from Level 1.
The Level 2 support team will troubleshoot the problem with the customer. If the problem
cannot be resolved, the Level 2 support team will arrange a callback and research the
problem to identify a solution. If a solution cannot be identified, it will be escalated as
appropriate to Level 3, NMHIC‘s Technical support.
As transactions are received, we will perform the following required steps:
   Troubleshoot with proper documentation
   Research the problem to identify solution
   Resolve and document solution
   Escalate and document as appropriate
The knowledge base system will serve as our solution repository for all applications
supported. MedPlus will work aggressively to identify all existing sources of support
information about the NMHIC support environment. MedPlus will use this information to
seed the knowledge base with NMHIC-specific support knowledge to augment its existing
content. MedPlus‘s approach is to leverage the knowledge base across all support groups
to continuously improve the content, and as such, the ability of the Help Desk to resolve
issues at the front line.


Reporting and Trend Analysis
NMHIC will utilize state-of-the-art reporting tools for reporting and trend analysis. With this
combination of best-of-breed technologies, NMHIC will always know where they stand with
their Help Desk operations. NMHIC and MedPlus network operations center will monitor
NMHIC servers and each node on the network. Using standard reporting schema, MedPlus
will be able to report uptime and any issues related to the network or NMHIC hardware via
the Internet. Beyond just reporting what is going on at the Help Desk level, MedPlus will
also build a knowledge base into NMHIC with MedPlus tools, so that over time, NMHIC‘s

                                                                                             44
             New Mexico HIE Strategic and Operational Plans

end-users will become more sophisticated in the use of the applications. The focus of
reporting will be in the following areas:
 Monthly Service Level Reports
 Performance Trends
 Asset Reporting
 Open Problems and Requests




                                                                                        45
                       New Mexico HIE Strategic and Operational Plans


Appendix F: HIE Network Technologies/Capabilities

  NMHIC System Architectural Overview
  The Lovelace Clinic Foundation (LCF) deployed the MedPlus FirstGateways products to
  support NMHIC operations. FirstGateways is a web enabled, n-tier, thin client solution based
  on a federated data model.
  FirstGateways‘ implementation of a federated model is done through the VLink™ engine.
  VLink‘s architecture deploys an instance of a database and interface engine on a server behind
  the firewall of each organization – this is referred to as an edge server or service. The edge
  service captures data by tapping into a site‘s existing electronic data streams. This data flows
  into and is permanently stored on the organization‘s edge server. While we store the clinical
  information at the edge, specific demographic data elements are sent for processing to the
  centralized master person index.
  When a user logs into FirstGateways and selects a patient, the FirstGateways clinical data
  service (CDS) is called and a query is sent to the sites containing patient data. The patient
  data is gathered and returned in an encrypted XML format. The multiple XML messages are
  then organized into a single XML document and sent to the FirstGateways‘ application and web
  servers. Once formatted, it is forwarded to the requestor‘s desktop.



         FirstGateways™                                   FirstGateways™                                    •   VLink server HP DL380 DP or
                                                                                                                similar

                                                                             Back Office                    •   Interface engine runs on VLink
                                                                                                                server



                                                                                                                              RL
                                                                                                                               S




        FirstGateways™                                                               Front Office Site #1
        VLink™


                   •    Any SQL dB for local data store
                                                                             Data
                   •    VLink server standard HP DL380
                                                                             Store
                        DP
                   •    Interface engine runs on VLink
                        server
                   •
         FirstGateways™
                        Alerts to contributing site if
                   interface is down                                                 Front Office Site #2

         VLink™
                                                                             Data
                   •    Any SQL dB for local data
                                                                             Store
                        store
                   •    VLink server standard HP
                        DL380 DP
                   •    Interface engine runs on

         FirstGateways™
                   VLink server
                                                                                     Front Office Site #3
         VLink™

                   •    Any SQL dB for local data                            Data
                        store                                                Store
                   •    VLink server standard HP
                        DL380 DP
                   •    Interface engine runs on
                        VLink server                     Figure 1 – FirstGateways Architecture




                                                                                                                                                 46
                           New Mexico HIE Strategic and Operational Plans

Components of the NMHIC System
       The NMHIC System is comprised of the following components:
      FirstGateways Clinician (web based viewer)
        o    String Templates (web screen customization tool)
        o    Home Page Content Manager (web site content customization tool)
      FirstGateways VLink (edge services):
        o    FirstGateways Clinical Data Store (relational database Data Repository)
        o    FirstGateways Integration Engine (interface engine)
      FirstGateways VLink (central services)
        o    Patient Identification - Master Patient Index (MPI) and Record Locator Service
             (RLS)
        o    Web and Application Server (processing and formatting data requests and
             responses)
        o    Auditing Services (logging of data requests, user activity and events)
        o    Security Service (authorization and authentication services)
        o    Clinical Data Service (accepts the clinical data requests, traverses the federated
             architecture and returns the appropriate data)


NMHIC System Data Flow
Figures 2a and 2b below illustrate the high level data flow for the NMHIC System. Figure 2a
shows the data flow for data acquisition. This diagram uses one edge server and one central
service. This data flow will work in a significantly similar fashion at all NMHIC constituents.
Figure 2b shows the data flow for a data request. Similar to Figure 2a, this diagram uses one
edge server and one central service. This data flow will work in a significantly similar fashion at
all NMHIC constituents.

                                   Data Center

                                                                     XML
                                                         Central
                                                       Integration
                                                         Engine
                                    Database
                                     Server
                                                                                                            VPN tunnel
                                                                                                          To Data Center
                                                                                                          (using Internet)

                                                EMPI




                                                                                                                                XML
                                       FirstGateways Defined
         Site‘s ADT System                Message Format



                              FirstGateways Defined
                                 Message Format                                                           XML                          Firewall
                                                                                 Vlink
            Site‘s Other System                                            Integration
                                                       Site’s Internal         Engine
                                                          Network
                                                                                         St
                                                                                           or
                                                                                              ed
                             FirstGateways Defined                                                 Pr
                                                                                                     oc
                                Message Format                                                            ed
                                                                                                            ur
                                                                                                              eC
                                                                                                                   all
              Site‘s LIS                     FirstGateways Defined
                                                                                                                      s
                                                Message Format




                                                                                                                            Vlink
               Site‘s Transcription System                                                                                Data Store


                                              Figure 2a – Data Acquisition Data Flow

                                                                                                                                                  47
                        New Mexico HIE Strategic and Operational Plans




                                                                                                   HTTPS
                                                                                                                                            Data Center
                                                                                  Web                                    Security
                                                                                 Server                                   Server


                                                                                                           XML
                                  HealthView                                               App
                                  Web-Based                                               Server                         Central            Database
                                    Viewer                                                                       XML   Integration           Server
                                                                                                                         Engine




                                                                                                                                     EMPI




                                         XML                          Firewall
                Vlink                                                                                      Public Internet
          Integration
              Engine

                        St
                          or
                            ed
                                 Pr
                                   oc
                                        ed
                                          ur
                                             eC
                                                  all
                                                     s




                                                           Vlink
                                                         Data Store


                                                             Figure 2b – Data Retrieval Data Flow




Scalability

NMHIC is building the Health Information Exchange for scalability. This means that adding
users will not require much increase of absolute cost. The infrastructure hardware and
software is architected to enable storage and other technical components to be added at small
incremental cost and will not require costly wholesale change out. While the HIE is designed
for scalability, adding data providers to the exchange will require additional expense to develop
data exchange interfaces.




                                                                                                                                                          48
                    New Mexico HIE Strategic and Operational Plans


Appendix G: Assumptions Regarding Network Availability

Assumptions Regarding Network Services Implementation and Commercial Availability
    The initial set of network services will be commercially available on the NMHIC Clinician
     Portal by October 1, 2009. They include: Summary Patient Records, Lab Results,
     Radiology and Imaging Reports, Discharge Summaries and Emergency Responder
     information.
    Also by October 1, 2009, users will have access to patient information via the NHIN from
     the Veterans‘ Health System, the DoD Military Health System, the Indian Health Service
     and other healthcare organizations connected to the NHIN.
    NMHIC will provide commercial availability of Laboratory Results reports in the form of an
     HL7 message by January 2010.
    Access to medication history (along with patient eligibility for medications and drug
     formulary information) via RxHub, and e-Prescribing via a gateway to the SureScript
     network will be commercially available by March 2010.
    User access to patient insurance eligibility and health claim information via a gateway to
     Health Xnet will be commercially available by July 2010.
    Laboratory order entry will be commercially available by July 2010.
    Biosurveillance will be commercially available by July 2010.
    Other network services (TBD) will be commercially available during 2011


Assumptions Regarding Additional Data Suppliers
    NMHIC has already signed Network Subscription Agreements with Presbyterian Health
     Services, TriCore Reference Labs and Taos Holy Cross Hospital during 2008.
    NMHIC plans to sign Network Subscription Agreements with several healthcare
     organizations during the next few years. The candidates for these NSA‘s during 2009
     include:
     o New Mexico Department of Health (April 2009)
     o Albuquerque Ambulance (April 2009)
     o ABQ Health Partners (August 2009)
     o SED Laboratory (August 2009)
     o Lovelace Health System (August 2009)
     o UNM Hospital (August 2009)
    The candidates for these NSA‘s during 2010 include:
     o Eye Associates of New Mexico (August 2010)
     o Heart Hospital of New Mexico (August 2010)
     o Additional New Mexico Hospitals
     o Additional New Mexico Medical Practices
    The candidates for these NSA‘s during 2011 include:
     o Presbyterian Health Plan (January 2011)
     o Lovelace Health Plan (January 2011)
     o Blue Cross/Blue Shield of New Mexico (January 2011)
     o United Health Care (January 2011)
     o Molina (January 2011)
     o Additional New Mexico Hospitals
     o Additional New Mexico Medical Practices




                                                                                                  49
                         New Mexico HIE Strategic and Operational Plans


Appendix H: National Savings Estimate Table

                                                                                     Total New
CITL -                                                                 Total New
                            National      National      New Mexico                    Mexico
INTEROPERABILITY                                                        Mexico
                            Savings       Savings           %                         Savings
BENEFITS                                                                Savings
                                                                                       10%
                           Study year     Adjusted
Programmatic period                                     (% health $)
                              2003        to 2008
                            billions of   billions of                  millions of
Dollar valuation
                             2003 $        2008 $                       2008 $
Outpatient Providers &
Laboratories
- Reduced tests                   4.00           4.8      0.55%              26.17         2.62
- Efficiencies on
                                 26.10          30.8      0.55%            169.35         16.94
remaining tests
Outpatient Providers &
Radiology Centers
- Reduced tests                   8.60          10.2      0.55%              56.09         5.61
- Efficiencies on
                                 16.20          19.1      0.55%            105.00         10.50
remaining tests
Providers & Other
Providers
- Physicians                      8.40           9.9      0.55%              54.50         5.45
- Hospitals                       4.10           4.9      0.55%              26.83         2.68
Providers & Public
Health Depts
- Physicians                      0.10           0.1      0.55%               0.67         0.07
- Public Health
                                  0.10           0.1      0.55%               0.67         0.07
Departments
Total Interoperability
                                 67.70          79.9      0.55%            439.28         43.94
Savings




                                                                                                  50
                     New Mexico HIE Strategic and Operational Plans



Appendix I: Total Annual Benefit to Payers Table

                  Total Annual Benefit to Payers by HIEI Level 4
                                                                                   NM
                                          National                    NM
                                                                               Savings to
  Payer Benefit                           Savings    New Mexico     Savings
                     Level 2   Level 3                                          Payers
     from:                               to Payers       %            to
                                                                                  10%
                                          Level 4                   Payers
                                                                                Savings
                                                                    millions   millions of
                                          billions   (% health $)   of 2008       2008
                                                                    dollars     dollars

Provider-Lab           $0.74     $1.09       $3.76         0.55%     $20.70         $2.07
Provider-Radiology     $1.59     $1.96       $8.04         0.55%     $44.20         $4.42
Provider-Payer            $0        $0       $9.84         0.55%     $54.10         $5.41
Total                  $2.32     $3.06      $21.60         0.55%    $119.00        $11.90




                                                                                             51
                      New Mexico HIE Strategic and Operational Plans


Appendix J: Savings to NMHIC Stakeholders Based on Local Estimates

The following presentation examines Albuquerque based medical institutions, because
Albuquerque: (1) is the state‘s tertiary care site, (2) accounts for a much higher volume of medical
activity than its population would dictate, (3) is the NMHIC foundation, and (4) has more available
information on which to base estimates.

Ambulatory Visits
Patients and physicians acknowledge that routine outpatient encounters entail missing data from
outside sources (laboratories, imaging centers, and other clinicians in the community). Missing
data is most likely for first patient visits or consultations, but a study in primary care in Colorado
indicated that 14% of all visits entailed missing data, with half of those impacting care the day of
the visit. Another study found 81% of academic medical center visits entailed missing data. The
consequence is greater time spent by clinic staff, and the best way to estimate this impact is to
estimate a number of repeat appointments arranged for data acquisition and repeat evaluation
needed to complete the medical care which might have been delivered in one visit.

Estimating the impact of missing information for outpatient, non-emergency department visits in
Albuquerque is explained below.
    1. First, we obtained summary total outpatient visit data from the largest Albuquerque delivery
       systems (Presbyterian Healthcare Services, ABQ Health Partners, and UNM Hospital). We
       conservatively estimated that new/consultation (New/Con.) encounters taking place with
       either primary care or specialty clinicians comprise 5% of PHS and ABQ ambulatory visits
       and 10% of those at UNMH. This even encompassed urgent care visits, where ―        new‖
       status would apply much more often than 5-10%.
    2. In the next column, we estimated the frequency of visits with missing data, based on the
       reports mentioned in the first paragraph. The probability of missing data will be higher for
       new/consultation visits (estimated at 25%) than for visits involving established patients
       (14% estimate).
    3. Of encounters with missing data, only 10% are estimated to require an extra visit due to
       lack of information.
    4. Of those extra visits, we estimated that 50% could have been obviated with the benefit of
       an HIE.
    5. The typical cost for new/consultation visits is $140 and for established patients $70.

                   1 Annual Visits 2 Missing Data 3 Extra Visit 4 HIE Prevented Visit 5 HIE Benefit
PHS                       950,000         133,000       13,300                  6,650    $465,500
PHS New/Con.               50,000            7,000          700                   350      $24,500
ABQ HP                    855,000         119,700       11,970                  5,985    $418,950
ABQ HP New/Con.            45,000            6,300          630                   315      $22,050
UNMH                      340,000          47,600         4,760                 2,380    $166,600
UNMH New/Con.              40,000            5,600          560                   280      $19,600
         Subtotal       2,280,000         319,200       31,920                15,960 $1,117,200
Private PC                600,000          84,000         8,400                 4,200    $294,000
Private New/Con.          200,000          28,000         2,800                 1,400      $98,000
             Total      3,080,000         431,200       43,120                21,560 $1,509,200


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                     New Mexico HIE Strategic and Operational Plans

We are unaware of any data about private practice volume, outside the three largest groups, so we
very conservatively estimated their volume. We applied the same logic for missing data impact;
however, their less connected status probably results in a higher percentage of missing data, extra
visits, and potential HIE benefit than shown above. Anyone wanting an even more conservative
approach to predicting HIE benefit can alter the above rates.

Emergency Department Referrals
We also estimated that a small fraction of the above ambulatory care visits are with complex and
chronically ill patients where data deficiency would lead to more extensive evaluation in the site of
last resort: emergency departments. Since the above visits include urgent care settings as well as
primary care and specialty care visits, it seems reasonable to estimate that 1 out of every 5,000
visits might result in an unnecessary ED visit that might have been obviated by HIE supplied
information. Since the typical ED visit costs $1,000, that translates into an HIE benefit of
$576,000.

                Ambulatory Visit Base Unnecessary ED Visits   ED Visit Cost HIE Benefit
                            2,880,000                     576        $1,000   $576,000

Emergency Department Efficiency
A second way ED care is impacted is efficiency. The best study of HIE impact on ED care was
conducted in Indianapolis, where an HIE has been in existence for nearly 15 years. They estimate
$26 is saved for each ED visit, due to more efficient information sharing, resulting in faster ED
care, less staff time devoted to data collection, and less redundant testing. The volume of ED care
in Albuquerque is outlined in this table. The maximum HIE savings is estimated in the next column
by multiplying visit volume by $26. Because Indianapolis has 13 hospitals participating in the HIE
and has several years of operation experience, we felt that our realistic benefit must be lower.
Therefore, we calculated gaining only 10% of the $26 potential HIE benefit.

           Annual Visits Indianapolis HIE Savings/Visit Maximum Savings/Visit             HIE Benefit
PHS              114,000                            $26            $2,964,000               $296,400
LSH                80,000                           $26            $2,080,000               $208,000
UNMH               70,000                           $26            $1,820,000               $182,000
Total                                                                                       $686,400

Adverse Drug Events
One of the most common elements missing during a typical clinical encounter is the patient‘s
complete list of prescribed medications and drug reactions or allergies. In Santa Barbara,
evidence indicated that 70% of primary care practitioners and 40% of specialty practitioners did not
have complete pharmaceutical information during their visit. The most common outcome of this
information fragmentation is additional visits and wasted time, which we assume is included in the
three prior sections.

However, an additional outcome is increased likelihood of an adverse drug event (ADE), due to
deficient patient information at the time of drug prescribing and dispensing. Applying national ADE
estimates to New Mexico, 33 New Mexicans experience an ADE each day. HIE impact on ADE
rates would most likely occur at the time of hospital admission, hospital discharge, emergency
department care, or outpatient encounters with new practitioners. Since Albuquerque medical
facilities and physicians provide care to New Mexicans outside Albuquerque, more of the estimated
33 ADEs will occur in Albuquerque than would be expected based on population alone. Therefore,
we estimate:



                                                                                                        53
                      New Mexico HIE Strategic and Operational Plans

          15 ADEs will occur in Albuquerque each day, even though greater Albuquerque‘s
           population is 30% of the state total, and
          1 of these could be prevented by
           o HIE provided patient information (past diagnoses, current medications, and
               especially prior medical allergies or reactions contained in existing electronic
               systems) AND
           o is sufficiently medically harmful to result in needless ED or hospital care.
          The needless care is estimated to be $1000, an approximation of ED visit or hospital
           day care.
                                         Unnecessary
            Estimated     Daily          ED/Hospital            Daily HIE Annual HIE
            Daily NM ADE Albuquerque ADE Care         Care Cost Benefit     Benefit
                       15             15             1 $1,000        $1,000         $365,000

Laboratory Service Redundancy
A local executive estimated New Mexico laboratory expenditures by using data from his
organization, the largest reference laboratory in the state, and extrapolating the expenditure of
other competing laboratories based on knowledge about their volume. He compared the numbers
with census data and found that he had derived very similar estimates of expenditures. He applied
calculations of waste to those summations based on literature other than the CITL study, and he
calculated the ability of the HIE network to reduce that waste.

He estimated total laboratory expenditures for New Mexico to be $326 M, and $60 M (18.4%) of
that as being ―unnecessary,‖ based on literature assessing when tests are redundant or ineffectual.
Although more than 50% of all NM tests are performed in Albuquerque, we chose to estimate the
Albuquerque-based, potential impact to be only 50%. Of ―     unnecessary‖ tests, our HIE would more
              redundant‖ than ―
likely impact ―                ineffectual‖ testing; therefore, we estimated ―redundant‖ testing to
be 10%. Finally, we estimated 33% of that would be impacted by the HIE.

           Estimated NM
                         Unnecessary Albuquerque                Albuquerque       Annual HIE
            Laboratory
                         Testing      Unnecessary                Redundant          Benefit
           Expenditures
            $326,000,000  $60,000,000 $30,000,000                  $3,000,000      $1,000,000

Imaging Services Redundancy
Unlike laboratory services, we have no local estimate of imaging redundancy, so we must rely on
the CITL estimate extrapolated to New Mexico. This $5.61 M estimate was mentioned earlier in
this report. Since this applies to the entire state, we reduce that estimate by 50% for an
Albuquerque estimate. To further our conservative approach, we estimated that an HIE would
eliminate only 10% of that redundancy, because its impact on hospital based care might be less
than estimated and because some aspects of imaging service and outpatient care efficiency is
contained in other aspects of our local estimates. Three major insurers in New Mexico were
interviewed about this specific question: Do you employ a claims based process to deny or
discourage redundant imaging services? All three indicated ―    no.‖

                             Estimated
                                        Albuquerque          Annual HIE
                                NM
                                        Redundancy             Benefit
                            Redundancy
                             $5,610,000    $2,805,000             $280,500



                                                                                                  54
                     New Mexico HIE Strategic and Operational Plans

Laboratory and Imaging Service Support Staff Efficiency
The HIE could affect these services in other ways. Executives from the two largest laboratories
and three largest radiology groups were interviewed for LCF/NMHIC‘s business planning. They
agreed that lack of complete patient information (insurance information, diagnostic information and
information about services rendered elsewhere) impedes their performance, and requires them to
hire staff to obtain that information.

For instance, the radiology executives agreed that the HIE service of exchanging actual images
(not reports) among radiology groups could significantly improve their efficiency, because prior
images are needed when one radiology group conducts a new study and needs prior, related
studies for comparison. One group of 30 radiologists estimated that they devoted 1-2 full time
people, and significant courier services, to finding and acquiring the prior images needed for their
operations. Extrapolating that to other radiology practices, we estimate that at least 6 employees
in Albuquerque‘s radiology groups could be replaced when HIE services can transport image data
files electronically. The estimated savings would be 6 x $30,000 or $180,000 of radiology support
staff time. However, exchanging actual image data will not be an HIE service for several years.
The above discussions, and others in the past 3 years, have helped us understand that radiology
groups and reference laboratories devote significant staff time to determining patient identity,
insurance status, and medical record information that is unavailable from the ordering physician,
but which is needed for image or laboratory processing.

Since Albuquerque is home to 4 radiology groups and 2 reference laboratories, we simply
estimated that each organization must expend the equivalent of one full-time person for
exchanging medical information. Those positions could be replaced by HIE information availability.

                Staff Devoted to                                HIE Laboratory and
                  Information              Staff Cost           Imaging Efficiency
                   Exchange                                          Benefit
                       6                            $30,000                 $180,000


Exchanging Patient Documents Among Hospitals, Support Staff Efficiency
Similarly to laboratories and imaging facilities, hospitals and medical groups devote staff time to
exchanging medical information with other organizations. For hospitals and emergency rooms, a
significant volume of faxed records occurs on a daily basis. We attempted to estimate the staffing
efficiencies which might occur with HIE. We conducted brief interviews with staff in Albuquerque
medical records departments and emergency departments at the 3 main hospital systems in
Albuquerque (PHS, Lovelace, and UNM).

A.    Emergency Department Staff Time Devoted to Requesting Summaries or Other Key
Record Information.

At the main Presbyterian ED, staff request faxed summary records, image reports, or laboratory
results at least 4 times each 24 hour period. We extrapolated this rate across Kaseman Pres ED,
UNMH, and Lovelace EDs, which produced at least 16 such requests on a daily basis or 5,200
annual requests. The time invested in these is greater than medical records staff processing a
standard request, because they usually involve multiple calls, identifying which information is
needed/available, tracking receipt, and matching reports with the emergency department record.
Some of this time will be clerical at $12/hour and some will involve PA, RN, or MD, so LCF/NMHIC
estimated $4 of clerical time plus $4 (5 minutes of someone more expensive, averaged at $48/hr),
thus $8 of staff time per request.

                                                                                                  55
                     New Mexico HIE Strategic and Operational Plans



                 ED Information
                                                                Albuquerque Annual ED
                   Exchange           Staff Cost/Request
                                                                 Document HIE Benefit
                   Instances
                            5,200                          $8                 $41,600

NOTE: This estimated amount ($41,600) is not included in the totals of this analysis
because it is subsumed in the Emergency Department Efficiency section above. We
included this discussion to explain the exact nature of local benefit, based on our
interviews and assessments.

B.     Medical Records Staff Time Devoted to Responding to Requests for a Discharge Summary
copy

Medical records staff members were contacted to estimate the number of discharge summary
records which are requested by clinicians who are not part of the original distribution of that
summary at the time of discharge.

Presbyterian = 12/day, including emergency department requests
Lovelace = 3 for each of 3 Lovelace medical records departments = 9/day
UNM = 20/day

For the Albuquerque hospital medical records staff, these daily 41 requests across 253 working
days results in 10,373 summaries processed annually for offices, hospitals, and emergency
departments.

Processing time = $3/summary based on medical records department employee at $12/hour
(including benefits), 15 minutes to receive request, exchange authorization or accept medical office
assertions, locate record, print copy of discharge summary, and fax.

       Medical Records                               Albuquerque Annual
         Information      Staff Cost/Request           Medical Records          HIE Benefit
         Exchanges                                    Department Cost
                   10,373                 $3                       $31,119              $15,000

C.     Routine Discharge Summary Distribution

Albuquerque hospital discharge summary volume for 2007:
                         Lovelace HS (all hospitals)                 22,474
                         UNM                                         15,844
                         Presbyterian                                49,800
                                                     Total           88,118

Estimated cost of routine discharge summary distribution to physicians who are indicated to
receive copies at the time of discharge was $1 each. HealthBridge in Cincinnati estimated the
average cost of paper distribution of hospital and laboratory documents, combined, was $.75
before HIE and $0.12 after HIE, a difference of $0.63. To stay on the conservative side, we will
estimate only a $0.50 reduction

Routine Discharge                               Reduction in Discharge    Albuquerque Annual
                      Staff Cost/Distribution
    Summary                                      Summary Distribution       Medical Records

                                                                                                   56
                       New Mexico HIE Strategic and Operational Plans


    Distribution                                                          Department HIE Benefit
     Instances
              88,118                       $1                      $.50                  $44,059


D.      Medical Records Staff Time Devoted to Responding to Requests for Social Security
Disability Documents

We have no local estimates of the volume of this activity, but national data indicates that SSA must
repeat requests 80% of the time, due to insufficient response or material. Therefore, the cost on
the hospital or medical practice side is probably similar. This activity is another area of potential
savings and the ability of HIE networks to dramatically improve the time and cost to perform this
function was demonstrated at the NHIN Trial Implementations in both September and December of
2008.

NOTE: This analysis includes only the $15,000 from B. and the $44,059 from C. above, for a
total of $59,059.


Summary
This discussion is not comprehensive, but it does derive from Albuquerque efforts to quantify HIE
benefits, based on local workload and current health information exchange activities. All benefits
are based on extremely conservative estimates. Quality benefits are only assessed in relation to
adverse drug events; other quality improvements are likely. Also, no attempt was made to
calculate patient benefits from their reduced work in exchanging or tracking their health
information.

                                                             HIE Benefit
                           Ambulatory Visits                   $1,509,200
                           ED Referrals                          $576,000
                           ED Efficiency                         $686,400
                           Adverse Drug Events                   $365,000
                           Laboratory Redundancy               $1,000,000
                           Image Redundancy                      $280,500
                           Lab/Image Staff Efficiency            $180,000
                           Medical Records Exchange               $59,059
                                     Albuquerque Total         $4,650,159
                           Estimated State Supplement          $1,396,848
                                      New Mexico Total         $6,053,007



Extrapolation to the state of New Mexico
We do not have specific data or interviews to extend beyond this Albuquerque focused HIE benefit.
Since many New Mexico practitioners and hospitals exchange patients with Albuquerque based
specialists, we assume relative benefit might be higher than those based on workload alone. On
the other hand, rural care may involve less frequent exchange of information. We do know the
distribution of citizens, hospital activity, and doctors:

                                           New Mexico   Albuquerque
                            Population        1,954,599        26%

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                     New Mexico HIE Strategic and Operational Plans

                            Hospital DC          215,000              45%
                            Doctors                4000               50%
                            Specialists            1440               53%

We, therefore, conservatively estimated 30% additional HIE benefit when adding services for the
entire state.



Appendix K: Scenarios 1 through 6 from Versions 1 and 2.2

The following scenarios were presented in Version 1 of the NMHIC Business Plan Report that was
distributed September 30, 2008. Some of the assumptions for Scenarios for 1, 2, and 3 are no
longer valid. They are included in this appendix of Version 2.2 for your reference only.

The information in the tables below was generated by the Pro Forma Software Tool developed by
the e-Health Initiative. Please note that this software tool recognizes start-up funding from federal
and state contracts and grants as part of cash flow, but it does not recognize these funds as
revenue. By using this approach NMHIC will not show a positive net income until the revenue from
network services exceeds the costs of providing those services (financial self-sufficiency). The net
income for each year is shown as the bottom line in each scenario below.

Scenario 1
Assumption:
1. NMHIC will receive $1.49 M per year for the NHIN contract for Year 2 (2009) and Year 3
   (2010).

                                  2004 -       2008         2009         2010        2011         2012
     Revenue/Expense
                                   2007        Year 1       Year 2      Year 3       Year 4      Year 5
Costs:
Total NMHIC Development
                                 $3.90 M      $3.30 M      $3.24 M     $3.82 M      $2.93 M     $2.94 M
and Operating Costs

Revenue:
Revenue From User
                                  $0.00        $0.00       $0.20 M     $0.65 M      $0.93 M     $1.12 M
Subscriptions
Revenue from Payers               $0.00        $0.00       $1.56 M     $1.87 M      $2.18 M     $2.21 M
 ▪ Number of Covered Lives          0            0          420 K       600 K        700 K       800 K
 ▪ Per Member Per Month ($)        N/A          N/A         $0.31       $0.26        $0.26       $0.23
Total Operating Revenue           $0.00        $0.00       $1.76 M     $2.52 M      $3.12 M     $3.33 M
Funding From Federal, State
                                 $3.45 M      $3.30 M      $1.49 M     $1.49 M       $0.00        $0.00
and Stakeholders
Total Operating and Funding
                                 $3.45 M      $3.30 M      $3.25 M     $4.01 M      $3.12 M     $3.33 M
Revenue

Financial Summaries:
Cash Flow (+/-)                  -$0.45 M      $0.00       +$0.04 M    +$0.20 M    +$0.19 M     +$0.29 M
Net Earnings (+/-)                 $0.00     -$2.67 M      -$1.37 M    -$1.33 M    +$0.05 M     +$0.18 M




                                                                                                  58
                     New Mexico HIE Strategic and Operational Plans


Scenario 2
Assumptions:
1. NMHIC will not receive $1.49 M per year for the NHIN contract for Year 2 (2009) and Year 3
   (2010).
2. Health plans will be willing to make up the difference for the loss of funding for Years 2 and 3.

                                  2004 -        2008         2009          2010        2011            2012
     Revenue/Expense
                                   2007        Year 1        Year 2       Year 3       Year 4      Year 5
Costs:
Total NMHIC Development
                                 $3.90 M      $3.30 M       $3.29 M      $3.88 M      $2.93 M     $2.94 M
and Operating Costs

Revenue:
Revenue From User
                                   $0.00       $0.00        $0.20 M      $0.65 M      $0.93 M     $1.12 M
Subscriptions
Revenue from Payers                $0.00       $0.00        $2.97 M      $3.24 M      $2.18 M     $2.21 M
 ▪ Number of Covered Lives           0           0           420 K        600 K        700 K       800 K
 ▪ Per Member Per Month ($)         N/A         N/A          $0.59        $0.45        $0.26       $0.23
Total Operating Revenue            $0.00       $0.00        $3.17 M      $3.89 M      $3.12 M     $3.33 M
Funding From Federal, State
                                 $3.45 M      $3.30 M        $0.00        $0.00        $0.00           $0.00
and Stakeholders
Total Operating and Funding
                                 $3.45 M      $3.30 M       $3.17 M      $3.89 M      $3.12 M     $3.33 M
Revenue

Financial Summaries:
Cash Flow (+/-)                  -$0.45 M       $0.00      -$0.10 M     +$0.02 M     +$0.18 M     +$0.39 M
Net Earnings (+/-)                 $0.00      -$2.67 M     +$0.01 M     -$0.01 M     +$0.05 M     +$0.18 M


Scenario 3
Assumptions:
1. NMHIC will receive $1.49 M per year for the NHIN contract for Year 2 (2009) and Year 3
   (2010).
2. To encourage clinician adoption, the user subscription fees will be reduced to zero.
3. Health plans will be willing to make up the loss of revenue from network subscriptions
.
                                    2004 -      2008        2009        2010        2011           2012
     Revenue/Expense
                                     2007      Year 1       Year 2      Year 3      Year 4        Year 5
Costs:
Total NMHIC Development
                                   $3.90 M    $3.30 M      $3.23 M     $3.82 M     $2.92 M       $2.94 M
and Operating Costs

Revenue:
Revenue From User
                                   $0.00       $0.00        $0.00        $0.00        $0.00       $0.00
Subscriptions
Revenue from Payers                $0.00       $0.00       $1.73 M      $2.45 M     $2.94 M      $3.36 M
▪ Number of Covered Lives            0           0          420 K        600 K       700 K        800 K
▪ Per Member Per Month ($)          N/A         N/A         $0.34        $0.34       $0.35        $0.35
Total Operating Revenue            $0.00       $0.00       $1.71 M      $2.45 M     $2.94 M      $3.36 M


                                                                                                   59
                     New Mexico HIE Strategic and Operational Plans

Funding From Federal, State
                                  $3.45 M     $3.30 M      $1.49 M      $1.49 M       $0.00        $0.00
and Stakeholders
Total Operating and Funding
                                  $3.45 M     $3.30 M      $3.23 M      $3.95 M     $2.94 M      $3.36 M
Revenue

Financial Summaries:
Cash Flow (+/-)                  -$0.45 M       $0.00     +$0.00 M     +$0.13 M     +$0.02 M     +$0.42 M
Net Earnings (+/-)                 $0.00      -$2.67 M    -$1.40 M     -$1.40 M     -$0.11 M     +$0.21 M


Scenario 4
The assumptions for Scenario 4 are described under the subsections Summary of NMHIC
Expenditures and Summary of NMHIC Revenue above.
                                          Scenario 4
                                 2004 -       2008       2009       2010      2011                 2012
      Revenue/Expense
                                  2007       Year 1      Year 2     Year 3    Year 4              Year 5
Costs:
Total NMHIC Development
                                $3.90 M     $3.64 M     $1.78 M    $2.88 M  $2.82 M              $2.78 M
and Operating Costs

Revenue:
Revenue From User
                                      0            0           0           0            0               0
Subscriptions
Revenue from Payers                    -           -           -        $3.01 M     $3.01 M      $3.01 M
 ▪ Number of Covered Lives             -           -           -         1.43 M      1.43 M       1.43 M
 ▪ Rate Per Member Per
                                       -           -           -        $0.175       $0.175       $0.175
Month
▪ Total Operating Revenue              -           -           -        $3.01 M     $3.01 M      $3.01 M
Funding From Federal, State
                                   $3.45 M      $3.64 M     $1.78 M         -           -               -
and Stakeholders
Total Operating and Funding
                                   $3.45 M      $3.64 M     $1.78 M     $3.01 M     $3.01 M      $3.01 M
Revenue

Financial Summaries:
Cash Flow (+/-)                   -$0.45 M         -           -        $0.12 M     $0.18 M      $0.22 M
Net Earnings (+/-)                    -            -           -        $0.30 M     $0.09 M      $0.09 M


Scenario 5
Scenario 5 is being offered as a ―   What if … ?‖ scenario. It shows the effect if additional funds,
maybe $700 K, are contributed in 2009 by payers (health plans or Medicaid) in New Mexico. If
these funds become available, NMHIC will be able to grow faster during 2009. This growth might
be in the form of additional interfaces to health care providers, expansion of network infrastructure
capacity, or earlier availability of new network services. The summary of financial projections for
Scenario 5 might look something like the following table.

                                            Scenario 5
                                      2004 -     2008          2009        2010        2011        2012
       Revenue/Expense
                                       2007     Year 1        Year 2      Year 3      Year 4      Year 5
Costs:


                                                                                                   60
                     New Mexico HIE Strategic and Operational Plans

Total NMHIC Development and
                                    $3.90 M      $3.64 M    $2.48 M    $2.88 M     $2.82 M     $2.78 M
Operating Costs

Revenue:
Revenue From User
                                          0            0          0        0           0          0
Subscriptions
Revenue from Payers                       -            -     $0.70     $3.01 M     $3.01 M     $3.01 M
 ▪ Number of Covered Lives                -            -       -        1.43 M      1.43 M      1.43 M
 ▪ Rate Per Member Per Month              -            -       -        $0.175      $0.175      $0.175
▪ Total Operating Revenue                 -            -       -       $3.01 M     $3.01 M     $3.01 M
Funding From Federal, State and
                                    $3.45 M      $3.64 M    $1.78 M           -        -           -
Stakeholders
Total Operating and Funding
                                    $3.45 M      $3.64 M    $2.48 M    $3.01 M     $3.01 M     $3.01 M
Revenue

Financial Summaries:
Cash Flow (+/-)                     -$0.45 M           -          -    $0.12 M     $0.18 M     $0.22 M
Net Earnings (+/-)                      -              -          -    $0.30 M     $0.09 M     $0.09 M


Scenario 6
Scenario 6 is another ―What if … ?‖ scenario. It shows the effect if additional federal funds become
available during 2010. There are no known federal grants or contracts to support this scenario as
of January, 2009, but this scenario is presented in case new funding is announced.

                                              Scenario 6
                                   2004 -        2008       2009        2010        2011         2012
     Revenue/Expense
                                    2007         Year 1    Year 2      Year 3       Year 4      Year 5
Costs:
Total NMHIC Development
                                  $3.90 M       $3.64 M    $1.78 M    $2.88 M      $2.82 M     $2.78 M
and Operating Costs

Revenue:
Revenue From User
                                     0             0          0           0           0           0
Subscriptions
Revenue from Payers                   -            -          -       $2.51 M      $3.01 M     $3.01 M
 ▪ Number of Covered Lives            -            -          -        1.43 M       1.43 M      1.43 M
 ▪ Rate Per Member Per
                                      -            -          -        $0.146      $0.175       $0.175
Month
▪ Total Operating Revenue             -            -          -       $2.51 M      $3.01 M     $3.01 M
Funding From Federal, State
                                  $3.45 M       $3.64 M    $1.78 M    $0.50 M         -            -
and Stakeholders
Total Operating and Funding
                                  $3.45 M       $3.64 M    $1.78 M    $3.01 M      $3.01 M     $3.01 M
Revenue

Financial Summaries:
Cash Flow (+/-)                   -$0.45 M         -          -       $0.13 M      $0.18 M     $0.22 M
Net Earnings (+/-)                    -            -          -          -         $0.09 M     $0.09 M

Appendix L: Scenario Analysis By Health Plan

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New Mexico HIE Strategic and Operational Plans




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New Mexico HIE Strategic and Operational Plans


             Appendix I:
  New Mexico State Designation Letter




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