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May 27 Minutes - The Massachusetts eHealth Institute
MINUTES Massachusetts Health Information Technology Council Meeting May 27, 2009 9:00 – 10:30 am Matta Conference Room One Ashburton Place Boston, Massachusetts MINUTES MASSACHUSETTS HEALTH INFORMATION TECHNOLOGY COUNCIL May 27, 2009 Attendees: Council Members JudyAnn Bigby, MD - (Chair) Secretary of Health and Human Services (Leslie Kirwan - Secretary of Administration and Finance)** Represented by: Marcie Desmond Tom Dehner - Director of Medicaid Deborah Adair - Director of Health Information Services / Privacy Officer at Massachusetts General Hospital David S. Szabo - Partner with Nutter, McClennen & Fish, LLP Lisa Fenichel, M.P.H. - E-Health Consumer Advocate at Health Care For All of Massachusetts Other David Martin (EOHHS) Glen Shor Charles Townley (Rep. Sanchez, Committee on Public Health) John Halamka Ray Campbell (MHDC) Greg DeBor (CSC) Adam Delmolino (MHA) Jessica Long (COBTH) Lorllyn Allan (Lahey Clinic) Alan Macdonald (South Shore Hospital) Rebecca Kaiser (Partners Healthcare) Lisa Nash (Health Care for All) Barbara Klein (Concordant) Jodi Holman (Concordant) Diane Stone (Stone & Heinold Associates, LLC) Jerilyn Heinhold (Stone & Heinold Associates, LLC) Krystle Teamer (Regis College, Graduate Nursing Student) Darline Joseph (Regis College, Graduate Nursing Student) Nicole Young (Regis College, Graduate Student) Katie Dickie (Regis College) Kerry Folkman (Regis College) Colleen Cormier (Regis College) Karen Welsh (student) MTC Staff Mitch Adams Glen Comiso Bethany Gilboard Judy Silva Barbara-Jo Thompson David O’Brien Rick Shoup The seventh meeting of the Massachusetts Health Information Technology Council was held on May 27, 2009, in the Matta Conference Room at One Ashburton Place in Boston, Massachusetts. Secretary Bigby called the Meeting to order at 9:06 a.m. AGENDA ITEMS I. Review and Approve Minutes for May 6. After motions made and seconded, it was unanimously agreed to accept the draft minutes as the official minutes of the May 6th meeting. II. Presentation, “NEHEN, MA-Share and MHDC Briefing to HIT Council” John Halamka, of Ma-Share; Ray Campbell of MHDC and Greg DeBor of NEHEN gave a combined presentation to the Council on The State of the Health Information Exchange in the Commonwealth in 2009. (Incorporated as part of the minutes) In spirit of all for one and one for all rather than approaching the topic from separate angles, the three presenters collaborated to present a unified presentation. All three are non profits and all are regional. All receive grant funding which is not ideal, and was referred to by the group as “the gift that keeps on costing.” During the presentation Council members raised several questions. Questions included asking the presenters to expound on the statement regarding “60 Million” transactions. Greg DeBor handed out a fact sheet. (Incorporated as part of the minutes) Does every licensed plan in Massachusetts have access to the new NEHEN? Greg DeBor explained they do not, but he will get the Council the information on how many do, and their capability to access the system. The presenters were asked about cost, they explained it is a monthly subscription fee and from a provider perspective it is cost effective. Delivery methods include secure email, fax or electronic Health Record. In closing Ray Campbell explained he has worked with the state and would like to offer some “policy” advice. Chapter 305 funds need to be kept in perspective. Money is not as important as the policy. There is not a successful exchange unless the public and private collaborate. They need to harmonize. The State needs to leverage existing organizations. There is a desperate need for point person, probably the Executive Director of MeHI, who should be the voice of HHS and in total sync with the Secretary. Vendors should be placed on a value added provider list. The $15 million at MeHI should be leveraged for federal dollars any remaining dollars could be used as a revolving loan fund. The Council also asked questions regarding the areas served by NEHEN and the software, opt in and opt out provisions, meaningful use, and the expectations of how to fulfill it. III. Discussion – Draft of the Key Elements of a State-Wide Strategic Plan (Rick Shoup) Secretary Bigby asked Rick Shoup to give a summary of the draft that had been sent to the Council a week prior. Rick Shoup explained the purpose of the planning elements document was to provide annotated planning elements. It is for consultants to know how they would conduct an overall planning process. This is an overview of the approach. (Presentation is incorporated as part of the minutes) We have a very aggressive time line, to insure we get federal funding and reimbursement. The Council had a discussion on Chapter 305 and its requirement that consumers have secure access to their own health record. It may be a PHR and may not be; which is an important distinction. Supporting PHRs maybe something we can’t afford to do, but the Council needs to pay attention to the requirements of 305. They also discussed one HIE vs. many and how it is determined. Meeting adjourned at 10:30 am. NEHEN, MA-SHARE and MHDC Briefing to HIT Council Boston MA Boston, May 27, 2009 Planned Discussion • Organizational Roles and Relationships • Expertise • Lessons Learned • How Our Organizations Can Help the Commonwealth • Relationship with the Commonwealth ©2009 CSC and NEHEN 781-890-7446 Health Delivery Services May 27, 2009 2 Massachusetts Health Information Exchange The State of Health Information Exchange g in the State in 2009 • Through voluntary funding and a collaborative approach, Massachusetts has created one of the most mature, proven HIE infrastructures in the nation: – Multi-stakeholder – Non-profit – 12+ years in the making – Public and private investment – Comprehensive and inclusive – Forward-looking and nationally recognized – Strong track record, connections, relationships and leadership in industry and national direction ©2009 CSC and NEHEN 781-890-7446 Health Delivery Services May 27, 2009 3 Our Organizations and Roles Organization Since Ownership, Business Model and Direction Role 1978 • Neutral convener, educator and facilitator • Non-profit • Continue and expand convening role and forums 1997 • Payer-provider transaction processing; HIPAA administrative solution • Payer/provider owned • Acquiring MA-SHARE’s assets • Converting to non-profit 501(c)3 and reincorporating as “New New England Healthcare Exchange Network” • New combined mission of administrative and clinical HIE 2003 • Simplify health information exchange ( i (primarily il clinical li i l d data) t ) among regional i l entities • Subsidiary of MHDC • Merging M i with ith NEHEN tto provide id combined bi d administrative and clinical HIE 2006 • Extending NEHEN services to small providers through a hosted solution • Payer-funded NEHEN subsidiary • Planning to leverage hosted infrastructure to support clinical HIE with such functions as: • Community provider directory • Portal / viewer for small providers • Program manager for NEHEN, 1959 ((local NEHENNet and MA-SHARE healthcare • Consultant / project manager for EMHI practice • Advisor to participants as a healthcare since 1996) consulting and technology company ©2009 CSC and NEHEN 781-890-7446 • No ownership stake in any of the above • Commonwealth vendor under ITS07/23/33 • Continued commitment to local, national and global public/private collaboration on administrative simplification and HIE Health Delivery Services May 27, 2009 4 Participation Organization Participation Broad Participation Limited • • • • • • • Institutional /Board members (17) Providers (30) Commercial payers (7) State agencies (3) Oth healthcare Other h lth members b (21) IT, consulting and services (35) Individuals (70) The following participate in at least 3 out of 4 of: MHDC CIO Forum, NEHEN / NEHENNet, MA-SHARE and EMHI: The following participate in only MHDC CIO Forum and / or NEHEN: • • • • Providers (27) Commercial payers (8) Affiliated clearinghouses / services (3) EOHHS / MassHealth • Including EMHI, past or present: • Providers (11) • Payers (4) • EOHHS • SureScripts-RxHub • • • • • Hospitals and large practices (11) Solo and small provider practices (41) Health centers (12) Ancillary services providers (25) Billing services (8) • • • • • • • • • • • • • • • Atrius Health Beth Israel Deaconess Blue Cross Blue Shield of MA Children’s Hospital Dana Farber Cancer Institute EOHHS Harvard Pilgrim Lahey Clinic Mass. Eye & Ear Institute MHDC Neighborhood Health Plan Partners HealthCare Tufts Health Plan Tufts Medical Center Winchester Hospital • L Locall • HIE collaborative activities • MAeHC QDC • MA EOHHS IT strategy and ESB • Commonwealth Connector • National • Broad healthcare IT and management consulting; outsourcing • ONC (NHIN) • Federal agencies ©2009 CSC and NEHEN 781-890-7446 • • • • • • • • • • • • • • • • • • • • • • • • Baystate Health BMC HealthNet Boston Medical Center Cambridge Health Alliance Cape Cod Health Caritas Christi Emerson Hospital Fallon Clinic Franciscan Hospital for Children Health New England Jordan Health Services Lawrence General Hospital Lifespan Lowell General Hospital Morton Hospital Network Health Northeast Health System South Shore Hospital y Southcoast Health System St. Joseph Health Services UMass Memorial Health Care UnitedHealthcare Westerly Hospital An additional 97 “small” providers and service providers ( shown (as h by b category t ffor NEHENNet) Health Delivery Services May 27, 2009 5 NEHEN’s Value Proposition • A single solution for administrative simplification Blue Cross Blue Shield of Massachusetts . . . provider staff uses the same system process the same transaction to p every time for every payer. BMC HealthNet Harvard Pilgrim Health Care Health New England MassHealth (MA M Medicaid) di id) Medicare For every Insurance Card presented . . . Health IInsurance A Health Insurance B Health IInsurance C ©2009 CSC and NEHEN Health Insurance D • Eligibility verification • Referral authorization • Referral inquiry • Claim submission • Claim status inquiry • Remittance advices • Other 781-890-7446 Neighborhood g Health Plan Network Health Alliance T ft Health Tufts H lth Plan Pl National payers Health Delivery Services May 27, 2009 6 MA-SHARE Functionality • Two lines of service – Rx R G Gateway t • Integrates provider EMRs with national network (SureScripts-RxHub) • Adoption to-date limited to organizations with proprietary EMRs – CDX G Gateway t • Uses Continuity of Care Document (CCD),standard to “push” data to interested parties • Discharge summary pilot in place; exploring other use cases • Servicing current community interests – Bi-directional data exchange within and across provider organizations – Payer P interest i t t iin using i CCD P Push h tto manage members’ b ’h health lth – Using referral management and other capabilities to manage malpractice risk – Standardized quality reporting – Aligning with other HIE efforts, most notably the Eastern Massachusetts Healthcare Initiative (EMHI) ©2009 CSC and NEHEN 781-890-7446 Health Delivery Services May 27, 2009 7 NEHEN / MA-SHARE Collaboration • NEHEN and MA-SHARE developed separately for historical reasons but have mutual cases for collaboration – Visions and plans for health information and interoperability, administrative and clinical, are merging – Considerable overlap in governance and participation – Already Al d sharing h i common architecture, hit t iinfrastructure f t t and d supportt services i • Investment and return – Leading healthcare organizations in MA and RI have invested over $20M in NEHEN and MA MA-SHARE SHARE over the last 10+ years – Avoided many millions more in labor, IT and compliance costs had they attempted to address requirements separately • Consolidation is planned for June 2009 – In progress since August 2008 – Expecting additional investment from Eastern Massachusetts Healthcare Initiative (EMHI) participants already funding NEHEN • EMHI participants see the combined NEHEN / MA-SHARE as a solution to meet HIE requirements in ARRA HITECH ©2009 CSC and NEHEN 781-890-7446 Health Delivery Services May 27, 2009 8 Working Towards Mutual Service Offerings With Continued Focus on Core Priorities Administrative • Continuing “compliance” and tactical support Clinical • CCD Push / Results Delivery – NewMMIS – Additional use cases – New or updated standards – Expanded membership • ICD-10 • Resulting support for sustainability • 5010 • Rx Gatewayy – Further coordination with national standardization and interoperability efforts (e.g., CAQH, etc.) – Near-term enhancements requested users – Relative to external influences • SureScripts-RxHub developments • NEHENNet p portal rollout and adoption p • Vendor V d capabilities biliti • Increasing “Classic” membership • Adding payers and payer functionality (national, Fallon, etc.) • CMS and other policies • Community Provider Directory IInfluenced fl db by EMHI • Claim-centric workflow / denial management • Consolidated management g and g governance • Jointly-developed combines services ©2009 CSC and NEHEN 781-890-7446 Health Delivery Services May 27, 2009 9 Combined Mission The New England Healthcare Exchange Network, Inc. (NEHEN) promotes the i t interoperability bilit off h health lth iinformation f ti ttechnology, h l electronic l t i h health lth records, d and d clinical and administrative health information exchange across organizational boundaries in the New England health care community. NEHEN’s efforts are directed at improving patient safety, satisfaction and the overall patient experience; simplifying the complexity of health care operations; removing barriers to automation though greater use of information technology; and reducing overall costs for all participants participants. NEHEN shares best practice with all interested parties and provides innovative business and technical solutions to make information available wherever it is needed to treat patients safely and to help the community operate at a world-class level of efficiency and value. NEHEN emphasizes collaboration, a federated model, standards-based information exchange and protection of patients’ rights to confidentiality and control over their health records. ©2009 CSC and NEHEN 781-890-7446 Health Delivery Services May 27, 2009 10 Current NEHEN Fee Structure Participant p Level of Ongoing g g Investment is TBD,, Consistent with MA-SHARE Fees,, Depending on Effort, Goals and Potential Sources of External Funding NEHEN Classic Participant Type / Tier Payer IDN / Hospital System Single Hospital Physician Group Diagnostic Facility Notes: Per Member Fee NEHEN.NET Portal Monthly Annual Definition / Criteria Participant Type / Tier Large $15,450 $185,400 > 2M members Medium $10,300 $123,600 250K – 2M members Small $5,150 $61,800 < 250K members Large $15,450 $185,400 > $2B gross revenue Medium $7,725 $92,700 $750K - $2B gross revenue Small $5,150 $61,800 <$75K gross revenue Large $7 725 $7,725 $92 700 $92,700 > $500M gross revenue Medium $3,090 $37,080 $100-500M gross revenue Small $2,060 $24,720 < $100M gross revenue Large $6,180 $74,160 > 200 physicians Medium $3,090 $37,080 50-200 physicians Small $1,030 $12,360 < 50 physicians Large $3,090 $37,080 >$25M gross revenue Small $1,030 $12,360 $0-25M gross revenue Per Member Fee Monthly Annual Single Hospital $509 $6,108 Health Center $259 $3,108 Large $509 $6,108 > 2000 claims / month Medium $359 $4,308 1000-2000 claims / month Small $209 $2,508 < 1000 claims / month Large $509 $6,108 > 8000 claims / month Medium $384 $4,608 5000-8000 claims / month Small $259 $3,108 < 5000 claims / month Large $209 $2,508 > 8 physicians Small $129 $1,548 2-8 p physicians y $109* $1,308* *Currently FREE to provider (subsidized by NEHENNet supporting payers) Ancillary Provider Billing Agency Physician Practice / Clinic Solo Practitioner Definition / Criteria All rates as of April 2008 Classic – Rates increase 3% annually. Budget is allocated 60% to ongoing support, 40% to R&D. NEHENNet – Payers are subsidizing development and pilot based on a proportion of covered lives, in addition to fees. ©2009 CSC and NEHEN 781-890-7446 Health Delivery Services May 27, 2009 11 Commonwealth Infrastructure for EHRs and HIE Provide Structure, Manage Connections and Deliver Information Tracking • What scope should an interoperability solution encompass to be complete? Mailroom Packet Storage – Provide address lookup? – Pickup your message? – Secure your message while in transit and check permissions for sending it? Delivery Service Packet Delivery – Provide routing and tracking? – Store yyour message g for p pickup p or delivery? y • What should a community solution solution’s s boundaries be in order to provide value? – Negotiate standard formats? Receiver’s Trash Bin Sender Mailroom – Print or present your message for viewing? – Set rules for how the receiver uses your message? Receiver Receiver Mailroom Packet Pickup Sender Tracking Provider Directory / Routing Message-inTransit Database Provider Directory / Routing Message-inTransit Database – Move it from doorstep to doorstep? – Store it at the receiver destination for routing within the organization? – Provide tracking, viewing and printing services? – Handle translation to and from standard f formats t att one or both b th ends? d ? – Provide services for routing within the organization? ©2009 CSC and NEHEN Internet / Network Sender’s Clinical System (EMR, Ancillary System, Clinical Data Repository, Portal, Interface Engine etc Engine, etc.)) Sender’s HIE Gateway Receiver’s HIE Gateway Tracking g Tracking, g, Viewing and Printing Receiver’s Clinical System (EMR, Ancillary System, Clinical Data Repository, Portal, Interface Engine etc Engine, etc.)) Interoperable Health Information Exchange 781-890-7446 Health Delivery Services May 27, 2009 12 Visit/Discharge Summary Exchange Send / push / route hospital data to interested parties p As a result of a referral, admission, or emergency, patient registers in hospital q Patient receives care and details are noted in hospital medical record t HIE service checks provider directory for routing instructions s Standard format discharge summary or ER report is transmitted to HIE network o Consents and provider routing preferences are sent to HIE service n Patient visits PCP or specialist and r Patient is discharged establishes trusted relationship and consents for release of data from hospital u HIE service routes discharge summary to PCP, p or other interested specialist and trusted party (e.g., health insurance case manager) ©2009 CSC and NEHEN 781-890-7446 Health Delivery Services May 27, 2009 13 Referrals Send / push / route visit and other data in support of referral consultation o Provider refers patient to a specialist, hospital or other provider for consultation or service p HIE service submits referral authorization request to payer for approval and referral # q HIE service checks provider directory for routing instructions and sends referral request with pertinent patient information / history diagnosis and service history, requested to consulting provider; business rules can be stored in HIE service for elements of realtime decision support t HIE service routes visit s Standard format visit n Patient visits PCP or specialist and establishes t bli h trusted t t d relationship and consents for release of data; consents and provider routing preferences are sent to HIE service ©2009 CSC and NEHEN summary with consultation notes transmitted to HIE network summary to PCP, specialist or other interested and trusted party (e.g., health insurance case manager) 781-890-7446 Health Delivery Services r Patient visits consulting provider, receives services, and details are noted in patient chart , electronic medical record or other result is created (e.g., at lab) May 27, 2009 14 Admission Notification Send / p push / route admission notification to p payers y and p providers o Consents, provider routing preferences, and admission notification notice are sent to HIE service i p HIE service checks provider directory for routing i instructions i and d sends d admission notification to patient’s preferred payer and provider n Patient visits hospital or other provider and establishes trusted relationship and consents for release of admission notification data q Authorized payers and providers are notified of patient hospital admission ©2009 CSC and NEHEN 781-890-7446 Health Delivery Services May 27, 2009 15 Laboratory Results o Consents, lab results, and provider routing preferences are sent to HIE service p HIE service checks provider directory for routing instructions and sends laboratory results to patient’s preferred provider n Patient undergoes tests from his or her physician, establishes trusted relationship and consents for release of laboratory data q Authorized providers can access patient’s laboratory results ©2009 CSC and NEHEN 781-890-7446 Health Delivery Services May 27, 2009 16 Standardized Quality Data Send / p push / route visit and other data for standardized q quality y reporting p g ((and other reporting) o Consents, provider routing preferences and applicable data are sent to HIE service n Patient visits PCP, specialist, hospital or other provider and establishes trusted relationship and consents for release of data ©2009 CSC and NEHEN p Standard format visit summary or batch with data for determining quality metrics is sent to payer, government agency or other quality metrics organization based on patient consent and business rules in HIE service 781-890-7446 Health Delivery Services May 27, 2009 17 Community Provider Directory p HIE service consolidates organizational provider information into a single community provider directory n Provider organizations track and maintains internal provider directory p y ©2009 CSC and NEHEN o Provider information from each provider organization is sent to HIE service i q Authorized HIE users can access community provider directory 781-890-7446 Health Delivery Services May 27, 2009 18 Architecture Overview Local Gateway Participant EMRs and Other Enterprise Systems Secondary Local System Interface Engine or Portal E-Mail Server Local Gateway Participant Published Patient Data Published Patient Data Local Provider Directory Local Provider Directory HIE Application Server / Gateway HIE Application Server / Gateway CCD Standard Messages, e-mail or fax encapsulation Web Server Fax Server Summary / Results Viewer • Local L l gateway t users control t l integration, i t ti etc. t • Can leverage infrastructure for internal integration • Interfaces can be direct or use interface engine or similar tools Fax Server Internet / Network N t Network kS Subscriber b ib Web Server Fax E-Mail Server Secondary Local System Summary / Results Viewer H t d Portal Hosted P t l E-Mail Server Printer • No infrastructure support requirement – just Internet connection, fax or e-mail ©2009 CSC and NEHEN Web Server EMRs and Other Enterprise Systems CCD Standard Messages, HTTP encapsulation E-mail, fax or HTTP encapsulation Summary / Results Viewer Interface Engine or Portal Published Patient Data External Networks Community Provider Directory HIE Application Server / Gateway S G t • Hosted by service provider (MA-SHARE) • Provides document / data storage, HTTP viewing for subscribers, and common provider index 781-890-7446 Health Health Delivery Services 781-890-7446 Delivery Services April 8, 2009 May 27, 2009 19 Conclusions • More than 10 years of operational data exchange in Massachusetts, moving g over 60 million transactions p per year y – Self sustaining organizations that have engaged the majority of stakeholders in the state to implement healthcare information exchange policy, governance and technology – National leadership in standards, healthcare information exchange and administrative simplification • Together, NEHEN and MA-SHARE can play an expanded role in supporting ti other th iimportant t t regional i l iinitiatives, iti ti iincluding: l di – Qualifying Massachusetts providers for ARRA HITECH incentives by satisfying requirements for health information exchange – Supporting health information exchange activities of the Massachusetts eHealth Collaborative (MAeHC) across Massachusetts communities – Implementing a statewide health information network as mandated in Chapter 305 and further support of Chapter 58 – Serving the evolving market for information related to performance-oriented contracts, medical homes, etc. ©2009 CSC and NEHEN 781-890-7446 Health Delivery Services May 27, 2009 20 What Can the Commonwealth Do? • Participate in multi-stakeholder collaborations • Work with the payers, providers, and patients in the Commonwealth to development policies and deploy technologies needed to achieve meaningful use of HIT • Leverage the expertise of our existing Massachusetts organizations which are recognized as leaders in the field • Communicate the Commonwealth’s leadership p and readiness in order to attract Federal funds. ©2009 CSC and NEHEN 781-890-7446 Health Delivery Services May 27, 2009 21 Discussion – Thank You! Ray Campbell Executive Director & CEO Massachusetts Health Data Consortium [email protected] John Halamka CIO, Beth Israel Deaconess Medical Center and Harvard Medical School [email protected] Greg DeBor Partner, Health Delivery CSC [email protected] @ NEHEN AND MA-SHARE Program Manager Electronic health record interoperability and health information exchange WORKING TOGETHER TO IMPROVE HEALTH CARE – COORDINATING AND COLLABORATING ACROSS CLINICAL, ADMINISTRATIVE AND ORGANIZATIONAL BOUNDARIES Participating Organizations • athenahealth.com* • Atrius Health* • Baystate Health* / Health New England* • Blue Cross Blue Shield of MA*† • BIDMC / CareGroup • Boston Medical Center*† / BMC HealthNet* • Brockton Hospital* • Cambridge Health Alliance* / Network Health* • Cape Cod Health* • Caritas Christi* • Children's Hospital*† • Community Care Alliance† • Dana Farber* • Emerson Hospital* • Commonwealth of Massachusetts Executive Office of Health and Human Services*† • Fallon Clinic* • Franciscan Hospital for Children* • Harvard Pilgrim Healthcare*† • Healthcare Data Exchange (HDX)* • Jordan Health Systems* • Lahey Clinic*† • Lawrence General * • Lifespan* • Lowell General Hospital* • Mass Eye & Ear Infirmary*† • MedAvant * • Morton Hospital* • NEHENNet subscribers* • Neighborhood Health Plan* • New England Medical Center* • Northeast Health Systems*† • Partners Healthcare System*† • South Shore Hospital* • Southcoast Health System* • SureScripts RxHub† • Tufts Health Plan*† • UMassMemorial Health Care* • United Healthcare* • Westerly Hospital* * NEHEN † MA-SHARE Two collaborative Massachusetts-based initiatives, the New England Healthcare EDI Network (NEHEN) and Massachusetts Simplifying Healthcare Among Regional Entities (MA-SHARE) – representing 55+ hospitals, 5,000+ physicians and 12 regional and national payer – are leading organizations in the emerging area of health information exchange. Together, NEHEN and MA-SHARE provide the region with one of the most mature health information exchange infrastructures in the nation today. OUR MISSION Working together as a team, NEHEN and MA-SHARE coordinate the interoperability of electronic health records, health information technology and health information exchange across organizational boundaries in the New England health care community. The collaborative efforts of NEHEN and MASHARE are directed at improving patient safety, satisfaction and the overall patient experience; simplifying the complexity of health care operations; improving productivity though greater use of information technology; and reducing overall costs for all participants. data in a model emphasizing collaboration, standards-based information exchange and protection of patients’ rights. NEHEN HISTORY NEHEN (pronounced “nee hen”) is one of the most established regional health information exchanges in the nation, with a broad participant base and operating continuously since 1997. Starting from a feasibility study at Partners HealthCare, NEHEN was soon formed by Partners and four other charter health plan and provider organizations as a member-owned limited liability corporation for electronic document interchange (EDI) in September 1998. NEHEN’s mission grew into the region’s cooperative approach to adopting standardized electronic transaction and code set processing required under the federal Health Insurance Portability and Accountability Act (HIPAA). Health plans and provider organizations in Massachusetts and Rhode Island complied with the law’s October 2003 deadline by collaborating on standardized ANSI X12 transactions through NEHEN. NEHEN and MA-SHARE develop and share best practices, provide innovative business and technical solutions that make information available where it is needed to treat patients safely, and help the community operate at a world-class level of efficiency and value. The NEHEN effort has been recognized as one of the leading examples in the nation of a HIPAA solution that not only successfully met the mandate, but also helped the payers and providers affected by the law meet internal business objectives related to improving their reimbursement and administrative functions. NEHEN and MA-SHARE bring together clinical and administrative processes and At the same time, NEHEN is regarded as a successful example of health information NEHEN and MA-SHARE Program Manager NEHEN Features Administrative Transaction Processing • Eligibility verification • Claim submission (institutional and professional) • Claim status inquiry • Electronic remittance advice exchange for its self-sustaining business model, having operated continuously for over 10 years as of 2008. With connectivity to over a dozen payers, serving more than 55 hospitals and thousands of physician practices in Massachusetts and Rhode Island. NEHEN processes over 50 million payment-related transactions per year. MA-SHARE HISTORY • Specialty care referral request • Authorization / precertification • Home health referral • Referral inquiry Technology Platforms • Distributed onsite servers (Classic) • Hosted portal (NEHENNet) Message Types • EDI • Web service / XML • Batch and real-time MA-SHARE Features Clinical Messaging Services • E-prescribing (via SureScripts RxHub) • Clinical Data Exchange MA-SHARE (pronounced “mass share”) was established in May 2003 as a program of the Massachusetts Health Data Consortium. Backed by many of the organizations active in NEHEN, with new leadership, vision and support from Blue Cross Blue Shield of Massachusetts, MA-SHARE has in many ways sought to do for clinical health information sharing what HIPAA and NEHEN have done for administrative processes – namely, to design and deploy technology solutions that assemble, organize and distribute clinical information to a broad range of clinical settings in a secure, confidential manner. Since its inception, MA-SHARE has tackled a number of challenging projects: • MedsInfo-ED – retrieving medication histories for emergency room patients (CDX) – “push” discharge summaries and ER reports Future Joint Services (planned) • Referral consultation routing • Medication history reconciliation • Quality / performance data routing • Personal health record (PHR) routing • Real-time adjudication / claim denial management • Record Locator Service – identifying where patient medical records reside • National Health Information Network (NHIN) Architecture Prototype – one of four projects nationally demonstrating how electronic health records can be developed across multiple states • Rx Gateway – a live electronic prescribing solution for MA-SHARE providers • Clinical Data Exchange (CDX) – a live exchange routing standard clinical summaries among MA-SHARE participants COMING TOGETHER Having developed separately for historical reasons, NEHEN and MA-SHARE increasingly find their visions and plans crossing administrative and clinical boundaries to incorporate data and processes from both areas. Over the last 10+ years, Massachusetts’ and Rhode Island’s leading healthcare organizations have invested over $20M in NEHEN and MA-SHARE to gain new capabilities and avoid spending many millions more in labor, information technology and compliance costs of multiple point-to-point solutions. The two organizations share a common architecture, infrastructure and support services. There is considerable overlap in leadership and governance that also makes collaboration natural. NEHEN and MASHARE are in ongoing discussions about how best to formalize their teaming to leverage their shared services and approach. CONTACT US For more information on services NEHEN and MA-SHARE provide today and their future plans for developing common clinical and administrative services, please contact their common program manager Computer Sciences Corporation (CSC): Gail Fournier, Partner, CSC 266 Second Avenue | Waltham, MA 02451 781.290.1356 [email protected] | www.csc.com Draft MeHI Planning Elements May 27, 2009 Massachusetts e-Health Institute a Division of the Massachusetts Technology Collaborative Purpose of Planning Elements Document • Document created to provide annotated planning elements to HIT Council for review and comment. • RFP for MeHI planning process did not require response for specific planning approach so Planning Elements Document is being provided to consulting firms with specific questions to: • Determine how firm would conduct overall planning process including description of approach, specific deliverables, approximate timeline, etc. • Determine their level of understanding of the various elements of the individual plans and their ability to clearly articulate how to leverage existing efforts in the Commonwealth and nationwide. • Set clear expectation that we need an actionable strategic plan/s with necessary level of detail to move rapidly from planning to operations. Appendix to summary of plan 1 Purpose of Planning Elements Document (cont.) • Not meant as an outline or proposed structure for plan/s. • Goal of MeHI planning process is to support delivery of quality health care in Massachusetts while promoting cost containment through the effective deployment of Health Information Technology (HIT). • Some key definitions required to complete the plan/s have not been finalized by federal government requiring the use of planning assumptions to begin planning process. For example: for MeHI planning process did not require response for specific planning approach so Planning Elements Document is being provided to consulting firms with specific questions to: • • • • • Meaningful use definition for EHRs Interoperability standards for HIEs Role of Research and Extension Centers Specific content of Public Health and Quality Reporting Essential to leverage work completed in the past including 2008 BCG plan for eHealth Rollout and Massachusetts experience in deployment of EHRs and HIEs. Appendix to summary of plan 2 Planning Element Categories • EHR Deployment – recommendation for approach including number of IOs, etc. • Hospital and ambulatory EHRs. • Updating “environmental scan” in Commonwealth to confirm number of providers with no EHRs and capturing lessons learned from past efforts. • Ensure community engagement in process. • Leverage HIT Council meetings and BCG interviews. • Other ways to engage the community? • Key questions: • How will we prioritize deployment of EHRs in the context of goals of Chapter 305 to address medically underserved areas? • How do we ensure sustainable of EHRs following deployment and how should the governance/funding be structured? • How many physicians need EHRs to achieve meaningful use? • How do we ensure the currency of clinical decision support and other features? • Deliverables will include actionable strategic plan with RFP for IO/s. Appendix to summary of plan 3 Planning Element Categories • Role of Consumer in Health Care Delivery Process - to ensure optimal clinical value and active patient engagement in own care. • Chronic disease management and other relevant functions. • Role of PHRs may also be included in EHR and HIE deployment plans. • Stand alone and integrated options. • Deliverables will include specific recommendations for engaging consumer and best practices for supporting PHRs. • HIE Implementation • Update “environmental scan” in Commonwealth to determine current status of HIE efforts in Massachusetts and nationwide. • NEHEN, EMHI, CHAPS, hospital-specific efforts, operational HIEs in other states • Review governance models, sustainable funding options, etc. • Evaluate architectures and technologies to support interoperability, etc. • Key question: How do we ensure long-term sustainability? • Deliverables may include a plan with specific recommendations for a “StateWide” HIE including: • Governance • Technical architecture • Funding models • RFP for IO/s Appendix to summary of plan 4 Planning Element Categories • Governance and management may include: • Process for oversight of contracted IOs providing deployment services including Program Management Office (PMO), tracking metrics, etc. • Role of HIT Extension Centers identified in HITECH Act to assist providers with implementation of EHRs to be defined. • Deliverables to include specific recommendation for governance, management and “tools” for overseeing state-wide efforts. • Funding and loan processes for hospitals, community health centers and communitybased providers • Utilize state, federal and stakeholder funding sources. • State funding – Chapter 305 • Use for matching requirement for federal EHR loans? • HITECH Act funding includes: • $ 2 B for ONC, standards adoption, improved privacy and security, grant and loan funding, etc. • $36 B in Medicare and Medicaid incentives for office-based providers and hospitals. • Determine specific loan requirements for each segment e.g., hospitals. • Deliverable: MTC/MeHI will develop plan for implementation of funding and loan process. Appendix to summary of plan 5 Planning Element Categories • Development of sustainable state-wide HIE model leveraging state, federal and stakeholder funding. • Review of successful state-wide HIEs in US. • How are they funded? • Expanded privacy and security standards. • Deliverable: Consulting firm to evaluate options and make recommendations for: • HIE/s in Massachusetts. • Management and oversight of all deployment efforts in Massachusetts. • Interoperability standards • Definitions not finalized in HITECH Act. • Review current standards and actively monitor federal efforts to ensure that plan recommendations conform to “new” standards. • New standards to be established by two committees under ONC: • HIT Policy Committee (HITPC) will recommend areas in which standards are needed. • HIT Advisory Committee (HITSC) will review and recommend standards. • Deliverable will include specific recommendations in RFPs for IO/s. Appendix to summary of plan 6 Planning Element Categories • Public Health and Quality Reporting • No final definitions for either report type or content. • Must closely monitor to ensure we meet federal reporting requirements when defined. • Assume the use of existing reports for planning purposes including bio-surveillance. • One possible approach: • Create inventory of reports for DPH, CMS, CDC, payer-specific reporting (P4P), etc. • Rationalize and map reporting requirements to appropriate sources including EHRs, HIE data repositories, etc. • Deliverable to include a recommendation for supporting reporting requirements on a state-wide level. Appendix to summary of plan 7
