MeHI Regional Health IT Meetings - Tewksbury, MA - Sept, 2013

The Massachusetts
eHealth Institute

MeHI Overview

MeHI is designated state agency for:




Advancing the dissemination of
electronic health records systems in all
health care provider settings



Connecting providers through the
statewide HIE


©2013 Massachusetts eHealth Institute. All Rights Reserved. Confidential.

Promoting health IT to improve the
safety, quality and efficiency of health
care in Massachusetts



2

Accelerating the adoption of health
information technologies



MeHI is a division of the Massachusetts
Technology Collaborative, a public
economic development agency

Coordinating health care
innovation, technology and
competitiveness

Managing HIE and REC grants from
Office of National Coordinator

Massachusetts Healthcare IT Drivers

Meaningful Use Stage 2 Reporting Starts
October 2013
All Provider Requirement
January 2017
Physician License Requirement Starts
January 2015

2013

2014

2015

2016



Meaningful Use Stage 2 requires use of an HIE, starts in October 2013



Federal HITECH Grants supporting EHR and HIE adoption



Physician Licensing Requirement Starts - January 2015
–



Massachusetts requires physicians to be proficient in the use of health information
technology as a condition of licensure. Proficiency, at a minimum, means demonstrating
the skills related to the “meaningful use” requirements.

All Providers on EHRs and the HIE - January 2017
–

3

2017

All providers (not just physicians) in the Commonwealth shall implement fully interoperable
electronic health records systems that connect through the statewide health information
exchange


Massachusetts EHR Adoption

 89% of Massachusetts physicians are using an EHR/EMR
system ranking us #1 in the US.*
 56% of eligible healthcare providers in Massachusetts have
received Meaningful Use payments ranking us #2 in the U.S.**
 62% of Massachusetts office-based providers have adopted an
EHR system ranking us #4 in the U.S.**
 89% of non-federal acute care hospitals in Massachusetts have
a certified EHR system ranking us in the Top 12 states***

*Jamoom E, Beatty P, Bercovitz, et al. Physician adoption of
electronic health record systems: United States, 2011. NCHS
data brief, no 98.
Hyattsville, MD; National Center for Health Statistics, 2012
**CMS Health IT Dashboards. http://dashboard.healthit.gov
***ONC Data Brief. No. 9. March 2013: Adoption of Electronic
Health Record Systems among U.S. Non-federal Acute Care
Hospitals 2008-2012

4


Meaningful Use in Massachusetts

5


Massachusetts EHR Incentive Payments

6


MeHI | How We Help

Awareness

Education

Motivate

Qualify

Engage

Adopt

Communications

Regional Extension Center

 Webinar Series

 Recruiting a few new providers

 Regional Meeting Series

 Helping providers get to
Meaningful Use

 HIway Newsletter
 EU-US Conference
October 22-23

Medicaid EHR Incentive Program
 Processing 2013 MU applications
HIE Last Mile Program
 HIway Implementation Grants
 HIway Vendor Grants

7

Implement

Optimize

Impact
eHealth
Economic
Development
 eHealth Firm
Listing (>150
firms in MA)
 Workforce
Planning
Provider and
Consumer
Research

Massachusetts Health Information HIway

 A collaboration between EOHHS and MeHI to deploy a secure
statewide health information exchange.
 EOHHS leads infrastructure development and operation
 MeHI leads the Last Mile Program:
– Connection and adoption
– Demonstrate measurable improvements in care
quality, population health and health care costs
– Catalyze innovation

 Funded through ONC and CMS with state matches – sustained
through private sector contributions
8


Health Information Exchange Progress

Decision support through
2-way exchange of data
Referrals from specialty
care to home health

Pre-hospital transport
care coordination for homeless

Care management for
Heart Failure patients
Discharge summaries from acute
care to SNF and Home Health

9

Coordination of care for
elderly psychiatric patients


Introducing A Massachusetts Success Story

 Lawrence General Hospital
– Andrea Sullivan
Director of Managed Care & PHO
– Caitlin Mundry
EHR Project Manager

 Beth Israel Deaconess Care Organization
– Leanne Harvey
Director EHR Implementation

10


Beth Israel Deaconess Care
Organization
Electronic Health Records and Clinical
Integration
September 2013

Beth Israel Deaconess Care Organization
The Beth Israel Deaconess Care Organization is a partnership
between BIDMC and community hospitals, independent physicians
and physician groups.
• organization of individual and groups of physicians and hospitals
who work together to coordinate care delivery, quality
improvement, and care efficiency in order to enhance the care of
individual patients and populations of patients.
 Foundation of that is EHR

BIDCO EHR Initiative
• Summary
 Successfully implemented 250 providers in 90 practices
between 2009-2012

• Practice Consulting and Project Management
– MAeHC
– BIDCO EHR Team

• Arcadia Solutions: Service Desk and technical services
 eClinicalWorks hosted by BIDCO via private cloud
 Standardization: eCW version and quality measure capture
 Meaningful Use Stage 1

• 100% of PCPs
• 90% of specialists

AVERAGE IMPLEMENTATION TAKES 20 WEEKS (1-5 MDs)
Week

Project phases

Week

Week

Week

Week

Week

Week

0

4

8

12

15

18

20

I
Workflow optimization

Design

System design

II
Site prep

Deploy

System install
and check

EHR customization

III
Pre-training preparation

Train

IV
Support
kickoff

Master

Key dates

MAeHC

Project
Kick-Off

EHR
Vendor
Kick-Off

Clearinghouse

Site
Remediation
Complete

Hardware
Install

Go-Live On-site
Plan
training

Evaluate

Improve

Trainer On
Site
Go Live

BIDCO EHR Implementation at LGH
•
•

BIDCO Team had implemented 75 practices prior to LGH joining BIDCO
LGH affiliated providers
 18 practices and 32 providers

•

BIDCO / LGH Partnership




•

BIDCO responsible for EHR implementation and project management
LGH identified providers and obtained legal agreements
Timeline/Schedule Creation
• LGH to prioritize and schedule providers
• Creation of mutually agreeable schedule

Lessons Learned and Applied to LGH practices





Pre-assessments to identify issues prior to commencing implementation
ISP installation, timing of hardware order
Practice engagement/meeting milestones
LGH as point of escalation

BIDCO EHR Initiatives: 2013+
•

Interfaces
 Lab/Rad/Discharge Summaries
 Clinical Data Warehouse

•

Viewer to and from BIDMC ambulatory EMR


•

eCWeHX/Health Exchange module


•

Patient consent to share record

Meaningful Use Stage 2 preparation


•

In patient context

Lab interfaces and Patient Portal

State HIE


Phase 1: October 2012: BIDCO provider from Lawrence was one of the “Golden Spikes” of
the Mass HIway
•



Received C32/CCD clinical summary direct from BIDMC into eCW via Mass HIway.

Phase 2: Scheduled to be a pilot for MA State HIE Integration with eCW via the Mass HIway

Lawrence General and MeHI
• Lawrence General Physicians of the Choice Plus Network
IPA supported the application submitted November 2009
for MeHI to become the REC for Massachusetts
• Those physicians were some of the first to become REC
members through IPA grants
• First REC regional meeting was held at Lawrence General
Hospital
• Two regional MeHI Meaningful Use meetings held at
Lawrence General
• IOO opportunity with BIDCO and eClinical Works

The Organizations

Lawrence
General
Hospital

BIDCO

Choice Plus
Network
IPA

The Key Elements
Existing
Relationships
and Local
Support

BIDCO:
Experienced
EHR Team

Successful
Implementation
and 100%
Meaningful Use
Achievement

Meaningful Use By The Numbers
• Lawrence General Project now includes 36 Providers:
Started May 2011
– 11 Primary Care Provider Practices
– 4 Specialty Practices
– 3 Pediatric Practices
• 35 of the 36 providers qualified for Meaningful Use
programs; all 35 attained MU for 100% result
– 14 Providers in the Medicaid program
– 22 Providers in the Medicare program
– Incentive dollars earned to date: $642,000

Additional LGH-Supported Initiatives
• Massachusetts HIWay Implementation Grant
– Merrimack Valley HIE Collaborative consists of Lawrence General
Hospital, Greater Lawrence Family Health Center, Pentucket Medical
Associates and Home Health VNA
– Awarded grant of $75,000.00 to develop an Emergency Room discharge
notification alert sent over the highway
• Via Choice Plus PHO at LGH, additional community connectivity:
– Established the role of Physician Integration Manager
– Laboratory orders and results delivery
– Radiology results delivery and future opportunities
• Meaningful Use Stage 2 preparation
– Education and Technical Support

Lawrence General

Hospital

BIDCO

Success!
Choice Plus PHO

Choice Plus
Network IPA

Coordinating and
Improving Care through
the Mass HIway

Sean Kennedy
Mass eHealth Institute
Director, Health Information Exchange

Agenda

 Health Information Exchange 101
 Overview of the Statewide HIE - the Mass HIway

 Introduction to the Last Mile Program
 Example Use Cases
 Questions

25


Health Information Exchange 101

Health Information Exchange 101




Electronic sharing of health information among
varied healthcare systems – while maintaining
meaning
HIE Model Types



“Push” vs. “pull” (query)
- Consent implications
Content standards
o

o

Create and display capabilities (CCDA, CCD/C32 or CCR)

o



Common MU data set
(data frequently exchanged)
Transport standards



o Transmit and receive capabilities
Health Information Service Provider
o



Certificate discovery, message
delivery, Direct address provisioning
The MA state-wide HIE

o
27

The Mass HIway


1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.

Patient name
Sex
Date of birth
Race **
Ethnicity **
Preferred language
Care team member(s)
Allergies **
Medications **
Care plan
Problems **
Laboratory test(s) **
Laboratory value(s)/result(s)
**
14. Procedures **
15. Smoking status **
16. Vital signs
NOTE:Data requirements marked with a double
asterisk (**) also have a defined vocabulary which
must be used.

Mass HIway Overview
Benefits
Governance
Security + Privacy
Roadmap
Services

Mass HIway | Hub for Health Information Exchange

The Mass HIway enables the secure electronic exchange of
health information among diverse participants in the
Commonwealth:
Acute &
Post-acute
Care

Patient

Long-term
Post-Acute
Care

Payer

Mass
HIway
Ambulatory
Care

29

Improve & streamline care coordination
Fewer medical errors/improved patient
safety
Reduce duplication

Supports achieving Meaningful Use

Pharmacy

Labs

The Benefits of HIE

Public
Health


Reduce costs throughout the care delivery
system
Ease & improve public health reporting &
analytics

Foundation for Accountable Care
Organizations & value-based healthcare
models

Governance and Advisory Groups

HIT Council

Consumer
Advisory Group

30

Provider Advisory
Group


Technology
Advisory Group

Legal & Policy
Advisory Group

Mass HIway | „Trust Fabric‟

 The Mass HIway „trust fabric‟ is achieved through the
combination of technical security standards + legal policies to
which all participants agree.

SECURITY
Encryption
Authentication

31

PRIVACY

TRUST


Participation Packet
Patient Consent

Mass HIway | Roadmap

PHASE 1

PHASE 2

Information Highway

Registries + Query Exchange

2012-2013

2013-2014

•
•

•

•

State assumes HISP role
„Directed‟ exchange of
electronic health information
Provider can „push‟ health
information to another provider

•
•

32


Query-based exchanged enabled
(Master Person Index, Relationship
listing service, Consent database)
Development of DPH
registries, analytical repositories
Patient-directed exchange

Mass HIway | Connection Options & Services

User Types
Physician Practice
Hospital

Long-term Care
Other Providers
Public Health
Health Plans
Labs &
Imaging Centers

HIway Services
CONNECTION OPTIONS
EHR
Connect directly
..................................................

Connect with local
gateway

Certificate repository
Secure messaging

..................................................

Connect through LAND
(Local Application for
Network Distribution)
..................................................

Browser access to
webmail inbox
..................................................

33

Participant directory


Message Transformation
Secure web mail

Last Mile Program | Mission

Grow adoptionof the Mass HIway by all
eligible participants, whilecatalyzing
innovationultimatelydemonstrating measurable improvementsin
care quality,
population health and health care costs

35


Last Mile Program | Goals

GOAL 1

Connect and Integrate
Connect participants to and enable integration
with the Mass HIway by all eligible participants

GOAL 2

Maximize Adoption
Optimize Mass HIway services and grow utilization

GOAL 3

Impact Healthcare
Demonstrate measurable improvements in
care quality (better care), population health
(healthy people and communities) and health
care costs (affordable care)

36


Last Mile Program | Our Environment
Barriers

Incentives

EHR technology interfaces & product timelines

Meaningful Use

Consumer on-ramps & workflows

HIway Implementation Grants

Consent infrastructure

HIway Interface Grants

Evolving HIway infrastructure
Evolving policies (consent, HISP-HISP)
HIway awareness
Enablers

Penalties

Chapter 224 – force of law to require
connectivity (patients, providers, etc)

Chapter 224 – Penalties for non-participation
in HIE (1/1/2017)

Pioneer Accountable Care Organizations
(ACOs)

CMS readmission penalty

Community-based care transition programs

BORIM – meaningful use licensure (1/1/2015)

Patient Centered Medical Home (PCHM)
Mergers & Acquisitions
Innovation & outcome funding
37


Last Mile Program | Initiatives

Connection

Adoption

Implementation & Support
Community of Practice
HIway Interface
Grant Program
HIway Implementation
Grant Program

Outreach - Education
38


Impact
Healthcare

Connection | Pricing
Annual Services Fee
One-time
Setup Fee

LAND HIE
Services
(per node)

Direct (XDR/SOAP
or SMTP/SMIME)
HIE Services (per node)

Direct Webmail
HIE Services
(per user)

Large hospitals

$2,500

$27,500

$15,000

$240

Health Plans

$2,500

$27,500

$15,000

$240

Multi-entity HIE

$2,500

$27,500

$15,000

$240

Small hospitals

$1,000

$15,000

$10,000

$240

Large ambulatory practices (50+)

$1,000

$15,000

$10,000

$240

Large TLCs

$1,000

$15,000

$10,000

$240

ASCs

$1,000

$15,000

$10,000

$240

Non-profit affiliates

$1,000

$15,000

$10,000

$240

Small LTC

$500

$4,500

$2,500

$120

Large behavioral health

$500

$4,500

$2,500

$120

Large home health

$500

$4,500

$2,500

$120

Large FQHCs (10-49)

$500

$4,500

$2,500

$120

Medium ambulatory practices (1049)

$500

$4,500

$2,500

$120

Small behavioral health

$25

$250

$175

$60

Small home health

$25

$250

$175

$60

Small FQHCs (3-9)

$25

$250

$175

$60

Small ambulatory practices (3-9)

$25

$250

$175

$60

Small ambulatory practices (1-2)

$25

$60

$60

$60

Tier
Tier 1

Tier 2

Tier 3

Tier 4

Tier 5

40

Category


Use Case Scenario 1.1/1.2 – Referral

Referral

PCP

Consult Note

Patient Scenario

Specialist

Specialist

1. Patient sees PCP

A. Receives Direct message with
summary of care document

2. PCP‟s plan includes a referral to a
Cardiac specialist

B. Provides necessary care

3. Referral to specialist is authorized and
generated via Direct with a summary
of care document
4. Referral and summary of care is sent
via HIway to Cardiac specialist

42


C. Generates a consult note for delivery
to PCP
D. Consult note is attached to a Direct
message and sent via the HIway
to PCP

Use Case Scenario 2.1/2.2 – Hospital Referral

Specialist

PCP

Patient Scenario

Hospital

1. Patient sees PCP or specialist

A. Receives Direct message with

2. Treatment plan includes a referral to a
local hospital

B. Provides necessary care

3. Referral to hospital is authorized and
generated via Direct with a summary
of care document

C. Generates an admission notification
and summary of care document

4. Referral is sent via HIway to hospital

43


D. Admission notification sent via HIway
to PCP and/or specialist

Use Case Scenario 3.1 – ED Notification

Referring
Physician

PCP

Patient Scenario
1. Patient presents at ED

Hospital
A. Provides necessary care
B. Generates an admission notification
and summary of care document

2. Patient is treated and released

44


C. Admission notification sent via HIway
to PCP and/or specialist

Use Case Scenario 3.2/3.3 – Discharge Summary

Specialist

PCP

SNF

Patient Scenario

Hospital
A. Provides necessary care

1. Patient is discharged from hospital to
the care of a referring physician, PCP
or other care setting

B. Generates a discharge summary and
C. Discharge summary sent via HIway to
referring physician, PCP, and/or other
care setting

45


Use Case Scenario 1.1/1.2 – Referral

XYZ Hospital

ABC Hospital

XYZ Hospital

ABC Hospital

1. Patient admitted to XYZ ED
2. Treatment plan calls for a tertiary level
of care

B. ABC hospital receives referral and

3. Patient is referred to ABC hospital

C. Provides necessary care

4. Referral and summary of care are
generated via Direct message

D. Generates a discharge summary and
summary of care via Direct

5. Direct message is sent via HIway to
ABC hospital

46

A. Patient is received at ABC hospital

E. Sends discharge summary and
summary of care via HIway to XYZ
hospital


Connect with MeHI & Last Mile

Massachusetts eHealth Institute
617-371-3999
617-725-8938 (fax)
info@maehi.org
Twitter - @massehealth
MeHI Community - www.thehitcommunity.org/mehi/
www.mehi.masstech.org

Mass HIway Last Mile Program
1.855.MA-HIWAY (1.855.624.4929) Option 1
MassHIway@masstech.org
mehi.masstech.org/what-we-do

47


MeHI Regional Health IT Meetings - Tewksbury, MA - Sept, 2013

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MeHI Regional Health IT Meetings - Tewksbury, MA - Sept, 2013

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