Commonwealth of Massachusetts Executive Office of Health and Human Services Mass HIway Overview MEDITECH Client Pilot Kick-off June 24, 2013

– Hospitals – Health Care Providers – Laboratories – Pharmacies – Skilled nursing facilities – Public Health Agencies – Health Plans – Patients (future release) 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: 2

Mass HIway Health System Hospital Small Practice Skilled Nursing Facility Public Health Laboratory Pharmacy Patient (future release) Health Plan Hub for Health Information Exchange 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 Depending on the specific application, data exchanged may include: 3

Connection options Participant directory Certificate repository Secure messaging Message Transformation Secure web mail HIway Services User types Methods of connecting to the Commonwealth’s HIE Connect with local gateway Browser access to webmail inbox Physician practice Hospital Long-term care Other providers Public health Health plans Laboratories and imaging centers Connect through LAND Device (Local Application for Network Distribution) EHR Connect directly 4

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 (HL format) Message transformation – technical format of messages are automatically changed to meet the requirements of the receiving system Secure Webmail – secure and attachments among participants of the network HIway Services 5

Phase 1Phase 2 HIE components Provider directory PKI infrastructure Direct/HL7 gateway Web portal mailbox Master Person Index Record locator service Consent database Patient-directed messaging Query/retrieve infrastructure HIE end-points Any TPO participant Public health SS, CBHI, MIIS MassHealth clinical data repository Medicaid/HIX participants Public health ELR, PMP, Opioid, Lead Capabilities phasing plan A richer set of services available to a broader set of participants 6

Direct S/MIME Overview 7

HIway Operations, Services and Support 8

OrganizationUse CaseStatus/Target Date In Production BIDMCSeveral 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 CenterDischarge 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 HealthReceive Discharge Summaries from Tufts Medical Center and BIDMC Production with BIDMC and Tufts Medical Center HIway Clients: In Production 9

OrganizationUse CaseStatus/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 MedicalPart 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 HarrisCoordination of behavioral care with multiple facilities HIway Clients: Live 10

OrganizationUse CaseStatus/Target Date Implementation Boston Public Health, Atrius, Children’s, Partners Care coordination, management Various levels of testing Harvard Pilgrim HealthDischarge 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: MEDITECH PilotPilot project with 4 MA key MEDITECH clients Kick-off session June 24 HIway Clients: Implementation and Onboarding 11

OrganizationUse CaseStatus/Target Date Near Horizon: Baystate Opiod Treatment Providers (DPH) DPH – Immunization, ELR, Syndromic and CBHI Several – Implementation Grant and PVIX Intake, Enrollment, Assessment and Treatment More active outreach to current users of DPH programs to move traffic to HIway Kick-off expected in July Provider kick-off – 6/25/13 Ongoing – with more concerted focus beginning in 3 rd 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 HIway Clients: Horizon 12

MA HIway Operating Model Pre-Implementation: LM Customer Relationship Managers or through a Service Manager if client is ready for Implementation Operations: Service Manager as single point of contact supported by Technical Engineers, Operations staff, web portal and MA-HIway 13

MA HIway Delivery Model Client Experience Project Management Installation Participant Relationship Call Center Back Office Support Contracts Verification Reporting Billing Documentation Technical Excellence Environmental Stability System Performance Enhancements Change Control Complex Clients 14

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 Usage Reports Request Tracking 15

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 16

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 :(781) 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 17