Yesterday, Rick Shoup, Manu Tandon and I presented the updated Massachusetts Stategic/Operating Plan, State Medicaid Health Plan/Medicaid Management Information System plan, and the Implementation Advance Planning Documents for Health Information Exchange to the HIT Council and the HIT/HIE Advisory Committee. The budgets and strategy were approved by the Council.
It’s based on 3 principles
What do we mean by “last mile”
There are roughly 20,000 licensed practicing physicians in Massachusetts and of those approximately 10,000 are currently or will be active users of EHRs and a Health Information Exchange (HIE). Some hospital and ambulatory applications are already connected to local or regional health information exchanges (HIEs) such as the New England Healthcare Exchange Network (NEHEN), SafeHealth, the North Berkshire eHealth Collaborative HIE, the Community Hospital and Physicians Practice System’s (CHAPS) HIE, the UMass HIE and Wellport HIE. However, many small providers have no HIE connectivity or use a web portal approach which is not integrated into their EHR workflows.
In order to optimize the transport capabilities of the state HIE, all hospital information systems and EHRs need to be connected to the transport backbone. The end result will be an integrated network of networks that enables any payer, provider, patient or consumer to exchange data. We refer to this as the “last mile.”
The “last mile” will be implemented as follows:
First, a better understanding of the scope must be gained. MeHI, the State Designated Entity and Regional Extension Center for Massachusetts, will do an analysis of Hospital Information System and EHR adoption in Massachusetts to identify those providers, institutions and applications which are not yet connected to an HIE.
Second, further analysis will identify the additional software or services required to enable HIE connectivity such as sending and receiving clinical summaries and HL7 lab/public health messages from Hospital Information Systems and EHRs to the HIE backbone. Massachusetts wants to move quickly to implement this connectivity before it is required by future stages of Meaningful Use.
Third, is the delivery of system integration services to connect to the HIE based on the prior analysis. These services will include the resources necessary to install and configure software, provide training and education or other support activities to practices throughout the Commonwealth.
Some types of providers were not included in the original scope of meaningful use incentives or have been slow to adopt for other financial reasons. These include the Behavioral Health and Long Term Care communities and some solo and two clinician practices. Last mile connectivity for these late adopters may include web-based applications that are easy to use and support. These applications will generate and receive electronic data that is being developed as part of the Commonwealth’s IMPACT Challenge Grant. Thus the Massachusetts HIE approach includes those without EHRs and those with EHRs but lacking the capabilities to send and receive data directly.
Fourth, a single project management office will manage support of the project. MeHI, as that project management office and in collaboration with EOHHS, will centralize last mile integration expertise and achieve economies of scale by creating an efficient approach to last mile integration.
Fifth, MeHI will provide educational materials and training so that clinicians are aware how to optimize their new HIE connectivity, achieving meaningful use stage 2 and maximizing the amount of data flowing to other clinicians, public health, and quality registries.
Hospital information system and electronic health record vendors report that State HIEs tend to build central infrastructure while assuming the endpoints will be able to connect to the HIE on their own. However, most practices lack the technical capability and incentives to do this work, so the value of the HIE is not realized and sustainability is never achieved. Massachusetts intends to avoid this failed scenario by actively ensuring the connection of the last mile.
With stakeholders aligned and the strategy approved, Massachsetts is ready to accelerate its efforts.
In addition to his CIO role at BIDMC, Dr. Halamka blogs at GeekDoctor.blogspot.com.