MA Health Information Exchange Live Today
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.