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Massachusetts Health Information Highway(The HIway)

Business Use Cases

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HIE Use Cases Currently Being Deployed under Phase 1

Use Case 1: Syndromic Surveillance • Objective: Electronically submit information

for data collection and response to possible epidemics outbreaks.

• Submitted through Emergency Rooms, primary care sites and infectious disease specialists.

Use Case 2: Children's Behavioral Health Initiative (CBHI)

• Objective: Provide comprehensive means to report data for the statewide behavioral health initiative.

• Create capability electronic and/or automated submission of information required in support of the Department of Public Health Children's Behavioral Health Initiative.

Use Case 3: Hospital Discharge Plan• Objective: Minimize re-hospitalizations through

active engagement, coordination and communication with the patient and care providers in the execution of their hospital discharge plan.

• Studies have documented the quality and cost implications of getting the discharge plan to the admitting physician, PCP and/or Case Management nurse(s) within 24-48 hours of the actual discharge. When providers receive the information in a timely way, they can intervene to ensure patients have the resources and support needed to comply with the discharge plan.

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HIE Use Cases: Opportunities for Consideration

Use Case 4: Emergency Room Visits• Objective: Provide for follow-up care of the

patient and work to redirect to other care settings.

• Network Health are receivers of ER visit summaries. With the summary, NH reaches out to its member to coordinate any after care support required and to assist its member with other care setting options that may be more appropriate.

Use Case 5: High-risk Patients • Objective: Provide care coordination of high risk

patients.

• Receive and send care plans for high-risk patients including future plans for the upcoming dual eligible program.

Use Case 6: Medical Documentation

• Objective: Reduce administrative costs through electronic submission of medical documentation.

• The CMS “esMD” (Electronic Submission of Medical Documentation) project which has been live for over a year leveraged existing Connect Gateway and HISP vendor capabilities to convert the paper process associated with “electronic submission of medical documentation” to an electronic process for submission. This capability can be supported through the HIway.

Use Case 7: Lab Data

• Objective: Electronically receive lab data and other clinical quality data.

• Receive lab data and other batch or real-time clinical quality data for administrative simplification for HEDIS and other quality measures.

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HIE Use Cases: Opportunities for Consideration

Use Case 6: Medical Documentation

• Objective: Reduce administrative costs through electronic submission of medical documentation.

• The CMS “esMD” (Electronic Submission of Medical Documentation) project which has been live for over a year leveraged existing Connect Gateway and HISP vendor capabilities to convert the paper process associated with “electronic submission of medical documentation” to an electronic process for submission. This capability can be supported through the HIway.

Use Case 7: Lab Data

• Objective: Electronically receive lab data and other clinical quality data.

• Receive lab data and other batch or real-time clinical quality data for administrative simplification for HEDIS and other quality measures.