The Massachusetts
eHealth Institute
MeHI Overview

MeHI is designated state agency for:



©2013 Massachusetts eHealth Institute. All Rights Reserved. Confi...
Massachusetts Healthcare IT Drivers

Meaningful Use Stage 2 Reporting Starts
October 2013
All Provider Requirement
January...
Massachusetts EHR Adoption

 89% of Massachusetts physicians are using an EHR/EMR
system ranking us #1 in the US.*
 56% ...
Meaningful Use in Massachusetts

5

©2013 Massachusetts eHealth Institute. All Rights Reserved. Confidential.
Massachusetts EHR Incentive Payments

6

©2013 Massachusetts eHealth Institute. All Rights Reserved. Confidential.
MeHI | How We Help

Awareness

Education

Motivate

Qualify

Engage

Adopt

Communications

Regional Extension Center

 W...
Massachusetts Health Information HIway

 A collaboration between EOHHS and MeHI to deploy a secure
statewide health infor...
Health Information Exchange Progress

Decision support through
2-way exchange of data
Referrals from specialty
care to hom...
Introducing Massachusetts Success Stories

 Brockton Neighborhood Health Plan
– Ben Lightfoot, M.D.
Medical Director
– To...
The Paperless
Path
A story of a little CHC that
could!
Why did we go paperless
 Improve

efficiency
 Improve documentation
 Patient Safety
 Improved information access
 Car...
The Brockton Neighborhood
Health Center Story
 Started

in a church parking lot 1 physician
19 years ago
 Expanded to 2 ...
MAEHC-Mass E-Heath
Coalition
 Founded

in 2004 with a BCBS 50 million $
grant to bring EHR technology to 3
communities
 ...
System Choice
 Practice

size/scalability
 Specialty support
 Reporting- quality and business reports
 User friendline...
PRE-GO LIVE













Choose a system- and pay for it
Map workflows- translate to EHR processes
TRAIN,TRAIN,T...
GO LIVE
 Cut

schedule by 50% for 1-4 weeks
 Have experts/superusers on hand to
trouble shoot and provide support
 Expe...
Lessons Learned
 Keep

on track of workload(chart
completion, task completion, ect)
 Make sure reports are correct- vet ...
When the system goes down
 DON’T

PANIC
 Have backup worflows in place before
this happens (downtime packets)
 Have pro...
Success Story
EHR incentives
 Meaningfull









use:

$44,000 for medicare eligible providers
$63,750 for medicade eligible pr...
Medicare ERX Incentive
 Thresholds

for # of ERX’s sent (low)
 Penalties for not participating (2%)
 Incentive is 0.5% ...
MEHI MEDICAID PROGRAM
What can MeHIdo for you?
 Funds

IOO’s (Implementation
Optimization Organization) to help
implement EHR use
 Funds consu...
Mass HIway







The Massachusetts Health Information Highway (The HIway) will further
advance the Commonwealth’s goa...
FUTURE DIRECTIONS
 Mass

HIway connection- case
management project with Network
Health
 MU Stage 2
 Patient Portal
 El...
Coordinating and
Improving Care through
the Mass HIway

Sean Kennedy
Mass eHealth Institute
Director, Health Information E...
Agenda

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

 Introduction to the Last Mil...
Health Information Exchange 101
Health Information Exchange 101




Electronic sharing of health information among
varied healthcare systems – while mai...
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 informat...
Governance and Advisory Groups

HIT Council

Consumer
Advisory Group

34

Provider Advisory
Group

©2013 Massachusetts eHe...
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

Information Highway

Registries + Query Exchange

2012-2013

2013-2014

•
•

•

•
...
Mass HIway | Connection Options & Services

User Types
Physician Practice
Hospital

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

Grow adoptionof the Mass HIway by all
eligible participants, whilecatalyzing
innovationultima...
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...
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...
Connect with MeHI & Last Mile

Massachusetts eHealth Institute
617-371-3999
617-725-8938 (fax)
info@maehi.org
Twitter - @m...
MeHI Regional Health IT Meetings - Taunton, MA - Oct, 2013
MeHI Regional Health IT Meetings - Taunton, MA - Oct, 2013
MeHI Regional Health IT Meetings - Taunton, MA - Oct, 2013
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MeHI Regional Health IT Meetings - Taunton, MA - Oct, 2013

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

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

  1. 1. The Massachusetts eHealth Institute
  2. 2. MeHI Overview MeHI is designated state agency for:   ©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 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. 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. 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 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. 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 Massachusetts Success Stories  Brockton Neighborhood Health Plan – Ben Lightfoot, M.D. Medical Director – Tom Velden NextGen Specialist 10 ©2013 Massachusetts eHealth Institute. All Rights Reserved. Confidential.
  11. 11. The Paperless Path A story of a little CHC that could!
  12. 12. Why did we go paperless  Improve efficiency  Improve documentation  Patient Safety  Improved information access  Care-Coordination  Blue Cross grant support  Reporting
  13. 13. The Brockton Neighborhood Health Center Story  Started in a church parking lot 1 physician 19 years ago  Expanded to 2 story office with 10 providers. Administrative and dental office in separate building  Moved to new building 6 years ago- 40 providers, 26,000 patients and 150,000 visits per year.
  14. 14. MAEHC-Mass E-Heath Coalition  Founded in 2004 with a BCBS 50 million $ grant to bring EHR technology to 3 communities  Brockton chosen as 1 community (also North Adams and Newburyport  2005- vetting of systems,  2006 GOLIVE with NextGen EMR/EPM
  15. 15. System Choice  Practice size/scalability  Specialty support  Reporting- quality and business reports  User friendliness  Plays well with others  Meaningful Use certified  Amount of IT support needed
  16. 16. PRE-GO LIVE           Choose a system- and pay for it Map workflows- translate to EHR processes TRAIN,TRAIN,TRAIN! Decide on infrastructure Decide on go live scheduling modificationsDecide how much data to abstract Data conversion if using another EHR Play with/test system in test environment Pick a EHR Champion Get a super-user group together to guide process
  17. 17. GO LIVE  Cut schedule by 50% for 1-4 weeks  Have experts/superusers on hand to trouble shoot and provide support  Expect some problems- have backup methods ready to go
  18. 18. Lessons Learned  Keep on track of workload(chart completion, task completion, ect)  Make sure reports are correct- vet them  You cannot train too much  Communicate- superuser group is a good venue  Try to keep template modifications to a minimum- complicates upgrades
  19. 19. When the system goes down  DON’T PANIC  Have backup worflows in place before this happens (downtime packets)  Have processes in place to backup data  Don’t throw away paper forms (archive them)  Make sure data gets back into EHR when it is back up (RX,problem lists, visit notes)
  20. 20. Success Story
  21. 21. EHR incentives  Meaningfull       use: $44,000 for medicare eligible providers $63,750 for medicade eligible providers Initial attestation that you are using a MU certified system Stage 1: some thresholds, some measures simply require that you be able to report data Stage 2- more and higher thresholds Stage 3- stay tuned!
  22. 22. Medicare ERX Incentive  Thresholds for # of ERX’s sent (low)  Penalties for not participating (2%)  Incentive is 0.5% of medicare billing  Must submit G8553 code when submitting and ERX on a medicare patient
  23. 23. MEHI MEDICAID PROGRAM
  24. 24. What can MeHIdo for you?  Funds IOO’s (Implementation Optimization Organization) to help implement EHR use  Funds consulting services to reach MU (REC program)  Implementation grants to help with care coordination  Educational services (webinars/conferences/site visits)
  25. 25. Mass HIway     The Massachusetts Health Information Highway (The HIway) will further advance the Commonwealth’s goal to electronically connect all of its health care community. The Commonwealth is working with public and private partners to extend its existing technology infrastructure. The HIway will be implemented in three phases. Phase One will support the direct connectivity among health care providers. Subsequent phases will support the analysis of protected health information (PHI) to better manage the quality and cost of care delivered; and query and retrieval of information across the health care community to achieve the best possible care coordination for Massachusetts residents. When fully developed, The HIway will provide a mechanism for the Commonwealth’s entire health care community—residents, providers, public health officials and others—to have appropriate access to health information
  26. 26. FUTURE DIRECTIONS  Mass HIway connection- case management project with Network Health  MU Stage 2  Patient Portal  Electronic Dental Record (go live 10/1)  UPGRADE  Improve patient education software  Improve quality reporting capacity/accuracy
  27. 27. Coordinating and Improving Care through the Mass HIway Sean Kennedy Mass eHealth Institute Director, Health Information Exchange
  28. 28. Agenda  Health Information Exchange 101  Overview of the Statewide HIE - the Mass HIway  Introduction to the Last Mile Program  Example Use Cases  Questions 29 ©2013 Massachusetts eHealth Institute. All Rights Reserved. Confidential.
  29. 29. Health Information Exchange 101
  30. 30. 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 31 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.
  31. 31. Mass HIway Overview Benefits Governance Security + Privacy Roadmap Services
  32. 32. 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 33 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
  33. 33. Governance and Advisory Groups HIT Council Consumer Advisory Group 34 Provider Advisory Group ©2013 Massachusetts eHealth Institute. All Rights Reserved. Confidential. Technology Advisory Group Legal & Policy Advisory Group
  34. 34. 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 35 PRIVACY TRUST ©2013 Massachusetts eHealth Institute. All Rights Reserved. Confidential. Participation Packet Patient Consent
  35. 35. 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 • • 36 ©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
  36. 36. 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 .................................................. 37 Participant directory ©2013 Massachusetts eHealth Institute. All Rights Reserved. Confidential. Message Transformation Secure web mail
  37. 37. 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 39 ©2013 Massachusetts eHealth Institute. All Rights Reserved. Confidential.
  38. 38. 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) 40 ©2013 Massachusetts eHealth Institute. All Rights Reserved. Confidential.
  39. 39. 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 41 ©2013 Massachusetts eHealth Institute. All Rights Reserved. Confidential.
  40. 40. Last Mile Program | Initiatives Connection Adoption Implementation & Support Community of Practice HIway Interface Grant Program HIway Implementation Grant Program Outreach - Education 42 ©2013 Massachusetts eHealth Institute. All Rights Reserved. Confidential. Impact Healthcare
  41. 41. 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 44 Category ©2013 Massachusetts eHealth Institute. All Rights Reserved. Confidential.
  42. 42. HIway Use Case Examples
  43. 43. 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 46 ©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
  44. 44. 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 47 ©2013 Massachusetts eHealth Institute. All Rights Reserved. Confidential. D. Admission notification sent via HIway to PCP and/or specialist
  45. 45. 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 48 ©2013 Massachusetts eHealth Institute. All Rights Reserved. Confidential. C. Admission notification sent via HIway to PCP and/or specialist
  46. 46. 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 49 ©2013 Massachusetts eHealth Institute. All Rights Reserved. Confidential.
  47. 47. 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 50 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.
  48. 48. 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 51 ©2013 Massachusetts eHealth Institute. All Rights Reserved. Confidential.

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