MeHI Last Mile Implementation and Support

MeHI Last Mile

Implementation and

MeHI Introduction

HIE Implementation

Last Mile Program

Massachusetts eHealth Institute

•

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

– Mass Technology Collaborative Board of Directors

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.

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.

Massachusetts Health Information

Exchange

MA HIway Planning – the Year in Review

Oct ’11 Jan ’12 Apr ’12 Jul ’12 Oct ‘12

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

Orion selected as HIE vendor

Customers step forward and form “golden spike group”

PAs and Pricing developed and vetted with customers

HIway go live! Updated strategy approved by CMS and ONC

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

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.”

Stages of Implementation

Golden Spike

GS Group Participants

• Berkshire Medical Center

• Beth Israel/Deaconess

• Children’s Hospital

• Holyoke Medical Center

• Network Health

• Partners Healthcare

• Tufts Medical Center

HIE 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

Last Mile Program

Connection Optimization

• 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 | Connection

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

EHR connects through LAND

• Designed to enhance efficiency and

effectiveness

• Available to all healthcare providers

• Grants available for qualified providers

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

3

4

•

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.

• 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

• 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 | Time Table

' 12

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'

10/16/12

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

Massachusetts EHR Vendor

Landscape

0% 5% 10% 15% 20% 25%

80% of surveyed Massachusetts healthcare providers that use EHRs are

using one of 7 EHR systems

%

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ov

ider

s

s

ur

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ey

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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%

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

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

Top vendors overall

+ Top inpatient vendors

+ Top Practice based vendors

+ Top Long Term Care vendors + Top Behavioral Health vendors

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

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 EHR No Capability

Some capability Full capability EHR vendors capability summary

Count of EHR vendors interviewed that answered question

N = 26

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 clear roadmap 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)

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

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)

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 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 21 22 23 24 25 26 27 Not interviewed 22

Actively engage, promote LAND option, provide grants

L ow Hi g 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 M A Prov id er Sha re 24 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