Connected Communities Implementation Grant Overview of Milestone Requirements Keely Benson, Connected Communities Program Manager

Answer questions at the end of the webinar Goals of Webinar Review each of the grant deliverables (Transformation Plan and 4 Milestones) Focus on areas of greatest interest Sharing examples Review challenges and strategies shared by grantees through the end of year reports submitted in December Answer questions at the end of the webinar Massachusetts eHealth Institute

Connected Communities Implementation Grant Grant is broken down into 5 major deliverables Transformation Plan and 4 Milestones Each focuses on technology and workflow Additional focus on privacy and security, outcome measures, sustainability and transaction volume Massachusetts eHealth Institute

Implementation Grant Deliverables Workflow Transformation Plan 1. Anticipated Operational or Clinical Outcomes 2. Current State Analysis 3. Future State Analysis 4. Grant Approach - Workflow 5. Budget 6. Use Case Development Forms 7. Transaction Volume Targets 8. Sustainability Overview Milestone 1 Description of Policies and Procedures to protect ePHI Description of Impacted Workflows to Implement Use Cases HIE/HISP Participation Agreements Transaction Logs detailing test transactions Attestation Forms confirming test transactions Milestone 2 Description of policies for sharing patient data Logical Process Diagram of Workflow Process Improvement Plan detailing workflow enhancements Transaction Logs detailing production transactions Attestation Forms confirming productions transactions Milestone 3 Update on Process Improvement Plan (and dates of completion for activities) Attestation Forms confirming active participation in use cases Milestone 4 Use Case Volume Table Use Case Expansion Plan Final Report Massachusetts eHealth Institute

Deliverable Roadmap: Technology Transformation Plan Current State Analysis (Health IT Spreadsheet) Future State Analysis (Health IT Spreadsheet) Use Case Development Forms Milestone 1 HIE/HISP Participation Agreements Transaction Logs detailing test transactions Attestation Forms confirming test transactions Milestone 2 Transaction Logs detailing production transactions Attestation Forms confirming production transactions Milestone 3 Attestation Forms confirming active participation in use cases Massachusetts eHealth Institute

Deliverable Roadmap: Workflow Transformation Plan Grant approach: general overview of impacted workflows Use Case Development Forms Milestone 1 Description of impacted workflows to implement Use Cases Milestone 2 Logical process diagram of workflow for each participating organization Process Improvement Plan detailing workflow enhancements Milestone 3 Updated Process Improvement Plan, including completion dates Attestation Forms confirming active participation in Use Cases Milestone 4 Use Case Expansion Plan (Informed by Process Improvement Plan, Use Case Development Forms, and Sustainability Overview) Massachusetts eHealth Institute

Deliverable Roadmap: Privacy & Security Transformation Plan Grant approach: general overview of impacted workflows Milestone 1 Description of policies and procedures to protect ePHI Description of impacted workflows to implement Use Cases Milestone 2 Description of policies for sharing patient data Process Improvement Plan detailing workflow enhancements (including processes relating to privacy and security of ePHI) Milestone 3 Updated Process Improvement Plan, including completion dates Massachusetts eHealth Institute

Deliverable Roadmap: Outcome Measures & Sustainability Transformation Plan Anticipated operational or clinical outcomes Budget Use Case Development Forms Transaction volume targets Sustainability overview Milestone 1 Description of impacted workflows to implement Use Cases Milestone 2 Process Improvement Plan detailing workflow enhancements Milestone 3 Updated Process Improvement Plan, including completion dates Milestone 4 Final Report Use Case Expansion Plan Massachusetts eHealth Institute

Anticipated Outcomes Table with Example Massachusetts eHealth Institute

Deliverable Roadmap: Transaction Volume Transformation Plan Transaction Volume Targets Milestone 4 Use Case Volume Table Massachusetts eHealth Institute

Transaction Volume Targets Table with Example Massachusetts eHealth Institute

Transformation Plan Deliverables Anticipated Outcomes (clinical and/or operational) Will inform the Final Report (Milestone 4) Examples: Reduce current hospital readmission rate by 12% Reduce the amount of time it takes for SNF or home care to conduct medication reconciliation because of access to med lists in HIE’s clinical data repository Current and Future State Analysis (included in Health IT Spreadsheet) Grant Approach (Project Plan and Workflow) Workflow description will inform Description of Impacted Workflows to Implement Use Cases (Milestone 1) Budget Will inform Use Case Expansion Plan (Milestone 4) Massachusetts eHealth Institute

Transformation Plan Deliverables (Continued) 5. Use Case Development Forms Will inform: Description of Impacted Workflows to Implement Use Cases (Milestone 1) Transaction Logs detailing test transactions (Milestone 1) Attestation Forms confirming test transactions (Milestone 1) 6. Transaction Volume Targets (Baseline Transaction Volume and Transaction Volume Targets) Will be used to measure final transaction volume as part of the Use Case Volume Table (Milestone 4) 7. Sustainability of Project Will inform the Use Case Expansion Plan (Milestone 4) Massachusetts eHealth Institute

Milestone 1 Deliverables Milestone 1 Template Description of policies and procedures to protect ePHI Will inform Description of Policies for Sharing Patient Data (Milestone 2) Description of impacted workflows and preliminary workflow enhancements to implement use cases (for grantee and trading partners) Will inform Process Improvement Plan and Logical Process Diagram (Milestone 2) Resources available on Connected Communities Grantee webpage Workflow Presentations What is Workflow? Why Do I Care About Workflow? How Do I Evaluate Workflow? Massachusetts eHealth Institute

Milestone 1 Deliverables (Continued) Attachments Copy of HIE/HISP or Mass HIway Participation Agreement for each organization participating in a use case Transaction log(s) or screenshots from sponsoring HIE/HISP detailing test transactions involved for each use case Logs or screenshots for each trading partner organization involved in a use case should be included Logs should identify date, sender and receiver (this may be a clinical data repository) for message Milestone 1 Attestation Form for grantee and each trading partner organization listed in the transaction log(s) If applicable, Grantee should also submit updated: Description of Health IT environment (Future Health IT State Spreadsheet) Use Case Development Form(s) Other updates to Transformation Plan (anticipated outcomes measures or baseline measures, collaborating organizations contact information, anticipated milestone completion dates, transaction volume targets) Massachusetts eHealth Institute

Milestone 2 Deliverables Milestone 2 Template Process Improvement Plan Logical Process Diagram of Workflow- for all trading partners Data sharing policies- No longer a consent requirement for Mass HIway Direct messaging Attachments Transaction log(s) or screenshots from sponsoring HIE/HISP detailing live, production transactions involved for each use case Logs or screenshots for each trading partner organization involved in a use case should be included Logs should identify date, sender and receiver (this may be a clinical data repository) for message Milestone 2 Attestations Form for Grantee organization and for each collaborating organization that is listed in the transaction log or screen shot and included in the Use Case Development Form(s) If applicable: updates to Health IT Spreadsheet; policies and procedures to protect ePHI (Milestone 1); Use Case Development Forms; and other updates to Transformation Plan. Massachusetts eHealth Institute

Milestone 2: Process Improvement Plan Massachusetts eHealth Institute

Milestone 2: Logical Process Diagram of Workflow (Example) This diagram includes the details that will change when you implement or change the Health IT at your organization, or participating organizations. Massachusetts eHealth Institute Source: https://healthit.ahrq.gov/health-it-tools-and-resources/workflow-assessment-health-it-toolkit/presentations

Updated Mass HIway Regulations Regarding Patient Consent Direct Messaging (Currently, this is the only service that is offered by the Mass HIway) If you are using the Mass HIway to send Direct messages, your organization does not need to obtain a separate consent from a patient before using the Mass HIway to share their information via a Direct message as long as you are in compliance with applicable federal and state privacy laws (e.g., HIPAA, 42 CFR Part 2, M.G.L Chapter 93H). Mass HIway-Sponsored Services (These are services that will be available beginning in 2018, including a planned state-wide Event Notification Service) “Opt-in with written notice” The opt-in mechanism for HIway-Sponsored Services will be fulfilled by participating organizations informing patients through written notice that they intend to use HIway- Sponsored Services. The written notice must describe how the patient can opt-out. Patients should be notified through one of the following methods: Privacy Notice Patient handout Letter, e-mail or other personal electronic communication to patients HIway Participants may choose to implement additional local opt-in/opt-out processes that would apply to their organization as supplemental processes, not replacements, of these provisions. MA HIway Updated Regulations (February 10, 2017) Massachusetts eHealth Institute

Milestone 2: Description of Data Sharing Policies If your organization uses a local HIE, which is storing protected health information, then your organization will satisfy this Milestone 2 requirement if it adopts policies consistent with the HIway Regulations for HIway Supported Services. This means that as a Connected Communities Grantee, you can satisfy “opt-in” consent requirements by providing written notice to all individuals whose information is stored by the HIE. This written notice can be distributed in any of the ways described in the HIway Regulations, including through inclusion in a privacy notice, on a patient portal, through email, or other mechanisms. This notice does not require a signature from the individual, and it can be distributed independently of a specific patient visit. In addition to the written notice, the local policies must include a mechanism for patients to opt-out of the exchange of their health information. MA HIway Updated Regulations (February 10, 2017) Massachusetts eHealth Institute

Milestone 2: Description of Data Sharing Policies Grantees are required to describe their organization’s policies for sharing patient information and approach to obtain patient consent to share documents electronically, if it is required. Grant Projects include sharing patient information through the following mechanisms Direct messaging to share data No separate patient consent required as long as you are in compliance with applicable state and federal requirements regarding consent Access to clinical data through a centralized data repository (e.g. local HIE) Opt-in with written notice Opt-in with signed consent Massachusetts eHealth Institute

Milestone 3 Deliverables Updates to Process Improvement Plan (Milestone 2) and noted completion dates of improvement activities Attestation Forms confirming that all trading partners are actively participating in use case This includes grant collaborators that: Are listed in the use case development form(s); and Signed attestation forms for Milestone 1 (confirming test transactions) and Milestone 2 (confirming production transactions). If applicable: updates to Health IT Spreadsheet; policies and procedures to protect ePHI (Milestone 1); Use Case Development Forms; and other updates to Transformation Plan. Massachusetts eHealth Institute

Milestone 4 Deliverables Final Report Provide updates on anticipated operational or clinical outcomes included in Transformation Plan (Were you able to achieve the target measures for each use case that you included in the Transformation Plan?) Use Case Expansion Plan How will Grantee sustain and expand participation in the implemented use cases with collaborating organizations and other healthcare organizations, in their community, that were not part of the grant? Expansion Plan will build upon Sustainability Overview (Transformation Plan) Use Case Volume Table (must be signed by officer from all organizations that participated in use case) Grantee and collaborating organizations must share whether they met their 3 month transaction volume targets (identified in Transformation Plan) Grantees should start considering how they will identify transaction volumes between trading partners soon, so that these data sources will be available to track and report on volume for the last three months of the grant period Next we’ll be looking for a Use Case Expansion Plan that will describe how the grantee organization intends to continue to work with the trading partners that were involved in this project and how you intend to expand your use cases to other healthcare organizations within your community that weren’t part of the grant. Finally, you will need to submit a completed Use Case Volume Table listing the number of transactions that were sent between trading partners to support each use case for the last three months of the grant. If you haven’t already, you should start thinking about how you and the trading partners involved in this project will identify transaction volumes so that these data sources will be available to track transaction volume at the end of the grant. Massachusetts eHealth Institute

2016 End of Year Report Feedback: Grant Challenges and Successes Collaborator Involvement Challenge Best practice/strategies to address challenge Finding a convenient/regular time to meet with collaborators, ensuring that collaborators are active participants in the grant project Engage with collaborators via teleconferences, webinars and e-mails on a more regular basis Hold community-wide meetings on a less frequent basis (quarterly) As grant progresses, meet with collaborators at their location for workflow assessments, training and updates Collaborators are behind schedule with EMR or HISP implementations; coordinating varying timelines for EMR implementations and testing with collaborators Shift efforts to collaborators that are ready while keeping those that are behind engaged in the project Manage expectations; get consensus on project design and set realistic timelines Massachusetts eHealth Institute

Best practice/strategies to address challenge 2016 End of Year Report Feedback: Grant Challenges and Successes (continued) Collaborator Involvement Challenge Best practice/strategies to address challenge Involving collaborators that are part of a larger corporation (corporate headquarters may be out of state) Make sure that staff at the corporate level and local sites are included on e-mails and invited to meetings Ensuring that staff at collaborating organizations consistently integrate updated workflow into their routine Include this expectation as part of the training process and follow up post-training Implement an alert to staff (e-mail or text) to ensure that they know that new electronic patient information is available Massachusetts eHealth Institute

Best practice/strategies to address challenge 2016 End of Year Report Feedback: Grant Challenges and Strategies for Improvement Challenge Best practice/strategies to address challenge Keeping staff engaged with project and goals Create leadership buy-in and delegate a “project champion” Limited resources (people, time, funding) and competing priorities Build strong internal talent Celebrate small “successes” Technical integration between different EMR vendors and HISPs Understand your vendor’s technical limitations and ask vendors to work together to identify solutions Addressing inability to separate sensitive information from other clinical information to be sent to trading partner Ongoing challenge Patient consent materials being developed by MeHI’s Learning Collabortive and will be shared later this year Massachusetts eHealth Institute

Communities Grantee Recommendations Create leadership buy-in and delegate a “project champion” Manage expectations, get consensus on project design  and set realistic timelines Have regular communication with grant collaborators and vendors. Frequent e-mails and phone conversations reinforce the relationships needed for a successful project. Provide collaborators with a detailed listing of grant requirements so they understand their responsibilities. Obtain current workflows from each collaborator as soon as possible to better understand each step and the opportunities to improve workflow If your organization is part of a continuum of care committee invite collaborators to join so they can discuss use cases that support transitions of care   Power through obstacles and find the workarounds “Keep your ears open for problems in your community and keep your mind open for creative solutions. Our communities have lots of use cases that are just waiting to be discovered.”   Massachusetts eHealth Institute

Innovative Successes Among Communities Grantees Reliant Medical Group went live with electronic signature for consent to release patient information. Whittier IPA has developed and tested admission and discharge alerts from Anna Jaques to Wellport HIE, and designed a standard workflow for medication reconciliation using the HIE. Upham’s Corner Health Center will be hiring a dedicated medical records staff member to ensure that all clinical notes sent from specialists to PCPs are included in patients’ records. Cape Cod Healthcare has successfully auto-routed CCDA’s to individual physician Direct addresses through testing. CCHC also expanded the level of engagement among post-acute care and community health centers in the area. Brockton Neighborhood Health Center and its 4 collaborators have successfully exchanged test messages and have used quarterly meetings to address project-related issues. Behavioral Health Network has enhanced its interfaces to separate sensitive information when sending clinical information to one of its collaborators. This will serve as a “roadmap” for other organizations that need to address this issue. Berkshire Medical Center plans to have single sign-on to patient records for the Berkshire Medical Center provider community. Lowell General PHO has implemented a care management solution that will allow members of a patient’s care team to update and view their full care plan. Massachusetts eHealth Institute

Connected Communities Resources Keely Benson, Connected Communities Program Manager and Northeast Community Manager (Lowell General PHO, Upham’s Corner Health Center and Whittier IPA) benson@masstech.org Stephanie Briody, Southeast Community Manager (Brockton Neighborhood Health Center, Cape Cod Healthcare) briody@masstech.org Andrea Callanan, Central/Western Community Manager (Behavioral Health Network, Berkshire Health Systems and Reliant Medical Group) callanan@masstech.org Olivia Japlon, Program Associate japlon@masstech.org Joe Kynoch, MeHI Technical Project Manager kynoch@masstech.org For more information and grant resources, please visit the Connected Communities Implementation Grantees and Collaborators webpage Massachusetts eHealth Institute

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