Commonwealth of Massachusetts
Executive Office of Health and Human Services

Health Information Technology Council Meeting

August 7, 2017

Agenda

Welcome – Alice Moore
Mass HIway infrastructure update – Dave Bowditch
HIway connection requirement:	Year 1 update – Michael Chin
Mass HIway Event Notification Service (ENS) update – David Whitham
BMC’s PreManage ED implementation – Arthur Harvey

Appendix A: HIway Operations Update
Appendix B: Additional slides regarding the Mass HIway infrastructure update

Mass HIway infrastructure update

Dave Bowditch

Implementing the new Mass HIway Direct Messaging System:	“HIway 2.0”

At the May 2017 HIT Council meeting, we reviewed the reasons why a new Direct Messaging System is required and the benefits to be achieved, including:

Accredited by EHNAC for participation in DirectTrust

Current standards supported making it easier to connect to other systems

Commercial solution with regular enhancement releases and product support

New features and improved functions that are easier to use

See Appendix B for the two slides that presented this information in more detail at the May 2017 HIT Council meeting.

Progress Update:

EOHHS is currently negotiating a contract with the selected vendor to implement a new Mass HIway Direct Messaging System, also known as HIway 2.0.

The parties expect to sign a contract before the end of October 2017.

Implementation Timeline

The following are some of the key milestones, with specific dates to be determined based on the date the contract is signed.

3 Months After Contract Signing

HIway 2.0 goes live

Start onboarding all new Participants to HIway 2.0

Start migrating existing Participants from HIway 1.0 to HIway 2.0

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

12 Months After Contract Signing

Finish migrating existing Participants from HIway 1.0 to HIway 2.0

Decommission HIway 1.0 after all Participant migrations have completed

Set-up Activities Prior to Go-Live

Initial Setup & Install – 2 months
Connection of EOHHS to a platform that is EHNAC Accredited and DirectTrust Certified
HISP-to-HISP setup for HIway 2.0 domains and services

Pilot Participant connections – 1 month
Pilot Participant sites
Specific sites to be identified by EOHHS
Early adopter planning: OCHIN, MEDITECH Multi-Recipient Users, etc.
Initial Webmail migrations
Optional depending on readiness and priorities

Participant Migration Plans

Selected vendor to develop project plan for EOHHS approval

EOHHS to determine priority of participants and/or connection methods
Migration Volumes (as of March 2017):
Webmail: 277 participants @ 4 hours each = 1,108 hours (~7 months FTE)
LAND: 150 participants @ 5 hours each = 750 hours (~5 months FTE)
Direct: 45 participants @ 40 hours each = 1,800 hours (~12 months FTE)
HISP: N/A – Direct Trust

Task Details by Connection Type
Webmail:
Data Migration
User Migration

Direct:
Domain Migration
Endpoint Migration

LAND:
Remote application upgrade or hardware replacement

HIway connection requirement:	Year 1 update

Michael Chin

Who & When: Provider organizations that have HIway connection dates that are specified in the Mass HIway Regulations are required to submit a Year 1 Attestation Form by July 1st after their initial HIway connection requirement.

	

Provider Organization	
Date of the “Year 1” HIway connection requirement	
Due date of the Year 1 Attestation Form		
					
	Acute Care Hospitals	February 10, 2017	July 1, 2017		

Large and Medium
Medical Ambulatory Practices	
January 1, 2018	
July 1, 2018		
	
Large Community Health Centers	
January 1, 2018	
July 1, 2018		
	
Small Community Health Centers	
January 1, 2019	
July 1, 2019		

How:	Year 1 Attestation Forms should be submitted to the Mass HIway (via email at: MassHIwayAttestation@state.ma.us )

The Year 1 Attestation Form (and instructions) are available on the Mass HIway web page.

The Year 1 Attestation Form is two pages long, and will be used by provider organizations that have a HIway connection requirement date.

The form will provide information about: (1) how the organization met the requirement, and
(2) their EHR (if they have one), and how they connect to the Mass HIway.

The Year 1 Attestation Form collects the following information:

How the organization met the Year 1 HIway connection requirement:
The Year 1 requirement:	To send or receive HIway Direct Messages for at least one use case
(The use case may be within any category of use cases)
Questions on the attestation form include:
The use case is within what category of use cases?
Categories include:	(1) Provider-to-Provider Communications, (2) Payer Case Management,
(3) Quality Reporting, (4) Public Health Reporting, (5) Other
Describe the use case
Approximate # of HIway Direct Messages per month for the use case

Describe whether or not the organization has an EHR (and if so, how does it connect 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	10

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:

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

Ye ar 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.

Ye ar 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 uses cases should be within the Provider-to-Provider Communications category of use cases.

Ye ar 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., in January 2020, at the earliest).

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.

11

Year 1 Attestation Form:	Status update

As of mid-July 2017: the HIway received Year 1 Attestation Forms from 53 acute care hospitals in the Commonwealth

The HIway is in the process of doing the following:

Reviewing individual attestation forms (and following up with hospitals if needed)

Aggregating information from the forms

Using information from the submitted forms to make minor improvement to the forthcoming:

Year 2 Attestation Form

Revised Year 1 Attestation Form (which is expected to be an on-line form)

Some preliminary findings from the Year 1 Attestation Forms:

What type of use case is being used to meet the HIway connection requirement?

~ 66% Public Health Reporting

~ 32% Provider-to-Provider Communications

~ 2% Quality Reporting

How are the hospital EHR systems connecting to the Mass HIway?

~ 96% via EHR connecting directly to the Mass HIway
~ 2% via EHR connecting via a HISP to the Mass HIway; ~2% via a LAND device 	12

Mass HIway Event Notification Service (ENS) update

David Whitham

Mass HIway ENS:	Overview

Goal of the Mass HIway ENS:

The goal of the Mass HIway Event Notification Service is to provide real-time notifications to authorized health care providers and organizations when a patient is admitted, discharged, or transferred to or from a hospital emergency room or inpatient setting.

Preparatory activities to date:

Dec 2016 – March 2017: HIway performed a scan of the existing ENS landscape
around the nation

March 2017 – June 2017: Stakeholder sessions were conducted throughout the state

June 6 - July 28, 2017: RFI was released in early June 2017 in order gain more detailed insight into the ENS landscape, and to inform the forthcoming RFR

RFI preliminary findings

Highlights:
Seven vendors responded to the RFI
Several vendors have a strong market presence in Massachusetts

Preliminary findings:

Vendors’ volume ranges from hundreds of thousands to millions of ENS notifications sent monthly

All vendors have connections to EHRs as well as HIEs

All vendors support standard ADT formats (HL7)

All vendors have the capability of managing an opt-in/opt-out mechanism

Two vendors have stand-alone opt-in/opt-out mechanisms (which may enable the HIway to potentially use this mechanism for other HIway-sponsored Services in addition to ENS)

All vendors provide provider-patient relationship management in an on-going fashion (frequency of updates is flexible for the subscribers to define)

Most vendors are above the 99.9 percentile for accuracy with patient identification

Granularity of information in the notifications can be user-defined

Deployment timelines vary from three months to eight months

Most vendors can send ADTs and ENS notifications via Direct Messages

Mass HIway ENS:	anticipated timeline

March – June 2017: Hold stakeholder sessions to gain input regarding the ENS

June – August 2017: Release RFI, review responses, meet with respondents as needed

February – September 2017: Prepare and release RFR

Late 2017: Review RFR responses, select vendor, negotiate contract

Early 2018: Preparations for launching the ENS (e.g., establish business processes, testing, defect remediation)

Summer 2018: ENS soft launch

Note: this timeline is the anticipated  timeline, and exact dates may be subject to change

BMC’s PreManage ED implementation

Arthur Harvey

PreManage ED at BMC
August 7, 2017

Care management system for tracking patients across multiple ED visits at different systems

Project initiated by MHA in response to “Guidelines for Emergency Department Opioid Management”

As of July there were 10 systems live with 7 more planned to be live by August, and an additional 11 by the end of 2017

67 Bed Unit including: Adult, Pediatric, Urgent Care, Psychiatric Emergency Services and 3 Trauma Bays

ACS Certified Level 1 Trauma Center

High Volume Department
•	FY 2016: 132,149 Visits

Principal use case is to assist in managing opioid utilization via bidirectional sharing of ED visit histories between organizations.

In addition to the principal use case BMC felt that many of these 130,000+ visits, and subsequent Inpatient readmissions, can be prevented with early identification and better mechanisms for patient outreach.

BMC believed that any type of duplicate data entry or reviewing patient records in multiple systems was likely to result in limited adoption due to volume and staffing levels.

Patient arrives at BMC ED.

Patient Demographic and Visit information is sent to PreManage ED via ADT interface

PreManage matches patients against their database of patient and visit history across all clients

If patient meets criteria set by BMC and/or the MHA, a result is sent via ORU interface to BMC’s Epic ED application (ASAP)

Clinicians to not have to directly access PreManage ED at all, data is automatically interfaced into and out of Epic

-

Icons:

Indicates the patient matches MHA criteria. Indicates the patient is a BMC Identified high utilizer.

A report will display attached to the Trackboard, containing the reason for inclusion, recent ED visits, recent IP visits, Care Plans, Security Events

Benefits and Challenges

More timely access to care management team has had an impact on utilization

ED staff has been pleased with the minimal impact to their workflows

Product Vendor (Collective Medical Technologies) has been accommodating and easy to work with

BMC IT team has worked directly with other organizations to share Epic integration code

Currently most of the impact has come from BMC internal data since there is not yet “critical mass” of participants

Current inability to access prescription information from MassPAT is reducing the ability to influence opioid use

Conclusion

Alice Moore

2017 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 2017 Meetings:
Monday, February 6, 2017
Monday, May 8, 2017
Monday, August 7, 2017
Monday, November 6, 2017

Commonwealth of Massachusetts
Executive Office of Health and Human Services

Thank you!

Appendix A:	HIway Operations Update

13 Month HIway Transaction Activity

8,000,000

7,000,000

6,000,000

5,000,000

4,000,000

3,000,000

2,000,000

1,000,000

7,894,635 Transactions* exchanged in July (06/21/2017 to 07/20/2017**)
158,342,312  Total Transactions* exchanged inception to date

0	Jul.2016	Aug.2016	Sep.2016	Oct.2016	Nov.2016	Dec.2016	Jan.2017	Feb.2017	Mar.2017	Apr.2017	May.2017	Jun.2017	Jul.2017	
Total transactions:	5,798,117	5,842,932	6,422,013	7,004,402	7,119,245	6,853,779	7,029,969	7,100,105	7,463,101	7,460,597	7,718,904	7,909,195	7,894,635	

* Note: Includes all transactions over Mass HIway, both production and test

HIway Production Transaction Trends – Provider to Provider (Jul 2016 – Jul 2017)

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

		

		

		
		
	Jul.2016	Aug.2016	Sep.2016	Oct.2016	Nov.2016	Dec.2016	Jan.2017	Feb.2017	Mar.2017	Apr.2017	May.2017	Jun.2017	Jul.2017	
Provider to Provider	176,069	171,657	182,934	193,363	214,852	205,901	216,487	186,118	186,244	217,828	219,597	361,745	267,970	

400,000

350,000

300,000

250,000

200,000

150,000

100,000

50,000

0

HIway Production Transaction Trends – Quality Reporting (Jul 2016 – Jul 2017) 5% of HIway activity in July* was for Quality Reporting transactions
500,000

450,000

400,000

350,000

300,000

250,000

200,000

150,000

100,000

50,000

0
Jul.2016   Aug.2016  Sep.2016   Oct.2016  Nov.2016  Dec.2016   Jan.2017   Feb.2017  Mar.2017  Apr.2017  May.2017  Jun.2017    Jul.2017
Quality Reporting   361,916	386,838	358,863	361,605	381,174	350,651	325,166	339,380	270,903	397,178	388,311	445,709	401,163

HIway Production Transaction Trends – Payer Case Management (Jul 2016 – Jul 2017)

< 1% of HIway activity in July* was for Payer Case Management transactions

		

		

		

	Jul.2016	Aug.2016	Sep.2016	Oct.2016	Nov.2016	Dec.2016	Jan.2017	Feb.2017	Mar.2017	Apr.2017	May.2017	Jun.2017	Jul.2017	
Payer Case	31,805	31,967	30,251	31,878	30,667	30,112	29,700	28,538	27,786	32,687	30,611	30,592	29,445	

34,000

33,000

32,000

31,000

30,000

29,000

28,000

27,000

26,000

25,000

HIway Production Transaction Trends – Public Health Reporting (Jul 2016 – Jul 2017)

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

		

		

		
		
	Jul.2016	Aug.2016	Sep.2016	Oct.2016	Nov.2016	Dec.2016	Jan.2017	Feb.2017	Mar.2017	Apr.2017	May.2017	Jun.2017	Jul.2017	
Public Health Reporting	4,655,899	4,692,602	5,258,256	5,779,042	5,911,276	5,843,908	6,401,741	6,452,225	6,867,272	6,656,846	6,122,834	6,790,207	7,072,265	

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

Public Health Reporting – Analysis by Application (Jul 2016 – Jul 2017)

Syndromic Surveillance Transactions

		

		

		
	Jul.2016	Aug.2016	Sep.2016	Oct.2016	Nov.2016	Dec.2016	Jan.2017	Feb.2017	Mar.2017	Apr.2017	May.2017	Jun.2017	Jul.2017	
Syndromic	3,941,092	3,906,947	3,867,053	3,690,015	4,214,062	4,667,528	5,480,332	5,454,437	5,094,559	5,742,681	5,400,986	5,899,280	6,232,258	

7,000,000

6,000,000

5,000,000

4,000,000

3,000,000

2,000,000

1,000,000

0

		

		
		
	Jul.2016	Aug.2016	Sep.2016	Oct.2016	Nov.2016	Dec.2016	Jan.2017	Feb.2017	Mar.2017	Apr.2017	May.2017	Jun.2017	Jul.2017	
MIIS	692,856	702,715	1,269,445	1,943,323	1,606,817	1,143,928	888,367	837,521	1,733,218	867,478	683,917	796,230	798,267	

2,500,000

Public Health Reporting – Analysis by Application (Jul 2016 – Jul 2017) Immunization (MIIS) Transactions

2,000,000

1,500,000

1,000,000

500,000

0

Public Health Reporting – Analysis by Application (Jul 2016 – Jul 2017) Boston Public Health Commission Transactions

		

		

		

	Jul.2016	Aug.2016	Sep.2016	Oct.2016	Nov.2016	Dec.2016	Jan.2017	Feb.2017	Mar.2017	Apr.2017	May.2017	Jun.2017	Jul.2017	
Boston Health	18,682	19,300	19,955	19,266	19,352	18,193	19,078	19,535	17,213	19,685	18,621	19,783	18,624	

20,500

20,000

19,500

19,000

18,500

18,000

17,500

17,000

16,500

16,000

15,500

160,000

Public Health Reporting – Analysis by Application (Aug 2016 – Jul 2017) Opioid Treatment Program (OTP) Transactions **

OTP

140,000

120,000

100,000

80,000

60,000

40,000

20,000

	Aug.2016	Sep.2016	Oct.2016	Nov.2016	Dec.2016	Jan.2017	Feb.2017	Mar.2017	Apr.2017	May.2017	Jun.2017	Jul.2017	
OTP	60,030	98,197	122,757	67,360	10,318	10,266	136,844	18,324	22,727	15,244	10,992	15,763	

0

38	* Note: Reporting cycle is through the 20th of each month.
** Note: OTP data available starting August 2016.

600

Public Health Reporting – Analysis by Application (Jul 2016 – Jul 2017) Other Public Health Transactions

500

400

300

200

100

ELR MCR PMP CBHI
eReferral

0
Jul.2016    Aug.2016   Sep.2016    Oct.2016   Nov.2016   Dec.2016    Jan.2017    Feb.2017   Mar.2017   Apr.2017   May.2017   Jun.2017	Jul.2017
ELR	169	166	176	170	186	170	176	402	268	233	236	242	227
MCR	60	67	92	72	10	316	226	73	111	57	82	32	98
PMP	0	0	0	0	0	0	0	0	0	0	0	0	0
CBHI	0	2	0	0	0	0	0	0	0	0	0	0	82
eReferral	157	189	179	238	187	235	250	426	430	485	360	333	238
39	* Note: Reporting cycle is through the 20th of each month.

Customer Status Dashboard (July 20, 2017)

Tier (As of Jul 20 2017)	Universe (Est.)  Actively Using  %ActivelyUsing  Connected  %Connected  Enrolled  Tier Total
1a. Large hospitals/Health Systems	37	27	73%	5	14%	5	37
1b. Health plans	9	3	33%	2	22%	5
1c. Multi-entity HIE	11	5	45%	6	55%	11
1d. Commercial imaging centers & labs	5	3	60%	2	40%	5

2a. Small hospitals	51	36	71%	15	29%	51
2b. Large ambulatory practices (50+)	33	19	58%	13	39%	32
2c. Large LTCs (500+ licensed beds)	8	2	25%	0%	2
2d. Ambulatory Surgical Centers	63	0%	1	2%	1
2e. Ambulance and Emergency Response	39	0%	1	3%	1
2f.Business associate affiliates	5	1	20%	1	20%	2
2g. Local government/Public Health	8	1	13%	7	88%	8

3a. Small LTC (<500 licensed beds)	310	30	10%	41	13%	71
3b. Large behavioral health (10+ licensed providers)	14	2	14%	11	79%	13
3d. Large FQHCs (10-49)	30	15	50%	10	33%	25
3e. Medium ambulatory practices (10-49)	365	50	14%	24	7%	74

4a. Small behavioral health(<10 licensed providers)	90	6	7%	15	17%	1	22
4b. Home health, LTSS	149	26	17%	33	22%	4	63
4c. Small FQHCs (3-9)	29	4	14%	1	3%	1	6
4d. Small ambulatory practices (3-9)	1595	126	8%	128	8%	1	255

5a. Very Small ambulatory practices (1-2)	4010	164	4%	347	9%	5	516

Grand Total	6861	520	8%	663	10%	17	1200

20 New Participation Agreements

Alexeyenko Medical Associates
Boschetti, Michael J. DMD
Boston Retina
Carlyle House We Do Care, Inc.
Coleman House
Commonwealth OB-GYN, PC
Community Services Institute
Douglas, David W. MD
Elder Services of Worcester
Mystic Valley Elder Services
Neyshtadt, Alla I. MD, PC
North Shore Oral Surgery
Peabody Podiatry
Pediatric Healthcare at Chestnut Hill
Retina Consultants of Boston
Sterling Village, LLC
The Brien Center (Northern Berkshire Counseling Center)
Tri-Valley, Inc.
Village Square
Wayland Personal Physicians

20 New Connections

	Alexeyenko Medical Associates
	Boston Retina
	Cape Cod Healthcare
	Carlyle House We Do Care, Inc.
	Coleman House
	Commonwealth OB-GYN, PC
	Douglas, David W. MD
	Franciscan Children’s Hospital
	Habit Opco, Inc.
	MAeHC
	Mystic Valley Elder Services
	North Shore Oral Surgery
	Old Colony Elder Services
	Peabody Podiatry
	Pediatric Healthcare at Chestnut Hill
	Retina Consultants of Boston
	Riverside Community Care
	Sterling Village, LLC
	Tri-Valley, Inc.
	Windsor Nursing Home
	Plus Non-Participant Orgs - 15

25 HISPs Connected to Mass HIway

Allscripts (MedAllies HISP)

Aprima

ASP.MD

Athenahealth

CareAccord

CareConnect (NetSmart HISP)

Cerner

DataMotion

eClinicalWorks

eClinicalWorks Plus

eLINC

EMR Direct

Inpriva

MaxMD

MatrixCare

McKesson (RelayHealth)

Medicity

MyHealthProvider (Mercy Hospital)

NextGen Share

NHHIO

PCE Systems

SES

Surescripts

UpDox

Wellport (Lumira HISP)

13 Month HIway Availability Trends

100.2%

100.0%

100.00%

100.00%

100.00%

100.00%

100.00%

100.00%

100.00%

100.00%

100.00%

99.8%

99.75%

99.78%

99.6%

99.4%

99.29%

99.2%

99.0%

98.82%

98.8%

98.6%

98.4%

98.2%

Jul-2016	Aug-2016	Sep-2016	Oct-2016	Nov-2016	Dec-2016	Jan-2017	Feb-2017	Mar-2017	Apr-2017	May-2017	Jun-2017	Jul-2017

Metric Targets:

Target % Availability	% Total Monthly Availability (Sev 1, 2 & PEM)

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

Appendix B:

Additional slides regarding the Mass HIway infrastructure update

This slide and the following slide are a recap of information that was presented on this topic at the May 2017 HIT Council meeting

The Mass HIway has an active procurement in progress to implement a new Mass HIway Direct Messaging System, with an expected go-live date of September 2017

Why Is This Necessary?

The Mass HIway custom designed the current system while Direct Messaging standards were being developed. Some common standards now in use are not supported by the Mass HIway.

As an example, the Mass HIway uses a single private key certificate for both message signing and encryption. The HISP used by OCHIN no longer accepts this approach and requires the use of two separate certificates.

DirectTrust is now the primary facilitator of HISP-to-HISP communications across the nation. By procuring a new system that is part of the DirectTrust, the Mass HIway will:

More easily connect to other HISPs

Be prepared to exchange messages with certain federal agencies including the Veteran’s Administration

Benefits of Procuring a New System:

The Mass HIway can procure a commercial product that is in use by other state and regional HIEs, and that is supported with regular enhancements to adapt and evolve with the industry.

New features are expected to make the Mass HIway easier to use, especially for Webmail users, and most products are enhanced regularly with improvements for efficiency, security, and usability.

The Mass HIway can procure a product that is already accredited by EHNAC (the Electronic Healthcare Network Accreditation Commission) for participation in DirectTrust.

Connecting to the Mass HIway will be easier, whether directly from an EHR system as a Mass HIway Participant or through another HISP.

EHR vendors may follow the prevalent standard for making an XDR Direct connection to the Mass HIway.

HISPs that are members of DirectTrust will be automatically connected.