Presentation from the Massachusetts eHealth Institute Regional Health IT meeting in Boston, MA in October, 2013.

1. The Massachusetts
eHealth Institute

2. MeHI Overview
MeHI is designated state agency for:


2013 Massachusetts eHealth Institute.
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

3. 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
2013 Massachusetts eHealth Institute.

4. 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
2013 Massachusetts eHealth Institute.

5. Meaningful Use in Massachusetts
5
2013 Massachusetts eHealth Institute.

6. Massachusetts EHR Incentive Payments
6
2013 Massachusetts eHealth Institute.

7. 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
2013 Massachusetts eHealth Institute.
Optimize
Impact
eHealth
Economic
Development
 eHealth Firm
Listing (>150
firms in MA)
 Workforce
Planning
Provider and
Consumer
Research

8. 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
2013 Massachusetts eHealth Institute.

9. 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
2013 Massachusetts eHealth Institute.
Coordination of care for
elderly psychiatric patients

10. Introducing Massachusetts Success Stories
 Brockton Neighborhood Health Plan
– Ben Lightfoot, M.D.
Medical Director
– Tom Velden
NextGen Specialist
10
2013 Massachusetts eHealth Institute.

11. Coordinating and
Improving Care through
the Mass HIway
Sean Kennedy
Mass eHealth Institute
Director, Health Information Exchange

12. Agenda
 Health Information Exchange 101
 Overview of the Statewide HIE - the Mass HIway
 Introduction to the Last Mile Program
 Example Use Cases
 Questions
12
2013 Massachusetts eHealth Institute.

13. Health Information Exchange 101

14. 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
14
The Mass HIway
2013 Massachusetts eHealth Institute.
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.

15. Mass HIway Overview
Benefits
Governance
Security + Privacy
Roadmap
Services

16. 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
16
Improve & streamline care coordination
Fewer medical errors/improved patient
safety
Reduce duplication
Supports achieving Meaningful Use
Pharmacy
Labs
The Benefits of HIE
Public
Health
2013 Massachusetts eHealth Institute.
Reduce costs throughout the care delivery
system
Ease & improve public health reporting &
analytics
Foundation for Accountable Care
Organizations & value-based healthcare
models

17. Governance and Advisory Groups
HIT Council
Consumer
Advisory Group
17
2013 Massachusetts eHealth Institute.
Provider Advisory
Group
Technology
Advisory Group
Legal & Policy
Advisory Group

18. 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
18
2013 Massachusetts eHealth Institute.
PRIVACY
TRUST
Participation Packet
Patient Consent

19. 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
•
•
19
2013 Massachusetts eHealth Institute.
Query-based exchanged enabled
(Master Person Index, Relationship
listing service, Consent database)
Development of DPH registries,
analytical repositories
Patient-directed exchange

20. 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
2013 Massachusetts eHealth Institute.
Certificate repository
Secure messaging
..................................................
Connect through LAND
(Local Application for
Network Distribution)
..................................................
Browser access to
webmail inbox
..................................................
20
Participant directory
Message Transformation
Secure web mail

21. Mass HIway | Last Mile Program
Mission
Goals
Environment
Approach & Initiatives

22. 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
22
2013 Massachusetts eHealth Institute.

23. 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)
23
2013 Massachusetts eHealth Institute.

24. 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
24
2013 Massachusetts eHealth Institute.

25. Last Mile Program | Initiatives
Connection
Adoption
Implementation & Support
Community of Practice
HIway Interface
Grant Program
HIway Implementation
Grant Program
Outreach - Education
25
2013 Massachusetts eHealth Institute.
Impact
Healthcare

26. Mass HIway | Get Connected
26
2013 Massachusetts eHealth Institute.

27. 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
27
Category
2013 Massachusetts eHealth Institute.

28. HIway Use Case Examples

29. 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
29
2013 Massachusetts eHealth Institute.
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

30. 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
summary of care document
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
30
2013 Massachusetts eHealth Institute.
D. Admission notification sent via HIway
to PCP and/or specialist

31. 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
31
2013 Massachusetts eHealth Institute.
C. Admission notification sent via HIway
to PCP and/or specialist

32. 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
summary of care document
C. Discharge summary sent via HIway to
referring physician, PCP, and/or other
care setting
32
2013 Massachusetts eHealth Institute.

33. 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
summary of care document
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
33
A. Patient is received at ABC hospital
E. Sends discharge summary and
summary of care via HIway to XYZ
hospital
2013 Massachusetts eHealth Institute.

34. 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
34
2013 Massachusetts eHealth Institute.