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

512 views

Published on

Presentation from the Massachusetts eHealth Institute Regional Health IT meeting in Tewksbury, MA in September, 2013.

Published in: Health & Medicine, Business
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
512
On SlideShare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
3
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide
  • Discuss the state agency alignmentGoal to become the go-to for all things Health IT
  • EasCare Ambulance & Boston Healthcare for the Homeless HIway Grant >> Exchanging patient information who are moving to and from respite facility including patient demographics and care history. Replaces paper and phone hand-offBaystate Health coordinates care for high-risk heart failure patients for important AIMS including Transition of Care Alert, Information Exchange on medication and procedures, and discharge care planMilford Hospital using HIway for discharge summaries from acute care to Skilled Nursing Facilities and Home HealthNorth Adams Regional Hospital is using the HIway for referrals from specialty care to home health Umass Memorial Health Care will exchange patient data with CVSCaremark Minute Clinic sites for a two-way patient data exchange initiative.
  • 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
  • Massachusetts has adopted a 2-phase approach to the development of its HIE infrastructure…
  • How long take?
  • MeHI Regional Health IT Meetings - Tewksbury, MA - Sept, 2013

    1. 1. The Massachusetts eHealth Institute
    2. 2. 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
    3. 3. 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 ©2013 Massachusetts eHealth Institute. All Rights Reserved. Confidential.
    4. 4. 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 ©2013 Massachusetts eHealth Institute. All Rights Reserved. Confidential.
    5. 5. Meaningful Use in Massachusetts 5 ©2013 Massachusetts eHealth Institute. All Rights Reserved. Confidential.
    6. 6. Massachusetts EHR Incentive Payments 6 ©2013 Massachusetts eHealth Institute. All Rights Reserved. Confidential.
    7. 7. 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
    8. 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 8 ©2013 Massachusetts eHealth Institute. All Rights Reserved. Confidential.
    9. 9. 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 ©2013 Massachusetts eHealth Institute. All Rights Reserved. Confidential.
    10. 10. 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 ©2013 Massachusetts eHealth Institute. All Rights Reserved. Confidential.
    11. 11. Beth Israel Deaconess Care Organization Electronic Health Records and Clinical Integration September 2013
    12. 12. 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
    13. 13. 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
    14. 14. 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
    15. 15. 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
    16. 16. 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
    17. 17. Choice Plus IPA and BIDCO
    18. 18. 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
    19. 19. The Organizations Lawrence General Hospital BIDCO Choice Plus Network IPA
    20. 20. The Key Elements Existing Relationships and Local Support BIDCO: Experienced EHR Team Successful Implementation and 100% Meaningful Use Achievement
    21. 21. 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
    22. 22. 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
    23. 23. Lawrence General Hospital BIDCO Success! Choice Plus PHO Choice Plus Network IPA
    24. 24. Coordinating and Improving Care through the Mass HIway Sean Kennedy Mass eHealth Institute Director, Health Information Exchange
    25. 25. Agenda  Health Information Exchange 101  Overview of the Statewide HIE - the Mass HIway  Introduction to the Last Mile Program  Example Use Cases  Questions 25 ©2013 Massachusetts eHealth Institute. All Rights Reserved. Confidential.
    26. 26. Health Information Exchange 101
    27. 27. 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 ©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.
    28. 28. Mass HIway Overview Benefits Governance Security + Privacy Roadmap Services
    29. 29. 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 ©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
    30. 30. Governance and Advisory Groups HIT Council Consumer Advisory Group 30 Provider Advisory Group ©2013 Massachusetts eHealth Institute. All Rights Reserved. Confidential. Technology Advisory Group Legal & Policy Advisory Group
    31. 31. 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 ©2013 Massachusetts eHealth Institute. All Rights Reserved. Confidential. Participation Packet Patient Consent
    32. 32. 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 ©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
    33. 33. 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 ©2013 Massachusetts eHealth Institute. All Rights Reserved. Confidential. Message Transformation Secure web mail
    34. 34. 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 ©2013 Massachusetts eHealth Institute. All Rights Reserved. Confidential.
    35. 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 ©2013 Massachusetts eHealth Institute. All Rights Reserved. Confidential.
    36. 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 ©2013 Massachusetts eHealth Institute. All Rights Reserved. Confidential.
    37. 37. Last Mile Program | Initiatives Connection Adoption Implementation & Support Community of Practice HIway Interface Grant Program HIway Implementation Grant Program Outreach - Education 38 ©2013 Massachusetts eHealth Institute. All Rights Reserved. Confidential. Impact Healthcare
    38. 38. 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 ©2013 Massachusetts eHealth Institute. All Rights Reserved. Confidential.
    39. 39. HIway Use Case Examples
    40. 40. 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 ©2013 Massachusetts eHealth Institute. All Rights Reserved. Confidential. 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
    41. 41. 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 43 ©2013 Massachusetts eHealth Institute. All Rights Reserved. Confidential. D. Admission notification sent via HIway to PCP and/or specialist
    42. 42. 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 ©2013 Massachusetts eHealth Institute. All Rights Reserved. Confidential. C. Admission notification sent via HIway to PCP and/or specialist
    43. 43. 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 45 ©2013 Massachusetts eHealth Institute. All Rights Reserved. Confidential.
    44. 44. 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 46 A. Patient is received at ABC hospital E. Sends discharge summary and summary of care via HIway to XYZ hospital ©2013 Massachusetts eHealth Institute. All Rights Reserved. Confidential.
    45. 45. 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 ©2013 Massachusetts eHealth Institute. All Rights Reserved. Confidential.

    ×