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MASSACHUSETTS eHEALTH COLLABORATIVE

MASSACHUSETTS eHEALTH COLLABORATIVE. December 2008. MASSACHUSETTS SPENDS MORE ON HEALTH PER CAPITA THAN ALMOST EVERYONE IN THE UNIVERSE…. Average spending on health per capita ($US PPP). Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006.

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MASSACHUSETTS eHEALTH COLLABORATIVE

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  1. MASSACHUSETTS eHEALTH COLLABORATIVE December 2008

  2. 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.

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

  4. 50+ physicians 1-9 physicians % % 50+ physicians 1-9 physicians Growing at about 1.5 percentage points per year CAGR = 8.6% CAGR = 8.2% 110 million 801 million 911 million visits in 2004 THE EHR MARKET IS MOVING, SLOWLY, BUT ALSO CREATING A DIGITAL DIVIDE IN THE PROCESS • Source: CDC; Center for Health Systems Change; National Ambulatory Care Survey

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

  6. 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 • 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 • 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

  7. Operations Technology & Vendor Mgt Practice Services Program Leader Newburyport Program Leader Brockton Program Leader North Adams Other Legal Contract admin & HR Support Practice consultants Data manager Health information exchange Evaluation Evaluation coordinator • Shared services • Design, deployment, & support • Community coordination • Project management • Program integrity Communication Project Mgmt MAeHC ORGANIZATION DESIGNED TO SCALE UP FOR STATEWIDE PROGRAM CEO More communities

  8. PILOT PROJECT COORDINATION Pilot Steering Committee Co-Chairs: Senior Pilot Exec & Community Advocate Members: Physicians, Hospital, Consumers Community Physician Council Community Consumer Council Privacy & Security Work Group

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

  10. MAeHC PILOT PROJECT EXPENDITURES2005-2008 $M % $50.4 MAeHC G&A 1.7 3% Professional fees 2.9 6% CPOE readiness 4.0 8% Evaluation 5.9 12% HIE 5.9 12% MAeHC business services 9.8 19% EHR 20.2 40% $M

  11. ACTUAL COST PER PHYSICIAN FOR EHR $42.8K $K $K % Support (6 mos) 2.8 7% MAeHC support 9.3 22% EHR software 7.9 18% EHR hardware 22.8 53%

  12. Outcomes analysis MAeHC-level: Analysis • Benchmarking • Negotiated reporting to plans • P4P • Chart review MAeHC-level: QDC Community-level: HIE • Brockton • Newburyport • North Adams Provider-level: EHR MAeHC ARCHITECTURE AND DATA FLOWS

  13. Docs link up to new record styleBy Jennifer Heldt PowellTuesday, March 14, 2006 FIRST PRACTICE LAUNCHED IN MARCH 2006 The end of the paper trailBy Ulrika G. Gerth/ ugerth@cnc.comFriday, March 17, 2006 Setting a new record: Local doctors pilot electronic patient history system By Stephanie Chelf Staff Writer

  14. OVER 550 CLINICIANS LIVE IN 18 MONTHS # practices North Adams (15) Newburyport (37) Brockton (89) 2006 2007

  15. CLINICAL USE OF DEPLOYED EHRs% of Encounters Documented Clinically in EHRs (Q2 2006 – Q2 2008) % Community 1 Community 2 Community 3

  16. CLINICIAN ATTITUDE TOWARD EHRs % agree Disagree Agree 61% Already has The EHR system has helped streamline our processes 80% Will in the future 91% The HIE will help streamline our processes 70% Already has Our patients are benefiting from new processes 87% Will in the future 65% Already has We are already able to provide higher quality care 87% Will in the future Our quality will improve from the HIE 93% 80% Overall I have already adopted the EHR 81% I would recommend EHRs to other practices n = 195, 2/08

  17. STAFF ATTITUDE TOWARD EHRs % agree Disagree Agree 86% Already has The EHR system has helped streamline our processes 95% Will in the future The HIE will help streamline our processes 96% 83% Already has Our patients are benefiting from new processes 94% Will in the future 96% Our quality will improve from the HIE 91% Overall I have already adopted the EHR 88% I would recommend EHRs to other practices n = 524, 2/08

  18. 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)

  19. On-demand portal services • View/download records • Secure messaging • Electronic referrals • Patient communication • Forms routing • View/download records • Physician communication • Appointment request • Forms routing Patient portal Physician portal Automated delivery services Lab/rad results Hospital reports EHR data Public health Clinical repository Community Indexes Patient Community record Clinician Entity Terminology MAeHC HEALTH INFORMATION EXCHANGE ARCHITECTURE AND STATUS 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 Infrastructure

  20. Doctor’s Office Record: • Private Office Notes • Consultation Letters • Scanned Reports • Non-consented items • The eHealth Summary: • Medication List • Problem List • Procedures • Social History • Allergies • Past Medical History • Family History • Lab Results • Radiology Results • Immunizations

  21. Send Community Network Pre-defined data sent to central server Consent Jane Jones eCommunity Record June 9, 2006 Visit history xxx xxx Active problem list xxx Dr. Jane Brody Current medications xxx Seacoast Cardio Current allergies xxx Dr. Jane Brody Recent laboratory results xxx AJ Hospital Recent radiology results xxx AJ Hospital Other xxx XXX Patient chooses which entity’s records to make available to network Physician views data prior to or during patient visit 3 Retrieve 4 2 N Y Y Y Y 1 Visit Patient visits clinical entity for care and is provided option at first visit to opt-in all clinical data from EACH entity OPT-IN PERMISSION MODEL Jane Jones Jane Jones

  22. NORTH ADAMS HIE SCREEN SHOT

  23. NEWBURYPORT & BROCKTON HIE SCREEN SHOT

  24. Reason for Access Required:

  25. 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]

  26. MAeHC QDC MEASURES Phase 1 Measures Phase 2 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

  27. MAEHC QDC LOG-IN SCREENSHOTS

  28. MAEHC QDC REPORT SCREENSHOTS Peer comparison report (2) Peer comparison report (1) Benchmark summary report Drill-down report

  29. MA-SHARE Intra-community connectivity Inter-community connectivity THE GRID AND THE LAST MILE

  30. www.maehc.orgMicky Tripathi, PhD MPPPresident & CEOmtripathi@maehc.org781-434-7905

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