April 2021 Newsletter

As of today, April 1, the New England Healthcare Exchange Network (NEHEN) has merged with MHDC.

In 1994, MHDC formed the Affiliated Health Information Networks of New England (AHINE). MHDC established AHINE to advance the use of information technology in improving the health status of the citizens of Massachusetts. AHINE served as a forum for the IT leadership of regional providers and payers and members of the healthcare IT service and product community to discuss common issues, share experiences, sponsor conferences, and develop white papers on current topics. AHINE enabled the regional IT leadership to develop close and effective working relationships, a critical contributor to that leadership's willingness to engage in the mutual development of NEHEN. In 1998, AHINE incorporated as NEHEN, a collaboration among payers and providers using a shared insurance EDI infrastructure to exchange transactions.

In many ways, NEHEN set the standard that MHDC upholds today – that collaboration among payers and providers in advancing shared data and technology priorities will achieve superior results, reduce costs substantially, and produce solutions that work for all. Before NEHEN, MHDC was a central data collection, dissemination, education, research, and analysis organization. AHINE, and then NEHEN, taught us a lot about how to collaborate effectively. With the merger, MHDC becomes a health data services partner for payers, providers, and patients. By assisting our community in advancing to a 21st century health data economy, we reduce our members' exposure to the risks of failing to comply with regulations as well as reduce investments in redundant and costly technologies and implementations that fail to meet their goals. We promulgate standards, engage industry leaders, and move as a group toward the common goal of a patient-centered health data system. MHDC's founder, Elliot Stone, envisioned MHDC achieving these goals and, were he alive today, I think he would be thrilled with the progress we have made. I know I am.

Be safe, and stay well.

Denny Brennan, Executive Director

Please let us know what you think of our newsletter at newsletter@mahealthdata.org and look for our next issue. Thank you for your continued support and participation!

Introducing The Vantage Point Series

Join us for exclusive interviews with some of healthcare’s most recognized leaders as they reveal how and why they chose their careers, what they learned on their journey, and how to apply their insights to the everchanging future of healthcare.

Our first Vantage Point Series event features former President and CEO of Cambia Health Solutions, Mark Ganz on April 20th from 1-3pm.

MHDC and NEHEN Events

April meetings:

  • Board of Directors: Apr 29, 8-10am
  • CIO Forum: Apr 14, 8-10am - CANCELLED
  • DGC Steering Committee: Apr 7, 21, 3-4pm
  • DGC Working Group: Apr 7, 14, 21, 11am-12:30pm
  • NEHEN Business Users Group: Apr 1, 9-10am
  • Spotlight Users Group: Apr 27, 2-3pm
  • The Vantage Point Series with Mark Ganz: Apr 20, 1-3pm
  • Webinar: Medically Home: Apr 8, 1-2:30pm

In addition, the next DGC Deep Dive on Telehealth is today (April 1) from 2-3:30pm

Want to learn more about any of these meetings? Email info@mahealthdata.org

MHDC Webinars

Join us for our upcoming webinar Build or Buy: Acute Care at Home presented by Medically Home on April 8 from 1-2:30pm. 

Missed any of our webinars in 2021? Click here to see what you've missed! 

Interested in holding an MHDC webinar or have an interesting topic you'd like to present? Contact us at webinars@mahealthdata.org

DGC Update

The Data Governance Collaborative (DGC) at MHDC is a collection of payers and providers throughout the region exploring ways to better exchange health-related data incorporating industry standards and automation as much as possible.

The DGC expects to move to the implementation phase of the code mapping service soon. This system will be available to anyone (with a discounted rate for DGC members). We anticipate going live around July.

In addition to continuing our successful series of deep dives (the next one is today at 2pm on telehealth), the DGC is digging into demographic and other patient data, mapping it to US Core, and determining what we want to support above and beyond the minimum requirements. We will continue this process for additional types of data as part of our process of defining the next specification on our way to the planned one pot of data exchange.

We are still working on getting signed agreements in place for the electronic prior authorization (ePA) project. Once we do we'll announce the participants. We plan to keep everyone updated on the process so watch this space!

We have also partnered with a company called Mettle Solutions to apply for an AHRQ grant involving setting up FHIR-enabled guidelines for screening, diagnosis, and non-surgical treatment of urinary incontinence in women that can be integrated into standard provider EHR workflows and available to patients via a FHIR-enabled mobile app. This project leverages both data standardization and interoperability to improve patient care. Our approach can be reused both by additional provider and patient communities and for the screening, diagnosis, and treatment of other conditions.

Membership in the DGC is open to any payer or provider with business in Massachusetts - big or small, general or specialist, traditional or alternative. Want to know more? Email datagovernance@mahealthdata.org

NEHEN Update

NEHEN (New England Healthcare Exchange Network) is now part of MHDC. NEHEN reduces administrative burden through the adoption of standard X12 (HIPAA transactions) for payer and provider trading partners. Existing NEHEN members will now be Affiliate members in MHDC with access to NEHEN services, forums, and events hosted by MHDC, as well as have the opportunity to participate with discounts in other Consortium efforts such as the Code Mapping Service, the Data Governance Collaborative and the Electronic Prior Authorization initiative. For information about NEHEN please contact us at members@nehen.org.

Spotlight Analytics Update

Spotlight Business Analytics helps your organization run custom analytics on health data such as analyses of market share, patient origin, disease prevalence, cost of care, and comparative costs and outcomes for acute care hospitals.

The Spotlight team is in the process of loading the Massachusetts (CHIA) Emergency FY19 data. Once it is loaded and ready for use, we will send out a notification to all users. We have just finished enhancements and updates to a new dashboard layout to make it easier to access the tools within Spotlight. The new dashboard is the home page and from there you can easily see each report as well as access custom reporting or your saved custom reports faster. You'll also notice the left hand side bar will have relevant links for quick access. For more information on these updates please feel free to reach out to us at spotlight@mahealthdata.org.

Please join us for our next Spotlight User Group meeting on Tuesday, April 27 at 2pm for our latest updates and any questions you may have. To receive login details please use the registration link above.

Our current status is:

Loaded and available for use:

  • Massachusetts Hospital Inpatient Discharge Data FY19 (HIDD)
  • Rhode Island Hospital Inpatient Discharge Data FY19
Received and in progress:
  • Massachusetts Emergency Department Discharges FY19 (ED)

Expected very soon: (CHIA has begun distributing this dataset)

  • Massachusetts Outpatient and Observation FY19 (OOD)

Future planned data:

  • New Hampshire Facility Discharge Data Sets (tentatively approved)
  • Maine Hospital Inpatient and Outpatient Data

Please feel free to drop us a line with any questions or comments at spotlight@mahealthdata.org. In the meantime, thank you for being a Spotlight Analytics user and a member of this community! Feel free to visit our Spotlight Business Analytics page or email us at the address above for more information.

Industry Events

Interested in webinars and online conferences through April? Here are some we recommend (they're free unless otherwise noted):

We do periodically post webinars we plan to attend on social media, so feel free to follow us on Twitter (@mahealthdata) and LinkedIn for more webinar ideas and for our take on interoperability, data, health equity, telehealth, APIs, and other topics of interest.

Have an upcoming event next month to suggest? Write us at newsletter@mahealthdata.org - no self-promotion please.

Event Notification: Massachusetts and Federal ADT Requirements

According to the EOHHS, all acute care hospitals in the State of Massachusetts are required to comply with a new statewide event notification service (ENS) framework by April 1, 2021. A month later on May 1, CMS will require all hospitals (including behavioral health and critical access hospitals) to send admission, discharge, and transfer (ADT) event notifications to all providers primarily responsible for a patient's care. This will be a condition of Medicare and Medicaid participation (CoP - Condition of Participation), meaning that hospitals that don't comply risk being unable to collect payments for patients and services from Medicare or Medicaid.

The good news is that participation in the Massachusetts ENS Framework also meets the CMS requirements. In fact, to meet the needs of care coordination within the commonwealth, the Massachusetts rules have additional requirements above those from CMS including requiring the use of one of two certified ENS vendors (Patient Ping or Collective Medical Technologies). Since the state regulations begin a month before the CMS regulation takes effect, no additional work should be required for Massachusetts hospitals.

Vendor Requirements

The CMS requirement falls solely on the hospital source to identify, keep records of, and make reasonable efforts to notify electronically the patient's primary care physician, applicable specialists, and applicable post-acute care providers who need the information for coordination of the patient's care. The use of vendor-based solutions to meet these requirements is allowed and encouraged but not required in the CMS rule.

The Massachusetts rule takes this a step further and not only requires the use of one of the certified solutions but also requires the certified vendors to accept and forward notifications from hospitals that are using a different certified solution. This is a key improvement over the Federal model because it ensures interoperability among different systems and vendor solutions. The point is to create an open exchange framework that allows hospitals to use the certified ENS services of their choice while assuring the patients, providers, and allied professionals that no matter where a patient is seen in the commonwealth, notifications will be sent.

Risks of the Massachusetts ENS System

There are inherent risks and caveats with this solution, as there are with any complex system. Each certified vendor will employ its own patient matching methods and algorithms since there is no universal patient identifier or standard mechanism for performing patient matching at this time. Most of these solutions will entail collating and comparing loosely controlled data, publicly known identifiers, and demographic information such as name, date of birth, address, and phone number. This data may not be consistent in every location being compared and even with sophisticated matching methods such as Soundex and leveraging publicly available demographic data, there will never be a matching process that works 100% of the time.

Another challenge is identifying and registering the providers who need to be notified of events related to a given patient. Patient attribution to providers is not an exact science and requires patient input and consent to administer. Also, the relevant list of providers may vary depending on the event triggering the notification and so even an accurate list may not be the correct list to use. This adds burden to providers and patients to coordinate and communicate around who should receive notifications and to register those providers in the notification services so they receive the expected notifications.

There are other challenges as well such as maintaining the correct interfaces to the notification services, proper standardization of the message data, technical issues with the sending or receiving systems, human error, and the list goes on.

MHDC CIO Forum on Event Notification Services

In a special MHDC CIO Forum (for members only) on November 19, 2020, state officials, both certified ENS vendors, leading provider organizations, and industry leaders gathered virtually to discuss the merits of the regulatory requirements, the Massachusetts versus CMS plans, and where the future is headed in terms of event notification.

We were joined by Micky Tripathi, formerly the CEO of the Massachusetts eHealth Collaborative (MAeHC) and now the National Coordinator for Health Information Technology. At MAeHC Micky and his team stood up and supported an ENS primarily for clients within the commonwealth. His vision aligned well with the group overall including a belief that the national ENS program should mimic what Massachusetts is doing and require coordination and exchange among all ENS services. There will never be a single source of truth for notices, patients, and providers so agreeing to exchange with each other strengthens the value considerably and creates a unified approach to care coordination and communication.

Micky went on to applaud EOHHS's efforts to do just that within Massachusetts. In addition to pointing out the inherent flaws in the Federal model and applauding our local approach, Micky also suggested we need an exit strategy for these regulations given how soon they could become obsolete. ENS-specific services are only necessary now because we do not have a direct method of accessing this data through normal workflows. The increasing availability and use of cooperating services like CommonWell and Carequality as well as adoption of RESTful APIs, FHIR frameworks, and data standards driven by the recent CMS and ONC rules will make this data readily available and thus remove the need for a separate workflow.

This should not to diminish the importance of both the CMS and State ENS regulations or dissuade anyone from their adoption. There is a clear and evident need for this service now before the advancements in technology and integration displace it. The Massachusetts model seems to have more merit and will likely withstand the test of time better than the Federal model, but as the evolution of health IT moves us forward and adds to the body of knowledge we should quickly move beyond the need for a separate ENS system.

Wrapping Up

Before we go, here's a reminder of upcoming data exchange deadlines from ONC and CMS (including the CMS rule that's currently frozen, as noted by *):

And that's it, folks. Loved it? Hated it? Have an idea for next time? Send us feedback and suggestions about this newsletter at newsletter@mahealthdata.org or send us feedback and suggestions about anything else at info@mahealthdata.org.

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