MASSACHUSETTS eHEALTH COLLABORATIVE December 2008

MASSACHUSETTS eHEALTH COLLABORATIVE

December 2008

- 2 -Massachusetts eHealth CollaborativeSlide title © MAeHC. All rights reserved.

MASSACHUSETTS SPENDS MORE ON HEALTH PER CAPITA THAN ALMOST EVERYONE IN THE UNIVERSE…

Average spending on healthper capita ($US PPP)

Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006.


...AND WE GET GENERALLY HIGHER QUALITY AS A RESULT, BUT THE COSTS ARE UNSUSTAINABLE


THE EHR MARKET IS MOVING, SLOWLY, BUT ALSO CREATING A DIGITAL DIVIDE IN THE PROCESS

1-9 physicians

CAGR = 8.2%

%50+ physicians

CAGR = 8.6%

801 million110 million

911 million visits in 2004

%

50+ physicians

1-9 physicians

Growing at about 1.5 percentage points per year

Source: CDC; Center for Health Systems Change; National Ambulatory Care Survey


MAeHC ROOTS ARE IN MOVEMENT TO IMPROVE QUALITY, SAFETY, EFFICIENCY OF CARE

• Company launched September 2004

– Non-profit registered in the State of Massachusetts

• CEO on board January 2005

• Backed by broad array of 34 MA health care stakeholders


MAeHC BOARD OF DIRECTORS

Health plans and payer organizations

• Blue Cross Blue Shield of Massachusetts

• Fallon Community Health Plan

• Harvard Pilgrim Health Care

• Massachusetts Association of Health Plans

• Tufts Associated Health Maintenance Organization

Healthcare purchaser organizations

• Associated Industries of Massachusetts

• Massachusetts Business Roundtable

• Massachusetts Group Insurance Commission

Non-voting members

• Center for Medicare & Medicaid Services

Hospitals and hospital associations

• Baystate Health System

• Beth Israel Deaconess Medical Center

• Boston Medical Center

• Caritas Christi

• Fallon Clinic, Inc.

• Lahey Clinic Medical Center

• Massachusetts Hospital Association

• Massachusetts Council of Community Hospitals

• Partners Healthcare

• Tufts-New England Medical Center

• University of Massachusetts Memorial Medical Center

Governmental agencies

• Executive Office of Health and Human Services

Healthcare professional associations

• American College of Physicians

• Massachusetts League of Community Health Centers

• Massachusetts Medical Society

• Massachusetts Nurses Association

Consumer, public interest, and at-large

• Health Care for All

• Massachusetts Coalition for the Prevention of Medical Errors

• Massachusetts Health Data Consortium

• Massachusetts Taxpayers Foundation

• Massachusetts Technology Collaborative

• MassPRO, Inc.

• New England Healthcare Institute

• Massachusetts Health Quality Partners

• Tufts University Medical School

• UMass Medical School


CEO

Operations

Contract admin & HR

Evaluation coordinator

Project Mgmt

Data manager

Communication

MAeHC ORGANIZATION DESIGNED TO SCALE UP FOR STATEWIDE PROGRAM

Practice Services

Practice consultants

Other

Legal

Evaluation

Technology & Vendor Mgt

Health information exchange

Support

Shared services

• Design, deployment, & support

• Community coordination

• Project management

• Program integrity

Program LeaderBrockton

Program LeaderNewburyport

Program LeaderNorth Adams

More communities


PILOT PROJECT COORDINATION

Community PhysicianCouncil

Privacy &Security

Work Group

Community Consumer

Council

Co-Chairs: Senior Pilot Exec & Community Advocate

Members: Physicians, Hospital, Consumers

Pilot SteeringCommittee


MAEHC SELECTED THREE PILOT SITES FROM 35 APPLICANTS: BROCKTON, NEWBURYPORT, NORTH ADAMS


MAeHC PILOT PROJECT EXPENDITURES2005-2008

$MMAeHC G&A 1.7 3%

Professional fees 2.9 6%

CPOE readiness 4.0 8%

Evaluation 5.9 12%

HIE 5.9 12%

MAeHC businessservices 9.8 19%

EHR 20.2 40%

$50.4 $M %


ACTUAL COST PER PHYSICIAN FOR EHR

$K

Support (6 mos) 2.8 7%

MAeHC support 9.3 22%

EHR software 7.9 18%

EHR hardware 22.8 53%

$42.8K

$K %


MAeHC ARCHITECTURE AND DATA FLOWS

Brockton Newburyport North Adams

Community-level:HIE

Outcomes analysis

BenchmarkingMAeHC-level:Analysis Negotiated reporting

to plans• P4P• Chart review

Provider-level: EHR

MAeHC-level:QDC


FIRST PRACTICE LAUNCHED IN MARCH 2006

Docs link up to new record styleBy Jennifer Heldt PowellTuesday, March 14, 2006

The end of the paper trailBy Ulrika G. Gerth/ [email protected], March 17, 2006

Setting a new record: Local doctors pilot electronic patient history system By Stephanie Chelf Staff Writer


OVER 550 CLINICIANS LIVE IN 18 MONTHS

# practices

2006 2007

North Adams(15)

Newburyport(37)

Brockton(89)


CLINICAL USE OF DEPLOYED EHRs% of Encounters Documented Clinically in EHRs (Q2 2006 – Q2 2008)

Community 1 Community 2 Community 3

%


CLINICIAN ATTITUDE TOWARD EHRs

The EHR system has helped streamline our processes

AgreeDisagree

Already has

Will in the future

Our patients are benefiting from new processes

Already has

Will in the future

We are already able to provide higher quality care

Already has

Will in the future

Overall I have already adopted the EHR

I would recommend EHRs to other practices

n = 195, 2/08

61%

% agree

80%

70%

87%

65%

87%

80%

81%

91%

93%

The HIE will help streamline our processes

Our quality will improve from the HIE


STAFF ATTITUDE TOWARD EHRs

The EHR system has helped streamline our processes

AgreeDisagree

Already has

Will in the future

Our patients are benefiting from new processes

Already has

Will in the future

Overall I have already adopted the EHR

I would recommend EHRs to other practices

86%

% agree

95%

96%

83%

94%

96%

91%

88%

n = 524, 2/08

The HIE will help streamline our processes

Our quality will improve from the HIE


PILOT COMMUNITIES WILL BE THE FIRST IN THE COUNTRY TO BE COMPLETELY “WIRED” FOR HEALTHCARE

Ethel Roy, 81, visited earlier this month with Dr. Stephen St. Clair, her urologist, at his office in North Adams. (Stephen Rose for the Boston Globe)


MAeHC HEALTH INFORMATION EXCHANGE ARCHITECTURE AND STATUS

Community Indexes

Terminology

Entity

Clinician

Patient

Clinical repository

Communityrecord

Automated delivery servicesLab/radresults

Hospitalreports

EHRdata

Publichealth

On-demand portal services

• View/download records• Secure messaging• Electronic referrals• Patient communication• Forms routing

• View/download records• Physician communication• Appointment request• Forms routing

Physician portal Patient portal

Infrastructure

Communities

• Three stand-alone HIEs

• Over 500K patients

• ~600 clinicians, 200+ clinical sites

• 4 hospitals, 1 community health center

Systems connected

• Ambulatory EHRs (eCW, NextGen, GE, Allscripts)

• Hospital systems (Meditech) , including EHR, lab systems, rad systems, transcription systems

Data exchanged

• Problems, procedures, allergies, medications, demographics, smoking status, diagnosis, lab results, rad reports

• Standards used: HL7, CCR/CCD, NCPDP Script 8.1, LOINC, CPT4, ICD9, RxNorm

Transactions to date (as of Nov 2008)

• Over 60K patients opted-in to date (91% opt-in rate)

• 300K+ clinical records exchanged to date

• 20K+ matched patient records in HIE


The eHealth Summary:• Medication List• Problem List• Procedures• Social History• Allergies• Past Medical History• Family History• Lab Results• Radiology Results• Immunizations

Doctor’s Office Record:• Private Office Notes• Consultation Letters• Scanned Reports• Non-consented items


OPT-IN PERMISSION MODEL

Jane Jones

Patient visits clinical entity for care and is provided option at first visit to opt-in all clinical data from EACH entity

Patient visits clinical entity for care and is provided option at first visit to opt-in all clinical data from EACH entity

1

Visit

YY Y YN

2

Patient chooses which entity’s records to make available to network

Patient chooses which entity’s records to make available to network

Consent

Jane Jones

3

Pre-defined data sent to central server

Pre-defined data sent to central server

Send

Physician views data prior to or during patient visit

Physician views data prior to or during patient visit

4 Retrieve

Community Network

Jane Jones eCommunity RecordJune 9, 2006

Visit historyxxxxxx

Active problem listxxx Dr. Jane Brody

Current medicationsxxx Seacoast Cardio

Current allergiesxxx Dr. Jane Brody

Recent laboratory resultsxxx AJ Hospital

Recent radiology resultsxxx AJ Hospital

Otherxxx XXX


NORTH ADAMS HIE SCREEN SHOT


NEWBURYPORT & BROCKTON HIE SCREEN SHOT


Reason for A

ccess Required:


DATA BEING SENT TO THE MAEHC QDC TODAY

• Problems

• Procedures

• Allergies

• Medication

• Demographics[de-identified]

• Social/Family hx if it can be sent in discrete data

• Smoking status- if it can be sent over in discrete data

• Visits

• Diagnosis

• Lab results

• Rad results

• Future[ inpatient data to include surgical history]


MAeHC QDC MEASURES

CAD - 1- LDL-C test ordered

- 2- LDL-C level <100

- 3- Lipid-lowering therapy prescribed

- 4- Antiplatelet therapy prescribed

Diabetes - 5- HbA1c test ordered

- 6- HbA1c level <9

- 7- BP level <140/90

- 8- LDL-C test ordered

- 9- LDL-C level <100

- 10- Eye exam performed

11- Asthma (appropriate Rx prescribed)

12- Hypertension (BP controlled)

Common pediatric conditions 13- Appropriate testing for pharyngitis

14- Appropriate treatment for URI

15- Prenatal care (screening for HIV)

Prevention

16- Flu vax

17- Pneumovax

18- Colorectal cancer screening

19- Breast cancer screening

20- Tobacco use

Phase 1 Measures Phase 2 Measures


MAEHC QDC LOG-IN SCREENSHOTS


MAEHC QDC REPORT SCREENSHOTS

Peer comparison report (1)

Drill-down reportBenchmark summary report

Peer comparison report (2)


THE GRID AND THE LAST MILE

Inter-community connectivity

MA-SHARE

Intra-community connectivity


www.maehc.org

Micky Tripathi, PhD MPPPresident & CEO

[email protected]

Documents

MASSACHUSETTS eHEALTH COLLABORATIVE December 2008