CMS awards $16.9 million to Massachusetts for health information exchange

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The Bay State has received $16.9 million to improve communication between providers, payers, and the government. Its efforts could serve as a model for other states.

Massachusetts has become the first state to secure Medicaid funding specifically to create a health information exchange (HIE) to improve communication between providers, payers, and the government. The commonwealth’s use of the funds could serve as a model for other states.

So says John D. Halamka, MD, MS, chief information officer of Beth Israel Deaconess Medical Center, chairman of the New England Healthcare Exchange Network (NEHEN), co-chairman of the federal advisory Health Information Technology Standards Committee, a professor at Harvard Medical School, and a practicing emergency medicine physician.

The Centers for Medicare and Medicaid Services (CMS) approved $16.9 million for the HIE in February. In June, Massachusetts signed a contract with Orion Health to build the exchange.

In a slide presentation to a Massachusetts Health Data Consortium event, Halamka outlined the following phases for implementation of the HIE:

Phase 1 (information highway): Create infrastructure to enable the secure transmission of clinical information that will support exchange among clinicians, public health, and stand-alone registries.
Phase 2 (analytics and population health): Create infrastructure to facilitate data aggregation/analysis that will support the Medicaid clinical data repository and quality measures infrastructure and support vocabulary translation services (such as lab and prescription).
Phase 3 (search and retrieve): Create an infrastructure for cross-institutional queries for and retrieval of patient records.

Massachusetts healthcare providers, payers, and e-prescribing vendors have been exchanging patient health information since 1997 through the NEHEN. The new Massachusetts HIE, according to Halamka, will connect every healthcare provider in the commonwealth through a common set of federal standards that mirror those found in the federal government’s proposed rule for meaningful use stage 2.

“We recognized that Medicaid, which exists in all states, has a strong desire to ensure that its patients receive coordinated care,” Halamka tells Medical Economics, adding that in Massachusetts, all hospitals and 80% of providers accept Medicaid. “So we asked Medicaid if they’d be willing to provide matching funds,” he says.

The state expects overall total funding of up to $50 million. CMS, however, has only approved the $16.9 million for phase one at this point.

“Other states can do this as well, but payers, providers, and government need to work together,” Halamka says. “If you build a backbone that connects hospitals and healthcare providers in the state…to support the care coordination Medicaid wants, you can reuse that backbone for all kinds of purposes. By using state funds with Medicaid matching funds and private contributions, we get a sustainable business model that isn’t just grants that run out and infrastructure that can’t be maintained.”

Halamka adds: “We can cover 80% of the hospitals, doctors’ offices, long-term care facilities, and behavioral health facilities by purchasing interfaces from 16 electronic health record [EHR] vendors.”

Three major work streams are required, he says. “Stream number one is for building the infrastructure. Stream number two is for buying the interfaces on behalf of the hospitals and physicians from the 16 EHR vendors. And stream number three is funding to pay for full EHR installation and training for 2000 providers and 20 hospitals that we considered ‘especially challenged’ to do this work on their own.

“In effect, we’re making sure that the last mile gets connected to those who can’t afford to do it themselves,” Halamka says.

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