MeHI Last Mile Implementation and Support

MeHI Last Mile Implementation and Support

Agenda MeHI Introduction HIE Implementation Last Mile Program 2

Massachusetts ehealth Institute Enabling Exchange of Healthcare Data 3

MeHI Overview Division of the Massachusetts Technology Collaborative, a public economic development agency State's entity responsible 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 that are networked through the statewide HIE Managing HIE and REC grants from Office of National Coordinator Chapter 305 created MeHI, which is overseen by the Health Information Technology Council Mass Technology Collaborative Board of Directors 4

MeHI Current Programs Health Information Exchange: Working in collaboration with other state entities and its private partners to deploy a secure statewide health information exchange. MeHI is responsible for supporting the Last Mile Initiative: connection, education and optimization. Regional Extension Center: Offers multitude of services designed to help primary care providers implement and meaningfully use EHRs and engage in health information exchange. Massachusetts Medicaid EHR Incentive Payment Program: MassHealth has partnered with MeHI to support key operational components of the Massachusetts Medicaid EHR Incentive Payment Program, with a goal is to reach 7,251 eligible providers and 64 eligible hospitals. 5

MeHI Statewide HIE Partnering With Executive Office of Health and Human Services (EOHHS) The Executive Office of Health and Human Services and more specifically, MassHealth, the Commonwealth s Medicaid Agency, will implement and deploy the HIE services and procurements. MeHI will focus on end-user integration and the Last Mile program that will maximize connectivity and effective use of the HIE by as many providers as possible. 6

Massachusetts Health Information Exchange 7

Update on the Health Information Highway 8

MA HIway Planning the Year in Review MA HIway planning milestones: September 2011 October 16 th, 2012 HIE HIT Advisory Committee and 5 multi-stakeholder work groups launched Statewide HIE and Medicaid strategies unified with widespread stakeholder support Sustainability model developed and presented to CMS and ONC HIT Council transferred funds to EOHHS to leverage federal Medicaid funds EHR vendor and HIE user roundtables held to gain input to strategy Updated strategy approved by CMS and ONC Orion selected as HIE vendor Customers step forward and form golden spike group PAs and Pricing developed and vetted with customers HIway go live! Oct 11 Jan 12 Apr 12 Jul 12 Oct 12 9

Why are we confident about the MA HIway? Incremental approach to remain flexible to market advances and not get ahead of national and industry-wide standards Technical standards aligned with 2011 and 2014 Edition Certification standards Multiple integration options to be accessible to wide variety of customers Starting with simple, standards-based commodity transport services to provide statewide dial-tone service available to any health care organization Complements and supports private HIE activities without trying to replace or compete with them Statewide provider directory and PKI Multiple drivers of sustainability Shared infrastructure with Medicaid and HIX Federal and State Medicaid participation subsidizing over 80% of ongoing costs Low annual subscription fees to customers High-level of customer and stakeholder engagement Many organizations across the continuum of care already enrolled and engaged in implementation work to go live on October 15 10

Stages of Implementation Massachusetts has adopted a three-phase approach to the development of its HIE infrastructure: Phase One (2012-2013): provider-directed exchange of electronic health information, provider can push health information to another provide;, e.g., Here is everything I know about Mrs. Jones. Phase Two (2013 2014): development of registries and analytical repositories. Phase Three (2015): add support for query-based health information exchange; e.g., Tell me everything I m allowed to see about Mrs. Jones. 11

Golden Spike Declare integration preference: 8/20/12 Detailed Technical calls started: 8/28/12 HIE Test System Ready: 9/17/12 Rolling Go- Live starts: 10/16/12 GS Group Participants Atrius Health Baystate Berkshire Medical Center Beth Israel/Deaconess Children s Hospital Holyoke Medical Center Network Health Partners Healthcare Tufts Medical Center Vanguard 12

Pricing 13

HIE Last Mile Program Enabling Exchange of Healthcare Data 14

Last Mile Program Program Goal Stimulate adoption and use of State Health Information Exchange (HIE) to improve coordination of care and clinical outcomes and reduce costs. Program Components Education Connection Optimization Education Optimization Connection 15

Last Mile Program Education and Outreach Providers Thought leadership on health information exchange, Meaningful Use, continuity of care, etc. Education materials: available online and distributed to practices MeHI Regional meetings and training sessions Consumers/Patients Patient materials, such as patient tool kit available in the provider practice and online EHR Vendors Information on Last Mile Program Vendor technical assistance with Direct integration 16

Last Mile Program Connection User types Support the three methods of connecting to the Commonwealth s HIE HIE Services Physician practice EHR connects directly Provider directory Hospital EHR connects through LAND (Local Application for Network Distribution) Certificate repository Long-term care Other providers Public health Health plans Direct gateway Browser access to webmail inbox 17 Labs and imaging centers Web portal mailbox

Last Mile Program Workflow Optimization Designed to enhance efficiency and effectiveness Available to all healthcare providers Grants available for qualified providers 18

Last Mile Program Driving Adoption Supply-side programs Program description 1 2 Vendor awareness/ activation Managed procurement of development Activate leading MA vendors through direct engagement Sell the vendors on why they should work with MA Build market demand for statewide HIE connectivity Provide vendors easy to use information resources Provide vendors with forums for learning and asking questions Purchase interface development on behalf of MA providers Demand-side programs 3 Provider awareness/ activation Integrate provider engagement program with overall communications plan Work at all levels to engage providers to join statewide HIE 4 Support for provider integration Grants to providers for integration costs Technical support to manage provider-side of EHR integration 19

Last Mile Program Management Office Goal: Connect 50,000 providers in the state to the HIE over the next two years Key LMMO Activities Offer technical assistance and financial incentives to EHR vendors in the state to accelerate the development of Direct messaging interfaces Establish vendor-specific project timelines with each of the participating EHR vendors Coordinate the necessary technical and project teams to ensure delivery according to the agreed upon scope and timelines. Ensure appropriate standards/implementation guides are available Provide oversight, vendor management, facilitation and coordination of requisite meetings, progress and risk reports, and other tasks that will be required to keep the interface projects on track. 20

Last Mile Program Vendor Grant Program Goal: Stimulate the rapid adoption of the state s HIE services to help the largest number of providers connect to the Massachusetts HIE in the shortest amount of time Encourage and support Electronic Health Record (EHR) vendors in the integration of the Direct messaging transport protocols within the workflow of their applications Support the development of an interface within the EHR application to enable providers the ability to create and send a Direct message to any other Massachusetts provider via the Massachusetts HIway Open to any EHR Vendor that currently markets an EHR system in Massachusetts and is federally certified by an ONC-authorized certification body Two tiers: Tier 1: Directed grants available to commercial EHR vendors with 3% or greater market share in Massachusetts. Tier 2: A competitive challenge grant program available to all other interested vendors. 21

Last Mile Direct Assistance Program Goal: Support communities and providers with the detailed work of adopting the Massachusetts HIE Key Aspects of the Program: Coordinate HIE Adoption in natural healthcare referral circles Provide additional support for ambulatory and hospital providers with limited financial and technical resources Behavioral Health Providers Unaffiliated Primary Care Physicians Community Hospitals and Health Centers Long-term Care Providers 22

Last Mile Time Table Last Mile Support Vendor Contracted October 2012 HIE Backbone 'Go-Live' 10/16/12 Last Mile Support Vendor Starts Oct/Nov 2012 Last Mile Program Complete (under HIE Federal Grant) 1/31/14 EHR Assessment Complete 7/15/12 ' 12 Jul 2012 Sep Nov Jan 2013 Mar May Jul Sep Nov Jan ' 14 2014 8/8/12 Education & Outreach 2/14 8/20/12 EHR Vendors Developing and Deploying HIE Connections 2/14 9/16/12 Enroll Providers in Statewide HIE 2/14 10/16/12 Provider Practice Deployment 2/14 23

Massachusetts EHR Vendor Landscape 24

80% of surveyed Massachusetts healthcare providers that use EHRs are using one of 7 EHR systems 25% EHR vendors with greatest share of Massachusetts provider customers % of total providers surveyed 20% 15% 10% 5% 80% 90% Notes: 7 Vendors serve 80% of surveyed providers 9 Vendors serve 90% of surveyed providers Over 90 EHR vendors represented 0% EHR vendors (names provided in chart) 25

A deeper dive by provider segments reveals additional leading EHR vendors Leading vendors serving providers working in Non Hospital employed Med & Small practices (<10) Hospitals Non Hospital employed large practices (10+) 80% 80% 80% Hospital Employed practices Pediatric practice Long Term Care 80% Community Health Centers 80% 80% Behavioral Health 80% 26

There are 16 vendors on the 80% short list when all sub-segments are accounted for Top vendors overall EHR vendors serving 80% of MA providers + provider segment leaders = 80% short list Meditech LMR (Self developed) Cerner Allscripts eclinicalworks GE WebOMR + Top inpatient vendors + Top Practice based vendors + Top Long Term Care vendors + Top Behavioral Health vendors Siemens Epic NextGen athenahealth Quest Care360 E-MDs Point Click Care Netsmart Technologies UNI/CARE Systems 27

Several communities have begun HIE work Aggregators are beginning to think about how to interface with statewide HIE VITL NH- HIO NYeC North Adams Berkshire Health Holyoke Winchester Emerson Newburyport Beverly Baystate SafeHealth NEHEN South Shore Aggregator Organization Summary 48 Physician Hospital Organizations (PHOs) were identified through provider survey - 42% of provider survey respondents are PHO members 36 IPAs identified through surveys - 28% of provider survey respondents are IPA members 8 of the CMS ACO pilots are in Massachusetts RIQI Sturdy Cape Cod Health 28

Of the vendors interviewed few are capable of DIRECT many have some capability for transporting health information EHR vendors capability summary Ability to deliver DIRECT compliant EHR 14 5 Ability to follow IHE profiles (XDR, XDS, XDM) 7 6 12 7 No Capability Some capability Full capability Ability to follow S/MIME SMTP standards 17 4 5 Ability to embed native link to web portal 0 5 16 Ability to pass credentials to web portal (SSO) 3 7 5 Ability to interface with Provider Directory 15 6 5 Ability to interface with PKI service 7 11 8 Ability to assemble & send and receive & import 0 7 19 N = 26 Count of EHR vendors interviewed that answered question 29

Vendors are moving directionally toward DIRECT development, but timing and focus are highly varied Vendor timing for a DIRECT software version release (n=26) Statewide HIE launch date October 15, 2012 7 8 10 MU Stage 2 begins: Q4 2013 11 (EH) Q1 2014 (EP) 15 1 Today Q4 2012 Q1 2013 Q2 2013 Q3 2013 No clear roadmap Cumulative number of vendors implementing DIRECT protocols 30

Vendors requested technical guidance, forums for learning, joint go to market approach, and funding from Last Mile program Vendor input on resources and assistance Last Mile program could offer Provide clear technical guidance Provide forum for vendors to learn and interact with the state and other vendors Conduct outreach and communication Provide education Provide support at the practices Provide financial support 31

The MA statewide HIE program has a number of levers available to ease last mile integration Communication with providers Grants to providers MeHI (Include in communication plan) EOHHS (Include in MassHealth communication plan) Integration support to providers X (Some through Orion) HIE pricing Communication with vendors X X Grants to vendors Technical guidance to vendors X X (communicate EOHHS technical guidance) X X 32

Thoughtful orchestration of levers will connect the largest number of providers in the shortest amount of time Multi-segment providers In-patient vendors Low High MA Provider Share 3 21 4 23 6 7 Actively engage, promote LAND option, provide grants Build awareness of LAND and web portal 26 12 27 28 19 1 11 2417 13 15 16 18 20 25 Actively engage, promote LAND and direct integration, provide grants 8 Actively engage, promote LAND and direct integration 2 9 10 14 29 5 1 LMR 2 Cerner 3 Allscripts 4 eclinicalworks 5 WebOMR 6 Epic 7 GE/Qvera Practice based vendors 8 NextGen 9 Athenahealth 10 Quest Care360 11 E-MDs 12 PCC 13 ehs Med 14 Greenway 15 ipatientcare 16 Medstreaming 21 Meditech 22 Seimens LTC vendors 23 Point Click Care 24 SigmaCare 25 ADS Beh. health vendors 26 SMIS 27 Echo Group 28 Interaction Tech 29 Qualifacts Not interviewed 22 17 Vitera Low DIRECT Capability High 18 19 Connexin Comchart 20 Amazing Charts 33