Connecting for Coordinated Care & Better Outcomesand measures with new ONC EHR technology...
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Connecting for Coordinated Care & Better Outcomes 1
Transcript of Connecting for Coordinated Care & Better Outcomesand measures with new ONC EHR technology...
Connecting for Coordinated
Care & Better Outcomes
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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
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MeHI Overview
2013 2014 2015 2016 2017
Meaningful Use Stage 2 Reporting Starts October 2013
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HIE and REC Grants end February 2014
Physician License Requirement Starts January 2015
All Provider Requirement January 2017
Massachusetts Healthcare IT Drivers
• Meaningful Use Stage 2 requires use of an HIE, starts in October 2013
• Federal HITECH Grants end in February 2014
• 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
complying with the “meaningful use” requirements.
• All Providers on EHRs and HIE Connection - 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
MeHI Website
MeHI Community
REC IOO Program
Medicaid Incentive Payment Program
Health IT Adoption Program (2014)
HIway Last Mile Adoption Program
Vendors
Technical Support
Provider Communities
Implementation Stories and Support
eHealth Roundtable
Identify and Promote Technology
Education EHRs HIway Innovation
Outreach - Communication
MeHI - How We Help
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Regional Extension
Center
Support priority primary care providers implement and meaningfully use EHRs and engage in HIE
Medicaid Health Information
Exchange
Partnership with EOHHS to support key operational components of the Medicaid Incentive Payment Program
Connects participants to, enables integration with, and maximizes adoption of the Mass HIway
MeHI | How We Help
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Ranked #3 for Incentive Payments
2,487 Primary Care Providers
enrolled with the REC
2,310 or 93% of Providers Live on
an EHR System
945 or 38% of Providers Achieving
Stage 1 Meaningful Use
$6M in Direct Assistance grants
paid on behalf of MA providers
National Massachusetts
Progress | Regional Extension Center
January 31, 2013
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Over 130,000 providers
participating in national
REC programs
Over 100,000 REC
providers are live on an
EHR System
$10B + paid in federal
incentives to date
Medicaid EHR Incentive Payment Program
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Program Planning and Administration
Outreach and Education
Enrollment and Eligibility Verification
Attestation and Pre-Payment Verification
Verification and Payment Authorization
Reconsideration, Denial & Appeals
Program Reporting and Analysis to State
and Federal Government
MeHI’s role in
administering the
Program
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Agenda
Health Information Exchange 101
HIE & Meaningful Use
Overview of the Statewide HIE - the Mass HIway
Introduction to the Last Mile Program
– Strategic Priorities
– Use case samples: how leverage for teaming with other
providers around patient care for improved outcomes
– Grant overview
• HIway Implementation Grant
• HIway Vendor Interface Grants
Questions
Overview of the State-wide
Health Information Exchange
Health Information Exchange 101
Health Information Exchange 101
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Electronic sharing of health information among
varied healthcare systems – while maintaining
meaning
HIE Model Types
- “Push” vs “pull” (query)
- Consent implications
Content standards
Create and display capabilities (C-CDA,
CCD/C32 or CCR)
Common MU data set (data frequently
exchanged)
Transport standards
Transmit and receive capabilities
Health Information Service Provider
- certificate discovery, message delivery,
provisions Direct addresses
The MA state-wide HIE
- The Mass HIway
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
HIE & Meaningful Use
HIE & Meaningful Use
MU Stage 2 objectives with an ‘exchange’ component
– Patient engagement
– Transitions of care
– Public health reporting
– e-prescribing
– Lab results reporting
MU2 rules combine CMS MU (care coordination) objectives
and measures with new ONC EHR technology certification
requirements to support standards-based information
exchange that satisfy these objectives
EHR technology certified to the 2014 Edition EHR certification
criteria that meets all the objectives for which they plan to
attest is a pre-requisite
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HIE & Meaningful Use | Relationship of CEHRT to MU
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• For Meaningful Use Stage 2, the ToC objective includes 3 measures:
• Measure #1: requires that a provider send a summary care record for more than 50% of transitions of care and referrals.
• Measure #2 requires that a provider electronically transmit a summary care record for more than 10% of transitions of care and referrals using CEHRT or eHealth Exchange participant
• Measure #3 requires at least one summary care record electronically transmitted to recipient with different EHR vendor or to CMS test EHR
Meaningful Use 2014 Edition Certification
• Two 2014 Edition EHR certification criteria
• 170.314(b)(1) : Transitions of care—receive, display, and incorporate transition of care/referral summaries.
• 170.314(b)(2) : Transitions of care—create and transmit transition of care/referral summaries.
Example: Transitions of Care
HIE & Meaningful Use | Relationship of CEHRT to MU
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• The eligible provider, eligible hospital or CAH that transitions or refers their patient to another setting of care or provider of care provides a summary of care record for more than 10% of such transitions and referrals either:
• (a) electronically transmitted using
CEHRT to a recipient; or
• (b) where the recipient receives the summary of care record via exchange facilitated by an organization that is a NwHIN Exchange participant or in a manner that is consistent with the governance mechanism ONC establishes for the nationwide health information network.
ToC Measure #2 170.314(b)(2)
• Transitions of care—create and transmit transition of care/referral summaries.
• (i) Enable a user to electronically create a transition of care/referral summary formatted according to the Consolidated CDA with, at a minimum, the data specified by CMS for meaningful use.
• (ii) Enable a user to electronically transmit CCDA in accordance with:
• “Direct” (required)
• “Direct” + XDR/XDM (optional, not alternative)
• SOAP + XDR/XDM (optional, not alternative)
Example: Transitions of Care
HIE & Meaningful Use | Relationship of CEHRT to MU
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Example: Transitions of Care
HIE & Meaningful Use | Relationship of CEHRT to MU
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Example: Transitions of Care
HIE & Meaningful Use | Relationship of CEHRT to MU
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Example: Transitions of Care
HIE & Meaningful Use | Direct
DIRECT Project
– a simple, secure, scalable, standards-based way for participants
to send authenticated, encrypted health information directly to
known, trusted recipients over the Internet
– Learn more
• ONC
– http://www.healthit.gov/policy-researchers-implementers/direct-
project
• DIRECT Project
– http://directproject.org/
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Mass HIway Overview Benefits
Security + Privacy
Roadmap
Services
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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
Massachusetts Health Information HIway
Governance and Advisory Groups
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Consumer
Advisory Group
Provider Advisory
Group
Technology
Advisory Group
Legal & Policy
Advisory Group
HIT Council
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The Mass HIway enables the secure electronic exchange of health
information among diverse participants in the Commonwealth:
Mass HIway | Hub for Health Information Exchange
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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The Mass HIway ‘trust fabric’ is achieved through the combination of
technical security standards + legal policies to which all participants agree.
Mass HIway | ‘Trust Fabric’
SECURITY Encryption
Authentication
PRIVACY Participation Packet
Patient Consent TRUST
Mass HIway | Roadmap
PHASE 2
Registries + Query Health
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
• Development of registries, analytical
repositories
• Patient-directed exchange
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Mass HIway | Roadmap > Phase 2 high level project schedule
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Activity Completion date
Submit IAPD to CMS Complete
CMS approval of Phase 2 IAPD Complete
Go-live for Phase 2, Release 1 May – Oct 2013
Public Health - Immunization Registry Node Complete
Public Health - Reportable Lab Results (ELR) Node Complete
Public Health - Syndromic Surveillance Node (testing) June 2013
EOHHS – Children’s Behavioral Health (CBHI) Node June 2013
Go-live for Phase 2, Release 2
(CDR, EMPI, RLS, Consent)
Oct 2013 – Mar 2014
HIway Services
EHR
Connect directly ..................................................
Connect with local
gateway
..................................................
Connect through LAND
(Local Application for
Network Distribution) ..................................................
Browser access to
webmail inbox ..................................................
Mass HIway | Connection Options & Services
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 | Last Mile Program
Mission
Goals
Environment
Approach & Initiatives
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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 | Mission
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Connect and Integrate
Connect participants to and enable integration with
the Mass HIway by all eligible participants
Last Mile Program | Goals
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 Vendor 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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Last Mile Program | Initiatives
Impact
Healthcare Adoption Connection
Outreach - Education
Vendor Interface
Grants
Implementation & Support
HIway Implementation
Grant Program
Community Collaboration
Program
Community of Practice
for Consent
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Join our email
list and
Community
Mass HIway | Get Connected
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Connection - Pricing
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HIway Use Case Examples
Use Case # 1 - Discharge Summary From Hospital to Provider
Hospital
Discharge
Summary
Notification
Care Team
Member
PCP, Specialist or
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‘close the loop’
Use Case #2 - Provider Refers Patient for Services
PCP Request for
Referral
Diagnostic Services
Specialty Services
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Use Case #3 - Support Service Sends Summary Care Record to Provider
Diagnostic Service
Specialty Service
Summary of
Care Record
Care Team
Member
PCP, Specialist
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COMING SOON!
Use Case #4 - Provider Sends Summary to Patient
Hospital
or
Specialty
Service
Discharge Summary
or
Summary of Care
Patient
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Last Mile Funding Opportunities
$2M; will issue awards up $75,000 each
Fund projects that 'catalyze connections' to the Mass HIway
by migrating existing processes away from paper-based
exchanges and those exchanges using proprietary interfaces.
Milestones
• M1 - Participant Agreement signed by all trading partners;
• M2 - Initial Participant Directory entries loaded for all trading
partners;
• M3 - Test transaction success among all trading partners;
• M4 - HIway production transactions exercising the identified use
case.
Last Mile Program | HIway Implementation Grants
Post Grants
3/15
Applications Due
4/16
Award Notification
5/5
Milestones 1-3
Complete
12/31
Funding Ends
1/31/2014
Grant Period Ends
~5/2014
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Last Mile Program | HIway Implementation Grants
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Grant Objectives 1. Build awareness
2. Catalyze connections
3. Build the value & cultivate
‘stories’
Map plotting ‘primary applicants’ of grants awarded
Grants Overview
Notified of Award 27
Unique trading partners 80+
Awards with proposed in-kind $ 24
Grant funding $1.9M
$1.5M; will issue awards up $75,000 each
– Release date May
– Notification of award date June
Fund Electronic Health Record (EHR) vendors to develop and
implement a Direct Project-compliant interface to the Mass HIway
Requirements
– At least (4) implementations in MA
– Integrate with HIway Participant Directory
– Enable product to create a CCD, send it as a Direct message over the
Mass HIway, and receive a CCD from another MA provider
– Make interface available to all MA customers by 12/31/2013, or on the
first release of the application following the end of the grant period
• Preference shall be given to applications that commit to deploy a production
interface by 12/31/13.
Last Mile Program | Vendor Interface Grants
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Massachusetts eHealth Institute 617-371-3999
617-725-8938 (fax)
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
mehi.masstech.org/what-we-do/mass-hiway
Connect with MeHI & Last Mile
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