Massachusetts Initiatives in

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Massachusetts Initiatives in Electronic Clinical
Data Exchange Putting it in Context Presented to
MHIMA Fall Meeting September 15, 2006
Diane L. Stone MHDC Project Manager
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Agenda
Agenda

• Overview Massachusetts HIE Initiatives
• Addressing Privacy Security Issues

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Health Information Exchange Activities

• The Massachusetts Virtual RHIO
• 1. Massachusetts Health Data Consortium
  (Convener)
• 2. MA-SHARE (Clinical HIE)
• MedsInfo ED
• RxGateway
• 3. NEHEN (Administrative HIE)
• 4. Massachusetts eHealth Collaborative (the Last
  Mile)
• 5. MassPRO (QIO DOQ-IT program)

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MASSACHUSETTS COMMUNITY OF E-HEALTH ORGANIZATIONS
1978
1998
2003
2004

• The Convener

The Transactor
The Grid
The Last Mile

• The convener and educational organization, the
  business incubator

• The transactor of administrative (HIPAA
  transaction) processes

• The grid of state-wide clinical utilities

• The last-mile to clinician offices

Source MAeHC
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The Convener, the Grid and the Last Mile
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Governance and Operation

• MHDC has been convening the Massachusetts HIE
  community for 28 years
• Deeply ingrained culture of collaboration on HIE
• Multiple organizations allows for tailored
  governance
• Large, inclusive, overlapping Boards of Directors
• Some Current MHDC Collaborative Initiatives
• Privacy and Security
• NPI
• MA Health Reform

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MA-SHARE HEALTH CARE EXCHANGE OFFERINGS

• Common
• Routing
• Security
• Translation
• Logging
• Validation
• Guaranteed delivery
• Trading partner registry
• Unique
• Business services
• eRx formulary lookup, pharmacy directories, drug
  eligibility, etc.
• CDX record location service, record publishing
  service, community MPI
• NEHEN NEHEN Express, NEHEN On-the-web
• System adaptors
• eRx clinical systems, stand-alone eRx systems
• CDX EHR, EMR systems
• NEHEN ADT and billing systems

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Source MA-SHARE
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MAeHC ROOTS ARE IN MOVEMENT TO IMPROVE QUALITY,
SAFETY, EFFICIENCY OF CARE

• Universal adoption of electronic health records
• MA-SAFE

• 50M commitment to heath information
  infrastructure
• Recognition of systems problem

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MAeHCs THREE PILOT COMMUNITIES STRONG
INDIVIDUALLY AND COLLECTIVELY
Pilot Characteristics

• High capture of medical encounters
• Breadth and depth of community cohesion
• Wide array of ancillary providers
• Broad deep physician commitment
• Strong, dedicated leadership
• Demonstrated commitment to using IT to transform
  health care delivery
• Represent a diversity of patients, practices,
  locations, and size
• Platforms for conducting all dimensions of
  evaluation
• Models to enable state-wide expansion

Source MAeHC
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Commonwealth Role

• Encouragement, support, and thought leadership
• Participation on every Board of Directors
• Financial support for certain initiatives
• MHDC ongoing support ()
• MA-SHARE development costs ()
• No legislation or executive orders needed to date

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Federal Role

• Provide thought leadership
• Establish initiatives to support/drive change and
  gain buy-in
• Remove federal barriers to HIE
• Help align incentives to foster a market for HIE
• Avoid proscriptive mandates providers and
  payers need flexibility to adapt to local
  circumstances
• Be cautious about trying to force a resolution
  it will take time and iterative learning before
  ultimate goal is reached

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Addressing Privacy and Security Issues and
Policies within Massachusetts And Nation Wide
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Nation-Wide Coordination of Policies, Resources
and PrioritiesONC Initiatives and Contracts for
Unifying regions
Overcoming the Barriers
Health Information Technology Standards Panel
(HITSP)
The Certification Commission for Health
Information Technology (CCHIT)

• The AHIC Community serves as hub for identifying
  breakthrough opportunities
• CCHIT focuses on developing a mechanism for
  certification of health care IT products
• HITSP bringing together all relevant stakeholders
  to identify appropriate IT standards
• HISPC is a partnership focused on addressing
  variations in business policy and state law that
  affect privacy and security
• NHIN focuses on interoperability pilots starting
  in 2006

American Health Information Community
Nation-Wide Health Information Network
Architecture Projects (NHIN)
The Health Information Security and Privacy
Collaboration (HISPC)

• Chaired by HHS Secretary Leavitt
• Seven federal agency representatives
• Six health industry members
• One IT industry member (Intel)
• One employer (Pepsi)
• One state health department member (IN)

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The HISPC ProjectHealth Information Security and
Privacy Collaborative
HISPC Project

• Goal Privacy and Security Solutions for
  interoperable Health Information Exchange
• Objective Identify current business practices
  and barriers to interoperability, then determine
  how to resolve
• Initiated at National level by American Health
  Information Community (AHIC) Project to further
  adoption of Electronic Health Records 44
  States/regions awarded subcontracts with AHRQ
  through RTI
• MHDC designated by Commonwealths Governor to
  manage HISPC Project
• Timetable 29 May 2006 30 March 2007

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The HISPC Workflow
HISPC Steps

• Assess Variations in organizational level
  business policies and practices that affect the
  exchange of interoperable electronic health
  information including process impacted by State
  laws
• Analyze results from Variations collected in
  context of how to solve for/with electronic HIE,
  while maintaining security and privacy
• Develop an Implementation Plan what is needed to
  get to solutions priorities, timelines,
  resources

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The Process
Process

• Massachusetts was provided with 18 scenarios
  developed by RTI specifically for the privacy and
  security project
• Provide a standardized context for discussing
  organization-level business practices across all
  states and territories
• These represent a wide range of purposes for the
  exchange of health information (e.g., treatment,
  public health, biosurveillance, payment,
  research, marketing, etc)

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Reprinted from RTI Web-ex 8/4/06
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Definition of Barrier
Definition

• Barrier
• Practices, policies or laws that impede,
  prohibit, or impose conditions on health
  information exchange. (without judgment at this
  stage regarding degree of appropriateness of the
  barrier).

Reprinted from RTI Web-ex 8/4/06
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Scenarios (sample)
Sample Scenario

• Patient Care Scenario A
• The emergent transfer of health information
  between two hospitals that represent the 2
  stakeholder organizations (i.e., Hospital A and
  Hospital B) when the status of the patient is
  unsure. The actors are the staff involved in
  carrying out the request. The ER physician is
  requesting the information on behalf of the
  Hospital A.
• Stakeholder organizations and exchanges
• Hospital emergency room in Hospital A is the
  organization requesting information
• Hospital B is the organization releasing the
  information.

Reprinted from RTI Web-ex 8/4/06
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Scenarios (continued)
Scenarios Cont.

• Potential areas for discussion of BUSINESS
  PRACTICES based on this scenario
• Determining status of the patient and chain of
  responsibility
• Practice and policy for obtaining information
  sufficient for treatment.
• Practice and policy for handling mental health
  information.
• Practice and Policy for securing the data
  exchange mechanism.
• Practice and policy related to authentication of
  requesting facility by the releasing facility.
• Practice and policy related to patient
  authorization for the release of information.

Reprinted from RTI Web-ex 8/4/06
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As of Today
As of Today

• Engaged Steering Committee and Stakeholder Groups
• Conducting 1 to 1 Stakeholder Variations meetings
  for business practice data collection, labor
  intensive
• Planning for legal and solutions working group
  November, December 2006
• Anticipating Implementation Plan Development
  January 2007

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Value Point
Value Point

• MHDC goal gain a fuller understanding of what
  is being done now at points of PHI
  transmission, and if there is a better way with
  electronic clinical data exchange how do we
  get there?
• Additional privacy issues, decisions and
  policies identified are being collected
• MHDC is determining a broader communication
  strategy, so entities dont have to reinvent the
  wheel.or hold back on an initiative

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Thank you Diane L. Stone dstone_at_mahealthdata.org
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