Minutes Massachusetts Health Information Technology Council Meeting - - PDF document

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Minutes Massachusetts Health Information Technology Council Meeting November 14, 2011 3:30 – 5:00 p.m. One Ashburton Place, 21st Floor Conference Room 3 Boston

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Minutes Massachusetts Health Information Technology Council November 14, 2011 Attendees: Council Members: JudyAnn Bigby, MD – (Chair) Secretary of Health and Human Services Deborah Adair – Director of Health Information Services/Privacy Officer, Massachusetts General Hospital Meg Aranow – VP and Chief Information Officer, Boston Medical Center Karen Bell, MD – Chair of the Certification Commission for Health Information Technology (CCHIT) James Ermillo - Special Council to Secretary Gregory Bialecki, representing EOHED Lisa Fenichel, MPH – E-Health Consumer Advocate Julian Harris, MD – Director of Medicaid, Commonwealth of Massachusetts John Letchford – Chief Information Officer, Commonwealth of Massachusetts Abigail Moncrieff, JD – Peter Paul Career Development Professor and Associate Profess of Law, Boston University School of Law HIE-HIT Advisory Committee: John Halamka, Co-Chair Manu Tandon, Co-Chair Nicolaos Athienites Rita Battles Peter Bristol (TP) Kathleen Donaher (TP) Steven Fox (TP) Larry Garber Gillian Haney Michael Lee Wendy Mariner Daniel Mumbauer (TP) Barbara Popper (TP) Naomi Prendergast Janet Rico (TP) Gillian Haney John Merantza (TP) (TP) participated by telephone

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MTC: Pamela Goldberg Rick Shoup Carole Rodenstein Bethany Gilboard Donna Nehme Tarsha Weaver Matt Schemmel Bridgett Scrimenti Marie Fell-Remmers Other: David Smith – Massachusetts Hospital Association Claudia Boldman – Administration and Finance Deb Schiel – EOHHS/MassHealth Venkat Jegadeesan – Executive Office, Health & Human Services Foster Kerrison – Royal College of Surgeons of Edinburgh Christina Moran – Massachusetts eHealth Collaborative Beth Marsden – ICA Informatics Adam Delmolino – Massachusetts Hospital Association Micky Tripathi – Massachusetts eHealth Collaborative Michal Regunberg – Solomon McCown & Company Helene Solomon – Solomon McCown & Company Mark Belanger – Massachusetts eHealth Collaborative Scott MacCloy – Verizon Business Carolyn Jussaume – Verizon Business Keith Puls – Verizon Business The thirty eighth meeting of the Massachusetts Health Information Technology Council was held on November 14, 2011 at One Ashburton Place, 21st Floor, Conference Room 3, Boston, Massachusetts. Secretary Bigby called the meeting to order at 3:35 p.m.

• I. Approval of the October 17, 2011 Meeting Minutes:

After motions were made, seconded, and approved with no abstentions, it was agreed to accept the draft minutes as the official minutes of the October 17, 2011 meeting.

• II. Overview of Statewide Communications Plan (see PowerPoint Presentation slides 3-23),

presented by Helene Solomon of SolomonMcCown& (Please refer to Slide Presentation; “Health IT Council and Advisory Committee Meeting” dated November 14, 2011 when reviewing meeting notes.)

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Question re slide 15: How will the broad provider community know what messages will be conveyed to the consumers? Answer: The plan is to inform providers about messages and tactics to consumers ahead of their release. Comment: Social media will be used appropriately and thoroughly to advertise messages to providers and consumers. III. Health Information Exchange Strategy: Updates and Recommendations Overview of activity since October 17 Advisory Committee meeting

• All 5 workgroups have met twice, have given feedback on the HIE strategy and the

Advanced Planning Document (APD) and are now working through the concrete details

• f the phases in each domain and engagement area.
• Centers for Medicare and Medicaid Services (CMS)/Office of the National Coordinator

(ONC) Meeting – October 24, Washington DC, Manu Tandon, John Halamka, Rick Shoup, and Micky Tripathi presented the strategy to representatives from CMS and ONC. ‒ The response to the updated strategy was very positive from both agencies (CMS and ONC). ‒ Support for the strategy that unifies Medicaid and HIE plans, resources and initiatives. ‒ Support for the proposed Fair Share cost allocation approach – offered additional ideas and approach refinement. ‒ Next steps: CMS and ONC leaders suggested that we move rapidly forward as with the following

• Update to the SMHP
• Update of APD
• Update to HIE Strategic and Operational Plan
• Plan Updates: Executive Office of Health and Human Services (EOHHS) and MeHI are

in process of updating the State Medicaid Health Plan (SMHP), APD, and HIE Strategic and Operational Plan (SOP) with input from the workgroups. All documents will be ready by end of this week.

• APD Update
• The Medicaid APD update draft which updates the APD approved by

CMS on 8/26/11 was completed on November 8, 2011.

• The APD was sent to workgroup members for input on 11/8/11.

Feedback received by 11/11 and incorporated into the current draft.

• EOHHS will submit a courtesy draft to CMS on November 15 and will

conduct an early feedback call with CMS on November 17, and will submit the final APD on November 21.

• The SMHP that was approved by CMS on June 13, 2011 has been updated and will be

submitted to CMS with the APD.

• SOP Update

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• The HIE Strategic and Operational Plan that was approved by ONC on

November 3, 2010 has been updated and a draft copy will be submitted to ONC at the same time as the SMHP and the APD. High Level Timelines for the Next 12 months Initiative Completion

• 1. Submit IAPD and SMHP to CMS and updated draft SOP

ONC 11/18/11

• 2. High level planning and approvals completed

01/15/12

• 3. Design, launch, and go live for phase 1 “Information

Highway” 10/15/12

• 4. Design, launch, and go live for End User Adoption Program

10/15/12

• 5. Design, launch, and go live for Impact Program

10/15/12

• 6. Design, launch, and go live for Phase 1 Public Health

Gateway 12/14/12 Recommendation to Approve Updated HIE Strategy

• Recommendation to the HIT Council to approve the HIE strategy: the Advisory

Committee recommends approval of the proposed MA Statewide HIE Strategy.

• The current strategy includes updates from the workgroups and the October 24, 2011

CMS/ONC meeting is in Appendix A. (see slide 37 PowerPoint Presentation)

• Core elements of the proposed strategy:

‒ Three-phase HIE plan beginning with creating the statewide Information Highway as a foundation for richer applications and services from 2012-2014. ‒ Aligned with national interoperability standards and emerging Meaningful Use (MU) stage 2 requirements ‒ Maximizing Medicaid SMHP/Medicaid Management Information System (MMIS) 90/10 Federal Finance Participation (FFP) funding ‒ Focusing Medicaid funding on building infrastructure for statewide services, and ONC Cooperative Agreement funding on maximizing end-user adoption of those statewide services. The Secretary thanked John Halamka, Rick Shoup, Manu Tandon, and Micky Tripathi for their work and success at this unique and great opportunity, and for getting a meeting with CMS and ONC.

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HIT HIE Advisory Committee Items

• II. Update from HIE HIT Advisory Committee and Workgroup Efforts.

HIT Council was presented with two motions for vote and approval. Motion #1 - $5.7 million transfer of funds The Health Information Technology Council (the “Council”) does hereby approve the transfer

• f funds from the Massachusetts E-Health Institute Fund to the Executive Office of Health and

Human Services (“EOHHS”) in an amount that shall not exceed $5,700,000, as presented. The funds shall be utilized by the State Medicaid Office (“MassHealth”) to maximize its ability to secure federal funding participation (“FFP”) at a rate of nine-to-one for state expenditures that will support the implementation of the State Medicaid Health Information Technology Plan (SMHP). It is the current expectation of the Council that the funds shall be transferred to EOHHS in two disbursements of approximately $2,300,000 (the “First Disbursement”) and $3,400,000 (the “Second Disbursement”); provided that the release of the Second Disbursement shall be contingent on EOHHS submitting written evidence to the Massachusetts Technology Collaborative (“MTC”) that is deemed to be satisfactory by MTC’s Chief Executive Officer documenting the federal approval of an amended SMHP and revisions to the associated Implementation Advanced Planning Document by the Center for Medicare and Medicaid Services (“CMS”) that will incorporate relevant elements of the revised statewide Health Information Exchange strategy and that is expected to be submitted to CMS on or about November 18, 2011. Motion #1 was unanimously approved by the HIT Council. Motion #2 – HIE Plan The Health Information Technology Council (the “Council”) does hereby approve a revised statewide strategy for the implementation of Health Information Exchange (“HIE”) activities in the Commonwealth, as presented, which incorporates elements that include but are not limited to: (1) a unified statewide approach that integrates the state Medicaid office (“MassHealth”) and Massachusetts e-Health Institute (“MeHI”) plans, resources and activities; (2) maximizes MassHealth’s ability to secure federal funding participation ("FFP") at a nine-to-one rate; and (3) provides for a focus of MeHI’s HIE activities on so-called “last mile” efforts that promote the adoption of health information technology. The Council recommends that the Executive Committee of the Board of Directors of the Massachusetts Technology Park Corporation (“MTC”) take corresponding final action to approve the revised HIE statewide strategy with the condition that implementation of the revised statewide HIE strategy should be contingent on MTC and MassHealth securing federal approval of the updated versions of all impacted

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planning, operational and implementation documents by the Office of the National Coordinator and/or the Center for Medicare and Medicaid Services to ensure that federal grant and FFP funding for HIE activities is not reduced, rescinded or otherwise negatively impacted. The updated documents requiring federal approval include but may not be limited to: (1) State Medicaid Health IT Plan; (2) Health Information Technology Advanced Planning Document; and (3) HIE Strategic and Operational Plan. Motion #2 was unanimously approved by the HIT Council. Co-chairs presented overall feedback and recommendations from Workgroups to the Advisory Committee regarding the straw plan. I. Overview of workgroup progress (Please refer to slide 31)

• a. All workgroup members were provided an opportunity to review and comment on the

draft APD-U and the SOP. Although the timeframe to review was short, there was

• verall very positive feedback regarding the quality of content of the documents
• i. Draft APD-U will be submitted to CMS on 11/16 for initial feedback
• ii. Final APD-U and SMHP and Draft SOP will be submitted to CMS on 11/21
• iii. SOP updates will need to be approved by the HIT Council in December before a

final draft can be submitted

• b. To promote cross-pollination and workgroup collaboration, the workgroup co-chairs

have met on a biweekly basis to discuss progress, and issues or concerns

• c. Prior to each workgroup meeting, the co-chairs and facilitators provide an overview of

the work occurring in the other workgroups

• i. Feedback regarding these practices has been positive
• d. Workgroups have been discussing and identifying work plans for the next six months

with specific focus areas (discussed on slide 32)

• e. All decisions made will be codified into versioned state guidance documents

II. Specific Workgroup Focus Areas and Next Steps were presented (Please refer to slides 32)

• a. Consumer and Public Engagement
• b. Provider Engagement and Adoption
• c. Legal and Policy
• d. Technology and Infrastructure
• e. Finance and Sustainability

III. Recommendation to the HIT Council was presented(Please refer to slide 40)

• a. As a group of stakeholders, we will bring a set of recommendations to the HIT Council

after collective review and an understanding that there is still a great deal of work to be done

• b. The Secretary thanked everyone for the feedback and hard work over the past few

months

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Question: With an October 15, 2012 “Go-Live” date for the information gateway, has the timeline considered any regulatory changes that would need to be addressed prior to then? Answer: It has been discussed that the process is largely mimicking the current “push” model, but electronically, and therefore regulatory changes are likely not needed. However the legal and policy workgroup is assessing the current framework. Question: Will the competition and unwillingness among some ACOs to share information be addressed legislatively or otherwise? Answer: Underpinning of the ACO model is the coordination of care which requires sharing information; therefore do not anticipate this as a problem. However will ensure that the consumer/patient protections will be closely watched as stated in the bill from Governor Patrick earlier this year. No further questions or comments. Meeting adjoined at 4:58 p.m. November 14, 2011 PowerPoint Presentation attached.

Health IT Council and Advisory Committee Meeting

November 14, 2011 One Ashburton Place, 21st Floor Conference Room 3, Boston

Agenda

Health IT Council Items

• Approval of October 17th Minutes
• Overview of Statewide Communications Plan
• Health Information Exchange Strategy: Updates and Recommendations

– CMS Visit – SOP – SMHP Vision – IAPDs – Next Steps

• Motion to Approve Proposed HIE Strategy
• Motion to Approve $5.7M Allocation from eHealth Fund for State Match

Requirement HIE-HIT Advisory Committee Items

• Workgroup Updates – 5 workgroups

11/14/2011

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Massachusetts Health IT Council and Advisory Committee

OVERVIEW OF STATEWIDE COMMUNICATIONS PLAN

11/14/2011

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MeHI’s Recent Media Outlet Interviews

11/14/2011

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MeHI Outreach Events (September, October and November)

Regional Extension Center Outreach and Educational Activities Conducted to Date:

• 8 CEO/CIO Meetings : Lowell General Hospital, Steward Physician Network meeting, New England College of

Optometry, HPHC meeting with Eric Schultz/Roberta Hermann, Jewish Geriatric Services, Mercy Hospital – Springfield, Heywood Hospital – Gardner, and Steward Healthcare.

• 4 Presentations: Mass Senior Care Association, Baystate Independent Physician Association (IPA) meeting, Western

Gastroenterology (GI) meeting, and Association of Behavior Health Members.

• 3 large meetings to network with providers: HealthMart, CIO Forum, Mass League Board Retreat.
• Other meetings: Privacy & Security Regional Meeting, Implementation Optimization Organization (IOO), Six provider

visits.

Medicaid EHR Incentive Payment Program Communication Outreach Activities Conducted to Date:

• Massachusetts Technology Forum
• Massachusetts League of Community Health Center’s Annual Member Retreat, For Eligible Professionals working in

an FQHC/RHC.

• Massachusetts Hospital Association, Workshop for Eligible Hospitals.
• Boston Medical Center, Workshop for Eligible Professionals Not Working in an FQHC and Eligible Professionals

Working Predominately in an FQHC.

• Marlborough Pediatrics, Workshop for Eligible Professionals not working in an FQHC/RHC.
• Massachusetts Hospital Association, Workshop for Eligible Hospitals, held at Massachusetts Technology Collaborative.
• IOO Roundtable Presentation
• Tufts Medical Center, Workshop for Eligible Professionals, held at Tufts Medical Center.
• Massachusetts Technology Forum
• Upcoming Outreach Events: Lowell General Hospital, Atrius Health, Holyoke Health Center

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11/14/2011

November 2 Statehouse Event

On November 2, Secretary Bigby and MeHI celebrated with some of the first group of physicians in Massachusetts to meet meaningful use

• standards. Senate President Therese Murray, Senator Moore,

Representative Walsh and Christie Hager of CMS joined over 75 physicians, stakeholders and advocates. 143 physicians in Massachusetts have met federal meaningful use guidelines, among whom 88 are members of MeHI’s Regional Extension Center.

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MeHI Website Update

• Site is in final stages of development
• Content is being loaded
• Training on content management system scheduled for November 18
• Beta testing will begin week of November 21. This will include content

modification, as needed.

• Site is scheduled to go live between November 28 and December 2

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Initial Communications Plan

November 14, 2011

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Communications Audit

Objectives:

• Uncover first-hand perceptions of health IT
• Identify gaps in perceptions
• Develop new messages and provide recommendations
• Create strategic communications plan around health IT and

to more consistently communicate MeHI’s impact throughout the Commonwealth

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What We Heard – The Gaps

• Need broader communication about how MeHI will

implement strategies

• Need for clarification about roadmap
• Define MeHI’s role and collaboration
• What’s the “value add” for MeHI?

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What We Heard – The Pluses

• Health IT community is on board – shared vision for 2015
• Perceptions align with MeHI’s goals and strategies
• Importance of leveraging public/private partnerships
• Consumers are critical to broad adoption

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Leveraging Strengths to Shape the Future

MeHI Smart Committed Passionate Resourceful Partner Visionary Influential Innovative Trusted

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MeHI’s Value Proposition Positioning The answer for health IT in Massachusetts Brand Promise Offers what you need to succeed with health IT now and in the future

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MeHI: Expert Resource for Providers

Provider Messages

• Access to the best up-to-date unbiased information, comprehensive

resources and objective advice about health IT as health care evolves.

• Partners with you from start to finish; offers guidance, expertise and

technical support -- from a live person -- when you need it.

• Connects you with the right resources (i.e. vendors, colleagues,

industry associations, networks) to deliver efficient, high-quality care for your practice and your patients.

• Simplifies the complex concepts of e-health and addresses privacy and

security concerns that will help you achieve better coordinated care for your patients.

• Has deep experience, connections and understanding of health care in

Massachusetts.

• Enables the delivery of more effective, efficient patient care.

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MeHI: Convener, Partner and Advocate for Health IT

General Audience Messages

• Advocates, partners and serves as an unbiased and objective resource

for health IT.

• Provides the roadmap and step by step support to help providers

deliver safer, higher-quality health care.

• Encourages patients to take control of their personal health

information through private and secure technology.

• Leads and connects payers, providers, patients, advocates and policy

makers, to raise awareness and understanding of the benefits of health IT to improve the standard of care for patients and their families.

• Advances economic growth and job creation and enables the

Commonwealth to lead the country to better health.

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MeHI: Advancing the Standard of Care for Patients

Patient Messages

• Helps to ensure that your health records are shared among the health

care providers you see – wherever you see them – through private and secure technology.

• Helps your providers and hospitals communicate with each other and

with you about your care.

• Gives you, the patient, a foundation to engage your doctors and

manage and maintain the most up-to-date information about your health.

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COMMUNICATIONS PLAN OVERVIEW

Health IT Campaign

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Building A Communications Roadmap: Audiences

• Providers – physicians, nurses, hospitals, etc.
• Patients/Advocates
• Payers
• Broader Health Care Community – medical associations, etc.
• Legislature and Administration
• Business Community
• Insiders/Champions

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Building A Communications Roadmap: Goals

• Engage: Health care organizations, employers, payers and thought

leaders as partners and champions of health IT for effective communication and outreach

• Persuade: Physicians and health providers that health IT can

transform their practice and help them to better serve their patients

• Introduce: The idea of health IT to patients and highlight the benefits

for their own care

• Demonstrate: The value of health IT (EHRs and HIE) across the

Commonwealth to employers and to the general public

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Health IT Campaign Strategies

• Market Research: Understand the audiences, their perceptions of health

IT, and their concerns about privacy and security

• Events:

– Held State House event (November 2) – Announce e-health awareness month at Governor’s Annual Health IT Conference (April 2012) – Launch and plug into supporting events statewide to begin to set the table to raise awareness and engagement with health IT

• Media Relations: Hyper-local, regional, ethnic media, op-eds, ed boards,
• etc. to raise overall public awareness of health IT
• Social Media: Engage providers, policy makers, patients with timely and

frequent content

• Collateral: Translate complicated concepts and terms, and bring health IT

to life for providers and patients in multiple languages

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Health IT Campaign Tactics: Put a Face On It Around the State

• Providers: Champions to Skeptics

– Roundtables

• Patients and Consumers: Trusted Sources

– Tap into strong existing healthcare and consumer-driven networks – Health Fairs throughout the State

• Business Community: Making the Economic Case

– Outreach across all regions of the State – Hospital co-hosted business breakfasts – Speaking ops: Chambers, AIM, NEHI, MHC, etc.

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• Consumer Market Research

– Statewide phone survey – Focus groups to test language, visuals, tactics

• Prepare for April e-health Awareness Month

– Collateral – Social media – Thought leadership- speaking opportunities – Ed boards, op-eds, bylines – community and ethnic

• Media Relations and Social Media

– Editorial board meetings, op eds, bylines in community papers – Social media editorial calendar, YouTube videos (patient and provider stories), copy for Facebook, LinkedIn, Twitter

• Collateral

Next Steps – Testing Perceptions and Telling The Story

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Thank You!

Solomon McCown & Company, Inc. www.solomonmccown.com @healthbostonpr 177 Milk Street tel 617-695-9555 Boston, MA 02109 fax 617-695-9505

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HIE STRATEGY: UPDATES AND RECOMMENDATIONS

Massachusetts Health IT Council and Advisory Committee

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Overview of Activity Since October 17 Advisory Committee meeting

• Workgroups: All 5 workgroups have met twice, have given feedback
• n the HIE strategy and APD, and are now working through the

concrete details of the phases in each domain and engagement area.

• CMS/ONC Meeting: On October 24 Manu Tandon, John Halamka,

Rick Shoup, and Micky Tripathi presented the strategy to representatives from CMS and ONC.

• Plan Updates: EOHHS and MeHI are in process of updating the State

Medicaid Health Plan (SMHP), Advanced Planning Document (APD), and HIE Strategic and Operational Plan (SOP) with input from the workgroups.

Detailed updates are provided in the following slides

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CMS/ONC meeting

• CMS/ONC Meeting: On October 24 a Massachusetts team that

included Manu Tandon, John Halamka, Rick Shoup, and Micky Tripathi presented the straw man strategy to representatives from CMS and ONC

• Response from Federal Agencies: The response to the updated

strategy was very positive from both agencies: – Support for the strategy that unifies Medicaid and HIE plans, resources, and initiatives – Support for the proposed Fair Share cost allocation approach –

• ffered additional ideas and approach refinement
• Next steps: CMS and ONC leaders suggested that we move rapidly

forward as with the following: – Update to the SMHP – Update of APD – Update to HIE Strategic and Operational plan

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Progress on APD, SMHP, and SOP

APD Update

• The Medicaid Advance Planning Document (APD) update draft, which

updates the APD approved by CMS on 8/26/11, was completed on 11/8/11

• The APD was sent to Workgroup members for input on 11/8/11 –

Comments were received on 11/11/11 and incorporated into the current draft

• EOHHS will submit a courtesy draft to CMS on 11/15/11, will conduct

an early feedback call with CMS on 11/17/11, and will submit the final APD on 11/21/11 SMHP Update

• The State Medicaid HIT Plan (SMHP), which was approved by CMS on

6/13/11, has been updated and will be submitted to CMS with the APD SOP Update

• The HIE Strategic and Operational Plan, which was approved by ONC
• n 11/03/10, has been updated and a draft copy will be submitted to

ONC at the same time as the SMHP and APD

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High Level Timeline for Next 12 months

Note: Detailed timelines provided in Appendix A

Initiative Completion Submit IAPD and SMHP to CMS and updated draft SOP to ONC Nov 18, 2011 High level planning and approvals completed Jan 15, 2012 Design, launch, and go live for phase 1 “Information Highway” Oct 15, 2012 Design, launch, and go live for End User Adoption program Oct 15, 2012 Design, launch, and go live for Impact program Oct 15, 2012 Design, launch, and go live for phase 1 Public Health Gateway Dec 14, 2012

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Recommendation to Approve Updated HIE Strategy

• Recommendation to HIT Council to approve the HIE strategy: The

Advisory Committee recommends approval of the proposed Massachusetts Statewide HIE Strategy.

• The current strategy, including updates from the workgroups and the

October 24, 11 CMS/ONC meeting, is included in Appendix A.

• Core elements of the proposed strategy:

– Three-phase HIE plan beginning with creating the statewide Information Highway as a foundation for richer applications and services from 2012-2014 – Aligned with national interoperability standards and emerging MU stage 2 requirements – Maximizing Medicaid SMHP/MMIS 90/10 FFP funding – Focusing Medicaid funding on building infrastructure for statewide services, and ONC Cooperative Agreement funding on maximizing end-user adoption of those statewide services

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Chapter 305 Funding

Chapter 305 Funds Allocated to HIE and Medicaid Incentive Payment Program

• ONC HIE Challenge Grants

Assuming Current Plan $2.6 M

• ONC HIE Grants

(Under Revised Plan) Currently Unknown

• MassHealth Federal Match Requirement

$2.2 M

• MassHealth Cash Flow Requirement

$3.5 M Total $8.3 M

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MOTION TO APPROVE PROPOSED HEALTH INFORMATION EXCHANGE (HIE) STRATEGY

Massachusetts Health IT Council and Advisory Committee

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Motion #1

Motion #1 - $5.7 million transfer of funds

The Health Information Technology Council (the “Council”) does hereby approve the transfer of funds from the Massachusetts E-Health Institute Fund to the Executive Office of Health and Human Services (“EOHHS”) in an amount that shall not exceed $5,700,000, as

• presented. The funds shall be utilized by the State Medicaid Office (“MassHealth”) to

maximize its ability to secure federal funding participation (“FFP”) at a rate of nine-to-one for state expenditures that will support the implementation of the State Medicaid Health Information Technology Plan (SMHP). It is the current expectation of the Council that the funds shall be transferred to EOHHS in two disbursements of approximately $2,300,000 (the “First Disbursement”) and $3,400,000 (the “Second Disbursement”); provided that the release of the Second Disbursement shall be contingent on EOHHS submitting written evidence to the Massachusetts Technology Collaborative (“MTC”) that is deemed to be satisfactory by MTC’s Chief Executive Officer documenting the federal approval of an amended SMHP and revisions to the associated Implementation Advanced Planning Document by the Center for Medicaid Services (“CMS”) that will incorporate relevant elements of the revised statewide Health Information Exchange strategy and that is expected to be submitted to CMS on or about November 18, 2011.

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11/14/2011

Motion #2

Motion #2 – HIE Plan The Health Information Technology Council (the “Council”) does hereby approve a revised statewide strategy for the implementation of Health Information Exchange (“HIE”) activities in the Commonwealth, as presented, which incorporates elements that include but are not limited to: (1) a unified statewide approach that integrates the state Medicaid office (“MassHealth”) and Massachusetts e-Health Institute (“MeHI”) plans, resources and activities; (2) maximizes MassHealth’s ability to secure federal funding participation ("FFP") at a nine-to-one rate; and (3) provides for a focus of MeHI’s HIE activities on so-called “last mile” efforts that promote the adoption of health information technology. The Council recommends that the Executive Committee of the Board of Directors of the Massachusetts Technology Park Corporation (“MTC”) take corresponding final action to approve the revised HIE statewide strategy with the condition that implementation of the revised statewide HIE strategy should be contingent on MTC and MassHealth securing federal approval of the updated versions of all impacted planning, operational and implementation documents by the Office of the National Coordinator and/or the Center for Medicaid Services to ensure that federal grant and FFP funding for HIE activities is not reduced, rescinded or otherwise negatively impacted. The updated documents requiring federal approval include but may not be limited to: (1) State Medicaid Health IT Plan; (2) Health Information Technology Advanced Planning Document; and (3) HIE Strategic and Operational Plan.

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Massachusetts Health IT Council and HIE HIT Advisory Committee

HIE WORKGROUP UPDATE

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Workgroup progress

Workgroup High level summary of discussion (detailed workgroup notes are available) Consumer & Public Engagement

• Discussed high level priorities and barriers for consumer engagement, specifically for Phase

1

• Identified initial areas for consumer input and engagement including; Consent policy, privacy

and security, and trust Provider Engagement & Adoption

• Discussed the end-state vision for health information exchange
• Identified need to shift from technical discussions to clinical use case and value identification
• Began discussion of differences in perceived value among different provider

types/specialties

• Identified need to articulate the value of the HIE to providers to encourage adoption

Legal & Policy

• Discussed approach for analyzing the current legal framework in place for the virtual

gateway and to identify gaps in this approach as the VG is extended for HIE use and users

• Beginning process of bringing policies forward from the ad-hoc workgroups and framing

them by the updated service and phasing framework Technology & Infrastructure

• Discussed specifics of PKI and Certificate Management
• Developed separate PKI task force to provide specific recommendations and requirements
• Discussed transport

Finance & Sustainability

• Discussed the currently proposed cost and revenue assumptions for both the

implementation and operations project phases.

• Discussed private sector contributions to both the implementation and future phases
• Discussed the Memorandum of Understanding (MOU) document and process to support the

APD submission to CMS

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Workgroup Next Steps and Focus Areas

Workgroup Immediate next steps and focus areas ALL WORKGROUPS

• Finalize membership
• Create high-level workplans and detailed 6-month workplans
• Create 6-month schedules (minimum monthly, some at higher frequency)
• Decide inputs required for Massachusetts Statewide HIE Policy Guidance V 1.1

Consumer & Public Engagement

• Identify possible opportunities for more direct patient engagement in earlier phases
• Develop strategy for broader reachout to consumers
• Reshape presentation for consumer communication

Provider Engagement & Adoption

• Develop ideas/approaches for “HIE Adoption Grant” program
• Develop strategy for broader reachout to physicians
• Reshape presentation for physician communication
• Identify possible pathways for “One Patient, One Record”

Legal & Policy

• Ownership, Governance, and Operations model for Phase 1 services
• Privacy and Security policies for Phase 1 services

Technology & Infrastructure

• Technical requirements for Phase 1 service RFPs
• Identify possibilities for using existing infrastructure components to meet statewide HIE

needs Finance & Sustainability

• Evaluate cost allocation approach and private contribution need
• Develop framework for evaluating HIE value propositions in the market

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APPENDIX A: PROPOSED MASSACHUSETTS STATEWIDE HIE STRATEGY

Massachusetts Health IT Council and HIE HIT Advisory Committee

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11/14/2011

Proposed Massachusetts Statewide HIE Strategy Table of Contents

• Introduction
• Aligning Existing Plans
• Priorities and Phasing
• Resources
• Governance
• Timelines

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Introduction

The projects and activities presented in the following proposed statewide HIE strategy support the Medicaid program while advancing the development of a statewide HIE. To date, the Strategic and Operational Plan and State Medicaid Health IT Plan have been developed in parallel but with close cooperation but two recent events led to the effort to unify these plans

• State Medicaid Director letter of May 2011 refining use of Medicaid funds for

HIE activities

• Massachusetts Secretary of Health and Human Services recasting the state’s

HIE governance structure The timing and impact of these two events led the state to develop a unified approach that:

• Maintains the priorities and phasing of the original SOP and SMHP
• Rationalizes and aligns differences to create a single plan incorporating SDE,

Medicaid, and DPH priorities and preferences

• Optimizes use of multiple funding streams (ONC, CMS, State, and Private)

and existing infrastructure into a single, integrated approach

• Focuses on both creating infrastructure AND removing barriers to adoption

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Proposed Massachusetts Statewide HIE Strategy Table of Contents

• Introduction
• Aligning Existing Plans
• Priorities and Phasing
• Resources
• Governance
• Timelines

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40

Current State of Market

Berkshire Health System NEHEN SafeHealth

MD MD MD MD

Fallon Clinic UMass Memorial Statewide HISP

PKI/certificate mgmt Web portal Provider/entity directory Audit log MD MD MD MD MD MD

BIDMC Partners

Direct gateway services

EOHHS NwHIN

MassHealth DPH

Atrius

Current state of the market favors a network of networks connected via a single statewide

• pen HISP supported by centralized project management

Illustrative example

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Transition to Heterogeneous Model

Berkshire Health System Atrius NEHEN SafeHealth MD MD MD MD NwHIN

Fallon Clinic UMass Memorial

MD MD MD MD MD MD BIDMC Partners

HISP HISP HISP HISP HISP

MassHealth

HISP HISP

Internet

PKI/certificate mgmt Provider/entity directory Other shared services

Eventually expect to transition to heterogeneous model with multiple, varied HISPs and decentralized shared services. Illustrative example

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34 Possible Projects Identified

SMHP (13 projects) Strategic & Operational Plan (21 projects)

Note: Does not include MU incentive administration project

Project SFY Direct gateway 2012 Public health interfaces 2012 VG upgrade 2012 Claims relay service 2013 PKI/certificate management 2013 Clinical data repository 2014 EMPI/RLS 2014 Formulary/medication management 2014 Open access HISP 2014 Provider directory 2014 Quality data infrastructure 2014 Re-architecting and enabling payment methodologies 2014 Statewide HIE solution integration services 2015 Project Phase Routing, packaging, and translation, de-identification 1 Provider/facilities directory services 1 Vocabulary services 1 Consent services 1 PKI/identity services 1 Immunization/Surveillance/ELR 1 Quality data aggregation 1 MPI/RLS 2 APCD 2 PCHRs 2 Routing service for patients 2 Advanced directives service 2 Patient education materials service 2 Radiology image exchange service 2 Event notification service 2 Pre-auth approval rules service 2 Disclosure logging services 3 i2B2 clinical research services 3 Pharmocosurveillance service 3 Medication safety analysis 3 Formulary service 3

34 possible projects have been identified in SMHP and MeHI Strategic and Operational plan

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15 priority projects

15 projects ready for detailed scoping, budgeting, and prioritization 11 projects need further definition – NOT ready for detailed scoping

Mapping results SMHP MeHI Strategic and Operational Plan Direct gateway Routing, packaging, translation, de-identification Provider directory Provider/facilities directory services PKI/certificate management PKI/identity services Public health interfaces Immunization/Surveillance/ELR EMPI/RLS MPI/RLS Quality data infrastructure Quality data aggregation Clinical data repository APCD Statewide HIE solution integration services Open access HISP Consent services Vocabulary services Routing service for patients Re-architect/enabling payment methods VG upgrade Claims relay service Formulary/medication management Formulary service PCHRs Advance directives service Patient education materials service Radiology image exchange service Event notification service Pre-auth approval rules service Disclosure logging services i2B2 clinical research services Pharmocosurveillance service Medication safety analysis na na na Projects common to SMHP and Strategic & Operational Plan na Projects requiring further definition through WG process MassHealth infrastructure projects Projects unique to Strategic & Operational Plan Projects unique to SMHP

Reconciling these projects across programs identifies 15 priority projects

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# Reconciled HIE Project List 1 Direct gateway 2 Provider directory 3 PKI/certificate management 4 Public health interfaces 5 EMPI/RLS 6 Quality data infrastructure 7 Clinical data repository 8 Statewide HIE solution integration services 9 Open access HISP 10 Consent services 11 Vocabulary services 12 Routing service for patients 13 Re-architect/enabling payment methods 14 VG upgrade 15 Claims relay service 16 HIE end-user integration

Strawman Priority Project List for Unified Statewide HIE Program

Recommend adding an additional project to address one-time adoption needs of end-users

Need to determine the Roadmap for implementing these projects Need to validate Strawman Priority List and Roadmap with stakeholders through Workgroup process

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Description of priority projects

# Reconciled HIE Project List Program description 1 Direct gateway Implementation of gateway implementing Direct specification for universal messaging interoperability 2 Provider directory Directory of providers and facilities to ensure unambigous and reliabe addressing of electronic transactions 3 PKI/certificate management Infrastructure to ensure security of statewide HIE infrastructure 4 Public health interfaces HL7 interfaces to variety of public health services, including ELR, MIIS, SSS, CBHI, CLPPP, PMP, OTP 5 EMPI/RLS Statewide patient-matching function to match medical records across

• rganizations

6 Quality data infrastructure Infrastructure to facilitate aggregation of quality and performacne measurement data for reporting to Medicaid and other purposes 7 Clinical data repository Integration of clinical data with APCD 8 Statewide HIE solution integration services System integration and project management for HIE infrastructure implementation 9 Open access HISP Service organization to provide network connection to statewide HIE services for providers unable to connect through their own organizations 10 Consent services Centralized management of patient consent status information 11 Vocabulary services Translation service to transform non-standard medical vocabulary to national standards-based nomenclatures 12 Routing service for patients Messaging services to allow providers to send messages and records securely to patient-controlled applications 13 Re-architect/enabling payment methods Flexible IT claim processing systems to address new forms of payment and organization (accountable care, PCMH, etc) 14 VG upgrade Upgrade of Virtual Gateway for standards-based HL7 transactions 15 Claims relay service Single gateway for the submission of claims for MassHealth (regardless of medical, pharmacy, Dental or Health Safety Net Claims) 16 HIE end-user integration Program to remove/lower barriers to HIE adoption

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46

Proposed Massachusetts Statewide HIE Strategy Table of Contents

• Introduction
• Aligning Existing Plans
• Priorities and Phasing
• Resources
• Governance
• Timelines

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47

Map Projects into Phases

Difficulty

• Are there significant business,

technical, governance, or legal complexities that need to be resolved before deploying the service/ Demand for HIE service

• Is there immediate market demand

for the transaction as a statewide HIE service? Gap in market today

• Is there a gap in the market today?
• Ready to go
• Move to requirements and

RFP development

• No significant technical or

policy barriers

• Needs governance & business

model development

• Needs scoping and budgeting
• Multiple barriers to tackle
• Needs policy, technical,

governance, and business model development

• Needs scoping and budgeting

Phasing criteria Phasing HIE projects

Phase 1 Phase 2 Phase 3

# Reconciled HIE Project List 1 Direct gateway 2 Provider directory 3 PKI/certificate management 4 Public health interfaces 5 EMPI/RLS 6 Quality data infrastructure 7 Clinical data repository 8 Statewide HIE solution integration services 9 Open access HISP 10 Consent services 11 Vocabulary services 12 Routing service for patients 13 Re-architect/enabling payment methods 14 VG upgrade 15 Claims relay service 16 HIE end-user integration

Various projects can be mapped into phases using criteria assessing difficulty, market demand, and market gaps

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Phasing defines Roadmap for Statewide HIE Program

• Create infrastructure to facilitate data aggregation/analysis
• Will support Medicaid CDR and quality measure

infrastructure

• Will support vocabulary translation services (lab, RX)

Increasing cost and complexity Facilitate normalization and aggregation Enable queries for records

Information Highway

• 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

Analytics and Population Health

• Create infrastructure for cross-institutional queries for and

retrieval of patient records

Search and Retrieve

Phase 2 Phase 3 Phase 1

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Reconciled Projects Grouped Into Three Phases

Phasing Reconciled HIE Project List Next steps Timing Statewide HISP w/ Direct Gateway Q3 2012 Provider directory Q3 2012 VG enhancement: Access & Identity Mgmt Q3 2012 VG enhancement: PKI Q3 2012 VG enhancement: HL7 gateway Q3 2012 HL7 interface: Syndromic Surveillance Q3 2012 HL7 interface: CBHI Q3 2012 HIE end-user integration program Q3 2012 IMPACT (ONC Challenge Grant) Q4 2012 Clinical data repository Q1 2013 Quality data infrastructure Q1 2013 HL7 public health interfaces Q1 2013 EMPI Q2 2013 Vocabulary services Q2 2013 Claims relay service Q3 2013 MDPHnet (ONC Challenge Grant) Q4 2013 RLS Q1 2014 Consent services Q1 2014 Routing service for patients Q3 2014 Re-architect/enabling payment methods Q3 2014

• Develop governance, business, and
• perational model

Phase 3

• Develop policy frameworks & governance

model

• Develop technical standards
• Develop business/operations model

Phase 1 Phase 2

• Develop detailed scope, requirements,

budgets, and RFPs

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Proposed Massachusetts Statewide HIE Strategy Table of Contents

• Introduction
• Aligning Existing Plans
• Priorities and Phasing
• Resources
• Governance
• Timelines

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51

VGShared Service Virtual Gateway

VG Shared Services

Virtual Gateway HIE Users

(Medicaid & Non-Medicaid)

Statewide HISP Direct Gateway**

Medicaid & Public Health Applications

Syndromic Surveillance

MMIS

Claims Engine Provider Online Service Center MMIS Base Application

MMIS Users

CBHI

(Children’s Behavioral Health Initiative )

Immunization Electronic Laboratory Reports

* Upgrade/Expansion ** New

AIMS

(Access and Identity Management)

Other Existing Enterprise Shared Services

Clinical Gateway

(HL7 Interfaces)

AIMS* (Access and Identity Management) Clinical Gateway* (HL7 Interfaces) PKI** (Public Key Infrastructure) Provider Directory**

Syndromic Surveillance CBHI

(Children’s Behavioral Health Initiative )

Upgrade and leverage Infrastructure

Upgrade and leverage infrastructure that is currently in use by MMIS users – extend to HIE users (Medicaid and non-Medicaid)

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MMIS Shared Service Virtual Gateway Medicaid & Public Health Applications Syndromic Surveillance MMIS

Claims Engine Provider Online Service Center MMIS Base Application

CBHI

(Children’s Behavioral Health Initiative )

Immunization Electronic Laboratory Reports Statewide HISP Direct Gateway** VG Shared Service Virtual Gateway AIMS

(Access and Identity Management)

Other Existing Enterprise Shared Services Clinical Gateway

(HL7 Interfaces)

AIMS*

(Access and Identity Management)

Provider Directory** PKI**

(Public Key Infrastructure)

Clinical Gateway*

(HL7 Interfaces)

Syndromic Surveillance CBHI

(Children’s Behavioral Health Initiative )

HIE Users (Medicaid and non-Medicaid)

HIE users serviced by existing service center Security and Provider Directory services leveraged for Statewide HISP Architecture and usage patterns identical for all users ~80K users already using Virtual Gateway EHR (Direct enabled)

Labs (HL7) Clinical documents (CDA) XDR or SMTP

EHR (not Direct enabled)

Labs (HL7) Clinical documents (CDA) Web portal

No interoperable EHR

Clinical documents Web portal

Simplify User Access

Repurpose new and existing components

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Medicaid & Public Health HL7 Interfaces Provider Directory PKI Service Virtual Gateway Syndromic Surveillance MMIS

Claims Engine Provider Online Service Center MMIS Base Application

MMIS & VG Users HIE Users Statewide HISP CBHI (Children’s Behavioral Health Initiative )

Direct Gateway

Immunization Provider Public HIPAA X12 Gateway AIMS 3.0 Clinical Gateway HIX & Integrated Eligibility System

Eligibility Domain HIX Domain

MDM Services ELR (not in VG) EDM HIX & IES Users

Anticipate HIX & IES integration

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Building Infrastructure is no Guarantee it will be used

Building an infrastructure is no guarantee that it will used - Need to bring

• n users and gain “network effect” values immediately
• Value of statewide HIE network and services will increase

exponentially with the number of users

• Removing adoption barriers is key to increasing number of users

– Up-front cost and difficulty of system integration is significant barrier to adoption to most users, especially small practices and safety-net providers

• Can address this barrier through a variety of means

– Align all funding streams to maximize opportunities for synergy – Leverage existing assets – Build services where the users are – Lower the cost and ease the difficulty of using the statewide HISP

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Approach is to complement infrastructure with a multi-pronged adoption program

MMIS Shared Service Virtual Gateway Medicaid & Public Health Applications Syndromic Surveillance MMIS

CBHI

Immunization Electronic Laboratory Reports Statewide HISP Direct Gateway** MMIS Shared Service Virtual Gateway AIMS

Other Existing Enterprise Shared Services Clinical Gateway

AIMS*

Provider Directory** PKI**

Clinical Gateway*

Syndromic Surveillance CBHI

Statewide outreach, recruitment, and training Managed procurements, grants, and PM/technical support Individual interfaces Ambulatory practices CAHs Long-term care Web portal recruitment and training Behavioral health Vendor-specific hubs (or HISPs) Hospital EHR vendor Ambulatory EHR vendor Sub-network hubs (or HISPs) HIE (e.g., SafeHealth) Hospital network (e.g., Berkshire)

CMS SMHP/MMIS (infrastructure) ONC Cooperative Agreement (last-mile services)

Synergies with REC

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Revising the Strategic and Operational Plan

• Priorities of original SOP have not changed

– Focus on Direct-enabled “network of networks” – Incremental approach starting with “push” as foundation for more advanced aggregation and “pull” transactions

• With broad-based governance and a consensus statewide roadmap now in place,

timelines and resource planning are now robust, executable, and aligned – Maps multiple federal and state initiatives to single statewide roadmap with consistent, coherent phasing – Gives concrete vision to providers getting eager for advanced HIE capabilities – Builds on state’s considerable public and private infrastructure already in place, and eliminates resource and capacity redundancies

• Statewide plan continues focus on addressing PIN priorities and MU

– eRX: Rapid EHR adoption is building on MA #1 national eRX ranking – Labs: HISP/Direct Gateway will provide low-cost and universally accessible means for electronic delivery where it’s not already in place – Summary care exchange: Primary use case of HISP/Direct Gateway – Public health: Eases rapid adoption by unifying public health with all other clinical transactions

• Current plan is to immediately begin revisions to SOP to reflect statewide plan priorities

and phasing, and adjust for new PIN priorities when available

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Determining Federal and State-level Cost Allocation

Total project cost

Basis

• Providers
• Claims
• Transactions
• Other?

MMIS or SMHP?

MMIS applies to all Medicaid providers; HITECH must correlate with EHR-IP program % Medicaid- relevant % not Medicaid- relevant

Medicaid share of market?

HIE share of service?

Applies to multi-purpose components

100% state-level 75% federal

25%

state-level 100% state-level

50%

federal

50%

state-level 100% state-level Development MMIS/SMHP O&M MMIS SMHP 90% federal 10% state-level

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Infrastructure Funding Approach

• Existing VG infrastructure leveraged to the greatest extent possible

– Repurpose existing components to lower incremental cost of new functions – Add new functions to platforms that already have high use

• Most new infrastructure built with MMIS funds

– Reuses centralized infrastructure consumed by MMIS – Lays foundation for future MMIS use cases (claims attachments, clinical outcomes data, etc)

• Direct Gateway and HL7 Syndromic Surveillance only Phase 1 projects funded

through SMHP

• Build for Medicaid-only use at outset

– Fixed infrastructure that is the same whether built for Medicaid-only or for universal use (100% of hospitals and +80% of physicians are Medicaid) – Non-Medicaid users pay allocation on operations for usage as they adopt once system is

• perational

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Budget estimate for Phase 1 projects and source

• f funds: Preliminary

Phasing Reconciled HIE Project List Funding vehicle Preliminary budget Statewide HISP w/ Direct Gateway SMHP 3,404,543 Provider directory MMIS 3,300,741 VG enhancement: Access & Identity Mgmt MMIS 2,591,240 VG enhancement: PKI MMIS 290,000 VG enhancement: HL7 gateway MMIS 2,793,028 HL7 interface: Syndromic Surveillance SMHP 2,856,965 HL7 interface: CBHI MMIS 1,938,341 HIE end-user integration program ONC HIE Grant 12,587,500 IMPACT (ONC Challenge Grant) ONC HIE Grant 2,018,750 Clinical data repository tbd tbd Quality data infrastructure tbd tbd HL7 public health interfaces tbd 4,846,000 EMPI tbd Vocabulary services tbd tbd Claims relay service tbd tbd MDPHnet (ONC Challenge Grant) ONC HIE Grant 2,018,750 RLS tbd tbd Consent services tbd tbd Routing service for patients tbd tbd Re-architect/enabling payment methods tbd tbd Phase 1 sub-total to date 31,781,109 Phase 2 sub-total to date 6,864,750 Phase 3 sub-total to date tbd Total budget to date 38,645,859

Phase 3 Phase 1 Phase 2

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Aligning Resources for Statewide HIE Services

ONC Cooperative Agreement $12.6M CMS SMHP/MMIS $17.1M (Phase 1) MA Chapter 305 $11.9M ONC Challenge Grants $3.4M Matching funds for ONC HIE programs Matching funds for CMS FFP

Infrastructure program for Statewide HIE Services Adoption program for Statewide HIE Services

Leverage programs as relevant for adoption and infrastructure SMHP/MMIS funds can be used only for infrastructure PIN priorities and user adoption

Private funds ~ $472K annual (O&M)

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SMHP & MMIS Phase 1: Delineation of Funding Sources

Project Build Operation 1 Statewide HISP/Direct Gateway SMHP + IMPACT (ONC Grant) + Private SMHP + Private Virtual Gateway Enhancements 2 AIMS (Identity Management) MMIS MMIS + SMHP & HIE Projects (based on usage) 3 Public Key Infrastructure 4 Clinical Gateway 5 Provider Directory 6 HL7 Interface - Syndromic Surveillance SMHP SMHP + Operating Funds 7 HL7 Interface – Children’s Behavioral Health Initiative(CBHI) MMIS MMIS + Operating Funds

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Uses and Sources of Phase 1 Funds (estimated)

2 4 6 8 10 12 14 16 18

Design, Development, Implementation Operations & maintenance (annual)

Millions

Public health: CBHI Public health: Synd Surv Public Health Gateway PKI (Security) AIMS (Identity) Provider Directory Direct Gateway

$ M

Uses

14.7 3.0 2.0 1.9 0.2 0.5

2 4 6 8 10 12 14 16 18

Design, Development, Implementation Operations & maintenance (annual) Private funds State funds Federal funds

Sources

$ M

$17.2M $5.4M $17.2M $5.4M Note: Cost and revenue data is preliminary and will be updated with finalization of APD

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Source of funds by project (estimated)

DDI Federal State Private Total Direct Gateway 3,036,853 367,691 3,404,543 Provider Directory 2,904,652 396,089 3,300,741 AIMS (identity) 2,280,291 310,949 2,591,240 PKI (Security) 96,800 13,200 180,000 290,000 Public health gateway 2,457,865 335,163 2,793,028 Public health: Synd Surv 2,514,129 342,836 2,856,965 Public health: CBHI 1,705,740 232,601 1,938,341 Total 14,996,330 1,998,529 180,000 17,174,859 O&M (annual) Federal State Private Total Direct Gateway 576,039 576,039 474,388 1,626,467 Provider Directory 185,776 61,925 247,702 AIMS (identity) 451,856 150,619 602,475 PKI (Security) 75,000 25,000 100,000 Public health gateway 166,881 55,627 222,508 Public health: Synd Surv 716,961 716,961 1,433,921 Public health: CBHI 847,234 282,411 1,129,646 Total 3,019,748 1,868,583 474,388 5,362,719

Note: Cost and revenue data is preliminary and will be updated with finalization of APD

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Proposed Massachusetts Statewide HIE Strategy Table of Contents

• Introduction
• Aligning Existing Plans
• Priorities and Phasing
• Resources
• Governance
• Timelines

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65

Secretary of HHS Oversight of Adoption and Infrastructure Programs

Massachusetts Technology Collaborative Massachusetts eHealth Institute HIT Council MassHealth (Medicaid) Secretary of Health and Human Services HIE/HIT Advisory Committee

ONC Cooperative Agreement CMS SMHP/MMI S ONC Challenge Grants Regional Extension Center

HIT/HIE Adoption HIE Infrastructure

SDE

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Workgroup structure, leadership, and staffing

Legal & Policy Workgroup Technology & implementation Workgroup Finance & sustainability Workgroup Consumer and public engagement workgroup Provider engagement & adoption workgroup

Co-Chairs:

• Wendy Mariner
• Gillian Haney

Facilitator:

• Ray Campbell

Business Analyst:

• Christina Moran

Co-Chairs:

• John Halamka
• Manu Tandon

Facilitator:

• Nael Hafez

Business Analyst:

• David Delano

Co-Chairs:

• Andrei Soran
• Steve Fox

Facilitator:

• Micky Tripathi

Business Analyst:

• Christina Moran

Co-Chairs:

• John Halamka
• Manu Tandon

Facilitator:

• Micky Tripathi

Business Analyst:

• Mark Belanger

Co-Chairs:

• Jessica Costantino
• Kathleen Donaher

Facilitator:

• Christina Moran

Co-Chairs:

• Michael Lee, MD
• Dirk Stanley, MD

Facilitator:

• Mark Belanger

Health IT Council

HIE-HIT Advisory Committee

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Proposed Massachusetts Statewide HIE Strategy

Table of Contents

• Introduction
• Aligning Existing Plans
• Priorities and Phasing
• Resources
• Governance
• Timelines

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Timeline

Update: High level timeline for next 12 months (1 of 4) Finalize all approvals

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Timeline

Update: High level timeline for next 12 months (2 of 4) Plan and launch phase 1 services for “Information Highway”

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Timeline

Update: High level timeline for next 12 months (3 of 4) Plan and launch phase 1 services for Public Health Gateway

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Timeline

Update: High level timeline for next 12 months (4 of 4) Plan and launch End User Adoption and Impact programs

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APPENDIX B: PROJECT OVERVIEW

Massachusetts Health IT Council and HIE HIT Advisory Committee

73

11/14/2011

• 1. Health Information Service Provider (HISP)
• Direct Gateway - based on NHIN Direct standards and specifications
• To support Information exchange: Provider <-> Provider, Provider <->State Agencies

and Provider <-> Patients

• using HTTPS,SMTP and XDR protocols

Scope

• SMHP

Funding

• Helps Medicaid providers to send clinical message electronically and to meet MU Stage

1 criteria.

• Helps Medicaid and DPH agencies to exchange administrative and clinical data

electronically with Medicaid providers. Rationale:

• SMHP – adds HTTPS and SMTP support
• IMPACT (ONC challenge grant) – adds XDR support
• Private sector contribution
• MeHI ONC grant –used for adoption
• Requires Provider Directory and PKI – cost allocated based on usage.

Cost Allocation Approach

• DDI : $3.4M
• O&M : $1.03M

Budget

Note: Budget and cost allocation information is preliminary and will be updated with finalization of APD

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• 2. Provider Directory
• Setup Infrastructure for Provider Directory
• Phase 1 – Direct gateway will use the infrastructure to store provider demographics, direct

email ids and public certificates

• Will be extended to support Phase 2 and Phase 3 use cases.

Scope

• MMIS

Funding

• 90% of providers in MA are Medicaid
• Supports MMIS in several ways
• One central repository for maintaining provider data
• Provides intelligent search capabilities using current and historical demographics
• Ensures up to date information reducing billing and claim errors
• Facilitates coordinated care by linking with member data
• Control the information shared and Audit information accessed
• Enables members to locate a Medicaid provider
• Improves analytics, detect and investigate any suspected fraudulent behavior
• Maintains electronic and paper based communication preferences
• Can be leveraged for HIE, Enables Medicaid provider to search for a specialist and send

“direct” email Rationale:

• Cost allocated based on usage by SMHP projects

Cost Allocation Approach

• DDI : $3.3M
• O&M : $619K

Budget

Note: Budget and cost allocation information is preliminary and will be updated with finalization of APD

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• 3. Virtual Gateway Enhancements
• AIMS - Expand capacity of Access and Identity Management Service (AIMS) to support

SMHP projects.

• AIMS -Migrate MMIS, CBHI and other related business applications to use new AIMS

infrastructure (built using Oracle IdM).

• PKI –Setup Public Key Infrastructure (PKI) for Direct and future SMHP projects.
• AIMS -Integrate PKI with Access Manager in AIMS to support Two-factor authentication.
• Gateway – Expand capacity of XML Gateway and Enhance it to support B2B transactions
• Gateway - Enhance Clinical gateway for
• Asynchronous transactions
• To support MU Stage 2 and 3 use cases (Pull, Publish/subscribe)
• Build centralized Audit, Logging and Monitoring solution
• Enhance message security

Scope

• MMIS

Funding

Note: Budget and cost allocation information is preliminary and will be updated with finalization of APD

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• 3. Virtual Gateway Enhancements (Cont'd)
• Virtual Gateway
• VG, SOA based architecture, acts as the front-door for MMIS– All user and web service

interaction goes through VG.

• Provides Single sign-on - Medicaid Providers can use the same user id to access MMIS

and HIE applications (e.g. Direct Web Mail)

• Reusing/Extending the existing infrastructure to support HIE
• Clinical Gateway
• Facilitates Medicaid providers to submit Immunization and bio-surveillance data to Public

Health agency - to achieve Meaningful use objectives

• Critical infrastructure to build Clinical data repository in phase 2.
• Clinical repository (Phase 2) will be used for claims adjudication, analysis, treatment

policy determination and fraud detection

• Will be used by MMIS to receive medical documentation from Providers – Facilitates

suspected fraud and improper payment investigation.

• Will be used by MMIS to receive Prior Authorization requests with ASC12n 275

transaction with embedded HL7 – Helps MMIS to process PA request without manual intervention. Rationale:

• Cost allocated based on usage by SMHP projects
• PKI – follows subscription fee based model

Cost Allocation Approach

• DDI : $5.67M
• O&M : $1.77M

Budget

Note: Budget and cost allocation information is preliminary and will be updated with finalization of APD

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• 4. HL7 Application Interface – Syndromic

Surveillance

• HL7 interface for Providers to submit Syndromic Surveillance to DPH in HL7 format

Scope

• SMHP

Funding

• Helps Medicaid provider to achieve MU Stage 1 criteria
• Support proactive Public Health initiatives
• Helps to build Clinical data repository in Phase 2

Rationale:

• Requires Clinical Gateway Infrastructure – cost allocated based on usage.

Cost Allocation Approach

• DDI : $2.85M
• O&M : $1.06M

Budget

Note: Budget and cost allocation information is preliminary and will be updated with finalization of APD

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• 5. HL7 Interface – Children Behavioral Health Initiative

(CBHI)

• HL7 interface for Providers and Managed Care Entities(MCE) to submit assessment

reports in HL7 format for

• Serious Emotional Disturbances (SED)
• Child and Adolescent Needs and Strengths (CANS)

Scope

• MMIS

Funding

• Helps MMIS Functions
• Early Periodic Screening, Diagnosis and Treatment (EPSDT) – performed for members

under age 21

• Claims
• Allows MMIS to identify any discrepancies in claims processing

Rationale:

• MMIS

Cost Allocation Approach

• DDI : $1.93M
• O&M : $869K

Budget

Note: Budget and cost allocation information is preliminary and will be updated with finalization of APD

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