mehi last mile implementation and support
TRANSCRIPT
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• Division of the Massachusetts Technology Collaborative, a public
economic development agency
• State's entity responsible 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 that are networked through the statewide HIE
– Managing HIE and REC grants from Office of National Coordinator
• Chapter 305 created MeHI, which is overseen by the
– Health Information Technology Council
– Mass Technology Collaborative Board of Directors
MeHI Overview
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Health Information Exchange: Working in collaboration with other
state entities and its private partners to deploy a secure statewide
health information exchange. MeHI is responsible for supporting the
Last Mile Initiative: connection, education and optimization.
Regional Extension Center: Offers multitude of services designed to
help primary care providers implement and meaningfully use EHRs and
engage in health information exchange.
Massachusetts Medicaid EHR Incentive Payment Program:
MassHealth has partnered with MeHI to support key operational
components of the Massachusetts Medicaid EHR Incentive Payment
Program, with a goal is to reach 7,251 eligible providers and 64 eligible
hospitals.
MeHI | Current Programs
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Partnering With Executive Office of Health and Human
Services (EOHHS)
• The Executive Office of Health and Human Services and
more specifically, MassHealth, the Commonwealth’s
Medicaid Agency, will implement and deploy the HIE
services and procurements.
• MeHI will focus on end-user integration and the “Last
Mile” program that will maximize connectivity and
effective use of the HIE by as many providers as
possible.
MeHI | Statewide HIE
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Massachusetts has adopted a three-phase approach to the development of its HIE infrastructure:
• Phase One: provider-directed exchange of electronic health information, provider can push health information to another provide;, e.g., “Here is everything I know about Mrs. Jones.”
• Phase Two: development of registries and analytical repositories.
• Phase Three: add support for query-based health information exchange; e.g., “Tell me everything I’m allowed to see about Mrs. Jones.”
Stages of Implementation
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Golden Spike
Declare integration preference:
8/20/12
Detailed Technical
calls started: 8/28/12
HIE Test System Ready: 9/17/12
Rolling “Go-
Live” starts: 10/15/12
GS Group Participants • Atrius Health
• Baystate
• Berkshire Medical Center
• Beth Israel/Deaconess
• Children’s Hospital
• Holyoke Medical Center
• Network Health
• Partners Healthcare
• Tufts Medical Center
• Vanguard
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• Program Goal
Stimulate adoption and use of State Health Information
Exchange (HIE) to improve coordination of care and
clinical outcomes and reduce costs.
• Program Components
– Education
– Connection
– Optimization
Last Mile Program
Connection
Optimization
Education
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• Thought leadership on health information exchange, Meaningful Use, continuity of care, etc.
• Education materials: available online and distributed to practices
• MeHI Regional meetings and training sessions
Providers
• Patient materials, such as patient tool kit available in the provider practice and online
Consumers/Patients
• Information on Last Mile Program
• Vendor technical assistance with Direct integration EHR Vendors
Last Mile Program | Education and Outreach
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Last Mile Program | Connection
Provider directory
Certificate repository
Direct gateway
Web portal mailbox
HIE Services User types
Support the three methods of
connecting to the Commonwealth’s HIE
EHR connects directly
Browser access to webmail inbox
Physician practice
Hospital
Long-term care Other providers
Public health
Health plans
Labs and imaging centers
EHR connects through LAND
(Local Application for Network Distribution)
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• Designed to enhance efficiency and
effectiveness
• Available to all healthcare providers
• Grants available for qualified providers
Last Mile Program | Workflow Optimization
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Last Mile Program | Driving Adoption
Vendor awareness/
activation
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Supply-side programs Program description
Activate leading MA vendors through direct engagement
“Sell” the vendors on why they should work with MA Build market demand for statewide HIE connectivity
Provide vendors easy to use information resources
Provide vendors with forums for learning and asking questions Purchase interface development on behalf of MA providers
Integrate provider engagement program with overall
communications plan
Work at all levels to engage providers to join statewide HIE
Grants to providers for integration costs Technical support to manage provider-side of EHR integration
Managed
procurement of
development
2
Provider
awareness/
activation
3
Support for
provider
integration
4
Demand-side programs
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• Goal: Connect 50,000 providers in the state to the HIE over the next
two years
• Key LMMO Activities
– Offer technical assistance and financial incentives to EHR vendors in the
state to accelerate the development of Direct messaging interfaces
– Establish vendor-specific project timelines with each of the participating
EHR vendors
– Coordinate the necessary technical and project teams to ensure delivery
according to the agreed upon scope and timelines.
– Ensure appropriate standards/implementation guides are available
– Provide oversight, vendor management, facilitation and coordination of
requisite meetings, progress and risk reports, and other tasks that will be
required to keep the interface projects on track.
Last Mile Program | Management Office
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• Goal: Stimulate the rapid adoption of the state’s HIE services to help the largest
number of providers connect to the Massachusetts HIE in the shortest amount
of time
• Encourage and support Electronic Health Record (EHR) vendors in the
integration of the Direct messaging transport protocols within the workflow of
their applications
• Support the development of an interface within the EHR application to enable
providers the ability to create and send a Direct message to any other
Massachusetts provider via the Massachusetts HIway
• Open to any EHR Vendor that currently markets an EHR system in
Massachusetts and is federally certified by an ONC-authorized certification body
• Two tiers:
– Tier 1: Directed grants available to commercial EHR vendors with 3% or
greater market share in Massachusetts.
– Tier 2: A competitive challenge grant program available to all other
interested vendors.
Last Mile Program | Vendor Grant Program
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• Goal: Support communities and providers with the
detailed work of adopting the Massachusetts HIE
• Key Aspects of the Program:
– Coordinate HIE Adoption in natural healthcare referral circles
– Provide additional support for ambulatory and hospital providers
with limited financial and technical resources
• Behavioral Health Providers
• Unaffiliated Primary Care Physicians
• Community Hospitals and Health Centers
• Long-term Care Providers
Last Mile | Direct Assistance Program
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Last Mile | Time Table
' 12 Jul 2012
Sep Nov Jan 2013
Mar May Jul Sep Nov Jan 2014 ' 14
Last Mile Program Complete (under HIE Federal Grant)
1/31/14
HIE Backbone 'Go-Live'
10/15/12
Last Mile Support Vendor Starts Oct/Nov 2012
Last Mile Support Vendor Contracted October 2012
EHR Assessment Complete 7/15/12
Education & Outreach 8/8/12 2/14
Enroll Providers in Statewide HIE 9/16/12 2/14
EHR Vendors Developing and Deploying HIE Connections 8/20/12 2/14
Provider Practice Deployment 10/16/12 2/14
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0%
5%
10%
15%
20%
25%
80% of surveyed Massachusetts healthcare providers that use EHRs are using one of 7 EHR systems
% o
f to
tal p
rovi
ders
su
rveyed
EHR vendors (names provided in chart)
EHR vendors with greatest share of Massachusetts provider customers
Notes:
•7 Vendors serve 80% of surveyed
providers
•9 Vendors serve 90% of surveyed
providers
•Over 90 EHR vendors represented
80%
90%
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A deeper dive by provider segments reveals additional leading EHR vendors
Leading vendors serving providers working in…
Hospital Employed practices
Non Hospital employed
large practices (10+) Hospitals
Non Hospital employed Med &
Small practices (<10)
Pediatric practice
80%
Community Health Centers
Long Term Care
80%
80%
80%
80%
80%
80%
Behavioral Health
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There are 16 vendors on the “80% short list” when all sub-segments are accounted for
EHR vendors serving 80% of MA providers +
provider segment leaders
= 80% short list
•Meditech
•LMR (Self developed) •Cerner •Allscripts
•eClinicalWorks •GE
•WebOMR
•Siemens
•Epic
•NextGen •athenahealth •Quest Care360
•E-MDs
•Point Click Care
•Netsmart Technologies
•UNI/CARE Systems
Top vendors overall
+ Top inpatient vendors
+ Top Practice based vendors
+ Top Long Term Care vendors
+ Top Behavioral Health vendors
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Several communities have begun HIE work – “Aggregators” are beginning to think about how to interface with statewide HIE
NEHEN
North Adams
Baystate SafeHealth
Newburyport
RIQI
VITL
NYeC Beverly
Winchester
Holyoke Emerson
Sturdy
Berkshire
Health
South Shore
NH-
HIO
Cape Cod Health
48 Physician Hospital Organizations (PHOs) were
identified through provider survey - 42% of provider survey respondents are PHO members
36 IPAs identified through surveys - 28% of provider
survey respondents are IPA members 8 of the CMS ACO pilots are in Massachusetts
Aggregator Organization Summary
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Of the vendors interviewed few are capable of DIRECT – many have some capability for transporting health information
0
7
15
3
0
17
7
14
7
11
6
7
5
4
6
5
19
8
5
5
16
5
12
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Ability to assemble & send and receive & import
Ability to interface with PKI service
Ability to interface with Provider Directory
Ability to pass credentials to web portal (SSO)
Ability to embed native link to web portal
Ability to follow S/MIME SMTP standards
Ability to follow IHE profiles (XDR, XDS, XDM)
Ability to deliver DIRECT compliant EHRNo Capability
Some capability
Full capability
EHR vendors capability summary
Count of EHR vendors interviewed that answered question
N = 26
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Vendors are moving directionally toward DIRECT development, but timing and focus are highly varied
1
7
8
10
11
15
Today Q4 2012 Q1 2013 Q2 2013 Q3 2013 No clearroadmap
Vendor timing for a DIRECT software version release (n=26)
Statewide HIE launch date
October 15, 2012
MU Stage
2 begins:
• Q4 2013
(EH)
• Q1 2014 (EP)
Cumulative number of vendors implementing DIRECT protocols
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Vendors requested technical guidance, forums for learning, joint “go to market” approach, and funding from “Last Mile” program
Vendor input on resources and assistance “Last Mile” program could offer
Provide clear technical guidance
Provide forum for vendors to learn and interact with the state and other vendors
Conduct outreach and communication
Provide education
Provide support at the practices
Provide financial support
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The MA statewide HIE program has a number of levers available to ease last mile integration
MeHI EOHHS
Communication with providers (Include in
communication plan)
(Include in
MassHealth
communication plan)
Grants to providers X
Integration support to providers X (Some through Orion)
HIE pricing X
Communication with vendors X X
Grants to vendors X
Technical guidance to vendors (communicate
EOHHS technical
guidance)
X
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Thoughtful orchestration of levers will connect the largest number of providers in the shortest amount of time
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Multi-segment providers
LMR
Cerner
Allscripts
eClinicalWorks
WebOMR
Epic
GE/Qvera
Practice based vendors
NextGen
Athenahealth
Quest Care360
E-MDs
PCC
eHS Med
Greenway
iPatientCare
Medstreaming
Vitera
Connexin
Comchart
Amazing Charts
In-patient vendors
Meditech
Seimens
LTC vendors
Point Click Care
SigmaCare
ADS
Beh. health vendors
SMIS
Echo Group
Interaction Tech
Qualifacts
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4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
Not interviewed
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Actively engage, promote
LAND option, provide grants
Lo
w
Hig
h
Build awareness of
LAND and web portal
Actively engage, promote
LAND and direct integration,
provide grants
Actively engage, promote
LAND and direct integration
DIRECT Capability
MA
Pro
vid
er S
hare
Low High
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5 7
8 9 10
11
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18 19 20
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25
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