Public and Private Participation Put the Massachusetts HIway on the Health IT Map
On Tuesday, October 16, 2012, in the Ether Dome at Massachusetts General Hospital, Governor Deval Patrick made history by sending his electronic health record from MGH in Boston to a different health system at Baystate Medical Center in Springfield, Massachusetts.
It is fitting that the first electronic health record transmission across the state would be sent from the Ether Dome, which was Mass General’s operating room from its opening in 1821 until 1867, and the site of the first public demonstration of inhaled ether as a surgical anesthetic, on October, 16, 1846, 266 years before the health information exchange (HIE) launch. And now, it is the site of the first transmission of a patient record over the HIway, Massachusetts’ new HIE. It is also fitting that Governor Patrick would be the one to send his patient record as the first electronic health record (EHR) transmission. Since assuming office in early 2007, one of the governor’s top priorities has been to ensure that Massachusetts patients have access to world-class, high-quality care, while addressing spiraling costs.
“We believe in this Commonwealth that health is a public good, and that everyone deserves to receive quality care,” Governor Patrick said before transmitting his patient record over the Massachusetts HIway. With the adoption of the HIway, Massachusetts health care providers will be able to securely send and receive patient records over the Internet for better coordinated care, patient safety and lower health care costs. While the HIway is not intended to replace private HIEs in the state, it offers a “dial tone” for HIE service, a provider directory and security via public key infrastructure (PKI) protocols—a collaborative effort of care.
At the recent event inside the Ether Dome, Governor Patrick was joined by health care leaders and physicians from health care organizations serving the Commonwealth. The Massachusetts HIway would not have come together without support from the health care industry and both state and federal public partners. The state effort was led by policy leaders including Senator Richard T. Moore and Representative Steven Walsh, who continue to work tirelessly on advancing health innovation. The HIway provides the foundation for a new era of health care IT innovation, and we are excited to help shape this progress.
Massachusetts, a global hub of innovation and technology development, has long enjoyed a reputation as a center for excellent health care delivery. We host leading medical centers, insurers and research institutions and boast an enviable talent pool. The Commonwealth’s public policy development has long recognized the role technology can play in improving health care quality while reducing costs and, as the CEO of the Massachusetts Technology Collaborative, I am proud that our team is part of this important mission.
Funding the HIway
The Massachusetts HIway could not have been built without significant support from the Obama administration and the Massachusetts state legislature. A unique funding combination of $13.4 million from American Recovery and Reinvestment Act (ARRA) funds, $16.9 million in Medicaid funds and $5.7 million in state-provided funds all facilitated our getting the state to this point.
Healthcare organizations will pay a low annual fee for HIE service, ranging from $60 for solo practitioners to $16,000 for the largest medical centers.
To take this funding and create a system that is secure and trusted by patients, we assembled a core coalition of state agencies, quasi-public state agencies, health care thought leaders and public advocacy organizations. Overall development of the HIway is governed by a 21-member Health Information Technology Council, supported by workgroups including more than a hundred health care leaders across the state. The Executive Office of Health and Human Services and Mass Health, the state’s Medicaid agency, are responsible for building and securing the core infrastructure, while the Massachusetts eHealth Institute (MeHI), a division of the Massachusetts Technology Collaborative, will focus on the “Last Mile” connection of health care providers from across the state to the HIE.
The Massachusetts legislature has charged the Executive Office of Health and Human Services and MeHI with creating a comprehensive health IT plan that ensures every health care provider in the state is using interconnected electronic health records by 2017.
Last Mile to the HIway
MeHI’s Last Mile program has three concurrently running phases: education, connection, and optimization. In this key role, the organization is working closely with EHR vendors to ensure that health care providers using their systems can successfully connect to the HIE.
To stimulate the technical work necessary, MeHI’s Last Mile Direct Assistance Program, funded by the Office of the National Coordinator (ONC, a division of the U.S. Health and Human Services department) will provide grants for qualified ambulatory and hospital settings, behavioral health providers, unaffiliated primary care physicians, community hospitals and health centers, specialists and long-term care providers and will make EHR — HIE workflow optimization services available to all Massachusetts providers.
The Last Mile Direct Assistance Program also includes grant monies to assist providers with connection to the HIE. Following a vendor assessment to determine which EHR vendors have the highest market share, MeHI is also offering grants in the neighborhood of $75,000 to the larger vendors such as eClinical Works, Siemens and Cerner to enable their systems to communicate directly with the MA HIway quickly. These grants are designed to accelerate product development and testing and will give vendors an early location to test their implementation of the standards required by Stage 2 Meaningful Use ONC.
A HIway under Construction
At the moment the governor sent his EHR to Baystate Health, the Massachusetts HIway officially opened for business. The Last Mile program is now building the critical on-ramps and off-ramps that will allow every health care entity in the state to connect within the next few years. The MA HIway uses the national standard Direct protocol to transmit patient records. Direct was created by a consortium of public and private entities and endorsed by the Office of the National Coordinator as a viable mechanism for achieving Meaningful Use Stage 2, which calls for production implementation of health record exchange for at least 10 percent of a practice’s patients by 2014.
Recognizing that currently not all providers have EHRs that support the national Direct standard, the MA HIway is providing many different options for connecting. These options include browser-based secure email, appliance-based translation technology and native integration with EHRs. Over time, we plan to offer additional connection mechanisms and services as the need and best value becomes clear. With our incremental approach, we are planning for an ongoing series of improvements that will best serve the community at large.
Massachusetts has committed to using the HIway to help patients gain access to their own health data, and this commitment has incredible potential to drive the growth of start-up health IT companies. While Massachusetts has a vibrant eHealth start-up community, including the recent launch of classes from accelerators Rock Health and Healthbox, a key issue for many start-ups is access to data. By leveraging the national Direct protocol and the HIway, this challenge can be largely overcome. Patients will be able to specify where their data are sent and this could help make start-ups with applications as diverse as personal wellness, disease management and population health more viable.
We believe meaningful economic growth forms best through public-private collaborations, where innovative thinking is encouraged among many stakeholders. Right now, we are experiencing the emergence of an exciting health IT cluster in our state, which industry and public partners alike are eager to support.
Health IT is advancing our health care system by helping lower costs, increasing quality of care for patients and growing our innovation economy. We are proud to be part of collaborations that are driving innovative changes in health care delivery for Massachusetts.