1	MASSACHUSETTS eHEALTH COLLABORATIVE David W. Bates, MD, MSc October 22, 2005
2	Overview Background Pilots Vendor Selection Conclusions
3	State Profile: Massachusetts 6.4 million people 1 million age 65 years or older ~88% white Relatively few payers BCBS HPHC Tufts Fallon MassHealth/Medicaid 500,000 Uninsured ~80 Acute-Care Hospitals ~18,000 practicing physicians ~6,000 office practices ~3,000 solo or 2-3 physician practices Highly ranked for quality (HEDIS, CAHPS) Among the hospitals: 10% have CPOE 20% are implementing 70%??? Among the office practices: 10-15% have EHRs
4	MAeHC ROOTS ARE IN MOVEMENT TO IMPROVE QUALITY, SAFETY, EFFICIENCY OF CARE
5	34 ORGANIZATIONS REPRESENTED ON MAeHC BOARD… Alliance for Health Care Improvement American College of Physicians Associated Industries of Massachusetts Baystate Health System Beth Israel Deaconess Medical Center Blue Cross Blue Shield of Massachusetts Boston Medical Center Caritas Christi Executive Office of Health and Human Services Fallon Clinic, Inc. Fallon Community Health Plan Harvard Pilgrim Health Care Health Care for All Lahey Clinic Medical Center Massachusetts Business Roundtable Massachusetts Coalition for the Prevention of Medical Errors Massachusetts Health Quality Partners
6	MAeHC VISION Improve quality, safety, and affordability of health care through: Universal adoption of modern information technology in clinical settings Access to comprehensive clinical information in real-time at the point-of-care
7	MAeHC STRATEGY
8	MAeHC ORGANIZATION STRUCTURE
9	WORKING GROUPS UNDERPIN COLLABORATIVE PROCESS
10	Three Pilot Communities Were Chosen From Six Finalists Finalist communities Boston HealthNet Emerson Community EHR Collaborative Greater Brockton eCare Alliance Greater Newburyport Community Holyoke Community Northern Berkshire Community
11	THREE MAIN AREAS OF ACTIVITY IN PILOT PROJECTS
12	WE CAN’T BUY ENTHUSIASM AND LEADERSHIP
13	HIGH-LEVEL OVERVIEW
14	PHYSICIAN/ COMMUNITY AGREEMENT TIMELINE
15	CONNECTIVITY AGREEMENT SUMMARY Purpose of agreement is to lay out the “rules of the road” for data exchange in each community Not a user agreement – no vendor or technical solution identified yet Provide enough info to physicians for them to feel comfortable signing participation agreements Lays foundation for creation of Community Network Organization (CNO) to manage exchange network after pilot period Steering Committees and MAeHC will oversee network vendor and governance during pilot period Sets basic ground rules Network is by membership Exchange network is for patient care only Physicians must make data available to network as permitted by patient consents Network not a substitute for medical judgment and other sources of information CNO will take over governance and management responsibilities post-pilot, but physicians not required to participate after the pilot period
16	NORTH ADAMS PRACTICES
17	NEWBURYPORT PRACTICES
18	BROCKTON PRACTICES
19	PHYSICIAN RECRUITMENT AND PRACTICE IMPLEMENTATION PROCESS WELL UNDERWAY
20	EHR SELECTION
21	COMMUNITY DOWN-SELECT
22	PHYSICIAN EHR SELECTIONS
23	SUMMARY (I) MAeHC and communities need to decide what patient notification or consent we will require for data exchange in community pilots Not required for stand-alone EHRs Will be required for data exchange across legal entities Data exchange already happens today, and in this sense, we are only changing the transport vehicle Current exchanges happen by fax, phone, mail, email, and remote access Community network could change the scale but probably not scope of that exchange (ie, same type of information will be exchanged but more often) With no “person-in-the-loop”, electronic data access may seem more risky, whether it is or not
24	SUMMARY (II) Even though we’re just changing the transport vehicle, we can’t rely on existing notifications and consents to cover exchange over the new network MAeHC commitment to transparency will necessitate some form of patient notification or consent about new network Furthermore, we can’t assume that current entities have gotten patient consent that conforms with MA consent laws– very likely that many have not Notification about the network is not enough – MA law argues for some form of affirmative consent BEFORE disclosing data across legal entities HIPAA Notice of Privacy Practices does NOT count for MA consent MA consent requires affirmative consent for disclosure of clinical information, and a second affirmative consent for disclosure of sensitive information Question before us now is how to get patient consent in a way that is legally and ethically robust and operationally sound
25	OPTION 1: ENTITY-BY-ENTITY OPT-IN
26	OPTION 2: NETWORK-LEVEL OPT-IN
27	OPTION 3: OPT-OUT AT POINT-OF-ACCESS
28	COMMENTS ON OPTIONS
29	RECOMMENDATION FOR MAeHC PILOT COMMUNITIES Entity-by-entity opt-in approach to network for physician network in MAeHC pilot communities Flexible approach to sensitive data Require that general clinical information be made available to network Allow physicians to segregate and withhold selected sensitive information if: Patient requests selective withholds Clinical entity assumes responsibility for segregating sensitive info Work closely and continuously with MA-SHARE to align approaches to achieve a unified strategy for statewide implementation
30	Key Components of Evaluation Use of technologies Economic evaluation Costs Savings Quality evaluation Quality Safety Adoption barriers Implementation/tactics Roles of employers/payers/consumers/government
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32	Conclusions Lots of good progress but still getting started Many of issues are social Choices about connectivity are complex Keys to success: All key parties included Payers particularly amenable to involvement Substantial initial investment Strong prior history of benefits of collaboration in state Many key organizations already had deep expertise and in place Massachusetts Health Data Consortium Massachusetts Health Quality Partnership Masspro (QIO) MaSHARE
33	MASSACHUSETTS eHEALTH COLLABORATIVE www.maehc.org Contact: Micky Tripathi, PhD MPP CEO mtripathi@maehc.org 781-434-7906