Commonwealth of Massachusetts
Executive Office of Health and Human Services

Health Information Technology Council Meeting

August 6, 2018

Agenda

Welcome
Undersecretary Lauren Peters

EOHHS Event Notification Service (ENS) Initiative Update
David Whitham

HIway 2.0 Migration Update
Kim Tuon-Mennella

HIway Connection Requirement: 2018 Update
Michael Chin, Chris Stuck-Girard

MeHI FY19 Operating Budget
Laurance Stuntz

HIway success story: Brockton Neighborhood Health Center
Allyson Pinkhover

Appendix A: HIway Operations Update

Welcome

Undersecretary Lauren Peters

EOHHS Event Notification Service (ENS) Initiative Update

David Whitham

ENS Initiative Background

EOHHS ENS Initiative goal:
The goal of the EOHHS ENS Initiative is to support timely statewide event
notification services (ENS) in order to improve health care delivery, quality,
and coordination

EOHHS ENS Initiative promotes:

Adoption and use of Electronic Health Records (EHR)

Interoperability and Meaningful Use

Admission, Discharge and Transfer (ADT) data exchange

Improved healthcare outcomes

Efficiency for providers

Safety and security for patients

Request for Responses (RFR) Milestones:

The RFR was posted to COMMBUYS on February 15, 2018

The Bid Opening date was April 27, 2018

Six Bidder Responses were received

EOHHS requested input from the HIT Council and incorporated feedback received into the evaluation process

Evaluation of the Bidder Responses is ongoing

Approval of the SST’s winning Bidder selection and commencement of contract negotiations is currently estimated for November 2018

First Quarter of Calendar Year 2018:
Release RFR (completed)

Begin Reviewing Responses (completed)

Second and Third Quarters of Calendar Year 2018:
Finish Reviewing Responses

Recommend Vendor Selection (Procurement Team)

Fourth Quarter of Calendar Year 2018:
Approve Recommendation (EOHHS Leadership)

Negotiate Contract

First Half of Calendar Year 2019:
Approve Contract (CMS)

Prepare for ADT Repository Launch
(includes establishing business processes, testing and defect remediation)

ADT Soft Launch
(repository ready to receive ADTs)

HIway 2.0 Migration Update

Kim Tuon-Mennella

HIway 2.0 Background Recap

The HIway team at EOHHS is working closely with Orion Health to implement and operate a new Mass HIway Direct Messaging System, also known as “HIway 2.0”

HIway 2.0 uses Orion Health Communicate, an EHNAC/DirectTrust accredited, cloud-based, multi-tenant, Software as a Service solution that is an ONC 2015 Edition certified Direct Project, Edge Protocol, and XDR/XDM product

The upgrade to HIway 2.0 was necessary to leverage the national standards for Direct Messaging that didn’t exist when the HIway was launched in 2012, and to make it easier for organizations to connect to the Mass HIway and to other health care organizations via the Mass HIway

Migration Progress Highlights

Migration of the Clinical Gateway nodes for Public Health Reporting is in progress, with 5 nodes migrated and in production use on HIway 2.0 and 4 nodes remaining to be migrated

The initial Webmail Participant migration into HIway 2.0 production was completed in June, with the first LAND and XDR Participant migrations scheduled for August

The pilot sites, besides being the first into production, have also worked carefully through the migration process and provided valuable feedback to help the HIway Migration Team improve the process as well as the instructions, forms, and other materials

Many Clinical Gateway Nodes Already On HIway 2.0

After extensive testing, the migration of the CG nodes to HIway 2.0 has been seamless for Participants, handled during scheduled maintenance downtimes with no system changes required by Participants.

Migrated to HIway 2.0 during May, June, and July:

MCR – Massachusetts Cancer Registry

CLPPP – Childhood Lead Poison Prevention Program

PMP – Prescription Monitoring Program

eREF – eReferral Program

ELR – Electronic Lab Reporting

Scheduled for Migration in August:

CBHI – Children’s Behavioral Health Initiative

MIIS – Massachusetts Immunization Information System

SYND – Syndromic Surveillance Program

OTP – Opioid Treatment Program

Thank You: Participant Organizations Helping to Pilot HIway 2.0

The HIway 2.0 Migration Team identified a number of active Participants that represent a variety of connection types and patterns to help pilot the migration process. We would like to thank them for their feedback and suggestions throughout the process.

Migrated to HIway 2.0 in June:

Cape & Islands Plastic Surgery – Webmail migrated to Communicate Webmail

Scheduled for Migration in August:

Boston Medical Center – LAND migration to Communicate Connect

Holyoke Medical Center – XPL migration to Communicate Direct XDR

Massachusetts eHealth Collaborative – XPL migration to Communicate Direct XDR

Tufts Medical Center – Test LAND migration to Communicate Connect

Migration to be Scheduled:

Cape Cod Health Care – XPL migration to Communicate Direct XDR

Emerson PHO – XPL migration to Communicate Direct XDR

Milford Regional Medical Center – LAND migration to Communicate Connect

Migration Activities Timeline

Initial Setup & Install – Complete

CG Node Testing and Pilot Participant Coordination – Complete

Pilot Operations – June through August 2018 – In Progress

Clinical Gateway nodes are being moved to production

Pilot Participant connections are being tested and moved to production

Migration Scheduling – through September 2018 – In Progress

Participant awareness campaign started in June with request for contact updates Follow-up email sent in July with instructions and links to forms on the HIway 2.0
Migration website and request for all forms to be returned by August 31, 2018

Declaration of Identity (DOID) Form

Health Care Organization (HCO) Account Request Form

Participants to be scheduled for migration based on the organization’s preferences, following verification of identity for the HCO Representative

Migration Activities Timeline (continued)

Production Operations – starting July 2018 – In Progress

All new Participants will be onboarded directly to HIway 2.0

Existing Participants will be migrated from HIway 1.0 to HIway 2.0

Migrations will take place in waves

Migration date will be set when registration and identity proofing is complete

HIway 1.0 will continue to operate in maintenance-only mode with no new enhancements or upgrades

HIway 1.0 Sunset – 1st Quarter 2019

All existing Participants expected to be migrated from HIway 1.0 to HIway 2.0

HIway 1.0 will be decommissioned after all Participant migrations are completed

What Migration to HIway 2.0 means for current Participants

New verification and paperwork requirements for LOA 3

Level of Assurance 3 (LOA 3) is the government standard for electronic authentication of identity required for health information exchange
Domain names and Direct addresses do not change (unless desired)

Webmail to Communicate Webmail

Low Participant impact
Migration of mailbox data
LAND to Communicate Connect

Device and Usage review (replace old hardware if necessary)
Remote login and image update will be more common
XDR/XPL to Communicate Direct XDR

New certificate chain and personal certificate delivery
Participant installs certificates on their infrastructure

HIway Connection Requirement:	2018 Update
Michael Chin, Chris Stuck-Girard

16

The HIway connection requirement is the requirement for providers to connect to the Mass HIway, as set forth in M.G.L. Chapter 118I, Section 7, and as detailed in the Mass HIway Regulations (101 CMR 20.00).

The providers that have a required HIway connection date specified in the Mass HIway Regulations
are listed below.

Provider Organization	Calendar Year (CY) 2017

CY 2018	CY 2019

Acute Care Hospitals	Year 1	Year 2	Year 3

Large and Medium
Medical Ambulatory Practices

No HIway connection
requirement	Year 1	Year 2

Large Community Health Centers	No HIway connection
requirement

Small Community Health Centers	No HIway connection
requirement

Year 1	Year 2

No HIway connection
requirement	Year 1

Who & when: Provider organizations that have HIway connection dates specified in the Mass HIway Regulations are
required to submit the applicable Attestation Form by July 1st of the applicable year.

In CY 2018, by July 1st:  (1) Acute Care Hospitals:  submit Year 2 Attestation Form
(2) Large & Medium Medical Ambulatory Practices + Large CHCs: submit Year 1 Attestation Form

17

The HIway connection requirement is implemented using a phased-in approach

The phased-in approach has four aspects:

Three types of Provider Organizations (i.e., Acute Care Hospitals, Large and Medium Medical Ambulatory Practices, and Community Health Centers) have connection dates that are specified in the Mass HIway Regulations.

EOHHS anticipates that Provider Organizations that are not specified in the regulations will be required to connect at a future date, with future guidance providing at least one year notice for affected organizations to connect.

The three types of Provider Organizations have an initial “Year 1” connection requirement between Calendar Year 2017 and 2019.

How Provider Organizations fulfill the HIway connection requirement is phased-in over four
years, with penalties for not meeting the requirement beginning in Year 4.

The statutory requirement that providers implement “interoperable EHR systems” that connect to the Mass HIway is fulfilled by implementing HIway Direct Messaging, as specified in the Mass HIway Regulations.

18

The HIway connection requirement follows a four-year phased-in approach that progressively encourages use of the Mass HIway for Provider-to-Provider communications and bi-directional exchange of health information.

How Provider Organizations connect:

Year 1:  Send or receive HIway Direct Messages for at least one use case.
The use case may be within any category of use cases.

Year 2:		Send or receive HIway Direct Messages for at least one use case that is within the Provider-to-Provider Communications category of use cases.

Year 3:		Send HIway Direct Messages for at least one use case, and also receive HIway Direct Messages for at least one use case. Both of these use cases should be within the Provider-to-Provider Communications category of use cases.

Year 4:		The Provider Organization may be subject to penalties if that organization has not met the requirements established in this section. Penalties do not take effect until Year 4 of the connection requirement (i.e., January 2020 at the earliest) as stated above.

Acute Care Hospitals: In addition to using HIway Direct Messaging, Acute Care Hospitals are also required to send Admission Discharge Transfer notifications (ADTs) to the Mass HIway within 12 months of the ENS’ launch as a part of the HIway connection requirement.

Categories of Use Cases for HIway Direct Messaging are detailed in the Mass HIway Policies & Procedures, and include the following categories:

Public Health Reporting
Provider-to-Provider   Communications
Quality Reporting
Payer Case Management

Examples of HIway Direct Messaging Use Cases:

Public Health Reporting:
Example:  Immunization information sent from Pediatric Primary Care Provider to the Massachusetts Immunization
Information System (MIIS) at DPH

Provider-to-Provider Communications
Example: Summary of Care sent from a Primary Care Provider to a consulting Specialist at time of a Patient referral

Quality Reporting
Example: CCDA documents sent from Healthcare Organizations to a Quality Data Center for measures calculation,
feedback, and reporting

Payer Case Management
Example:  Summary of Care sent from Primary Care Provider to a Case Manager for intensive case management support

Supporting documents related to the Mass HIway Regulations include the following:

Mass HIway Regulations Summary (February 2017)

Mass HIway Fact Sheet for Patients (February 2017)

Mass HIway Regulations FAQs (version 2 was released in April 2018)

Mass HIway Polices & Procedures (version 4 became effective in December 2017)

Year 1 and Year 2 Attestation Forms:
for use by Provider Organizations that have a HIway connection requirement in 2018
updated PDF versions for planning purposes were released in April 2018
online versions were available beginning in May 2018

The Year 1 & Year 2 Attestation Forms are used by Provider Organizations that have a HIway connection
requirement date. These forms are used to provide two areas of information:

how the organization met the HIway connection requirement, and

whether the organization has an EHR, and if so, how it connects to the HIway

The Year 1 Attestation Form collects the following information:

How the organization met the Year 1 HIway connection requirement:
Questions on the Attestation Form include:
The use case is within which category of use cases?
Use case categories: (1) Provider-to-Provider Communications, (2) Payer Case Management,
(3) Quality Reporting, (4) Public Health Reporting
Describe the use case
Approximate # of HIway Direct Messages per month for the use case

Whether the organization has an EHR (and if so, how it connects to the HIway):
Questions on the Attestation Form include:
Name and version of the EHR?
Is the EHR an ONC Certified Health IT Product?
How is the organization connecting to the HIway?
Options include:  (1) EHR directly to HIway, (2) EHR via a HISP, or (3) via Mass HIway webmail 	22

23

Where: The Attestation Forms are available on the Mass HIway website: www.masshiway.net
How: Provider Organizations attest using the online Attestation Form
–	Note: Incomplete online Attestation Forms cannot be saved; therefore the recommended steps include …
–	Step 1:	Download a PDF version of the form by going to the “Resources” drop-down menu and selecting “Participant Forms.”	
–	Step 2:	Use the PDF version to prepare answers	
–	Step 3:	When ready to submit the online form in a single session, click on the link for “Click here to access the online version…”	

MASSACHUSETTS HEALTH INFORMATION HIGHWAY

Puroose: This Attestation form shall be completed by Provider Orgartizations m order to report compJiance witll
the first year of the Hlway connection requirement, which is the statutory requiremenUhmiProvider Organizations
·connect to tile Mass Hlway in accordanc e with the Mass Hlway Regulations (101CMR 20). The Mass Hlway is the Commonwea'lfh's statewide,state-sponsored healtll informt'ltion exchange.Instru ctions for this form tlppear as endnotes on pages 7 to 8 of tills document.

A n aulhorized individualat the app1ict'lble Provider Orgm1 zation should complete t'lnd submit this Attes tation Form by the date specifiedin the instructions.1Provider Organizations should contact Mt'lss Hlway (via emaiJ t'lt: MassHiwayAite.station@stafe.ma.uslif tt1ey have questions regarding tills Attestation Form or if their o rganization does not meet their 2018 Mass Hlway connection requkement.

Sect i on A : Proyjder Org'anjzat j on l nfonnatjon:

11 legalname of the Provider Organi!zation (Ex ample: Geotge· Washington Hospftal}:

2) Street Address (Please fnclude tile address for the Provider Organization.not for the administrative or billing
office if these are different):

Ouesions 3-5 t'lre required in order to helpidentify the Provider Orga nization that is complefing tile Attestation Fom1.

.3J 1Massachusetts Tax 10 (TIN):

41Org1aniz.ation NPI(Can be retrieved from the NPPES NPI Registry here:htilps /fnpirooisbv.cms.hhs.gov/l:
https://npiregistry.

51 Provider Org1anizatio n''s Direct address domain(s J2 :·

24
61 Name of parent company or organization (if app icable):

Calendar Year 2018 Attestation Forms: Update

The HIway has used multiple forums for conducting outreach and education related to the HIway connection requirement.

As of mid-July 2018, the HIway had received Attestation Forms from most Acute Care Hospitals and outreach with Community Health Centers and Medium/Large Medical Ambulatory Practices is ongoing.

Status update (as of July 23, 2018):

45 Acute Care Hospitals submitted Year 2 forms, and 7 provided information regarding HIway connection plans
(i.e., 77%; 52 out of 67 expected)

23 Large Community Health Centers submitted Year 1 forms, and 1 provided information (i.e., 66%; 24 out of 36 expected)

60 Large & Medium Medical Ambulatory Practices submitted Year 1 forms, and 8 provided information
A total of 546 entities (including organizations, sub-organizations and practice locations) were represented in the
60 forms submitted. There are approximately 600 practices that meet the regulatory definition of a Large &
Medium Ambulatory Practice.

Developing the list of Medical Ambulatory Practices that have a connection requirement:

The list is being developed from multiple sources, including information from Mass HIway, MeHI, Registration of Provider Organizations Program (RPO), and outreach with individual practices and organizations

Plans For Organizations
To Meet Connection Requirement

If a Provider Organization does not meet its connection requirement, instead of completing an Attestation Form, the Organization is required to send the HIway an email explaining why it did not comply and its plans to become compliant.

If a Provider Organization does not meet its 2018 HIway connection requirement, then instead of completing an Attestation Form, the Provider Organization is required to email the Mass HIway with the following information:

Identifying/contact information

Information about their EMR/EHR

Reason for not complying with the connection requirement

Brief description and estimated timeline of the organization’s plan to comply with the connection requirement

Questions & Input from Provider Organizations

Numerous Provider Organizations have submitted questions on topics including how to fill out the Attestation Forms and whether a certain activity fulfills the connection requirement.

Questions from Provider Organizations:
Leading up to and following the July 1 attestation deadline, the HIway responded to Provider Organizations’ attestation questions. These answers have been saved so they can be quickly deployed if similar questions are asked.

Question themes include:
Whether certain activity fulfills the connection requirement
How to fill out the Attestation Form
Whether the Provider Organization has a connection requirement in CY 2018
How “sub-organizations” should be included on a Provider Organization’s form

Current Activity and Next Steps

The HIway continues to review Attestation Forms and engage Provider Organizations that have a connection requirement. The HIway is making plans for the Calendar Year 2019 attestation cycle.

The HIway is currently:

Reviewing individual Attestation Forms (and following up as needed)

Continuing outreach to Provider Organizations (instructional webinars, monthly newsletters, reminder emails, conference calls)

Communicating with Provider Organizations to address questions (see previous slide)

Next steps:

Develop outreach plan and supporting materials for Calendar Year (CY) 2019 HIway connection requirement. In CY 2019 …

Acute Care Hospitals will have a Year 3 requirement

Large Community Health Centers and Large/Medium Medical Ambulatory Practices will have a Year 2 requirement

Small Community Health Centers will have a Year 1 requirement

Gather input from the HIT Council regarding the HIway connection requirement for additional
types of provider organizations

Mass eHealth
Institute

FY19	Plan & Budget

MeHI Vision, Mission and Goals

30

MeHI Key Accomplishments
2008-2018

Digitize Healthcare Data
100% of acute hospitals in MA on EHRs
>90% of physicians
>80% of post-acute facilities
>60% of Community Behavioral Health
orgs
Developed and Deployed Toolkits for
EHR Adoption
Meaningful Use
Health Information Exchange
Direct support for >70 hospitals, >8,000 physicians, and hundreds of post-acute and behavioral health orgs
Channeled > $300 million in federal and state funding to hospitals and providers to
31	support EHR adoption

Share Healthcare Data
MeHI and EOHHS worked together to make Massachusetts the first in the nation to leverage federal Medicaid funds to build a statewide Health Information Exchange
100% of large ambulatory practices connected to the HIway
>90% of hospitals
>80% of large community health centers
>80% of large behavioral health practices

Drive Innovation in Healthcare
Helped launch the Massachusetts Digital Health Initiative
> 350 digital health companies are headquartered in MA
13 of the 100 largest in the US are headquartered in MA
Launched PULSE@MassChallenge and TechSpring innovation hubs
Developed Community Digital Health Assessments for every community in the state
Innovation grants
33 for HIway adoption and use
Eight connected communities grants across the state

Vendor grants to support the Children’s Behavioral Health Initiative

The eHealth Institute Fund will be primarily used to encourage and support innovation using digital health technologies and the development of the digital health cluster in Massachusetts. We will place particular emphasis on supporting innovation in Aging
& Caregiving, Health Reform, and responses to the Opioid Crisis in alignment with
the Baker Administration’s priorities
MeHI will continue providing contractual services as appropriate and available to support EHR and HIE adoption. These services are likely to be exclusively funded by public programs, state or federal
Continue our business supporting the Medicaid Meaningful Use program for MassHealth
(contract began in 2011)
Fully operationalize the new service program providing adoption and utilization consulting support as well as outreach and education for the Mass HIway (contract began in March 2018)
Connected Communities grants will be completed by June 2018. Minimal close out
and promotion of program accomplishments to occur in FY ‘19.
The Digital Health Initiative will continue to grow and evolve in connection with the activities of the Digital Health Council and our own stakeholder research

Digital Health Initiative-related programs will be focused on using technology innovation to solve health challenges
Less focus on grant projects that support adoption of particular technology
More focus on the growth of the market for digital health
Grant program to support healthcare provider access to innovation

Educational offerings on EHR and HIE adoption will continue being
provided as part of the contractual side of our business
Both contractual programs include funding for educational content development and deployment

Digital Health Marketplace
Support PULSE@MassChallenge and TechSpring with grants and staff assistance
Continue rollout of Marketplace Assessment Tool
Partner with the Health Policy Commission to support additional pilot opportunities to address the needs of the MassHealth ACOs
Launch Sandbox Network and Matching Program*
Healthcare Innovation Workforce Development (collaboration with BWH, MGH, TechSpring, Children’s and others)
Develop and support a Cybersecurity in Digital Health Community*
CHIA Healthcare Price Transparency Challenge
Cluster Marketing and Business Development Support
Build and maintain pitch decks, massdigitalhealth.org, cluster directory
Continue providing concierge service for digital health companies coming to MA
Aging & Caregiving Initiative
Make Massachusetts the “Silicon Valley” for Aging (coordinated with Governor’s Council to Address Aging in Massachusetts)
Advanced Care Directives and eMOLST Pilot (collaboration with BCBSMA, MA DPH and the Coalition for Serious Illness Care)
Continue partnership with EOEA re innovation to support aging in place
Activities to promote digital health technology and support for family caregivers
Staffing
6.35 FTE

*Launched to support Governor’s Digital Health Council priorities

Digital Health Initiative Impacts

PULSE provides support to > 30 high-potential startups

TechSpring brings innovative solutions to Western MA and integrates
with the rest of MA

Statistics on digital health companies and customers helped

Assess and report on the diversity of presenters at events that our grantees and we support

Continue successful operation of the Medicaid Services work under contract to MassHealth
MassHealth posted a Notice of Intent to extend the current master
contract with MeHI through the end of the program in 2022
Current contract was extended for 90 days while this was completed
After approval of the NOI, MeHI and MassHealth will negotiate the scope of work for FY19
Key Outcome Goals/Metrics
Total number of applications processed
Maintain processing efficiency and cycle time for applications
Increase emphasis on education and support to improve provider compliance and retention

Staffing
–	11.3 FTE

HIway Adoption and Utilization Services are focused on:
Enrollment, Account Management, and Delivery of Consulting Services
Education and Outreach
Development of Consulting Services Toolkits and Methodologies
HIT Council Meeting Support

Key Outcome Goals/Metrics shall include:
Number of organizations enrolled for HIway Adoption and Utilization Services (HAUS)
% of HAUS-enrolled organizations that have transitioned processes
% of HAUS-enrolled organizations that are engaged in care coordination activity on the HIway
# of providers actively using the Mass HIway for provider to provider/care
coordination activities
% of provider organizations meeting their HIway attestation requirements

Staffing
6.7 FTE

MeHI Financial Overview

FY19 Funding Sources
$2M revenue for contracted Medicaid Services
$1.7M revenue for contracted HIway Adoption and Utilization Services
$1.7M from the eHealth Institute Fund

Beyond FY19
Medicaid Services Contract is projected to be continued through 2022
HIway Outreach Services agreement goes through June 30, 2020 with options to extend to 2025
The eHealth Institute Fund would fund remaining MeHI activities

MeHI Connected Communities Implementation Grant Project

Allyson Pinkhover, MPH

Brockton Neighborhood Health Center

Project Manager – Substance Use Community Initiatives

Spirit of Connected Communities 	

Work collaboratively to improve care coordination for patients with
substance use disorder or other behavioral health needs

Involved 5 partner organizations:

BAMSI – Whitman Counseling
Brockton Neighborhood Health Center – Mental & Behavioral Health Teams, HRC
Good Samaritan Medical Center – ED
High Point Treatment Center – Brockton Campus
Signature Healthcare Brockton Hospital – ED & Inpatient psychiatric unit

Overview of Connections 	

Organization	EHR	HISP	Connection Type	
BAMSI	eHana	Mass HIway	Direct	
Brockton Neighborhood	Nextgen	Nextgen Share	Direct	
Good Sam	Meditech	Interfaced to StewardConnect	Direct	
High Point	Netsmart TIER	Netsmart CareConnect	Direct	
Signature	Meditech	Mass HIway	Direct	

Overview of Use Cases 	

Coordinating care for patients with behavioral health needs.
BNHC, HPTC, BAMSI, & Brockton Hospital

Coordinating care for patient in detox or inpatient SUD treatment
who experience a medical emergency.
Good Samaritan Medical Center & HPTC

Coordinating care for patients requiring Section 12 emergency psychiatric evaluation.
BNHC & Brockton Hospital

Auto-populates
demographics

Consent to Release Information 	

Ended up being the issue we spent the most time on

Require revisions to Release forms at multiple organizations

BNHC ultimately developed an eConsent module in its EHR
Able to block the transmission of a CCD if patient denies consent
Release form available in languages for the first time

Allows for e-signature Tracks expiration date

Use Case Deep Dive 	

Coordination for psychiatric patients
Patients sent to Brockton Hospital from BNHC for Section 12 psychiatric evaluation
Patients released from C3 inpatient psychiatric unit with a PCP at BNHC

Was an organically identified use case by BNHC mental health staff

Multiple meetings between BNHC & Brockton Hospital

Participated in “Connected Communities Meet & Greet”

Developed communication chart for BNHC

Use Case Deep Dive

Use Case Story 	

Patient arrives at BNHC for Primary Care visit

Integrated behavioral health clinician is dispatched

Clinician determines Section 12A is necessary

Given patient insurance, they will go to Brockton Hospital

Charge nurse calls ED to let them know we are sending a patient & expect a CCD

Behavioral health clinician adds their notes to referral/CCD and transmits

ED staff have CCD while patient is en route via ambulance.

Added layer of complexity:
Patient is best served in CVC
LCSW is Cape Verdean Creole-speaking
Hospital knows they will need interpreter

Accomplishments 	

Established the ability to exchange Continuity of Care Documents (CCDs) and electronic referrals between trade partners.

Developed streamlined workflows in order to better coordinate care and eliminate paper exchange of documents.

Implemented a new Authorization to Release Information form via an eConsent module that: a) extended period of consent from 60 days to 1 year, b) incorporated a general designation, and c) allowed for translation of consent form.

Small volumes of CCDs/electronic referrals exchanged as staff become accustomed to the new workflow, EHR updates are made, and ACO technology rolls out.

Outcomes

221 staff trained in workflows across 5 organizations

Average number of minutes for workflow decreased 14 minutes across the 5 organizations

Measure	Baseline	Target	Actual	
Brockton Hosp: repeat ED
visits for all BH diagnoses	20.4%	18.4%	19.9%	
Brockton Hosp: readmissions for all BH diagnoses	11%	9.0%	5.3%	

Lessons Learned 	

Collaboration is key

Evaluating consent to release information is extremely important

Clinicians like the ability to send information electronically – fewer steps, faster, and less paper, however adoption of new workflows is slow

Working with EHR and HISP vendors can be a challenge

Competing IT priorities can hinder project implementation

Implementing new workflows is especially challenging in emergency situations

 Looking ahead… 	

BNHC hopes to continue its work with Brockton Hospital’s psychiatric
unit

Connect directly with the CCBC Crisis team via similar workflow

Connect with Gosnold Treatment Center

Continue community-wide efforts to coordinate care for behavioral health patients

Conclusion

Undersecretary Lauren Peters

2018 Schedule

HIT Council - Meeting Schedule:
Typically the 1st Monday of every third month
Meetings are from 3:30 to 5:00 PM unless otherwise noted
All meetings are at One Ashburton Place, 21st Floor, Boston

Planned upcoming 2018 meetings:
o Monday, November 5, 2018

Planned upcoming 2019 meetings:
Monday, February 4, 2019
Monday, May 6, 2019
Monday, August 5, 2019
Monday, November 4, 2019

Commonwealth of Massachusetts
Executive Office of Health and Human Services

Thank you!

Appendix A:	HIway Operations Update

MASSACHUSETTS HEALTH INFORMATION HIGHWAY

Tier (As of July 2018)	
Universe (Est.)	
Act ively Using	
%Actively Using	Connected or
Implementing	%Connected or
Implementing	
Enrolled	
Tier Total	
1a. Large hospitals/Health Systems	37	29	78%	1	3%	4	34	
1b. Health plans	9	3	33%	2	22%		5	
1c. Multi-entity HIE	12	6	50%	6	50%		12	
1d. Commercial imaging cent ers & labs	8	5	63%	3	38%		8	
2a. Small hospitals	51	38	75%	12	24%		50	
2b. Large ambulatory practices (50+)	33	18	55%	12	36%		30	
2c. Large LTCs (500+ lic ensed beds)	8	1	13%		0%		1	
2d. Ambulatory Surgical Centers	63		0%	1	2%		1	
2e. Ambulance and Emergency Response	39		0%	2	5%		2	
2f. Business associate affiliates	5	1	20%	1	20%		2	
2g. Local governmentlPublic Health	8	1	13%	7	88%		8	
2h. MassHealth ACO , CP, or CSA Technic al Integrator	TBD			1			1	
3a. Small LTC (<500 licensed beds)	310	41	13%	37	12%		78	
3b. Large behavioral health (10+ licensed providers)	16	3	19%	13	81%		16	
3d. Large FQHCs (10-49)	30	18	60%	7	23%		25	
3e. Medium ambulatory practice s (10-49)	365	60	16%	22	6%		82	
4a. Small behavioral health(<10 licensed providers)	90	8	9%	19	21%	1	28	
4b. Home health, LTSS	149	29	19%	45	30%	4	78	
4c . Small FQHCs (3-9)	29	5	17%	2	7%		7	
4d. Small ambulatory practices (3-9)	1595	185	12%	121	8%	3	309	
4f. CP or CSA management only entity	TBD			1			1	
5a. Very Small ambulatory practices (1-2)	4010	294	7%	292	7%	3	589	
TBD - Categorization into Tier is pending	N/A	11		13		5	29	
Grand Total	6867	756	11%	620	9%	20	1396	

20 New Participation Agreements

Boston Urogyn
Brookline Village OB/GYN Carla Ginsberg, MD  David Kieff, MD LLC
DaVita Salem Northeast Dialysis
Eye Care and Laser Surgery of Newton Wellesley Gary Perlmutter, MD
Highland Valley Elder Service Center, Inc.
Hyde Park Pediatrics Jeffrey Bentley, MD John Niles, MD Middleboro Pediatrics
Personalized Medical Care Quincy Pediatric Associates Richard Eisner, DPM
Sang-Gil Lee, MD
Start Line Pediatrics
Stavros Center for Independent Living US Renal Care – Foxborough Dialysis Vitreo Retinal Associates

AdLib, Inc.

21 New Connections

Behavioral Health Partners Metrowest (BHPMW)
Boston Urogyn* Boulevard Medical Group Carla Ginsberg, MD* David Kieff, MD LLC *
DaVita Salem Northeast Dialysis*
Eye Care and Laser Surgery of Newton Wellesley* Greater Springfield Senior Services, Inc. (GSSSI) Highland Valley Elder Service Center, Inc.*
Hyde Park Pediatrics* John Larossa MD Middleboro Pediatrics*
Personalized Medical Care* Qualifacts
Quincy Pediatric Associates*
Richard Eisner, DPM* Sang-Gil Lee, MD * Start Line Pediatrics*
Stavros Center for Independent Living* Vitreo Retinal Associates* 57

* Participants that were enrolled
and connected in the same period

13 Month HIway Transaction Activity

10,564,442 Transactions* exchanged in July 2018 (06/21/2018 to 07/20/2018**)
268,854,552 Total Transactions* exchanged inception to date

12,000,000

10,000,000

8,000,000

6,000,000

4,000,000

2,000,000

	Jul.2017	Aug.2017	Sep.2017	Oct.2017	Nov.2017	Dec.2017	Jan.2018	Feb.2018	Mar.2018	Apr.2018	May.2018	June.2018	July.2018	
Total transactions:	7,894,635	7,793,259	8,685,940	10,305,258	10,555,739	9,673,458	9,757,005	10,864,328	9,029,211	10,166,649	9,767,805	11,068,050	10,564,442	

0

* Note: Includes all transactions over Mass HIway, both production and test
58  ** Note: Reporting cycle is through the 20th of each month.

HIway Production Transaction Trends – Provider to Provider (July 2017 – July 2018)

3% of HIway activity in July 2018* was for Provider to Provider transactions

		

		

		
	Jul.2017	Aug.2017	Sep.2017	Oct.2017	Nov.2017	Dec.2017	Jan.2018	Feb.2018	Mar.2018	Apr.2018	May.2018	June.2018	July.2018	
Provider to Provider	267,970	248,112	264,261	254,248	273,854	263,471	235,936	267,449	251,407	286,722	274,321	335,319	283,610	

400,000

350,000

300,000

250,000

200,000

150,000

100,000

50,000

0

HIway Production Transaction Trends – Quality Reporting (July 2017 – July 2018)

5% of HIway activity in July 2018* was for Quality Reporting transactions

			

		
		
	Jul.2017	Aug.2017	Sep.2017	Oct.2017	Nov.2017	Dec.2017	Jan.2018	Feb.2018	Mar.2018	Apr.2018	May.2018	June.2018	July.2018	
Quality Reporting	401,163	454,485	427,053	509,461	317,913	286,607	257,233	415,873	403,347	569,939	496,738	493,967	553,724	

600,000

500,000

400,000

300,000

200,000

100,000

0

HIway Production Transaction Trends – Payer Case Management (July 2017 – July 2018)

< 1% of HIway activity in July 2018* was for Payer Case Management transactions
35,000

30,000

25,000

20,000

15,000

10,000

5,000

	Jul.2017	Aug.2017	Sep.2017	Oct.2017	Nov.2017	Dec.2017	Jan.2018	Feb.2018	Mar.2018	Apr.2018	May.2018	June.2018	July.2018	
Payer Case	29,445	28,104	30,663	30,004	30,181	29,554	25,010	30,736	25,375	27,243	25,428	28,578	26,413	

0

HIway Production Transaction Trends – Public Health Reporting (July 2017 – July 2018)

91% of HIway activity in July 2018* was for Public Health Reporting transactions.
These Public Health transactions are analyzed by application on the following slides.
12,000,000

10,000,000

8,000,000

6,000,000

4,000,000

2,000,000

0
Jul.2017	Aug.2017	Sep.2017	Oct.2017	Nov.2017	Dec.2017	Jan.2018	Feb.2018	Mar.2018	Apr.2018	May.2018   June.2018    July.2018
DPH Transactions   7,072,265    6,845,895    7,739,614    9,315,930    9,719,506    8,911,308    8,886,811    9,871,667    8,180,562    9,052,798    8,793,724    9,979,661    9,493,635

10,000,000

Public Health Reporting – Analysis by Application (July 2017 – July 2018) Syndromic Surveillance Transactions

9,000,000

8,000,000

7,000,000

6,000,000

5,000,000

4,000,000

3,000,000

2,000,000

1,000,000

0
Jul.2017	Aug.2017    Sep.2017	Oct.2017    Nov.2017   Dec.2017	Jan.2018	Feb.2018   Mar.2018   Apr.2018   May.2018  June.2018   July.2018
Syndromic  6,232,258  6,253,392  6,292,697  6,824,744  7,364,445  7,539,295  7,899,103  8,704,466  7,387,984  7,985,952  7,746,449  8,695,533  8,231,303

3,000,000

Public Health Reporting – Analysis by Application (July 2017 – July 2018) Immunization (MIIS) Transactions

2,500,000

2,000,000

1,500,000

1,000,000

500,000

0
Jul.2017	Aug.2017	Sep.2017	Oct.2017	Nov.2017	Dec.2017	Jan.2018	Feb.2018	Mar.2018	Apr.2018	May.2018   June.2018   July.2018
MIIS	798,267	500,981	1,407,977   2,402,660   2,324,526   1,337,427	928,058	1,111,071	739,769	981,979	951,398	1,212,717   1,157,351

Public Health Reporting – Analysis by Application (July 2017 – July 2018)

Boston Public Health Commission Transactions
20,500

20,000

19,500

19,000

18,500

18,000

17,500

17,000

16,500

16,000

15,500

Jul.2017	Aug.2017   Sep.2017   Oct.2017   Nov.2017   Dec.2017   Jan.2018   Feb.2018   Mar.2018   Apr.2018  May.2018  June.2018  July.2018

Boston Health	18,624	19,117	19,505	19,003	19,116	17,731	17,923	19,118	17,094	19,209	18,806	20,013	18,813

		

		

		

	Jul.2017	Aug.2017	Sep.2017	Oct.2017	Nov.2017	Dec.2017	Jan.2018	Feb.2018	Mar.2018	Apr.2018	May.2018	June.2018	July.2018	
OTP	15,763	68,811	14,332	59,607	3,060	7,266	31,704	18,498	26,270	55,094	63,891	34,384	76,369	

90,000

Public Health Reporting – Analysis by Application (July 2017 – July 2018) Opioid Treatment Program (OTP) Transactions **

80,000

70,000

60,000

50,000

40,000

30,000

20,000

10,000

0

* Note: Reporting cycle is through the 20th of each month.
** Note: OTP data available starting August 2017.

14,000

Public Health Reporting – Analysis by Application (July 2017 – July 2018) Other Public Health Transactions

12,000

10,000

8,000

6,000

4,000

2,000

0
Jul.2017	Aug.2017	Sep.2017	Oct.2017	Nov.2017    Dec.2017	Jan.2018	Feb.2018   Mar.2018    Apr.2018   May.2018  June.2018   July.2018
ELR	227	223	246	289	514	579	589	755	562	651	902	646	651
MCR	98	179	1,204	6,261	4,469	5,679	5,527	5,659	5,134	5,364	6,727	11,476	4,146
PMP	0	0	0	0	0	0	0	0	0	0	0	0	2
CBHI	82	0	65	0	8	349	834	694	991	799	997	1,508	1,141
eReferral	238	212	461	430	478	327	391	393	142	281	225	154	108
* Note: Reporting cycle is through the 20th of each month.

Target: “Total Monthly Availability” – no lower than 99.9% (downtime no more than ~44 minutes/month)

June 2018 Availability Note: From Sunday, 6/24, 10:22pm, until Monday, 6/25, 8:45am, Mass HIway experienced a Severity Level 2 degradation in service for Webmail, XDR, and LAND.

68