In October, Massachusetts policymakers, health officials and health IT leaders celebrated the proverbial golden spike hammered into the Commonwealth’s statewide health information exchange, with the governor having his records sent from a hospital in Boston to Springfield.
[See also: Massachusetts lands $17M to launch statewide HIE.]
Massachusetts health officials are calling the HIE a highway — hinting at its public service mission, as one of several tools the state hopes will help control healthcare spending, and at the public investment its received from the federal government.
Managed by the nonprofit Massachusetts eHealth Institute, or MeHI, the HIE launched a health internet service provider to connect providers as part of its first phase. Phases 2 and 3 — loosely following the stages of meaningful use — are designed to bring the state’s healthcare systems analytics and population health management tools, along with an Electronic Master Patient Index and record locator service.
Two months after the launch of the Massachusetts HIE, Laurance Stuntz, director of the MeHI, discusses the HIE’s journey so far and the road ahead. Formerly a senior vice president at the healthcare communications company NaviNet and a partner at Computer Science Corporation, Stuntz joined MeHI in May.
[See also: MAeHC tapped to lead New England Healthcare Exchange Network.]
Q: Aside from the health systems like Partners Healthcare and Beth Israel Deaconess that joined the HIE in October, about how many organizations have signed up for the HIE since then?
Stuntz: There’s over 40 organizations that are in our pipeline to bring on board, beyond the golden spike organizations. We’re working out the best way for them to connect and the use cases that they’re going to use. We’ve been very encouraged by the response from the provider community; we’ve got conversations going with health plans, providers and public health organizations.
Q: What are some of the most common use cases providers are signing up for?
Stuntz: There’s a couple. The most common I would say are related to transitions of care — for instance, discharge summaries from a hospital out to say a nursing home. One of the key areas that we’re looking at is the use of the highway as a tool to prevent readmissions — with the recent readmission penalties that [the Centers for Medicare and Medicaid Services] recently announced for hospitals that have too high a rate of 30 day readmissions. We’re looking to use the highway to close that loop and make sure information gets out to the nursing homes or gets out to the primary care provider. Another key use case that we’re looking at is public health data submissions — using the highway as the primary vehicle to submit data to any public health agency, whether that be statewide or the Boston Public Health Commission. We’re also looking at referrals as another key use case.
Q: There’s three ways organizations can connect to the HIE: direct-enabled EHR systems, Local Area Network devices and the secure webmail portal. What are most using now?
Stuntz: All the golden spike participants are using the LAN device, and there’s a new release of the software coming out this month that will enable the webmail component. We’ve got a grant program for EHR vendors to build in Direct connections.
Q: What are some of the use case and implementation goals for 2013 and 2014?
Stuntz: In the next year, for what we’re calling Phase 2 of the health information exchange, the key areas are additional public health interfaces. Being able to link to the state’s cancer registry, the immunization registries, syndromic surveillance, opioid use registries — that’s a key piece of it. Another is developing patient consent management infrastructure, to allow patients to register easily their consent for sharing their information at a statewide and centralized level. Going along with that is building a query capability — for instance, looking up and saying “Where has Laurance Stuntz been seen and do I have permission to see those records.” And then I think finally, and one of the most interesting and important pieces, is developing the mechanism for patients to access their information.
Q: The Massachusetts eHealth Collaborative is part of MassTech, a public development agency that a has a broad mission to expand and improve technology throughout Massachusetts. One of MassTech’s programs is expanding broadband access, and another is the Big Data initiative. do they overlap at all with the HIE?
Stuntz: One of the requirements of the new health reform legislation in Massachusetts is that providers adopt health information technology and connect it using the Mass Highway health information exchange. One of the potential exceptions to that is if a provider does not have broadband access in their office, so MeHI and the Mass Broadband Institute are working closely to make sure that every provider does have access to broadband so that that exception doesn’t come into play. We both have a last mile program to help providers adopt, and we’re working together to understand broadband availability.
The Governor announced back in May a Big Data initiative, where we’re backing putting a lot of energy at a Commonwealth-wide level and looking broadly for sources of big data. One of the keys is the publicly-available data associated with the all-payer claims database. MeHI and the Center for Health Information and Analytics are asked to work very closely on Big Data analysis in healthcare. Just analyzing the data we’ve got is going to be a key piece of informing our efforts around cost-containment. We’re looking at exactly how it’s going to work. The Center for Health Information and Analysis does a lot of analysis for providers. There are other organizations looking at how to best analyze the data from the documents flowing over the highway. It’s an evolving field and we don’t know how it’s all going to play out. But we fully expect to be supporting providers, payers and the Commonwealth with information to help drive down costs and increase quality.
Q: Where do you see MeHI fitting into Massachusetts healthcare cost-containment efforts?
Stuntz: We see the health information exchange as a key enabling component. Now it’s not going to be sufficient to hold down costs on its own. But, for instance, one of the key expectations of the cost-containment legislation is that care will be delivered in the most cost-effective setting. A key enabling factor for that to happen is making sure that all the information that’s available for patient care is available in that most effective setting. So the health information exchange will help providers across the care continuum have updated information about a patient so they can deliver that most appropriate and cost-effective care in whatever setting they’re in. For instance, a home health agency or a skilled nursing facility should be able to get the discharge summary from a hospital with an updated medication list. If the skilled nursing facility has that list, the patient is on the most appropriate medications and you don’t run into issues where the discharge summary takes a week to get back to that facility.
