the mass hiway overview of the state-wide health information exchange
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The Mass HIwayOverview of the State-wide
Health Information Exchange
2 ©2013 Massachusetts eHealth Institute. All Rights Reserved. Confidential.
Agenda
MeHI Introduction
Health Information Exchange 101
Mass HIway Overview
Last Mile Program
Example Use Cases
Massachusetts eHealth InstituteIntroduction
4 ©2013 Massachusetts eHealth Institute. All Rights Reserved. Confidential.
MeHI is designated state agency for:
Coordinating health care innovation, technology and competitiveness
Accelerating the adoption of health information technologies
Promoting health IT to improve the safety, quality and efficiency of health care in Massachusetts
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
MeHI is a division of the Massachusetts Technology Collaborative, a public economic development agency
MeHI Overview
• Tech Hub Collaborative• Big Data Consortium• Advanced Manufacturing
Collaborative• Innovation Index
• Mass Broadband 123• MassVetsAdvisor
• Regional Extension Center• HIE Last Mile• Medicaid Services
5 ©2013 Massachusetts eHealth Institute. All Rights Reserved. Confidential.
2013 2014 2015 2016 2017
Meaningful Use Stage 2 Reporting StartsOctober 2013
Massachusetts Healthcare IT Drivers
HIE and REC Grants endFebruary 2014
Physician License Requirement StartsJanuary 2015
All Provider RequirementJanuary 2017
Meaningful Use Stage 2 requires use of an HIE, starts in October 2013
Federal HITECH Grants end in February 2014
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 complying with the “meaningful use” requirements.
All Providers on EHRs and HIE Connection - 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
6
MeHI | How We Help
Awareness Education Qualify Engage Implement Optimize
ImpactAdoptMotivate
Communications
Webinar Series
Regional Meeting Series
HIway Newsletter
EU-US ConferenceOctober 22-23
Regional Extension Center
Recruiting a few new providers
Helping providers get to Meaningful Use
Medicaid EHR Incentive Program
Processing 2013 MU applications
HIE Last Mile Program
HIway Implementation Grants
HIway Vendor Grants
eHealth Economic Development
eHealth Firm Listing (>150 firms in MA)
Workforce Planning
Provider and Consumer Research
Health Information Exchange 101
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Health Information Exchange 101
1. Patient name2. Sex3. Date of birth4. Race **5. Ethnicity **6. Preferred language7. Care team member(s)8. Allergies **9. Medications **10. Care plan 11. Problems **12. Laboratory test(s) **13. 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.
Electronic sharing of health information among varied healthcare systems – while maintaining meaning
HIE Model Types- “Push” vs. “pull” (query)
- Consent implications
Content standards Create and display capabilities (C-CDA,
CCD/C32 or CCR) Common MU data set
(data frequently exchanged)
Transport standards Transmit and receive capabilities
Health Information Service Provider- certificate discovery, message delivery,
provisions Direct addresses
The MA state-wide HIE- The Mass HIway
HIE & Meaningful Use
HIE & Meaningful Use
MU Stage 2 objectives with an ‘exchange’ component
– Patient engagement
– Transitions of care
– Public health reporting
– e-prescribing
– Lab results reporting
MU2 rules combine CMS MU (care coordination) objectives and measures with new ONC EHR technology certification requirements to support standards-based information exchange that satisfy these objectives
EHR technology certified to the 2014 Edition EHR certification criteria that meets all the objectives for which they plan to attest is a pre-requisite
10
Mass HIway OverviewGovernance
Benefits Security + Privacy
Roadmap Services
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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
– Work toward demonstrating 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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Governance and Advisory Groups
Consumer Advisory Group
Provider Advisory Group
Technology Advisory Group
Legal & Policy Advisory Group
HIT Council
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October 16, 2012: Golden Spike Day!
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Mass HIway | Hub for Health Information Exchange
The Mass HIway enables the secure electronic exchange of health information among diverse participants in the Commonwealth:
The Benefits of HIE
Improve & streamline care coordination
Fewer medical errors/improved patient safety
Reduce duplication
Supports achieving Meaningful Use
Reduce costs throughout the care delivery system
Ease & improve public health reporting & analytics
Foundation for Accountable Care Organizations & value-based healthcare models
Public Health
AmbulatoryCare
Long-term Post-Acute
Care
Acute & Post-acute
Care
Payer
Pharmacy
Labs
Patient
MassHIway
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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.
SECURITYEncryptionAuthentication
PRIVACYParticipation Packet
Patient ConsentTRUST
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PHASE 2Search + Retrieve
PHASE 1Send + Receive
2012-2013• State assumes HISP role• ‘Directed’ exchange of
electronic health information• Provider can ‘push’ health
information to another provider
2013-2014• Query-based exchanged enabled
(Master Person Index, Relationship listing service, Consent database)
• Development of DPH registries, analytical repositories
• Patient-directed exchange
Mass HIway | Roadmap
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HIway Services
EHRConnect directly
..................................................
Connect with local gateway
.................................................. Connect through LAND(Local Application for Network Distribution)
..................................................
Browser access to webmail inbox
..................................................
CONNECTION OPTIONS
Participant directory
Certificate repository
Secure messaging
Message Transformation
Secure web mail
User Types
Physician Practice
Hospital
Long-term CareOther Providers
Public HealthHealth Plans
Labs & Imaging Centers
Mass HIway | Connection Options & Services
Mass HIwayLast Mile Program
Mission Goals
EnvironmentApproach & Initiatives
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Last Mile Program | Mission
Grow adoption of the Mass HIway by alleligible participants, while catalyzing innovation ultimately demonstrating measurable improvements in care quality,
population health and health care costs
21 ©2013 Massachusetts eHealth Institute. All Rights Reserved. Confidential.
Last Mile Program | Goals
Connect and Integrate
Connect participants to and enable integration with the Mass HIway by all eligible participants
Maximize Adoption
Optimize Mass HIway services and grow utilization
Impact Healthcare
Demonstrate measurable improvements in care quality (better care), population health (healthy people and communities) and health care costs (affordable care)
GOAL 1
GOAL 2
GOAL 3
22
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
Last Mile Program | Our Environment
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23 ©2013 Massachusetts eHealth Institute. All Rights Reserved. Confidential.
Impact Healthcare
Adoption Connection
Outreach - Education
HIway Interface Grant Program
Implementation & Support
HIway Implementation Grant Program
Community of Practice
Last Mile Program | Initiatives
HIway Implementation Grant Program | Grantees & Collaborators
Coordination of care for elderly psychiatric patients
Pre-hospital transportcare coordination for homeless
Referrals from specialty care to home health
Care management forHeart Failure patients
Decision support through 2-way exchange of data
Discharge summaries from acute care to SNF and Home Health
HIway Interface Grants | Vendors & Products
Vendor Product Name Version Aprima Aprima for Physicians Aprima 2011ClaimTrak ClaimTrak Version 9.05
Comchart Medical Software, Inc. ComChart Version 211.04y (and later)DICOM Grid DICOM Grid DICOM 2013
eClinicalWorkseClinicalWorks Electronic Medical Record eClinicalWorks v10.0
eHana eHana EHR eHana 2013HealthWyse OfficeWyse and MobileWyse version 18.xx,Version 11.xx
McKessonHomecare & Hospice
McKesson Homecare & McKesson Hospice (formerly Horizon Homecare) Version 13.1.x
MEDfx Corporation MEDfx PM Version 3.xNextJ NexJ Connected Wellness NoMoreClipBoard NMC-MD patient portal NetSmart MyAvatar GE Centricity
26
Mass HIway | Get Connected
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Connection | Pricing
Annual Services Fee
Tier CategoryOne-time Setup Fee
LAND HIE Services (per node)
Direct (XDR/SOAP or SMTP/SMIME)
HIE Services (per node)
Direct Webmail HIE Services
(per user)
Tier 1 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
Tier 2 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
Tier 3 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 (10-49)
$500 $4,500 $2,500 $120
Tier 4 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
Tier 5 Small ambulatory practices (1-2) $25 $60 $60 $60
HIway Use Case Examples
29
Use Case Scenario 1.1/1.2 – Referral
Patient Scenario
1. Patient sees PCP
2. PCP’s plan includes a referral to a Cardiac specialist
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
Specialist
A. Receives Direct message with summary of care document
B. Provides necessary care
C. Generates a consult note for deliveryto PCP
D. Consult note is attached to a Direct message and sent via the HIway to PCP
Referral
Consult NotePCP Specialist
30
Use Case Scenario 2.1/2.2 – Hospital Referral
Patient Scenario
1. Patient sees PCP or specialist
2. Treatment plan includes a referral to a local hospital
3. Referral to hospital is authorized and generated via Direct with a summary of care document
4. Referral is sent via HIway to hospital
Hospital
A. Receives Direct message with summary of care document
B. Provides necessary care
C. Generates an admission notification and summary of care document
D. Admission notification sent via HIway to PCP and/or specialist
PCP
Specialist
31
Use Case Scenario 3.1 – ED Notification
Patient Scenario
1. Patient presents at ED
2. Patient is treated and released
Hospital
A. Provides necessary care
B. Generates an admission notification and summary of care document
C. Admission notification sent via HIway to PCP and/or specialist
PCP
ReferringPhysician
32
Use Case Scenario 3.2/3.3 – Discharge Summary
Patient Scenario
1. Patient is discharged from hospital to the care of a referring physician, PCP or other care setting
Hospital
A. Provides necessary care
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
Specialist
PCP
SNF
33
Use Case Scenario 1.1/1.2 – Referral
XYZ Hospital
1. Patient admitted to XYZ ED
2. Treatment plan calls for a tertiary level of care
3. Patient is referred to ABC hospital
4. Referral and summary of care are generated via Direct message
5. Direct message is sent via HIway to ABC hospital
ABC Hospital
A. Patient is received at ABC hospital
B. ABC hospital receives referral and summary of care document
C. Provides necessary care
D. Generates a discharge summary and summary of care via Direct
E. Sends discharge summary and summary of care via HIway to XYZ hospital
XYZ Hospital ABC Hospital
How our Grantees plan to use the HIway?
Use Case ranking by type
Receive ED Visit Summary
Receive Hospital Discharge Notification
Receive Imaging Notifications
Receive Lab Orders
Receive Lab Results
Receive Discharge Summary
Receive Referral Request
Receive Care Summary
1
1
1
1
1
5
5
13
Receive
Send CANS Data to MDPH
Send ED Admission Notification
Send enrollment/admission and disenrollment/dicharge data to MDPH
Send Hospital Admission Notification
Send Imaging Notifications
Send Lab and Radiology Orders
Medication Reconciliation
Send Hospital Discharge Notification
Send Lab Results
Send Hospital Discharge Summary
Send Referral Request
Send Care Summary
1
1
1
1
1
1
2
2
2
6
9
17
Send
8 12
20 Use Case Types
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Massachusetts eHealth Institute617-371-3999617-725-8938 (fax)info@maehi.orgTwitter - @massehealthMeHI Community - www.thehitcommunity.org/mehi/www.mehi.masstech.org
Mass HIway Last Mile Program1.855.MA-HIWAY (1.855.624.4929) Option 1MassHIway@masstech.orgmehi.masstech.org/what-we-do
Connect with MeHI & Last Mile
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