MeHI Last Mile Implementation and

Support

2

MeHI Introduction

HIE Implementation

Last Mile Program

Agenda

3

Massachusetts eHealth Institute Enabling Exchange of Healthcare Data

4

• 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

MeHI Overview

5

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.

MeHI | Current Programs

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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.

MeHI | Statewide HIE

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HIE Implementation Three Phase Approach

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Massachusetts has adopted a three-phase approach to the development of its HIE infrastructure:

• Phase One: 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: development of registries and analytical repositories.

• Phase Three: add support for query-based health information exchange; e.g., “Tell me everything I’m allowed to see about Mrs. Jones.”

Stages of Implementation

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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: 10/15/12

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

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HIE Last Mile Program Enabling Exchange of Healthcare Data

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• 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

Last Mile Program

Connection

Optimization

Education

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• 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

Providers

• Patient materials, such as patient tool kit available in the provider practice and online

Consumers/Patients

• Information on Last Mile Program

• Vendor technical assistance with Direct integration EHR Vendors

Last Mile Program | Education and Outreach

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Last Mile Program | Connection

Provider directory

Certificate repository

Direct gateway

Web portal mailbox

HIE Services User types

Support the three methods of

connecting to the Commonwealth’s HIE

EHR connects directly

Browser access to webmail inbox

Physician practice

Hospital

Long-term care Other providers

Public health

Health plans

Labs and imaging centers

EHR connects through LAND

(Local Application for Network Distribution)

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• Designed to enhance efficiency and

effectiveness

• Available to all healthcare providers

• Grants available for qualified providers

Last Mile Program | Workflow Optimization

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Last Mile Program | Driving Adoption

Vendor awareness/

activation

1

Supply-side programs Program description

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

Integrate provider engagement program with overall

communications plan

Work at all levels to engage providers to join statewide HIE

Grants to providers for integration costs Technical support to manage provider-side of EHR integration

Managed

procurement of

development

2

Provider

awareness/

activation

3

Support for

provider

integration

4

Demand-side programs

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• 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.

Last Mile Program | Management Office

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• 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.

Last Mile Program | Vendor Grant Program

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• 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

Last Mile | Direct Assistance Program

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Last Mile | Time Table

' 12 Jul 2012

Sep Nov Jan 2013

Mar May Jul Sep Nov Jan 2014 ' 14

Last Mile Program Complete (under HIE Federal Grant)

1/31/14

HIE Backbone 'Go-Live'

10/15/12

Last Mile Support Vendor Starts Oct/Nov 2012

Last Mile Support Vendor Contracted October 2012

EHR Assessment Complete 7/15/12

Education & Outreach 8/8/12 2/14

Enroll Providers in Statewide HIE 9/16/12 2/14

EHR Vendors Developing and Deploying HIE Connections 8/20/12 2/14

Provider Practice Deployment 10/16/12 2/14

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Massachusetts EHR Vendor Landscape

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0%

5%

10%

15%

20%

25%

80% of surveyed Massachusetts healthcare providers that use EHRs are using one of 7 EHR systems

% o

f to

tal p

rovi

ders

su

rveyed

EHR vendors (names provided in chart)

EHR vendors with greatest share of Massachusetts provider customers

Notes:

•7 Vendors serve 80% of surveyed

providers

•9 Vendors serve 90% of surveyed

providers

•Over 90 EHR vendors represented

80%

90%

22

A deeper dive by provider segments reveals additional leading EHR vendors

Leading vendors serving providers working in…

Hospital Employed practices

Non Hospital employed

large practices (10+) Hospitals

Non Hospital employed Med &

Small practices (<10)

Pediatric practice

80%

Community Health Centers

Long Term Care

80%

80%

80%

80%

80%

80%

Behavioral Health

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There are 16 vendors on the “80% short list” when all sub-segments are accounted for

EHR vendors serving 80% of MA providers +

provider segment leaders

= 80% short list

•Meditech

•LMR (Self developed) •Cerner •Allscripts

•eClinicalWorks •GE

•WebOMR

•Siemens

•Epic

•NextGen •athenahealth •Quest Care360

•E-MDs

•Point Click Care

•Netsmart Technologies

•UNI/CARE Systems

Top vendors overall

+ Top inpatient vendors

+ Top Practice based vendors

+ Top Long Term Care vendors

+ Top Behavioral Health vendors

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Several communities have begun HIE work – “Aggregators” are beginning to think about how to interface with statewide HIE

NEHEN

North Adams

Baystate SafeHealth

Newburyport

RIQI

VITL

NYeC Beverly

Winchester

Holyoke Emerson

Sturdy

Berkshire

Health

South Shore

NH-

HIO

Cape Cod Health

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

Aggregator Organization Summary

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Of the vendors interviewed few are capable of DIRECT – many have some capability for transporting health information

0

7

15

3

0

17

7

14

7

11

6

7

5

4

6

5

19

8

5

5

16

5

12

7

Ability to assemble & send and receive & import

Ability to interface with PKI service

Ability to interface with Provider Directory

Ability to pass credentials to web portal (SSO)

Ability to embed native link to web portal

Ability to follow S/MIME SMTP standards

Ability to follow IHE profiles (XDR, XDS, XDM)

Ability to deliver DIRECT compliant EHRNo Capability

Some capability

Full capability

EHR vendors capability summary

Count of EHR vendors interviewed that answered question

N = 26

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Vendors are moving directionally toward DIRECT development, but timing and focus are highly varied

1

7

8

10

11

15

Today Q4 2012 Q1 2013 Q2 2013 Q3 2013 No clearroadmap

Vendor timing for a DIRECT software version release (n=26)

Statewide HIE launch date

October 15, 2012

MU Stage

2 begins:

• Q4 2013

(EH)

• Q1 2014 (EP)

Cumulative number of vendors implementing DIRECT protocols

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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

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The MA statewide HIE program has a number of levers available to ease last mile integration

MeHI EOHHS

Communication with providers (Include in

communication plan)

(Include in

MassHealth

communication plan)

Grants to providers X

Integration support to providers X (Some through Orion)

HIE pricing X

Communication with vendors X X

Grants to vendors X

Technical guidance to vendors (communicate

EOHHS technical

guidance)

X

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Thoughtful orchestration of levers will connect the largest number of providers in the shortest amount of time

1

Multi-segment providers

LMR

Cerner

Allscripts

eClinicalWorks

WebOMR

Epic

GE/Qvera

Practice based vendors

NextGen

Athenahealth

Quest Care360

E-MDs

PCC

eHS Med

Greenway

iPatientCare

Medstreaming

Vitera

Connexin

Comchart

Amazing Charts

In-patient vendors

Meditech

Seimens

LTC vendors

Point Click Care

SigmaCare

ADS

Beh. health vendors

SMIS

Echo Group

Interaction Tech

Qualifacts

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

Not interviewed

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Actively engage, promote

LAND option, provide grants

Lo

w

Hig

h

Build awareness of

LAND and web portal

Actively engage, promote

LAND and direct integration,

provide grants

Actively engage, promote

LAND and direct integration

DIRECT Capability

MA

Pro

vid

er S

hare

Low High

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1

2 3 4

5 7

8 9 10

11

12

13

14

15 16

17

18 19 20

21

23

25

26 27

6

28

29

28 29