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HOME CARE ALLIANCE OF

MASSACHUSETTS REPORT ON
HEALTH INFORMATION EXCHANGE
(HIE)ADOPTION SUPPORT PROJECT
2016
Report Prepared by: HCA of MA Project Committee
Based on survey work by: Massachusetts EHealth Collaborative
(MAeHC)

Background

Member agencies of the Home Care Alliance in many cases have worked with various technology vendors
to implement internal electronic health records (EHRs), but are challenged in terms of connectivity with
referral sources and physician practices.
A 2014 report from the Massachusetts eHealth Institute (MeHI), the designated state agency for
promoting Health IT innovation, technology and competitiveness to improve the safety, quality and
efficiency of health care, found that 74 percent of home health agencies have adopted electronic health
records and only 28 percent of healthcare entities use health information exchange (HIE) for transitions
of care. Despite being relatively advanced with the use of mobile technology and home tele-monitoring
systems, among other tools, the MeHI report identified home health agencies as being among the least
likely of all provider types to participate in health information exchange, with current participation
estimated at 17 percent.
This report starts with this question: Given the promise and availability of the HIE in Massachusetts, why
arent more than 17% of home health providers participating in this important technology? Perhaps the
most important factor is that home health, along with behavioral health and long term care providers did
not receive financial incentives under the HITECH Act and American Recovery & Reinvestment Act (ARRA)
that hospitals and eligible medical professionals have used to offset costs related to achieving meaningful
use of health IT, such as HIE adoption. In addition, the anticipation that new care and payment models,
such as ACOs, might support the cost of health IT/HIE adoption among non-incentivized providers, such
as home health, has not yet been realized.
Despite the low participation by home health in HIE, and a lack of government sponsored funding thus
far, connectivity has been identified as an essential strategy for sustainability and success for home care
going forward. For example, electronic connections between home health agencies and physicians are
becoming increasingly critical to support multiple care processes including continuous updates and signoff on care plans, alerts/status updates, medication ordering and oversight, and chronic care
management.
While the industry continues to lobby for IT funding for long term care in future phases of meaningful
use, Home Care Alliance of Massachusetts (HCA of MA) has taken steps to better position home health
agencies to demonstrate their value proposition as connected partners. To do this, HCA of MA contracted
with the Massachusetts eHealth Collaborative (MAeHC) to survey members agencies in order
to develop strategies for expanding home health participation in health information exchange (HIE).
The Massachusetts eHealth Collaborative (MAeHC) is a national leader in health information technology
implementation, delivery strategy, and best practices for meaningful adoption of electronic health
records, including Health Information Exchange (HIE) projects.
This report presents an overview of the survey process and findings as well as general recommendations
to the membership regarding HIE adoption. Members who participated in the survey were provided with
individualized strategies for accessing and utilizing the Mass HiWay. Agencies who did not participate in
the survey may find this report a useful tool to complete an assessment of their agencys state of readiness
for HIE adoption.

I.

Understanding this Report

The purpose of this report is to present key findings from the HCA of MA landscape survey and provide
recommended next steps for participation in HIE. The data was collected from a 40 question electronic
survey which was sent to all certified home health agencies across the Commonwealth. (See Appendix
A). Questions were divided into 6 categories: 1) Leadership & Organizational Alignment, 2) Alternative
Payment Models, 3) Infrastructure, 4) EHR/HIE capabilities, 5) Use of Electronic tools, 6) IT Staffing

Agencys survey answers were analyzed and a level of readiness for HIE/HIT adoption was
assigned for each of the 5 categories of questions. The following was used to benchmark each
responding agencys readiness.
Category

Level 1

Level 2

Level 3

Level 4

1) Leadership &
Organization
Alignment

No defined clinical Clinical and business


and business needs needs for IT are loosely
for IT and
defined and leadership
leadership is
primarily is involved at
inactive
key decisions

Clinical and business


needs align with IT and
are clear but not widely
shared across leadership

2) Alternative
Payments

Funding sources
not identified to
cover investment

Funding identified to
Funding identified to cover
cover investment
HIT investment through
through HIT focused
value-based initiatives (i.e.
metrics within state level ACO, preferred provider)
grants

3) Infrastructure

No internet access Dial-up and/or no


for clinical staff
broadband access

Broadband available to
staff but no remote
access and/or mobile
devices not deployed

Secure wireless network and


deployment of mobile
devices to clinical staff

4) EHR/HIE

No electronic
documentation
system

Have some type of


electronic
documentation system

Use EHR and do


exchange some
information with other
orgs

Use EHR and exchange


information with other orgs
over an HIE and/or send or
receive alerts

5) Use of
electronic tools

Do not use any


electronic tools
regularly

Use an electronic order Use multiple electronic


entry or reporting
tools for clinical,
system
reporting or
administrative functions

6) IT Staffing

No IT resources,
IT resources engaged as Dedicated IT resources Dedicated, full-service IT
staff not trained to needed (not dedicated), engaged Staff trained resources engaged Staff
use HIT
staff has some training in in basic use of HIT
highly trained in use of HIT
HIT

Funding to cover
investment is possible
through grants

Clinical and business needs


for IT alignment are clear and
shared across an active
leadership

Regularly use electronic tools


(such as e-referrals),
reporting tools (such as for
OASIS, and mobile tools
(devices, monitors)

A. Summary of General Survey Findings


1. Despite the lack of direct incentives available to other health care providers, home care agencies
in Massachusetts have a high level of adoption of basic EHR technology, and their use of this
technology for core EHR functions appears to be high as well. (See Charts A and B below.)
2. Achievement of interoperability is uniformly low, and where it exists, it is very fragmented.
Patchwork of types and methods of exchange exist which vary by vendor, agency factors, and
local environmental factors. For example: although 45% are connected to the Mass HIway, none
of the surveyed agencies use it for routine interoperability needs.
3. Leadership and organization alignment with advanced payment model goals appears to be a
key factor in adoption of EHR/HIE technology. At this point, not all agencies have equal access
to advanced payment model opportunities, however, some type of models are available to
virtually all agencies (e.g., bundled payments, etc)
4. Progress in EHR/HIE maturity is highly dependent on local factors. A major driver is the
technology capability and requirements of key trading partners, such as hospitals and physician
practices. Agencys query/retrieve and view capabilities are highly dependent on actions and
motivations of these partners. As a result, each agencys roadmap will need be adapted to these
local factors
5. Some core EHR/HIE technology functions should be adopted by all home care agencies. This
would include the ability to send/receive Clinical Care Documents (CCDs) through Direct
messaging capability via the Mass HIway or connected networks. Additionally, having basic
send/receive capability will be important to all care transitions
6. Choice of vendor may influence HIE capacity. 14 different technology vendors were identified
in the survey, only 6 vendors have versions that are ONC certified: Allscripts, Cerner, Epic, GE,
Healthwyse and McKesson.

The vendors that the responding agencies used were as follows:


Vendor
Healthwyse
Allscripts
Axxess
McKesson
Cerner
Homecare Homebase
Additional (only 1 agency per vendor)

# Agencies
7
4
3
2
2
2
8

Chart A. Use of Electronic Communication by Responding Agencies

Chart B Type of Clinical Information Received Electronicaly

A. Summary of Key Findings by Category


1. LEADERSHIP & ORGANIZATIONAL ALIGNMENT
Key Findings: Leadership and staff buy-in on the transformation of health care delivery models from feefor-service to an outcomes/ value-based model is vital for bridging the transition of these two models. An
emphasis on quality care delivery, in a highly-reliable model through integrated and interoperable systems
across the continuum is integral to this success.
Leadership and organizational alignment with advanced payment model is a key factor in adoption of
EHR/HIE technology
Recommendations:

Leadership should identify patient outcomes of care and utilize dashboards and benchmarks
to facilitate staff understanding of the shift from a fee for service model to an outcomes based
model. Some tools for informing staff on the value-based and alternative payment models
can be found at: https://innovation.cms.gov/index.html

Leadership should identify the participation of trading partners (hospitals, physician practices,
post-acute partners) in alternative payment models and seek alignment. Consider creating
care pathways with hospitals or providers participating in a bundled-payment for a disease

which your organization offers stellar home care (i.e. CHF bundle at hospital and tele
monitoring in the home).

Leadership should determine if there are preferred provider and/or integrated delivery
networks within the agencys catchment area and speak with point of contact to inquire about
the participation requirements, goals, quality metrics, and benchmarking possibilities.
Business plans and clear marketing tools to portray clinical offerings are vital for care
managers to have access to when referral patients, ensure these are regularly circulated and
to the correct contacts.

Finally, leadership should monitor transformation funding opportunities by subscribing to


pertinent mailing lists and regularly visiting leading funding sources, such as Robert Wood
Johnson Foundation and the Department of Health and Human Services grant website. State
funding opportunities for system redesign with technology as integral for enabling care
innovation can be found through both the Health Policy Commission and Massachusetts
eHealth Institute. Regularly exploring areas of potential grant funding is necessary for many
agencies to invest in HIT.

2. INFRASTRUCTURE
Key findings:
All agencies have access to broadband internet.
Reliable, high speed internet is a prerequisite for a range of technologies that can provide more costeffective and higher-quality care, such as telemedicine and remote patient monitoring. This is especially
important for the providers who wish to participate in alternative payment and care delivery reforms like
medical homes, bundled payments, and Accountable Care Organizations, which are particularly likely to
depend on telemedicine and better communication capabilities to succeed.
Recommendations:

Agencies with slow and/or unreliable internet connection should consider speaking to your
service provider about increasing bandwidth. The Federal Communications Commissions (FCC)
Connect2HealthFCC initiative provides a list of potential federal funding sources for
telecommunication
and
broadband
services.
For
more
information,visit:
https://www.fcc.gov/general/funding-broadband-enabled-health-care

Many organizations have a dedicated internet connection for their electronic medical record.
Consider weighing the cost of setting up an additional connection with the cost of wasted staff
time and frustration.

3. EHR & HEALTH INFORMATION EXCHANGE


Key findings:
Most agencies are documenting information electronically, but many cannot electronically exchange data
with trading partners. There are EHR/HIE technology functions that should be adopted by all home care

agencies, including ability to send and receive Continuity of Care Documents through Direct messaging
capability via an HIE.

Recommendations:

All home health agencies should adopt Office of the National Coordinator (ONC) certified
Electronic Health Records as soon as possible. Of those not currently using an HER at the time of
the survey, 100% reported that they intend to in the near future.
All home health agencies should take steps to connect to the Mass HiWay. Only thirteen agencies
indicated that they were participating in the Mass HiWay. (Details about connecting to the Mass
HiWay are provided in Appendix B.) The Mass HiWay relies upon participants commercial
internet connectivity and does not utilize any private networks or dedicated circuits.

4. USE OF ELECTRONIC TOOLS


Key Findings
Most agencies report using smart phones and or tablets for Point of Care documentation. Almost all
agencies utilize an electronic order system and roughly 73% of respondents regularly use electronic tools
for referrals and OASIS reporting.
Recommendations

Full adoption of a paperless, electronic- based system. Trading partners want a single method
of sharing information. Faxing and mailing documents will be obsolete in the near future

Provide all staff with electronic devices to communicate across the continuum.

Implement telehealth programs for chronic disease management. Most systems provide
alerts to agencies as well reports, which can be electronically sent to physicians. MassHealth
may soon be reimbursing agencies for telehealth monitoring.

Utilize encrypted smartphones to send pictures along with clinical information to physicians
for ongoing patient management and updating of orders.

5. IT STAFFING
Key Findings:
EHR vendors recognize the importance of attending to client workflow and process changes, but most
agencies do not have the dedicated staff resources to make it a cost-effective part of their
implementations. Most EHR vendors offer self-service tools such as online videos and user groups.

Suggested Actions:

Low cost and/or free part-time workforce development programs are available at a number of
Massachusetts institutions. Bristol Community College offers an online program designed to
prepare a workforce of seasoned professionals with the requisite knowledge able to assist and
support HIT adoption. http://mehi.masstech.org/programs/workforce-development/bristolcommunity-college-hitech-program.

Additional

workforce

development

related

programs

are

listed

here:

http://mehi.masstech.org/programs/workforce-development

II.

Conclusions and Possible Next Steps:

The HCA Member Survey was undertaken in order: 1) to assess an agencys readiness to use the Mass
HiWay, and 2) to provide individualized road maps for participating agencies to connect to, and begin
sharing information via the Mass HiWay
Electronic connectivity to healthcare partners has been identified as an essential strategy for sustainability
and success for home care going forward. Results from the Home Care Alliance of Massachusetts HIE
Adoption Survey suggest that the industry may be ready, but that many member agencies are not well
connected electronically to their referrers, physicians, hospitals and other trading partners along the
healthcare continuum. Without the financial support of the Federal Government, and other stakeholders,
home health agencies have been forced to rely on their own financial resources to both adopt and
implement electronic health records. Many of the home health EHRs do not communicate well with each
other and this has negatively impacted an agencys ability to utilize communication across the continuum
through the use of a health information exchange.
Agencies who did participated in the survey received readiness roadmaps. Other agencies as well as policy
makers should find this report useful as a means of assessing their agencys and the industrys state of
readiness to begin utilizing the Mass HiWay to connect to their trading partners across the continuum.
Possible Next Steps for HCA of MA:

Continue efforts to educate all member agencies on the importance of electronic connectivity

Work with MAeHC and MeHi to assist all non-participating agencies to access and utilize the Mass
HiWay

Engage funding sources to support home care agencies to adopt electronic technologies

Appendix A
The MAeHC survey document.

Appendix B
Information on the Statewide Health Information Exchange (The Mass HIway)
1. Overview
The Mass HIway is a state-wide Health Information Exchange (HIE) that is open to all interested
providers, hospitals, and other organizations within the healthcare community. Mass HIway offers two
services to support exchange of health information:
Direct Messaging: Secure point-to-point transport of electronic patient health information among
healthcare organizations and authorized government agencies for purposes of patient treatment,
payment, or operations.
Query and Retrieve: Relationship Listing Service (RLS) for authorized healthcare organizations to locate
other healthcare organizations that hold records for a particular patient. Medical Record Request (MRR)
service for initiating a query for a patients records.
The HIway is not a repository of health information, it is a tool for sending secure health information
from one organization to another. Similar to package delivery, the HIway reads only the address on the
message, it does not open the message content.
There are three regional presentations available for download which provide a geographically focused
update on HIway active use:
Mass HIway Overview: Whats happening in My Community?
Southeast Region Presentation
Western Central Massachusetts Presentation
Northeast Region Presentation

2. Current HIway Participants and Provider Directory


Over 600 organizations are participating in the HIway, the full list of participants is available here. If you
don't see your trading partner on this list, let the HIway team know by emailing masshiway@state.ma.us
or calling 1-855-MA-HIway (624-4929) and pressing option 1.

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The Participant list includes organizations that have signed a Participation Agreement with the Mass
HIway and are either implementing or actively transacting. Use this list to identify any organizations in
your referral circles are on the Mass HIway, then reach out to them to discuss a potential use case for
the Mass HIway with your organization.
Some EHR vendors use a Health Information Service Provider (HISP), providing a connection to the
HIway on behalf of their users. If your vendor allows you to choose which HISP to connect to, you can
connect directly to the Mass HIway HISP. If your vendor requires that you use their designated HISP,
you will have to connect to the Mass HIway through their HISP, as long as their HISP is connected to the
Mass HIway.
If you are a member of a HISP that is connected to the Mass HIway, contact your vendor representative
to discuss the steps to get connected to the Mass HIway network. The following HISPs are connected
with the Mass HIway:

Aprima
Athenahealth
CareConnect (NetSmart)
Cerner
DataMotion
eLinc
eClinicalWorks
EMR Direct
Inpriva
MaxMD
MedAllies
Medicity
MyHealthProvider (Mercy
Hospital)
NextGen Share
NHHIO
RelayHealth
SES
Surescripts
UpDox
Wellport (by Lumira)

3. Provider Directory Service


The Mass HIway Provider Directory (PD) is a look up tool to locate a known contact at another
participating organization (i.e. locating Dr. X at facility Y). In order to use the Mass HIway, all Participants
must provide contact addresses where departments or individual staff can send and receive secure
communications.

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Getting data in: Mass HIway provides the domain name and the Participant provides the organization
information, individual addresses for their authorized users, and the minimal data set required to power
the Directory.
For first time uploads into the Provider Directory, Participants must supply this information using the
below documents. Once the initial upload is completed, Participants must use the HIway Directory
Provider Upload file to submit new additions, changes, or deletions.

4. Public Health Reporting


The Mass HIway enables the electronic submission of reporting for public health registries to improve
public health research, intervention, and program development. This allows for easier compliance with
applicable state laws and can also help providers earn incentives in Stage 2 of Meaningful Use. For more
information on Meaningful Use and Public Health objectives and steps to submit, click here.
The following state registries and applications are connected to the Mass HIway:
1. Syndromic Surveillance (SS): State data submitted to the CDCs BioSense program to identify
excess morbidity and mortality.
2. Immunizations (MIIS): Supports compliance with state law M.G.Lc.111, s.24M for submission of
immunization data to the Massachusetts Department of Public Health (MDPH). Click here
for official MIIS Regulations and here for the MIIS Compliance Schedule (March 2015)
3. Electronic Lab Reporting (ELR) Supports electronic submission of laboratory results to the
MDPH Bureau of Infectious Disease to meet regulation 105 CMR 300.170.
4. Cancer Registry (MCR): Provides an electronic means to comprehensively identify and report
cancer cases to the Massachusetts Cancer Registry for further reporting to the CDC as required
by Massachusetts law.
5. Specialized Registry (MAVEN): Web based disease surveillance and case management system.
6. Children's Behavioral Health Initiative (CBHI)
7. Opioid Treatment Program (OTP)
8. Childhood Lead Prevention Program (CLPP)
9. Intake Enrollment and Assessment Transfer Service (IEATS): Supports electronic information
submission of provider data to evaluate client outcomes and assure program effectiveness for
opioid treatment services.
10. e-Referral: Supports health information exchange from healthcare provider organizations to
affiliated community-based organizations.
5. Registry Interface Connections by Vendor *as of December 2015

MIIS: Allscripts, athenahealth, Cerner, eClinicalWorks, GE Qvera, Netsmart, SMART, Surescripts


Opioid Treatment Program: Netsmart, SMART
eReferral: eClinicalWorks
Syndromic Surveillance: Cerner

6. Mass HIway Connection Options

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There are several options to connect to Mass HIway: LAND, Webmail, Direct, SOAP Web Services.
Determining which method is best will depend upon technical capabilities of your system, the volume of
data you intend to transmit, and your use case. The below information can help you decide the best
solution.

LAND

LAND allows for a high-volume connection to the Mass HIway with multiple options for how messages
are sent to the gateway and then onto the HIway. This connection involves a physical piece of hardware
that is installed at the participating site and can then be integrated into the participants infrastructure.
Benefits:

Supports high-volume and automatic/scripted message and data dropping


Multiple options for integrating message transmission into a Participants infrastructure (HTTP
POST, Directory drop, and more) to create minimal impact for non-technical users
Participant is not responsible for appliance maintenance or installation

Considerations:

LAND appliance is a black box and cannot be accessed by participant staff


Some configuration of the IT environment is required for messages to reach the LAND, so
Participant IT support is required until connectivity is established
Installation and/or physical replacement of the box requires Mass HIway staff to visit the site

Recommended for:

Participants who need to regularly send data or are expecting to transmit a lot of messages but
who do not have a dedicated IT staff to manage their infrastructure
Larger sized Participants with an implemented EHR that is not compatible with the Direct
solution

Webmail

Webmail provides for communication on the Mass HIway through a web browser, such as Internet
Explorer or Firefox. Users log into a website to receive and send messages manually. The user interface
looks very much like modern online mail sites (such as Gmail or Yahoo) and has many of the same
capabilities. Attachment files can be sent through webmail and the communications are secure.
Benefits:

No hardware or software installs at the participant site; no IT staff required


Non-technical interface for users; access through web browser
Communication functions just like e-mail but is secure through The Mass HIway

Considerations:

Configuring automatic uploads of clinical information requires expert resources


Users manually check for received messages on an e-mail system that is not integrated with
their EHR

Recommended for:

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Participants without a need to regularly send large volumes of data but who would like to be
able to send or receive clinical and patient information securely on an ad-hoc basis

Direct
Direct XDR and/or SMTP/SMIME is the most robust connection option and allows for seamless
integration into a Participants system with the proper configuration. The direct connection can
interface directly with the participants EHR or SMTP message sending service. The connection
provides the largest opportunity for the participant to integrate their HIway connection, but
requires the IT staff and infrastructure to manage the connection.

Benefits:

Interfaces directly with EHR or other message sending software given correct protocols on the
Participant side
Can receive data files and/or messages directly from the Participant's systems and transmit
them automatically with proper setup
Can be configured to deliver messages directly to the Participants internal mail system to
create a seamless experience for end users

Considerations:

Established IT infrastructure must be present at the participant site to implement the


connection and install the secure certificate(s)
Experienced IT staff is required to implement and integrate the connection for use
Not all EHRs are compatible with the connection

Recommended for:

Participants who anticipate sending a lot of data or messages on the Mass HIway and have a
compatible EHR and/or a dedicated IT team who can configure existing system to interface with
the connection
SOAP Web Services

SOAP is the alternative method of transport to and from the Massachusetts Immunization Information
System (MIIS). This method uses a CDC standardized WSDL with local specifications. For more details,
on this transport method, visit the MIIS Resource Center at https://www.contactmiis.info/crcnews.asp.
The MIIS is a secure web-based immunization registry and vaccine management system for the
Commonwealth of Massachusetts. Healthcare providers can report immunizations to the MIIS directly
through the web interface or via electronic data exchange from their sites EHR system and through the
Mass HIway. HL7 messages are processed in real time and acknowledgements are sent to the initiating
system as soon as the message processing is complete.
Benefits:

14

Executing a Mass HIway Participation Agreement (PA) is not a requirement, which can speed up
process of submitting data to MIIS as it may take time to process at your organization. Instead,
you work only with the MIIS team, which will provide a username and password- based
connection to MIIS via SOAP.

Considerations:

SOAP Web Services are for data transmission to MIIS only. Participants that connect to MIIS via
SOAP will need an alternate connection to the Mass HIway to send and receive data to other
Mass HIway Participants and all other public health registries.
Should you wish to migrate to a certificate-based Mass HIway connection in the future to
transact with other Mass HIway Participants, your organization will need to complete a Mass
HIway PA first, then go through the steps of onboarding.
Mass HIway does not charge for any set up and related service fees for any connection option,
including SOAP Web Services, if the Mass HIway is being used solely to send and receive data to
and from the MDPH.

Recommended for:

Organizations that are not already connected to the Mass HIway and need to quickly transmit
data to MIIS.
Organizations not ready operationally to manage a more technical Mass HIway implementation.
Organizations not ready or able to execute a Mass HIway PA in order to implement a certificatebased connection to the Mass HIway.
Fees

7. HIway Rates/Fees
Mass HIway services are flexible to the services participants access and to the ways in which these
services are deployed. Mass HIway pricing is designed around this flexibility:

Participants may access Direct Messaging as a standalone offering or combine with Query &
Retrieve Services. As Query & Retrieve is dependent upon a Participant's connectivity for Direct
Messaging, Query & Retrieve is not available as a standalone service.

Participants may connect to the services directly through their electronic health record if
available, or through a Local Access Network Device (LAND) appliance or via Webmail. Click here
for more information about each connection method.

Participants may access the services through a single node (connection) or through multiple
nodes.

Prices have two components: One time set up fee and annual services delivery fee. The annual HIE
services delivery fee is based on the Participant's connection type(s) and number of connections.
HIE services fees are fixed regardless of message volume, message size, number of users or number of
underlying organizations. For example, a legal entity with multiple sub-organizations (e.g. Integrated
Delivery Network) may purchase a single node and take responsibility for all onward message handling.
Webmail fees are fixed per mailbox and subject to storage and message size restrictions as noted in the
HIway Policies and Procedures.

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A participant may pay fees on behalf of other organizations (e.g. a small hospital that wants to buy
Webmail accounts for affiliated ambulatory practices).
Mass HIway encourages Technical Integrators to assist Participants to connect to the Mass HIway. In
general, the Technical Integrator will not be charged a fee. However, a Technical Integrator may pay fees
on behalf of the Participants it connects to the Mass HIway. If the Technical Integrator pays the fee on
behalf of the Participant, it will be considered a "Tier 1- Multi Entity HIE" type. This rate allows a
Technical Integrator to connect as many Participants as they like. If Participant wishes to act as a
Technical Integrator on behalf of trading partners or other related entities, and the Participant plans to
pay on behalf of the additional parties, the Participant would be charged the "Multi Entity HIE" fee and
will not be charged separately as a Participant.
Mass HIway does not charge for HISP connections nor does it charge organizations to connect to the
Mass HIway via a HISP.
Mass HIway program costs are covered through a combination of funds from the Centers for Medicare
& Medicaid Services (CMS), the state government, and Participant fees. Mass HIway is highly subsidized
by CMS, and Participant fees and state funds allow Mass HIway to meet the match requirement to
access these subsidies. The HIway rate card is below:

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Tier

Tier 1

Tier 2

Tier 3

Tier 4

Tier 5

Category Definition
Large hospitals/Health Systems: Large hospitals include teaching hospitals and/or large health care delivery
systems. Includes: Baystate, Beth Israel Deaconess, Boston Medical Center, Cambridge Health Alliance,
Childrens Hospital of Boston, Dana-Farber Cancer Institute, Lahey Clinic, MEEI, Mount Auburn Hospital,
Partners, Saint Vincent Hospital, Steward, Tufts Medical Center, UMass Memorial. Small hospitals include all
others. The list of Large hospitals will be reviewed and may be updated annually.
Health Plans: Health insurance carriers.
Multi Entity HIE: Health Information Exchange (HIE) networks that include more than one authorized legal
entity (e.g., NEHEN, SafeHealth, Wellport).
Commercial Imaging and Lab Centers: Standalone imaging and lab centers as defined by Massachusetts state
licensing and not included in larger health systems.
Small Hospitals: Hospital or Healthcare systems not included in list of Large hospitals/Health Systems above.
Large Ambulatory practices (50+): Practices with 50 or more licensed providers (MD/DO/NP/PA) in a single
legal entity regardless of number of sites, and not otherwise included in larger systems (i.e. not employed or
owned by a hospital or health system). Category does not include federally qualified health centers (FQHCs) or
FQHC look-alikes.
Large Long Term Care entities: Nursing homes or nursing home systems with 500+ licensed beds (e.g.,
Kindred, Genesis, Golden Living Center, Wingate, Life Care Centers, Epoch Senior Healthcare, Radius
Healthcare, Beaumont).
Ambulatory surgical centers: As defined by Massachusetts state licensing.
Ambulance and Emergency Response: Standalone emergency medical service providers as defined by
Massachusetts state licensing and not included in larger systems.
Business Associate Affiliates: Business associates of participant covered entities.
Small Long Term Care entities: Nursing homes or nursing home systems with <500 licensed beds.
Large Behavioral health (10+): Standalone mental health or counseling clinics with 10+ licensed providers and
not included in larger systems.
Large Federally Qualified Health Centers (10+): FQHC and FQHC look- alikes with 10+ licensed providers. Does
not include hospital-owned community based health clinics.
Medium Ambulatory practices (10-49): Practices with 10-49 licensed providers (MD/DO/NP/PA) in a single
legal entity regardless of number of sites, and not otherwise included in larger systems (i.e. not employed or
owned by a hospital or health system). Category does not include federally qualified health centers (FQHCs) or
FQHC look-alikes.
Small Behavioral health (1-9): Standalone mental health or counseling clinics with < 10 licensed providers and
not included in larger systems.
Home Health: Home Health providers that are Non-Medicare/Medicaid certified agencies. Standalone as
defined by Massachusetts state licensing and not included in larger systems.
Long Term Services and Supports (LTSS): Medical supports only.
Small Federally Qualified Health Centers (1-9): FQHC and FQHC look- alikes with < 10 licensed providers.
Does not include hospital-owned community based health clinics.
Small Ambulatory practices (3-9): Practices with 3-9 licensed providers (MD/DO/NP/PA) in a single legal
entity regardless of number of sites, and not otherwise included in larger systems (i.e. not employed or
owned by a hospital or health system). Category does not include federally qualified health centers (FQHCs) or
FQHC look-alikes.
Very Small Ambulatory practices (1-2): Practices with 1-2 licensed providers (MD/DO/NP/PA) in a single legal
entity regardless of number of sites, and not otherwise included in larger systems (i.e. not employed or
owned by a hospital or health system). Category does not include

For more information on the Mass HIway visit www.masshiway.net

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APPENDIX C
Project Team Members:
Micky Tripathy, Ph.D., MPP, President and CEO MAeHC
Jessica Hatch, MS, CNL, RN, Business Analyst
Jennifer Monahan, Business Analyst
Pat Kelleher, Executive Director, Home Care Alliance of Massachusetts
Jeanne Ryan, MA, OTR, MBA, HIT, Home Care and Hospice Consultant
Steering Committee Members (will receive by 2/15/16)
Tim Burgers

Associate Director

Home Care Alliance

Peg Doherty

Vice-President

Home Health VNA

Jim Ellsworth

IT Systems Administrator

Porchlight VNA

Judy Flynn

Vice-President, Quality

Partners Healthcare at Home

Russ Duboc

Chief Financial Officer

Community VNA

Wendy Cofran

Chief Information Officer

Natick VNA

Judy Dionne

Hospice Director

Baystate VNA & Hospice

Ricardo Muchitti

Chief IT Officer

Metro West Home Care

Kate Mercier

Quality Director

Brockton, VNA

Additional References
1)

MeHI Provider and Consumer Health IT, Research Study (2014)

http://mehi.masstech.org/education/resources-tools/ehealth-reports/Survey2014-KeyFindings
2) Massachusetts Health Information Highway, (2015)
http://www.mass.gov/eohhs/gov/commissions-and-initiatives/masshiway/
3) Health Information Technology for Economic and Clinical Health Act-HITECH (2009)
http://searchhealthit.techtarget.com/definition/HITECH-Act
4) Home Care Alliance of Massachusetts Strategic Plan (2015-2017)
file:///C:/Users/Owner/AppData/Local/Microsoft/Windows/INetCache/IE/PD5N3M4Y/HCAM-20152015-Strategic-Pla.pdf

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