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Presentation from the Massachusetts eHealth Institute Regional Health IT meeting in Tewksbury, MA in September, 2013.
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The Massachusetts eHealth Institute
2 ©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
3 ©2013 Massachusetts eHealth Institute. All Rights Reserved. Confidential.
2013 2014 2015 2016 2017
Meaningful Use Stage 2 Reporting StartsOctober 2013
Massachusetts Healthcare IT Drivers
Meaningful Use Stage 2 requires use of an HIE, starts in October 2013
Federal HITECH Grants supporting EHR and HIE adoption
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
Physician License Requirement StartsJanuary 2015
All Provider RequirementJanuary 2017
4 ©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 an 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***
*Jamoom E, Beatty P, Bercovitz, et al. Physician adoption of electronic health record systems: United States, 2011. NCHS data brief, no 98. 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
5 ©2013 Massachusetts eHealth Institute. All Rights Reserved. Confidential.
Meaningful Use in Massachusetts
6 ©2013 Massachusetts eHealth Institute. All Rights Reserved. Confidential.
Massachusetts EHR Incentive Payments
7
MeHI | How We Help
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
8 ©2013 Massachusetts eHealth Institute. All Rights Reserved. Confidential.
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
9 ©2013 Massachusetts eHealth Institute. All Rights Reserved. Confidential.
Health Information Exchange Progress
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
10 ©2013 Massachusetts eHealth Institute. All Rights Reserved. Confidential.
Introducing A Massachusetts Success Story
Lawrence General Hospital
– Andrea SullivanDirector of Managed Care & PHO
– Caitlin MundryEHR Project Manager
Beth Israel Deaconess Care Organization
– Leanne HarveyDirector EHR Implementation
Beth Israel Deaconess Care Organization
Electronic Health Records and Clinical Integration
September 2013
Beth Israel Deaconess Care Organization
The Beth Israel Deaconess Care Organization is a partnership between BIDMC and community hospitals, independent physicians and physician groups.• organization of individual and groups of physicians and hospitals
who work together to coordinate care delivery, quality improvement, and care efficiency in order to enhance the care of individual patients and populations of patients. Foundation of that is EHR
BIDCO EHR Initiative
• Summary Successfully implemented 250 providers in 90 practices
between 2009-2012• Practice Consulting and Project Management
– MAeHC– BIDCO EHR Team
• Arcadia Solutions: Service Desk and technical services eClinicalWorks hosted by BIDCO via private cloud Standardization: eCW version and quality measure capture Meaningful Use Stage 1
• 100% of PCPs• 90% of specialists
Deploy
Train
Master
AVERAGE IMPLEMENTATION TAKES 20 WEEKS (1-5 MDs)
Workflow optimization
System designDesign
I
II
III
IV
Site prep
EHR customization
System install
and check
Pre-training preparation Go-Live Plan
On-site training
Support kickoff
Evaluate
Improve
Project phases
Week
0
Week
4
Week
8
Week
12
Week
18
Key dates
Week
15
Week
20
Project Kick-Off
EHR Vendor Kick-Off
Hardware Install
Trainer On Site Go Live
ClearinghouseSite
Remediation Complete
MAeHC
BIDCO EHR Implementation at LGH
• BIDCO Team had implemented 75 practices prior to LGH joining BIDCO• LGH affiliated providers
18 practices and 32 providers
• BIDCO / LGH Partnership BIDCO responsible for EHR implementation and project management LGH identified providers and obtained legal agreements Timeline/Schedule Creation
• LGH to prioritize and schedule providers• Creation of mutually agreeable schedule
• Lessons Learned and Applied to LGH practices Pre-assessments to identify issues prior to commencing implementation ISP installation, timing of hardware order Practice engagement/meeting milestones LGH as point of escalation
BIDCO EHR Initiatives: 2013+
• Interfaces Lab/Rad/Discharge Summaries Clinical Data Warehouse
• Viewer to and from BIDMC ambulatory EMR In patient context
• eCW eHX/Health Exchange module Patient consent to share record
• Meaningful Use Stage 2 preparation Lab interfaces and Patient Portal
• State HIE Phase 1: October 2012: BIDCO provider from Lawrence was one of the “Golden Spikes” of
the Mass HIway• Received C32/CCD clinical summary direct from BIDMC into eCW via Mass HIway.
Phase 2: Scheduled to be a pilot for MA State HIE Integration with eCW via the Mass HIway
Choice Plus IPA and BIDCO
Partnership for Electronic Health Record Success
MeHi Regional Meeting - September 12, 2013
Lawrence General and MeHI• Lawrence General Physicians of the Choice
Plus Network IPA supported the application submitted November 2009 for MeHI to become the REC for Massachusetts
• Those physicians were some of the first to become REC members through IPA grants
• First REC regional meeting was held at Lawrence General Hospital
• Two regional MeHI Meaningful Use meetings held at Lawrence General
• IOO opportunity with BIDCO and eClinical Works
The Organizations
The Key Elements
Meaningful Use By The Numbers
• Lawrence General Project now includes 36 Providers: Started May 2011– 11 Primary Care Provider Practices– 4 Specialty Practices– 3 Pediatric Practices
• 35 of the 36 providers qualified for Meaningful Use programs; all 35 attained MU for 100% result– 14 Providers in the Medicaid program– 22 Providers in the Medicare program– Incentive dollars earned to date: $642,000
Additional LGH-Supported Initiatives
• Massachusetts HIWay Implementation Grant– Merrimack Valley HIE Collaborative consists of
Lawrence General Hospital, Greater Lawrence Family Health Center, Pentucket Medical Associates and Home Health VNA
– Awarded grant of $75,000.00 to develop an Emergency Room discharge notification alert sent over the highway
• Via Choice Plus PHO at LGH, additional community connectivity:– Established the role of Physician Integration Manager– Laboratory orders and results delivery– Radiology results delivery and future opportunities
• Meaningful Use Stage 2 preparation– Education and Technical Support
Coordinating and Improving Care through
the Mass HIway
Sean KennedyMass eHealth InstituteDirector, Health Information Exchange
25 ©2013 Massachusetts eHealth Institute. All Rights Reserved. Confidential.
Agenda
Health Information Exchange 101
Overview of the Statewide HIE - the Mass HIway
Introduction to the Last Mile Program
Example Use Cases
Questions
Health Information Exchange 101
27 ©2013 Massachusetts eHealth Institute. All Rights Reserved. Confidential.
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
o “Push” vs. “pull” (query)- Consent implications
Content standards
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 The Mass HIway
Mass HIway Overview Benefits
GovernanceSecurity + Privacy
Roadmap Services
29 ©2013 Massachusetts eHealth Institute. All Rights Reserved. Confidential.
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
30 ©2013 Massachusetts eHealth Institute. All Rights Reserved. Confidential.
Governance and Advisory Groups
Consumer Advisory Group
Provider Advisory Group
Technology Advisory Group
Legal & Policy Advisory Group
HIT Council
31 ©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.
SECURITYEncryptionAuthentication
PRIVACYParticipation Packet
Patient ConsentTRUST
32 ©2013 Massachusetts eHealth Institute. All Rights Reserved. Confidential.
PHASE 2Registries + Query Exchange
PHASE 1Information Highway
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
33 ©2013 Massachusetts eHealth Institute. All Rights Reserved. Confidential.
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 HIway | Last Mile Program
Mission Goals
EnvironmentApproach & Initiatives
35 ©2013 Massachusetts eHealth Institute. All Rights Reserved. Confidential.
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
36 ©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
37
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.
38 ©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
39
Mass HIway | Get Connected
©2013 Massachusetts eHealth Institute. All Rights Reserved. Confidential.
40 ©2013 Massachusetts eHealth Institute. All Rights Reserved. Confidential.
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
42
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
©2013 Massachusetts eHealth Institute. All Rights Reserved. Confidential.
43
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
©2013 Massachusetts eHealth Institute. All Rights Reserved. Confidential.
44
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
©2013 Massachusetts eHealth Institute. All Rights Reserved. Confidential.
45
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
©2013 Massachusetts eHealth Institute. All Rights Reserved. Confidential.
46
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
©2013 Massachusetts eHealth Institute. All Rights Reserved. Confidential.
47 ©2013 Massachusetts eHealth Institute. All Rights Reserved. Confidential.
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