Commonwealth of MassachusettsExecutive Office of Health and Human Services

Mass HIway 2016 Update

February 25, 2016

Introducing today’s speaker

Murali AthuluriMass HIway Account Management Massachusetts eHealth Collaborative

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• What is the Mass HIway?

• How can Mass HIway help Improve Care Coordination?

• Mass HIway 2015 Year in review

• What’s ahead on the Mass HIway – 2016 & Beyond?

• Q&A

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Agenda

The Mass HIway is the statewide Health Information Exchange (HIE) providing secure, electronic transport of health-related information between health care organizations and providers regardless of affiliation or technology.

The Mass HIway offers two services:

1. Direct Messaging - Secure point-to-point transport of electronic patient health information among healthcare organizations and authorized government agencies for purposes of patient treatment, payment, or operations.

2. Query and Retrieve – Relationship Listing Service (RLS) for locating healthcare organizations that hold records for a particular patient. Medical Record Request (MRR) service for initiating a query for a patient’s records.

The Mass HIway is not a clinical data repository HIE and holds no clinical information.

The Mass HIway is also not the state health insurance exchange known as the Health Connector.

What is the Mass HIway?

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Hospital B

Provider Directory

Provider name Local name Institution Direct address

Smith, Marilyn M Smith, Marilyn Hospital B Marilyn.Smith@direct.HospitalB.masshighway.net

Smith, Marilyn M Smith, Mary Highland Primary Care Marilyn.Smith@direct.HPC.masshighway.net

Specialist Hospital APCP

Y YN

1. Consent

2. Look up Provider Address

(optional – depends on EHR vendor)

3. Send message

Direct Messaging Service

Data holder sends patient information to recipient

Public Health reporting

• Immunizations

• Electronic Lab Reports (ELR)

• Syndromic Surveillance

• Opioid Treatment Program

• Cancer Registry

• Intake Enrollment and Assessment Transfer Service (IEATS)

• Childhood Lead Poisoning Prevention Program (CLPPP)

• e-Referrals

Patient clinical information:

• Emergency Department Notifications

• Discharge Summaries

• Referral summary information

• Specialist consult notes

• Transfer of Care Summaries (TOC)

• Progress notes

• Request for patient care summaries

Quality reporting:

• Information for calculation and reporting of clinical quality measures

What can you send?

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Mass DPH Registries and other state Applications connected with Mass HIway:

• Massachusetts Immunization Information System (MIIS)

• Electronic Lab Reporting (ELR)

• Syndromic Surveillance (SS)

• Massachusetts Cancer Registry (MCR)

• Opioid Treatment Program (OTP)

• Childhood Lead Poisoning Prevention Program (CLPPP)

• Occupational Lead Poisoning Registry (Adult Lead)

• E-Referral

In Testing:

• Prescription Monitoring Program (PMP)

Public Health Registry Connectivity

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Sending Referrals (TOC)

UMASS

Reliant

Tri County MA

Partners

Using

direct.xxxx.masshiway.net

Patient Scenario:1. Patient sees PCP @ Intermed2. PCP refers patient to a Cardiac specialist3. Patient sees specialist4. Patient sees PCP for follow up care

(Intermed Associates)

PCP

direct.webstermd.com

Information Flows:A. PCP sends Specialist a summary of care document via the

Mass HIwayB. Specialist sends PCP a consult note via the Mass HIway

Referral Summary of

Care

Consult Note

(TBD)

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TOC from ‘Intermed Associates’ to Specialists on Mass HIway

Lab Results to VNA

Gardner VNA

Workflow:1. After a Gardner VNA provider, or the patient’s primary care physician, orders lab work the patient

takes the lab order to Heywood Hospital. 2. Heywood Hospital receives the order3. Information for Gardner VNA patients is entered with a specific location code so that results for

Gardner VNA patients can be filtered. 4. Once the patient’s lab work is completed, the results are passed to Heywood’s Iatric interface engine,

which does the filtering, and sends the appropriate results from Heywood Hospital (LAND) over the Mass HIway to Gardner VNA (LAND).

5. The lab result is then accepted into Gardner VNA’s McKesson Home Health system where the result is attached to the patient record for review and follow-up.

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Heywood Hospital Sending Lab Results to Gardner VNA

Heywood

Lab Results

Hospital Discharges to PCP

PCP

(Reliant Medical Group)

Patient Scenario:1. Patient discharged from Emergency

Department of SVH or Milford Regional2. Discharge CCDA is sent via Mass HIway3. Patient sees PCP for follow up care, PCP has

access to Meds prescribed during discharge

Information Flows:A. SVH informs Reliant that patient is in ED via point to point

interfaceB. PCP sends critical information to Hospital ED via the Mass

HIwayC. Hospital sends PCP discharge summary via the Mass HIway

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SVH Sends Patient Discharge CCDA to PCP @ Reliant Medical Group

Hospital A

(SVH)

Discharge

Summary

Summary of Care

Public Health Reporting

DPH

(MIIS, OTP, SS etc.)

Patient Scenario:1. Patient sees Pediatrician and receives DTaP

vaccination2. Pediatrician sends immunization information

to Department of Public Health

Information Flows:A. Pediatrician sends immunization information to the MIIS via

the Mass HIway

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Provider reports to applicable DPH registry

Provider(s) / Practices

DPH Transactions

Hospitals / Health Centers

Automated Transitions of Care

Patient Scenario:1. Patient Admitted/Registered at SVH or

Milford Regional ED2. ADT alert sent to Reliant EHR for it’s patients3. Reliant triggers CCD back to respective

Hospital

Information Flows:A. SVH alerts Reliant that patient is in ED via point to point

interfaceB. Reliant’s EHR sends CCD to Hospital ED via the Mass HIway

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Between Saint Vincent Hospital/Milford Regional Medical Center and Reliant Medical Group

SVH / MRMC

ADTs

Summary of

Care

CCD with

Hospital MRN

Reliant Medical Group

Mass HIway community grew to 650 organizations

Care Continuum

Hospitals/Health Systems Ambulatory Long-Term & Post-Acute

~58 organizations

Majority of MA hospitals ranging from large health

systems and medical centers to single-site community hospitals

>450 organizations/providers

Primary care providers and specialists across a broad range of medical services

Health centers and clinics providing medical, emotional,

behavioral, and additional social services

Urgent care and minute clinics

~90 organizations

Range of services and organization types

including but not limited to:Area Agency on Aging

(AAA) Aging Service Access Point (ASAP), Skilled

Nursing Facilities (SNF), nursing homes, Inpatient Rehabilitation Facilities

(IRF), home health, palliative care, and hospice

650+ Participants

Note: 10+ additional orgs include Labs, Payers, Imaging Centers, and Quality Reporting service13

Mass HIway Participants

There are currently 650+ participant organizations signed up for the HIway.

– The full participant list is available at http://masshiway.net/HPP/Resources/ParticipantList/index.htm

The Provider Directory contains over 7,000 addresses (department and individual level addresses included)

- The latest Provider Directory extracts are available at the Mass HIway website http://masshiway.net/HPP/Services/ProviderDirectory/index.htm. You will need to sign up to receive monthly notifications of PD extract updates

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51 discreet EHR vendors have been connected, or are currently in implementation

• ADS

• Allscripts

• Amazing Charts

• Aprima

• Athenahealth

• BayCIS/ehana/AMS

• Care at Hand

• Carelogic

• Cerner

• CPSI

• Credible

• Dentrix

• Eaglesoft Clinician

• eClinicalWorks

• EMA Modernizing Medicine

• eMDs

• encite

• Netsmart

• Nextech

• NextGen

• OCHIN (Epic)

• Office Practum

• Point N Click

• PointClickCare

• Practice Fusion

• Practice Partners

• Quest

• Siemens

• SMART

• Soarian

• Spring Charts

• STC

• Unitcare

• WebOMR

• Zoll ePCR

• EPIC

• Flatiron (oncologyEHR)

• GE Centricity

• gEHRiMed

• Greenway

• HealthWyse

• HermesIQ

• Homecare Homebase

• InterSystems

• LMR

• Lytec

• MatrixCare

• McKesson

• Medflow

• MEDITECH

• MediTouch

• MedNet Medical Solutions

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HISP Connections

• 23 Private HISPs connected successfully and can exchange with Mass HIway Participants

• ~7,000 addresses now available in the Mass HIway provider directory

Mass HIway is interconnected with 23 private HISPs – A rich network for Direct

Messaging is fully available to MA providers

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>4 million messages now traverse Mass HIway per month

13 Month HIway Transaction Activity

* Note: Includes all transactions over Mass HIway, both production and test

** Note: Reporting cycle is through the 20th of each month.

4,017,293 Transactions* exchanged in December (11/21 to 12/20/2015**)

35,265,948 Total Transactions* exchanged inception to date

-

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

4,500

Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

2014 2015 2015 2015 2015 2015 2015 2015 2015 2015 2015 2015 2015

Transactions (000's) 623 1,129 1,412 1,626 1,815 1,964 2,148 2,293 2,888 2,713 3,217 3,890 4,017

% Change 81% 25% 15% 12% 8% 9% 7% 26% -6% 19% 21% 3%

Tra

ns

ac

tio

ns (

tho

usa

nd

s)

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2015 HIway Production Transaction Trends by Use Case Type

• Note: Reporting cycle is through the 20th of each month

• 89% of HIway activity in 2015* was for production transactions

-

1

2

3

4

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

Nu

mb

er

of

Tran

sact

ion

s (M

illio

ns)

Public Health Reporting

Quality Data Reporting

Payer Case Management

Provider Org to Provider Org

18% avg. monthly growth

42 senders, 45 receivers

In December

10% avg. monthly growth

5 senders, 1 receiver in

December

6% avg. monthly growth

4 senders, 3 receivers in

December

11% avg. monthly growth

212 senders, 196 receivers

In December

Use Case Trends

PH reporting was the leading use case in 2015 - there has been strong (6-18%) month-over-month growth for all uses

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35,000 unique patients are now in the Relationship Listing Service – RLS is now out of pilot and open to other orgs

13 Month RLS Growth – Cumulative Unique Patients Count

Note: Reporting cycle is through the 20th of each month.

-

5,000

10,000

15,000

20,000

25,000

30,000

35,000

40,000

Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

2014 2015 2015 2015 2015 2015 2015 2015 2015 2015 2015 2015 2015

Total Unique Patients 2,080 2,111 2,138 2,176 2,209 2,211 8,408 14,739 20,050 24,126 28,557 32,466 35,214

% Change 5% 1% 1% 2% 2% 0% 280% 75% 36% 20% 18% 14% 8%

Relationship Listing Service(RLS) Update

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Over 80% of Massachusetts Hospitals or large health systems connected to HIway and continue to enable community for improved care coordination and care transitions

650+ Connected Organizations with over 7000+ Direct addresses across 50+ EHRs and 23 vendor HISP connections

A strong technical backbone that successfully processed over 35 million transactions since ITD and growing consistently with about 4million transactions per month

Reliable and dependable team of Outreach, Implementation and Support members that continue to facilitate, engage and empower healthcare organizations across the care continuum

Deep dive engagement with participating organizations to facilitate clinical workflows for care transitions, discharge summaries, closed loop referrals and exchange other necessary and/or applicable clinical exchange needs

Educate and empower all types of organizations from single provider practices, LTPACs, SNFs, social services to hospitals/large health systems.

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2015 Year Summary

• What is the Mass HIway?

• How can Mass HIway help improve Care Coordination?

• Mass HIway 2015 Year in review

• What’s ahead on the Mass HIway – 2016 & Beyond

• Q&A

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Agenda

Goals established in the 2010 strategic plan still hold as the north star for eHealth in 2016.

2010 Commonwealth of Massachusetts Health IT Strategic Plan Goals:

Goal 1: Improve availability of comprehensive, coordinated, person-focused health

care through widespread provider adoption and meaningful use of certified EHRs.

Goal 2: Demonstrably improve the quality and safety of health care across all

providers, through Health IT that enables better coordinated care, provides useful

evidence-based decision support applications, and can report data elements to

support quality measurement.

Goal 3: Slow the growth of health care spending through efficiencies realized

through the use of Health IT.

Goal 4: Improve the health of the Commonwealth’s population through public

health programs, research and quality improvement efforts, enabled through

efficient, accurate, reliable and secure health information exchange processes.

Strategic Planning

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Tactical goals added this year to complete EHR/HIE adoption, engage patients more deeply, and modernize workflows

2016 tactical goals:

1. EHRs for All: Transition remaining MA healthcare providers to EHRs and provider portals - prioritize Post-Acute Care, Long Term Care, Behavioral Health providers

2. HIE for All: Interconnect remaining MA healthcare providers so they have the capability to exchange clinical information securely and electronically

3. Patient Engagement: Provide patients and care givers with the means to learn about and participate in eHealth

4. Modernize Workflows for Care Transitions: Update clinical workflows for care transitions – prioritize hospital admissions, discharges, transfers and closed loop referrals

2016 Strategic Planning

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7 draft strategies to advance eHealth are currently under consideration by state agency leadership

Strategies to support eHealth goals under consideration:

1. Provide critical technical services in dynamic balance with private market

2. Provide targeted subsidies, grants, and investments to offset provider barriers

to participation in eHealth

3. Provide technical expertise and inter-organizational coordination support

4. Engage Consumers in eHealth

5. Align payment to encourage technology modernization

6. Require technology use through legislation and regulation

7. Cultivate eHealth innovation and entrepreneurship

2016 Strategic Planning Cont.

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Simplification (Ongoing)

1. Simplify connection process and ensure expected timelines are met

Consent Initiative

1. Evaluate feasibility of consent workgroup recommendations and pursue potential policy and procedure improvements

2. Educate providers and consumers about current consent requirements and potential changes

Event Notification Service Initiative

1. Identify, develop and launch new functionality to facilitate new or third-party tools that support care delivery goals

2. Event Notifications Service (ENS) identified as a priority tool to facilitate in the near-term

Mass HIway Initiatives in discussion

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• What is the Mass HIway?

• How can Mass HIway help Improve Care Coordination?

• Mass HIway 2015 Year in review

• What’s ahead on the Mass HIway – 2016 & Beyond?

• Q&A

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Agenda

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If your organization is interested in connecting to the Mass HIway or improving Care Coordination

• Talk to one of the Mass HIway Account Managers that are here today:

• The Mass HIway Account Manager will be your personal liaison to take you through Enrollment, Onboarding, Addressing, Connection steps, and exchanging with your trading partners

Getting Started with Care Coordination?

The Massachusetts Health Information Highway1.855.MAHIWAY (1.855.624.4929) Option 1General Support: masshiway@state.ma.us

www.masshiway.net

Account Manager Email Phone

Murali Athuluri mathuluri@maehc.org 781-296-3857

Len Levine llevine@maehc.org 339-223-3498

Kelly Luchini kluchini@maehc.org 339-222-2143

Question & Answer

Please use the webinar’s chat function to submit a question or feel free to contact us directly after the presentation.

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Visit www.masshiway.net for the latest information, resources and to sign up for our newsletter!

Additional Information

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Commonwealth of MassachusettsExecutive Office of Health and Human Services

Thank you!