The Mass HIway
Overview of the State-wide
Health Information Exchange
Agenda

 MeHI Introduction
 Health Information Exchange 101

 Mass HIway Overview
 Last Mile Program
 Example Use Cas...
Massachusetts eHealth Institute
Introduction
MeHI Overview

MeHI is designated state agency for:




Advancing the dissemination of
electronic health records systems...
Massachusetts Healthcare IT Drivers

Meaningful Use Stage 2 Reporting Starts
October 2013
All Provider Requirement
January...
MeHI | How We Help

Awareness

Education

Motivate

Qualify

Engage

Adopt

Communications

Regional Extension Center

 W...
Health Information Exchange 101
Health Information Exchange 101


Electronic sharing of health information among
varied healthcare systems – while mainta...
HIE & Meaningful Use
HIE & Meaningful Use
 MU Stage 2 objectives with an „exchange‟ component
– Patient engagement

– Transitions of care
– Pu...
Mass HIway Overview
Governance
Benefits
Security + Privacy
Roadmap
Services
Massachusetts Health Information HIway

 A collaboration between EOHHS and MeHI to deploy a secure
statewide health infor...
Governance and Advisory Groups

HIT Council

Consumer
Advisory Group

13

Provider Advisory
Group

©2013 Massachusetts eHe...
October 16, 2012: Golden Spike Day!

14

©2013 Massachusetts eHealth Institute. All Rights Reserved. Confidential.
Mass HIway | Hub for Health Information Exchange

The Mass HIway enables the secure electronic exchange of
health informat...
Mass HIway | „Trust Fabric‟

 The Mass HIway „trust fabric‟ is achieved through the
combination of technical security sta...
Mass HIway | Roadmap

PHASE 1

PHASE 2

Send + Receive

Search + Retrieve

2012-2013

2013-2014

•
•

•

•

State assumes ...
Mass HIway | Connection Options & Services

User Types
Physician Practice
Hospital

Long-term Care
Other Providers
Public ...
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 ult...
Last Mile Program | Goals

GOAL 1

Connect and Integrate
Connect participants to and enable integration
with the Mass HIwa...
Last Mile Program | Our Environment
Barriers

Incentives

EHR technology interfaces & product timelines

Meaningful Use

C...
Last Mile Program | Initiatives

Connection

Adoption

Implementation & Support
Community of Practice
HIway Interface
Gran...
HIway Implementation Grant Program | Grantees & Collaborators

Decision support through
2-way exchange of data
Referrals f...
HIway Interface Grants | Vendors & Products

Vendor
Aprima
ClaimTrak
Comchart Medical Software, Inc.
DICOM Grid
eClinicalW...
Connection | Pricing
Annual Services Fee
One-time
Setup Fee

LAND HIE
Services
(per node)

Direct (XDR/SOAP
or SMTP/SMIME)...
HIway Use Case Examples
Use Case Scenario 1.1/1.2 – Referral

Referral

PCP

Consult Note

Patient Scenario

Specialist

Specialist

1. Patient se...
Use Case Scenario 2.1/2.2 – Hospital Referral

Specialist

PCP

Patient Scenario

Hospital

1. Patient sees PCP or special...
Use Case Scenario 3.1 – ED Notification

Referring
Physician

PCP

Patient Scenario
1. Patient presents at ED

Hospital
A....
Use Case Scenario 3.2/3.3 – Discharge Summary

Specialist

PCP

SNF

Patient Scenario

Hospital
A. Provides necessary care...
Use Case Scenario 1.1/1.2 – Referral

XYZ Hospital

ABC Hospital

XYZ Hospital

ABC Hospital

1. Patient admitted to XYZ E...
How our Grantees plan to use the HIway?

 Use Case ranking by type
Receive

Send
13

Receive Care Summary

9

Send Referr...
Connect with MeHI & Last Mile

Massachusetts eHealth Institute
617-371-3999
617-725-8938 (fax)
info@maehi.org
Twitter - @m...
The Mass HIway Overview of the State-wide Health Information Exchange
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The Mass HIway Overview of the State-wide Health Information Exchange

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Collaboration between EOHHS and MeHI to deploy a secure statewide health information exchange.

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  • Discuss the state agency alignmentGoal to become the go-to for all things Health IT
  • 2014 Edition certification criteria defines the content standards (C-CDA, Continuity of Care Document/Continuity of Care Record (CCD/C32 or CCR) for the create and display capabilities; the criteria provides options for the transport standards used in implementing the transmit and receive capabilities. Required. The Applicability Statement for Secure Health Transport specification v1.1 (Direct or the Direct Project) Optional. Applicability Statement for Secure Health Transport specification and the Cross-Enterprise Document Reliable Interchange and Cross-Enterprise Document Media Interchange (XDR and XDM) for Direct Messaging specification Optional. The Simple Object Access Protocol (SOAP)-Based Secure Transport Requirements Traceability Matrix (RTM) v1.0 standard and the XDR and XDM for Direct Messaging specification
  • If a provider or hospital does not possess a complete EHR, at a minimum, they must start with a system that meets the Base EHR definition.A Base EHR is certified for a Core set of MU functionality
  • Massachusetts has adopted a 2-phase approach to the development of its HIE infrastructure…
  • How long take?
  • The Mass HIway Overview of the State-wide Health Information Exchange

    1. 1. The Mass HIway Overview of the State-wide Health Information Exchange
    2. 2. Agenda  MeHI Introduction  Health Information Exchange 101  Mass HIway Overview  Last Mile Program  Example Use Cases 2 ©2013 Massachusetts eHealth Institute. All Rights Reserved. Confidential.
    3. 3. Massachusetts eHealth Institute Introduction
    4. 4. 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  4 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
    5. 5. Massachusetts Healthcare IT Drivers Meaningful Use Stage 2 Reporting Starts October 2013 All Provider Requirement January 2017 HIE and REC Grants end February 2014 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 end in February 2014  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 complying with the “meaningful use” requirements. All Providers on EHRs and HIE Connection - January 2017 – 5 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 ©2013 Massachusetts eHealth Institute. All Rights Reserved. Confidential.
    6. 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 6 Implement Optimize Impact eHealth Economic Development  eHealth Firm Listing (>150 firms in MA)  Workforce Planning Provider and Consumer Research
    7. 7. Health Information Exchange 101
    8. 8. Health Information Exchange 101  Electronic sharing of health information among varied healthcare systems – while maintaining meaning   Content standards  Create and display capabilities (CCDA, CCD/C32 or CCR)  Common MU data set (data frequently exchanged)  Transport standards  Transmit and receive capabilities  Health Information Service Provider - certificate discovery, message delivery, provisions Direct addresses  8 HIE Model Types - “Push” vs. “pull” (query) - Consent implications The MA state-wide HIE - The Mass HIway ©2013 Massachusetts eHealth Institute. All Rights Reserved. Confidential. 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.
    9. 9. HIE & Meaningful Use
    10. 10. HIE & Meaningful Use  MU Stage 2 objectives with an „exchange‟ component – Patient engagement – Transitions of care – Public health reporting – e-prescribing – Lab results reporting  MU2 rules combine CMS MU (care coordination) objectives and measures with new ONC EHR technology certification requirements to support standards-based information exchange that satisfy these objectives  EHR technology certified to the 2014 Edition EHR certification criteria that meets all the objectives for which they plan to attest is a pre-requisite 10
    11. 11. Mass HIway Overview Governance Benefits Security + Privacy Roadmap Services
    12. 12. 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 – Work toward demonstrating 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 12 ©2013 Massachusetts eHealth Institute. All Rights Reserved. Confidential.
    13. 13. Governance and Advisory Groups HIT Council Consumer Advisory Group 13 Provider Advisory Group ©2013 Massachusetts eHealth Institute. All Rights Reserved. Confidential. Technology Advisory Group Legal & Policy Advisory Group
    14. 14. October 16, 2012: Golden Spike Day! 14 ©2013 Massachusetts eHealth Institute. All Rights Reserved. Confidential.
    15. 15. 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 15 Improve & streamline care coordination Fewer medical errors/improved patient safety Reduce duplication Supports achieving Meaningful Use Pharmacy Labs The Benefits of HIE Public Health ©2013 Massachusetts eHealth Institute. All Rights Reserved. Confidential. Reduce costs throughout the care delivery system Ease & improve public health reporting & analytics Foundation for Accountable Care Organizations & value-based healthcare models
    16. 16. 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 16 PRIVACY TRUST ©2013 Massachusetts eHealth Institute. All Rights Reserved. Confidential. Participation Packet Patient Consent
    17. 17. Mass HIway | Roadmap PHASE 1 PHASE 2 Send + Receive Search + Retrieve 2012-2013 2013-2014 • • • • State assumes HISP role „Directed‟ exchange of electronic health information Provider can „push‟ health information to another provider • • 17 ©2013 Massachusetts eHealth Institute. All Rights Reserved. Confidential. Query-based exchanged enabled (Master Person Index, Relationship listing service, Consent database) Development of DPH registries, analytical repositories Patient-directed exchange
    18. 18. 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 .................................................. 18 Participant directory ©2013 Massachusetts eHealth Institute. All Rights Reserved. Confidential. Message Transformation Secure web mail
    19. 19. Mass HIway Last Mile Program Mission Goals Environment Approach & Initiatives
    20. 20. 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 20 ©2013 Massachusetts eHealth Institute. All Rights Reserved. Confidential.
    21. 21. 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) 21 ©2013 Massachusetts eHealth Institute. All Rights Reserved. Confidential.
    22. 22. 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 22 ©2013 Massachusetts eHealth Institute. All Rights Reserved. Confidential.
    23. 23. Last Mile Program | Initiatives Connection Adoption Implementation & Support Community of Practice HIway Interface Grant Program HIway Implementation Grant Program Outreach - Education 23 ©2013 Massachusetts eHealth Institute. All Rights Reserved. Confidential. Impact Healthcare
    24. 24. HIway Implementation Grant Program | Grantees & Collaborators Decision support through 2-way exchange of data Referrals from specialty care to home health Coordination of care for elderly psychiatric patients Pre-hospital transport care coordination for homeless Care management for Heart Failure patients Discharge summaries from acute care to SNF and Home Health
    25. 25. HIway Interface Grants | Vendors & Products Vendor Aprima ClaimTrak Comchart Medical Software, Inc. DICOM Grid eClinicalWorks eHana HealthWyse McKessonHomecare & Hospice MEDfx Corporation NextJ NoMoreClipBoard NetSmart GE Product Name Aprima for Physicians ClaimTrak Version Aprima 2011 Version 9.05 ComChart DICOM Grid eClinicalWorks Electronic Medical Record eHana EHR OfficeWyse and MobileWyse McKesson Homecare & McKesson Hospice (formerly Horizon Homecare) MEDfx PM NexJ Connected Wellness NMC-MD patient portal MyAvatar Centricity Version 211.04y (and later) DICOM 2013 eClinicalWorks v10.0 eHana 2013 version 18.xx,Version 11.xx Version 13.1.x Version 3.x
    26. 26. 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 27 Category ©2013 Massachusetts eHealth Institute. All Rights Reserved. Confidential.
    27. 27. HIway Use Case Examples
    28. 28. 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 29 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
    29. 29. 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 summary of care document 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 30 D. Admission notification sent via HIway to PCP and/or specialist
    30. 30. 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 31 C. Admission notification sent via HIway to PCP and/or specialist
    31. 31. 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 summary of care document C. Discharge summary sent via HIway to referring physician, PCP, and/or other care setting 32
    32. 32. 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 summary of care document 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 33 A. Patient is received at ABC hospital E. Sends discharge summary and summary of care via HIway to XYZ hospital
    33. 33. How our Grantees plan to use the HIway?  Use Case ranking by type Receive Send 13 Receive Care Summary 9 Send Referral Request 5 Receive Referral Request 17 Send Care Summary 6 Send Hospital Discharge Summary Receive Discharge Summary 5 Send Lab Results Send Hospital Discharge Notification Receive Lab Orders 1 Receive Imaging Notifications 1 Receive Hospital Discharge Notification 1 Receive ED Visit Summary 1 2 Medication Reconciliation 1 Receive Lab Results 2 2 8 Send Imaging Notifications 1 Send ED Admission Notification 10 1 Send Hospital Admission Notification Send enrollment/admission and disenrollment/dicharge data to… 5 1 1 Send CANS Data to MDPH 0 Send Lab and Radiology Orders 1 15 12 20 Use Case Types 1 0 5 10 15 20
    34. 34. 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 35 ©2013 Massachusetts eHealth Institute. All Rights Reserved. Confidential.
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