Commonwealth of Massachusetts
Executive Office of Health and Human Services
Mass HIway Overview
MEDITECH Client Pilot Kick-off
June 24, 2013
Mass HIway Overview
The Massachusetts Health Information Highway (Mass HIway)
enables the secure electronic exchange of health information
among diverse participants in the Commonwealth and supports
meeting Meaningful Use requirements:
–
–
–
–
Hospitals
Health Care Providers
Laboratories
Pharmacies
–
–
–
–
2
Skilled nursing facilities
Public Health Agencies
Health Plans
Patients (future release)
Hub for Health Information Exchange
Depending on the specific
application, data exchanged
may include:
Health
System
Health
Plan
Hospital
Patient
(future
release)
Small
Practice
Mass
HIway
Skilled
Pharmacy
Nursing
Facility
Laboratory
Public
Health
3
1. Patient name
2. Sex
3. Date of birth
4. Race
5. Ethnicity
6. Preferred language.
7. Smoking status
8. Diagnostic codes
9. Medications
10. Medication allergies
11. Laboratory tests
12. Laboratory value/results
13. Vital signs (height, weight, BP, BMI)
14. Care plan fields, including goals
and instructions
15. Procedures
16. Care team members
17. Immunizations
Connection options
User types
Methods of connecting to the Commonwealth’s
HIE
EHR
Connect directly
HIway Services
Participant directory
Physician practice
Connect with local gateway
Certificate repository
Hospital
Secure messaging
Long-term care
Other providers
Public health
Health plans
Connect through LAND Device
(Local Application for Network Distribution)
Message Transformation
Secure web mail
Laboratories and
imaging centers
Browser access to webmail inbox
4
HIway Services
• Participant directory - provides HIway network addresses of
all the participants in the network and enables
communication via the network
• Certificate repository – holds, manages the private/public key
that enables the participant to encrypt and decrypt messages
• Secure messaging - encrypted message will be sent in a
secure manner within the network (HL7 2.5.1 format)
• Message transformation – technical format of messages are
automatically changed to meet the requirements of the
receiving system
• Secure Webmail – secure email and attachments among
participants of the network
5
Capabilities phasing plan
Phase 1
HIE
components
HIE
end-points
•
•
•
•
Phase 2
Provider directory
PKI infrastructure
Direct/HL7 gateway
Web portal mailbox
• Any TPO
participant
• Public health
• SS, CBHI, MIIS
•
•
•
•
•
Master Person Index
Record locator service
Consent database
Patient-directed messaging
Query/retrieve infrastructure
• MassHealth clinical data
repository
• Medicaid/HIX participants
• Public health
• ELR, PMP, Opioid, Lead
A richer set of services available to a broader set of participants
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Direct S/MIME Overview
SMTP Client Send
Organization Provider
(Direct Enabled)
SMTP Client
Organization Provider
(Direct Enabled)
SMTP Client
IMAP (Pull)
S/MIME
SMTP (Push)
S/MIME
Mass HIE
Email Server
SMTP (Push)
S/MIME
IM
A
S/M P (P
IM ull)
E
Organization Provider
SMTP Server
Encrypted
XDR
Mass HIE
Transformation
Service
Organization Provider
XDR
SMTP Client Receive
Organization Provider
XDR
Encrypted
XDR
Mass HIE
Direct Gateway
SM
T
S/MP (Pu
IM sh)
E
Organization Provider
SMTP Server/Client
IMAP (Pull)
SMTP (Push)
S/MIME
Mass HIE
Email Server
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S/MIME
Organization Provider
(Direct Enabled)
SMTP Client
HIway Operations, Services and Support
8
HIway Clients: In Production
Organization
Use Case
Status/Target Date
In Production
BIDMC
Several use cases – registries, data
analytics and information exchanged
between provider organizations.
• In production: MAeHC; Network
Health and DPH – Immunization
• Testing: Boston Public Health; Atrius;
Partners and DPH – Lab Reporting
Tufts Medical Center
Discharge Summaries to Network Health;
• Successful transmission of up to 1M
test transactions
• Worked through consent –
implementing processes, forms;
moving to production with NH –
6/24/13
Network Health
Receive Discharge Summaries from Tufts
Medical Center and BIDMC
• Production with BIDMC and Tufts
Medical Center
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HIway Clients: Live
Organization
Use Case
Status/Target Date
Live
Holyoke Medical
Center/Holyoke HIE
First implementation of Direct connect
among Holyoke Medical Center and its
HIE, HealthConnect. Successful
implementation will allow exchange
among the current 43 independent
providers, HMC and HIway participants
• Successful test with S/MIME and XDR
• Working toward exchange with HIway
customers – Network Health
Beaumont Medical
Part of the IMPACT grant with 16 other
organizations including Reliant,
Metrowest and several LTC facilities
• In process of provisioning services for
the other participants
• Move to test with intent to move to
production
Dr. Gregory Harris
Coordination of behavioral care with
multiple facilities
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HIway Clients: Implementation
and Onboarding
Organization
Use Case
Status/Target Date
Implementation
Boston Public Health,
Atrius, Children’s,
Partners
Care coordination, management
• Various levels of testing
Harvard Pilgrim Health
Discharge summaries; data analytics
• Completed extensive security testing –
moving to implementation
Metrowest, St.
Vincent, Pediatric Care
Associates, Notre
Dame Long Term Care,
Care coordination
• Provisioning with some level of testing
Pilot project with 4 MA key MEDITECH
clients
• Kick-off session June 24
Pilot Project:
MEDITECH Pilot
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HIway Clients: Horizon
Organization
Use Case
Status/Target Date
Near Horizon:
Baystate
Several – Implementation Grant and PVIX
Kick-off expected in July
Opiod Treatment
Providers (DPH)
Intake, Enrollment, Assessment and
Treatment
Provider kick-off – 6/25/13
DPH – Immunization,
ELR, Syndromic and
CBHI
More active outreach to current users of
DPH programs to move traffic to HIway
Ongoing – with more concerted focus
beginning in 3rd quarter
Last Mile Program
Innovation
Implementation
Grants
Extensive set of use cases among
community providers, local HIEs,
facilities and service entities
Active ongoing efforts ; project plans
being finalized
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MA HIway Operating Model
Customer Acquisition
Customer Implementation
Last Mile
Outreach
Outreach
Sales
Sales
Operations
Implement
Implement
Support
Support
Operations
Select
Select outreach/sales
outreach/sales
OnOnboard
board
Pre-Implementation: LM Customer Relationship
Managers or through a Service Manager if client
is ready for Implementation
Verify
Verify
Provision
Provision
Operations: Service Manager as single point of
contact supported by Technical Engineers,
Operations staff, web portal and 1-855-MA-HIway
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MA HIway Delivery Model
Technical
Excellence
Client
Experience
Environmental Stability
Project Management
System Performance
Installation
Enhancements
Participant Relationship
Change Control
Call Center
Complex Clients
Back Office
Support
Contracts
Verification
Reporting
Billing
Documentation
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HIway Operations Monitoring
To ensure delivery meets objectives , we have and continue to implement
operational metrics and performance measures of the end to end process
Transaction Analysis by Client
Client Metrics
Usage Reports
System Access Metrics
Page 1
Outbound Transactions
Connection
Method Client ID Client Name
LAND
12345 Hospital A
LAND
12346 System B
LAND
12347 Hospital C
TOTAL LAND
MIIS
255,600
255,600
255,600
766,800
ELR Syndromic
144,450 103,350
144,450 103,350
144,450 103,350
433,350 310,050
CBHI
HIWay
34,023 29,902
34,023 29,902
34,023 29,902
102,069 89,706
Inbound Total
Transactions Transactions
34,530 601,855
12,340 579,665
9,940 577,265
56,810 1,758,785
Request Tracking
Date
Opened ST#
Issue Summary
2/25/2014 29956 Send/Receive error
2/27/2014 29988 Printing failure
3/1/2014 30009 Out of memory message
3/1/2014 30058 LAND swap
3/2/2014 30067 Connection not recognized
3/2/2014 30069 Password Reset
3/2/2014 30071 Password Reset
3/3/2014 30082 LAND swap
3/4/2014 30085 Connection not recognized
St. Eligious
General Hospital
General Hospital
County General
Hope
BIDMC
Medical Center
County General
Hope
Alexi Strogonoff
Bob Adams
Mary Janes
Alexi Strogonoff
Bob Adams
Bob Adams
Alexi Strogonoff
Mary Janes
Alexi Strogonoff
Total
29,521
3,236
4,328
33,849
Patient Records
Total Received as of Last Month
Received This Period
Received This Month
Total Received To Date
Patient Records Accessed
Total Access as of Last Month
Access This Period
Access This Month
Total Access To Date
Total
10,721
1,456
1,823
12,544
User IDs - Total
Login IDs Existing Last Month
Created This Period
Created This Month
Total Accounts To Date
Break The Glass Attempts
Total Attempted as of Last Month
Attempted This Period
Attempted This Month
Total Attempted to Date
Total
Total
1,009,765
3,457
8,564
1,018,329
Unique
700,543
2,267
6,102
706,645
Total
6,441
54
103
6,544
LvL 1 & 2
1,762
0
0
1,762
1,446
12
25
1,471
Performance Metrics
Production Environment (Percentage)
System Uptime - Period
System Uptime - This Month
Portal Uptime - Period
Portal Uptime - This Month
DSM Uptime - Period
DSM Uptime - This Month
Total
99.999%
99.999%
99.999%
99.999%
100.000%
100.000%
Outages (Minutes)
Scheduled Outage - Period
Scheduled Outage - This Month
Unscheduled Outage - Period
Unscheduled Outage - This Month
Total
Security Incidents (Occurances)
Incidents Detected - This Period
Incidents Detected - This Month
Total
Issues Report
Issues Created - This Period
Issues Resolved - This Period
Issues Created - This Month
Issues Resolved - This Month
Issues Remaining - To Date
Total
Jira # Escalated
Current Status
ICS-2090
Y Closed
N Closed
N Closed
N Closed
ICS-2099
Y Closed
N Closed
N Closed
N Closed
N Closed
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Period: 04 Nov 2012 - 10 Nov 2012
Volume Metrics
Login Access
Total Login as of Last Month
Login This Period
Login This Month
Total Login To Date
5
5
0
2
0
0
Direct Secure Messsaging Metrics
Accounts
Accounts Existing Last Month
Created This Period
Created This Month
Total Accounts To Date
Total
5,503
123
175
5,678
Total Sent as of Last Month
Sent This Period
Sent This Month
Total Sent To Date
Total
15,245
3,325
4,871
20,116
Total Received as of Last Month
Received This Period
Received This Month
Total Received To Date
Total
32,456
4,235
5,987
38,443
Sent
Received
1
2
1
2
5
Last Days Since
Activity Last Activity
3/2/2014
3/3/2014
3/1/2014
3/5/2014
3/13/2014
3/2/2014
3/2/2014
3/8/2014
3/10/2014
-
Closed Sat. Survey Total Days
Date Returned Open
3/2/2014
5
3/3/2014
4
3/1/2014
9
3/5/2014
4
3/13/2014
11
3/2/2014
10
3/2/2014
10
3/8/2014
9
5
3/10/2014
6
HIway Environment Monitoring
•
•
State of the art security practices and monitoring of the technical
environment has been established to fortify the trust of the HIway use
24/7 monitoring of the environment has been implemented
–
–
–
–
•
•
Network,
Applications,
Database, operating systems,
Infrastructure
Performance thresholds are established to automatically notify and
escalate when threshold limits are within range of thresholds for system
level agreements
Within the environment, constant security monitoring and reporting
occurs for the following:
– Environment security – identifying access and frequency of changes to the
firewall source IP, opened ports in the firewall, changes to the VPN access in
the firewall and changes in the IP routing
– Intrusion, penetration monitoring and detection of incidents, vulnerabilities
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Pilot Proposal to Move Forward
Project Management:
• Ryan Thomas: Service Manager
– Will be the single point of contact for the pilot coordination, planning, and oversight of
effort, resources within the HIway Operations Team
– Ryan’s contact information
•
•
Cell :
E-mail:
(781) 790-6101
ryan.thomas@orionhealth.com
Suggested Next Steps:
• Plan
– Plan effort with MEDITECH to test connection with the 3 platforms;
– In parallel, begin coordination planning, onboarding with all pilot clients
– Ensure that these efforts are in-sync, dovetail with the Implementation Grant plans
• Checkpoint: Status, Go-forward Review
• Execute
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