mehi regional health it meetings - taunton, ma - oct, 2013
DESCRIPTION
Presentation from the Massachusetts eHealth Institute Regional Health IT meeting in Taunton, MA in October, 2013.TRANSCRIPT
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
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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
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
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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.
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Meaningful Use in Massachusetts
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Massachusetts EHR Incentive Payments
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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
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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
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
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Introducing Massachusetts Success Stories
Brockton Neighborhood Health Plan
– Ben Lightfoot, M.D. Medical Director
– Tom VeldenNextGen Specialist
The Paperless
PathA 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 KennedyMass eHealth InstituteDirector, Health Information Exchange
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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
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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
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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
AmbulatoryCare
Long-term Post-Acute
Care
Acute & Post-acute
Care
Payer
Pharmacy
Labs
Patient
MassHIway
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Governance and Advisory Groups
Consumer Advisory Group
Provider Advisory Group
Technology Advisory Group
Legal & Policy Advisory Group
HIT Council
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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
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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
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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
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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
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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
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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
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Impact Healthcare
Adoption Connection
Outreach - Education
HIway Interface Grant Program
Implementation & Support
HIway Implementation Grant Program
Community of Practice
Last Mile Program | Initiatives
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Mass HIway | Get Connected
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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
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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
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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
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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
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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
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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
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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