1. HIE Perspectives and Understanding
National, State, and Local Initiatives

2. Learning objectives
 Recognize and differentiate national HIE efforts
 Indicate the current level of HIE adoption
 Describe drivers of HIE at the national and Massachusetts
levels
 Delineate challenges inherent in HIE
 Characterize emerging HIE trends
2

3. Agenda
 The “apples” and “oranges” of HIE
 HIE Facts and Figures
 HIE drivers, challenges and trends
 eLINC HIE and the Salter/Winchester Hospital use case
 Use Case for a regional HIE: Wellport HIE
3

4. About Us
Sean Kennedy, MPH, MS, PMP
Health Information Exchange Director
Massachusetts eHealth Institute at the Massachusetts
Technology Collaborative
Eddy Rospide
EMR/HIE Director
Winchester Highland Management, LLC
eLINC Health Information Exchange
Joe Heyman, MD
Chief Medical Information Officer
Wellport Health Information Exchange

5. The “apples” and “oranges” of HIE
Collaborations
• Care Connectivity Consortium
• CommonWell Health Alliance
• Carequality
Trust
• Direct Trust
• National Association for Trusted
Exchange (NATE)
HIEs
• eHealth Exchange (federal)
• Mass HIway (public, state)
• eLINC & Wellport HIE(private,
regional)
Certification / Accreditation
• Federal Bridge Certification
Authority (FBCA)
• Electronic Healthcare Network
Accreditation Commission
(EHNAC)
5

6. HIE Facts and Figures
National

7. How many HIEs are there?
 Although estimates vary depending on the data source, there
are as many as 280 health information exchanges (HIEs) in
the United States that enable the electronic sharing of health-
related information.
7
Source: 2012 CapSite U.S. Health Information Exchange (HIE) Study

8. Adoption of HIEs is on the rise
 One-half of the nation’s hospitals are now participating in a
regional, State, or private HIE, and 71 percent plan to buy
new HIE technology in the next 2 years.1
 Furthermore, nearly one-half of the nation’s physicians plan to
join an HIE.2
8
Source:
1 2012 CapSite U.S. Health Information Exchange (HIE) Study
2 McCann E. HIEs see rise in physician enrollment; demonstration of Stage 1 gains
similar traction. PhysBizTech. 2012 Oct.

9. 4 in 10 hospitals report an exchange capability for PHI
9
Percent of Hospitals Able to Send and Receive Secure Electronic
Messages Containing Patient Health Information to and from External
Sources
Source: ONC/American Hospital Association (AHA), AHA Annual Survey Information
Technology Supplement.

10. 51 percent of hospitals can query from external sources
10
U.S. Hospitals' Capability to Electronically Query Patient Health
Information from Outside Their Organization or System
Source: ONC/American Hospital Association (AHA), AHA Annual Survey Information
Technology Supplement.

11. HIE Facts and Figures
Massachusetts

12. HIE Participation (% among all MA practices)
12
26%
16%
18%
2%
32%
7%
Overall HIE Current and Future Participation
Currently participate in HIE
Will participate in next 12 months
Will participate in 1 - 2 years
Will participate in 3+ years
Unsure of participation date
Will not participate in HIE
Source: Massachusetts eHealth Institute Practice Health IT Study 2014

13. HIE Use (among the 26% MA practices participating in HIE)
13
77%
75%
74%
45%
39%
28%
11%
2%
0% 20% 40% 60% 80% 100%
Public Health and Quality Measures
Requests for Referral
eRX
Lab &Test Ordering
Eligibility Verification
Transitions of Care
None of these
Anything else
HIE Users: What information are they exchanging?
Source: Massachusetts eHealth Institute Practice Health IT Study 2014

14. The HIway works and delivers value!
14
219,931 Transactions exchanged during April 29
2,450,425 Total Transactions (inception to date)
April Transaction Activity
HIway Status
(organizations)
Count
Contracted 200
Connected 105
SOURCE: Health Information Technology Council slides, May 2014

15. Mass HIway Status Map - IN DEVELOPMENT
15
as of March 2014
Organization Name:Milford Regional Medical Center
HIway Status: Transacting
Billing City: MILFORD
Billing Street: 14 PROSPECT ST
Use Cases: Discharge summaries from acute
care to skilled nursing facility and
home health in the form of a CCDA

16. HIE drivers, challenges and trends

17. Drivers
 Alignment to Meaningful Use objectives and CEHRT
criteria - specifically, MU2 requires HIE – to gain
incentive payments
 ONC grant funding to promote adoption of HIE and
EHRs
 Emerging value-based payment models and ACOs
 Patient safety and patient care
17

18. Drivers from the Commonwealth Fund Report - “Getting it Right…”
 “Physicians sharing the same patient ordered duplicate tests
and therapies. The same drug and radiology exam were
ordered 11 percent of the time. Half of the time, patients
followed the duplicate instructions.
 Physicians did not know what other physicians were doing to
their patients. Primary care physicians were not aware of one
of four prescriptions taken by patients.
 Uncertainty and hassle reduction drove decisions. One of
seven admissions resulted from missing information in EDs or
primary care settings. One of five lab and X-ray tests were
duplicates because of retrieval barriers.”
18
Source: Electronic Medical Records—Getting It Right and Going to Scale, W. Edward Hammond,
The Commonwealth Fund, January 2004

19. Drivers prompted locally - in MA
 All Providers able to access an EHR networked through the
statewide HIE - January 2017
 C.224 cost containment provisions
19

20. 20
Source: MA Cost Trends Report, 2013

21. 21
Opportunity for HIE
Source: MA Cost Trends Report, 2013

22. Challenges
 Little implementation guidance
 Establishing convincing value proposition
 HISP-HISP and directory sharing
 Compatibility of exchanged data sets
 “You can’t draw a border, and say ‘patients stop here.’”
– J. Marc Overhage, MD, PhD, Chief Medical Informatics Officer at Siemens
Healthcare, Health Services on HIEs ending at state borders
22
“Ecosystem maturity and workflow changes represent the two main
challenges for vendors and providers as they implement two Meaningful
Use (MU) Stage 2 requirements related to health information exchange:
transition of care (ToC) and view, download and transmit (VDT)
requirements.”
Micky Tripathi, CEO, Mass eHealth Collaborative

23. Challenges from the eHealth Institute 2013 Survey
 Interoperability – without steep technical interface costs, more
plug n play
 Financial sustainability – private vs public financing
 Competitive concerns
 Patient engagement remains low
23
Source: eHealth Institute, 2013 Survey on Health Data Exchange
http://www.ehidc.org/resource-center/surveys/view_document/333-survey-results-results-from-
survey-on-data-exchange-2013-data-exchange

24. Trends
 From exchange to interoperability
 Quality over quantity incentives being implemented
– Shifting payment models – from fee for service to value-based
 Faster adoption of EHRs than HIEs
 Consumerism of healthcare
– Majority (52%) of consumers want to access tools,
websites rankings for quality, patients’ reviews of
doctors and hospitals
24

25. 25
What’s ahead
 HIE gets easier – EHRs get there, experience in the
market grows, trust established
 Exchanges show value
 Capturing social and behavioral domains in electronic
health records
 Distributed analytics
 Interoperability - “ONC’s 10-year plan”

26. The rise of private HIEs
 “In general, privately funded HIEs are growing at a much faster rate
than publicly funded HIEs. From 2010 to 2011, the number of live public
HIEs in the United States rose from 37 to 67, whereas the number of
live private HIEs more than tripled from 52 to 161.”
26
Source: Prestigiacom J. Private HIEs on the upswing. Healthc Inform. 2012;29(3):24,
26.

27. Governed and managed by
Winchester Highland Management,
LLC.

28. eLINC Heath Information Exchange (HIE)
• Our eLINC HIE was formed by Winchester Hospital
and the IPA under Highland Management. More info
can found at http://elinc.businesscatalyst.com for
now. eLINC stands for:
– electronically Leveraging information
– Improving care
– Networking providers, and
– Communicating with each other
• eLINC a vehicle for our stakeholders to message each
other, and share or exchange health information in a
safe, secure, and non-competitive manner
28

29. eLINC Participant Services
• The same folks that implemented the HM supported EMRs in the
community also make up the eLINC implementation and support Team.
They provider the following services:
– EMR implementation
– Meaningful Use Attestation assistance
– Secure direct messaging accounts which can communicate with any EMR
vendor who uses a HISP that participates and implemented the direct trust
framework and certificate bundles respectively.
– Hospital admission and discharge notifications for PCPs and ACOs
– Clinicians access to patient clinical information (delivered directly in the EMR) ,
aggregated from many organizations (eLINC HIE), for use at the point of care
• Central Data Repository (CDR) services for aggregation of patient data from HIE participant
EMR systems (Deploying in June 2014)
– Results delivery from Winchester Hospital laboratory, radiology, and other
departments (Current)
– Business Intelligence(BI) services for network and provider quality
performance reporting (TBD)
29

30. Winchester Community - Current Environment
• Community of close to 400 physicians and
Winchester Hospital
– 182 out of 208 eligible providers have attested for MU
Stage 1.
– There are a total of 81 interfaces between Winchester
Hospital and physician practices
• 23 Different EMRs but mainly 11 supported
– eClinicalWorks, AthenaHealth, Allscripts Professional,
NexTech, GE Centricity, Origin, Practice Partners,
MDIntellesys, Vitera, Nexgen, and Amazing Charts.
• 23 Practices or 27 physicians are still on paper.
30

31. Supported Use Cases and Activities
• Care Transitions across healthcare organizations
– Excel Orthopedics Winchester Homecare
– Excel Orthopedics  Winchester Hospital surgical preadmission and testing
– Salter Healthcare  Winchester Hospital ED and Medical Records
department
• Upcoming Activities
– Deploy secure messaging across the community
– Work with physicians to attest for MU 2
– Pilot HIE Clinical repository with 2 pilot eCW practices
– Integrate Athena, Practice Partner EMR products as
well as all your EMR vendor products to the HIE
clinical repository
31

32. Clinical Data Repository – eCW eEHX
Features and Capabilities:
– Integrated directly with the EMR as an IHE compliant cross enterprise
document repository
– Access may also be through secure web login
– Aggregates data from all contributing organizations
– Supports C32 CCD integration
– Document may only uploads only through eCW
– Patient consent flows directly from ADT integrated EMRs
Work in progress:
– Encrypted CCD download
– Patient consent capture by participant front staff in cases where no ADT
interface with consent exists between participant EMR
– Monitoring report on performance of live eCW EMRs when tightly integrated
with eEHX
– Performance report on nightly sweep of patient data from eCW EMRs where
patients have opted into the eLINC HIE
– Workflow concerns related to consent capture
– Proper education and training of participants 32

33. eLINC High Level End State Diagram
33
HL7 ADT, Results
Patient Results
Ambulatory Orders
Ambulatory Orders
Secure Messaging
MA State HIway
Secure Messaging
Clinical Encounter Data
Expanding Concentric Circle
NEQCA
SNFs
Rehabs
Winchester Homecare
Tufts Medical Center
Lahey Health
TBD
RLS Query/Response

34. Health Information Exchange
Joe Heyman, MD
Chief Medical Information Officer
June 12, 2014

40. The Genesis
The Whittier IPA
The need to provide services and products for
members without attaching requirements
The need for clinical integration for contracting
and avoiding antitrust issues
The opportunity (2004-2008)
The importance of physician independence
Improving quality and efficiency of care
MAeHC

41. Early history after the
● Discontinuation of the minimal system
● Four years of coming close to signing
– No references of a major vendor
– Change the deal about hospital sign-on
– on the last day
– Quadruple the price on the last day
– Finally signing last summer
MaeHC

42. After Signing
● Clinician Commitments (marketing)
● Access to databases
● Reformatting
● 17 different vendors
● Mission and Vision
● Committees
– Policy, Usage, Technology

43. Documents
● Mission and Vision Statements
● Operating Principles
● Policies and procedures
● Consent and assent
● FAQs
● Trifold for marketing
● Education for clinicians about proper use and legitimate access
● Internal HIPAA required security documents
● Business Associate Agreement
● Service Agreements
● Mass HIway agreements (HISP to HISP)
● Vendor SOW and contract
● EMR vendor interface agreements

44. Vision and Mission
OUR VISION
The widespread use of the Wellport Health Information
Exchange will improve the quality and efficiency of
healthcare for all patients in the lower Merrimack Valley and
beyond -- in an atmosphere of trust.
OUR MISSION
The Wellport Health Information Exchange (HIE) will
provide the communication vehicle to improve the quality and
efficiency of healthcare for its subscribers and their patients
and clients by developing and providing services for
managing and exchanging health information in an
atmosphere of trust. The HIE will be guided by its Operating
Principles which may evolve over time.

45. Operating Principles
● Patients always come first.
● Patient privacy, security and confidentiality are paramount.
● We dedicate our services to the entire community of
medical institutions and patients regardless of
affiliations.
● Clinical data are not shared for purposes other than
treatment, quality measurement and improvement, and
public health.
● We will not share confidential business data among
institutions or physicians unless requested by the
contributor of that information.
● We will not sell clinical data.

46. ●Advantages of an IPA ownership
● Physicians are stewards of the patients’ data
● Ethical use of data for improvement of quality
and efficiency
● Instantaneous access to aggregated data
● No physician imprisonment
● Potential income stream for the IPA
● Private Direct addresses
● Helps with MU achievement

47. ●Advantages of Regional HIE
● Clinicians can see ALL patients’ data
● No silos
● Improves health of entire community
● Improves efficiency for entire community
● Ease of referrals
– You can easily attach other clinical information (that
does not come from your own practice) to a direct
message over the Mass HIway
● Single patient portal

48. Long term advantage of regional
physician owned HIE
● Quality measurement for entire community
● Quality measurement for any subset of the
community
● Potential addition of new innovative
services (billing, third party applications,
mobile, analytics)

49. Where are we now?
● How many clinicians on production
platform? 43
● How many patients on the system?
101,027
● How many progress notes? 794,233
● How many patients have opted in? 0
● Platform is live and running
● Patient opt-in about to begin

50. Health Information Exchange
Owned and Operated by the Whittier IPA, Inc.
Joe Heyman, MD
Chief Medical Information Officer
255 Low Street
Newburyport, MA 01950
(978) 462-2345 Office
(978) 807-5365 Cell
joseph.heyman@verizon.net
www.wellporthealth.net

51. Questions & Discussion
Sean Kennedy, MPH, MS, PMP
Health Information Exchange Director
Massachusetts eHealth Institute at the Massachusetts
Technology Collaborative
Eddy Rospide
EMR/HIE Director
Winchester Highland Management, LLC
eLINC Health Information Exchange
Joe Heyman, MD
Chief Medical Information Officer
Wellport Health Information Exchange

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NEXT WEBINAR!
Meaningful Use Stage 2 & Health Information
Exchange (HIE)
Thursday, July 17 at 12:00pm-1:00pm
Join the Massachusetts eHealth Institute (MeHI) for an educational webinar on health
information exchange (HIE) and Stage 2 Meaningful Use (MU). Sean Kennedy,
Health Information Exchange Director and Al Wroblewski, a Meaningful Use subject
matter expert will lead this important session and discuss how using an HIE can assist
eligible participants in meeting Stage 2 Meaningful Use measures. Important
Meaningful Use topics will include transitions of care, the submission of public health
measures, and patient engagement.
Register

53. 53
617-371-3999
info@maehi.org
@MassEHealth
www.mehi.masstech.org