Tuesday, September 20, 2011

Next Steps for Health Information Exchange in Massachusetts

Health Information Exchange (HIE) is challenging.   As I've written about previously, several state HIEs have failed or are failing.

There are Federal HIE goals,  State Medicaid goals, private sector goals, and many varied sources of funding.   Each stakeholder has their own self interest.

The Harvard Program for Health Care Negotiation and Conflict Resolution teaches about the "Walk in Woods", moving from self interest, to enlarged interests, to enlightened interests, to aligned interests.

On September 19, the HIT Council and the HIT/HIE Advisory Committee of Massachusetts stakeholders took such a walk to review a straw man plan that aligns all the interests and optimizes available budgets.

Here's the idea.

There's an ONC-approved State Health Information Exchange plan.   There's a State Medicaid plan.   There are many existing regional health information exchanges in Massachusetts.

We created a Venn diagram of all these projects and identified their points of intersection.

Then, we developed objective criteria for what could be done now, what needs minor policy/technical work and what needs substantial additional work.

The end result was a phased plan making 2012 the year of connectivity to support push transactions, 2013 the year of databases to support analytics/population health and 2014 the year of the pull transaction.

We then worked on reconciling sources of funds.

There are two state programs with substantial federal matching grants - the Medicaid Management Information System (MMIS) and HITECH funds for State Medicaid Health Plans.    Every dollar from state resources that is invested in these programs yields $10 of spending.   A very wise use of state funds would be to leverage every dollar using federal matching programs.   Since 100% of hospitals in Massachusetts receive Medicaid funds,  Federal matching programs for Medicaid improvements are ideal for building the "information highway" to connect stakeholders as well as for state public health gateways to receive syndromic surveillance, reportable lab, and immunization data required by meaningful use.

However, what if we build the highway, but no one uses it?   It's important to connect EHRs by overcoming technical and resource barriers.   Our workgroups will devise a plan to create a grant or procurement program that leverages ONC HIE funds to  accelerate EHR to HIE connectivity.

With senders, receivers, and a pipe connecting the stakeholders, we have a clear HIE plan.

With aligned federal, state and private resources, we can define the timelines and we've developed Gantt charts for all our FY12 projects.

To guide the projects, we'll have 3 "functionality" workgroups
Finance and Sustainability Workgroup,
Technology and Implementation Workgroup
Legal & Policy Workgroup

and 2 "engagement" workgroups
Provider engagement & Adoption Workgroup
Consumer and Public Engagement Workgroup

With clear goals that align the interests of all parties, a budget that optimizes every source of funds, and a multi-stakeholder Advisory Committee with community-wide participation in workgroups, we have the foundation to move forward.

As we proceed with a sense of urgency, our rallying cry to all stakeholders is "focus on making the HIE happen, not on the impediments and barriers that we'll encounter along the way."

I look forward to the work ahead and numerous go lives in FY12.

1 comment:

David said...

John, thanks for sharing this MA plan. I'm curious about the sequencing of capabilities for 2013 vs 2014. I would have thought that using a "pull" pattern there would be Record Locators and Repositories and that some data would be "mined" from those records to support analytics. But since you have databases and analytics before pull, it implies that the data is probably mined from "push" transactions. Did you have in mind HISPs that not only route Direct Messages but also store them and mine them? Generally in Direct Project, that was not viewed as the role of a HISP, because they would be "opening the envelopes" and additional consent issues would be raised that Direct doesn't explicitly address. Or were you thinking of "push" in the form of HL7 messages rather than Direct Project?