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DATA SHARING AGREEMENT BETWEEN (HOSPITAL NAME) AND THE AGENCY FOR HEALTHCARE ADMINISTRATION FLORIDA CENTER FOR HEALTH INFORMATION AND POLICY ANALYSIS

This agreement is entered by and between [Hospital Name] (hereinafter referred to as the Hospital) and the State of Florida, Agency for Healthcare Administration, Florida Center for Health Information and Policy Analysis.

Whereas, the parties shall exchange certain data that is confidential and must be afforded special treatment and protection; and,

Whereas, data exchanged by the parties may be used or disclosed only in accordance with this agreement and state and federal law;

Now, therefore, the Hospital and the Agency agree as follows:

1. Purpose of Agreement. The purpose of this agreement is to govern the exchange of clinical laboratory data between the Agency and the Hospital. The Agency shall use the data specified in this agreement for a hospital quality pilot project funded through a contract with the Agency for Healthcare Research and Quality (AHRQ), AHRQ Project-07-10042. In addition, the Agency shall use the clinical data to create joined record sets by merging the clinical data with the administrative data. The Agency may share the data specified in this agreement with its subcontractors 3M HIS, for purposes of fulfilling its obligations pursuant to the AHRQ contract or any other contract to which the Hospital consents.



2. Description of Data. Pursuant to the terms of this agreement, the Hospital shall disclose specific clinical laboratory data elements as set forth in Attachment I to the Agency.



3. Method of Data Transfer. The Hospital will upload the clinical records as a comma delimited file into the Agency’s secure FTP sites.



4. Point of Contact. The Agency designates Dr. Christopher Sullivan, AHRQ project director, whose address is 2727 Mahan Drive, Mail Stop #16 Tallahassee, FL 32308-5403, and who can be contacted at 850-414-5421, as its point of contact for this agreement.
   
   The Hospital designates [name and title], whose address is [address], and who can be contacted at [phone number], as its point of contact for this agreement.



5. Payment. The parties shall provide the data specified in this agreement at no cost.



6. Permissible Uses and Disclosures of Data. Upon receipt of the data specified in this agreement, the Agency will download the records from the secure FTP sites into Oracle Database then merge them with the administrative data for a joined record set. The joined record sets will be de-identified and uploaded to a secure FTP site accessible by 3M HIS to create the APR DRG groupings and to conduct the preliminary analysis.
   
   The Agency shall not use or further disclose, transmit, copy, or disseminate the data specified in this agreement except as permitted by this agreement or as required by federal law.
   
   The Agency shall establish appropriate administrative, technical, and physical safeguards to protect the confidentiality of and to prevent unauthorized use or access to the data specified in this agreement. This also governs any electronic transmission of the data.
   
   The Agency shall not release or allow the release of the data specified in this agreement to any person or entities other than as permitted by this agreement.
   
   The Agency shall restrict disclosure of the data specified in this agreement to the minimum number of individuals who require the information in order to perform the functions of this agreement. The Agency shall instruct individuals to whom the data is disclosed of all obligations under this agreement and shall require the individuals to maintain those obligations.
   
   The Agency shall secure the data specified in this agreement when the data is not under the direct and immediate control of an authorized individual performing the functions of this agreement. The Agency shall make a good faith effort to identify any use or disclosure of the data not provided for by this agreement.



7. Disclosure to Agents. The Agency shall ensure that any agents, including, but not limited to, a contractor or subcontractor, to whom the Agency provides the data specified in this agreement agree to the same terms, conditions, and restrictions that apply to the Agency with respect to the data.



8. Indemnification. The Hospital agrees to indemnify, defend, and hold harmless the Agency from any or all claims and losses accruing to any person, organization, or other legal entity as a result of violation of this agreement to the extent permitted by federal and state law.



9. Term of Agreement. This agreement shall be effective upon execution by both parties and shall remain in effect until September 30, 2009, unless terminated by one of the parties. This agreement may be terminated by either party without cause upon thirty (30) days written notice. Notice of termination shall be delivered by certified mail, return receipt requested, or in person with proof of delivery.

The terms of this agreement may not be waived, altered, modified, or amended except by written agreement of both parties.

This agreement supersedes any and all agreements between the parties with respect to the use of the data specified in this agreement.

In witness whereof, the Hospital and the Agency have caused this agreement to be signed and delivered by their authorized representatives as of the date set forth below.

For (Hospital)

Signature line

Print Name

Title

Date

For the Florida Center for Health Information and Policy Analysis

Signature line

Print Name - Christopher Sullivan

Title - SMA II/Administrator

Date - November 3, 2008

Attachment I: Clinical Data Elements