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)
9,000
United States
Germany
Canada
France
Australia
United Kingdom
Massachusetts
8,000
7,000
6,000
5,000
4,000
3,000
2,000
1,000
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
0
Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006.
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Massachusetts eHealth Collaborative
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...AND WE GET GENERALLY HIGHER QUALITY AS A RESULT,
BUT THE COSTS ARE UNSUSTAINABLE
Breast cancer deaths
2
7
First trimester pre-natal care
Colo-rectal cancer deaths
8
Mammogram screening (2000)
10
HbA1c measurement
10
Cholesterol screening
10
Left vent. ejection eval for heart failure patients
13
Long-term diabetes complications
15
Pediatric asthma admissions
18
Beta blocker treatment upon hospitalization
21
Providers listened
2
Appointments availables for routine care
6
% giving best rating for health care received
25
Cost differential
37
0
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5
10
Massachusetts eHealth Collaborative
15
20
25
30
35
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40
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THE EHR MARKET IS MOVING, SLOWLY, BUT ALSO CREATING
A DIGITAL DIVIDE IN THE PROCESS
50+
physicians
1-9
physicians
% 100
50+ physicians
90
Growing at about
80
CAGR = 8.6%
1.5 percentage
64
70
64
points per year
60
46 46
50
40
30
19
20
10
0
20012001
2003 2005 2002
2003
2004
2005
2001
2002
110
million
100
90
80
70
60
50
40
30
19
20
10
0
2003 2001
1-9 physicians
CAGR = 8.2%
26
2002 2004 2003
26
2004 2005 2005
801 million
911 million visits in 2004
Source: CDC; Center for Health Systems Change; National Ambulatory Care Survey
Slide title
Massachusetts eHealth Collaborative
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MAeHC ROOTS ARE IN MOVEMENT TO IMPROVE QUALITY,
SAFETY, EFFICIENCY OF CARE
• 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
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Massachusetts eHealth Collaborative
© MAeHC. All rights reserved.
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MAeHC BOARD OF DIRECTORS
Hospitals and hospital associations
• Baystate Health System
• Beth Israel Deaconess Medical
Center
Health plans and payer organizations
• Blue Cross Blue Shield of
Massachusetts
Healthcare professional associations
• American College of Physicians
• Fallon Community Health Plan
• Massachusetts League of
Community Health Centers
• Boston Medical Center
• Harvard Pilgrim Health Care
• Massachusetts Medical Society
• Caritas Christi
• Massachusetts Association of Health
Plans
• Massachusetts Nurses Association
• Fallon Clinic, Inc.
• Lahey Clinic Medical Center
• Tufts Associated Health Maintenance
Organization
• Massachusetts Hospital
Association
• Massachusetts Council of
Community Hospitals
• Partners Healthcare
• Tufts-New England Medical
Center
• University of Massachusetts
Memorial Medical Center
• Health Care for All
Healthcare purchaser organizations
• Associated Industries of
Massachusetts
• Massachusetts Business Roundtable
• Massachusetts Group Insurance
Commission
Non-voting members
Governmental agencies
• Executive Office of Health and
Human Services
Consumer, public interest, and at-large
• Center for Medicare & Medicaid
Services
• 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
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Massachusetts eHealth Collaborative
© MAeHC. All rights reserved.
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MAeHC ORGANIZATION DESIGNED TO SCALE UP FOR
STATEWIDE PROGRAM
CEO
Other
Operations
Technology &
Vendor Mgt
Practice Services
Legal
Contract admin
& HR
Support
Practice
consultants
Evaluation
Data manager
Health
information
exchange
More communities
Program Leader
Newburyport
Program Leader
Brockton
Program Leader
North Adams
Shared services
• Design, deployment, &
support
Evaluation
coordinator
• Community coordination
Communication
• Project management
• Program integrity
Project Mgmt
Slide title
Massachusetts eHealth Collaborative
© MAeHC. All rights reserved.
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PILOT PROJECT COORDINATION
Pilot Steering
Committee
Co-Chairs: Senior Pilot Exec &
Community Advocate
Members: Physicians, Hospital,
Consumers
Community
Physician
Council
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Community
Consumer
Council
Massachusetts eHealth Collaborative
Privacy &
Security
Work Group
© MAeHC. All rights reserved.
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MAEHC SELECTED THREE PILOT SITES FROM 35 APPLICANTS:
BROCKTON, NEWBURYPORT, NORTH ADAMS
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Massachusetts eHealth Collaborative
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MAeHC PILOT PROJECT EXPENDITURES
2005-2008
$M
$50.4
$M
%
MAeHC G&A
1.7
3%
Professional fees
2.9
6%
CPOE readiness
4.0
8%
40
Evaluation
5.9
12%
30
HIE
5.9
12%
20
MAeHC business
services
9.8
19%
20.2
40%
50
10
EHR
0
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Massachusetts eHealth Collaborative
© MAeHC. All rights reserved.
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ACTUAL COST PER PHYSICIAN FOR EHR
$42.8K
$K
45
40
$K
%
Support (6 mos)
2.8
7%
MAeHC support
9.3
22%
EHR software
7.9
18%
EHR hardware
22.8
53%
35
30
25
20
15
10
5
0
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Massachusetts eHealth Collaborative
© MAeHC. All rights reserved.
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MAeHC ARCHITECTURE AND DATA FLOWS
MAeHC-level:
Analysis
Outcomes
analysis
Benchmarking
Negotiated reporting
to plans
• P4P
• Chart review
MAeHC-level:
QDC
Community-level:
HIE
Brockton
Newburyport
North Adams
Provider-level:
EHR
Slide title
Massachusetts eHealth Collaborative
© MAeHC. All rights reserved.
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FIRST PRACTICE LAUNCHED IN MARCH 2006
Docs link up to new record style
By Jennifer Heldt Powell
Tuesday, March 14, 2006
The end of the paper trail
By Ulrika G. Gerth/ ugerth@cnc.com
Friday, March 17, 2006
Setting a new record: Local doctors
pilot electronic patient history system
By Stephanie Chelf
Staff Writer
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Massachusetts eHealth Collaborative
© MAeHC. All rights reserved.
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OVER 550 CLINICIANS LIVE IN 18 MONTHS
# practices
North Adams
(15)
Newburyport
(37)
Brockton
(89)
2006
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2007
Massachusetts eHealth Collaborative
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CLINICAL USE OF DEPLOYED EHRs
% of Encounters Documented Clinically in EHRs (Q2 2006 – Q2 2008)
%
Community 1
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Community 2
Massachusetts eHealth Collaborative
Community 3
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CLINICIAN ATTITUDE TOWARD EHRs
Disagree
% agree
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
Already has
70%
Will in the future
87%
Already has
65%
Will in the future
87%
Our patients are benefiting
from new processes
We are already able to
provide higher quality care
Our quality will improve from the HIE
93%
Overall I have already adopted the EHR
80%
I would recommend EHRs to other practices
81%
n = 195, 2/08
Slide title
Massachusetts eHealth Collaborative
© MAeHC. All rights reserved.
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STAFF ATTITUDE TOWARD EHRs
Disagree
% agree
Agree
Already has
86%
Will in the future
95%
The EHR system has helped
streamline our processes
The HIE will help streamline our processes
96%
Already has
83%
Will in the future
94%
Our patients are benefiting
from new processes
Our quality will improve from the HIE
96%
Overall I have already adopted the EHR
91%
I would recommend EHRs to other practices
88%
n = 524, 2/08
Slide title
Massachusetts eHealth Collaborative
© MAeHC. All rights reserved.
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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)
Slide title
Massachusetts eHealth Collaborative
© MAeHC. All rights reserved.
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MAeHC HEALTH INFORMATION EXCHANGE
ARCHITECTURE AND STATUS
On-demand portal services
•
•
•
•
•
View/download records
Secure messaging
Electronic referrals
Patient communication
Forms routing
•
•
•
•
View/download records
Physician communication
Appointment request
Forms routing
Automated delivery services
Lab/rad
results
Hospital
reports
Community Indexes
• Three stand-alone HIEs
Patient portal
Physician portal
EHR
data
Public
health
Communities
Systems connected
Data exchanged
Clinician
Terminology
Infrastructure
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~600 clinicians, 200+ clinical sites
•
4 hospitals, 1 community health center
• Hospital systems (Meditech) , including EHR,
lab systems, rad systems, transcription
systems
• 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
Community
record
Entity
•
• Ambulatory EHRs (eCW, NextGen, GE,
Allscripts)
Clinical repository
Patient
• Over 500K patients
Transactions to date
(as of Nov 2008)
Massachusetts eHealth Collaborative
• Over 60K patients opted-in to date (91% opt-in
rate)
• 300K+ clinical records exchanged to date
• 20K+ matched patient records in HIE
© MAeHC. All rights reserved.
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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
Slide title
Massachusetts eHealth Collaborative
© MAeHC. All rights reserved.
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OPT-IN PERMISSION MODEL
Send
Pre-defined data sent to
central server
Consent
Community Network
Patient chooses
which entity’s
records to make
available to
network
Jane Jones eCommunity Record
June 9, 2006
3
2
Y
Y
Y
1
N
Physician views data prior to
or during patient visit
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
Y
4
Retrieve
Jane Jones
Jane Jones
Visit
Other
xxx
XXX
Patient visits clinical entity
for care and is provided
option at first visit to opt-in
all clinical data from EACH
entity
Slide title
Massachusetts eHealth Collaborative
© MAeHC. All rights reserved.
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NORTH ADAMS HIE SCREEN SHOT
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Massachusetts eHealth Collaborative
© MAeHC. All rights reserved.
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NEWBURYPORT & BROCKTON HIE SCREEN SHOT
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Massachusetts eHealth Collaborative
© MAeHC. All rights reserved.
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Massachusetts eHealth Collaborative
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DATA BEING SENT TO THE MAEHC QDC TODAY
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•
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]
Massachusetts eHealth Collaborative
© MAeHC. All rights reserved.
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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
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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
Massachusetts eHealth Collaborative
© MAeHC. All rights reserved.
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MAEHC QDC LOG-IN SCREENSHOTS
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Massachusetts eHealth Collaborative
© MAeHC. All rights reserved.
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MAEHC QDC REPORT SCREENSHOTS
Peer comparison report (1)
Benchmark summary report
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Peer comparison report (2)
Drill-down report
Massachusetts eHealth Collaborative
© MAeHC. All rights reserved.
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THE GRID AND THE LAST MILE
MA-SHARE
Inter-community
connectivity
Intra-community
connectivity
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Massachusetts eHealth Collaborative
© MAeHC. All rights reserved.
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www.maehc.org
Micky Tripathi, PhD MPP
President & CEO
mtripathi@maehc.org
781-434-7905
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Massachusetts eHealth Collaborative
© MAeHC. All rights reserved.
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