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

The Massachusetts
eHealth Institute

MeHI is designated state agency for:
  Coordinating health care innovation,
technology and competitiveness
  Accelerating the adoption of health
information technologies
  Promoting health IT to improve the
safety, quality and efficiency of health
care in Massachusetts
  Advancing the dissemination of
electronic health records systems in all
health care provider settings
  Connecting providers through the
statewide HIE
  Managing HIE and REC grants from
Office of National Coordinator
MeHI is a division of the Massachusetts
Technology Collaborative, a public
economic development agency
2 ©2013 Massachusetts eHealth Institute. All Rights Reserved. Confidential.
MeHI Overview

2013
2014
2015
2016
2017

Meaningful
Use
Stage
2
Repor4ng
Starts

October
2013

Massachusetts Healthcare IT Drivers
  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
–  All providers (not just physicians) in the Commonwealth shall implement fully interoperable
electronic health records systems that connect through the statewide health information
exchange
Physician
License
Requirement
Starts

January
2015

All
Provider
Requirement

January
2017


4
Massachusetts EHR Adoption
©2013 Massachusetts eHealth Institute. All Rights Reserved. Confidential.
  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***
*Hsiao CJ, Hing E. Use and characteristics of electronic health record systems among office-based physician practices:
United States, 2001–2012. NCHS data brief, no 111. Hyattsville, MD: National Center for Health Statistics. 2012.
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.

5
Meaningful Use in Massachusetts

6
Massachusetts EHR Incentive Payments

7
MeHI | How We Help
Awareness Education Qualify Engage Implement Optimize
ImpactAdoptMotivate
Communications
  Webinar Series
  Regional Meeting Series
  HIway Newsletter
  EU-US Conference
October 22-23
Regional Extension Center
  Recruiting a few new providers
  Helping providers get to
Meaningful Use
Medicaid EHR Incentive Program
  Processing 2013 MU applications
HIE Last Mile Program
  HIway Implementation Grants
  HIway Vendor Grants
eHealth
Economic
Development
  eHealth Firm
Listing (>150
firms in MA)
  Workforce
Planning
Provider and
Consumer
Research

8
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

Health Information Exchange Progress
Coordination of care for
elderly psychiatric patients
Pre-hospital transport
care coordination for homeless
Referrals from specialty
care to home health
Care management for
Heart Failure patients
Decision support through
2-way exchange of data
Discharge summaries from acute
care to SNF and Home Health

10
Introducing Massachusetts Success Stories
  Baystate Health, Inc.
–  Joel L. Vengco
Vice President & Chief Information Officer
  Holyoke Medical Center
–  Carl R. Cameron
Chief Information & Analytics Officer

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

Health Information Exchange 101

Health Information Exchange 101
1.  Patient name
2.  Sex
3.  Date of birth
4.  Race **
5.  Ethnicity **
6.  Preferred language
7.  Care team member(s)
8.  Allergies **
9.  Medications **
10.  Care plan
11.  Problems **
12.  Laboratory test(s) **
13.  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.
  Electronic sharing of health information among
varied healthcare systems – while maintaining
meaning
  HIE Model Types
o  “Push” vs. “pull” (query)
-  Consent implications
  Content standards
o  Create and display capabilities (C-CDA,
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  The Mass HIway

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:
The Benefits of HIE
Improve & streamline care coordination
Fewer medical errors/improved patient safety
Reduce duplication
Supports achieving Meaningful Use
Reduce costs throughout the care delivery
system
Ease & improve public health reporting &
analytics
Foundation for Accountable Care
Organizations & value-based healthcare
models
Public
Health
Ambulatory
Care
Long-term
Post-Acute
Care
Acute &
Post-acute
Care
Payer
Pharmacy
Labs
Patient
Mass
HIway

Governance and Advisory Groups
Consumer
Advisory Group
Provider Advisory
Group
Technology
Advisory Group
Legal & Policy
Advisory Group
HIT Council

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
PRIVACY
Participation Packet
Patient Consent
TRUST

PHASE 2
Registries + Query Exchange
PHASE 1
Information Highway
2012-2013
•  State assumes HISP role
•  ‘Directed’ exchange of
electronic health information
•  Provider can ‘push’ health
information to another provider
2013-2014
•  Query-based exchanged enabled
(Master Person Index, Relationship
listing service, Consent database)
•  Development of DPH registries,
analytical repositories
•  Patient-directed exchange
Mass HIway | Roadmap

HIway Services
EHR
Connect directly
..................................................
Connect with local
gateway
..................................................
Connect through LAND
(Local Application for
Network Distribution)
..................................................
Browser access to
webmail inbox
..................................................
CONNECTION OPTIONS
Participant directory
Certificate repository
Secure messaging
Message Transformation
Secure web mail
User Types
Physician Practice
Hospital
Long-term Care
Other Providers
Public Health
Health Plans
Labs &
Imaging Centers
Mass HIway | Connection Options & Services

Mass HIway | Last Mile Program
Mission
Goals
Environment
Approach & Initiatives

Last Mile Program | Mission
Grow adoption of the Mass HIway by all
eligible participants, while catalyzing innovation ultimately
demonstrating measurable improvements in care quality,
population health and health care costs

Last Mile Program | Goals
Connect and Integrate
Connect participants to and enable integration
with the Mass HIway by all eligible participants
Maximize Adoption
Optimize Mass HIway services and grow utilization
Impact Healthcare
Demonstrate measurable improvements in
care quality (better care), population health
(healthy people and communities) and health
care costs (affordable care)
GOAL 1
GOAL 2
GOAL 3

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
24
Last Mile Program | Our Environment

Impact
Healthcare
AdoptionConnection
Outreach - Education
HIway Interface
Grant Program
Implementation & Support
HIway Implementation
Grant Program
Community of Practice
Last Mile Program | Initiatives

Mass HIway | Get Connected

Connection | Pricing
Annual Services Fee
Tier Category
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)
Tier 1 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
Tier 2 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
Tier 3 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 (10-49) $500 $4,500 $2,500 $120
Tier 4 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
Tier 5 Small ambulatory practices (1-2) $25 $60 $60 $60

Use Case Scenario 1.1/1.2 – Referral
29
Patient Scenario
1.  Patient sees PCP
2.  PCP’s plan includes a referral to a
Cardiac specialist
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
Specialist
A.  Receives Direct message with
summary of care document
B.  Provides necessary care
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
Referral
Consult NotePCP Specialist

Use Case Scenario 2.1/2.2 – Hospital Referral
30
Patient Scenario
1.  Patient sees PCP or specialist
2.  Treatment plan includes a referral to a
local hospital
3.  Referral to hospital is authorized and
generated via Direct with a summary
of care document
4.  Referral is sent via HIway to hospital
Hospital
A.  Receives Direct message with
B.  Provides necessary care
C.  Generates an admission notification
and summary of care document
D.  Admission notification sent via HIway
to PCP and/or specialist
PCP
Specialist

Use Case Scenario 3.1 – ED Notification
31
Patient Scenario
1.  Patient presents at ED
2.  Patient is treated and released
Hospital
A.  Provides necessary care
B.  Generates an admission notification
and summary of care document
C.  Admission notification sent via HIway
to PCP and/or specialist
PCP
Referring
Physician

Use Case Scenario 3.2/3.3 – Discharge Summary
32
Patient Scenario
1.  Patient is discharged from hospital to
the care of a referring physician, PCP
or other care setting
Hospital
A.  Provides necessary care
B.  Generates a discharge summary and
C.  Discharge summary sent via HIway to
referring physician, PCP, and/or other
care setting
Specialist
PCP
SNF

Use Case Scenario 1.1/1.2 – Referral
33
XYZ Hospital
1.  Patient admitted to XYZ ED
2.  Treatment plan calls for a tertiary level
of care
3.  Patient is referred to ABC hospital
4.  Referral and summary of care are
generated via Direct message
5.  Direct message is sent via HIway to
ABC hospital
ABC Hospital
A.  Patient is received at ABC hospital
B.  ABC hospital receives referral and
C.  Provides necessary care
D.  Generates a discharge summary and
summary of care via Direct
E.  Sends discharge summary and
summary of care via HIway to XYZ
hospital
XYZ Hospital ABC Hospital

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
Connect with MeHI & Last Mile

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

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