2. MeHI is the designated state
agency for:
Coordinating health care
innovation, technology and
competitiveness
Accelerating the adoption of
health information technologies
Promoting health IT to improve
the safety, quality and
efficiency of health care in
Massachusetts
Advancing the dissemination of
electronic health records
systems in all health care
provider settings
Massachusetts eHealth Institute
MBI
MASSACHUSETTS
BROADBAND INSTITUTE
MeHI is a division of the Massachusetts
Technology Collaborative, a public
economic development agency
2 Massachusetts eHealth Institute
• Tech Hub Collaborative
• Big Data Consortium
• Advanced Manufacturing
Collaborative
• Innovation Index
• Mass Broadband 123
• MassVetsAdvisor
• Health IT Adoption & Use
• Connected Communities
• eHealth Services & Support
• eHealth Innovation
• eHealth Learning Center
THE INNOVATION INSTITUTE
at the MassTech Collaborative
MeHI
MASSACHUSETTS
eHEALTH INSTITUTE
3. Learning objectives
1. Describe the Massachusetts HIE opt in legislative mandate
2. Locate and share community-developed Mass HIway
consent resources
3. Describe the different approaches organizations are taking to
meet the opt in mandate
4. Recognize the various technical, policy and procedural
elements to consent
3
Massachusetts eHealth Institute
4. Agenda
1. Overview of the Massachusetts HIE opt in legislative
mandate
2. Review community-developed Mass HIway consent
resources
3. Organizational approaches to meeting the opt in mandate
– Partners Healthcare / Mass General Hospital – Christine Griffin
– Beth Israel Deaconess Medical Center – John Halamka
4. Questions
4
Massachusetts eHealth Institute
5. Meet the speakers
Massachusetts eHealth Institute
5
Sean Kennedy, MPH, MS, PMP
Health Information Exchange Director
Massachusetts eHealth Institute at the Massachusetts Technology
Collaborative
Amy Caron, MPH
Project Manager for Mass HIway Communications, Outreach, Education
Executive Office of Health and Human Services
Christine Griffin
Health Information Services Manager
Massachusetts General Hospital, Health Information Services
John Halamka, MD, MS
CIO
Beth Israel Deaconess Medical Center
6. The Massachusetts Health
Information Highway
Operationalizing ‘Opt In’
September 11, 2014
www.masshiway.net
7. What is the Mass HIway?
Mass HIway: Secure, statewide health information exchange (HIE) network
operated by the Massachusetts’ Executive Office of Health and Human Services.
Mass HIway does NOT store clinical information or medical records (not a ‘hub
and spoke’ model HIE).
Goals: Improve and enhance information sharing and communication among
cross institutional care teams in a secure and efficient way to:
• Improve care coordination/transitions
• Avoid readmission and medical errors
• Reduce costs/duplication
• Improve patient outcomes/satisfaction
Services:
1) Direct Messaging enables secure “push” of health information.
2)Query & Retrieve adds functionality to allow query, location, requests and
receipt (“pull”) of health information.
8. Why Opt In?
Opt Out: All or some pre-defined set of data are qualified to be included and
available for e-exchange. Patients need to take action to opt out.
Opt In: No patient data are made available for e-exchange until patients express
that they allow their providers to use the HIE to send/receive health information.
•Builds patient trust and buy in to improve participation.
•Patient- centric and sensitive to privacy concerns.
•Increases patient engagement.
9. What are the consent policies?
• Consent is only applicable for use of the Mass HIway to exchange information
as allowed by law. Must follow existing laws for sending sensitive information.
• Consent for Direct Messaging must mention that the Mass HIway is being used
as a mode of exchange.
• Must obtain new consent if implementing Query & Retrieve because more
information must be provided about the functionality requirements.
• Participants may get consent for all services at one time if all contract
obligations are followed.
• Consent must be documented and auditable.
• Process must be in place for patients to change their consent preferences and
for Mass HIway to be notified.
• Process must be in place for patients to request and receive an audit log of
Mass HIway transactions from the Participant.
• Consent time limits are up to Participants; must follow consent policies for
emancipated minors and minors turning 18 years old.
• Does NOT apply to mandatory DPH reporting or BAs.
10. Consent Publish
Query &
Retrieve
Consent preference
sent to Mass HIway
in ADT Message
using Direct
Protocol.
If “Yes”,
demographic data is
pulled and stored in
Master Patient Index
(part of the RLS).
If “No”, it’s
discarded.
Patient relationship
to Participant
published to
Relationship Listing
Service (RLS).
Made viewable by
search to other
authorized users
on the Mass
HIway.
Participant uses the
RLS to search for
where other records
are held and are
available, based on
consent. Can request
health information
through Clinical Portal.
Recipient can reply
over Mass HIway.
Reply sent to
requestor directly, not
viewable or stored by
Mass HIway.
Why is consent different for Q&R?
11. Tell me how its done…
• Mass HIway does not prescribe or require any particular process. Allows for
flexibility from small to large practices.
• Mass HIway, Advisory Groups, P&S officers, Participants, health literacy experts
convened to develop a community approved approach to opt in that includes:
1. Using simple consent language that can be incorporated into existing
consent forms or used as a stand alone form.
2. Giving the patient educational material to review before making their
choice.
3. Training frontline staff on Mass HIway and consent so they can have a
dialogue with patients.
More details and links to resources can be found at:
http://www.masshiway.net/resources/masshiwayconsent.jsp
14. Final thoughts…
When planning consent for Mass HIway:
• Changing your process and forms, and educating your staff can take time, so
start early and engage all teams.
• Think about your patient population and any specific needs, such as
translations for educational material.
• If implementing Query & Retrieve, engage your vendor early. Your system needs
to be able to generate HL7s with a “Yes” consent flag to populate the RLS.
• If considering getting consent for Direct Messaging only, that’s ok- just
remember the process needs to be auditable and new consent will need to be
obtained if you get Q&R services.
• Remember, your staff should be able to discuss the Mass HIway with your
patients and Participants should have an internal escalation path.
16. Design and implement an enterprise on-line
patient HIway consent model
Collect patient consent one time
Consistently apply patient choice
throughout Partners Healthcare (including
our EHR affiliates)
Meet Meaningful Use Stage 2
measures related to HIE
18. HIPAA Privacy Notice & Patient
Acknowledgement Form
◦ flag in local registration systems and Y/N stored at
EMPI
Patient Portal
Release of Protected Health Information Form
◦ paper
◦ scanned
19. Build HIway consent into PHS e-Care registration
system (deploying over next 3 yrs)
Sync with registration workflow
Use e-form/signature pads & update form status
◦ “Received” (populates when patient signs)
◦ “Patient Refused” (staff selects if patient opts-out)
◦ “Unable to Obtain” (staff selects if applicable (e.g.: patient undecided))
Sites not on e-Care are building or using existing
flags in their local registration systems
e-Care and local systems interface with PHS EMPI
EMPI populates future encounter visits
MGH went live with e-Care registration system in
July
20. Use patient portal to collect consent
Show EMPI consent status in the EHR for
clinicians to use
Flip Consent flag in the EHR
◦ allows a variety of workflows for obtaining consent
◦ medical assistants, nurses and other staff may
obtain consent beyond the front desk
21.
22.
23.
24.
25.
26.
27. • BICS will query EMPI at
registration to determine if a
consent already exists
• Consent is captured in BICS
and transmitted to EMPI
EMPI
(Future)
potentially other sites
Consent Data
Consent Data
• Consent is captured in
Epic and transmitted to
EMPI
• Single consent for all
sites.
• Applies to all service
areas in Epic.
July 2014
BICS
(Future)
Epic to accept consent data
from EMPI
28. HIway Consent Implementation Workgroup
◦ Met weekly since 2/12/14 to drive consent solution
◦ Health Information Services
◦ Information Systems
◦ Patient Access - Registration Areas
◦ PeCare
◦ Providers
◦ Legal
Endorsed and supported by senior
leadership via HIE Steering Committee
29. Establish governance and structure to
effectively “operationalize” HIE
Transition Consent Implementation
workgroup into HIE Operating Committee
◦ set goals and objectives for 2014/2015
◦ align with other existing committees’ efforts to
accomplish MU/HIE goals, create efficiency and value
◦ determine required membership to get started
31. Existing processes
• General Consent form
• Medical Records release
• Example from the Social Security Administration
32. The “push” use case
• Automating existing processes
• Organized Health Care Arrangement issues, affiliates, and
third parties
• HIPAA Considerations
33. The “pull” use case
• Meeting the needs of many stakeholders
• Putting the patients first
• Passing the Boston Globe Test
• The final solution
• Withdrawing consent
34.
35. Discussion & Questions
Massachusetts eHealth Institute
35
Sean Kennedy, MPH, MS, PMP
Health Information Exchange Director
Massachusetts eHealth Institute
Amy Caron, MPH
Project Manager for Mass HIway Communications,
Outreach, Education
Executive Office of Health and Human Services
Christine Griffin
Health Information Services Manager
Massachusetts General Hospital, Health
Information Services
John Halamka, MD, MS
CIO
Beth Israel Deaconess Medical Center
kennedy@masstech.org
amy.caron@state.ma.us
cgriffin7@partners.org
jhalamka@bidmc.harvard.edu
http://geekdoctor.blogspot.com
36. NEXT WEBINAR!
Effective and Proper Use of the Mass HIway
Directory
Thursday, October 9 at 12:00pm-1:00pm
The state's health information exchange network, the Mass HIway, is a secure way for
health information to be shared among providers and organizations. The Mass HIway
Directory, also referred to as the Provider Directory (PD), is a listing of authorized
users of the Mass HIway that can actively send and/or receive information over the
network. This session will include an overview of the Directory's components, best
practices on listing your organization within the Directory, the proper usage of the
Directory, and how to help ensure effective transmission of health information and
communication with other Mass HIway participants.
36
Register at
http://mehi.masstech.org/calendar/event/2896
Query & Retrieve functionality is new and requires that:
The health care organization using the Mass HIway (Participant) send demographic data (name, DOB, gender, address, email, phone, medical record number) about the patient to the Mass HIway (State)
Demographic data is stored by the Mass HIway (State) and made searchable by other authorized users.
A patient’s “Relationship” to that health care organization (the patient has received care there) is published and viewable by (disclosed to) other authorized users (Relationship Listing Service or RLS).
Patients also need to know that:
Data is secure in transport and the Mass HIway does not receive or store any health data.
They can change their mind anytime and they have access rights.
Stress- all the materials are flexible and you’re able to build upon them or adapt them to your population or needs.
As I prepared to discuss our experience with implementing a HIway Consent process with you today, what I found most striking is how quickly we were able to implement the consent process despite the many complexities we grappled with during the process.
I hope you’ll find our experience encouraging and I also hope that by sharing we can help others to chart their own course.
I’m going to give you some history on how we got to where we are today, what we are doing currently, and where we hope to be in the near future.
First, early this year, Deb Adair, who directs HI and privacy at MGH was asked to shepherd this project for Partners. Deb is the proof that you can do it, without ownership, strong leadership and the right team. One of the major drivers for the consent piece is, of course, Meaningful Use, stage 2.
MU set a firm timeline for us. We needed a HIway opt-in process in place by October 1st. Oct 1st, we wanted to hit the ground running with sending SOC documents over the HIway for as many patient discharges as possible.
With those goals in mind, we had to take an organizational approach to both maximize our opportunities to obtain patient consent and also to pool all the opt-ins so patients would not have to be asked at every appointment at every office.
We also had to create a process – that would in sync -- with the fact Partners isideploying a single system-wide integrated electronic medical health record and administrative system over the next several years.
With that in mind, we needed a way to collect consent one time; store it electronically, and consistently apply it.
Believe or not, looking at existing processes was helpful.
Currently, we have to give each patient a privacy notice at their first visit, collect a signed receipt and track it.
Patient has to sign once,
signing flips the PN flag to yes,
it goes to the PHS EMPI,
it populates future visits ,
and you don’t have to ask again.
The PN is given out in all areas where patients check in for an appt or hospitalization, in pat and out pat.
We also have a patient portal which serves as an efficient way to share information with the patient. But no everyone using it. Don’t want to miss certain populations.
Decision made to build a consent process workflow that mirrors the PN.
A PHS Consent workgroup began meeting in Feb.
I was assigned as the consent implementation project manager April.
A consent form was created /vetted/ approved.
Sites on epic had a flag to use. Only 1.
The form was built it Epic. The form is listed in Documents Table along with the PN and a consent to treat. Staff checks the table to see which documents a patient needs to sign. If patient has opted in or out yet, they give educational materials to read and asked if they want to opt-in. e=signing updates the status.
Unable to obtain – always an option.
EMPI source of truth. --- consent checked at the EMPI as part of the auto-transition of care process, we are creating.
Staff trainings.
We created a HIway toolkit: sort of a press kit for staff checking in patients to use.
Business card – to introduce HIway to patient and has PO # to call with any questions.
We created a short patient handout on the benefits of opting in.
We use the Mass HIway Fact Sheet for Patients. We also created a Spanish translation.
The consent form
We have instructions on what to do
Epic doc table Screenshot
Script patient Q&A
Powerpoint about the HIway and MGH
A document that shows what’s on a Summary of Care document – to what we will be sending over the hiway
Site HIS directors, managers and admitting/registrations directors working together to train staff and implement the consent form. We shared all documents.
We printed, delivered 500 + toolkits and also posted them for DIY printing. We probably covered about 100 areas with toolkit trainings.
At MGH, since went live with Epic in July, we implemented in inpatient and outpatient areas. Some sites, only doing inpatient.
Staff trainings.
We created a HIway toolkit: sort of a press kit for staff checking in patients to use.
Business card – to introduce HIway to patient and has PO # to call with any questions.
We created a short patient handout on the benefits of opting in.
We use the Mass HIway Fact Sheet for Patients. We also created a Spanish translation.
The consent form
We have instructions on what to do
Epic doc table Screenshot
Script patient Q&A
Powerpoint about the HIway and MGH
A document that shows what’s on a Summary of Care document – to what we will be sending over the hiway
Site HIS directors, managers and admitting/registrations directors working together to train staff and implement the consent form. We shared all documents.
We printed, delivered 500 + toolkits and also posted them for DIY printing. We probably covered about 100 areas with toolkit trainings.
At MGH, since went live with Epic in July, we implemented in inpatient and outpatient areas. Some sites, only doing inpatient.
Staff trainings.
We created a HIway toolkit: sort of a press kit for staff checking in patients to use.
Business card – to introduce HIway to patient and has PO # to call with any questions.
We created a short patient handout on the benefits of opting in.
We use the Mass HIway Fact Sheet for Patients. We also created a Spanish translation.
The consent form
We have instructions on what to do
Epic doc table Screenshot
Script patient Q&A
Powerpoint about the HIway and MGH
A document that shows what’s on a Summary of Care document – to what we will be sending over the hiway
Site HIS directors, managers and admitting/registrations directors working together to train staff and implement the consent form. We shared all documents.
We printed, delivered 500 + toolkits and also posted them for DIY printing. We probably covered about 100 areas with toolkit trainings.
At MGH, since went live with Epic in July, we implemented in inpatient and outpatient areas. Some sites, only doing inpatient.
Staff trainings.
We created a HIway toolkit: sort of a press kit for staff checking in patients to use.
Business card – to introduce HIway to patient and has PO # to call with any questions.
We created a short patient handout on the benefits of opting in.
We use the Mass HIway Fact Sheet for Patients. We also created a Spanish translation.
The consent form
We have instructions on what to do
Epic doc table Screenshot
Script patient Q&A
Powerpoint about the HIway and MGH
A document that shows what’s on a Summary of Care document – to what we will be sending over the hiway
Site HIS directors, managers and admitting/registrations directors working together to train staff and implement the consent form. We shared all documents.
We printed, delivered 500 + toolkits and also posted them for DIY printing. We probably covered about 100 areas with toolkit trainings.
At MGH, since went live with Epic in July, we implemented in inpatient and outpatient areas. Some sites, only doing inpatient.
Staff trainings.
We created a HIway toolkit: sort of a press kit for staff checking in patients to use.
Business card – to introduce HIway to patient and has PO # to call with any questions.
We created a short patient handout on the benefits of opting in.
We use the Mass HIway Fact Sheet for Patients. We also created a Spanish translation.
The consent form
We have instructions on what to do
Epic doc table Screenshot
Script patient Q&A
Powerpoint about the HIway and MGH
A document that shows what’s on a Summary of Care document – to what we will be sending over the hiway
Site HIS directors, managers and admitting/registrations directors working together to train staff and implement the consent form. We shared all documents.
We printed, delivered 500 + toolkits and also posted them for DIY printing. We probably covered about 100 areas with toolkit trainings.
At MGH, since went live with Epic in July, we implemented in inpatient and outpatient areas. Some sites, only doing inpatient.
Staff trainings.
We created a HIway toolkit: sort of a press kit for staff checking in patients to use.
Business card – to introduce HIway to patient and has PO # to call with any questions.
We created a short patient handout on the benefits of opting in.
We use the Mass HIway Fact Sheet for Patients. We also created a Spanish translation.
The consent form
We have instructions on what to do
Epic doc table Screenshot
Script patient Q&A
Powerpoint about the HIway and MGH
A document that shows what’s on a Summary of Care document – to what we will be sending over the hiway
Site HIS directors, managers and admitting/registrations directors working together to train staff and implement the consent form. We shared all documents.
We printed, delivered 500 + toolkits and also posted them for DIY printing. We probably covered about 100 areas with toolkit trainings.
At MGH, since went live with Epic in July, we implemented in inpatient and outpatient areas. Some sites, only doing inpatient.
If patient opts-in, the EMPI will send message to the automated TOC to send a CCDA to a provider if a) he is listed as a HIway participant and b) if patient has signed or opted-in. If not, this would stop the automated TOC from sending the CCDA
Lot of committees, PHS & site level, swirling around – with MU objectives. And lots of questions– physician education, patient education.