MA Health Information Exchange Live Today

October 16, 2012 in health care costs, Member Stories, News

Our new health information exchange went live today starting with the ceremonial transmission of Governor Patrick’s health record from one hospital to another. The best description of the event is on John Halamka’s Blog today and yesterday. The exchange is interesting to the healthcaresavvy for a couple of reasons including its Direct secure email roots and future tie-ins to payment reform.

The Massachusetts Health Information Highway (the HIway) is based on the Direct secure messaging protocols mandated as part of federal EHR Meaningful Use Stage 2. As of 2014, all electronic health records that are eligible for federal incentive payments will have to send and receive Direct messages. Although patients do not have access to MA HIway yet, patients do have access to Direct messaging. Microsoft HealthVault offers free Direct email addresses, for example. I don’t know how long it will be before your doctor can send your health record to your Direct email address but there’s no fundamental reason it could not be done today using the MA HIway. Having your doctor receive a secure message from you, the patient, is also technically now possible. The questions of spam filtering, reimbursement and the doctor’s liability in receiving possibly unsolicited messages from patients (and, for that matter from other doctors) remain to be sorted out.

The tie-in to payment reform will come in future enhancements to the exchange. As it stands today, Mass HIway is just a message passer that does not save the messages or aggregate them into patient accounts. The exchange does not provide a central source of truth or even a historical archive of you as a patient. Payment reform is widely considered to benefit from improved transparency of cost and quality as well as improved patient engagement. The relevant cost is the total cost across all of your health care providers, labs, pharmacy, nursing and caregiver services. The relevant quality is your overall outcome and satisfaction across all of the providers you might see. The new MA payment reform law includes provisions for you, the patient, to access your own information as aggregated in health information exchanges and registries. It will be interesting to see how conveniently MA HIway provides patients with their aggregated information and if it chooses to offer a central portal to interact with your real-world care team instead of having to sign in to each and every one of them separately.

My dream is that the MA health insurance exchange (The Health Connector) will have my claim and provider information directly from the HIway (for my eyes only, of course). That way, at re-enrollment time, the Connector can estimate my total out of pocket expense for each of the available alternatives. Given today’s 5-digit deductibles, that simple connection to the HIway could save many of us thousands of dollars per year.

3 responses to MA Health Information Exchange Live Today

  1. Hey Adrian – it seems it’s a big step from having all your claim and provider info in one place – and being able to estimate your total oop expenses based on the alternatives. That would suggest that the Connector has an inventory of all the prices each insurer pays each provider. Is that what they plan to do with data from the All Payer Claims Database?

    • There are two ways this can happen: Blue Button and APCD. The claims information is presumably available in both places.

      Blue Button files are nicely detailed and available from the payor (Medicare, Aetna, Cigna and maybe more by now) and, by design, accessible to the patient. The patient would need to track expenses that were not associated with insurance claims (in a PHR, I guess) and that could be a bit of work. The Automate Blue Button Initiative of ONC is designed to make access to Blue Button records (claims as well as clinical) easy and secure for the patient and the patient’s advocates.

      The APCD is currently an institutional construct that is totally and mysteriously inaccessible to patients. APCD are presumably much easier to integrate with another state-operated service like The Connector but there would have to be significant public pressure before the bureaucracy will take on this patient-centered perspective.

      On the legal side, the recently enacted MA Payment Reform Law http://www.malegislature.gov/Bills/PDF?billId=119663&generalCourtId=1 addresses both Blue Button and APCD-like access. It gives patients the right to access databases that are aggregating private information about them and it asks payors to improve access to their information.

      Here are the lines that pertain to APCD:

      1903 The center shall, to the extent feasible, make data in the payer and provider claims
      1904 database available to payers and providers in real-time; provided, however, that all data-sharing
      1905 complies with applicable state and federal privacy laws The center may charge a fee for access to
      1906 the data.
      1907 To the maximum extent feasible, the center shall also make data available to health care
      1908 consumers, on a timely basis and in an easily readable and understandable format, data on health
      1909 care services they have personally received.

      and here’s a paragraph from the official summary:

      Improving Consumer Transparency of Health Care Costs
      • Establishes new transparency tools to help consumers make health care purchasing
      decisions based on comparative cost and quality, including the establishment of a consumer
      health information website with transparent prices and shared-decision making online tools.
      • Directs health insurance carriers to disclose the out-of-pocket costs for a proposed health
      care service and protects patients from paying more than the disclosed amount.
      • Requires health insurance carriers to provide a summary to health care consumers in an
      easily readable and understandable format showing the consumer’s responsibility, if any, for
      payment of any portion of a health care provider claim.

      It’s up to all of us to make sure that the regulations and technologies that result from this law are as useful and accessible as we need them to be.

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