Massachusetts moved forward with Phase 2 of its state health information exchange (HIE) project yesterday, called “Query and Retrieve”. Massachusetts healthcare providers are now able to pull patient records from other healthcare organizations whose patients have “opted in” to the network, allowing providers to pull the records from different locations.
The news wasn’t necessarily ground-breaking, but because Beth Israel Deaconess Medical Center (BIDMC) CIO John Halamka has been diligent in explaining some of the nuances to the project in his blog, it’s easy to appreciate the significance of this step. This most recent part of the MassHIway development was a bit more complicated than the first part of the process, which was dedicated to the Stage 2 Meaningful Use Direct protocol. Halamka explained in his most recent blog post that building the MassHIway was a multi-tier process:
- A state-wide master patient index for patients who opt in, storing name, gender, date of birth and other demographic data elements
- A state wide consent registry indicating the medical record numbers and locations where patients have opted in to disclose their data to caregivers
- A portal which enables providers to securely login and view patient medical record locations
- A viewer which enables secure retrieval of medical records from organizations which support real time data display
- An electronic medical record request system for those organizations which support a request/release by the medical records department workflow.
- Full audit trails of all activity – an accounting of disclosures
Deciding how to approach patient privacy within a state-wide master patient index has been a consistent part of Privacy and Security Tiger Team discussions and was a big consideration for MassHIway stakeholders. For example, pulling data for a patient with HIV from a statewide master patient index and record locator service can get complicated because of the patient’s potential desire to filter the data and ensure privacy. Dating back to last April, Massachusetts has been working HISP-to-HISP trust and consent for query (targeted and untargeted) into MassHIway phase 2 policy.
From a policy development perspective, the Tiger Team has been on record agreeing that patients should have meaningful choice regarding whether or not they are included in a record locator service (RLS), or other product that permits queries from external providers. Halamka described some of the index’s details:
The state’s master patient index and consent registry (collectively called the relationship locator service) will be populated as patients consent to be included. 57 organizations including providers, public health, health plans, local HIEs and clinical registries are already part of the Massachusetts HiWay and all will be working hard in 2014 to expand the use of the new services.
Another noteworthy part of the Phase 2 building process should be accounting of disclosures, a subject the Tiger Team spent a great deal of time on in forming recommendations to the HIT Policy Committee. Here were two of the key recommendations regarding accounting of disclosures:
- Given the uncertainties and complexities involved in implementing the HITECH requirements, HHS should approach this in a step-wise fashion, initially pursuing an implementation pathway that is workable from both a policy and technology perspective.
- In approaching these issues, the Tiger Team endorses an philosophy of a “less is more,” (or value over volume, quality over quantity) in which the scope of disclosures and related details to be reported to patients provide information that is useful to patients, without overwhelming them or placing undue burden on covered entities (CE).
It seems as though, from a high level, the MassHIway has used these types of philosophies. It will be interesting to watch the next phases of development.