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Wellport Testimony to the State Department of Health and Human Services on Consent

  • By Joe Heyman, MD, Wellport Chief Medical Information Officer
  • With No Comments
  • On 12 Jan | '2017
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Testimony to the Executive Office of Health and Human Services from the Whittier IPA, Inc.
Joseph M. Heyman, MD, Chief Medical Information Officer  —  November 28, 2016

I am Dr. Joe Heyman, Chief Medical Information Officer of the Whittier IPA. I would like to address two parts of the proposed regulations: 101 CMR 20.07 and 20.10. Thank you for this opportunity.
The Whittier IPA is a non-profit organization of about 200 physicians in the Merrimac Valley, established in 1984, and providing contracting, group purchasing, technology and patient care services to its physician members. It owns and operates the Wellport Health Information Exchange which serves the Greater Newburyport, Amesbury, Haverhill, and Lawrence Communities.

The Wellport Health Information Exchange has been in operation since August 2014 and has medical records from almost 400,000 patients, some 400 physicians and nurses in about 40 practices and the Anna Jaques Hospital. All our subscribers can use the Mass HIway through our interface.

We have patients and physicians subscribing to Wellport from three networks, Partners, Beth Israel Deaconess and Steward Healthcare. We also serve two nursing homes, two home health services, a behavioral health subscriber, and six laboratories. We make all clinical office notes, lab results, xray reports, and patient demographics viewable on a single timeline for each patient. While we have a repository of the charts of 400,000 patients, only 15,000 are viewable because — to be consistent with the Mass HIway process — we must opt them in.

We want to congratulate the Executive Office of Health and Human Services for this very important and needed improvement in the Mass HIway’s new consent policy described in 101 CMR 20.07. The state has realized something the Whittier IPA learned early on: The opt-in process for consent is the major barrier to interoperability. It is a practical barrier, a resource barrier, and an economic barrier.

It is a practical barrier because there is a chicken and egg situation with physicians and patients. Physicians won’t join unless their patients are included. Patients won’t join unless their physicians are included. That situation makes early growth extremely difficult.

It is a resource barrier because — on an unpredictable and irregular basis — hours upon hours are consumed in physician offices, hospitals, and other agencies –and at the health information exchange itself — with unrewarding consent busy-work.

It is an economic barrier because opting in requires additional personnel who would not otherwise be needed.

It has been our experience that — when properly informed about the risks and benefits of health information exchange –about 97% of patients elect to participate. In the two years
since we started opting in patients to our exchange — using our subscribers to consent our patients — we have managed to address the needs of only 15,000 patients.

After consent is obtained there is a resource-intense process of scanning the consent forms into our exchange and electing opt-in status for our patients. It has been an expensive time-consuming process for our subscribers and for ourselves. If we had used the proposed opt-out process instead — and patients would have the very same opportunity to decide whether to participate — almost 400,000 patient charts would be available to doctors and other health care subscribers to improve coordination of patient care. We would have only a very small number of patients who would need special processing.

As soon as these regulations are final — for consistency — we plan to move to an opt-out process for the Wellport Health Information Exchange. We don’t want patients and our physician subscribers to be confused by opposing processes. Access to all this additional clinical information can only improve the quality and efficiency of the care our patients receive.

Anything the Executive Office of Health and Human Services can do make it clear that the opt-out process for regional exchanges is both needed for consistency with the HIway – and legal — will be most appreciated. There is no apparent guidance in Massachusetts law for regional exchanges.

Turning our attention to 101 CMR 20.10: Interoperable Electronic Health Record Systems. Our understanding is that you are requiring all medical practices and hospitals to interact with the HIway through an electronic medical record. We have no problem with the requirement to interact, but we urge that it not be required through an electronic health record for two reasons.

First, our subscribers can send more robust information through the HIway with Wellport than they would be able to accomplish with an EHR connection alone. Second, we do not know what systems soon may replace EHRs, and it is the connectivity that is important for coordination of care, not where the information comes from.

All our subscribers have access to the HIway through our Wellport regional health information exchange. This requirement to connect through an EHR would add confusion, duplication, and cost without improving care.

In summary, the Whittier IPA supports the language in 101 CMR 20.07. Thank you for this important change and for supporting the quality and efficiency of health care for our patients.

With respect to the language in 101 CMR 20.10, we hope you will remove the requirement that the connection to the HIway must use an EHR.

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