Connecting Small Provider Organizations to the Massachusetts State HIE

Transcription

1 Connecting Small Provider Organizations to the Massachusetts State HIE MHDC CIO Forum - March 29 th, 2012 Larry Garber, MD Medical Director for Informatics Reliant Medical Group (AKA Fallon Clinic) 0

2 Overview How to get organizations to connect to the state s HIE How will organizations to connect to the state s HIE What is unique about small practices How will IMPACT help 1

3 How to get organizations to connect to the HIE: Provide value (Benefits > Cost) Fit into real-world workflows Earn the trust of the stakeholders 2

4 How will organizations actually connect to the Massachusetts State HIE? 3

5 Direct Gateway Providers Labs Hospitals HIE PHR Payer Registry Direct Gateway Web Mail SMTP/SMIME XDR/SOAP Enterprise Service Bus Direct Components/ Enterprise XDR,XDM & SMIME Conversion Sign/Encryption (for Full Service ) Access & Identity Management Provider Directory PKI Document Editor/Viewer (for web mail) Audit & Logging Reporting & Monitoring Message Store (for web mail) Backend Systems SMTP Server DNS LDAP Provider Directory 4

6 MA Statewide HIE Everyone Connects Senders Web Browser (No EHR and no ) EHR or HIE with IHE XDR HTTPS SOAP Provider Directory / Certs MA Data Rules Pipe Recipients HTTPS SOAP Web Browser (No EHR and no ) EHR or HIE with XDR, DPH, Medicaid, QDC, etc EHR or HIE w/ Direct MIME EHR* but no XDR or Direct SMTP LAND Internet ( ) Fixtures SMTP LAND EHR or HIE w/ Direct MIME EHR* but no XDR or Direct Statewide MPI/Consent EHR with Direct Deidentification Data Translation Fax Server EHR with Direct HIE with Direct 5 SEE CCD+ Viewer / Editor *Also pertains to users of MDS, OASIS, CMS-485, INTERACT, CARE-Tool, IRF-PAI, etc Medical Vocabulary Local Master Patient Index 5 HIE with Direct

7 Small Orgs Part of IDN (e.g. PCPs) Senders Web Browser (No EHR and no ) EHR or HIE with IHE XDR HTTPS SOAP Provider Directory / Certs MA Data Rules Pipe Recipients HTTPS SOAP Web Browser (No EHR and no ) EHR or HIE with XDR, DPH, Medicaid, QDC, etc EHR or HIE w/ Direct MIME EHR* but no XDR or Direct SMTP LAND Internet ( ) Fixtures SMTP LAND EHR or HIE w/ Direct MIME EHR* but no XDR or Direct Statewide MPI/Consent EHR with Direct Deidentification Data Translation Fax Server EHR with Direct HIE with Direct 6 SEE CCD+ Viewer / Editor *Also pertains to users of MDS, OASIS, CMS-485, INTERACT, CARE-Tool, IRF-PAI, etc Medical Vocabulary Local Master Patient Index 6 HIE with Direct

8 Small Orgs no EHR (e.g. Psychologists) Senders Web Browser (No EHR and no ) EHR or HIE with IHE XDR HTTPS SOAP Provider Directory / Certs MA Data Rules Pipe Recipients HTTPS SOAP Web Browser (No EHR and no ) EHR or HIE with XDR, DPH, Medicaid, QDC, etc EHR or HIE w/ Direct MIME EHR* but no XDR or Direct SMTP LAND Internet ( ) Fixtures SMTP LAND EHR or HIE w/ Direct MIME EHR* but no XDR or Direct Statewide MPI/Consent EHR with Direct Deidentification Data Translation Fax Server EHR with Direct HIE with Direct 7 SEE CCD+ Viewer / Editor *Also pertains to users of MDS, OASIS, CMS-485, INTERACT, CARE-Tool, IRF-PAI, etc Medical Vocabulary Local Master Patient Index 7 HIE with Direct

9 Small Orgs with EHR (e.g. most solo MDs) Senders Web Browser (No EHR and no ) EHR or HIE with IHE XDR HTTPS SOAP Provider Directory / Certs MA Data Rules Pipe Recipients HTTPS SOAP Web Browser (No EHR and no ) EHR or HIE with XDR, DPH, Medicaid, QDC, etc EHR Direct MIME EHR* but no XDR or Direct SMTP LAND Internet ( ) Fixtures SMTP LAND EHR Direct MIME EHR* but no XDR or Direct Statewide MPI/Consent EHR with Direct Deidentification Data Translation Fax Server EHR with Direct HIE with Direct 8 SEE CCD+ Viewer / Editor *Also pertains to users of MDS, OASIS, CMS-485, INTERACT, CARE-Tool, IRF-PAI, etc Medical Vocabulary Local Master Patient Index 8 HIE with Direct

10 What is unique about small organizations? Limited financial resources Limited free time Limited legal and technical expertise Limited technological infrastructure: LAN/WIFI Security/Policies Backup/Redundancy EHR, if present, likely to be ASP model Less likely to have risk-sharing contracts so incentives/value to connect may be limited SNFs/ECFs, IRFs & HHAs have assessment data 9

11 What are the implications for small orgs? Don t have resources to put effort into connecting to the HIE Expertise and money to physically connect to HIE needs to come externally (MeHI?) ASP model EHR means dealing with a third party to establish connectivity EHR may have less connectivity functionality Ongoing connection costs may need to be subsidized because of limited financial value SNFs/ECFs, IRFs and HHAs would find value in reusing clinical data (MDS, IRF-PAI, OASIS) 10

12 What is the state doing to make the Last Mile more like the Last Quarter Mile? IMPACT 11 11

13 IMPACT Grant February 2011 HHS/ONC awarded $1.7M grant to State (MTC/MeHI) to: Improve Long-Term and Post-Acute Care Transitions using electronic Health Information Exchange Improving MA Post-Acute Care Transfers 12 12

14 IMPACT Goals Enable nursing and rehab facilities, and home health agencies to participate in regional and statewide Health Information Exchange Improve the speed, efficiency, and satisfaction of processes to provide essential clinical data during transitions of care Decrease avoidable ER visits, hospital admissions, and hospital readmissions Reduce unnecessary tests and treatments Reduce the total cost of care Replicate this model in other communities 13 13

15 IMPACT Strategies Finish development and testing of paper UTF Extend CCD to include all UTF data elements Develop applications to acquire/view/edit/send CCD+ (LAND & SEE) Develop consumer-oriented translator Integrate tools into Worcester County: St Vincent Hospital and UMass Memorial Healthcare Reliant Medical Group (formerly known as Fallon Clinic) and Family Health Center of Worcester (FQHC) 2-3 Home Health agencies 8 SNFs/ECFs 1 Inpatient Rehab Facility 1 Long Term Acute Care Hospital Measure outcomes 14 14

16 Coordinated with State HIE Plan 15 15

17 ocal Application for Network Distribution (LAND) Virtual Gateway Documents* with destination Direct address, local patient ID, and patient demographics Interface Engine + Mapper Consistent Time (CT) LAND ATNA (Audit Trail & Node Authentication) Private Key Store Assemble/Extract XDR + Metadata Assemble XDM Zip File/ Unzip Sign/Verify w/ Private Key XDR/SOAP/ Statewide XDR Gateway Send/Receive via Encrypt/Decrypt w/ Destination Certificate PKI (Public Key Infrastructure) SMTP/SMIME NwHIN & other s Internet Supports both IHE XDR and SMTP/SMIME Direct *Also includes MDS, OASIS, CMS-485, INTERACT, CARE-Tool, IRF-PAI, etc Direct Gateway Statewide 16

18 SEE and ( Webmail ) Requirements Ability to persist data in mailbox that is accessed by standard PC & Mac browsers Configurable mailbox size and message retention limitations Standard functionality (SMTP/S-MIME: Send, Receive, Reply, Reply to All, Forward, CC s, distribution lists, manual flagging/categorization of messages) Address book integration with state s Provider Directory Organize messages into folders and subfolders (e.g. each provider and their patients) Ability for multiple users to access same mailbox using their own logins (e.g. MD, RN ) Be notified when there s new mail in mailbox. This includes the ability to receive a You ve got mail notification either by , fax, text message or page so user doesn t need to check every day. This will help the infrequent users. Ability to set the equivalent of Out of Office rules that can reply automatically, or reroute messages or copies of messages to another Direct mailbox Sort and search messages based on available standard Direct metadata (e.g. date, sender, receiver), as well as subject, flags, and categories. Drag-and-Drop capability to import/export attachments from local PC or network Ability to view CCD or other CDA-based documents, TXT, RTF, and PDF image file Ability to reconcile multiple CDA-based documents to create a new document, including controlled standard vocabularies to add new data (e.g. new meds or problems) 17

19 Summary All organizations need to trust the state s HIE, find it valuable, and find it usable Smorgasbord of approaches to connect to the state s HIE Small practices need someone else s money and expertise to physically connect them to the HIE IMPACT s LAND & SEE can help connect organizations with some electronic data as well as those with no electronic data 18

20 Questions? 19