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
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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
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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.
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5. Meaningful Use in Massachusetts
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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
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Implement
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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
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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
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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
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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
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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
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The Mass HIway
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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.
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
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Improve & streamline care coordination
Fewer medical errors/improved patient
safety
Reduce duplication
Supports achieving Meaningful Use
Pharmacy
Labs
The Benefits of HIE
Public
Health
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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
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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
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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
•
•
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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
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Certificate repository
Secure messaging
..................................................
Connect through LAND
(Local Application for
Network Distribution)
..................................................
Browser access to
webmail inbox
..................................................
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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
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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)
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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
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25. Last Mile Program | Initiatives
Connection
Adoption
Implementation & Support
Community of Practice
HIway Interface
Grant Program
HIway Implementation
Grant Program
Outreach - Education
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Impact
Healthcare
26. Mass HIway | Get Connected
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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
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Category
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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
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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
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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
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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
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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
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A. Patient is received at ABC hospital
E. Sends discharge summary and
summary of care via HIway to XYZ
hospital
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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
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Editor's Notes
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…