the mass hiway overview of the state-wide health information exchange

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


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


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



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

http://www.healthit.gov/buzz-blog/meaningful-use/meaningful-use-stage-2/

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


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


Governance and Advisory Groups

Consumer Advisory Group

Provider Advisory Group

Technology Advisory Group

Legal & Policy Advisory Group

HIT Council


October 16, 2012: Golden Spike Day!

http://youtu.be/HfOC-MWqd4o


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


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


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


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


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


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

©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


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


Massachusetts eHealth Institute617-371-3999617-725-8938 (fax)[email protected] - @massehealthMeHI Community - www.thehitcommunity.org/mehi/www.mehi.masstech.org

Mass HIway Last Mile Program1.855.MA-HIWAY (1.855.624.4929) Option [email protected]/what-we-do

Connect with MeHI & Last Mile

the mass hiway overview of the state-wide health information exchange

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