Provider Advisory Group February Meeting February 26, 2013 Agenda Advisory Group description HIE Phase 2 description Key Questions for Advisory Group Discussion Next Steps New HIT Council and Advisory Groups Changes for 2013: •Ad hoc HIE-HIT Advisory Committee subsumed by expanded HIT Council •Volunteer advisors continue to be a vital part of MassHIway planning - Working Groups transition to Advisory Groups •Advisory Groups to mirror Federal Advisory Committees •Purpose is to provide advice and expert opinion to the HIT Council •Requires focused but limited commitment in order to encourage involvement •Focused on targeted issue areas where advice is most needed – supported by staff who will be responsible for documenting AG recommendations •Existing volunteers have been initially attached to an Advisory Group to get us started in Feb 26/27 meetings – There is flexibility for moving groups and recruiting others Consumer Advisory Group Provider Advisory Group Technology Advisory Group Legal & Policy Advisory Group HIT Council HIT Council & Advisory Group structure going forward Advisory Group membership Provider Advisory Group – Proposed members Member Organization Nicolaos Athienites Renal Medical Care William Corbett UMass Memorial Medical Center Drexel DeFord Steward Health Care Ronald Dunlap South Shore Jim Frutkin ServiceNet Gregory G Harris Psychiatrist Neil Kudler Baystate Health Michael Lee Atrius Health Norma Lopez Physician to Physician EHR Strategies Eugenia Marcus Pediatric Health Care at Newton-Wellesley Judy Melin Lahey Clinic Member Organization Daniel O'Neil Steward Health Care Paul Oppenheimer Sisters of Providence Health System Mike O’Reilly Steward Health Care Naomi Prendergast D'Youville Senior Care David Smith MA Hospital Association Jim Richter Massachusetts General Hospital Dirk Stanley Cooley Dickinson Hospital Scott Wolf Mercy Hospital Andrei Soran Metrowest Medical Center Steve Fox BCBSMA Lynda Young Former MMS President, retired UMASS Advisory Group Charges Overall Purpose: Provide advice and expert opinion to the HIT Council Objectives by Advisory Group: Consumer Advisory Group Provider Advisory Group Technology Advisory Group Legal & Policy Advisory Group •Use cases enabled by Phase 2 services •Statewide MPI and record location approach •Consent for search & retrieve functions •Patient-directed messaging •Outreach and education approaches •Use cases enabled by Phase 2 services •Statewide MPI and record location approach •Consent for search & retrieve functions •Patient-directed messaging •Alignment with MU •Trusted exchange between participants •EHR system capabilities and integration options •Outreach and education approaches •Phase 2 functions, technical architecture, and components •Phase 2 participant integration requirements •Statewide MPI and record location approach •Search/retrieve options •EHR system capabilities and integration options •HISP-to-HISP connectivity •Statewide MPI and record location approach •Consent for search & retrieve functions •Business and legal requirements for Phase 2 participation •Trusted exchange between participants Agenda Advisory Group description HIE Phase 2 description Key Questions for Advisory Group Discussion Next Steps Mass HIway Phasing Send and receive •Create infrastructure to enable secure transmission (“directed exchange”) of clinical information •Will support exchange among clinicians, public health, and stand-alone registries •Focus on breadth over depth Search and retrieve Phase 2 Phase 1 •Create infrastructure for cross-institutional queries for and retrieval of patient records •Add additional public health services Mass HIway 2 phase strategy Phase 1 Phase 2 HIE components •Provider directory •PKI infrastructure •Direct/HL7 gateway •Web portal mailbox •Master Person Index •Record locator service •Consent database •Query/retrieve infrastructure •Patient-directed messaging HIE users •Any TPO participant •Public health •SS, CBHI, MIIS •Any TPO participant that chooses Phase 2 services •Public health -ELR, PMP, Opioid, Lead •Possibly Medicaid/HIX participants (patient messaging) Deployment and Operation (EOHHS and MeHI Last Mile Program) Detailed Planning (EOHHS with Advice from HIT Council & Advisory Groups) Phase 1 – Deployment progress to date Golden Spike - October 16, 2012 •9 organizations sent production transactions over the Massachusetts HIway Mass HIway December release – December 28, 2012 •Hosted Webmail (Early Adopter release v.1.0): Webmail user can send and receive secure email with payload attachments, view and save attachments, and access provider directory. •LAND Device (General Availability (GA) Release v.1.0): Supports interfaces for Golden Spike beta release plus local support of XDR, FTP, and HTTP (REST) and communication to the HIE via S/MIME XDR or the HIE proxy mode. • Clinical Gateway: Supports two-way secure communication between EOHHS applications and HIway participant systems for Syndromic Surveillance, CBHI, and Immunization reporting. HIway address is @direct.clinicalgateway.masshiway.net •Security: Web based managed services in place to issue digital certificates to support secure messaging, Symantec certificates installed in production infrastructure and all LAND devices deployed during Golden Spike release and webmail. Last Mile Program has been launched and is setting up to connect organizations to MassHIway Phase 2 overall timeline Activity Completion date Submit IAPD to CMS Complete CMS approval of Phase 2 IAPD Feb 2013 Procurement for Phase 2 services (RFP, Change Orders, Internal Development) Feb 2013 Phase 2 infrastructure vendor selected March 29, 2013 Phase 2 contract (or change order) executed Apr 15, 2013 Go-live for Phase 2, Release 1 (Public Health interfaces) Apr-Oct, 2013 Go-live for Phase 2, Release 2 (CDR, EMPI, RLS, Consent) Oct 2013 – Mar 2014 Mass HIway Phase 2 high level project schedule 3 ways to connect to Mass HIway Services C:\Documents and Settings\gdebor\Local Settings\Temporary Internet Files\Content.IE5\KB5QX7WN\MPj04387060000[1].jpg Provider directory Certificate repository DIRECT gateway Web portal mailbox HIE Services User types 3 HIE Access Methods EHR connects directly Browser access to webmail inbox Physician practice Hospital Long-term care Other providers Public health Health plans Labs and imaging centers EHR connects through LAND Master person index Record locator and retrieval service Consent database Phase 1 Phase 2 Phase 2 Component Description Master person index Record locator and retrieval service Consent database Phase 2 C:\Documents and Settings\gdebor\Local Settings\Temporary Internet Files\Content.IE5\KB5QX7WN\MPj04387060000[1].jpg HL7 ADT •Probabilistic patient matching using Initiate system •Only provide matches that are “direct hits” •No “fishing” or wildcard searches allowed •Patient provides consent for organization to respond to queries •Consent captured at organization and status sent to Mass HIway in HL7 ADT message •Record locator shows only those organizations that patient has authorized to respond to queries •Preferred query and response method determined by data-holding entity Entities decide query-response method Three Query-Retrieve Methods will be available Phase 2 HIE Services User types Three Query-Retrieve Methods Master person index Record locator and retrieval service Consent database Cross-entity viewing “Push-Push” “Query-response” RequestAsynchronous reply Synchronous responseQuery C:\Documents and Settings\gdebor\Local Settings\Temporary Internet Files\Content.IE5\KB5QX7WN\MPj04387060000[1].jpg Physician practice Hospital Long-term care Other providers Public health Health plans Labs and imaging centers •View another EHR within own EHR •No data or documents exchanged •Single-sign on across systems •Used by Atrius, BI, and others today •Use existing Direct standards for manual request-reply •Email-like functionality •Does not require new standards – leverages Stage 2 MU •Query with automated response •Like electronic eligibility or RX history requests •Requires new standards beyond Stage 2 MU Two Steps: Record Location and Record Request/Retrieval Master person index Record locator and retrieval service Consent C:\Documents and Settings\gdebor\Local Settings\Temporary Internet Files\Content.IE5\KB5QX7WN\MPj04387060000[1].jpg Emergency Department Dr Smith’s Practice Patient record Dr Smith’s Practice Patient record Dr Jones’ Practice Patient record Dr Cortes’ Practice Locate Record 1 Request and Retrieve Record 2 Request Response Patient Medical Summary Record locations Phase 2 supports high-value use cases •An emergency room provider uses MassHIway to determine the organization(s) that holds a patient’s medical records •A case manager uses HIway to identify the care team that may be serving a patient Mass HIway service Use case examples Medical record location Medical record retrieval Consent management Public health reporting Patient-directed Messaging •An emergency room provider uses MassHIway to retrieve a summary record for a patient •A provider uses HIway to retrieve prior diagnostic test results and specialist visit records to aid in patient diagnosis •A provider uses MassHIway to report to the public health cancer registry, immunization registry, lab reporting program, opioid treatment program, syndromic surveillance program, or childhood lead poisoning prevention program •A hospital provider uses MassHIway to send discharge instructions to a patient-specified PHR/portal •A patient uses MassHIway to send “clipboard” information to a specialist prior to an initial visit •A provider uses MassHIway to record a patient’s consent preferences for information sharing via the MassHIway •A patient uses MassHIway to set his/her own consent preferences Value drivers: •Continuity of care •Patient safety & reduction in adverse events •Reduction in controlled substance overuse •Reduction in utilization of medical services •Enhanced public health reporting adherence •Supports MU achievement •Administrative simplification Agenda Advisory Group description HIE Phase 2 description Key Questions for Advisory Group Discussion Next Steps Questions for Advisory Group Discussion 1.Does the overall model and phasing seem reasonable and achievable? 2.Do the Phase 2 services address patient and provider needs for interoperability to enhance quality, efficiency, and affordability of care? 3.Will record location be valuable on its own if it is implemented and made available in advance of electronic query-retrieve capabilities? 4.Do the proposed query-retrieve methods provide enough flexibility and options to maximize adoption? 5.Will organizations be willing to populate the statewide MPI with patient demographic information? 6.What are the most important concerns with the approach at this point? Agenda Advisory Group description HIE Phase 2 description Key Questions for Advisory Group Discussion Next Steps Next steps Next steps •Key points and recommendations synthesized and provided back to Advisory Group for final comments •Presentation materials and notes to be posted to EOHHS website •Poll to go out to determine regular meeting time •Next HIT Council – March 13, 2013, 3:30-5:00 One Ashburton Place, 11th Floor, Matta Conference Room HIT Council meeting schedule, presentations, and minutes may be found at http://www.mass.gov/eohhs/gov/commissions-and-initiatives/masshiway/hit-council- meetings.html