the massachusetts ehealth institute · no. 9. march 2013: adoption of electronic health record...

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   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

©2013 Massachusetts eHealth Institute. All Rights Reserved. Confidential.

  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.

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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


Health Information Exchange Progress


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

  Brockton Neighborhood Health Plan –  Ben Lightfoot, M.D.

Medical Director –  Tom Velden

NextGen Specialist


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


Health Information Exchange 101


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


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


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.


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


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


Mass HIway | Connection Options & Services

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


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


Impact Healthcare Adoption Connection

Outreach - Education

HIway Interface Grant Program

Implementation & Support

HIway Implementation Grant Program

Community of Practice


Last Mile Program | Initiatives

Mass HIway | Get Connected



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


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


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


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


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


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


Connect with MeHI & Last Mile

the massachusetts ehealth institute · no. 9. march 2013: adoption of electronic health record...

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