Technology Advisory Group

September Meeting

 	September 20, 2013
Agenda

Project Update
Mass HIway Phase 2 – Reactions to the near final design
Next Steps

Phase 1 – Transaction and deployment update (as of Aug 2013)  
 	Deployment update:
 	Total Organizations in Production:		28
 	Total Organizations Live	                  13
 	Total Organizations on the HIway                    41

Major Clients slated for Sept/Oct Testing:	3
•	Holyoke (MIIS)
•	PVIX/Baystate
•	Atrius, Reliant, and VNA Care Network (MIIS)

Phase 2 overall timeline
Agenda

Project Update
Mass HIway Phase 2 – Reactions to the near final design
Next Steps

Current consent position is that phase 2 will require 2 separate patient permissions – One for RLS publish/view – One for query
 	Mass HIway Phase 2 consent policy under discussion:
 	Healthcare provider organization must obtain and record Patient permission to: 
•	Publish to and view the patient’s demographic information and organization relationship on the Mass HIway Relationship Listing Service (RLS)
•	Request the patient’s medical record from another provider organization via the Mass HIway Medical Record Request service 
The first Consent determines data available to RLS and the entities that are permitted to access that information
 	Data Collection: 
 	Mass HIway will disregard all but the Patient identifier (PID segment) and organization identifier (MSH segment) of messages received – only the following information will be stored: Patient Identifier (e.g., Org specific MRN), Patient name, Patient gender, Patient date of birth, Patient address (and address type), Patient email, Patient phone number. Organization, Sender Direct Address (for each message persisted), Message Date and Consent preference will also be captured.
 	Data Persistence:
 	Demographic data and patient : entity relationship is only accepted and persisted when patient permission is recorded (consent = “Y”) 
 	The only exception is when patient permission has changed from consent = “Y” to consent = “N.” In this case data is persisted only for purposes of auditing the consent preference change and will not be viewable through the RLS or  Provider Portal. 
 	Data Access:
 	Demographic data and patient : entity relationship is only disclosed to entities that have established a relationship with the patient.
For discussion - Options for transmitting consent to publish to and view RLS from member to the HIway
 	Options on the table for the consent to publish to and view the RLS include the following:

•	Include a consent Y/N indicator in each ADT message, utilizing a pre-defined “Z segment”
•	Transmit a separate consent transaction – i.e. provider will send a Direct message expressing consent status updates via a standard message structure
•	Route ADT messages to separate Direct addresses conveying consent status - i.e. consent.yes@direct.rls.masshiway.net vs. consent.no@direct.rls.masshiway.net

For discussion – Establishing an RLS relationship for entities that wish to view RLS without contributing patient information 
 	There are a range of organizations that may find value in accessing the RLS but cannot, or do not wish to contribute patient information to the RLS. These may include:
•	Provider organizations that have no technical capability to send patient demographic information at this time
•	Provider organizations that deal primarily with patients with sensitive conditions and where listing the patient : entity relationship could be considered disclosing (e.g., Title 42 substance abuse treatment center)
 	Technical options on the table for those entities that wish to access RLS data for patients without providing patient data:
•	Do not permit RLS view for those that have not provided patient information at this time.
•	Institute a process to vet and permit a sub-set of Mass HIway members to be “Access Only” entities. Establish a new process for transmitting patient demographic information and “consent to view RLS” flag to HIway.
For discussion – Establishing Patient : Payer relationship
 	Payer participation
 	Mass HIway is anticipating Payer participation in phase 2 services. EOHHS legal and the Legal & Policy Advisory Group are working through the policy implications.
 	Mass HIway is looking to find a way to establish Patient : Payer relationship

 	We will form a sub-group of payer technical leaders to determine Payer capabilities for sending HL7 ADTs or comparable messages.

 	We will form a sub-group of payer privacy & security leaders to tease out remaining policy issues and consent.
The second consent indicates patient authorization for a query initiated through the Mass HIway 
 	Consent to request information from another HIway member:
 	A query initiated through the Mass HIway needs to indicate that a patient has authorized the query. 

 	Technical  Options on the table for denoting patient permission for query:
•	(current preferred position) Consent to request a medical record will be asserted within the clinical portal by the act of clicking on the MRR – Data holder will be alerted to this requirement – request will be logged
•	Provider is required to take an extra step to assert patient consent for query. This could be accomplished with a check box, a pop-up
 Option 1 presents the smoothest workflow, however it will require that all users understand that query may only be used with patient permission
 Option 2 puts up an additional “gate” for explaining consent requirement and asserting permission
Background: RLS and Query-Retrieve Available Either Through HIway Portal or Integrated in EHR
Background: Overview of HIway Query-Retrieve Use Patterns
Agenda

Project Update
Mass HIway Phase 2 – Reactions to the near final design
Next Steps

Next steps
 	Next steps
•	Reactions to be taken into account by phase 2 design team
•	Meeting notes synthesized and provided back to Advisory Group for final comments
•	Presentation materials and notes to be posted to EOHHS website
•	Next Advisory Group Meeting – October 18, 2:00-3:30
-	Conference call (866) 951-1151 x. 8234356
•	HIT Council – scheduled for Oct 7, 3:30-5:00 One Ashburton Place, 21st Floor

 	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