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

The Massachusetts
eHealth Institute

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

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


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


Meaningful Use in Massachusetts

5


Massachusetts EHR Incentive Payments

6


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

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


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


Introducing Massachusetts Success Stories

 Brockton Neighborhood Health Plan
– Ben Lightfoot, M.D.
Medical Director
– Tom Velden
NextGen Specialist

10


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
 Care-Coordination
 Blue Cross grant support
 Reporting

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.

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

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

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

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

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

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)

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!

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

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)

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

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

Coordinating and
Improving Care through
the Mass HIway

Sean Kennedy
Mass eHealth Institute
Director, Health Information Exchange

Agenda

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

 Introduction to the Last Mile Program
 Example Use Cases
 Questions

29


Health Information Exchange 101

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


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.

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 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


Reduce costs throughout the care delivery
system
Ease & improve public health reporting &
analytics

Foundation for Accountable Care
Organizations & value-based healthcare
models

Governance and Advisory Groups

HIT Council

Consumer
Advisory Group

34

Provider Advisory
Group


Technology
Advisory Group

Legal & Policy
Advisory Group

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


Participation Packet
Patient Consent

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


Query-based exchanged enabled
(Master Person Index, Relationship
listing service, Consent database)
Development of DPH registries,
analytical repositories
Patient-directed exchange

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


Message Transformation
Secure web mail

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


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


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


Last Mile Program | Initiatives

Connection

Adoption

Implementation & Support
Community of Practice
HIway Interface
Grant Program
HIway Implementation
Grant Program

Outreach - Education
42


Impact
Healthcare

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


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


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

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

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


D. Admission notification sent via HIway
to PCP and/or specialist

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


C. Admission notification sent via HIway
to PCP and/or specialist

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
C. Discharge summary sent via HIway to
referring physician, PCP, and/or other
care setting

49


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

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


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


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

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