Health Information Technology Council March Meeting 

March 2, 2015

Agenda

Today’s Agenda:

•	Welcome [15 min] 
•	Participant Update: OTP Node – [45 min] – Cathy Wheeler 
•	Operations Update [25 min] – Darrel Harmer
–	Uptime/Downtime Update
–	HIway Participation and Use Update
–	HIway Release Schedule Update
–	HISP-HISP Update
–	Query & Retrieve Update
–	Communications and Outreach Update
•	Wrap up [5 min]
–	2015 Meeting Schedule 

Discussion Item 1: Welcome

Discussion Item 2: OTP Node Update

EOHHS Clinical Gateway
  
Inbound 
Enrollment and Assessment 
Transfer Service
(I-EATS)

                             

I-EATS
(formerly OTP-HL7). The secure, encrypted, electronic transfer of Intake, Enrollment and Health Assessment data from the Provider’s Electronic Medical Record to the Virtual Gateway.

Why I-EATS?
•	DPH Bureau of Substance Abuse Services uses the EOHHS Application, EIM-ESM (Enterprise Invoice Management/Enterprise Service Management) as it’s system of record. All data entry was manual.
•	While opioid use was increasing and more quality data was needed, the Opioid providers were left behind on the inadequate legacy system.
•	The larger OTPs had already moved to electronic medical records that generated excel files for the legacy system and were understandably resistant to moving to EIM-ESM.
•	The electronic submission of the critical Opioid Treatment data was the option required to bring these providers into EIM-ESM.

Background 

Background

SAMIS – Substance Abuse Management information System
Aging legacy system - SQL database no longer supported by Microsoft
No longer compliant with Federal data requirements
Goal was to get all providers off before system retired.

By 2010 all DPH contacts in EIM-ESM  -  Opioid Treatment Programs  were exempted
Several large providers were already “paperless”
Cost prohibitive for providers to add data entry staff for the redundant entry of data already in their EMR systems
BSAS did not want resources to go to data entry staff rather than program enhancements that would directly impact the quality of client services.

Rise in Opioid Addiction/SAMIS Failing
•	2014 -The failure of the legacy system and the move to HL7 was happening as opioid addiction and overdose deaths were increasing.
•	Risk: SAMIS fails before OTP providers move to EIM-ESM there will be loss of data
•	In response, OTP providers not prepared to submit HL7 by July  
 2014 were immediately moved to EIM-ESM, representing 30% of the
 opioid data.

•	This left 4 large providers serving 70% of the clients in treatment on
  the legacy system though FY14, waiting for their EMR’s to promote
  an HL7 
•	Legacy system was retired June 2014 and IEATS transmission began in FY15
•	IEATS is now a critically important source of data from these large
 providers as BSAS responds to the Opioid crisis.  

DPH Benefits

•	Timely and relevant reporting for program management, planning and quality control
•	Data readily available to:
o	Identify and promote best practices 
o	Support business decisions
o	Evaluate the impact of increased investment in services
o	Identify trends in socio-economic characteristics of clients
o	Document data on overdoses and treatment outcomes
•	Ability to comply with Federal reporting requirements 
•	Improved operational controls and audit trails

Provider Benefits

Additional Benefits for Providers
•	Eliminate redundant data entry
•	Health Assessments customized for level of care
•	Ability to submit 837 electronic claims for payment

•	Ability to track billing submissions and payments in EIM-ESM
•	Payments received in 5-7 days rather than 15-30
•	Tools for reconciling client enrollment reporting and billing

Provider Benefits

•	Client Enrollment Status Report 
Clients served during a specific time period. References provider and EIM identifiers 

•	HIPAA Claim Status Report 
Payment report by Claim Number/Service Date within 48 hours of submission – available before 835 is generated. De-identified
277 Errors

•	Payment Detail Report
By Client Name/Claim/Service Date
Details all adjustments

Overview

Electronic transmission of HL7 messages for Client Intake/Enrollment and Health Assessment data

Diagram showing the high level view of the IEATS Project. 

I-EATS
Message Format: HL7
 A01 Intake and Enrollment 
 A03 Disenrollment
 A08 Health Assessments
Liberal use of OBX segments to capture required data
 A19 Query for Identifiers and Errors report
Messages sent to:  Mass HIway to Clinical Gateway
Intake Data and Enrollments: Persisted in EIM-ESM. 
Health  Assessments: Persisted in Clinical Gateway Oracle database

I-EATS Process

Day One
A01 Intake/Enrollment message transmitted to Clinical Gateway
Message validated and sent to EIM-ESM
EIM-ESM sends back ESM Client IDs.
Day Two
A19 Query transmitted referencing Transaction ID
Synchronous response returned with ESM IDs and Error Messages
A08 Enrollment Assessments transmitted, referencing ESM Client and Enrollment ID
Messages validated and persisted in Clinical Gateway I-EATS Oracle database

I-EATS Development
2009 -2011
OTP-HL7 initiated as a VG Project.
$400,000 from BSAS for EIM-ESM enhancements
$200,000 in seed money from MeHI to fund documentation of message requirements; business rules specification and coding
2012-2014
I-EATS added to EOHHS HIE initiative.
Architecture changed with the new option of Mass HIway and Clinical Gateway.
I-EATS development in Clinical Gateway 
Participating OTP providers on-boarded to Mass HIway and EIM-ESM

I-EATS Development

April 2014 - I-EATS Goes-Live

October 2014 - First Provider Submissions

  February 2015 – 3,000+ Enrollments transmitted

  BY April 2015 -  Expect 15,000+ Enrollments in 
                         the system

On-Going Challenges

EMR Vendor Issues
•	Customization of system is only for Massachusetts customers  
•	Some vendors decline to offer the functionality 
•	High cost are passed to providers - prohibitive for the smaller agencies
•	Not Meaningful Use providers – did not qualify for funding.
•	Process is complex and technically challenging
•	Problems with middleware and connectivity

System Enhancements
•	Enhancing system  so providers can better understand their errors
•	Coordinating change requests for new or updated data elements

Provider Summary 

Current Provider Status

Providers transmitting HL7 – Smart, Inc. 
•	Habit OpCo 
•	SSTAR
•	CSAC

Providers waiting to transmit HL7 – NetSmart
•	Spectrum (Avatar)
•	Seven Hills (Tier) - currently Manual EIM-ESM
•	High Point (Tier) - currently Manual EIM-ESM

Current Provider Status

Providers currently manual in EIM-ESM, planning to transmit in FY16
•	Boston Public Health Commission

Providers currently manual in EIM-ESM  planning to transmit in FY17
•	Lahey Clinic – Northeast Behavioral Health / CAB Health and Recovery
•	Mercy Hospital
Providers who will remain manual submitters
•	North Charles
•	Bay Cove Human Services
•	Addiction Treatment Service of NE

Discussion Item 3: HIway Operations Update 

2015 Mass HIway Incident Summary Dashboard - December 2014
The December 2014 calendar was shown with outage dates highlighted. 

2015 Mass HIway Incident Summary Dashboard – January 2015
The January 2015 calendar was shown with outage dates highlighted. 

2015 Mass HIway Incident Summary Dashboard – February 2015
The February 2015 calendar was shown with outage dates highlighted. 

2015 Mass HIway Incident Summary Dashboard
(Dec. 2014 to Feb. 2015, as of February 20, 2015)
Monthly Mass HIway Availability Target: Less than 44 minutes of Sev1+Sev2+PEM outage (99.9% availability)

HIway Availability Trends
A graph showing the HIway availability trends was provided. See meeting minutes for details. 

HIway Stabilization Plan
•	EOHHS and Orion signed a contract amendment in December that includes a two phase plan to improve HIway stability, resilience and sustainability
•	Enhancements being made include:
–	More robust Monitoring and Automated Alerts
•	LANDs, Infrastructure, Services, Comm. Points, etc.
–	Finalized documentation of all HIway components
–	Resilience/scalability/performance at infrastructure and application levels
–	Additional audit/reporting/logging capabilities
–	Process improvements
–	Key enhancements are scheduled on a 30/60/90 day release plan
•	First delivery on January 20 (30 day)
–	Included upgrade of LAND monitoring tools to support proactive monitoring
–	EOHHS is reviewing the delivered items for acceptance
•	60 day delivery received on Feb 20; currently being reviewed 
•	90 day delivery scheduled on March 20
•	A 2nd phase for complex and less urgent improvements will follow
•	EOHHS and Orion are also intensively working on a “stabilization sprint” to resolve recent critical stability issues on an accelerated timeline

Stabilization Sprint
•	What
–	6 week Agile sprint to provide 99.9%, or better, solution availability / up time

•	When
–	Sprint completion by 1 April, 2015

•	Overview
–	Orion’s HIway project team, LogicWorks and EOHHS are working as one team to swiftly push changes to the HIway solution that will increase stability by April 1. 
–	Orion is allocating additional product development resources, Rhapsody optimization and Java/Tomcat resources from across its global organization to work onsite on HIway Stabilization. 
–	Team is identifying, testing and implementing system changes, tuning enhancements, etc. to improve stability & performance
–	Stage 1 & 2 Documentation Effort tasks are being reprioritized and rescheduled to increase resource availability for stabilization tasks

•	Next Steps after sprint is completed
–	Analyze the HIway infrastructure, environments and business requirements to formulate strategies to simplify, improve agility, scalability and sustainability and reduce support costs

HIway Participation
•	Aftercare Services Inc.
•	Allergy Medical Associates of North Shore Inc. 
•	Betsy August M.D. 
•	Boston ENT Associates P.C. 
•	Boston Spine Group
•	Community Health Programs Inc.
•	Community Nurse & Hospice Care
•	David Lhowe M.D.
•	E. Russell Young M.D.
•	Family Medicine North – Alain Chaoui M.D. P.C. 

•	Foundation Medical Partner’s Inc.
•	Harvard Street Neighborhood Health Center
•	Hill Eye Associates P.C.
•	Internal Medicine Physicians of the North Shore
•	James Haines M.D.
•	Karen Szczechowicz M.D. P.C.
•	Kevin DeLacy M.D.
•	Longwood Urology Associates
•	Mark Latina M.D.

HIway Participation Cont. Dec
•	Medical Associates of Saugus
•	Michael Zach M.D.  P.C.
•	Nicola Mogavero M.D.
•	North Shore Cardiovascular Associates
•	North Shore Gynecology 
•	Northshore Physicians Associates P.C.
•	Pain & Wellness Center
•	Renin Associates P.C.
•	S. Charles Khani M.D. 
•	Saltzman Urological Associates P.C.
•	Shields Health Care Group Inc.
•	South Shore Skin Surgeons P.C.
•	Steven Rozak M.D.
•	Thomas Pearce M.D.
•	Walpole Area VNA
•	William Belcastro M.D.

HIway Participation - Jan
•	Allen Engel M.D. 
•	Chang & Winchell Co.
•	Essex Surgical Associates P.C. 
•	Genesis Health Care
•	Greater New Bedford Health Center
•	Harold L. Freedman M.D. 
•	Lahey Health
•	Lee Albert M.D.
•	Lowell Community Health Center
•	Michael Fabrizio M.D. P.C.
•	Microsurgical Eye Consultants 
•	Mitchell Abramson M.D. 
•	Mitchell Zager M.D. 
•	New England OB/GYN Associates Inc.
•	New England Podiatry Associates 
•	Northeast Surgery Center LLC.
•	Primary Care North 
•	Reading Pediatrics Associates P.C.
•	South End Community Health Center
•	Stafford Pediatric Associates P.C.
•	Surgical Neurological Associates 
•	Wellesley Primary Care Medicine P.C. 
•	Wissam Khoory M.D. 

HIway Participation Feb
•	Adams Street Dermatology Associates P.C.
•	Alexander Kopp M.D. P.C. (Partner’s)
•	Asthma & Allergy Affiliates Inc.
•	B.D. Gupta M.D. P.C. (Partner’s)
•	Brockton Pediatrics Inc. (Partner’s)
•	Centre Pediatrics (Partner’s)
•	Community Health Center of Cape Cod
•	Darin Gogstetter M.D.
•	Edward Busick M.D. (Partner’s)
•	Epoch Senior Living LLC.

•	Gastroenterology Healthcare Associates (Partner’s)
•	Gigi Girgis M.D. (Partner’s)
•	Hand Surgery P.C. (Partner’s)
•	InterMed Associates
•	Jay L. Cohen M.D. P.C. (Partner’s)
•	Newton-Wellesley Internists P.C. (Partner’s)
•	Newton Wellesley Primary Care (Partner’s)
•	North End Waterfront Health (Partner’s)
•	Northeast Cardiology (Partner’s)
•	Quest Diagnostics

HIway Connections Dec
•	Allergy Medical Associates of North Shore Inc. 
•	Betsy August M.D. 
•	Boston ENT Associates P.C. 
•	Boston Spine Group 
•	David Lhowe M.D. 
•	Family Medicine North – Alain Chaoui M.D. P.C. 
•	Internal Medicine Physicians of the North Shore 
•	Karen Szczechowicz M.D. P.C.
•	Longwood Urology Associates 

•	Mark Latina M.D. 
•	Medical Associates of Saugus
•	Michael Zach M.D.  P.C. 
•	Nicola Mogavero M.D. 
•	North Shore Cardiovascular Associates
•	North Shore Gynecology
•	Northshore Physicians Associates P.C.
•	Renin Associates P.C. 
•	S. Charles Khani M.D. 
•	Saltzman Urological Associates P.C. 
•	South Shore Skin Surgeons P.C. 
•	Thomas Pearce M.D.

          

HIway Connections Jan
•	Allen Engel M.D.
•	Chang & Winchell Co.
•	Essex Surgical Associates P.C.
•	Harold L. Freedman M.D. 
•	Microsurgical Eye Consultants 
•	Mitchell Abramson M.D. 
•	Mitchell Zager M.D. 
•	New England Podiatry Associates 
•	Primary Care North 
•	Stafford Pediatric Associates P.C.

•	Surgical Neurological Associates 
•	Wellesley Primary Care Medicine P.C. 
•	Wissam Khoory M.D. 

HIway Connections Feb

•	Alexander Kopp M.D. P.C. (Partner’s)
•	B.D. Gupta M.D. P.C. (Partner’s)
•	Brockton Pediatrics Inc. (Partner’s)
•	Centre Pediatrics (Partner’s)
•	Community Nurse & Hospice Care
•	Edward Busick M.D. (Partner’s)
•	Gastroenterology Healthcare Associates (Partner’s)
•	Gigi Girgis M.D. (Partner’s)

•	Hand Surgery P.C. (Partner’s)
•	Jay L. Cohen M.D. P.C. (Partner’s)
•	Newton-Wellesley Internists P.C. (Partner’s)
•	Newton Wellesley Primary Care (Partner’s)
•	North End Waterfront Health (Partner’s)
•	Northeast Cardiology (Partner’s)
•	Shields Health Care Group

Progress Relative to SFY’15 Targets
The “421 Dashboard” was displayed 

HIway Transaction Activity
HIway transaction volumes were displayed using a bar graph. 

Comparison of Key Metrics: 
1 Year Look-back
A comparison of March 2014 and 2015 metrics were displayed. 

Development Release Schedule
The development release schedule was provided with target dates. 

HISP to HISP Connectivity
A graph showing the HISP connection progress was provided. 

HIway RLS - Unique Patients

A bar graph showing RLS volumes was displayed. 

Query & Retrieve Pilots
•	BID: 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. There is no ETA for testing PatientSite for this purpose at this time.
 
•	Atrius: Using a newly automated process, 55,928  out of 284,930 consent forms have been filed in Epic as of 2/17. The ability to send ADTs to the Mass HIway for patients that have a consent on file is functioning with a successful test of both opt-in and opt-out consented patients. Ongoing efforts are in place for additional testing and a process for identifying duplicate patients within Epic. 

•	Tufts:  The first 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.

•	Holyoke: Work continues on the consent process to finalize internal workflow and enable consent flags to be captured separately for Direct Secure Messaging vs. Query & Retrieve.

Query & Retrieve Timelines
Q&R implementation timelines were provided. 

Communications & Outreach

•	Webinars
–	Guide to Using Webmail Webinar 3/23/2015 
–	Mass HIway Overview Webinar 2/26/2015: 15 attendees
–	Quick Guide to Using Webmail 12/11/2014: 32 attendees 
–	Mass HIway Overview  1/29/2015 : 49 attendees 
–	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 
–	December: 638 sent with 33% unique open rate
–	January:  714 sent with 30% unique open rate 
–	February: 728 sent with 30% unique open rate

•	Provider Directory Extract
–	Files now available on website, email masshiway@state.ma.us for password

Discussion Item 4: 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