MINUTES
NORTH CAROLINA ASSOCIATION OF LOCAL HEALTH DIRECTORS
Executive Committee Meeting
February 20, 1997
Albert Coates Building - Auditorium
Raleigh, North Carolina

CALL TO ORDER - President Barry Bass called the meeting to order at 9:10 AM. He welcomed everyone in attendance and then made the following announcements:

1. Dr. David Bruton, Secretary of the Department of Human Resources has been invited to the March meeting of the NCALHD.

2. Barry Goldstein has requested to discuss the MCH accountability standards at the March meeting of the NCALHD.

3. Incoming/Outgoing Local Health Directors: Bob Parker has resigned his position as Health Director of the New Hanover County Health Department to take a position as Vice President for Community Services, Baptist Hospital, Winston-Salem.

4. Dr. Louis Latour has requested support of the NCALHD in his bid to run for the NACCHO Board of Directors. There are ten At-Large seats. Bob Parker urged his support and asked for others to seek seats. Dennis Harrington made the motion that the NCALHD send a letter of endorsement and for its membership vote for Louis Latour. Bob Wood seconded. During discussions regarding other potential candidates to also represent North Carolina on the NACCHO Board of Directors, Wayne Raynor, offered his candidacy. On the friendly amendment to the motion to include NCALHD support of both Louis Latour and Wayne Raynor, the motion passed unanimously.

5. President Barry Bass urged the membership to complete the NACCHO questionnaires that had been recently mailed out.


APPROVAL OF THE MINUTES FOR JANUARY 22, 1997 MEETING - Terry Pierce requested a correction in the January minutes to reflect the Environmental Health Committee meeting schedule be changed from the 1996 schedule of meetings to the 1997 schedule of meetings. Bob Wood made the motion that the January 22,1997 minutes be approved with the correction. Dennis Harrington seconded and the motion passed unanimously. Tom Bridges said he would send the revised Environmental Health meetings schedule for 1997 in the February minutes mailing.


TREASURER'S REPORT - President Barry Bass recognized Dennis Harrington to give the report of the 1996 Audit Report. Dennis Harrington said that he, Bill Smith, Margaret Dollar and Tom Bridges met the previous night to conduct the audit. After a thorough review of the records there was a correction needed to adjust the monthly January 21, 1997 checking account of the Treasurer's report by $ 2,114.04 due to a few omissions over the previous year. To change the January 21, 1997 balance from $ 34,559.16 to $ 36,673.20 would bring the monthly report in line with the bank checking statement. The savings account was found to be correct with a balance at that time of $ 24,812.21. On motion duly executed, the audit was approved by all.

Tom Bridges then presented the monthly Treasurer's Report that the checking balance as of February 14, 1997 was $ 31,024.89. The State Health Director's Meeting balance was $ 3,809.90 leaving a balance excluding the SHD of $ 27,214.99. The savings account balance was at that time $ 24,919.51. The 1997 Budget receipts showed $ 5,820.73 and expenses of $ 333.48. The 1997 NCALHD dues notice was sent out with the January 21, 1997 meeting minutes. Tom Bridges urged members to let know if they needed some more explicit invoice in order to pay their dues. On motion duly executed the Treasurer's report was approved by all.


HAM STEVENS AWARD RECIPIENT - Dr. Louis Latour reported that he was not able to arrange for the Ham Stevens Award recipient to be present at the January NCALHD meeting. He called upon Bob Parker to present the latest Ham Stevens Award to Daniel Shingleton. Bob Parker said that it was his high honor, having personally known Ham Stevens as a Health Director and his mentor, to present the Award to Dan Shingleton. He said that Dan is to be credited for so much to Public Health in North Carolina. Among his many accomplishments, he served as President of the NCPHA, has written extensively on the history of public health in North Carolina, established the Public Health Forum journal, and is credited with establishing the Wood Endowment.


COMMITTEE REPORTS


NOMINATION & BYLAWS - Dr. Louis Latour reported that the Committee had not met, but he wanted to encourage the remaining health directors to get on E-mail and the Internet.


EDUCATION AND AWARDS - Leonard Wood had the following items to report:

1. The Health Directors' Spring Workshop will be held on April 17, 1997 PM and April 18, 1997 AM, at the Carolina Inn, Chapel Hill. Barbara Chavious has reserved six classrooms in buildings near the Carolina Inn and should be called if any committees need a room to conduct their meetings prior to the NCALHD meeting which is scheduled for the morning of April 17, 1997. Her telephone number is 919/966-1104.

Ron Rosenberg, from Cary, NC is to give a full day's seminar on leadership issues for the 90's. This year's planning efforts has been to have an intensive, one speaker in-service, which is not normally available in group settings. He urged all members to attend. Space is being made for 100 - 120 to attend to allow for local health directors to invite one key management person from their health department to also attend.

2. Leonard Wood presented Bob Parker with the NCALHD Retirement Clock. Bob said that it was 22 years ago that he began as a Family Planning Health Educator with the Neuse River Council of Governments. Over the years he has advocated for and will continue to advocate for public health. He said he believes that his mission now is to work through the private sector to secure a dedicated source of funding for public health.

3. Leonard Wood presented the motion from Committee that the NCALHD recognize Barbara Matula for the support she has given over the years to public health by donating $ 500.00 to the Wood Endowment. He said that this one time gift would perpetually recognize her by name for her years of dedication and support to public health. The motion passed unanimously. President Barry Bass will send Barbara Matula a letter informing her of the action taken by the NCALHD to recognize and thank her.


ENVIRONMENTAL HEALTH - Terry Pierce reported the following:

1. The Public Water Supply Section is proposing to contract with local health departments to provide several activities. These activities include: verifying the existence and updating the mailing addresses for inventoried systems; locate systems that are not currently listed on the PWS inventory; completing a one page form; perform a sanitary survey of systems; and collecting samples. The payment for these services are not firm at this time. The PWS staff will submit a more concrete proposal, including payment amounts, at the March EH Committee meeting.

2. The Authorization Work Group has almost completed its task. Health directors should have received an E-mail notification from Malcolm Blalock that environmental health supervisors would be sent authorization information. The Environmental Health Supervisors Association is supportive, but suggested the process be put on hold, pending the reorganization of DEHNR and DHR.

3. The Restaurant Rules Review Committee was discussed yesterday at the Commission for Health Services. Terry Pierce thanked the fifteen local health directors who were in attendance. He especially praised John Shaw for his help in presenting the concerns of local health departments, the Commission voted to receive the Report as information, and asked that the Committee be expanded and continue to work toward resolving the concerns expressed by the public health community. The Commission voted to add six additional local health department representatives to the Committee, two local health directors, two environmental health supervisors, and two environmental health specialists that perform restaurant inspections. These additional members will give the Committee a total of seven local health department representatives. The Commission requested that an update of the Committee's progress be presented at their May meeting and that the final revisions to the Rules be presented at the November meeting. Dr. Levine will be soliciting nominations for the six representatives. Chris Hoke said that the legislative mandate to the Commission had been met. He said that it was obvious that the Commission had heard the local concerns and were responsive to the public health concerns. John Shaw's comments to the Commission are included with the minutes.

4. Terry Pierce requested a summary report from a recent survey conducted of local environmental health program activities be included in the minutes. The report is entitled, "Preliminary Site Evaluation Survey Results".

5. The primary concerns of the "Hog Caucus" regarding intensive livestock operations (ILOs) are addressed in HB 85. This bill appears to provide greater protection from ILOs and allows more local health department involvement in protecting against violations. Chris Hoke and Milton Heath had a few concerns about the wording, but believe it can be modified for a positive outcome. Bill Smith indicated the bill had bi-partisan support. A motion from the Environmental Health Committee for the NCALHD to support House Bill 85 was passed unanimously.

6. Terry Pierce presented a report on a draft bill entitled "An Act to Expedite Training of Environmental Health Specialists" (Special Provision) to be included in the minutes. Ed Regan, Deputy Director, NC Association of County Commissioners, said that the Division of Environmental Health had demonstrated a commitment to address the training needs that most concerned the Commissioners. He said the Commissioners are looking for a sponsor for the bill. Terry Pierce said the Environmental Health Committee supports the concepts outlined in the draft, but is awaiting an introduced bill before recommending the Association's endorsement.

7. A letter from Secretary Howes has been sent to health directors and other stakeholders regarding the proposed reorganization of DEHNR and DHR. This letter indicates that the On-site Wastewater Program will be transferred to the Division of Water Quality in DEHNR and the other environmental health programs will be moved to a new department, Department of Health and Human Services. Terry Pierce presented a motion from Committee that the NCALHD support the On-site Wastewater Program remain with the other public health programs that will move to DHR/Health and Human Services. He stated the following reasons to support the motion: the authorization process for environmental health specialists would involve two departments, rather than one division with the current process; the rule-making authority would go from the Commission for Health Services to the Environmental Management Commission; DWQ is more "permit oriented" and less attuned to public health issues; there will be numerous logistical and operational concerns at the local level. Bill Smith said the NCPHA also supports this issue and will concert their efforts with the NCALHD on this matter. The motion passed unanimously.

Dennis Harrington then moved that the NCALHD advocate for all the "traditional" environmental, public health programs remain in public health and move to the new department. Louis Latour seconded. A friendly amendment to list the "traditional" environmental health programs by name was accepted. The motion passed unanimously.

8. Linda Sewall reported the requests that still remain in the Expansion Budget for Environmental Health include funding: for the "straight-pipe" program with two positions; for additional Regional Environmental Health Specialists positions; of $ 9.2 million to provide the match for $ 46 million in federal funds for Public Water Supply to assist local expansion and improvements of water projects.

9. Concerns were expressed regarding the number of surveys and requests for information to local health departments and the lack of coordination and/or knowledge of the parties involved. This was specifically in reference to requests from the State Environmental Health staff to local EH Specialists and Supervisors.


EPIDEMIOLOGY - Dr. Walter Linz reported the following items:

1. In 1996 there were 740 cases of rabies and to date in 1997, there have been 90 cases. There is an inadequacy of veterinarian staff to handle local calls on rabies cases, the lab in lacking in capacity and the rabies education budget is severely lacking. Walter Linz presented two motions from Committee:

a. The motion from Committee to support the Governor's $ 200,000 Expansion Budget for rabies control ($ 100,000/year over next 2 years) was passed unanimously.

b. The motion to request funding of $ 175,000/year over next 2 years to expand state laboratory capacity to handle rabies testing passed unanimously. Since this is not in the Governor's Expansion Budget, President Barry Bass directed this item to the Policy/Planning Committee.

2. The HIV Minority Health Advisory Council has reported that the sharing of needles affects a disproportionate share of African-Americans. They are in support of a pilot program(s) for needle exchange. This concept has been endorsed by numerous groups, including the American Medical Association. A motion was presented from the Epidemiology Committee that the NCALHD support state legislation for pilot programs offering needle exchange. Representative Wright, New Hanover County is sponsoring a bill. The approach to pilot test designated areas to assure that North Carolina communities would work as effectively as other parts of the United States would be more politically feasible at this time. This motion passed unanimously. The NCALHD also went on record to become better educated on the issue of needle exchange programs.

3. Expansion Budget concerns include loss of aid-to-counties funding to 18 rural counties for HIV prevention programs. Approximately $ 209,000 was taken out of the Governor's Expansion Budget. At the suggestion of Dr. Leah Devlin, this item was turned over to State and Local Relations Committee to carry to Secretary Bruton.

4. Concerns are arising about dual health problems requiring improved cooperation and coordination from Mental Health and Public Health. This is especially apparent in cases where individuals suffer from HIV and are non-conforming due to mental health problems. Solutions as to how to best confine and control potential spread of HIV among these individuals.


ADULT HEALTH PROMOTION - Curtis Holloman reported the following items:

1. Senior Vaccination Sunday. A draft report from Hugh Young is being mailed next week to local health departments. His report reveals that in one way or another, all local health departments participated last fall in SVS. Medicare data addendum will follow when completed. The Medicare data will indicate whether there was an increase in vaccines administered. Any significant increase in vaccines administered may be attributed to SVS efforts. An Ad Hoc SVS Planning Committee, of which Wanda Sandele is serving, will make recommendations on future activities.

2. The Governor's Expansion Budget a. did not include funding for the Community Health Promotion for an Aging Population (Healthy Carolinians) -- this had been an number one priority of the Division of Health Promotion. It will now take special legislation to put this funding in place. b. included the $ 100,000 funding to support the Heart Disease Stroke Prevention Task Force activities. The physical fitness piece is out. The motion from Committee to support $ 200,000 each year (Expansion Budget) to develop a Cardiovascular data base and educational campaign and $ 100,000 to support the Task Force in the Continuation Budget.

3. Also mentioned was that the $ 2.3 million public health projected cuts from the Governor's Budget would translate to a reduction in force of approximately 80 positions in DEHNR before July 1, 1997. Dr. Anne Wolf said that many public health positions are funded with federal funds and will complicate determining how to make the cuts.

4. BCCCP/CVD Continuation Grant Application. The Division of Health Promotion requested a letter of support from the NCALHD to support its 5 year continuation grant submitted to the CDC. The current funding level is $ 2.5 million. The committee recommended that the NCALHD send a letter of support to be attached to the grant application. This motion from committee passed unanimously.

Due to special funding requirements regarding prior unexpended funds established by CDC, it is necessary to return revised BCCCP budget prior to June 30, 1997. If not returned before this date, the local agency budget will be reduced by 15 percent.

5. The Division of Health Promotion is looking for ways to support local health departments with purchase of computer equipment compatible with the proposed Enhanced HSIS.

6. BCCCP Supplemental CVD Project. The Division of HP is considering requesting approval of this project for a full 5 year project period to coincide with the anticipated new project period for BCCCP. The additional funds would be for:
a. Conducting screening and interventions in at least 20-25 counties for BCCCP eligible women. All counties would utilize the "New Leaf" nutrition and physical activity program. Smoking cessation would be added to the current interventions.

b. Streamlining clinic visits, decentralizing laboratory procedures and data collection.

c. Develop linkages between community health promotion efforts, such as Healthy Carolinian coalitions, Physical Fitness Councils, 5-A-Day, etc.

d. Provide training for health department staff (blood pressure, nutrition, physical activities, etc.). The motion from Committee was that the NCALHD support this project and efforts to secure funding from the CDC. Motion passed unanimously.

7. Request for Proposal - AIDS Care Branch. Steve Sherman shared with the HP Committee that the AIDS Care Branch is requesting proposals to provide Adult Day Care/Day Health Care for the HIV/AIDS population. The funds available are federal Housing and urban Development funds. $ 300, 000 is available to fund two new facilities for two years. Currently there are four such facilities in the state. These are start-up funds and continuation funds are not available. Please contact Steve Sherman with the Division of HP if you are interested. The deadline is April 1, 1997.

8. Commission for Health Services. Two rule changes:

a. HIV Medicine Program Financial Eligibility increased from 100% poverty to 125% poverty. Effective: April 1, 1997, due to additional Ryan White funds.

b. Requested temporary rule change to lower eligibility for the Cancer Control Program. From 200% poverty to 115% poverty, effective March 1, 1997 due to funds running low.

9. Community Health Partnerships. Results of a survey conducted last spring which sought to determine local health departments' commitment to creating and being part of partnerships. Gene Lengerich and Phil Bors shared results with the HP Committee. The information collected will help a local health department identify what others are doing by way of partnerships. This may be used as part of the community diagnosis process.


HOME HEALTH ALLIANCE (NCAPHHA) - Dennis Harrington reported that things are going well with the Alliance. He encouraged all to stay for the 2:00 PM meeting of the Alliance, and said that a special meeting was also being called for 4:00 PM in which Barry Bass, Bill Smith, Tom Bridges, Margaret Dollar, Marian Duncan and Barry Blick are to attend.

MANAGED CARE AND REIMBURSEMENT - Dennis Harrington said that the minutes from the January 20, 1997 meeting will be included in the NCALHD minutes.

Dr. Dale Simmons and Nan Rideout were commended for their efforts in providing their assistance to local health departments. A letter in response to an inquiry from Tim Green will be included in the NCALHD minutes. Dennis Harrington said that local health departments have one year to do something about preparation for managed care. Dale and Nan have prepared a 10 - 12 page survey that they are using with local agencies. The survey form is included in the NCALHD minutes.

The Division of MCH is still making progress in negotiations about wrap around services. In the negotiations, it was decided that Health Check Case Management would be added to the originally proposed wrap arounds. Also, the issue of unbundling payment from Medicaid for services that health departments provide and actually billing them similar to private sector providers was discussed. This may indeed have some very positive impacts on public health providers as follows: it may increase overall reimbursement, it may be revenue neutral, it may be revenue negative, it would help us compare our care to that provided in the public sector, it would help us to price our services for managed care contracts again making us comparable to private sector providers. We think there would be a positive outcome, but no one is actually sure. So the decision was made to contract with a management firm (Deloit and Touche out of Charlotte) to conduct a study of the impact of such a conversion of billing from bundled packages to CPT codes. Mr. Barry Blick, Catawba Co., agreed to help with designing the study for local health departments. The next meeting of the Managed Care and Reimbursement Committee will be March 12, 1997 at 1:30 p.m., room 297, Kirby Building on Dix Campus, Raleigh, NC.


MATERNAL AND CHILD HEALTH / DENTAL - Dr. Harold Gabel reported the following:

1. MCH Contract Addenda items: a. Negotiating process with MCH Committee and the Division of MCH. Changes incorporated into the Contract Addenda. For example, the Immunization Action Plan has been reduced from 32 pages to only 2 pages.

2. Child Health assessment training will cost $ 1,200 but capabilities of trained staff will enable recoupment of this cost. Local agencies will be able to use MCH funds to pay for this.

3. Tom Vitaglione says that Smart Start programs in general are not focusing on health issues.
He would like to see more involvement of local health departments in Smart Start projects.

4. $ 1.2 million is available to support the Caring Program, which provides health insurance to children who ordinarily would not be insured. A pharmacy component has been added to the program.

5. MCH Committee urges local MCH home visitors, local liaisons, fire departments, etc., to promote fire safety and smoke detector preventive measures. Danny Jacob said that the morning news reported a child had died in a home where a smoke detector was not functioning. He made the motion that the NCALHD members see to it that their staff at every home visit made to assure that families have functioning smoke detectors. The motion passed unanimously.

6. The Social Services Block Grant (SSBG) continues to be a concern. Last year $ 1.8 million was lost to public health programs. This year a letter has been sent to DHR requesting restoration of $ 1.3 million of these funds since there has been no further activity with the Medicaid maximization funds. Dr. Ron Levine said he has not heard back yet on the letter. He said he will press our case in this matter. The motion from committee to pass the SSBG concerns along to Policy and Planning. It was clarified that the transfer of the funds in the current year was not a legislative issue but that it is in subsequent years. It was determined then that State and Local Relations Committee would address the current year's concerns and that Policy and Planning would address subsequent years. The amended motion was approved unanimously.

Dennis Harrington thought that perhaps it would benefit local health directors to know more about the Caring Program. It covers 70% of what local health departments or physicians bill. Enrollment process may be a service provided by local health departments. Information has already been sent out to local health departments. Health departments need a Blue Cross - Blue Shield number to bill for services rendered. BC-BS administers the program. Judith McKay will be contacted to provide an in-service to health directors on this program.


SMOKING ORDINANCE LAWSUIT IN GUILFORD COUNTY - Dr. Harold Gabel reported that he and his Board of Health are considering repeal of a smoking ordinance in Guilford County. The local rule had been suspended pending the NC Court of Appeals' decision on the Halifax County suit. A law suite was filed causing the suspension. The plaintiff's attorney said they would seek final judgment if the Board of Health did not repeal their Smoking Ordinance by their next meeting. The Board of Health is offering public comment prior to considering their options. Lawyers for the Board of Health felt that the Guilford ordinance is similar to the Halifax ordinance and a pursuit of this matter in court would probably not be successful.

Chris Hoke said that he is working with the State Attorney General's Office for a remedy to the ruling problem that local Boards of Health face as the result of the Halifax ruling from the NC Court of Appeals. He is hopeful that new legislation will be introduced that would be favorable to Local Boards of Health.


POLICY AND PLANNING - Bill Smith provided an outline for the minutes of key legislation and the P&P Committee's involvement. Motion from Committee to approve the agenda was approved unanimously.

Leah Devlin reported that the NCPHA is developing a common public health legislative agenda that all public health groups can support together in one unified voice. More to follow later.
STATE AND LOCAL RELATIONS - Margaret Dollar reported that Secretary Howes could not attend the Committee meeting held at 8:00 AM prior to the NCALHD meeting, but Leah Devlin and Chris Hoke were able to provide an update on the reorganization efforts being made to move Public Health from DEHNR to DHR (DHHS).

Bill Smith said that April 10, 1997 was last date for any bills to be filed.


STATE HEALTH DIRECTOR'S REPORT - Dr. Ron Levine had the following items to report:

1. The Governor has determined that the time had come that health is occupying such a huge percentage of the state budget, measures must be taken to assure quality outcomes and improved health status. He has recommended that all Public Health functions report to the State Health Director with the exception of On-Site Sewage and that the Public Health functions would go to the new Department of Health and Human Services, effective July 1, 1997. Dr. Levine said it is not yet clear what, if any, DHR services would be lateraled off to other Departments. Certainly the new DHHS will need to address welfare reform and health reform. Having an MD as Department Head sends a clear, strong signal on the importance of these efforts.

The looming question is what happens with regard of Environmental Health programs? What is considered Environmental Health and what is considered Environmental Protection? Secretary Jonathan Howes believes that public drinking water is public health, however other programs, such as on-site sewage is hotly contested. Also, what level of Administrative Support areas will be allow to go to the new Department and what will stay? Other than these issues, the move is going very smoothly. Dr. Levine hopes they will quickly get approval of the General Assembly on this reorganization. Clearly, no one will politically support forming another new cabinet position.

Secretary Bruton, DHR, desires to think of this reorganization as an opportunity to see how personnel and services can fit together. He wants a creative, bottoms-up approach to find better ways that local, regional, Raleigh organizations can better work. Also, he want more public/private partnerships set in motion. Dr. Levine is lead with health and Stephanie Bass will lead in the other portion of the new Department. Dr. Levine said that an improved mechanism for communication is needed. Tom Bridges suggested that the Department's Web homepage and E-mail could be used in greater ways to accomplish many of the communication needs. There are now over 70 local health directors using E-mail and the Internet.

Louis Latour reported that the Task Force on Districting is looking not only at districting counties, but at how services can be provided differently.

2. The Governor's Budget highlights:

a. He has requested $ 1/2 million per year for Environmental Health efforts, which includes centralized training of Environmental Health Specialists.
b. Funds to be made available for rabies control.

c. Increase staff for the On-Site Sewage program.

d. Provide one time $9.5 million to get the federal match of $ 46 million for public water supply.

e. $ 1 million to Healthy Start foundation grants that will provide for innovative approaches to address infant mortality.

f. Funding for vision screenings in schools.

g. Funding for CVD/Stroke prevention.

Dr. Levine was disappointed that the number one priority Health Promotion for an Aging Population was cut, and that there were no funds for the HIV prevention/care issue. Dr. Levine felt there is yet another opportunity to make views known about the support for the HP for an Aging Population.

Also a big blow to the Continuation Budget is the Governor's huge cut of $ 2.3 million that will surely result in fork force reductions of at least 80 positions out of 4,500 DEHNR positions. The effort will be a flattening effect to reduce the layers of bureaucracy from 12 layers to seven. The ratio of supervision would change from an average of 1:4 to 1:7 by July 1, 1997. DHR by that time must trim its budget by $ 5 million. An additional problem is that many health positions are federal funded, limiting options as to how the adjustments can be made.

Leah Devlin said that there is a $ 20 million Kate B. Reynolds grant for some innovations in delivery of services. A meeting is coming up about this new grant. The Hospital Association has a Rural Hospitals' person who will be working with local health departments on this initiative.

Anonymous Testing for HIV case was heard by the State Supreme Court on February 14, 1997. Attorney's said the Justices are aware of the issues, but it often takes months to reach decisions. The stay is still in effect pending the Court's ruling.

In-home anonymous testing seems to not be very popular. The market has had dismal results so far. It costs between 45 - 50 dollars for the HIV test kit.

The President's budget includes funding increases in the MCH block grant and immunizations.

The SSBG cuts were never restored and counties may now face additional cuts in the new year.

The Title V program appears to have a funding increase, but it is really a decrease. The increase is only for people with brain injuries.



TECHNOLOGY - George Bond reported the following:

1. The Committee saw a demonstration of the Enhanced HSIS system module for TB. It will be piloted in some local health departments in March 1997. Its development was based on a platform around which many other things can be built.

2. A draft Memorandum of Understanding between the Department and the NCALHD was presented which gave a funding breakdown for EHSIS of 50% Medicaid, 25% state and 25% local. Local supplement would run approximately $ 100,000 per year, averaging $ 1,000 per county. A more detailed breakdown based on size and usage was provided. The MOU will be further developed by the Technology Committee and presented to the NCALHD at a subsequent meeting.

3. There are 11 Ann Presnell counties that will get a letter from the State Center for Health Statistics that their private software system needs to be updated in order to receive reimbursements.

4. George Bond said that the Technology Committee is considering making a recommendation to set a cut off date for all local health departments to get E-mail and Internet capability to avoid further "snail mail" with regards to meeting minutes and other communications. The Committee will be working the State Center on possibilities with using the Internet for public access to the NCALHD homepage and Intranet for limited access areas.

5. George Bond said he recently attended a teleconference on telemedicine. It was sponsored by the North Carolina Healthcare Information and Communications Alliance (NCHICA). There is much interest in establishing standards for electronic medical records and telemedicine. NCHICA wants local public health involvement. The State Center for Health Statistics has had representation on this group. Motion from Committee that the NCALHD join NCHICA on a one year trial basis, membership which costs $ 250.00. The motion passed unanimously.


HOSPITAL AND COUNTY COMMISSIONERS - Jim Baluss said the Committee met yesterday and had the following items to report:

Had a health directors only meeting to give some thought about developing a philosophical position on collaboration especially with the Hospital Association. In this endeavor the Committee will:

1. Continue work with Hugh Tilson, Jr., on the local public health and hospital survey form.

2. Plan to convene at least one meeting of the NCALHD and the Hospital Association.

a. One possible outcome of this joint effort would be a collaborative diagnosis which will look at issues such as policy, funding, and organizational culture. He will be asking for joint development of an annual survey of hospital administrators and local health directors.
b. Another outcome could be to learn about impediments and opportunities for collaboration. Jim Baluss said he will be working with the Education Committee on planning for the joint meeting.


LIAISON REPORTS


NCPHA - Deborah Rowe said that the NCPHA Forum Journal is being mailed to members who have paid their dues. The Glaxco-Wellcome awards applications will be out by mid March.

NCIH - No report.

OPHN - Joy Reed could not be present, but furnished a written report for the minutes.

NC SOPHE - Susan Hockaday could not be present, but furnished a written report for the minutes.

ANCBH - No report.

Regional Reports - None.

Layton Long, President of the Environmental Health Supervisors Association was recognized for having attended the meeting.

Barbara Smith, President of the NC Local Public Health Management Support Supervisors' Association was recognized for having attended the meeting.


ADJOURNMENT

There being no further business, the meeting was adjourned at 1:10 PM. The next Executive Committee meeting of the NCALHD is scheduled for Thursday, March 20, 1997 at 9:00 AM in the Auditorium, Albert Coates Building, Raleigh.

Respectfully Submitted,



Thomas D. Bridges, MPH
Secretary/Treasurer