SENATE, No. 263

SECTION 1. e – HEALTH INSTITUTE

Chapter 40J of the general laws is hereby amended by inserting after section 6A, the following new section:-

     Section 6B, The corporation shall establish an institute for health care innovation, technology and competitiveness, to be known as the Massachusetts e-Health Institute, and a fund to be known as the e-Health Institute Fund, to be held by the corporation separate and apart from its other funds, to finance the activities of said institute. The executive director of the corporation shall appoint a qualified individual as director to manage the affairs of said institute. The corporation, on recommendation of the executive director, shall appoint not less than 7 qualified individuals to a governing board to assist the corporation in matters related to said institute and said fund and in matters related to the research center matching fund established in section 4F, including a dean of a medical school, head of an emerging health technology company, a cio of a major teaching hospital, and a technology transfer officer or individual qualified in technology commercialization from a university in the commonwealth. The executive director, the director of the office of business and technology, and the president of the Massachusetts development finance agency shall serve as ex-officio members of said governing board. Said board shall consult with the joint committee on health care financing, the house and senate committees on science and technology and ways and means during the preparation of a detailed plan for the operation of said institute and the matching fund. Upon approval of such detailed plan by the board of directors of the corporation, said board shall delegate such authority to the governing board of the institute as it deems appropriate to implement such plan. The members of said governing board shall be deemed to be directors for purposes of the fourth paragraph of section 3. The purpose of the institute shall be to serve as an agent of the commonwealth to create and maintain a more favorable and responsive environment in the commonwealth for the development, growth, attraction and retention of technology to improve patient safety and quality, and to lower costs in the state’s health care system, with a particular attention paid to promoting deployment of health information technology in discrete and underserved regions of the commonwealth by harnessing local support and involvement in such development activities and by improving the health information technology infrastructure for such clusters. In furtherance of these public purposes, the institute shall endeavor to identify regions of the commonwealth in which compelling opportunities to make strategic investments appear to be present and develop strategies therefor. The institute may also provide development support more generally to organizations in regions across the commonwealth to assist the formation and growth of emerging health technology sectors in those regions and may provide support to departments, agencies, and quasi-public entities of the commonwealth for activities that are consistent with the purposes of the institute. The institute may make grants in support of Massachusetts-based public and private enterprises developing and deploying new technologies to significantly increase the efficiency, safety and quality of the health care system. The institute may work in collaboration with the Massachusetts technology collaborative, the New England Health Care Institute, the Massachusetts Hospital Association, the Massachusetts Association of Community Hospitals, other quasi-public and not-for-profit agencies. Successful grants should incorporate regional involvement through alliances among municipalities, colleges, hospitals, health centers, skilled nursing facilities, business and industry, community based organizations, non-profits and labor unions. Insofar as apt, in the determination of the board, the provisions of this chapter that apply to centers and to the center fund shall apply to said institute and to the e-health institute fund, respectively. Without limiting the generality of the foregoing, the corporation may apply moneys in said fund to start-up expenses and project costs of said institute and related activities, grants or loans to nonprofit or other organizations to promote the use of electronic health records, computerized physician order entry systems, telemedicine, and to promote the adoption of promising, innovative technologies to create and test methods by which payers and providers can actively speed the uptake of selected innovations that are valuable to patients. The institute may also make grants to support health care workforce development including, but not limited to, providing funds for programs that provide education and training to enhance the skills of physicians and nurses, as well as low skilled workers, brokered business assistance services and marketing expenses, provided that written notice shall be given to the house and senate committees on ways and means at least 10 business days before any disbursement of funds amounting to $250,000 or more. The institute shall also file an annual report of its activities with the joint committee on health care financing, the house and senate committees on science and technology and ways and means.

  (b) No grant shall be awarded from the e-health institute fund without the corporation first having consulted with the public health council established pursuant to. The request for consultation shall be submitted not less than 15 business days prior to the execution of any grant award contract. All successful grant applications shall define specific goals and expected outcomes and contain corresponding accountability measures. Applicants that fail to meet these accountability measures shall be barred from pursuing any additional grants under this section for 5 years from the effective date of the grant. Notwithstanding any general or special law or rule or regulation to the contrary, in order to support health care improvement throughout the commonwealth, any organization found to be eligible to receive financial assistance from the e-health institute fund in support of certain specified purposes and activities shall be deemed to be eligible as well to receive financial assistance for such specified purposes and activities as qualified investments of the emerging technology fund established pursuant to section 27 of chapter 23G of the General Laws and a portion of the emerging technology fund shall be allocated and reserved for such application.

  (c) In making the initial round of grants from the innovation institute fund, no less than $500,000 shall be distributed over a 3 year period to each of the 5 geographic regions of the state, the central area, the greater Boston area, the north east area, the south east area and the western area, as those areas are defined generally as follows:

  "Central Area'', the Northern Worcester Service Delivery Area and the Southern Worcester Service Delivery Area as specified in 20 CFR 661.280;

  "Greater Boston Area'', the Boston Service Delivery Area, the Metropolitan North Service Delivery Area and the Metropolitan South/West Service Delivery Area as specified in 20 CFR section 661.280;

 "North East Area'', the Lower Merrimack Valley Service Delivery Area, the Northern Middlesex Service Delivery Area and the Southern Essex Service Delivery Area as specified in 20 CFR 661.280;

  "South East Area'', the Bristol Service Delivery Area, the Brockton Service Delivery Area, the Cape and Islands Service Delivery Area, the New Bedford Service Delivery Area and the South Coastal Service Delivery Area as specified in 20 CFR 661.280; and

  "Western Area'', the Berkshire Service Delivery Area, Franklin/Hampshire Service Delivery Area and Hampden Service Delivery Area as specified in 20 CFR 661.280.

(d) The purpose of said initial round of grants shall be to spur deployment of electronic health records (EHR) and computerized physician order entry (CPOE) systems to every physician office in the Commonwealth and to develop and implement a statewide health information technology plan that provides for—

(1)   a health information network that will serve a geographic area that—

          (a) is located in 1 or more regions of the Commonwealth; and

          (b) does not include any area to be served by the health information      

                 network of any other grantee under this section;

(2)   a plan to finance acquisition and implementation of technology by health care providers as needed to allow participation by the providers in the network;

(3)   to identify best practices for implementing these IT systems across the state and develop a plan to share this information with all health care providers in the state, 

(4)   a plan to use the network to improve patient safety, quality, and efficiency within the health care system through the establishment and implementation of electronic health records (EHR) and computerized physician order entry (CPOE), and

(5)   the pursuit of facilitating adoption of advanced technologies in all of the state’s hospitals, community health centers and doctors’ offices with the circulation of its Readiness Roadmap, Draft CPOE Standards, and Readiness Scores.

(e) USE OF FUNDS- The Massachusetts e-Health Institute may not make a grant under this section unless the recipient organization agrees to use the grant—

(1)   to develop and implement a electronic health records (EHR) or computerized physician order entry (CPOE) or both; and

(2)   to begin implementation of the plan not later than the beginning of the second year of the grant.

(f) STATEWIDE HEALTH INFORMATION TECHNOLOGY PLAN-

(1)   STATEWIDE HEALTH INFORMATION TECHNOLOGY PLAN- The institute shall prepare a statewide health information technology plan that shall provide for—

(a)    the establishment and implementation throughout the Commonwealth of a statewide health information network        

                    that—

i)                    allows the seamless, secure, electronic sharing of health information among health care providers, health plans, and other authorized users;

ii)                   provides consumers with secure, electronic access to their own health information;

iii)                 meets data standards for interoperability adopted by the Massachusetts Technology Collaborative, including any standards providing for interoperability among other health information networks, in cooperation with the Massachusetts e-Health Initiative, the Massachusetts Health Data Consortium, MA-SHARE and other appropriate organizations;

iv)                 provides for interoperability with any health information technology product certified by the certification entity described in section 4(a);

v)                  meets the privacy requirements of subsection (b);

vi)                 gives patients the option of allowing only designated health care providers to access their individually identifiable information concerning diagnosis and treatment of sexually transmitted diseases, addiction, and mental illnesses;

vii)               provides such public health reporting capability as the Secretary of Health and Human Services requires;

viii)              allows for such reporting of, and access to, health information for purposes of research (other than individually identifiable patient health information) as the Secretary of Health and Human Services requires; and

ix)                 allows for the reporting of provider-specific health information (other than individually identifiable patient health information) required for the calculation of any voluntary consensus standard endorsed by the National Quality Forum;

(b)   the financing and technical assistance required to allow health care providers, especially small physician groups, to acquire and implement electronic medical records, computerized physician order entry, or other technology necessary to participate in the statewide health information network; and

(c)    agreements among health care stakeholders regarding data reporting, reimbursement practices, or other mechanisms to use the statewide health information network to improve patient safety, quality, and efficiency within the health care system.

(2)   CONTENTS- A statewide health information technology plan shall--

a)      be developed with the participation and widespread support of all health care stakeholders of the Commonwealth, including but not limited to hospitals, practicing physicians (including those from small physician groups), nursing facilities and skilled nursing facilities, other health care providers, health plans, employers, and patient groups;

b)      describe the governance structure of the statewide health information network;

c)      describe the technologies and systems, including interoperability data standards, that will be used to establish a health information network consistent with paragraph (A)(i);

d)      explain what information will be able to be accessed, transferred, or exchanged through the health information network and what capabilities the network will have to include other types of information in the future;

e)      describe plans to ensure network reliability, expected frequency of network interruptions, and backup procedures in the event of network interruptions;

f)        describe sources of initial financing for the development of the health information network and a financing model for long-term sustainability of the network;

g)      describe sources of financing the acquisition, implementation, and maintenance of technology necessary to allow health care providers, especially small physician groups, to participate in the health information network;

h)      describe how the health information network will be used to improve health care quality and the health outcomes of patients;

i)        establish how administrative and clinical savings resulting from widespread use of the new health information network will be accounted for and allocated;

j)        explain how the statewide health information organization involved will ensure widespread participation by health care providers (especially small physician groups) in the health information network and what support and assistance will be available to physicians seeking to integrate health information technologies into their practices;

k)      describe how patients and caregivers who are not health care providers will be able to access and utilize the health information network;

l)        explain how the statewide health information network will protect patient privacy and maintain security; and

m)    explain how the statewide health information network will ensure the participation of health care providers serving minority communities, including communities in which English is not the primary language spoken.

(3)   SELECTION- In selecting grant or loan recipients under this section, the e-health institute shall take into account—

(a)    existing technological and organizational infrastructure upon which the health information network can build;

(b)   the extent of stakeholder participation;

(c)    health care provider participation commitments;

(d)   capacity to measure quality and efficiency improvements;

(e)    replicability;

(f)     the extent of the opportunity for a plan to improve health care quality and the health outcomes of patients in the region to be served;

(g)    such other factors as the Collaborative considers relevant.

(4)   Privacy Protections-

(a)    Any health information network funded in whole or in part under this section shall--

i)                    comply with the privacy protections of regulations promulgated pursuant to section 264(c) of the Health Insurance Portability and Accountability Act of 1996 (Public Law 104-191; 110 Stat. 2033); and

ii)                   (ii) allow patients to exclude their health information from the health information network.

(b)    UNAUTHORIZED DISCLOSURE- In the event of the unauthorized access to or disclosure of individually identifiable patient health information by or through the statewide health information network, or by or through any technology grantees funded in whole or in part under this section, the operator of such network or grantee shall—

i)                    report the conditions of such unauthorized access or disclosure to the Collaborative in such manner as the Collaborative requires; and

ii)                   (ii) provide notice to any individuals whose patient health information may have been compromised in violation of this subsection as a result of such unauthorized access or disclosure.

(c)    Application- To seek a grant under this section, an applicant shall submit an application to the Collaborative in such form, in such manner, and containing such information and assurances as the Collaborative may require.

(d)    Technical Assistance-

i)                    The Collaborative shall provide to the statewide health information technology network and to individual technology grantees such technical assistance as the Collaborative deems appropriate to carry out this section, including assistance relating to questions of governance, financing, and technological approaches to the creation of health information networks.

ii)                   STATEWIDE TECHNICAL ASSISTANCE CENTER-

(A)   ESTABLISHMENT- The e-health institute shall by contract or grant establish and maintain a statewide technical assistance center to provide assistance to physicians to facilitate successful adoption of health information technologies and participation in the development and implementation of the statewide health information technology plan by such physicians.

(B)   PHYSICIANS- The statewide technical assistance center shall provide assistance to physicians in all geographical areas served by a health information network.

(C)   PRIORITY- In providing assistance to physicians under this paragraph, the statewide technical assistance centers shall--

i)                    give priority to physicians in small physician groups; and

ii)                   (ii) as resources allow, provide assistance to physicians in larger groups.

(D)   REQUIREMENTS- Technical assistance provided under this paragraph shall, at a minimum, include the following:

i)                    A clearinghouse of best practices, guidelines, and implementation strategies directed at the small medical practices that plan to adopt electronic medical records, electronic prescribing, and other health information technologies.

ii)                   A change management tool kit to enable physicians and their office staffs to successfully prepare practice workflows for adoption of electronic medical records and electronic prescribing, to receive guidance in the selection of vendors of health information technology products and services that are appropriate within the context of the individual practice and the community setting, to implement health information technology solutions and manage the project at the practice level, and to address the ongoing need for upgrades, maintenance, and security of office-based health information technologies.

iii)                 (iii) The capability to provide consultations and advice to small medical practices to facilitate adoption of health information technologies.

(iii) Prohibition- No funds under this section may be used for the establishment of a database of individually identifiable patient health information.

(e)    Not later than 4 years after the date of the enactment of this Act, the e-health institute shall submit a report to the joint committee on health care financing and the senate and house committees on ways and means on the progress in realizing the purposes of this Act, with particular attention to the following:

(1)   The capacity to exchange health information between and among components of the health system.

(2)   Rates of health information technology usage and provider participation in electronic health records and computerized physician order entry systems.

(3)   The security and privacy of health information technology supported by this Act.

(4)   The impact of health information technology on health care quality, health outcomes of patients, and health care costs.

(f)      INTEROPERABILITY.

No state funds may be made available to any entity under this Act for the purchase of a health information technology product, unless—

(1)   the product is certified by the appropriate entity; or

(2)   if a certification process has not yet been developed for the product by an appropriate entity, the Federal department or agency involved has determined that the product incorporates, to the extent feasible, appropriate interoperability data standards and compliance criteria adopted by the entity for another product;