The Massachusetts-SHARE Initiative

DWT is pleased to feature the Massachusetts Simplifying Healthcare Among Regional Entities initiative (MA-SHARE) as our Health Information Technology Regional Health Information Organization (RHIO) in the Spotlight.

Background
MA-SHARE, LLC is a regional collaborative created and operated by the Massachusetts Health Data Consortium (MHDC), a nonprofit coalition founded in 1978 by the state’s major public and private health care organizations, to oversee the implementation of community projects for both administrative simplification and clinical data exchange. Launched in 2003, the creation of MA-SHARE evolved from a growing consensus that health care organizations underutilize information technology, thereby missing opportunities to greatly improve quality and reduce medical errors. MA-SHARE ultimately envisions the creation of a national health care information infrastructure that consists of a network of RHIOs that can utilize real-time clinical information (e.g., diagnoses, test results).

What MA-SHARE does
MA-SHARE seeks to promote the inter-organizational exchange of health care data in an open technology model to connect payors, providers, and patients in order to improve patient safety, encourage integrated reporting of accurate clinical health information, and increase administrative efficiency using a sustainable economic model. MA-SHARE achieves its goals by facilitating and developing regional collaborative projects that pilot and demonstrate new technologies and platforms that can be used across communities and enterprises. Specifically, MA-SHARE identifies and funds proposals that further its mission and use or develop secure platforms or methods for communicating clinical information. Where they exist, projects are to adhere to national standards for data exchange. MA-SHARE solutions are intended to be dedicated to public use and available throughout Massachusetts to all patients, regardless of insured status, and to all relevant health care entities.

How MA-SHARE is funded
MA-SHARE was initially funded by a cornerstone grant from Blue Cross Blue Shield of Massachusetts, and has since received additional funding from various local health plans and provider organizations the Massachusetts Medical Society, and an e-Health Initiative grant. Once a specific project is identified, MA-SHARE arranges financing from partners, which includes a federal contract from the e-Health Initiative.

How MA-SHARE is organized
MA-SHARE, LLC, a non-profit and wholly owned subsidiary of MHDC, is a regional collaborative operated by a 10-member Board of Managers appointed by the MHDC Board of Directors. MA-SHARE also convenes a community-based Advisory Committee as an ad hoc committee for the purpose of advising and assisting in planning efforts. The current Advisory Committee membership consists of community leaders representing hospitals, physician organizations, other health care providers, health plans, state government, academia, employers, the CIO Forum of the MHDC (consisting of information technology leaders various plans, provider, government agencies, and suppliers in the state), and the MHDC.

The Board of Managers includes two directors and the Chief Executive Officer of MHDC. The remaining membership is comprised of user/customer organizations which will purchase services from MA-SHARE, including major health plans, provider organizations and state government.

Highlighted MA-SHARE projects
MA-SHARE furthers its mission through various projects. Here are a few examples:

1. MedsInfo in Emergency Departments Project

MedsInfo in Emergency Departments (MedsInfo-ED) is a patient safety tool that uses internet technology to make patient prescription history information more accurate, complete, and readily accessible for use in emergency departments (EDs). MedsInfo-ED is intended to supplement the information that the patient provides the ED staff and it automates the transmission and communication of medication history to EDs. The project is designed to demonstrate the value of making medication history accessible to clinicians at the time of treatment, which can often be critical to the patient’s well-being.

The hospitals piloting MedsInfo-ED—Emerson Hospital, Boston Medical Center and Beth Israel Deaconess Medical Center—represent community and medical teaching hospitals with a combined volume of approximately 14,000 ED patients per month. MedsInfo-ED has been able to contract to include prescription history data from various insurers and health plans in Massachusetts. Thus, part of the challenge for MedsInfo-ED is to aggregate medication histories from multiple data sources. To obtain access to multiple sources of dispensed drug history, including PBMs, health plans, and employers , MedsInfo-ED created community consensus on the privacy and security requirements for medication history transmission and standards for audit performance.

2. E-Prescribing Gateway Project

The E-Prescribing Gateway Project (Rx Gateway) seeks to develop a single, secure gateway to support all e-prescribing-related inquiries and transactions. Using a single point-of-access, Rx Gateway will make it easier and less expensive for physicians and other prescribers to: obtain medication histories; check eligibility, benefits and formularies; process claims; and send prescriptions directly to pharmacies and mail order companies for dispensing. The project seeks to speed up the adoption, accuracy, and value of e-prescribing applications by electronically linking prescription information with all major payors, PBMs, and prescription dispensing locations in Massachusetts, using standards-based interfaces to route prescription data between the stakeholders. MA-SHARE intends to coordinate Rx Gateway and its e-Prescribing education projects with current e-prescribing efforts in the area as well as with vendors currently active in the market.

Rx Gateway will act as a traffic manager, not an e-prescribing solution. Rx Gateway’s functions will include:

• Identifying and matching patients to all sources of clinical information required to complete and manage e-prescribing transactions
• Acquiring and distributing prescription data, such as eligibility, drug history, refill notices, formulary information, preauthorization requirements, and patient pick-up confirmation
• Filtering the data based on regulatory and business requirements
• Auditing the data and services to ensure compliance with HIPAA and other utilization and performance reporting
• Providing system security

Rx Gateway will contract with data sources and data users to establish the terms governing access and distribution rights to connected stakeholders. Rx Gateway users only need to build one interface and negotiate a single contract with MA-SHARE.

3. Record Locator Service: Identifying the patient

A working group of MHDC spent a year on the problem of patient data linkage and designed an approach which can be layered on top of our existing healthcare IT infrastructure—the record locator service (RLS). The RLS will be a community-wide master patient index that contains no clinical data but does contain pointers to the sites at which a patient has received care. With patient consent, a record documenting the occurrence of each patient encounter will be forwarded to the MA-SHARE RLS as part of each institution's registration process. Since no clinical data is forwarded to the RLS, the potential for privacy spills will be minimized. The RLS will function as a cross index, and provide a list of all locations which may contain data. By requiring consent, the RLS will assure that the patient remains in control of the institutional entries which are maintained in the RLS.

The MA-SHARE Record Locator Service was funded by a grant from the Markle Foundation and rollout will begin in August of 2005.

4. Clinical Data Exchange

Once the Record Locator Service is available, it can serve as the foundation for the fourth major MA-SHARE project, the Clinical Data Exchange (CDE). One major driver for such exchange is the desire to reduce medication error in the state.

Since the patient’s sites of care are known via the RLS, MA-SHARE will build electronic interfaces to the hospital information systems and electronic health records at those sites, retrieving medication list and allergy list information to inform treating providers about patient history, as well as to provide lifetime care data to decision support systems. The initial exchange of clinical data in Massachusetts will include medications and laboratory results.

The Markle Foundation, eHealth Initiative, and Robert Wood Johnson Foundation funded MA-SHARE to implement the Clinical Data Exchange, utilizing the RLS, by the end of 2005. Massachusetts was chosen for this project because of its early experience with MedsInfo-ED, the 2004 MA-SHARE pilot project for medication history exchange.

5. Secure Email Project

The Secure Email Project is focused on enabling secure business-to-business email in compliance with the HIPAA privacy and security regulations which require health care providers to assure the protection of protected health information (PHI), including PHI transmitted as part of an email. The Secure Email Project seeks to foster and standardize technology-based approaches that would encrypt email messages as they travel over the Internet. The long-term goal of the project is to provide a secure e-mail community for health care providers and patients in Massachusetts.

The project group has worked with several MHDC members to be organization sponsors for the technology and various email security vendors to define user requirements, develop a security standard, and define the product certification program for secure email. The goal of the Secure Email Project is to gain consensus on secure messaging requirements so that defining a method for secure message exchange across the Internet can move forward.

6. Physician Credentialing Project

The Physician Credentialing Project seeks to streamline and coordinate the physician credentialing and re-credentialing process throughout the state of Massachusetts. Its goals are to maintain accurate and timely credentialing information for hospitals and health plans to ensure patient safety and quality care, link relevant data sources, and reduce the administrative and financial burden of redundant and inefficient credentialing processes.

The project will develop uniform credentialing applications to be adopted for use by hospitals, health plans, and physicians so that they can be completed once and sent by the physician (with updated information and signatures) to different hospitals and payors. An abbreviated application will accompany the physician profile for the re-credentialing process. The project will also assess the feasibility of a centralized data entry point and repository for physician credentialing data and primary source verification.

For more information regarding the MA-SHARE initiative and its projects, please contact Jim Stowe, MA-SHARE Program Director at JStowe@mahealthdata.org or at (781)890-6040, or visit: http://www.mahealthdata.org/ma-share/.

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