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MeHI Regional Health IT Meetings - Boston, MA - Oct, 2013
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MeHI Regional Health IT Meetings - Boston, MA - Oct, 2013


Presentation from the Massachusetts eHealth Institute Regional Health IT meeting in Boston, MA in October, 2013.

Presentation from the Massachusetts eHealth Institute Regional Health IT meeting in Boston, MA in October, 2013.

Published in Health & Medicine , Business
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  • Discuss the state agency alignmentGoal to become the go-to for all things Health IT
  • Bullet #2. We are ranked right behind Maine. Rumor has it we are getting close to #1. (cannot verify this so use “rumor”) CMS site still has us at #2Bullet #3. We are ranked behind Wisconsin, Minnesota, and North Dakota
  • 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?


  • 1. The Massachusetts eHealth Institute
  • 2. MeHI Overview MeHI is designated state agency for:   2013 Massachusetts eHealth Institute. 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 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
  • 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 2017  Meaningful Use Stage 2 requires use of an HIE, starts in October 2013  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 3 2013 Massachusetts eHealth Institute.
  • 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 a certified 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. ***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.
  • 5. Meaningful Use in Massachusetts 5 2013 Massachusetts eHealth Institute.
  • 6. Massachusetts EHR Incentive Payments 6 2013 Massachusetts eHealth Institute.
  • 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 2013 Massachusetts eHealth Institute. Optimize Impact 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 8 2013 Massachusetts eHealth Institute.
  • 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 2013 Massachusetts eHealth Institute. Coordination of care for elderly psychiatric patients
  • 10. Introducing Massachusetts Success Stories  Brockton Neighborhood Health Plan – Ben Lightfoot, M.D. Medical Director – Tom Velden NextGen Specialist 10 2013 Massachusetts eHealth Institute.
  • 11. Coordinating and Improving Care through the Mass HIway Sean Kennedy Mass eHealth Institute Director, Health Information Exchange
  • 12. Agenda  Health Information Exchange 101  Overview of the Statewide HIE - the Mass HIway  Introduction to the Last Mile Program  Example Use Cases  Questions 12 2013 Massachusetts eHealth Institute.
  • 13. Health Information Exchange 101
  • 14. 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 (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 14 The Mass HIway 2013 Massachusetts eHealth Institute. 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.
  • 15. Mass HIway Overview Benefits Governance Security + Privacy Roadmap Services
  • 16. 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 16 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. Reduce costs throughout the care delivery system Ease & improve public health reporting & analytics Foundation for Accountable Care Organizations & value-based healthcare models
  • 17. Governance and Advisory Groups HIT Council Consumer Advisory Group 17 2013 Massachusetts eHealth Institute. Provider Advisory Group Technology Advisory Group Legal & Policy Advisory Group
  • 18. 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 18 2013 Massachusetts eHealth Institute. PRIVACY TRUST Participation Packet Patient Consent
  • 19. 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 • • 19 2013 Massachusetts eHealth Institute. Query-based exchanged enabled (Master Person Index, Relationship listing service, Consent database) Development of DPH registries, analytical repositories Patient-directed exchange
  • 20. 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 2013 Massachusetts eHealth Institute. Certificate repository Secure messaging .................................................. Connect through LAND (Local Application for Network Distribution) .................................................. Browser access to webmail inbox .................................................. 20 Participant directory Message Transformation Secure web mail
  • 21. Mass HIway | Last Mile Program Mission Goals Environment Approach & Initiatives
  • 22. 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 22 2013 Massachusetts eHealth Institute.
  • 23. 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) 23 2013 Massachusetts eHealth Institute.
  • 24. 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 24 2013 Massachusetts eHealth Institute.
  • 25. Last Mile Program | Initiatives Connection Adoption Implementation & Support Community of Practice HIway Interface Grant Program HIway Implementation Grant Program Outreach - Education 25 2013 Massachusetts eHealth Institute. Impact Healthcare
  • 26. Mass HIway | Get Connected 26 2013 Massachusetts eHealth Institute.
  • 27. 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.
  • 28. HIway Use Case Examples
  • 29. 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 2013 Massachusetts eHealth Institute. 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
  • 30. 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 2013 Massachusetts eHealth Institute. D. Admission notification sent via HIway to PCP and/or specialist
  • 31. 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 2013 Massachusetts eHealth Institute. C. Admission notification sent via HIway to PCP and/or specialist
  • 32. 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 2013 Massachusetts eHealth Institute.
  • 33. 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 2013 Massachusetts eHealth Institute.
  • 34. Connect with MeHI & Last Mile Massachusetts eHealth Institute 617-371-3999 617-725-8938 (fax) Twitter - @massehealth MeHI Community - Mass HIway Last Mile Program 1.855.MA-HIWAY (1.855.624.4929) Option 1 34 2013 Massachusetts eHealth Institute.