Tag Archives: health information exchange

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 The original plan was publicly announced in Jan 2009, but withdrawn due to the announcement of the HITECH Act portion of ARRA.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
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Public Health & Technology Conference, May 1, Harvard School of Public Health

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The HSPH Public Health & Technology Forum is hosting the 1st annual Public Health & Technology Conference on Friday, May 1 featuring keynote John Halamka, CIO of Boston Beth Israel Deaconness Hospital and Harvard Medical, and panelists Karen Bell (ONC), Blackford Middleton (Clinical Informatics Research & Development, Partners HealthCare), John Loonsk (ONC), John Moore (Chilmark Research), Ashish Jha (HSPH), Isaac Kohane (Boston Children’s Medical Informatics Program), Jonathan Bush (AthenaHealth), Sharona Hoffman (Case Western Law School).

Despite health IT’s promise of better, faster, and cheaper health care, adoption of electronic health records in the US remains low. This conference brings together many of the leaders in the field to explore the potential to use health IT to improve health delivery, the challenges of health information exchange and the impact of the 2009 American Recovery and Reinvestment Act on health IT.

Registration is free and all are welcome (www.hsph.harvard.edu/phat).

A sustainable business model for health information exchange

Personal Health Records (PHRs) have received a lot of attention lately with the release of Google Health and Microsoft HealthVault. PHRs allow individuals to securely organize their own health information and to control who has access. PHRs allow users to import data from many large repositories, including insurers, pharmacies, and laboratories, but mostly do not connect to care providers, excepting a few integrated delivery networks such as Kaiser and Beth Israel in Boston.

RHIOs are less well known but have been around much longer. RHIOs exist at the community level to facilitate the exchange of health information between care providers (e.g. doctor notes), though some also aggregate data from insurers, pharmacies, and labs. The primary audience here is care providers, rather than consumers. In theory, a network of RHIOs could form together to create a National Health Information Network (NHIN), but this is unlikely to occur without significant federal funding. More than 140 RHIOs exist today, but only a handful are considered sustainable (look at the Regenstrief Institute and MA-SHARE). Interoperability between EHR systems is complex and expensive, and though it will improve quality of care, there will be a negative return on investment until a significant proportion of providers is sharing data in a standardized way. Read The State Of Regional Health Information Organizations: Current Activities And Financing by Julia Adler-Milstein, et al for a better understanding of the current RHIO landscape.

Given the similar goals of PHRs and RHIOs, I have speculated that these ideas may eventually end up merging. John Halamka, CIO of Harvard Medical School, commented on Google Health’s new sharing and auditing features in his Cool Technology of the Week update:

I’ve already invited my primary care doctor, my family, and a few of my clinical systems colleagues who built the BIDMC-Google interface. Thus, in one morning I’ve become my own regional health information organization, sharing medical records across multiple organizations with perfect privacy controls.

However, Dr. John Glaser, CIO of Partners Healthcare, estimates that only 1 out of 10 American’s with access to an electronic health record will access it, meaning that consumers are unlikely to drive the healthcare industry’s to adoption of EHR and HIE (see Glaser’s interview with Information Weekly).

Though PHRs do not have a huge chunk of the health consumer market, 6 million users (10% of the estimated 60 million American’s with electronic health records) is large enough to give Google, Microsoft, Dossia and Revolution Health some leverage with data furnishers. PHRs also capture a monetizable audience (consumers) whether through advertising or sales of health applications. RHIOs, on the other hand, make participating providers pay to use their service, but are not large enough to offer providers significant incentives for involvement. Most rely on government funding to stay afloat. I am of the opinion that unless government steps in to fund a largescale network, PHRs have settled on a more sustainable business model and could more easily extend their data aggregation efforts into doctors notes and other administrative data handled by RHIOs. In this case, both providers and consumers would be the primary audience of the platform. By using the PHR for both consumer and clinical needs, the record becomes immensely more useful, assuming that audit trails, quality control, and security measures are in place.