Micky Tripathi is a perpetually busy man.
When the president and CEO of the Massachusetts eHealth Collaborative (MAeHC) is not busy strategically leading a nonprofit organization that has helped multiple organizations, including several regional extension centers (RECs), deploy electronic health records (EHRs) and achieve meaningful use, he is serving on an array of boards and committees, including the Information Exchange Workgroup of the HIT Policy Committee.
Recently, Tripathi was in attendance when the second phase of the Massachusetts health information exchange (HIE), the Mass HIway, was demonstrated at Beth Israel Deaconess Medical Center in Boston. The event was attended by Massachusetts Governor Deval Patrick. The Massachusetts Executive Office of Health and Human Services (EOHHS) and Massachusetts eHealth Institute (MeHI) selected MAeHC to provide advisory services for the design and launch of the Mass HIway.
The second phase involved the release of a query feature that allows providers to locate, request, and retrieve medical records from other participants on an interconnected system. Tripathi recently spoke with Healthcare Informatics’ Senior Editor, Gabriel Perna, on the second phase of the Mass HIway, what it entails, how it’s different from other query technologies, the question of HIE sustainability, and what’s next for the Massachusetts HIE.
Below are excerpts from that interview.
Explain the new developments with the Massachusetts HIE?
The first phase went live in October 2012, and it enabled the Direct-based push of messages and documents among participants. There are 57 participants who are live on that Phase 1 service. They are able to send documents, data, whatever they want, over the HIway to another provider. What Phase 2 enables is kind of the reverse, which is a query – the ability to identify where a patient’s records are with the patient’s permission, and then being able to retrieve those records from other providers.
How does this retrieval system work?
It’s got two layers. One is the creation of a statewide relationship listing service, and what that will do, with your permission, is it will list where you have records. That’s the first layer, and it’ll create that on an ongoing basis, based on the permission you’ve given to each of the legal entities that has records on you. If you give them permission to publish on this secure website that you have records with them, then it will publish that. It’s a master-patient index, with a listing of where records are available.
The second layer is the ability to query those organizations that have records and be able to get something back. That’s a separate layer. The first part is just where those records are. That on its own is valuable. If we didn’t even have the second piece, it’s still valuable that if you show up in emergency room, they can look up your name and find your records in three places, and be able to call up, say, your primary care physician. That still provides value to the market that isn’t there today.
With the point-to-point query, it doesn’t necessarily invoke the Mass HIway, because the provider that is making the request knows where the records are if they want to generate a request. There is no repository, unlike other HIEs, of clinical medical information. The only repository is the listing of the patient and where the patient has records. The queries are done directly to the organization that holds the record and that organization has the ability to determine how they are going to respond.
Without the repository, how is that information going from one provider to another?
One thing we’ve tried to do is have as much flexibility in the process as possible and not dictate, say, in order for an organization to use this service they have to do it according to [various] standards. Right now, there are no federally sanctioned standards for query and retrieve. We’re hoping in Stage 3 of meaningful use we get there, but we’re not there.
So what we showed, for example, in that demo is that Atrius Health (an alliance of medical groups based in Newton, Mass.) has a tight relationship with Beth Israel. They have a clinical affiliation with Beth Israel and they refer their patients there. Because they have built a lot of trust between those organizations, in that case, because they know it’s Beth Israel that’s asking, and they know it is a Mass HIway participant, they have a high degree of trust, and will allow Beth Israel a single sign onto its EHR. So Beth Israel is actually looking at the patient’s record in the Atrius EMR. In that case, no data actually flows, what flows is the credential to enable single sign on.
We also showed for Tufts Medical Center (Boston.) and Holyoke Medical Center (Holyoke, Mass.), they don’t have tight relationship with Beth Israel. In that case, Beth Israel actually sent a Direct message on the “patient,” with his consent, and a request to get his medical information. The medical centers reviewed it and sent it back. That query and response can be flexible according to the relationship that the requesting and the data holding organizations have with each other.
How is this different than how most HIEs do query and retrieve?