HIT Council

Health Information Technology Council August MeetingAugust 5, 20133:30-5:00 P.M.One Ashburton Place, 21st Floor,BostonCommonwealth of MassachusettsExecutive Office of Health and Human Services

1Todays Agenda:Meeting Minutes approval [5 min]Last Mile Program Update [10 min] Sean Kennedy Mass HIway Implementation UpdatesBaystate Healthcare/Pioneer Valley Information Exchange (PVIX)[25 min] Heather NelsonBeth Israel Deaconess Medical Center [10min] John HalamkaAdvisory Group Discussion & Updates [20 min] Micky TripathiMass HIway UpdateImplementation & Support Update [10 min] Manu TandonPhase 2 Update [5 min] Manu TandonWrap up and next steps [5 min] Manu TandonAgenda22Discussion Item 1: Last Mile Program Update33Outreach updateSales UpdatePrograms UpdateInterface Grant ProgramImplementation Grant ProgramLast Mile ScorecardComing SoonLast Mile Program Update4Outreach = Demand CreationCollateral development

CollateralPurposeURLHIway SummaryGeneral purpose 2-page brochurehttp://www.mehi.masstech.org/sites/mehi/files/images/HIway/HIway-Overview-Final.pdfHIE Use Case GuideGuide use case ideation & generationhttp://www.mehi.masstech.org/health-information-exchange-0/mass-hiway/develop-hiway-use-caseHIway FAQsTo respond to commonly asked questionshttp://www.mehi.masstech.org/sites/mehi/files/images/HIway/HIway%20FAQs%20July%202013.pdf5Outreach = Demand CreationCommunications

MediumPurposeCommentsMass HIway ConnectorMonthly topical information with a goal of propagating HIway updates and emerging best practicesSent to ~ 1,614Avg open rate 22%Social MediaBroad digital outreach to share daily, weekly activities; grow awarenessTwitter is main source; evaluating Linked InHealth IT CommunityForum for collaborationHIE group serves our GranteesPressPress releases (e.g. Implementation & Interface Grants)and select coverage (e.g. regional grant coverage)http://mehi.masstech.org/news6GoalsEncourage vendor development of Direct-complaint interfaces, initiated within the workflow of their applications and that will enable use of the Mass HIway by Massachusetts providersAccelerate connections to the Mass HIwayGrow transaction volume Support our ultimate goal: to demonstrate measurable improvements in care quality, population health, and cost containment through use of health information technology and the Mass HIway

HIway Interface Grants 7Grant RequirementsInterface StandardsAdhere to Direct Project Standards for packaging, encrypting and transmitting messages.Use standard documents: C-CDA CCD preferred.Integrated into the workflow of the applicationNumber of Customers in Massachusetts 4 or more current live installations of the product and version on which the interface will be developed.2 customers willing to join the Mass HIway and implementAgree to make the interface available to all Massachusetts customers by 1/31/2014 or first release after the grant period ends.HIway Interface Grants 8MilestoneDescription1HIway Grant Agreement signedLetters of support from 2 customers willing to implement the interfaceUpdated work planLogical architecture diagram2Use case description (to include details on the data to exchanged), any 3rd party applications or services included in the solution3Inbound and outbound test transactions exchanged using the Mass HIway test account 4The interface implemented at 2 or more Massachusetts customers that have joined the Mass HIwayA test transaction exchangedFinal ReportAll required support documentation provided to MeHIHIway Interface Grants 9Grantee description9 of 12 have signed the grant agreement. We will share the grantees at next HIT-C.NOTE: GE and NetSmart were awarded Interface Grants under the Tier 1 solicitation; lifeIMAGE has an Implementation GrantHIway Interface Grants DescriptionAmountAmbulatory EHR & Practice Management$101,085.00Ambulatory and Inpatient EHR$108,000.00Ambulatory EHR$50,000.00Imaging $59,720.50Ambulatory EHR$150,000.00Behavioral Health EHR$150,000.00Homecare$75,000.00Homecare & Hospice EHR$92,600.00Practice management$150,000.00Patient engagement$150,000.00Physician practice patient portal$51,940.00Ambulatory EHR$150,000.00Total$1,288,345.5010Grant GoalsBuild awareness of the HIway Catalyze & accelerate connections to the HIwayBuild the HIways value & cultivate stories

HIway Implementation Grants11UpdateGrant Agreements signed 31 / 32Grantees achieved M1 4 / 32Organizations signed PA 29 / 7575 = high number; may be fewer depending on how orgs choose to connectGrants with collaborators in the following sector:Behavioral HealthLong-term Care 19 / 32Small PracticeGrant Program kick-off call attendees 70+Grantee-specific kick-offs 29/32HIway Implementation Grants12

Grantees & their trading partners by location

32 grantees80 unique trading partners$2.3MHIway Implementation Grants13MilestoneDescriptionDeliverable(s)1HIway Participant Agreement signed by all organizations that will be exchanging dataSigned Grant AgreementUpdated WorkplanSigned HIway Agreements & W-92Initial Participant Directory entries loaded for all trading partners - at least one (1) entry per organizationSubmitted [and accepted] PD xls to HIway Ops for each trading partner3HIway test transaction success among all trading partners (confirmed by HIway Operations)Executed test transaction using the production solution by each trading partner; confirm to MeHI by HIway Ops4HIway production transactions exercising the identified use caseEmail to MeHI PO certifying you executed your use case in productionHIway Implementation Grants14

Sean KennedyBaystate HealthBerkshire Health SystemKeely BensonWinchester Highland Management, LLCSalter HealthcareJoe KynochCentral MA Independent Physician AssociationThe Dimock CenterJim BushCenter for Human Development, IncClinical & Support Options, Inc.Harbor Medical AssocHebrew Senior Life/Hebrew Rehabilitation CenterHolyoke Health CenterHome Health VNAMetroWest Accountable Healthcare OrganizationMilford Regional Medical CenterNetwork HealthNorth Adams Regional HospitalUMass Memorial Health CareSo Shore HospitalKevin MullenCommunity Healthlink, Inc.Cutchins Programs for Children & FamiliesEasCare Ambulance Service, LLCHigh Point Treatment CtrJoseph M. Smith Community Health CenterOverlook Visiting Nursing AssociationPinnacle Health Management, LLPSenior Link via Caregiver HomesTrustees of Noble HospitalHeywood HospitalMRN Corp/Sippican Healthcare CenterLife Image, Inc.

HIway Implementation Grants POs & Grantees15CY2013Q1 Q2 Q3 Q4 TOTAL PAs signed0 / 216 / 216275160Organizations enabled for connection 0 / 3912 / 7 *75200321Vendors enabled for connection 0 / 00 / 021012ONC Grant $ Spent30% / 35%46% / 44%68%91%91%Last Mile | Scorecard TargetsNOTE: Planned / Actual

* Q2 - major push was to conduct the HIway grant solicitations Implementation & Interface GrantsONC Grant Spend Down Trackeras of 6/30/20130Spent to Date $5.9M44%Committed$9.98M75%$13.2MProjected$13.2M100%16Coming soon

ItemDescriptionCommunity Engagement ProgramA program designed to educate providers and consumers on the HIway Provider ToolkitA toolkit that arms organizations with basic HIway information so they may directly educate their communityHIway Services Summary A polished white-paper-type document that provides a broad overview of the HIway services, connection options, path to connectionHIway Implementation Grant SummaryA refined summary of each grant; intended for healthcare professionals and the pressPath Forward for one Implementation GranteeMilford Regional Medical Center to share their plans to connect to the HIway17Discussion Item 2: Mass HIway Implementation Updates Baystate Healthcare/Pioneer Valley Information Exchange(PVIX), Beth Israel Deaconess Medical Center1818Heather Nelson, Senior Director Enterprise Clinical Applications and IT Operations

HIT CouncilAugust 5, 2013

Baystate HealthPioneer Valley Information Exchange (PVIX)OverviewMission of PVIXPVIX Phase 1 & Timelines PVIX Architecture Patient ConsentUpdate on MeHI GrantPVIX to MA HIway Architecture ChallengesFuturesAbout Baystate HealthAt a GlanceType of Organization: IDN/ teaching hospitalFTEs: 10,000+Physicians: 1700 (580 employed)Academic Program: ~320 residents in 1o ACGME-accredited residencies & 20 fellowships; 250 medical studentsHIMSS Analytics Level 6Statistics$1.6B revenuesInpatient Facilities: 840 beds at 3 sitesAdmissions: 44,000Patient Days: 210,000Amb Practices: 70 Primary & Specialty Care sites

21About Baystate Health

Other details:831combined bed total at Baystate Medical Center, Baystate Franklin Medical Center and Baystate Mary Lane Hospital1.3 million outpatient visits, including home visits, throughout the year43,003 patients admitted for care15 Baystate Medical Practices are NCQA-Certified Patient Centered Medical Homes128,605 home visits by Baystate Visiting Nurse Association & Hospice nurses

22

Pioneer Valley Information Exchange (PVIX)Connecting our Communities of CareSharing a common vision about Community:To provide Clinicians access to relevant healthcare information as frictionless as possible to ensure cost-effective, high quality care;To empower Patients with information and tools to enrich their relationship with their clinician and lead healthier lives;To connect our Care Communities in a way that improves population health, the care experience, and cost;To Collaborate so that we do this in a way that is unified, sustainable, and effective. Many private HIEs in Western MA underway

Community is concerned about too many HIEs for connecting

PVIX focus is to be Hub among Western MA community Hubs

NEHENNorth AdamsPVIXSafeHealthNewburyportRIQIVITLNYeCBeverlyWinchesterHolyokeEmersonSturdyBerkshireHealthSouth ShoreNH-HIOCape Cod HealthHITE-CTBoston Medical CenterMercy/SPHSCDHPVIX As The Connector24Initiated by the Community

Community (founding members)AdvisorPlatform

PVIX is the Foundationto a Larger Information Platform VisionAggregated Data RepositoriesKnowledge Platform

Center for AnalyticsBig DataPioneer Valley Health Information Exchange (PVIX)EHRLab & RxRegistration (ADT)Practice ManagementClaimsGenomicsOther Data SourcesProductsProduct TranslationInnovation CenterProduct Development & ResearchInnovationsAnalytic FeedsDataInformationInsightActionBaystate Medical Center, like many hospitals, is undergoing a major remodeling of its operations in light of the Affordable Care mandates.Their approach is heavily based on information technology and they are making major investments in systems and people.All except the upper right rectangle is part of this remodeling.The Innovation Center, in connection with PVLSI, will use the separate $5.5 million MLSC capital investment to leverage the infrastructure and become a test bed for product development, behind the firewall.We will link to that directly in the area of patient monitoring.26PVIX & MeHI Grant TimelinesHIE build & testPVIX Phase 1:Requirements & DesignPVIX Phase 1: ScopeVendor SelectionVendor of Choice: InterSystemsPolicy, Governance, Business ModelPVIX Phase 2:Requirements & DesignPVIX Phase 1: BH Go-LivePVIX Phase 1A: Addl Mbr Go-LivesOct Dec 2013PVIX, LLC PA MeHI Grant Approval & Kick-OffMeHI Grant build & testMeHI Grant Go-LiveLetters of Intent Signed by PVIX Trading PartnersPioneer Valley RegionalHealth Information Exchange SummitLOIs Signed:Riverbend Medical Group Valley Medical Group Valley Medical Associates Springfield Medical Associates Berkshire Health System Baystate OB/GYN Group Sisters of Providence Health System (Mercy)Noble Hospital

27Phase 1: Connecting Our CommunitiesHealth Information Exchange

Medical Groups

Family

Patient

Community Health Center

Specialties

Hospital

PVIX

Other HIE,Health Plans,EmployersFeatures in Phase 1:Master Patient IndexPatient Demographics and Visit InformationDischarge/Visit Summaries Lab ResultsContinuity of Care Document including Allergies, Problems, Immunizations, Medications and Vital SignsEncounter Event notifications example PCP notified of ED AdmissionSingle Sign on from participants EMR into PVIX if supported by EMR vendorProvider to Provider MessagingConsent ManagementPVIX Architecture

29Patient Consent

HIPAA Compliant

Current consent to treat and share information IS permission to share information. Providers already get consent to share information with other providers involved in the patient's care.

Any organization can choose to have a higher level of consent for PVIX, however, that is NOT required by law.

The MAHIWay does require opt-in. The State is advising that a general consent to treat and share along with a specific reference to the MAHIWay in the NPP would constitute an acceptable form of opt-in for the MAHIWay. 30PVIX HIPAA-Based Access Controls

Update on MeHI GrantKick-off in early-July with MeHI teamAim #1 Transition of Care AlertAim #2 Collaboration & Information ExchangeAim #3 Care Plan DisseminationAim #4 Medication AdherencePreliminary architecture reviewed and design is underwayProject team forming (internal and external resources)Bi-weekly meetings scheduledMilestone #1 met:Project Plan drafted and sent to MeHI teamParticipant Agreements signed and returned to MeHI teamMeHI Grant Participants:BMP/BMCBHVNAHRiverbend Medical GroupValley Medical AssociatesBaycare Health PartnersSisters of Providence Health System (Mercy)Berkshire Medical

Description of Grant (Goals):This project will demonstrate how alignment can be possible even among cordial competitors because sharing information and collaborating on behalf of the patients is the right thing to do for the patients that we share.This grant proposes to utilize the local HIE and the MAHIWay to connect the non-affiliated and technology diverse providers enabling communication, collaboration, and information exchange about an HF patient. This project also aspires to develop a basic medication reconciliation algorithm. Deriving data from SureScripts medication history as well as order history from the local HIE and EHRs, the algorithm should present a comprehensive and potentially de-duplicated med list to the provider at discharge. The project also looks to alert primary care providers and care managers of patients who were ordered a med post-discharge but did not pick up after 24 hours. This project also looks to disseminate the post-discharge Care Plan through to all providers involved in the patients care, including the patient, to ensure that the plan of care is executed. The expected outcome from this MAHIWay implementation project is increased collaboration between physicians caring for CHF patients evaluated in an ED or admitted to an acute care facility. 32PVIX to MA HIway Architecture

PVIX Relationship with HIwayPVIX will sign the Technical Integration Vendor agreement on behalf of its members

Chain of trust extension PVIX members will sign the PVIX PA which will also include the MA HIway PA as an addendum

PVIX accepts HIway certificate

PVIX customers loaded in HIway directory .@direct.pvix.masshiway.net

Challenges Weve FacedOn-boarding trading partnersPVIX is ready.the EMR vendors may not beEMR vendor readiness with information exchange features & functionsContinuity of Care DocumentsLegal TasksParticipant AgreementIdentifying the future state and value-added servicesOperational Sustainability Phase 2 challengeFuturesPhase 2: Value Added ServicesSustainability through membership subscriptionPatient Engagement PlatformBH Patient & Employee Portal to support Meaningful Use State 2 and beyondCommunity Portal for Western MAHealth Plans as PVIX Trading PartnersAnalytics to support:Population HealthIntegrated Case ManagementResearchMobile Solutions

Thank You.

Questions?Beth Israel Deaconess Medical CenterMass HIway Progress Report38

BIDMC Mass HIway Progress ReportExchanging Data over the HIway with:MAeHCMDPH ImmunizationsMDPH Lab reportingNetwork Health C32's and Lab HL7

Testing HIway Data Exchange with:MDPH SyndromicBPHC LabsBPHC SyndromicPartners Joint patient management initiativeAtrius They need to setup an automated conversion from CCD to EPIC transcription

39Discussion Item 3: Advisory Group Discussion & Updates403 of the Advisory Groups met in July and revisited the phase 2 draft design in more detail

The Provider AG gave input on the following:Responsibilities of data holders and data requestorsCommunicating with patients regarding consent for Phase 2 services (RLS publish, RLS view, medical record request)Implied consent in Emergency Department use cases

The Legal & Policy AG and the Consumer AG gave input on the following:Policy and technical controls being put into place to support Phase 2 services (RLS publish, RLS view, medical record request)Advisory Group Update41The Consumer Advisory Group raised the following concerns for HIT Council discussion and consideration:

Consumer representation on HIT Council: Assumed to be an oversight in MA Chapter 224, there is no formal consumer representative on the HIT Council. The Consumer Advisory Group requests a short term solution and a change to the law

Public education plan for informing and educating the public about the Mass HIway: As Phase 2 service planning is now well underway, the Advisory Group recommends development of a formal Mass HIway communications plan as well as clear accountability for its execution. Several Advisory Group members are eager to assist in being conduits to various parts of the patient population, especially the under-served and under-represented.Consumer AG Concerns42Discussion Item 4: Mass HIway Update Implementation & Support Update, Phase 2 Update43Live (successful transactions sent) and In Production or Moving to Production:

Beth Israel Deaconess (BIDMC)MAeHCNetwork HealthTufts Medical CenterBoston Public Health CommissionBeaumont Rehab and Skilled NursingBrockton Neighborhood HealthPediatric Care AssociatesJessica Foley, LMHCGreg HarrisNotre Dame Long Term CareMillbury Health Care Center

Holyoke HM Connect HIEHolyoke Medical CenterWestern Massachusetts Physicians Associates (29 providers)Holyoke Medical Center Specialties (12 providers)7 Individual, independent practices

44On the Bubble Successfully sent test transactions:Childrens HospitalPartners Vanguard/Metrowest Medical Center Pediatric Care Associates

Major Clients slated for August/September Testing:MEDITECHPVIX/BaystateAtrius, Reliant and VNA Care Network 400+ providers loaded4546Transactions exchanged for July 2013 93,132Cumulative transactions to date 1,349,083

Testing between MEDITECH platforms and HIway is in processWill move to test directly with MEDITECH clients that have upgraded to compliant platforms

Significant effort to work through HISPs connectionsSuccessfully worked through Holyoke HIE connectionWorking through PVIX agreement Ongoing discussions: Epic, eCW, eLINC, Surescipts and Athena

ActivityTarget dateCMS approval of Phase 2 IAPDCompletedPhase 2 contract (or change order) executedCompletedGo-live - Public Health - Immunization Registry NodeCompletedGo-live - Public Health - Reportable Lab Results (ELR) NodeCompletedTesting - Public Health - Syndromic Surveillance NodeCompletedTesting - EOHHS Childrens Behavioral Health (CBHI) NodeCompletedPhase 2 Requirements Gathering & ValidationJuly 26, 2013CompletedPhase 2 Design Approach DecisionAugust 2, 2013CompletedGo-live - Opiod Treatment Program (OTP) Node Sept 2013Go-live for Phase 2, Release 1 (Other Public Health interfaces)Nov Feb 2014Go-live for Phase 2, Release 2 (EMPI, RLS, Consent, Provider Portal, Consumer Portal)Oct 2013 Mar 2014Phase 2 overall timelineMass HIway Phase 2 high level project schedule47Discussion Item 4: Wrap up and next steps48HIT Council 2013 Meeting Schedule*:January 14 11th Floor Matta Conference RoomFebruary 4 11th Floor Matta Conference RoomMarch 13 11th Floor Matta Conference RoomApril 8 21st Floor Conference RoomMay 6 21st Floor Conference RoomJune 3 21st Floor Conference RoomJuly 1 21st Floor Conference RoomAugust 5 21st Floor Conference RoomSeptember 9 TBDOctober 7November 11December 9

*All meetings to be held from 3:30-5:00 pm at One Ashburton Place, 21st Floor,Boston, unless otherwise noted

HIT Council meeting schedule49Next HIT Council Meeting: September 9, 2013Preliminary Agenda:Customer Implementation UpdatesAdvisory Group Update/DiscussionDiscussion Topics?Mass HIway UpdateWrap up50