Laurance Stuntz Director Massachusetts ehealth Institute

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2 Laurance Stuntz Director Massachusetts ehealth Institute

3 MeHI Overview 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 MeHI is a division of the Massachusetts Technology Collaborative, a public economic development agency 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 Massachusetts ehealth Institute. All Rights Reserved. Confidential.

4 Massachusetts Healthcare IT Drivers Meaningful Use Stage 2 Reporting Starts October 2013 Physician License Requirement Starts January 2015 All Provider Requirement January 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 Massachusetts ehealth Institute. All Rights Reserved. Confidential.

5 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, NCHS data brief, no 111. Hyattsville, MD: National Center for Health Statistics Hyattsville, MD; National Center for Health Statistics, **CMS Health IT Dashboards. ***ONC Data Brief. No. 9. March 2013: Adoption of Electronic Health Record Systems among U.S. Non-federal Acute Care Hospitals Massachusetts ehealth Institute. All Rights Reserved. Confidential.

8 MeHI How We Help Awareness Education Qualify Engage Implement Optimize Motivate Communications Webinar Series Regional Meeting Series HIway Newsletter Grantee Forum(s) EU-US Conference October Adopt 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 Behavioral Health and Long Term Care Planning, Selection, Adoption, Optimization Impact ehealth Economic Development ehealth Firm Listing (>200 firms in MA) Workforce Planning Technology Evaluation for Cost and Quality 8

9 Health Information Exchange Progress Referrals from specialty care to home health Decision support through 2-way exchange of data Coordination of care for elderly psychiatric patients Pre-hospital transport care coordination for homeless Care management for Heart Failure patients Discharge summaries from acute care to SNF and Home Health Massachusetts ehealth Institute. All Rights Reserved. Confidential.

10 10 Demonstrating Meaningful Use for Physician Licensure in Massachusetts

11 Chapter 224 Language SECTION 108. The first paragraph of section 2 of chapter 112 of the General Laws, as so appearing, is hereby amended by inserting after the second sentence the following 2 sentences: The board shall require, as a standard of eligibility for licensure, that applicants demonstrate proficiency in the use of computerized physician order entry, e-prescribing, electronic health records and other forms of health information technology, as determined by the board. As used in this section, proficiency, at a minimum shall mean that applicants demonstrate the skills to comply with the meaningful use requirements, as set forth in 45 C.F.R. Part

12 Demonstrating Meaningful Use Eligible providers can submit their MU attestation data If providers receive an incentive, CMS publishes their NPI and the attestation date for verification If the provider is not eligible for Incentives, how will they demonstrate that they are Meaningful Users? Hospital-based specialties should be able to leverage the EHRs in use at their hospital to demonstrate meaningful use. Rules for this demonstration may need to be developed Non-hospital based specialties may be able to submit measures that conform to the MU rules, but a program will need to be developed to support this certification Regional Extension Center M3 Tool example Board will need to develop rules for other types of non-eligible physicians 12

13 Licensees not eligible for incentives Licensee doesn t qualify for a Meaningful Use Incentive Program Pediatricians who don t see 20% Medicaid OB/GYNs who don t see 30% Medicaid Physicians who don t bill $24,000 to Medicare Hospital-based specialties Pathologists, anesthesiologists, radiologists, etc. There are no Meaningful Use rules for these providers Non-practicing licensees Health plan CMOs, Researchers, Retired Consultants Timing issues To qualify for MU Incentive Payments, physicians need to provide quality measures from a period of performance 13

14 DRAFT Framework for Demonstrating the skills required for Meaningful Use NOT FINAL Category Approx. # in MA Possible Demonstration Method(s) Other Considerations Physician is eligible for MU Incentives 13,000-15,000 (~10,000 have received payments) Submit attestation # Or Submit appropriate quality measures from a certified system What stage will be required? Hospital-Based Physician (90% of practice is Inpatient or Emergency Room) ~5,000 Hospital submits MU certification and attests to physician use of the system Can be verified through MassHealth or APCD claim data Hospitals are required by DPH regulations to adopt EHRs Physician is not eligible for MU incentives and practices outside the hospital Physician is not in clinical practice Total Active Licensees ~4,000-7,000 Submit quality measures from a certified system 1,500-3,000 CME to support knowledge of EHRs and issues related to population health management ~28,000 Full What stage will be required? How will not in clinical practice be defined? 14 New licensees ~2,000 Attestation of certified system to be used Should new licensees have a mentor?

15 15 Licensure Renewal Timing

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17 Manu Tandon Secretariat CIO Executive Office of HHS

18 Commonwealth of Massachusetts Executive Office of Health and Human Services Update on Massachusetts Health IT and HIE

19 Agenda 1. Massachusetts' Vision of Reform 2. Massachusetts ACA IT Initiatives 3. HIE Where we are and where we are headed 4. Benefits of the ACA 19

20 Massachusetts is a leader in health care innovation The Commonwealth has a long and proud history of health care innovation: Chapter 58 First in the nation to secure nearly universal health coverage for all citizens Chapter 224 First in the nation to lay out a plan for cost containment Health care reform in the state is rooted in a strong collaborative effort between the private and public sectors Massachusetts leads the nation in insurance coverage 97% insured 91% of residents report having a usual source of care 20

21 However, there is still more progress to be made Cost containment Massachusetts per capita health care expenditures are among the highest in the nation Health care spending in Massachusetts has nearly doubled over the past 10 years versus while the Consumer Price Index has only increased by 27% Payment reform ~30% of MassHealth lives are in alternative payment models Clinical care delivery transformation ~10% of primary care practices are patient centered medical homes 21

22 Massachusetts Vision of Reform Reduce overall health care costs while ensuring accessible, quality, affordable health care for the Commonwealth s residents by: System redesign Redesigning the health care system to an integrated model in order to deliver higher quality, coordinated, personcentered care Vision: Improved Affordability, Accessibility, and Quality of Health Care Payment Reform Aligning payment methods with desired outcomes through payment reform Consumer Engagement Promoting consumer engagement in health care decisionmaking, and through wellness initiatives 22

23 Mass ACA IT Initiatives ACA heavily promotes the use of information technology as a differentiator to achieve quality improvements and cost containment in the healthcare system. In Massachusetts three major ACA driven IT related initiatives are being executed in parallel. Health Insurance Exchange (HIX) and Integrated Eligibility System ( ) Statewide Incentives to promote use of Electronic Health Records ( ) Statewide Health Information Exchange (HIE) phased in from

24 Massachusetts Health Insurance Exchange (HIX) and Integrated Eligibility System (IES) Allows individuals and small business employees to access a central marketplace of health plans. Streamlined eligibility across unsubsidized, subsidized and Medicaid The new solution required updates to existing MA state systems: Leveraging existing Health Connector site Leveraging current self-service solutions for Medicaid members Integrating and pulling health care eligibility rules under one umbrella Massachusetts approach was to build a reusable component based custom solution in the public domain that can be leveraged by other states. Massachusetts also has build an integrated eligibility platform that would allow other means based program to leverage the underlying platform. 24

25 Massachusetts Medicaid EHR Incentive Payment Program Program to provide financial assistance to providers who install EHR systems and subsequently achieve Meaningful Use Mass share of population 2.1% Nationwide Medicaid EHR incentive payments $ 5,338,067,398 Mass EHR incentive payments to date $ 138,347,416 MA share of total incentive payments issued 2.6% Number of Nationwide Payments 100,770 Number of MA Payments 3,749 MA Share of Payments 3.7% 25

26 Several communities have begun working together for purposes of exchanging health information VITL NH- HIO NYeC North Adams Berkshire Health Holyoke Emerson Winchester Newburyport Beverly Baystate SafeHealth NEHEN South Shore RIQI Sturdy Cape Cod Health 26

27 A statewide HIE service flexible to a wide variety of current and future market needs Illustrative example HIE infrastructure and operations program HIE last mile adoption program 27

28 Mass HIway serves as the Hub for Health Information Exchange Health System Patient Hospital Pharmacy Mass HIway Small Practice Labs Public Health Behavior al Health 28

29 Mass HIway Phasing Release 1 (2012) Send and receive Create infrastructure to enable secure transmission ( directed exchange ) of clinical information Will support exchange among clinicians, public health, and stand-alone registries Focus on breadth over depth Release 2 (2013) Search and retrieve Create infrastructure for cross-institutional queries for and retrieval of patient records Add additional public health services 29

30 3 Ways to Connect to Mass HIway Services User types 3 HIE Access Methods HIE Services Phase 1 Phase 2 Physician practice EHR or PHR connects directly Provider directory Master person index Hospitals Long-term care Other providers Public health Health plans Labs/imaging EHR connects through LAND Certificate repository Consent database DIRECT gateway Record locator and retrieval service Browser access to HIE portal and webmail inbox Patients Web portal mailbox 30

31 HIway Connection Pricing 31

32 The Mass HIway Goes Live Oct 2012 The first-in-the-nation CMS-funded HIE, the Massachusetts HIway, went live on October 16, 2012 in a Golden Spike ceremony at MGH Over 1.5M transactions have now traversed the MA HIway, with over 45 organizations live 32

33 45 Organizations Live on the HIE Beth Israel Deaconess Medical Center Women's Health Associates of MA Holy Trinity Nursing and Rehabilitation Center Tufts Medical Center Central MA IPA Taunton Nursing Home Partners Healthcare Millbury Health Care Center River Valley Health Mass ehealth Collaborative Notre Dame LTCC Network Health Atrius Health Jessica Foley, LMHC Holyoke Health Reliant Medical Group Heywood Hospital Holyoke Medical HIE Beaumont Rehab & Skilled Holyoke Medical Center VNA Care Network Nursing Center Boston Childrens Hospital MetroWest Medical Center Holyoke Medical Center Specialties Milford Regional Medical Center Jewish Healthcare Center Care Tenders Medway Country Manor St. Vincent Hospital Brockton Neighborhood Healthcare Pediatric Care Associates Boston Public Health Western Massachusetts Physicians Associates 12 Individual, independent practices (within Holyoke HIE) 33

34 55 Orgs with Signed agreements We have 55 organizations that have signed agreements and are in various stages of moving toward Live Status 16 are actively moving toward Implementation/Live status 19 are awaiting for vendor solutions to be deployed with the next step to test with the HIway 10 are awaiting the Hiway/Vendor to enable the HISP-to-HISP solution 34

35 Mass HIway Website Single source of HIway information: Enrollment forms Rate Card Policies/Procedures Helpful Links (MeHI, Advisory Groups, HITC, etc.) Access point for future services: Provider Portal Self-Service Enrollment Provider Directory self-service 35

36 RLS and Query-Retrieve Available through HIway Portal or Integrated in EHR Data requestor Record search: Portal or EHR-integrated Phase 2 HIway Service Relationship Listing Service Four Query-Retrieve Methods Manual retrieve Cross-entity viewing Find record location via portal Retrieve records manually (phone, fax, etc) View other EHR within own EHR or HIE Portal SSO-like access between participating systems Record request: Portal- or EHRgenerated Record response: Directly back to requestor (ie, portal does not RECEIVE any response information) Push-Push Request Asynchronous reply Query-response Query Synchronous response -like manual process Does not require new standards leverages Stage 2 MU Query with automated response Like electronic eligibility or RX history requests Requires new standards beyond Stage 2 MU 36

37 Overview of HIway Query-Retrieve Use Patterns Relationship Listing Service Patient name Local name Institution MRN Last visit date # visits Jones, Jennifer L Jones, Jennifer Hospital A 1234 Dec 3, Jones, Jennifer L Jones, Jenny PCP 5678 Jul 8, Send demographics to RLS 4. View Patient Relationships (constrained to patients with established relationships) 5. Request patient record Specialist N PCP Y Hospital A Y 6. Send patient record Hospital B Y 1. Consent to Publish Provider Relationships 3. Consent to Search or Retrieve Jennifer L Jones Jennifer L Jones 37

38 HIway Provider Portal (HPP) Future features to include single sign-on and launch from within EHRs (pending vendor collaboration) 38

39 Landing Page to them Search for Patients on the HIway Request a Patient s medical record Area for notifications, HIway information, etc. 39

40 Search for Patient Search by demographic data or MRN & MRN Issuing Organization Only direct matches returned (no fishing or wild card searches allowed) 40

41 Patient Relationship Summary Displays Organizations having sent patient consented information (ADT message) to the HIway Relationship Listing Service (RLS) Displays the number of encounters for each Organization and the date of the most recent ADT message sent to the HIway 41

42 Relationship Selection Displays basic Organization information for reference and manual retrieval Displays electronic retrieval options (Cross Entity Viewer or Medical Record Request) Electronic retrieval options displayed based on permitted query methods from both the requestor and data holder 42

43 Medical Record Request HIway sends request for a patient s medical record on behalf of the requestor Medical record source system evaluates request and responds directly to requestor HIway Portal only tracks request no visibility of response 43

44 Cross Entity Viewer (aka Magic Button) JONES, JOHN M 55 Aug 27,1957 JONES, JOHN M 55 Aug 27,1957 Option is only presented as a link to entities who have determined agreements and parameters in advance Patient data is viewed in a separate browser window completely independent of HPP 44

45 HIway Phase 2 Timeline Activity CMS approval of Phase 2 IAPD Mass HIway Phase 2 high level project schedule Phase 2 contract (or change order) executed Go-live - Public Health - Immunization Registry Node Go-live - Public Health - Reportable Lab Results (ELR) Node Testing - Public Health - Syndromic Surveillance Node Testing - EOHHS Children s Behavioral Health (CBHI) Node Phase 2 Requirements Gathering & Validation Phase 2 Design Approach Decision Target date Completed Completed Completed Completed Completed Completed Completed Completed Testing Opioid Treatment Program (OTP) Node Sept 2013 Completed Go-live Cancer Registry Node Dec 2013 Go-live Lead Poisoning Prevention Program Node March 2014 Go-live for Phase 2, Release 2 (EMPI, RLS, Consent, Provider Portal, Consumer Portal) Oct 2013 Mar

46 Top 10 Benefits Of the Affordable Care Act (ACA) for Massachusetts 10. Enhances insurance protections by eliminating limits on the amount of benefits you can receive. 9. Expands coverage to young adults, who are now able to stay on their parents coverage until age Provided more than $130 million to community health centers in Massachusetts to strengthen their programs while expanding access to primary care for community members. 7. Provides grants to improve emergency medical services for children, reduce childhood obesity and encourage tobacco cessation. 6. Supports the goals of the Commonwealth s 2012 cost containment law by promoting the formation of Accountable Care Organizations that reward quality and efficiency of care rather than the quantity of care. 5. Closes the donut hole in Medicare prescription drug coverage, making prescription drug coverage more affordable for seniors. Nearly 60,000 Massachusetts seniors saved an average of $667 each on prescription drugs in Most health plans must now cover preventive services like shots, smoking cessation and cancer screenings at no cost to the consumer. 3. Very low-income employees who cannot afford their employer s coverage will become newly eligible for MassHealth, without any penalty for employers. 2. Streamlines state health insurance programs while providing additional federal reimbursement for people already covered. The ACA also provides grants to help states protect taxpayers from excessive premiums. 1. Extends health subsidies to those with incomes up to 400% of the federal poverty level (approx. $46,000 for an individual), making health insurance affordable for more low-and-middle-income families. 46

47 Contact Details Manu Tandon CIO, Massachusetts State HIT Coordinator 47