april, 18, 2014

State of MaineDepartment of Health and Human Services (DHHS)

Office of MaineCare ServicesOffice of the State Coordinator for Health Information

Technology

Evaluation Report

April, 18, 2014

Scope of the Evaluation

• ONC assessment requirement under the Cooperative Agreement Grant• Approved evaluation template for State of Maine• Required measurement for ONC program priority areas

• Assessment of the OSC for HIT• Acting as the State Designated Entity (SDE)• Goal of expanding and evolving health information exchange in

Maine

• Creating demand for exchange

• Supporting advanced care transformation models and payment reform initiatives

• Fostering systemic changes to support health information exchange

As the SDE, OSC Is Charged With:

• Program strategy shift in 2011• Health Information exchange the verb• Exchange sustainability not necessarily the sustainability of HIE

organizations• Greater linkage to Meaningful Use goals• Definition of exchange as being between non-affiliates

• PIN #002 defines key reporting requirements• Program priority measures• Sustainability

ONC Goals in Context

• Program priority areas• Reduced categories• Specifically third party sourced data excluded (SureScripts,

AHA)• Most significant is no measurement for Summary of Care

Documents required

• Assessment continues to be required per the PIN-002 as modified• Appendix A Final Report (distinct from Assessment)• Reduced to 6 areas, limited to 3-5 paragraphs or lists for each

area• Final reports to be non-public documents

2014 ONC Final Reports Requirements

• Governance• OSC• 26 Member Steering Committee• 5 Standing Sub-committees

• Encouragement of the broadest development of HIE

• Recognition of unique challenges of demographics, rural populations, geographic dispersion

Overview of Assessment

• Traffic/Descriptive statistics• Survey data (secondary analysis)• Census of labs• Focus Group• Sustainability including value-added and targeted services• Integration with other programs

Assessment Methodology

• HealthInfoNet (HIN)• Statewide network• Sole-source contractor under Cooperative Agreement• All 38 hospitals under contract, 35 are live• Nationally recognized leader for innovation• Grants and extramural funding recipient

• Nascent exchange initiatives within Maine• IDNs with referring entities (non-affiliates)• ACOs under development• Complimentary to HIN

Health Information Exchange in Maine

Number of Hospitals Connected to HIN

• 35 of Maine’s 38 Hospitals (all under contract and are at various stages of onboarding)• 405 Ambulatory Practices (and increasing)• 3 LTC Facilities with 17 additional being

onboarded• 3 Home Health Agencies• 15 FQHCs• 22 CAHs

HIN Participation (12/30/13)

• 1.3 million individuals or 88% of the population have records with HIN

• Only 14.6k have opted-out (1.1%)

• LD-1331 allows patients to opt-in for the defined electronic exchange of sensitive data• Behavioral health• HIV status• Potentially in the near term substance abuse• No default opt-in for behavioral health as there is for physical health


• 74% Patient “Cross Over” Between Corporately Unaffiliated Provider Organizations• 1,789 Maine clinicians and support staff have active HIN user

accounts• Over 10,501 clinicians are eligible to access• 3.5M inbound messages are received by HIN each week• The HOV Central Data Repository (CDR) is 1.5 TB in size and is

growing at 4 GB a day• Patient accesses up from 1342 in 2010 to 105,944 in 2013


Broadband Survey: HIE Participation by Organization Type

• Lack of knowing the health information exchange existed• Providers were not aware of HIN• Providers did not know what health information

exchange is or capabilities• Not all data were in the systems• Some providers indicated there was too much data,

others indicated there was not enough data

Provider Survey: Reasons For Not Using HIE

• Range and timeliness of medication lists and ability for reconciliation

• Availability of discharge summaries for transitions in care

• Ease of use of HIN

Provider Survey: Reasons to Use HIE

• Suggestions of new data to include:• Providers interested in pathology reports• Providers interested in inclusion of images (which points out

the need for high speed broadband)

• Most significant result of survey is HIE adoption requires a local champion• HIN using train the trainer approach and putting more

“boots on the ground”• HIN hired a clinical coordinator for on-going education

needs

Provider Survey: Recommendations

• Detailed and wide-ranging findings• Recognition of progress and focus on leveraging resources

through OSC• HIN strategy continues to evolve and includes new

services, payer involvement, consumer engagement, positioning as “middleware”• Sustainability includes these strategies plus new funding

sources• Consider positioning health information exchange to

attract and support payers

Stakeholder Focus Group: December 2013

Report in first SOP update Report Feb 2014

Program Priority Status as ofDecember, 2011

Target forDecember, 2012/13

Status as ofJanuary, 2014

Target forDecember, 2014

1. % of labs sending electronic labresults to providers in a structured format4

67% 75% 93% 95%

1. % of labs sending electronic labresults to providers using LOINC

67% 75% 81% 95%

ONC Program Priority Areas:Electronic Lab Results

Report in first SOP update Report Feb 2014

Program Priority Status as ofDecember, 2011

Target forDecember, 2012/13

Status as ofJanuary, 2014

Target forDecember, 2014

Public Health agencies receiving ELR data produced by EHRs or other electronic sources. Data are received using HL7 2.5.1 LOINC and SNOWMEDYes/no or % 1=Yes

1=Yes

1=Yes

1=Yes

Immunization registries receiving electronic immunization data produced by EHRs. Data are received in HL7 2.3.1 or 2.5.1 formats using CVX code.Yes/no or % 1=Yes

1=Yes

1=Yes

1=Yes

1. Public Health agencies receiving electronic Syndromic surveillance hospital data produced by EHRs in HL7 2.3.1 or 2.5.1 formats (using CDC reference guide)Yes/no or %

0=No

0=No

0=No

0=No

1. Public Health agencies receiving electronic Syndromic surveillance ambulatory data produced by EHRs in HL7 2.3.1 or 2.5.1Yes/no or %

0=No

0=No

0=No

0=No

ONC Program Priority Areas:Public Health

• Not required in 2014 Assessment• SureScripts data would

provider higher levels

E-Prescribing from the Broadband Survey

• Improve population health through immunization compliance and HIE

• Improve cost effectiveness through technology investment and use

• Improve management of chronic conditions through HIE

Beacon Community Grant: Outcomes

• Maine is a leader in the amount of per capita funds paid to providers • Development of implementation rules, policies, procedures, system

enhancements to support MU• Collaborative work across stakeholders to support MU Stage 2 • Outreach and education to MaineCare members in accessing and

using PHRs and health information• Master Client Index and technologies to support MaineCare

members• Initiatives to support underserved populations• Initiatives to support evidence-based protocols

MaineCare Meaningful Use Program: Outcomes

• 20 behavioral health organizations/agencies were provided with the ability to access health information about their clients in the HIE and five collaborated on the ability to share protected mental health information through the HIE for improved delivery of care and coordination with other health care providers. • Consumers and providers educational tools to support informed consent

for consumers.• Providers provided implementation toolkits • Recommendations were made for a common set of data elements • Strategies were developed to integrate behavioral health providers into

the new emerging payment reform models in Maine.• Maine’s SIM grant includes a proposal to provide incentive payments to

assist behavioral health providers in EHR adoption and implementation.

SAMHSA Grant: Outcomes

• September, 2013 grant to improve care coordination for Maine’s vets

• Bidirectional connection between the VA and HIN

• Augusta Medical Center and 11 outpatient clinics

HRSA VA Grant: Outcomes

• Measuring quality of care and outcomes and supporting foster children• Automation of EPSDT data• Build automated quality measures into HIN data

warehouse• Children will have comprehensive health assessments

uploaded and available to PCPs

IHOC CHIRA Grant: Outcomes

• Maine’s web-based immunization information system• Provides client and vaccination management functions • Resource for MaineCare• IMMPACT2 contains records for more than half the

children in Maine• HIN provides a feed to CDC for provider reporting

IMMPACT2: Outcomes

• Supporting MU Stage 2• OSC, State Information Technology Organization, CDC

project• A single online web based reporting system for special

registry data• Plan to include diabetes registry in 2014

MeCDC Special Registries Program: Outcomes

• MEREC supported the adoption and use of certified EHRs and e-prescribing

• Repurposing following expiration of HITECH funding

Regional Extension Center: Outcomes

• Key focus of HITSC • MaineCare MU State Medicaid Health Plan held four listening

sessions including more than 80 consumer stakeholders• Draft plans issued for comment then used to successfully

implement the state MU program• HIN’s Consumer Advisory Committee provides strong

representation• Critical to implementation of physical health opt-out and

mental health opt-in provisions• Continued focus of all OSC strategy

Consumer Engagement

• Maine is one of the leaders in the nation in providing the path to HIE sustainability• HIN one of the few HIEs to have subscription model in place• Track record of grant and extramural funding for Maine

entities• Strategy in place to continue to leverage existing assets and

new funding opportunities• Value-added and enhanced services in process and planned• Roll-out payer strategy, including CMS

HIE Sustainability