mehi regional health it meetings - springfield, ma - sept, 2013
DESCRIPTION
Presentation from the Massachusetts eHealth Institute Regional Health IT meeting in Springfield, MA in September, 2013.TRANSCRIPT
The Massachusetts eHealth Institute
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
2 ©2013 Massachusetts eHealth Institute. All Rights Reserved. Confidential.
MeHI Overview
2013 2014 2015 2016 2017
Meaningful Use Stage 2 Repor4ng Starts October 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 Starts January 2015
All Provider Requirement January 2017
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Massachusetts EHR Adoption
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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***
*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.
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Meaningful Use in Massachusetts
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Massachusetts EHR Incentive Payments
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MeHI | How We Help
Awareness Education Qualify Engage Implement Optimize
Impact Adopt Motivate
Communications Webinar Series
Regional Meeting Series HIway Newsletter
EU-US Conference October 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
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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
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Health Information Exchange Progress
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Coordination of care for elderly psychiatric patients
Pre-hospital transport care coordination for homeless
Referrals from specialty care to home health
Care management for Heart Failure patients
Decision support through 2-way exchange of data
Discharge summaries from acute care to SNF and Home Health
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Introducing Massachusetts Success Stories
Baystate Health, Inc. – Joel L. Vengco
Vice President & Chief Information Officer
Holyoke Medical Center – Carl R. Cameron
Chief Information & Analytics Officer
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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
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Health Information Exchange 101
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Health Information Exchange 101
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.
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
Governance Security + Privacy
Roadmap Services
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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
Ambulatory Care
Long-term Post-Acute
Care
Acute & Post-acute
Care Payer
Pharmacy
Labs
Patient
Mass HIway
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Governance and Advisory Groups
Consumer Advisory Group
Provider Advisory Group
Technology Advisory Group
Legal & Policy Advisory Group
HIT Council
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.
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SECURITY Encryption Authentication
PRIVACY Participation Packet
Patient Consent TRUST
PHASE 2 Registries + Query Exchange
PHASE 1 Information 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
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Mass HIway | Roadmap
HIway Services
EHR Connect 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 Care Other Providers
Public Health Health Plans
Labs & Imaging Centers
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Mass HIway | Connection Options & Services
Mass HIway | Last Mile Program
Mission Goals
Environment Approach & Initiatives
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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
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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
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
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Last Mile Program | Our Environment
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Impact Healthcare Adoption Connection
Outreach - Education
HIway Interface Grant Program
Implementation & Support
HIway Implementation Grant Program
Community of Practice
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Last Mile Program | Initiatives
Mass HIway | Get Connected
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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
HIway Use Case Examples
Use Case Scenario 1.1/1.2 – Referral
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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 delivery to PCP
D. Consult note is attached to a Direct message and sent via the HIway to PCP
Referral
Consult Note PCP Specialist
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Use Case Scenario 2.1/2.2 – Hospital Referral
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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
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Use Case Scenario 3.1 – ED Notification
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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
Referring Physician
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Use Case Scenario 3.2/3.3 – Discharge Summary
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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
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Use Case Scenario 1.1/1.2 – Referral
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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
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Massachusetts eHealth Institute 617-371-3999 617-725-8938 (fax) [email protected] 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 [email protected] mehi.masstech.org/what-we-do
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Connect with MeHI & Last Mile