page 1 Commonwealth of Massachusetts Executive Office of Health and Human Services Health Information Technology Council February Meeting February 4, 2013 3:30-5:00 P.M. One Ashburton Place, 10th Floor, Boston Page 2 - Agenda Today’s Agenda: 1.Mass HIway Update a)Phase 2 – Manu Tandon b)Last Mile Program – Laurance Stuntz 2.Last Mile Program Scorecard – Laurance Stuntz 3.Mass HIway Phase 2 Functionality – Manu Tandon 4.HIT Council Advisory Groups – Manu Tandon 5.Legal Requirements pertaining to the Council – JoAnn Buckland a)Open Meeting Law b)Ethics Law c)Public Records Law 6.HIT Council Bylaws – JoAnn Buckland 7.Wrap up and next steps Page 3 - Discussion Item 1: Mass HIway Update – Phase 2 Status, Last Mile Program Update Page 4 - Phase 2 overall timeline Activity Completion date Submit IAPD to CMS - Complete CMS approval of Phase 2 IAPD - Feb 2013 Procurement for Phase 2 services (RFP, Change Orders, Internal Development) - Feb 2013 Phase 2 infrastructure vendor selected - March 29, 2013 Phase 2 contract (or change order) executed - Apr 15, 2013 Go-live for Phase 2, Release 1(Public Health interfaces)- Apr-Oct, 2013 Go-live for Phase 2, Release 2(CDR, EMPI, RLS, Consent)- Oct 2013 – Mar 2014 Page 5 - Phase 2 critical path - Calendar year 2013 Mass HIway Phase 2 high level project schedule is a graph depicting Phase 2 critical path - calender year 2013 showing progress in the interaction with the highway and Technology, business and policy's & PA's till the end of the year. Page 6 - The Mass HIway Last Mile Program Update Page 7 - Last Mile Program | Sampling of Recent Meetings graph of the procedure of moving organizations through the learning stages of the HiWay. Harvard Pilgrim Healthcare Blue Cross / Blue Shield Foundation Association of Behavioral Health Merrimack Valley HIE Collaborative Berkshire Health System Commonwealth Behavioral Health Assoc. BIDMC Page 8 - Last Mile Program / HIway Implementations Grants •Fund projects that catalyze connections to the Mass HIway by migrating away from proprietary interfaces or paper-based efforts •Budgeted at $2M; will issue awards up $75,000 each •Release date – mid-late February •Award date – rolling, starting in late March •Requirements: –Milestone-based payments –Share experiences & lessons learned Preference given to behavioral health, long-term care, community hospital, and/or small practice organizations Page 9 - Discussion Item 2: Last Mile Program Scorecard Page 10 - Mass HIway Last Mile Dashboard •A communication tool to sync expectation •Indicates performance & status •Built to reflect alignment of strategy to action –Goals > Objectives > Measures > Targets –Targets are supported by initiatives •Metrics are being implemented – this will take time, adjustments may be necessary •Targets reflect CY13 projected performance – feedback is helpful to set the proper expectation Page 11 - Mass HIway Last Mile Dashboard (targets set for CY13) this is a graf depicting connection Adoption and Impact Healthcare Page 12 - Discussion Item 3: Mass HIway Phase 2 Functionality Page 13 - Phase 2 supports high-value use cases MassHIway service Use case examples Medical record Location: •An emergency room provider uses MassHIway to determine the organization(s) that holds a patient’s medical records medical records retrieval: •A case manager uses HIway to identify the care team that may be serving a patient Medical record retrieval: •An emergency room provider uses MassHIway to retrieve a summary record for a patient •A provider uses HIway to retrieve prior diagnostic test results and specialist visit records to aid in patient diagnosis Public health reporting: •A provider uses MassHIway to report to the public health cancer registry, immunization registry, lab reporting program, opioid treatment program, syndromic surveillance program, or childhood lead poisoning prevention program Patient-directed Messaging: •A hospital provider uses MassHIway to send discharge instructions to a patient-specified PHR/portal •A patient uses MassHIway to send “clipboard” information to a specialist prior to an initial visit Consent management: •A provider uses MassHIway to record a patient’s consent preferences for information sharing via the MassHIway •A patient uses MassHIway to set his/her own consent preferences Value drivers: •Continuity of care •Patient safety & reduction in adverse events •Reduction in controlled substance overuse •Reduction in utilization of medical services •Enhanced public health reporting adherence •Supports MU achievement •Administrative simplification Page 14 - Enterprise Master Patient Index (EMPI)and Record Locator Service (RLS) Mass HIway approach is for all clinical records to remain with the providers. Thus the EMPI will unambiguously identify a patient and the RLS will locate and retrieve (“pull”) patient records from another provider organization in accordance with patient consent preferences. Description •IBM Initiate patient database shared with HIX/MMIS •Only stores secured, blinded demographic information necessary for record linking (MRN, patient demographics and encounter type) •Fed by HL7 ADT feeds from source systems Focus of effort •Policy framework for creating a statewide MPI •Data sharing agreements with clinical entities •HL7 ADT specification and deployment •Provider engagement •EHR vendor engagement Page 15 - Consent database Description •Central consent database of patient data-sharing preferences •Linked to EMPI •Fed by HL7 ADT feeds from source systems Focus of effort •Policy framework for consent •Consent agreements and patient outreach/education •Provider outreach/engagement •Data sharing agreements with clinical entities •EHR consent management and handling specifications •HL7 ADT specification and deployment •EHR vendor engagement Page 16 - Query/retrieve infrastructure Description •Automated retrieval of patient summary information •Consent-based retrieval leveraging EMPI/RLS and consent database Focus of effort •Policy framework for query/retrieve •Consent agreements and patient outreach/education •Data sharing agreements with clinical entities •EHR consent management and handling specifications •EHR query/retrieve specifications and interface deployment •Provider engagement •EHR vendor engagement Page 17 - Patient-directed messaging Description •Database of Direct addresses to support provider-to-patient document transmission •Linked to master person index •Fed by HIX/MMIS and (possibly) HL7 ADT feeds from clinical source systems Focus of effort •Policy framework for patient identity-proofing and authentication •Business model for patient enrollment through HIX/MMIS processes •EHR patient Direct address database interface specifications Page 18 - Additional Public Health transactions Description •Opioid treatment: Add back end system to HIE as node; back end system development •ELR: Add ELR to HIE as node; Onboarding support. Additional support for Lead poisoning support •Cancer (NPCR): Add Cancer Registry system to HIE as node; Back end system deployment based on CDC NPCR implementation •Prescription monitoring: Add PMP to HIE as a node; modify back end system to support use on HIE Focus of effort •Opioid treatment: Receive Intake, Enrollment, and Assessments for Opioid treatment program related to Medicaid claims •ELR: Receive infectious disease lab reports as per MA public health regulations •Cancer (NPCR): Receive reports of malignant disease per public health regulations; MU stage 2 •Prescription monitoring To curb prescription drug abuse, this system enables providers to query patient controlled substance history to inform prescribing Page 19 Discussion Item 4: HIT Council Advisory Groups Page 20 - HIT Council Advisory Groups 2011/12 HIT Council, Advisory Committee, and Work Group structure HIT Council HIE-HIT Advisory Committee Consumer and public engagement Workgroup Provider engagement & adoption workgroup Legal & Policy Workgroup Technology & implementation Workgroup Finance & sustainability Workgroup Proposed HIT Council & Advisory Group structure going forward Proposed HIT Council & Advisory Group structure forward HIT Council Consumer Advisory Group Provider Advisory Group Technology Advisory Group Legal & Policy Advisory Group Changes for 2013 •Ad hoc HIE-HIT Advisory Committee is no longer needed given expansion of the HIT Council •Advisory Committee Working Groups are to transition to HIT Council Advisory Groups •Advisory Groups are to provide advice, counsel, and expert opinion to the HIT Council •Advisory Groups are not to be used to perform staff roles – they are to be advisory Page 21 - Advisory Group Membership Consumer Advisory Group – Proposed members Member & Organization Kathleen Donaher - Regis College Barbara Popper - Federation for Children with Special Needs Effie Pappas Brickman - MA Coalition for the Prevention of Medical Errors Jennifer Burns - MA Organization for Addiction Recovery (MOAR) Jessica Constantino - AARP of MA Lisa Fenichel - eHealth Consumer Advocate MaryAnne Frangules - MOAR Karen Granoff - MA Hospital Association Linda Kenney - Medically Induced Trauma Support Services Lisa Lambert - Parent/Professional Advocacy League Member & Organization Georgia Simpson May - MA Dept of Public Health Vanessa Pettigrew - Regis College Lucilla Prates - Medicare Senior Patrol Barbra Rabson - MA Health Quality Partners Winnie Tobin - Medically Induced Trauma Support Services Charlotte Yeh - AARP Services Inc. Alec Ziss - Health Care for All Rita Battles - MA Dept of Mental Health JD Chesloff - MA Business Roundtable Eric Linzer - MA Association of Health Plans Alan McDonald - MA Business Roundtable Page 22 - Advisory Group Membership Provider Forum – Proposed members Member & Organization Nicolaos Athienites -Renal Medical Care Justine Carr - Steward Health Care William Corbett - UMass Memorial Medical Center Ronald Dunlap - South Shore Jim Frutkin - ServiceNet Gregory G Harris - Psychiatrist Neil Kudler - Baystate Health Michael Lee - Atrius Health Norma Lopez - Physician to Physician EHR Strategies Eugenia Marcus - Pediatric Health Care at Newton-Wellesley Member & Organization Judy Melin -Lahey Clinic Daniel O'Neil - Steward Health Care Paul Oppenheimer - Sisters of Providence Health System Naomi Prendergast - D'Youville Senior Care Jim Richter - Massachusetts General Hospital Dirk Stanley - Cooley Dickinson Hospital Scott Wolf - Mercy Hospital Andrei Soran - Metrowest Medical Center Steve Fox - Blue Cross Blue Sheild Massachusetss Page 23 - Advisory Group Membership Technology Advisory Group – Proposed members Member & Organization Atia Amin - Network Health Peter Bristol - Network Health Alec Cheloff - Mass Eye & Ear Infirmary Nancy Christensen - Medicaid Chris Diguette - Atrius Health Larry Garber - Reliant Medical Group Bill Gillis - BIDMC Adrian Gropper - John Halamka - BIDMC Venkat Jegadeesan - EOHHS John Kelly - EOHHS Anurag Lal - EOHHS Nitin Gujral - Children's Hospital Boston Matthew Moss - South Shore Hospital Member & Organization Neil Meehan - Lawrence General John Merantza - Joseph Pavao - Network Health Alin Pop - Joseph Smith CHC Pat Rubalcaba - Partners Healthcare Marc Silverman - MA Department of Public Health Jason Snyder - Information Technology Division Manu Tandon - EOHHS Bill Young - Berkshire Health Systems Qiang Wang - BIDMC David Whitman - The Dimock Center Keith Worthley - BIDMC Karen Bell - CCHIT David Smith - MA Hospital Association Page 24 - Advisory Group Membership Legal & Policy Advisory Group – Proposed members Member & Organization Claudian Boldman - Information Technology Division Liz Fluet - MA Association of Health Plans Gillian Haney - MA Department of Public Health Paul Jeffrey - MassHealth Foster Kerrison - EOHHS Legal Wendy Mariner - Boston University Henry J. Och - Lowell Community Health Center Ken Patterson - Harvard Pilgrim Health Care Institute David Polakoff - UMass Memorial Medical Center Member & Organization Jacqueline Raymond - Brigham and Women's Hospital Kathleen Snyder - EOHHS Legal Deborah Stevens - Tufts Health Plan Diane Stone - Stone and Heinhold Associates David Szabo - Edwards Wildman Palmer LLP Gavi Wolfe - American Civil Liberties Union of Massachusetts Bill Corbett - UMass Memorial Medical Center Kenneth Faulconer - Partners Healthcare Gillian A. Haney - MA Department of Public Health Page 25 - Consumer Advisory Group Charge Purpose: To provide input and consumer/patient perspective to the HIT Council regarding the statewide health information exchange Objectives: •Review and provide input regarding the HIway statewide HIE services •Review and provide input regarding the HIway policies and procedures •Provide consumer input and perspectives to HIT Council for important technical and policy design decisions Membership: Members of the public representing a diversity of consumer segments, consumer membership organizations, advocacy organizations Page 26 - Provide Advisory Group Charge Purpose: •To provide input and provider perspective to the HIT Council regarding the statewide health information exchange Objectives: •Review and provide input regarding the HIway statewide HIE services •Review and provide input regarding the HIway policies and procedures •Provide provider input and perspectives to HIT Council for important technical and policy design decisions Membership: Providers representing a variety of clinical settings and roles Page 27 - Technology Advisory Group Charge Purpose: •To provide input and expert advice to the HIT Council regarding technology design, configuration, deployment, and operation of statewide health information exchange Charge: •Review and provide input to the technical design and configuration of the Mass HIway services •Assist with resolution of challenging technical decisions including identifying paths forward where federal standards guidance and the direction of the market is unclear •Provide expert opinion regarding operational repercussions of policy various policy options •Provide expert advice regarding technology deployment Membership: Technical experts familiar with HIE and EHR technology, CIOs, and business analysts Page 28 - Legal & Policy Advisory Group Charge Purpose: •To provide input and expert advice to the HIT Council regarding the legal & policy framework for statewide HIE activity Charge: •Provide expert advice regarding state and federal statutes and regulations impacting exchange of personal health information •Review and provide input to key HIway documents including Policies and Procedures and Participation Agreement addenda •Identify statutory and/or regulatory barriers to health information exchange and recommend changes to the HIT Council Membership: Lawyers familiar with federal and state legal and privacy and security requirements, security and compliance officers, and policy planners/ analysts Page 29 Discussion Item 5: Overview of Legal Requirements of the Council Page 30 - Open Meeting Law (M.G.L. c. 30A §§ 18-25) All Council meetings are subject to the Open Meeting Law and are open to the public. All deliberations and decisions must be made at an open, public meeting. –“Meeting” is defined as a deliberation by a quorum of a public body with respect to any matter within the body’s jurisdiction. –Deliberations include any kind of discussion (about Council matters) among a quorum of your members, i.e., 11 members. So… If the topic is an HIT Council matter: –An email among 11 members could constitute a deliberation –A discussion in a restaurant among 11 members could be a meeting Page 31 - Open Meeting law Meeting Minutes •Accurate minutes will be taken that include the time, date, place, members present or absent and actions taken at each meeting –Actions taken includes discussions of an issue even if no vote or determination was made by the Council on that issue. No votes may be taken by secret ballot. •Minutes are public record and are publically posted Remote attendance •Only permitted due to a Member’s: –Personal illness; –Personal disability; –Emergency; –Military service; or –Geographic distance •All members (including remotely attending members) must be clearly audible to each other and to all members of the public. •A quorum of the body, including the chair, must be present at the meeting. Roll call votes will be taken. Page 32 - Conflict of Interest Law (M.G.L. c. 268A) Free Legal Advice –As Special State Employees, you can receive free confidential advice about the conflict of interest law from the Massachusetts State Ethics Commission’s Legal Division at: http://www.mass.gov/ethics/ Important Considerations –Members will NOT violate the Conflicts of Interest Law by receiving their regular compensation from their employer while serving on the Council. –The Council may purchase from, sell to, borrow from, contract with or otherwise deal with any organization in which a council member in interested or involved; as long as the interest or involvement is disclosed in advance to the Council and recorded in the minutes of the Council. Page 33- Conflict of interest Law: Impermissible Conduct Violations Include: –Asking for or taking bribes –Accepting gifts or gratuities valued at $50 or more, meant to influence official actions. Or, using position to get something valued at $50 or more that would otherwise be unavailable to you –Presenting a false claim or causing someone else to present a false claim for a payment or benefit –Appearance of conflict (acting in a way that seems as though you have been improperly influenced) –Improperly disclosing or using confidential information –Acting as an agent or attorney for any matter in which the state has a substantial or direct interest Violations of the Conflicts of Interest Law can result in criminal penalties. Page 34 - Public Records Law (M.G.L. c. 66) •The Public Records Law applies to all records created by a state agency or board. Every document, paper, and record (including emails) made or kept by a government entity is considered a public record and is available to the public. •Council Minutes are public records. •Private, personal information (e.g., your home telephone number, etc.) will not be disclosed under the Public Records Law. This information can be redacted from Council Minutes. •The Secretary of State’s office publishes an online Guide to the Public Records Law. •There are numerous statutory exceptions to what constitutes a disclosable,public record. Of relevance to the Council are the following: –Medical files and information (which are also confidential under HIPAA) –Letters or memoranda circulated within the Council or to other Agencies relating to policy positions being developed –Personal notes and materials that are not kept as Council files –Commercial or financial information voluntarily provided to an agency for use in developing governmental policy and upon a promise of confidentiality Page 35 - Discussion Item 6: Distribution of HIT Council Bylaws Page 36 - Discussion Item 7: Wrap up and next steps Page 37 - HIT Council meeting schedule HIT Council 2013 Meeting Schedule*: –January 14 – 11th Floor Matta Conference Room –February 4 – 10th Floor Conference Room C –March 4 –April 8 –May 6 –June 3 –July 1 –August 5 –September 9 –October 7 –November 11 –December 9 *All meetings to be held from 3:30-5:00 pm at One Ashburton Place, 21st Floor, Boston, unless otherwise noted Page 38 - Wrap up Next HIT Council Meeting: March 4, 2013 Preliminary Agenda: •Mass HIway Update •Last Mile Program Scorecard •Advisory Group Updates Immediate next steps: •Reconvene Advisory Groups and continue phase 2 planning