Summary of Massachusetts Health IT Plan

Overview

The Massachusetts Health IT Draft Plan was released for public comment in January 2010 and the commenting period is now closed. The plan outlines high-level statewide goals and strategies for achieving improved health outcomes and reduced costs through the use of interoperable EHR systems and health information exchange (HIE). The document sets up governance structures and policy priorities for the planning for use and implementation of federal HI-TECH funds. Currently MA has been awarded ~$25mil, $14mil to MeHI for regional extension centers (RECs) and $10mil to MeHI for HIE. After the MA HIT Plan is adopted, the HIT Council is responsible for the governance structure and MeHI is the Project Management Office (PMO).

The HIT Plan was created in response to a number of MA statutes, including Chapter 305, MA 201 CMR 17:00, and Executive Order 504. The original plan was publicly announced in Jan 2009, but withdrawn due to the announcement of the HITECH Act portion of ARRA. The HIT Council and MeHI contracted Deloitte to update the plan to correspond with the HITECH Act and Meaningful Use regulations.

The tentative milestones lay out an aggressive plan in line with federal meaningful use requirements.

Tentative Milestones

Target Year Key Milestone Examples
2010
  • Develop HIT Strategic Plan
  • Establish PMO
  • Develop Governance structure with decision-making processes
  • Convene Ad-Hoc Workgroups
  • Produce Program communication plan
  • Initiate Vendor Management and contractual agreements
  • Submit the HIE operational plan including sustainability, privacy and security, etc.
  • Develop Certification Program IOO
  • Provider funding alternatives
  • Oversee the REC Operational Plan
  • Establish Medicaid Partnership
  • Recruit approximately 25% Priority Providers for REC
  • Coordinate Workforce development activities
  • Select HIE Vendor(s)
2011
  • Recruit approximately75% priority providers for REC
  • Establish Patient Engagement baseline
  • Provide Certification Program statewide HIE
  • Pilot Operational HIE (clinical)
  • Ensure REC Priority Providers achieve stage 1 meaningful use
  • Provide Initial Population Health Reporting (local)
2012
  • Ensure Operational HIE comleted with governance structure in place
  • Provide Consumer Engagement survey
  • Ensure the Integration of EHRs to operational HIE
2013
  • Ensure REC Priority Providers achieve stage 2 meaningful use
  • Develop Expansive Population Health Reporting (local, state, national)
2014
  • Pilot Interstate HIE Interoperability
  • Re-Certify IOOs
  • Perform Privacy and Security Audit
2015
  • Meet Chapter 305 requirement of implementing EHR systems in all provider settings and integrating those systems through a robust HIE Interstate
  • Complete HIE Interoperability
  • REC Priority Providers achieve stage 3 meangingful use
  • Provide Consumer Engagement survey
  • NHIN pilot if available

Statutory Overview

  • Chapter 2008 passed in August 2008
  • MA Legislation Chapter 305 formed the HIT Council
  • The HIT Council was charged with creating a statewide HIT Plan and updating it annually. Plans must be approved by the council and the MA Technology Collaborative Board
  • HIT Council Members – (look this up), includes Karen Bell
  • Background – contracted BCG to create plan which was completed by Jan 2009, right when the Stimulus bill & HITECH Act were released, so plan was pulled back. Deloitte was contracted to create updated plan which was released Jan 2010
  • “Community-Based Approach” – inspired by Mass eHealth Collaborative’s 2004 EHR deployment in 3 communities with attempted interoperability, supported by $50mil MA BCBS grant
  • MA Plan adopts opt-in HIE and anytime opt-out (which is different than many other states which are opt-out)

MA HIT Plan – Table of Contents

  • Executive Summary
  • Introduction
  • Establish Multi-stakeholder governance
  • Establish a Privacy Framework to Guide the Development of a secure HIT environment
  • Implement interoperable electronic health records in all clinical settings and assure they are used to optimize care
  • Create a local workforce to support HIT related initiatives
  • Monitoring success
  • Path forward

Discussion

  • ARRA
    • Regional Extension Centers (RECs): Provided ~$14mil to MeHI (the MA regional extension center) for implementation of regional extension centers in MA ($625mil total, and ~$100mil given out so far)
    • Health Information Exchange (HIE): Provided $10.6mil for HIE funds to MeHI (again, the state-selected entity), to create the plan (and no one knows where the plan will take us)
  • Carol Rodenstein, MeHI Program Director
  • HIT Council Members
    • JudyAnn Bigby, MD, Secretary of HHS Massachusetts
    • Deborah A. Adair, Director of Health Information Services and Privacy Officer, MGH
    • Meg Aranow, VP & CIO, Boston Medical Center
    • Karen Bell, MD, Sr. VP of HIT Services, Masspro
    • Lisa Fenichel, MPH, eHealth Consumer Advocate
    • Jay Gonzales, Secretary of Administration and Finance, Massachusetts
  • Median practice size in MA is 3 physicians
  • Masspro has a lot of experience with small practices and workflow issues associated with EHR implementation
  • End of April, governor is inviting governors from entire country, all 50 HIT coordinators, all 50 Medicare reps, all 50 Mecaid reps, and others to bang heads re: conference
  • Health care is the largest employer in Mass, employing ~450k workers with $29bil in revenue in 2005.
  • Small practices aren’t going away…will lead to the rise of the IPAs
  • Health delivery will look a lot different in 2015

High Level Policy Goals:

  • Goal 1: Improve access to comprehensive, coordinated, person-focused health care through widespread provider adoption and meaningful use of certified EHRs
  • Goal 2: Demonstrably improve the quality and safety of health care across all providers through HIT that enables better coordinated care, provides useful evidence-based decision support applications, and can report out data elements to support quality measurement.
  • Goal 3: Slow the growth of health care spending through efficiencies realized from the use of HIT.
  • Goal 4: Improve te health and wellness of the Commonwealth’s population through public health programs, research, and quality improvement efforts enabled through efficient, reliable and secure health information exchange processes.

Strategies to Accomplish these  Goals:

  1. Establish multi-stakeholder governance
    1. The components of the proposed governance structure are:
      1. These organizations: HIT Council, MTC, MeHI
      2. 6 Ad Hoc workgroups: Clinical Quality and Public health, consumer engagement, education, and outreach, Privacy and security, regional extension center, HIE, workforce development
    2. Estimated that this will be >= 90% private funded
    3. HIT Council oversees governance structure
    4. MeHI is acting Project Management Office
  2. Establish a privacy framework to guide the development of a secure HIT environment
    1. ONC’s 6 Privacy Principles: Individual Access, Correction, Openness and Transparency, Individual Choice, Collection, Use and Disclosure Limitation, Data Quality and Integrity
    2. Commonwealth’s privacy and security framework will focus on four key areas: Compliance with policies and standards, Secure HIE technology, Process for certification, Consent management
    3. Privacy/Security rules based on the following previous rulings:
      1. Federal: HIPAA, HITECH Act, FISMA, MITA, HITSP, NIST 800 Series, Privacy Act of 1974
      2. State: Chapter 305, MA 201 CMR 17:00, and Executive Order 504
  3. Implement interoperable health records in all clinical settings and assure they are used to optimize care
    1. MA  has officially adopted the goal of meaningfully used EHR in all physician practices by January 1, 2015
    2. MA will provide direct assistance to ~2500 providers to achieve Meaningful Use by contracting with Implementation Optimization Organizations (IOOs)
    3. To ensure adequate funding – 1) promote a loan program, 2) endorse use of state funds, 3) provide support to providers to receive Medicare incentives
    4. Build an effective REC program for the Commonwealth focusing on: individual & small group practices, public and critical access hospitals, community health centers and rural health clinics, other clinics serving the underserved
  4. Develop and implement a statewide HIE infrastructure to support care coordination, patient engagement, and population health
    1. HIE Priorities: administrative simplification, e-prescribing, electronic laboratory ordering, electronic public health reporting, quality reporting, prescription status, coordination of care/clinical summary exchange
    2. Will continue to support PHR’S currently supported by MA providers and payers
    3. This effort will be lead by MeHI
    4. Existing HIE Initiatives in MA: Northern Berkshire eHealth Collaborative, Newburyport, SAFEHealth, CHAPS, and NEHEN
    5. MeHI has selected a hybrid HIE model (as opposed to centralized or federated) which will use both centralized and distributed data repositories, allowing the majority of the data to stay at the site of collection
  5. Create a local workforce to support HIT related initiatives
    1. High demand and low supply right now for health IT employees
    2. Estimated through 2016 that 64k new health care jobs will be created in the Commonwealth
    3. Development of training programs using federal dollars focusing on implementation, project management, practice management, and data management. Programs will intentionally seek out unemployed persons.
  6. Monitor success
    1. Quality measurement program for REC, HIE, and Workforce Development programs
    2. Indicators selected for reporting will fit into the objectives of the high-level goals of the MA HIT Plan
    3. The HIT Council is responsible for selecting the indicators

The Internet? Bah!

Check out this hilarious 1995 Newsweek article by Clifford Stoll entitled The Internet? Bah!. Boy did he guess wrong. My favorite excerpt (my comments are in bold):

Then there’s cyberbusiness. What is cyberbusiness? We’re promised instant catalog shopping–just point and click for great deals. We’ll order airline tickets over the network, make restaurant reservations and negotiate sales contracts. Stores will become obselete. Right. So how come my local mall does more business in an afternoon than the entire Internet handles in a month? Malls are going bankrupt all over the country. Even if there were a trustworthy way to send money over the Internet–which there isn’t–the network is missing a most essential ingredient of capitalism: salespeople. Economists have been wrong this whole time, salespeople are the key to capitalism, not competitive free markets!

Enjoy!

Health IT Update – Feb 22

1. Health IT in Developing Countries – a 9-yr history and its future – open to all Harvard community members as part of the Harvard Kennedy
School of Government lunch seminar

2. Global Health Technologies Coalition: Advancing Innovation to Save Lives – useful website with lots of information on technology innovation – http://www.ghtcoalition.org

3. MIT Sloan Bioinnovations Conference – March 12 – see event details below…

4. PHAT/Health Underground Networking Event w/ AthenaHealth’s Jonathan Bush – April 1 (website coming soon)

——————-

Save the Date!
MIT Sloan BioInnovations 2010 Conference: The New Age of Opportunity
http://web.mit.edu/bbc/bioinnovations/2010/

Friday, March 12, 2010
9:00 AM – 4:00 PM
Boston Marriott Cambridge (next to Kendall Square T-stop)

Register before March 1 for Early-Bird Discounts:
http://www.acteva.com/booking.cfm?bevaid=197535

Keynote Speakers:

Peter Wirth, Esquire
Executive Vice President, Genzyme Corporation

Dr. Robert Langer
M.I.T. David H. Koch Institute Professor

Matthew W. Emmens
Chairman, CEO, and President, Vertex Pharmaceuticals

Panels:

Healthcare Reform
Emerging Markets
Bringing Innovation to Market
Connected Healthcare

BioInnovations is a premier gathering of nearly 300 healthcare pioneers from a broad range of industries; from bio-pharma and medical devices to healthcare providers and non-profits.

Health IT Update – Feb 4, 2010

1. Today: Free Public Forum on HIT National Policy with David Blumenthal – Thursday, 8am-noon (www.hitpublicforum.com)

The Public Form on HIT National Policy is hosting a free conference this morning (it is starting right now!) with a great lineup of speakers, including David Blumenthal, the National Coordinator for Health IT, Marc Overhage, Director of Med Informatics at Regenstrief Institute, Aneesh Chopra, US Chief Technology Officer at the White House, and several others. Registration is free and the entire event will be webcasted. Blumenthal speaks from 9-9:30am. Content will be available online for 6 months…

2. Free OpenMRS Developer Training Week starting Feb 8

The Regenstrief Institute at Indiana University, the developers of OpenMRS, the popular open-source medical record system, are hosting a free week-long training session at IU beginning Monday, Feb 8. Most of the event will be webcasted. For more details: http://openmrs.org/wiki/OpenMRS_Developer_Training_Week_8-February-2010

3. Health Affairs February Issue on e-Health in the Developing World

This month’s Health Affairs issue is focused on e-health in the developing world, and includes articles on “An Agenda For Action On Global E-Health”, “e-Health Technologies Show Promise in Developing Countries”, and others on cell phones, EMR, informatics, and more.

http://content.healthaffairs.org/content/vol29/issue2/

“There is an opportunity to build Haiti back better”

Paul Farmer testified yesterday before the US Senate Committee on Foreign Relations regarding the work he and Partners in Health are doing to rebuild Haiti.

He opened: “Today, my hope is to do justice to Haiti not by chronicling the events of the past two weeks, which are well known to you, but by attesting to the possibility of hope for the country, and of the importance of meaningful investment and sustainable development in Haiti. That said, I will not pretend that hope is not at times difficult to muster.”

“In my role as the UN Deputy Special Envoy for Haiti, as well as from my long-standing homes at Partners In Health and at Harvard, I have witnessed the many varieties of privation endured by Haiti as well as the country’s extraordinary resilience. But in more than twenty-five years of working there, I have never seen devastation or suffering on this scale. The response from our community has been equally immense: acts of great courage within Haiti, and of great generosity beyond it.

“I know that Haiti can and will recover. I believe that there is an opportunity to build Haiti back better. I am convinced that it will require a massive and ongoing commitment on all of our parts, and that the road will be a long one. We are fortunate to have many partners in this effort, in addition to the five thousand employees of Zanmi Lasante: my colleagues now joining them in Haiti, many of whom have been sharing updates with us and with you; the extraordinary team in Boston; the legions of PIH supporters, old and new, as well as our organizational partners and our colleagues at the Clinton Foundation and the UN. Together, we are all working to serve the people of Haiti, especially those marginalized by chronic poverty as well as the acute insult (to use medical terms) of January 12.”

Read the full script of Paul Farmer’s testimony: http://standwithhaiti.org/haiti/news-entry/pih-co-founder-paul-farmer-testifies-at-senate-foreign-relations-committee/

Highlights from President Obama’s First State of the Union Address

President Obama delivered his first State of the Union Address last night. The Presidential blog at www.whitehouse.gov/blog has an excellent summary of all the initiatives Obama announced and the entire 90 minute video. The full script is also available at http://www.whitehouse.gov/the-press-office/remarks-president-state-union-address.

I am going to highlight just a few initiatives that are particularly important to me:

  • 3-year federal budget freeze – Beginning in 2011, Obama has called for a 3-year federal budget freeze that applies to everything but defense, Medicare/Medicaid, and Social Security. He claimed that without true health reform, it would be impossible to freeze spending on health.
  • Financial reform package – use the Stimulus bank bailout money that banks are repaying to go towards funding small business loans; create a small business tax credit; eliminate all capital gains taxes on small businesses (the latter 2 received bipartisan clapping while imposing a fee on large banks to repay the stimulus bailout is not supported by republicans)
  • College Financing Reform – this one is big! “To increase college access and completion, the Administration will make student loans more affordable by limiting a borrower’s payments to 10 percent of his/her income and forgives remaining debt after 20 years – 10 years for public service works. We will also make permanent the American Opportunity Tax Credit. The President urges the Senate to pass the American Graduation Initiative, which invests more than $10 billion over the next decade in reforming our nation’s community colleges, promoting college completion, and moving toward the President’s goal of having the highest proportion of college graduates in the world by 2020. The President is also asking colleges and universities to do their share to make college affordable for all Americans cutting their own costs.”
  • Health IT – despite all the political action surrounding health IT right now (and a good amount of talk for and against it), this was not mentioned at all
  • Nuclear Power Plants – FINALLY the government is going to pave the way to open up some more power plants, after a 30-yr hiatus
  • Changing the way the government does business – The administration is going to continue with lobbying reform, increasing government transparency, and creating a public “earmarking” database so that the public can see what budget amounts have been earmarked for certain purposes. To see how serious this administration is about transparency, check out http://www.data.gov. For a very specific example, I have been able to call into every workgroup meeting and download the materials related to the Office of the national Coordinator’s work on meaningful use and the HITECH Act. Here’s the schedule: https://singularityblog.wordpress.com/2010/01/11/upcoming-hit-policy-standards-committees-workgroup-meetings/
Also, a few quotables:
  • And what the American people hope -– what they deserve -– is for all of us, Democrats and Republicans, to work through our differences; to overcome the numbing weight of our politics.  For while the people who sent us here have different backgrounds, different stories, different beliefs, the anxieties they face are the same.
  • It’s because of this spirit -– this great decency and great strength -– that I have never been more hopeful about America’s future than I am tonight. Despite our hardships, our union is strong.  We do not give up.  We do not quit.  We do not allow fear or division to break our spirit.  In this new decade, it’s time the American people get a government that matches their decency; that embodies their strength.
  • To recover the rest, I’ve proposed a fee on the biggest banks. Now, I know Wall Street isn’t keen on this idea.  But if these firms can afford to hand out big bonuses again, they can afford a modest fee to pay back the taxpayers who rescued them in their time of need.
  • Now, let’s clear a few things up. I didn’t choose to tackle this issue to get some legislative victory under my belt.  And by now it should be fairly obvious that I didn’t take on health care because it was good politics. I took on health care because of the stories I’ve heard from Americans with preexisting conditions whose lives depend on getting coverage; patients who’ve been denied coverage; families –- even those with insurance -– who are just one illness away from financial ruin. After nearly a century of trying — Democratic administrations, Republican administrations — we are closer than ever to bringing more security to the lives of so many Americans…Here’s what I ask Congress, though:  Don’t walk away from reform.  Not now.  Not when we are so close.  Let us find a way to come together and finish the job for the American people.  Let’s get it done.
  • for the first time in history –- my administration posts on our White House visitors online.  That’s why we’ve excluded lobbyists from policymaking jobs, or seats on federal boards and commissions.But we can’t stop there.  It’s time to require lobbyists to disclose each contact they make on behalf of a client with my administration or with Congress.  It’s time to put strict limits on the contributions that lobbyists give to candidates for federal office. With all due deference to separation of powers, last week the Supreme Court reversed a century of law that I believe will open the floodgates for special interests –- including foreign corporations –- to spend without limit in our elections. I don’t think American elections should be bankrolled by America’s most powerful interests, or worse, by foreign entities.  They should be decided by the American people.  And I’d urge Democrats and Republicans to pass a bill that helps to correct some of these problems.
  • In the end, it’s our ideals, our values that built America — values that allowed us to forge a nation made up of immigrants from every corner of the globe; values that drive our citizens still. Every day, Americans meet their responsibilities to their families and their employers. Time and again, they lend a hand to their neighbors and give back to their country. They take pride in their labor, and are generous in spirit. These aren’t Republican values or Democratic values that they’re living by; business values or labor values. They’re American values.

Meaningful Use Privacy & Security Concerns

The Privacy and Security requirements of the recently released Meaningful Use NPRM and Certification IFR have received a lot of attention due to their lack of definition. I joined in on the Jan 22 ONC Privacy & Security Workgroup meeting to discuss which topics the workgroup will comment on and send to the HIT Policy Committee. The topics included risk assessments, the phrase “implement security updates as necessary”, HIPAA investigations, privacy and data transparency, and “consumer preference”.

  • Risk assessments – There is still a lot of concern about the lack of clarity surrounding risk assessments. The ONC will need to ensure that education on risk assessments is available, especially targeted at small providers. Most organizations currently think they are HIPAA compliant, but few would feel comfortable if the government performed a HIPAA audit, because there is no guidance as to what the government would audit against. Guidance is needed on the “intended outcomes” of MU Security objective and greater transparency, such as Audit Program Compliance Guidelines, is needed on the audit process that will be used. It is unlikely that any guidance will be available by the time the final rulings are released. Large organizations commonly perform internal or 3rd party security/privacy audits, but this is rare (and not feasible) among smaller providers. Many of the comments related to this topic will not change the objective but how the ONC responds to the need for additional information.
  • “Implement security updates as necessary” – The term “updates” is both a technology (i.e. software update) and business process (i.e. modify password policy) term, and its intended meaning (whether one or the other or both) should be clearly stated. Time requirements were discussed, such as software security patches must be updated within 90 days of release, but this was thrown out due to complications of implementing updates, especially in enterprise settings.
  • HIPAA Investigations – ~5k HIPAA investigations are currently underway. Unclear if these are ~5k different hospitals, individual doctors, multiple investigations per entity, etc. Unclear if an open investigation will prevent an eligible professional or hospital from receiving incentive payments. The “expected” length and cost of investigations will be important to allow providers to make informed decisions. Unclear which HIPAA investigation types are relevant to MU.
  • Privacy and Data Transparency – No objectives or measures for privacy and data transparency are present in Stage 1. The Committee wants to propose these for Stage 2. “Accounting of disclosures” is included in Stage 1 and is already required by HIPAA. The connection between the security/certification piece and the MU/privacy piece is weak. For example, the capability to prevent many breaches is a part of certified EHR, but there are no objectives or measures to guide providers in the use of these certification criteria.
  • “Consumer-preference” – Also referred to as “patient-choice” requirements, consent management, or access control. There was some disagreement as to what the proper language was to discuss  patient preference. Dixie Baker, who is also involved in the Security Standards Workgroup, posted a presentation (available on the ONC website), to address Access Control and its relation to privacy. There is no IFR criteria for access control to help entities manage the patient consent requirement with which they must comply. This discussion was cut short due to time and will probably be completed in private conversation.

Refer to my previous post to join in on future workgroup meetings: https://singularityblog.wordpress.com/2010/01/11/upcoming-hit-policy-standards-committees-workgroup-meetings/