communityinterophie-foa-4-10-15rev.pdf

U.S. Department of Health and Human Services Office of the National Coordinator for Health Information Technology

Community Interoperability and Health Information Exchange Cooperative Agreement Program

Funding Opportunity Announcement

Program Guidance Funding Opportunity Announcement

Fiscal year 2015 Application Due Date: June 15, 2015

Anticipated Award Date: August 14, 2015

Contents

Opportunity Overview

Summary............................................................................................................................................................ 6Executive

I. Funding Opportunity Description

A. Background

B. Purpose

C. Program Description

D. Project Approach

Area One: Identify a specific non-eligible care provider population—those who will ultimately use the HIE service or tool

Area Two: Extend an existing HIE service or use case

Area Three: Engagement strategy for Use by the Non-eligible care provider population

E. Proposal Criteria

F. General Funding Requirements

G. Project Deliverables, Evaluation and Measurement

II. Award Information

A. Summary of Funding

B. Performance Evaluation

C. Award Type

D. Substantial Involvement in Cooperative Agreements

III. Eligibility Information

A. Eligible Applicants

B. Cost-Sharing or Matching

C. Application Responsiveness Criteria

D. Application Completeness Criteria

IV. Application and Submission Information

A. Address to Request Application Package

Application procedures:

B. Content and Form of Application Submission

Project Abstract

Budget Forms

Project Narrative

C. Submission Dates and Times

D. Application Responsiveness and Completeness Criteria

E. Notice of Intent

V. How to Apply Information

A. Address to Request Application Submission

B. Application procedures

C. Grants.gov Registration

D. Applying Electronically through Grants.gov

E. Intergovernmental Review

F. Funding Restrictions

VI. Application Review Information

A. Merit review Criteria

B. Evaluation

C. Merit review and Selection Process

D. Discussions and Award

E. Anticipated Announcement and Award Dates

VII. Award Administration Information

A. Performance Evaluation

B. Public Material Use

C. Intellectual Property/Copyrights

D. Award Notices

E. Notice of Award

VIII. Other Terms and Conditions

A. Administrative and National Policy Requirements

B. Post-Award Reporting Requirements

C. Audit Requirements

D. HHS Grants Policy Statement

E. Records Retention

F. Reporting

G. Financial Status and Cash Transaction Reports

H. Performance Reports

I. Non-Disclosure Requirements

J. Potential for Organizational and Personal Conflicts Of Interest (COI)

K. Cooperative Agreement Terms and Conditions of Award

Cooperative Agreement Roles and Responsibilities

Grantee

IX. Standard Terms and Conditions- ONC Grants

X. Agency Contacts

XI. Other Information

A. Restrictions

Appendix A. Budget Detail

A. Instructions for completing the SF 424, Budget (SF 424A), Budget Narrative/Justification, and Other Required Forms

B. Budget Narrative/Justification, Page 1 – Sample Format with EXAMPLES

Appendix B. Logic Model Example

Appendix C. Example Certification Criteria That Support Interoperability

Opportunity Overview Funding Opportunity Announcement Title: Community Interoperability and Health Information Exchange Cooperative Agreement Program

Federal Funding Agency: Office of the National Coordinator for Health Information Technology (ONC), U.S. Department of Health and Human Services (HHS)

Announcement Type: Cooperative Agreement

Funding Opportunity Number: II-II-15-002

Catalog of Federal Domestic Assistance (CFDA) Number: 93.239

Statutory Authority:

Consolidated and Further Continuing Appropriations Act, 2015, Pub. L. No. 113-235, Division G, Title II, (“For expenses necessary for the Office of the National Coordinator for Health Information Technology, including grants, contracts, and cooperative agreements for the development and advancement of interoperable health information technology, $60,367,000.”) and Title XXX, §3011 of the Public Health Service Act.

Approximate amount of funding available: $1,000,000

Anticipated number of awards: Up to ten (10) awards

Approximate Range of funding per award: $100,000

Period of Performance: 1 year

Important Dates: The table below sets out the required submission and other useful target dates related to the Funding Opportunity Announcement (FOA).

Public FOA Release April 14, 2015 Notice of Intent to Apply Due May 15, 2015 at 11:59 p.m. EST Applications Due June 15, 2015 at 11:59 p.m. EST Estimated Award Announcements August 14, 2015 Anticipated Project Start Date August 14, 2015

Executive Summary

This Funding Opportunity Announcement (FOA) will provide funds to entities (United States-based non-profit institution or organization, state or local government, agency or group in a designated community) to work collaboratively with non-eligible care providers1 to identify opportunities to support and extend the use of secure, interoperable health information technology (health IT) tools and health information exchange (HIE) services. This FOA will build upon existing community efforts to ensure health information is appropriately accessed and used to support people improve their health.

Additionally, this FOA will help increase the number of non-eligible care providers who are able to send, receive, find, and use electronic health information (inclusive of all determinants of health) in a manner that is appropriate, standardized, secure, timely, and reliable for both senders and receivers. This FOA will be a full and open competition. Up to ten (10) new cooperative agreements will be awarded.

This new FOA will fund organizations for one year that propose actionable approaches to extend an existing HIE service or use case to a non-eligible care provider population and engage the population in to share health data across the entire health spectrum of care. Exchanging of health information is both critical to enable care coordination and other improvements and to support both individual and community health.

The U.S. Department of Health and Human Services activities support community efforts to increase adoption and use of health information exchange. The total funding available under this FOA is $1,000,000. Applicants are encouraged, but not required, to propose projects that could be replicable in other communities and are cross jurisdictional, interstate or regional in nature. However, one entity must act as the responsible fiscal agent and submit the application on behalf of all the partners.

1 Non-eligible providers includes those not eligible for the Centers for Medicare & Medicaid Services’(CMS) Electronic Health Record(EHR) Incentive Programs (EHR Incentive Programs), including long-term and post-acute care (LTPAC) providers, behavioral health providers, individuals (includes care providers and others including family members authorized to act on the patient’s behalf) and other care settings and care providers (e.g., safety net providers, public health, social services, emergency medical services) or other recognized stakeholders that applicants are encouraged to engage. See http://www.cms.gov/Regulations-and- Guidance/Legislation/EHRIncentivePrograms/index.html?redirect=/ehrincentiveprograms/ http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/index.html?redirect=/ehrincentiveprograms/%20%20 http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/index.html?redirect=/ehrincentiveprograms/%20%20

I. Funding Opportunity Description

A. Background

The U.S. Department of Health and Human Services (HHS) has an important responsibility to advance the connectivity of electronic health information and interoperability of health IT. This responsibility is consistent with HHS’s mission to protect the health of all Americans and provide essential human services, especially for those who are least able to help themselves. This work has become particularly urgent given the need to address the national priority of better health, smarter spending and healthier people. Achieving this goal will only be possible with a strong and flexible health IT ecosystem that can appropriately support transparency and decision-making, reduce redundancy, inform payment reform, and help to transform care into a model that enhances access and addresses health beyond the confines of the health care system. This infrastructure will support more efficient and effective systems, scientific advancement, and lead to a continuously improving health system that empowers individuals, customizes treatment, and accelerates cure of disease.

Interoperability is generally accepted to mean the ability of two or more systems or components to exchange information and use the information that has been exchanged.2

There are two steps to interoperability: 1) the ability to exchange information; and 2) the ability to use the information that is exchanged. By building incrementally over time from current technology using multiple methods of exchange, an interoperable health IT ecosystem makes the right data available to the right people at the right time across products and organizations in a way that can be relied upon and meaningfully used. As a first step in working towards a consensus-driven interoperability roadmap as articulated in the HHS Principles and Strategy for Accelerating Health Information Exchange, the Office of the National Coordinator for Health Information Technology (ONC) released the concept paper, A 10-Year Vision to Achieve an Interoperable Health IT Infrastructure in June 2014 and then in January 2015 the more recent Connecting Health and Care for the Nation: A Shared Nationwide Interoperability Roadmap (DRAFT Version 1.0)(draft Roadmap) and the Federal Health IT Strategic Plan 2015-2020. In addition, ONC recently released three funding opportunities, including the Advance Interoperable Health Information Technology Services to Support Health Information Exchange Funding Opportunity Announcement (Advance HIE FOA), to support the draft Roadmap and a broad scale learning heath system by 2024. All of these efforts support the goal of ensuring that all individuals and care providers can send, receive, find, and use a basic set of essential electronic health information across the health care continuum to enhance care coordination and enable health system reform to improve care quality.

The first interoperability step, health information exchange (HIE), viewed as a verb not a noun, enables health care professionals and individuals to electronically access and securely share an individual’s essential health information. In 2010, ONC, through the State Health Information Exchange Cooperative Agreement Program, awarded funding to states and territories to rapidly build capacity for exchanging health information across the health system both within and across states. Today, state, territory and community-based exchanges and enterprise and private exchange networks are enabling and supporting three primary types of HIE3:

2 See IEEE Standard Computer Dictionary: A Compilation of IEEE Standard Computer Glossaries (New York, NY: 1990).

3 The Strategy for Advancing the Exchange of Health Information http://content.healthaffairs.org/content/31/3/527.abstract?sid=bb311bc8- 2442-4d73-b90e-e33e8ef91f40 http://healthit.gov/sites/default/files/acceleratinghieprinciples_strategy.pdf http://healthit.gov/sites/default/files/acceleratinghieprinciples_strategy.pdf http://healthit.gov/sites/default/files/ONC10yearInteroperabilityConceptPaper.pdf http://healthit.gov/sites/default/files/ONC10yearInteroperabilityConceptPaper.pdf http://www.healthit.gov/sites/default/files/nationwide-interoperability-roadmap-draft-version-1.0.pdf http://www.healthit.gov/sites/default/files/federal-healthIT-strategic-plan-2014.pdf http://healthit.gov/newsroom/grants-funding http://healthit.gov/policy-researchers-implementers/state-health-information-exchange http://healthit.gov/policy-researchers-implementers/state-health-information-exchange http://content.healthaffairs.org/content/31/3/527.abstract?sid=bb311bc8-2442-4d73-b90e-e33e8ef91f40 http://content.healthaffairs.org/content/31/3/527.abstract?sid=bb311bc8-2442-4d73-b90e-e33e8ef91f40

• Directed exchange: point-to-point, secure, electronic communication enabling sending and receiving of health information between care providers and individuals to support coordinated care. This includes the Direct Project4 specifications and other industry approaches to secure messaging. Other technologies have also been in use for some time to support unsolicited transmission of electronic health information including, secure File Transfer Protocol (sFTP) and Simple Object Access protocol (SOAP) and Representational State Transfer (REST).5

• Query-based exchange: pull transactions, or query through an HIE entity, enabling a user to submit a request for individual information and ask the HIE entity to discover and provide any records it may have about the patient in accordance with policies governing patient consent and data use agreements between exchange users. A variety of technologies and standards are in use to support query, including HIE profiles, which have become the basis for a variety of efforts (including the eHealth Exchange, EHR|HIE Work Group and the Care Connectivity Consortium). Web services are widely used with these and other standards to enable query/response transactions.6

• Consumer mediated exchange: ability for individuals to collect, use, share and control their health information among and between providers and other sources of their health information.

As we move forward, health information exchange continues to evolve and grow. Transport standards, or specified ways to move data from place to place, will continue to be developed and maintained to support various interoperability needs. In particular those priorities identified through a coordinated governance process based on the architecture of a learning health system. Transport standards should be consistent with core Internet technologies that are spread throughout. Direct is one core exchange technology. Web services based on SOAP (using HIE profiles) and RESTful approaches—including HL7’s Fast Healthcare Interoperability Resources (FHIR)—will continue to be used for more automated transactions, including query/response and some point-to-point transactions. Additionally, to support individual sharing of electronic health information, as well as patient-generated data, secure transport techniques will be necessary.7

The increased use of HIE services is happening across the nation8. However, in the past decade, the United States has made dramatic advancements in digitizing the care delivery system:

• Over one half of office-based professionals and more than 8 in 10 hospitals are meaningfully using EHRs.9

4 http://wiki.directproject.org/ 5 Connecting Health and Care for the Nation: A Shared Nationwide Interoperability Roadmap (DRAFT Version 1.0) 6 Ibid.

7 Ibid.

8 See http://www.healthit.gov/policy-researchers-implementers/hie-bright-spots for examples of lessons and successes from recent health information exchange efforts and http://healthit.gov/policy-researchers-implementers/state-hie-program-measures-dashboard for data on adoption and use of exchange activity supported and/or enabled by State HIE Cooperative Agreement grantees.

9 http://www.healthit.gov/facas/sites/faca/files/HITPC_Data_Analytics_Update_2014-04-08.pdf http://wiki.directproject.org/ http://wiki.directproject.org/ http://www.healthit.gov/sites/default/files/nationwide-interoperability-roadmap-draft-version-1.0.pdf http://www.healthit.gov/sites/default/files/nationwide-interoperability-roadmap-draft-version-1.0.pdf http://www.healthit.gov/sites/default/files/nationwide-interoperability-roadmap-draft-version-1.0.pdf http://www.healthit.gov/policy-researchers-implementers/hie-bright-spots http://healthit.gov/policy-researchers-implementers/state-hie-program-measures-dashboard http://www.healthit.gov/facas/sites/faca/files/HITPC_Data_Analytics_Update_2014-04-08.pdf

• Half of hospitals are able to electronically search for patient information from sources beyond their organization or health system.10

• The format of electronic clinical care summaries is standardized and the EHR Incentive Programs have specified minimum data elements that must be included when summaries are exchanged.

• All 50 states have some form of health information exchange services available to support care.11

By 202412, individuals, care providers, communities, payors and researchers should have an array of interoperable health IT products and services that allow the health care system to continuously learn and advance the goal of improved health care and health. Individuals should be able to securely share electronic health information with care providers and novel health information sources (e.g., personal health records, patient portals, and evidence based mobile apps) and make use of the information to support their own health and wellness through informed shared decision-making. An interoperable health IT ecosystem should support data movement and critical population public health functions such as real-time disease surveillance and disaster response, and data aggregation for research and value-based payment that rewards higher quality care. This health IT ecosystem should also be a place where people and communities can effectively use and manage their health data to improve where they live, work, and play.

This funding opportunity announcement will provide entities (United States-based non-profit institution or organization, state or local government, agency or group in a designated community) the opportunity to collaborate with providers and individuals, who have been excluded from federal incentive programs (i.e., CMS’s EHR Incentive Programs). Community entities will work with these providers to send, receive, find and use HIE services and health IT tools to move towards a learning health system.13

B. Purpose

The objective of this FOA is to inspire community entities (United States-based non-profit institution or organization, state or local government, agency or group in a designated community) to work collaboratively with non-eligible care providers, those providers not eligible for the EHR Incentive Programs, to identify opportunities to support and extend the use of secure, interoperable health IT tools and HIE services that will eventually lead to the enabling of individual and community health improvement through collective impact14. Communities have a much greater chance of improving health and well-being if organizations collaborate to create formal and informal networks to integrate health and social and community services.15 Health should be viewed beyond the walls of health care, and is inclusive of all the determinants of health.16

10 Office of the National Coordinator for Health Information Technology. 'U.S. Hospitals' Capability to Electronically Query Patient Health Information from Outside Their Organization and System,' Health IT Quick-Stat, no. 25. April 2014 11 http://healthit.gov/policy-researchers-implementers/state-hie-implementation-status 12 http://healthit.gov/sites/default/files/ONC10yearInteroperabilityConceptPaper.pdf 13 Connecting Health and Care for the Nation: A Shared Nationwide Interoperability Roadmap (DRAFT Version 1.0) 14 http://www.ssireview.org/articles/entry/collective_impact 15 http://www.rwjf.org/content/dam/farm/reports/reports/2015/rwjf418628 16 http://www.healthypeople.gov/2020/about/foundation-health-measures/Determinants-of-Health http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/index.html http://healthit.gov/policy-researchers-implementers/state-hie-implementation-status http://healthit.gov/sites/default/files/ONC10yearInteroperabilityConceptPaper.pdf http://www.healthit.gov/sites/default/files/nationwide-interoperability-roadmap-draft-version-1.0.pdf http://www.ssireview.org/articles/entry/collective_impact http://www.rwjf.org/content/dam/farm/reports/reports/2015/rwjf418628 http://www.healthypeople.gov/2020/about/foundation-health-measures/Determinants-of-Health

The term “care providers” is defined broadly to reflect the entire health care continuum. Non-eligible care providers include: long-term and post-acute care (LTPAC), behavioral health, individuals17 and other care settings and care providers (e.g., safety net providers, public health, social services, emergency medical services) or other recognized stakeholders that applicants are encouraged to engage.

For purposes of this funding opportunity, health IT tools should not include the purchase and adoption of EHRs, but instead tools that promote data sharing between providers and individuals (e.g., patient portals, personal health records, and mobile health technologies).

This FOA will enable applicants to increase use of HIE and adoption of health IT among non-eligible care providers in the community to help address critical challenges to widespread interoperability including, but not limited to, the following:

• Proprietary vendor or health care system interests;

• Workflow challenges in automating health information;

• Differing policies and laws governing electronic health information sharing;

• Fragmentation of the health care system; and

• Disconnection between the health care system and key social service providers.18

These funds can be used to foster connections and data sharing between non-eligible care providers in existing community HIE efforts but not to fund separate siloed efforts for non-eligible care providers.

HHS will fund approximately ten (10) community interoperability projects to address high-impact use cases through the accelerated adoption and use of standards-based interoperable tools and to increase HIE services among non-eligible care providers in order to achieve a learning health system.

This FOA is intended to direct resources to specifically support non-eligible care providers in HIE adoption and use and to develop models for a learning health system. Although the FOA does not direct resources specifically to eligible professionals and eligible hospitals as defined in the EHR Incentive programs, it will support the work they do to share and coordinate care with non-eligible care providers.

Technical assistance and support for eligible professionals and eligible hospitals has also been made available through funding from the Regional Extension Center Program.

C. Program Description

The Community Interoperability and Health Information Exchange Cooperative Agreement Program will fund organizations that propose actionable approaches to increase adoption and use of standards-based interoperable health IT tools and HIE services among non-eligible care providers through effective training and workflow redesign. Proposed projects will leverage existing state and local health IT and HIE assets that may have resulted from the previous State HIE Program. The prior work of the State HIE Program, along with this funding opportunity and the recently released ONC FOAs (specifically the Advance HIE FOA), should, in combination, continue and complement each other to support the work and goals of the draft Interoperability Roadmap.

17 For the purposes of this FOA, the term “individual” includes care providers and others including family members authorized to act on the patient’s behalf.

18 Connecting Health and Care for the Nation: A Shared Nationwide Interoperability Roadmap (DRAFT Version 1.0) http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/eligibility.html http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/eligibility.html http://www.healthit.gov/providers-professionals/regional-extension-centers-recs http://www.healthit.gov/policy-researchers-implementers/state-health-information-exchange http://healthit.gov/newsroom/grants-funding http://www.healthit.gov/sites/default/files/nationwide-interoperability-roadmap-draft-version-1.0.pdf http://www.healthit.gov/sites/default/files/nationwide-interoperability-roadmap-draft-version-1.0.pdf

All applications must address the project theme of supporting non-eligible care providers to send, receive, find, and use electronic health information in a manner that is appropriate, secure, timely, and reliable for both senders and receivers. Applicants will identify and use a common clinical data set across unaffiliated organizations that align with national standards to improve care coordination and promote a learning environment. Awards may go to communities where EHRs are not in place—there are HIE activities and health IT solutions where an EHR is not necessary to exchange health information. Cross jurisdictional, interstate or regional collaborative projects are encouraged.

Applicants will need to describe how the proposed project will contribute towards achievement of a learning health system in their community and how the project will ensure continuous learning, innovation and quality improvement. Proposed projects should focus on all three of the following areas to support the project theme.

D. Project Approach

Area One: Identify a specific non-eligible care provider population—those who will ultimately use the HIE service or tool

Applicants should target a non-eligible care provider population that will adopt and use the specified health IT tool or HIE service under this funding opportunity announcement. Applicants should seek to identify a specific non-eligible care provider population that has a compelling interest in adoption and use of health information exchange. Below are some examples of non-eligible care providers that would serve individuals better as part of the care continuum, and support a more comprehensive, integrated individual record or care plan:

• Long-term and post-acute care providers (LTPAC)

• Behavioral health

• Individuals—including care providers and other family members authorized to act on a patient’s behalf;

• Other care settings and care providers (e.g. safety net providers and those serving vulnerable populations, public health, social services, emergency medical services) are recognized clinical and non-clinical stakeholders across the entire care continuum that applicants are encouraged to engage.

Area Two: Extend an existing HIE service or use case

Below is a list of example projects; however, applicants are not limited to this list:

Facilitate transitions of care and promote care coordination. Applicants could expand or extend the use of an existing, in production HIE service. Some examples are as follows:

• Improve long-term and post-acute care transitions by extending an HIE service or health IT tool (e.g., Direct mailboxes) to skilled nursing facilities and provide a training for staff on how to incorporate these services into provider workflows.

• Improve pre-hospital quality of care and potentially decrease emergency room transports by onboarding emergency medical services (EMS) to a Health Information Organization/Health Information Exchange to allow access to electronic health information and support the sharing of electronic health information with the hospital.

• Improve care coordination with behavioral health providers by extending an HIE service or health IT tool (e.g., Direct mailboxes or access to a Health Information Organization/Health Information Exchange query portal) to better share clinical health information and to improve integration of behavioral and physical health information.

• Support the individual continuum of care by expanding HIE connectivity and the use of data by other providers (e.g., public health, behavioral health, and others). Applicants should support and facilitate exchange between these providers by sharing electronic health information such as clinical summaries, care plans, or medication lists with the entire care team.

• Increase individual (including care providers and family members) access to their health data electronically, including behavioral health to ensure their data moves with them and they have access when and where when needed. This could be accomplished through increasing use of standards-based, secure exchange tools such as an HIE shared personal health record (PHR), patient portal, or mobile health IT application. Increasing access to these tools will better enable individuals to make choices about disclosure of specific information that is sensitive to an individual and/or legally protected and allow easy, timely, secure access to download, and share their health information.

Individual population focus to improve care coordination. Applicants could focus efforts on a specific non-eligible care provider, such as a community-based care program, and create a digital infrastructure to better integrate the community-based organization with electronic health information for individuals.

Some examples are as follows:

• Extend existing health IT tools and HIE services (i.e., Direct services or access to a Health Information Organization/Health Information Exchange query portal) to interconnect or link school, child care, health care provider, hospital information, pharmacy and legal systems. This would ensure that children, adolescents and their family have a longitudinal record of care captured from various medical and nonmedical points of care.

• Use a health information portal or HIE tool to link a hospital and a local social service agency so that they can better access electronic health records to improve individual health. This may enable a hospital to share electronic health information with a home visitor immediately after a baby is born, or a worker at a homeless shelter to take an individual’s blood pressure and share the results immediately with the hospital staff for follow-up.

Community care coordination. Applicants could propose to extend a community-based care transition effort and to support the linking and exchange of medical and nonmedical data (e.g., social, environmental, and behavioral). Some examples are as follows:

• Expand HIE services to health educators or health professionals who visit discharged individuals as they transition from the hospital to their home or other health care settings. By encouraging them to use health IT services such as Direct messaging, clinical alerting or event notifications, they will be able to securely share updates, identify concerns, and send notifications when individuals are discharged and returned home or to another place of residence.

• Extend or broaden current electronic referral or electronic consult services within the community among providers and social service agencies or other organizations. This would increase the sharing and exchanging of not only clinical data but also other determinants of health data that would support the entire health and well-being of individuals.

Building HIE Capacity. Applicants could propose to support non-eligible care providers without EHRs. There are several low-cost, community-driven, standards-based health IT tools (e.g., IMPACT SEE Tool, BEAT–ADT Tool, Transform, Consent2Share, PopHealth and other emerging tools) that could support the interoperable exchange of electronic health information for those without EHRs.

Applicants will need to provide a description regarding plans to integrate these tools into existing infrastructure and the proposed timeline to enable use by non-eligible care providers. Applicants must make any software they build fully open source, either under an Apache 2.0 license or a license that is even less restrictive than Apache 2.0.

Area Three: Engagement strategy for Use by the Non-eligible care provider population

Finally, applicants must describe the strategy and approach that they will use to engage the specified non-eligible care provider population, both to successfully onboard them to the health IT or HIE solution, and to demonstrate effective use within the specified timeframe. Applicants should describe their onboarding, technical assistance, and/or training and education strategy and provide a justification for why they believe that their strategy will be successful. An example could be providing technical assistance to a non-eligible care provider population around workflow or workflow redesign to implement the new HIE service and demonstrating how it will improve quality care. The engagement strategy can be built upon previous successful experiences with the target population, strong relationships with targeted non-eligible care providers, or a strong evidence base.

E. Proposal Criteria

Applicants must address the following in their proposal:

• Describe the overall community, specifically the non-eligible care provider target population, and their current use of the proposed HIE service extension or use case.

• How the proposed project will complement, build upon, or leverage existing health IT infrastructure and coordinate with, not duplicate, existing efforts occurring through other state and federal partners including but not limited to: the CMS State Innovation Model, Health Care Innovation Awards, the Medicaid Accelerator Program, and other recent ONC FOAs.

• How applicants will extend existing HIE services to a specific non-eligible care provider population and achieve proposed milestones to increase adoption and use of the HIE service.

• How the proposed project will build processes necessary to track/improve electronic health information exchange for individual and community health.

http://mehi.masstech.org/programs/past-programs/impact-improving-massachusetts-post-acute-care-transfers/land-and-see http://mehi.masstech.org/programs/past-programs/impact-improving-massachusetts-post-acute-care-transfers/land-and-see http://transform.keyhie.org/ http://www.healthit.gov/policy-researchers-implementers/consent-management http://healthit.gov/newsroom/grants-funding

• How the proposed project will aid in the achievement of a learning health system within the community, as described in the draft Interoperability Roadmap.

• What standards will the project support and what infrastructure/technology is “live” or used in the real world by other participants across the care continuum.

• How the proposed project will be evaluated and measured.

• Through the use of a logic model, describe how the funding and proposed work will support objectives such as improving care quality, reducing inappropriate utilization of health care, delivering more efficient care, building processes necessary to track/improve individual outcomes, or increasing individual activation/engagement (see Appendix B).

• Identify assumptions made in the organization, financing, technical infrastructure, political climate and stakeholder participation to identify the facets of both scalability and replicability.

• How to share lessons learned, challenges, successes, outcomes (e.g., via news articles, journals, presentations, communities of practice, traditional and non-traditional media outlets, etc.) and how the proposed project may be replicated in a similar community or region.

F. General Funding Requirements

All applications must address the following requirements:

• The applicant’s approach can focus on a targeted geographic area and set of participants within a region, state or community, but must address health information exchange with non-eligible care providers not already benefiting from HIE services. The specific geographic target area and partners must be defined.

• Applicants must create results (i.e., technology, process, and infrastructure) that are openly available and reusable by others. For example, by offering such solutions as community-driven, standards-based tools or under Apache 2.0 license or a license that is even less restrictive than Apache 2.0.

• Initiatives must strive to create processes, strategies and approaches that are scalable and replicable in other communities, regions, states and/or territories.

• Where applicable, the awardee (also referred to as “grantee” in this FOA) should use the EHR technology standards and implementation specifications adopted by HHS or another federal agency and any other standards and implementation specifications identified by ONC, including those that may be applicable to the Nationwide Health Information Network (NwHIN)19.

Applicants will enable and support non-eligible care providers to send, receive, find and use a common clinical data set (that aligns with national standards) across unaffiliated organizations to improve care coordination and promote a learning environment. See Appendix C for example certification criteria that support interoperability. Awardees should also plan to participate, when possible, in ONC committees, work groups, communities of practice and other meetings or events to support the development and refinement of health IT standards and specifications.

19 http://www.healthit.gov/policy-researchers-implementers/nationwide-health-information-network-nwhin http://www.healthit.gov/sites/default/files/nationwide-interoperability-roadmap-draft-version-1.0.pdf http://www.healthit.gov/policy-researchers-implementers/nationwide-health-information-network-nwhin

G. Project Deliverables, Evaluation and Measurement

This FOA allows flexibility for applicants to propose projects that support and enable local and innovative health information exchange. Depending upon the project, and the non-eligible care provider population we will measure awardee success, during the reporting period, by the effect of this project on the following:

Total number or percent increase of onboarding new non-eligible care providers to the HIE service.

Total number of secure messages delivered to distinct production (non-test) end points by the non-eligible care provider population.

Total number of patient record queries or transactions submitted through the applicant by the non-eligible care provider population.

Total number or percent increase of onboarding new individuals to an untethered Personal

Health Record, patient portal, or other solution.

Total numbers of individuals, who are able to view, download or transmit to a third party their electronic health information.

Use of qualitative data methods to assess engagement strategy.

The applicant will work with the non-eligible care provider population to determine baseline data on adoption and use for the non-eligible care provider population participating in the project. The applicant will determine appropriate milestones of professionals or individuals within the non-eligible care provider population to successfully adopt and use the health IT tool or HIE services based on geographic size, service area of applying community entity and other factors in the market or region and determine the frequency of adoption and usage over the one year time period. This system of reporting on adoption and use of health information exchange may be created to generate individual level reports for internal use and aggregated reports for ONC.

Awardees will be required to use ONC’s Customer Relationship Management Tool (CRM). The CRM will be used for tracking non-eligible care provider milestone information. Post award, ONC will provide the awardee with access and additional information about the CRM. Awardees will partner with ONC to establish quarterly reporting mechanisms in the CRM to track and monitor progress towards milestones (qualitative and quantitative data).

The proposed deliverable at the end of the period of performance will be a public-facing Final Project Report. The Report will document the project and include: challenges, successes, baseline and benchmark data for the target population, engagement strategies of the target population (training and workflow redesign solutions), how the project may be adopted or replicated, and how the project links back to a learning health system.

Additional use or transaction milestones may be established post award. Attendance at one ONC meeting is highly encouraged.

II. Award Information

A. Summary of Funding

Type of Award: Cooperative Agreement

Approximate Amount of Funding Available:

$1,000,000

Award Floor: $50,000 Award Ceiling: $100,000 Maximum Applications per Applicant:

One

Approximate Number of Awards: Up to ten (10)

Project Period and Budget Period End Date:

1 year after date of award

Estimated Start Date: August 14, 2015

ONC reserves the right to make additional awards under this announcement, consistent with Agency policy, if additional funding becomes available after the original selections are made. Any additional selections for awards will be made no later than 12 months after the original selection decisions.

B. Performance Evaluation

The Awardee’s performance will be evaluated on a continuous basis by ONC to ensure that the project is meeting program objectives.

C. Award Type

The funding instrument used for this program will be the cooperative agreement, an award type in which substantial ONC programmatic involvement with each grantee is anticipated during the performance of the activities. Under the cooperative agreement, ONC’s purpose is to support and stimulate a grantee's activities by involvement in and otherwise working jointly with the grantees in a partnership role; it is not to assume direction, prime responsibility, or a dominant role in the activities. Consistent with this concept, the dominant role and prime responsibility resides with each grantee for the project as a whole, although specific tasks and activities may be shared among a grantee and ONC as defined below.

D. Substantial Involvement in Cooperative Agreements

Awards will be in the form of Cooperative Agreements. ONC will work closely with each grantee to plan and implement progress in a collaborative way.

III. Eligibility Information

A. Eligible Applicants

Applicants must be a United States-based non-profit institution or organization, state or local government, agency or group. Applications must meet the requirements of Responsiveness and Completeness Criteria found under Section III.C and D below.

B. Cost-Sharing or Matching

There is no cost-sharing or matching requirement.

C. Application Responsiveness Criteria

Applications that do not meet the following responsiveness criteria will be administratively eliminated and will not be sent forward for merit review:

• The application clearly addresses the project theme (Section I.C).

• The applicant meets the eligibility criteria as required by Section III.A, Eligible

Applicants.

• The application is complete and includes the required components (Section IV.B), including all elements of the program narrative needed to forward it for merit review.

D. Application Completeness Criteria

ONC will screen all applications to identify those that do not meet criteria outlined below. The application screening criteria are:

• The application is received by the deadline required under Section IV.C, Submission Dates and Times.

• The application meets the formatting and length requirements found in Section IV.B, Content and Form of Application Submission.

• The application includes specification of the geographic area and target population (estimated number of individuals and/or providers) of the project.

• Appendices and attachments are not used as a mechanism to exceed page limits of the Project Narrative.

IV. Application and Submission Information

A. Address to Request Application Package

The applicants will be able to download a copy of the application packet, complete it off-line and then upload and submit the application electronically via: http://www.grants.gov.

APPLICATIONS WILL NOT BE ACCEPTED THROUGH ANY WEBSITE, AND WILL NOT BE

ACCEPTED THROUGH PAPER MAIL, COURIER, OR DELIVERY SERVICE.

http://www.grants.gov/

• THE APPLICANTS ARE STRONGLY ENCOURAGED TO COMPLETE AND SUBMIT

APPLICATIONS AS FAR IN ADVANCE OF THE SUBMISSION DEADLINE AS

POSSIBLE. THE APPLICATION INCLUDING ALL REQUIRED ATTACHMENTS AND

INCLUDED FILES FOR POTENTIAL CONSIDERATION IN THE REVIEW PROCESS

MUST BE RECEIVED BY 11:59 PM EASTERN TIME ON THE DATE SPECIFIED IN

SECTION IV C, BELOW. All applicants should have a Dun and Bradstreet (D&B) Data Universal Numbering System (DUNS) number and register in the Systems for Award Management (SAM). Allow a minimum of five (5) days to complete the SAM registration.

• Grants.gov will automatically send lead awardees a tracking number and date of receipt verification electronically once the application has been successfully received and validated in Grants.gov.

Application procedures:

• Applicants must access the electronic application for this program via http://www.grants.gov.

Search the downloadable application page by the Funding Opportunity Number II-II-15-002or CFDA number (93.239).

• Applicants should have a Dun and Bradstreet (D&B) Data Universal Numbering System (DUNS) number and register in the System for Award Management (SAM). Allow a minimum of five days to complete the SAM registration. It is critical to know that SAM registration requires an annual renewal.

• Submit all documents electronically, including all information included on the SF424 and all necessary assurances and certifications.

• Ensure that the application complies with any page limitation requirements described in this Program Guidance.

• After electronically submitting your application, an automatic email notification will be sent to confirm that the application was received. This notification does not provide assurance that your application was complete, only that the email was received.

• After ONC reviews the submission, a return receipt will be emailed to the lead Grantee contact indicating the files that were received and able to be successfully opened and read.

Organizations applying for federal grants will need to be registered with the System for Award Management (SAM) . You can register with the SAM online in about 30 minutes (http://www.sam.gov). If you have already registered with SAM, but have not renewed your registration in the last 12 months, you will need to renew your registration at http://www.sam.gov.

Key Contact for Applications:

Inquiries should be addressed to:

U.S. Department of Health and Human Services Office of the National Coordinator for Health Information Technology Email: HIECommunityFOA@hhs.gov http://www.grants.gov/ https://www.sam.gov/portal/SAM/ https://www.sam.gov/portal/SAM/ https://www.sam.gov/portal/SAM/ http://www.sam.gov/ http://www.sam.gov/ mailto:HIECommunityFOA@hhs.gov

B. Content and Form of Application Submission

Project Abstract

Applicants must include an abstract of the application of no more than two pages single spaced and 500 words. This abstract is often distributed to provide information to the public and Congress and represents a high-level summary of the project. Applicants should prepare a clear, accurate, and concise abstract that can be understood without reference to other parts of the application and which gives a description of the proposed project, including: the project’s goal(s), objectives, the project theme addressed, overall approach (including target population and significant partnerships), anticipated outcomes, products, and duration.

The Project Abstract must have a font size of no less than 11 point Times New Roman font.

The applicant must place the following information at the top of the Project Abstract (this information is not included in the 500 word maximum):

• project title;

• state/territory, geographic area and specific non-eligible care provider population for the project;

• applicant name;

• address;

• contact name;

• contact phone numbers (voice, fax);

• e-mail address;

• web site address, if applicable; and

• Congressional Districts within the target area.

Budget Forms

All applicants are required to fill out the following budget forms to include the costs associated with the proposed project activities. These forms will be submitted through grants.gov as part of the application package and will include the following:

Application for Federal Assistance SF-424

Budget Information for Non-Construction Programs SF-424A

Assurances for Non-Construction Programs SF-424B

Disclosure of Lobbying Activities SF-LLL

Please note that these forms do not replace program-specific guidance provided in this funding opportunity announcement. Additional instruction regarding budget forms can be found in Appendix A.

Project Narrative The Project Narrative is the most important part of the application, since it serves as the primary basis to determine if the proposed project meets the minimum requirements for a grant. The Project Narrative should provide a clear and concise description of your project. Successful proposals will provide a complete description and justification for how the applicant will use funds to:

• extend an existing HIE service or use case to a specific non-eligible care provider population— including the specific technology solutions to address those needs,

• implement the engagement strategy with the non-eligible care provider population—including onboarding, technical assistance, and/or training,

• contribute towards achievement of a learning health system, as described in the draft Roadmap in their community and how the project will ensure continuous learning, innovation and quality improvement,

• share results with other communities, states and territories, and

• build processes necessary to track/improve individual and community health.

The project narrative must be on 8 ½” x 11” size paper with 1” margins on both sides, Times New Roman font and a font size of not less than 11. Smaller font sizes may be used to fill in the Standard Forms and Sample Formats. The maximum length for the project narrative is five (5) pages single spaced. Letters of support, participant lists and résumés of key project personnel do not count as part of the Project Narrative for purposes of the five (5) page limit.

The project narrative must follow the outline provided below and include the information required under each section.

Section 1: Purpose, Approach, Project Work Plan, and Activities This section must set out an…