Detailing the Mass HIE launch effort

BOSTON—The Massachusetts health information exchange—the Mass HIway—was launched in the fall of 2012 through two grant mechanisms, awareness, testing and a lot of communication, said Sean Kennedy, MS, PMP, MPH, director of Massachusetts eHealth Institute, speaking at the Medical Informatics World Conference on April 28.

Massachusetts is farther along regarding health IT than many other states, with 79 percent adoption of EHRs among 4,500 care delivery organizations and 27,000 physicians for 6.5 million citizens. Massachusetts providers have received $561 million in Meaningful Use incentive payments and 97 percent use electronic prescribing.

The state plans to have all physicians demonstrating EHR proficiency by January 2015 and have all providers on an EHR and participating in the HIE by January 2017.

Kennedy said the launch was a “golden spike event” that the state took on because “this is the new era of healthcare where organizations have to be able to communicate outside the walls of their institutions. Health IT is now viewed as a strategic enabler.”

The Mass HIway is based on the Direct protocol, he said, because it is the only transport mechanism accepted in the Meaningful Use program. The organization had to align technologies, policies, standards and priorities, Kennedy said, as well as establish HIway ramps and catalyze connections.

The Mass eHealth Institute established HIway interfaced grants to vendors that ultimately went to 13 organizations. Grantees had to identify customers willing to work with them to develop use cases. Kennedy admits the requirements were rigorous but vendors were interested because their customers were asking for such services anyway. The original participation built up a sense of competition and another 15 vendors became involved, which was “hugely helpful in lowering the barrier to connection.”

HIway implementation grants were directed at providers and eventually totaled $2.3 million to 32 grantees representing 75 trading partners. These early adopters “battle tested” the HIway, Kennedy said. He cited examples of efforts across the state which included a focus on reducing readmissions, improving hospital transport and care coordination for the homeless and coordinating care plans between a health plan and community health center. An early goal, he said, was raising awareness of the HIway outside of Boston and these use cases did just that.

Grantees also are in the process of measuring the number of patient records electronically shared, the number of 30-day hospital readmissions for patients going from the hospital to long-term care, average turnaround time from receipt of lab result to entry into an EMR and duplicate diagnostic testing.

Most of the provider grantees are midsize and are primarily utilizing the HIway for care summaries, referral requests and hospital discharge summaries.

The grants come to an end this June and at the end of 2013 HIway grantees accounted for 87 percent of HIway participants, Kennedy said. The grants served as a significant catalyst for getting people connected, he added.

“Connections can be hard,” he said, with providers at different readiness levels—some because their vendors aren’t ready or because they just don’t have the technical staff to get connected.

Regarding standards for information exchange, Kennedy recommended inventing them where needed and then keeping it simple. For example, the Direct protocol is the only transport mechanism cited in the Meaningful Use certification criteria. “Getting too far ahead of standards can be dangerous” simply because of the possibility of change.

Kennedy also said that consent matters take time. Massachusetts is an opt-in state, meaning patients have to provide their consent, which is “an enormous lift on organizations. Not only do they have to have the capability in the front office to capture consent, they have to figure out where to log that consent.” Most information systems allow for just one flag rather than ways to classify different forms of consent.

Using the Mass HIway—or another HIE—shouldn’t be viewed as an IT project, Kennedy said. “Clinical and business leaders need to be involved early on.” The impact on workflow cannot be underestimated, he said, recommending use cases to “make it real” for participants.