Connected Communities Implementation Grant

Milestone 1 Template(updated 3/1/17)

Organization Name:

  1. Include a description of your policies and procedures to protect electronic Protected Health Information (ePHI). The description should include the following elements and should be no longer than 1.5 pages in length.
  • the development and/or distribution of the Notice of Privacy Practices (NPP) to patients (See the Connected Communities Grantee webpage for guidance and best practices around NPPs);
  • how staff will be trained to ensure the privacy and security of ePHI;
  • how the organization will perform a security risk analysis that identifies and analyzes risks to ePHI;
  • the physical safeguards to protect ePHI;
  • your organization’s plan to protect ePHI with business associates; and
  • the actual written policies that exist for protecting ePHI (you may attach your current policies to this document).
  1. Building upon the workflow description in your Transformation Plan (Section 4.a.),describe the impacted workflows that will be required for the grantee and collaborating organizations to implement your proposed use cases. Also describe preliminary workflow enhancements that have been implemented since the beginning of the grant project. Workflow information should be included for the grantee and each collaborator that will be participating in a use case. (You can find workflow related information and resources on theConnected Communities Grantee webpage.)
  1. Please attach a copy of the HIE/HISP or Mass. HIway participation agreement for your organization andfor each collaborating organization that will be using a HIE/HISP or the Mass. HIway. (Please see the Connected Communities Grantee webpage for an example of a HIE/HISP agreement.)
  1. Please attach a transaction log(s) from the sponsoring HIE/HISP detailing the test transactions – as described in the HIE Use Case Development Form(s) that you submitted with your Transformation Plan – and the organizations involved with the test transactions. The transaction log should include (at a minimum) the fields listed below. Please redact any sensitive patient information from the transaction logs.

Date (Year – Month) / Sender (May include sender’s Direct address) / Recipient (May include recipient’s Direct Address) / Number of Transactions
  1. Please complete the attestation form for Milestone 1. Each collaborating organization that is listed in the transaction log must also complete the attestation form for Milestone 1 (attach forms to this document). The attestation form can be found on the Connected Communities Grantee webpage.
  1. If applicable to your organization or your collaborating organizations, please update the following documents with any changes:
  • Description of the health IT environment at your organization and collaborating organizations on Health IT Spreadsheet (part of Transformation Plan deliverable);
  • HIE Use Case Development Form(s) (part of Transformation Plan deliverable); and
  • Any additional changes to Transformation Plan

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