Health Information Technology Council April Update

April 6, 2015

Agenda
Today’s Agenda:

•	Welcome  
-	March meeting minutes approval 
•	Participant Update : Partners HealthCare [30 min] – Pam May
•	Future Policy Discussion  Topics [30 min] – Micky Tripathi 
•	Operations Update [30 min] – Darrel Harmer 
-	Uptime/Downtime Update
-	Mass HIway Stabilization Sprint 
-	HIway Participation and Use Update
-	New Participation and Use Goals 
-	Transaction Analysis 
-	DPH Registry Update
-	HISP-HISP Update
-	Query & Retrieve Update
-	Communications and Outreach Update
•	Wrap up 
-	2015 Meeting Schedule 

Discussion Item 2: Partners HealthCare 

Partners HIway Implementation

Presentation to the MA HIT Council
April 6, 2015

Partners Approach to MA HIway Implementation
•	Focus on Direct implementation and meeting MU Stage 2 requirements
•	Implement and scale the ability to transmit and receive external documents
•	Provider Directory
•	Publish individual providers in HIway Provider Directory
•	Import HIway Provider Directory, maintain in local repositories
•	Develop enhanced search capabilities
•	Patient Consent Process
•	Implement operational processes to obtain and document patient consent
•	Capture/maintain consent data in Epic (NWH, MGH) and PHS EMPI 
•	Two systems synchronized; consent information available for query

Technology Progress
•	Current State
•	Ability to receive a CCDA, incorporate into the EHR and notify the provider
•	Ability to send a transition of care documents (TOC)
•	Ability for a patient to retrieve a clinical summary in Patient Gateway, and view, download, transmit
•	Public Health submissions
•	Immunizations
•	Syndromic Surveillance submissions 
•	Reportable Laboratory Results (future)
•	Incorporation of MA HIway providers into local stores
•	Sensitive data management

Communication with hospitals & physician organization
•	PHS HIE Operating Committee
•	Membership
•	Health Information Services, IS, Chief Medical Information Officers, physician champions, MU managers, legal, compliance, EHR and EMPI team from 
•	5 hospitals and physicians organizations represented
•	Develop standard forms, policies, procedures, communication and educational materials for all sites to use
•	Outreach to other hospitals through PHS Health Information Services Operating Committee
•	Hospital Meaningful Use Committees

Enrollment	
•	Approved by CMO of Hospital and Physicians Organization
•	Physicians notified
•	Closing the Loop on Outside Referrals with the Mass HIway 
•	Registering with direct addresses
•	Receiving incoming CCDAs
•	Clinical Message
•	Sending CCDAs for transitions and referrals
•	Workflows developed and implemented
•	Physician lists generated and verified
•	Information provided to PHS access administrator

Outreach to Practices
•	Partners Community HealthCare (PCHI)
•	Management services organization for the Partners network of physician and hospitals.  
•	Ambulatory Clinical Systems & Development Support Team
•	PCHI arm that supports the relationship with the practices using Partners Ambulatory EHR (LMR)
•	Support Team Efforts
•	Divided Practices into tiers
•	Letters sent to practices
•	Provided information and materials for enrollment
•	Information about HIway shared at Community Physician Organization meetings and MU meetings
•	Assist practices with process
•	Deliver provider information to PHS Access Administrator for enrollment in state directory.

Communication between Partners and MA HIway
•	‘Team’ 
•	Project Manager for Partners HIE (HIway Access Administrator)
•	Project Manager from Health Information Services
•	HIway Account Manager – Len Levine
•	MAEHC Consultant – Murali Athuluri
•	Weekly Meetings
•	Opportunities
•	Clarification on Partners practices
•	Assistance with communication with other participants
•	Provider Directory Guidance
•	Weekly PCHI Meeting
•	Review practices that are on boarding
•	HIway Account Manager attends

Partners Enrollment  Numbers to Date
•	Total Providers Enrolled  3155
•	Physicians 3052
•	Non – Physicians 103

•	Breakdown Across Partners
•	MGPO    1651
•	BWPO     820
•	DFCI       145
•	NSPG     140
•	NWAS      69
•	Partners Community Physicians 330
•	 89 practices

Identifying Trading Partners
•	Run report to see which PCPs and Referring Physicians receive highest volume of discharge summaries
•	Analyze one year of discharge data
•	Sort by physicians with highest volume
•	Identify institution or affiliation
•	Aggregate by institution/organization
•	Identify top 10 organizations
•	Cross reference with HIway membership

Discussion Item 3: Future Policy Topics for Discussion 

Future Policy Topics for Discussion

We would like to have the HIT Council comment on key policy issues related to the HIway

Consent – there are many dimensions to this question.
•	HIway consent
­	Direct Messaging
­	Relationship Listing Service
­	Query for record
­	Event notification (future service)
•	HIV and Genetic Testing (State)
•	Mass Chapter 111 70F HIV Privacy Protections (State)
•	Substance Abuse CFR 42 Part 2 (Federal)
•	Other?

Aside from Consent, are there other key policy areas that merit HIT Council consideration?

Discussion Item 4: HIway Operations Update 

2015 Mass HIway Incident Summary Dashboard December 2014
The severity level (green, yellow, red) by day was provided in a graph. 

2015 Mass HIway Incident Summary Dashboard January 2015

The severity level (green, yellow, red) by day was provided in a graph.

Stabilization Sprint Overview
Goal: Increase system reliability, performance, and client/participant confidence

•	Review past incidents, identify root causes and implement real fixes, not work-arounds
•	6+ week Agile sprint to enhance maximum solution availability / stability
•	4 weekly releases through March with fixes and upgrades; releases rigorously tested and promoted from Dev  Stage  Provider Test Production
•	Orion and EOHHS teams working as one team, in collaborative Agile sprint cycles
•	Implement comprehensive and proactive solution monitoring (LANDs, infrastructure, etc.)
•	Hold daily noon calls with the entire team
–	Identify any implementations, solution changes, infrastructure changes, stability issues or other critical issues that need to be addressed
•	Reallocated additional expert resources from across Orion’s global organization
•	Encompass software solution and hardware infrastructure components
•	Focus on operations process improvement, back-up, recovery; improved security/change management/incident management maintenance and monitoring activities
•	Include infrastructure upgrades, Rhapsody tuning, performance enhancement/management, Rhapsody and Webmail upgrades, environment handovers
•	Transfer knowledge on pain points for EOHHS staff; resolve customer-indicated challenge areas and use cases
•	Institute internal process and management changes and improvements

Stabilization Sprint Highlights
Increased monthly uptime from a low of 94.9% in December to 99.7% in March. 
•	Rhapsody Error Queues – Corrections/Cleanup (reduced disk usage & error queues, greater stability) 
•	Rhapsody Upgrades – Direct Gateway (DG)/XPL/Clinical Gateway (CG)/LAND (performance enhancements, issue fixes with product releases, greater stability)
•	DG Active/Active Setup – HSM and Trust Gateway Active/Active Clustering (High Availability)
•	Update DG Connection Limit (increased connection limit, reduced processing queue in Audit, XDR, and Routing)
•	TG Java and Tomcat Update (upgrade for security, issues, and enhancements)
•	LDAP, DG and XPL Tuning (duplicate message handling for XDR in DG, greater stability)
•	XDR Filter Upgrade to v2.9 (performance enhancements and issue fixes)
•	SEE Critical Fixes (Lantana/SEE attachment file size limitation and XDR attachment viewing error resolved)
•	Underlying Stabilization Issues Addressed that Relate to 5 Critical Mass HIway Use Cases (clears the way for implementation of functional changes to support these use cases)
–	BIDMC/LAND to MAeHC/LAND 
–	Partners/LAND to DPH MIIS/CG Node
–	eCW/HISP to Meditech/XPL 
–	Tufts/LAND to MetroWest/XPL
–	BID Plymouth/XPL to Webmail

Improvements to the Clinical Gateway and Overall Infrastructure - 1

General Improvements:
•	Implemented monitoring of all CG nodes and critical applications
–	Alerts sent to team members for action
•	Reevaluated architecture of the Clinical Gateway Nodes 
–	fine tuning and implement best practices 
•	Created Gold Code for Clinical Gateway components 
–	Embedding best practices into the templates. 
•	Implemented automated Daily Health Checks – 7am, 2pm & 8pm. 
–	Any anomalies are immediately identified and corrected.
•	Upgrading Rhapsody to version 5.5.4 Hotfix 2 being applied to all CG nodes.
–	improve system stability and performance

Improvements to the Clinical Gateway and Overall Infrastructure - 2
Clinical Gateway Modifications
•	MIIS CG Node – CDC standard WSDL deployed:  a new webservice with CDC WSDL that allows providers to easily adopt and exchange information with MIIS systems
•	OTP CG Node – Enhancements:  lookup table values updated; additional business validations added; fixes to improve error handling; cleanup unwanted/unused logs
•	E-Referral CG Node – Enhancements:  SMIME capabilities
•	MCR CG Node – Enhancements:  new version of Rhapsody software installed to improve system stability and performance
•	CLPPP CG Node – Enhancements:  new version of Rhapsody software installed to improve system stability and performance
•	Syndromic CG Node – Enhancements:  fixes applied to address a few ACK-specific issues
Infrastructure Modifications
•	Upgraded memory on database server
•	Updated storage array - VNX HBA 

2015 Mass HIway Incident Summary Dashboard
February 2015
The severity level (green, yellow, red) by day was provided in a graph.

2015 Mass HIway Incident Summary Dashboard March 2015
The severity level (green, yellow, red) by day was provided in a graph.

2015 Mass HIway Incident Summary Dashboard
Dec. 2014 to Dec. 2015
The monthly severity dashboard was provided. 

HIway Availability Trends

The availability trends were provided in a graph (days with outages and total monthly availability) 

What’s next?
Over the next 2 – 3 months…
•	Complete stabilization “loose ends”
•	Performance and load test HIway infrastructure and components
•	Complete system management documentation for existing HIway environment
•	Complete development and implementation of key system management processes
•	Refine monitoring tools – dashboards, reports, etc. (on-going)
•	Publish monthly uptime metrics on HIway web site
•	Begin analysis and assessment of future options – i.e. Orion’s multi-tenant Direct Secure Messaging solution

•	Refocus on enhancing HIway functionality and simplifying the logistics/mechanics required for providers to connect to the HIway – process, technology, etc.

 HIway Participation – March 
•	Avner Aliphas – New England Ear, Nose & Throat
•	Boston Common Podiatry 
•	Cape Regency Rehabilitation & Health Care Center
•	Essex Inpatient Physicians
•	Gleason & Greenfield Pediatrics
•	HealthFirst Family Care Center
•	Lazarou Urology Associates 
•	Mark Abensohn M.D. LLC. d.b.a. Medfield Internal Medicine 
•	Sal Markowitz M.D. 
•	Solomon Gabbay M.D. P.C.
•	Steven Kornbleuth M.D. 
•	Mercy Hospital Inc. d.b.a. Mercy Medical Center 
•	Universal Pediatric Associates

HIway Participation – March New Connections 
•	Avner Aliphas – New England Ear, Nose & Throat 
•	Boston Common Podiatry
•	Cape Regency Rehabilitation & Health Care Center
•	Community Health Programs Inc.
•	Genesis Healthcare
•	Gleason & Greenfield Pediatrics 
•	Lazarou Urology Associates 
•	Mark Abensohn M.D. LLC. d.b.a. Medfield Internal Medicine 
•	Sal Markowitz M.D. 
•	Solomon Gabbay M.D. P.C. 
•	Steven Kornbleuth M.D. 

Setting new targets
Connection 
Status	Current 
Goal	New 
Goal	Actuals 
(As of Mar 19 2015)	Target
(By Jun 30 2015)	
Signed On	431	431	382	49	
Connected	431	431	386	45	
Actively Using	431	100	69	31	

Goal Revision Contributors:
 Low turnaround of customers via another HISP (e.g. eCW shift in Direct strategy) 
Challenges and competing priorities for large health systems and/or hospitals in operationalizing internal workflows for sending Discharge Summaries and/or Transition of Care
Longer than anticipated cycle times and complexities for interfacing and testing with multiple parties (HIway participants, vendors, DPH)
Limited visibility into non-HIway HISP activity 
Resource shift to address stability concerns
Limited usability of service of certain customer configurations (e.g. CCD rendering in Webmail, XDR  <---> SMIME)
Setting new targets
New enrollments & Actively using Prospects	Pipeline
Est.	Confidence
Factor	New Actively Using	
Current eClinicalWorks practices ready to onboard with existing Direct Strategy	120	5%	6	
Actively using Hospital Hubs enabling respective trading partners (receivers)	134	15%	20	
Constituents from IMPACT grant Webmail users	100	5%	5	
NextGen Share HISP organizations	8	25%	2	
Total			33	

Confidence factor enablers:
Obtained definitive practice list from various eCW constituents to connect to Mass HIway
Improved response times and willingness from existing and new participants since completion of MU stage2 attestation deadline
Improved response times from other new HISPs to enable connectivity with Mass HIway
Pro-active objective engagements with Hospital HUBs to operationalize sending and enabling specific critical receiving trading partners

Progress Relative to SFY’15 with Revised Targets
The dashboard with revised targets was displayed. 

HIway Transaction Activity
The 13 month transaction volume graph was provided. 

HIway Transaction Analysis

A graph of 2015 HIway Production Transaction Trends by Use Case Type was provided. 

DPH Registry Update
Currently Available Public Health Registry Connections:
•	Massachusetts Immunization Information System (MIIS)
•	Electronic Lab Reporting (ELR)
•	Syndromic Surveillance (SS) *ED and EH only 
•	Opioid Treatment Program (OTP)
•	Massachusetts Cancer Registry (MCR)
•	eReferral 
•	Childhood Lead Paint Poison Prevention Program (CLPPP)
•	Occupational Lead Poisoning Registry (Adult Lead)

Connections in Progress: 
•	Children’s Behavioral Health Initiative (CBHI) – April 2015 

Future Development:
•	Prescription Monitoring Program (PMP) 

HISP to HISP Connectivity
An update on HISP connections was provided in a graph. 

Query and Retrieve Pilots

BIDMC	Now using PatientSite (patient portal ) for the first entry point where patients can opt-in or opt-out to the Mass HIway.  The programming for that shift is in progress. 	Summer 2015
Atrius	As of 3/20/2015 , 79,587 consent forms have been filed in Epic out of 330,979  requests for consent that have been given to patients. Additional ADT testing with the Mass HIway for patients that have a consent on file continues.  Working on patient portal to capture patient consent. 	Summer 2015
Tufts	Initial test transactions have been successfully completed. Weekly testing resumes during the month of March to confirm additional send/receipt of ADT submissions to the Mass HIway. Production status to be updated upon completion of testing. 
Testing revealed that when a patient  changes their consent from yes to no  the patient is still searchable in the RLS	TBD – Pending RLS update 
Holyoke	The consent process has been finalized. Next steps are to operationalize the new process and anticipated workflow changes for efficient capture of patient consent preferences. Once complete, Holyoke is production ready. 	TBD

HIway RLS - Unique Patients
The RLS volume graph was provided. 

Communications & Outreach

•	Webinars
–	Guide to Using Webmail Webinar 3/23/2015: 41 attendees
–	Mass HIway Overview  3/26/2015 : 25 attendees 
–	Upcoming Webinar: Provider Directory Overview 4/9/2015
Calendar,  registration links, and previous presentations at: http://www.masshiway.net/HPP/NewsandEvents/Events/index.htm

•	Mass HIway Participant Newsletter- Sign up now at www.masshiway.net 
–	March: 685 sent with 29% unique open rate

Discussion Item 5: Wrap Up

HIT Council meeting schedule
HIT Council 2015 Meeting Schedule*:

2015 Meeting Schedule:
–	No meeting scheduled in January 2015 
–	February 2 - meeting cancelled 
–	March 2 
–	April 6
–	May 4 
–	June 1 
–	July 6 
–	August 3 
–	September 14 (1st Monday of September is Labor Day)
–	October 5 
–	November 2 
–	December 7

*All meetings to be held from 3:30-5:00 pm at One Ashburton Place, 21st floor, Boston, unless otherwise noted