State of Maine Department of Health and Human Services (DHHS) Office of MaineCare Services Office 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 Health Information Exchange in Maine

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 Health Information Exchange in Maine

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 updateReport Feb 2014 Program PriorityStatus as of December, 2011 Target for December, 2012/13 Status as of January, 2014 Target for December, % of labs sending electronic lab results to providers in a structured format 4 67%75%93%95% 1. % of labs sending electronic lab results to providers using LOINC 67%75%81%95% ONC Program Priority Areas: Electronic Lab Results

Report in first SOP updateReport Feb 2014 Program Priority Status as of December, 2011 Target for December, 2012/13 Status as of January, 2014 Target for December, 2014 Public Health agencies receiving ELR data produced by EHRs or other electronic sources. Data are received using HL LOINC and SNOWMED Yes/no or % 1=Yes 1=Yes 1=Yes 1=Yes Immunization registries receiving electronic immunization data produced by EHRs. Data are received in HL or 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 HL or 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 HL or Yes/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