regional collaboratives

REGIONAL COLLABORATIVES

September 14, 2009

- 2 -Massachusetts eHealth CollaborativeSlide title © MAeHC. All rights reserved.

MAeHC ROOTS ARE IN MOVEMENT TO IMPROVE QUALITY, SAFETY, EFFICIENCY OF CARE

• Company launched September 2004

– Non-profit registered in the State of Massachusetts

• CEO on board January 2005

• Backed by broad array of 34 MA health care stakeholders

- 3 -Massachusetts eHealth CollaborativeSlide title © MAeHC. All rights reserved.

MAeHC ARCHITECTURE AND DATA FLOWS

Brockton Newburyport North Adams

Community-level:HIE

Outcomes analysis

BenchmarkingMAeHC-level:Analysis Negotiated reporting

to plans• P4P

• Chart review

MAeHC-level:QDC

Provider-level: EHR

- 4 -Massachusetts eHealth CollaborativeSlide title © MAeHC. All rights reserved.

QUALITY MEASURES DON’T HAPPEN, THEY GET DONE

Overall project management

Readiness assessment &

planning

Practice transformation

& workflow planning

System deployment & Implementation

Post- implementation

support

Reporting, decision support, and performance measurement

Inter-operating with internal

and external systems

Illustrative EHR Implementation Value Chain

Vendor contracting

and management

• Gaps at any point along the way will undermine adoption

- 5 -Massachusetts eHealth CollaborativeSlide title © MAeHC. All rights reserved.

WHY DO SO MANY PHYSICIANS OFFICES LOOK LIKE THIS?

Courier just dropped off moreenvelopes

Courier just dropped off moreenvelopes

Prescription refill request on fax machine (Rightbehind the joke of the day)

Prescription refill request on fax machine (Rightbehind the joke of the day)

Unopened mail

Unopened mail

Printer with results from one lab

Printer with results from one lab

“Hey Sally! Where is Mrs. Jones x-ray?”

“Hey Sally! Where is Mrs. Jones x-ray?”

Unsorted results

Unsorted results

About to ring with stat results

About to ring with stat results

Web portal (from one hospital)

Web portal (from one hospital)

- 6 -Massachusetts eHealth CollaborativeSlide title © MAeHC. All rights reserved.

CLINICAL USE OF DEPLOYED EHRs% of Encounters Documented Clinically in EHRs (Q2 2006 – Q2 2008)

Community 1 Community 2 Community 3

%

- 7 -Massachusetts eHealth CollaborativeSlide title © MAeHC. All rights reserved.

BREAKOUT OF CLINICAL USE MEASUREMENT

Community BrocktonPracticeName (All)Quarter (Multiple Items)

Specialty GroupsData Primary Care Specialty CareClinical Enc 90.7% 82.6%Follow-up 82.8% 76.2%HPI 68.5% 41.1%Allergies 34.4% 23.3%Vitals 65.0% 22.5%Current Meds 42.3% 50.2%Medical Hx 45.9% 33.1%Social Hx 23.3% 21.7%Family Hx 19.5% 11.7%Surgical Hx 14.2% 16.3%ROS 22.7% 17.6%Rx 41.6% 15.2%Phys Exam 11.8% 14.4%Exam 68.0% 32.7%Total Office Encounters 204,079 213,134

Legend:1 - Includes all Caritas site including central support2 - Quarters = Q3 2006 thru Q1 2008 (last data feed)3 - Includes Brockton data only4 - Clinical enc = an encounter that had any clinical documentation

- 8 -Massachusetts eHealth CollaborativeSlide title © MAeHC. All rights reserved.

NORTH ADAMS HIE SCREEN SHOT

- 9 -Massachusetts eHealth CollaborativeSlide title © MAeHC. All rights reserved.

MAeHC ARCHITECTURE AND DATA FLOWS

Outcomes analysis

Benchmarking Other reporting• P4P• Chart review

Brockton Newburyport North Adams

How to handle consent policy for unanticipated expansion of use, even if it’s legally allowed?

Is 5-10% opt-out acceptable for public health and population health?

How to handle physician desire for routine re-identification?

Are physicians enthusiastically pursuing consent? How to deal with “non-believers” and free-riders?

Entity-by-entity opt-in consent

(North Adams exception)

Encrypted identifiers

Re-identifiable

- 10 -Massachusetts eHealth CollaborativeSlide title © MAeHC. All rights reserved.

DATA BEING SENT TO THE MAEHC QDC TODAY

• Problems

• Procedures

• Allergies

• Medication

• Demographics[de-identified]

• Social/Family hx if it can be sent in discrete data

• Smoking status- if it can be sent over in discrete data

• Visits

• Diagnosis

• Lab results

• Rad results

• Future[ inpatient data to include surgical history]

- 11 -Massachusetts eHealth CollaborativeSlide title © MAeHC. All rights reserved.

Records Received By MAeHC QDCThrough May 2009

North Adams

Newburyport

Brockton

000

• 437,000 total records since Jul 2008• 57,000 records received in May 2009

- 12 -Massachusetts eHealth CollaborativeSlide title © MAeHC. All rights reserved.

MAEHC QDC DATA COUNTS (I)

Patients Patient visits

Diagnoses Procedures

North Adams

Newburyport

Brockton

- 13 -Massachusetts eHealth CollaborativeSlide title © MAeHC. All rights reserved.

Problems Lab results

Medications Vaccinations

MAEHC QDC DATA COUNTS (II)

North Adams

Newburyport

Brockton

- 14 -Massachusetts eHealth CollaborativeSlide title © MAeHC. All rights reserved.

MAEHC QDC LOG-IN SCREENSHOTS

- 15 -Massachusetts eHealth CollaborativeSlide title © MAeHC. All rights reserved.

MAEHC QDC REPORT SCREENSHOTS

Peer comparison report (1)

Drill-down reportBenchmark summary report

Peer comparison report (2)

- 16 -Massachusetts eHealth CollaborativeSlide title © MAeHC. All rights reserved.

QUALITY DATA CENTER IS BECOMING A “PUBLIC UTILITY” AS WELL AS A COMMERCIAL PLATFORM

MEANINGFUL USE INTEROPERABILITY REQUIREMENTS COULD PUSH THE ENTIRE INDUSTRY TOWARD HIE

• Lab results delivery

• Prescribing

• Claims and eligibility checking

• Quality & immunization reporting, if available

2011

Increases volume of transactions that are most commonly happening today

– Lab to provider

– Provider to pharmacy

• Registry reporting and reporting to public health

• Electronic ordering

• Health summaries for continuity of care

• Receive public health alerts

• Home monitoring

• Populate PHRs

2013

Substantially steps up exchange

– Provider to lab

– Pharmacy to provider

– Office to hospital & vice versa

– Office to office

– Hospital/office to public health & vice versa

– Hospital to patient

– Office to patient & vice versa

– Hospital/office to reporting entities• Access comprehensive data from all

available sources

• Experience of care reporting

• Medical device interoperability

2015Starts to envision routine availability of relatively rich exchange transactions

– “Anyone to anyone”

– Patient to reporting entities

Meaningful Use objectives requiring health exchange

- 18 -Massachusetts eHealth CollaborativeSlide title © MAeHC. All rights reserved.

CREATING INFRASTRUCTURE TO FACILITATE MEANINGFUL USE

Regional Health IT Extension Centers

• Non-profit implementation assistance organizations to facilitate meaningful use among “priority primary care providers”

• 70 will be set up across the country– 3 cycles of funding– 12/09, 4/10, 9/10

• Awards of $1M to $30M – does NOT pay for hardware, software, or interfaces

• Must commit to getting at least 1000 priority PCPs to meaningful use in 2 years

• Matching funds required:– Years 1 & 2: 10%– Years 3 & 4: 90%

State-level HIE

• Each state given planning and implementation grants to implement HIE

• 50 awards across the country– Awards announced 12/09

• Awards of $4M to $40M

• Managed by States or non-profit state-designated entities (SDEs)

• Must implement state plans aligned with federal goals

•State-level directories•eligibility and claims•eRX & medication histories•Lab ordering and results•Public health reporting•Quality reporting•Clinical summary exchange

• Matching funds required:– FY 2010: 0%– FY 2011: 10%– FY 2012: 25%– FY 2013: 12.5%

$564 million$598 million

- 19 -Massachusetts eHealth CollaborativeSlide title © MAeHC. All rights reserved.

http://www.maehc.org

Micky Tripathi, PhD MPPPresident & CEO

mtripathi@maehc.org781-434-7905