The Massachusetts ehealth Institute

MeHI Overview MeHI is designated state agency for: MeHI is a division of the Massachusetts Technology Collaborative, a public economic development agency 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 2 2013 Massachusetts ehealth Institute. All Rights Reserved. Confidential.

Massachusetts Healthcare IT Drivers Meaningful Use Stage 2 Repor4ng 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. All Rights Reserved. Confidential.

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. All Rights Reserved. Confidential.

MeHI How We Help Awareness Education Qualify Engage Implement Optimize Motivate Communications Webinar Series Regional Meeting Series HIway Newsletter EU-US Conference October 22-23 Adopt 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 Impact ehealth Economic Development ehealth Firm Listing (>150 firms in MA) Workforce Planning Provider and Consumer Research 7

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. All Rights Reserved. Confidential.

Health Information Exchange Progress Decision support through 2-way exchange of data Coordination of care for elderly psychiatric patients 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. All Rights Reserved. Confidential.

Introducing Massachusetts Success Stories Brockton Neighborhood Health Plan Ben Lightfoot, M.D. Medical Director Tom Velden NextGen Specialist 10 2013 Massachusetts ehealth Institute. All Rights Reserved. Confidential.

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 modifications- Decide 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)

Success Story

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

MEHI MEDICAID PROGRAM

What can MeHI do 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 2013 Massachusetts ehealth Institute. All Rights Reserved. Confidential.

Health Information Exchange 101

Health Information Exchange 101 Electronic sharing of health information among varied healthcare systems while maintaining meaning HIE Model Types o Push vs. pull (query) - Consent implications Content standards o o Create and display capabilities (C-CDA, CCD/C32 or CCR) 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 The Mass HIway 1. Patient name 2. Sex 3. Date of birth 4. Race ** 5. Ethnicity ** 6. Preferred language 7. 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. 31 2013 Massachusetts ehealth Institute. All Rights Reserved. Confidential.

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: Payer Pharmacy Patient Labs Mass HIway Acute & Post-acute Care Public Health Long-term Post-Acute Care Ambulatory Care 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 33 2013 Massachusetts ehealth Institute. All Rights Reserved. Confidential.

Governance and Advisory Groups HIT Council Consumer Advisory Group Provider Advisory Group Technology Advisory Group Legal & Policy Advisory Group 34 2013 Massachusetts ehealth Institute. All Rights Reserved. Confidential.

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 TRUST PRIVACY Participation Packet Patient Consent 35 2013 Massachusetts ehealth Institute. All Rights Reserved. Confidential.

Mass HIway Roadmap PHASE 1 Information Highway PHASE 2 Registries + Query Exchange 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 36 2013 Massachusetts ehealth Institute. All Rights Reserved. Confidential.

Mass HIway Connection Options & Services User Types HIway Services Physician Practice Hospital Long-term Care Other Providers Public Health Health Plans Labs & Imaging Centers CONNECTION OPTIONS EHR Connect directly... Connect with local gateway... Connect through LAND (Local Application for Network Distribution)... Browser access to webmail inbox... Participant directory Certificate repository Secure messaging Message Transformation Secure web mail 37 2013 Massachusetts ehealth Institute. All Rights Reserved. Confidential.

Mass HIway Last Mile Program Mission Goals Environment Approach & Initiatives

Last Mile Program Mission Grow adoption of the Mass HIway by all eligible participants, while catalyzing innovation ultimately demonstrating measurable improvements in care quality, population health and health care costs 39 2013 Massachusetts ehealth Institute. All Rights Reserved. Confidential.

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 2013 Massachusetts ehealth Institute. All Rights Reserved. Confidential.

Last Mile Program Our Environment Barriers EHR technology interfaces & product timelines Meaningful Use Incentives Consumer on-ramps & workflows Consent infrastructure HIway Implementation Grants HIway Interface Grants Evolving HIway infrastructure Evolving policies (consent, HISP-HISP) HIway awareness Enablers Chapter 224 force of law to require connectivity (patients, providers, etc) Pioneer Accountable Care Organizations (ACOs) Penalties Chapter 224 Penalties for non-participation in HIE (1/1/2017) 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 2013 Massachusetts ehealth Institute. All Rights Reserved. Confidential.

Last Mile Program Initiatives Connection Adoption Impact Healthcare Implementation & Support Community of Practice HIway Interface Grant Program HIway Implementation Grant Program Outreach - Education 42 2013 Massachusetts ehealth Institute. All Rights Reserved. Confidential.

Connection Pricing Annual Services Fee Tier Category 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) 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 44 2013 Massachusetts ehealth Institute. All Rights Reserved. Confidential.

HIway Use Case Examples

Use Case Scenario 1.1/1.2 Referral Referral PCP Consult Note Specialist Patient Scenario Specialist 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 A. Receives Direct message with summary of care document B. Provides necessary care 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 46 2013 Massachusetts ehealth Institute. All Rights Reserved. Confidential.

Use Case Scenario 2.1/2.2 Hospital Referral Specialist PCP 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 47 2013 Massachusetts ehealth Institute. All Rights Reserved. Confidential.

Use Case Scenario 3.1 ED Notification Referring Physician PCP Patient Scenario Hospital 1. Patient presents at ED 2. Patient is treated and released 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 48 2013 Massachusetts ehealth Institute. All Rights Reserved. Confidential.

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 49 2013 Massachusetts ehealth Institute. All Rights Reserved. Confidential.

Use Case Scenario 1.1/1.2 Referral XYZ Hospital ABC Hospital 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 50 2013 Massachusetts ehealth Institute. All Rights Reserved. Confidential.

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 2013 Massachusetts ehealth Institute. All Rights Reserved. Confidential.