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The 189th General Court of the Commonwealth of Massachusetts

Section 6D: Massachusetts e–Health Institute; dissemination of health information technology; electronic health records plan; public-private partnership; funding; annual report

  Section 6D. (a) There shall be established an institute for health care innovation, technology and competitiveness, to be known as the Massachusetts e-Health Institute. The executive director of the corporation shall appoint a qualified individual to serve as the director of the institute, who shall be an employee of the corporation, report to the executive director and manage the affairs of the institute. The institute shall advance the dissemination of health information technology across the commonwealth, including the deployment of interoperable electronic health records systems in all health care provider settings that are networked through a statewide health information exchange. The institute shall (1) conduct the regional extension center program for the coordination and implementation of electronic health records systems by providers; (2) fulfill its current and any future contract obligations with the Office of Medicaid to administer specific operational components of the MassHealth electronic health records incentive program; and (3) develop a plan to complete the implementation of electronic health records systems by all providers in the commonwealth. The corporation and the institute shall maintain responsibility for fulfilling the obligations under the Office of the National Coordinator for Health Information Technology Challenge Grant Program and the Health Information Exchange Cooperative Agreement Program.

  (b) The institute, in consultation with the health information technology council established under section 2 of chapter 118I of the General Laws, shall advance the dissemination of health information technology and support the state's efforts in meeting the health care cost growth benchmark established under section 9 of chapter 6D by: (1) facilitating the implementation and use of interoperable electronic health records systems by health care providers in order to improve health care delivery and coordination, reduce unwarranted treatment variation, eliminate wasteful paper-based processes, help facilitate chronic disease management initiatives and establish transparency; (2) supporting the council in the creation and maintenance of a statewide interoperable electronic health information exchange that allows individual health care providers in all health care settings to exchange patient health information with other providers; (3) identifying and promoting an accelerated dissemination in the commonwealth of emerging health care technologies that have been developed and employed and that are expected to improve health care quality and lower health care costs, but that have not been widely implemented in the commonwealth, including, but not limited to, evidence-based clinical decision support and image exchange tools for advanced diagnostic imaging services; (4) facilitating health care providers in achieving and maintaining compliance with the standards for meaningful use, beyond stage 1, established by regulation by the United States Department of Health and Human Services under the Health Information Technology for Economic and Clinical Health Act and referred to in this section as "meaningful use''; and (5) promoting to patients, providers and the general public, a broad understanding of the benefits of interoperable electronic health records systems for care delivery, care coordination, improved quality and ultimately greater cost efficiency in the health care delivery system.

  (c) The institute director shall prepare and annually update a statewide electronic health records plan. Each plan shall contain a budget for the application of funds from the e-Health Institute Fund for use in implementing each plan. The institute director shall submit the plans and updates, and associated budgets, to the council for its review and comment. Each plan and the associated budget shall be subject to approval of the board following review by the council. Each plan shall be consistent with the statewide health information exchange plan developed by the health information technology council under section 4 of chapter 118I.

  Components of each plan, as updated, shall be community-based implementation plans that assess a municipality's or region's readiness to implement and use electronic health record systems and an interoperable electronic health records network within the referral market for a defined patient population. Each implementation plan shall address the development, implementation and dissemination of interoperable electronic health records systems among health care providers in the community or region, particularly providers, such as community health centers and community-based behavioral health, substance use disorder and mental health care providers that serve underserved populations, including, but not limited to, racial, ethnic and linguistic minorities, uninsured persons and areas with a high proportion of public payer care.

  Each plan as updated shall: (1) allow seamless, secure electronic exchange of health information among health care providers, health plans and other authorized users; (2) provide consumers with secure, electronic access to their own health information; (3) meet all applicable federal and state privacy and security requirements, including requirements imposed by 45 C.F.R. §§ 160, 162 and 164; (4) meet standards for interoperability adopted by the institute; provided that the standards are consistent with the statewide health information exchange plan developed by the health information technology council under section 5 of chapter 118I; (5) give patients the option of allowing only designated health care providers to disseminate their individually identifiable information; (6) provide public health reporting capability as required under state law; (7) support any activities funded by the Healthcare Payment Reform Fund; and (8) allow reporting of health information other than identifiable patient health information for purposes of such activities as the secretary of health and human services may consider necessary.

  (d) The corporation may contract with implementing organizations to: (1) facilitate a public-private partnership that includes representation from hospitals, physicians and other health care professionals, health insurers, employers and other health care purchasers, health data and service organizations and consumer organizations; (2) provide resources and support to recipients of grants awarded under subsection (f) to implement each program within the designated community pursuant to the implementation plan; (3) certify and disburse funds to subcontractors, when necessary; (4) provide technical assistance to facilitate successful practice redesign, adoption of electronic health records and utilization of care management strategies; (5) ensure that electronic health records systems are fully interoperable and secure and that sensitive patient information is kept confidential by exclusively utilizing electronic health records products that are certified by the Office of the National Coordinator under the federal Health Information Technology for Economic and Clinical Health Act; and (6) certify, with approval of the corporation, a group of subcontractors who shall provide the necessary hardware and software for system implementation. Before issuing requests for proposals relating to contracts to be entered into under this section, the institute's director shall consult with the council regarding the content of the requests for proposals. Nothing in this section shall be construed to provide the corporation or the institute any authority with respect to any contract relating to the development and implementation of the statewide health information exchange by the executive office of health and human services under section 2 of chapter 118I; provided, however, that the corporation shall maintain authority over contracts entered into by the corporation that the institute deems necessary: (i) to implement its responsibilities under the Office of the National Coordinator for Health Information Technology Challenge Grant Program and the Health Information Exchange Cooperative Agreement Program; or (ii) in conjunction with any grants or other funding authorized under subsection (e) or any loan arrangements authorized under section 6E1/2.

  (e) Funding for the institute's activities shall be through the e-Health Institute Fund, established in section 6E. The institute, in consultation with the health information technology council, shall develop mechanisms for funding health information technology, including a grant program to assist health care providers with costs associated with health information technologies, including electronic health records systems, and coordinated with other electronic health records projects seeking federal reimbursement. Providers eligible for receipt of amounts from the Fund shall be limited to (1) any individual or institutional provider of health care services that is not in a category of individual or institutional provider eligible to receive Medicare or Medicaid incentive payments under the federal Health Information Technology for Economic and Clinical Health Act, such payments being referred to in this subsection as "incentive payments,'' and that lack access, as reasonably determined by the director of the institute, to resources needed to implement interoperable electronic health records systems that satisfy standards established by the institute; and (2) physicians, hospitals and community health centers that are eligible for incentive payments but lack access, as reasonably determined by the director of the institute, to resources needed to support their meeting meaningful use standards as determined in accordance with the federal Health Information Technology for Economic and Clinical Health Act. In the case of hospitals eligible for funding from the Distressed Hospital Trust Fund, established under section 2GGGG of chapter 29 and administered by the health policy commission under section 2 of chapter 6D, the institute shall first determine if there is available funding within the Distressed Hospital Fund to support their meeting meaningful use standards as determined in accordance with the federal Health Information Technology for Economic and Clinical Health Act. Individual or institutional providers under clause (1) may include, but shall not be limited to, mental health facilities and community-based behavioral health, substance use disorder and mental health care providers, chronic care and rehabilitation hospitals, skilled nursing facilities, visiting nursing associations, home health providers, registered nurses, licensed practical nurses, physicians, physician assistants, chiropractors, dentists, occupational therapists, physical therapists, optometrists, pharmacists, podiatrists, psychologists and social workers. In making the determinations regarding available resources as described in clauses (1) and (2), the director of the institute shall consider:

  (A) the demonstrated need for investment, taking into account all resources available to the particular provider including the relationship or affiliation of the particular provider to a health care delivery system and the capacity of such system to provide financial support for the provider's meeting the standards established by the institute or meaningful use standards;

  (B) the anticipated return on investment, as measured by improved health care coordination, reduction in health care costs, reduction in unwarranted treatment variation and elimination of wasteful paper-based processes;

  (C) the amount of financial or in-kind support the particular provider will commit to supplementing or supporting any investment by the corporation;

  (D) whether there is a reasonable likelihood that the provider's use of such amounts will achieve the long term benefits expected from implementing an interoperable electronic health records system;

  (E) whether the investment will support innovative health care delivery and payment models as identified by the health policy commission;

  (F) whether the investment will support efforts to integrate mental health, behavioral and substance use disorder services with overall medical care;

  (G) the extent to which the investment will support efforts to meet the health care cost growth benchmark established by the health policy commission;

  (H) whether the provider serves a high proportion of public payer clients; and

  (I) any other factors that the director determines are appropriate.

  The institute shall consult with the office of Medicaid to maximize all opportunities to qualify any expenditures for federal financial participation. Applications for funding shall be in the form and manner determined by the institute director, and shall include the information and assurances required by the institute director. The institute director may consider, as a condition for awarding grants, the grantee's financial participation and any other factors it deems relevant.

  All grants shall be recommended by the institute director and subsequently approved by the executive director. The institute director shall work with implementation organizations to oversee the grant-making process as it relates to an implementing organization's responsibilities under its contract with the corporation. Each recipient of monies from this program shall: (i) capture and report certain quality improvement data, as determined by the institute in consultation with the department of public health and the center for health information and analysis; (ii) fully implement an electronic health record system, including all clinical features, with the maximum feasible level of interoperability, not later than the second year of the grant; and (iii) make use of the system's full range of features. In the event that any recipient of grant monies from this program does not achieve installation of a fully functioning electronic health record system or does not achieve the appropriate level of interoperability within the 2 year grant period, such recipient shall be required to repay to the corporation all or some portion, as determined by the corporation, of the grant funds previously provided to such recipient under this section.

  (I) The institute shall establish a pilot partnership with community colleges or vocational technology schools in the commonwealth to support health information technology curriculum development and workforce development. Funding for the program shall be from the Health Care WorkForce Transformation Trust Fund established under section 2FFFF of chapter 29.

  (J) The institute shall encourage and promote the implementation by hospitals, clinics, and health care networks of evidence-based best practice clinical decision support tools for the ordering provider of advanced diagnostic imaging services by January 1, 2017. Advanced diagnostic imaging services shall include, but is not limited to, computerized tomography, magnetic resonance imaging, magnetic resonance angiography, positon emission tomography, nuclear medicine, and such other imaging services. The institute shall develop clinical decision support guidelines and protocols that may be incorporated into the provider order entry systems of hospitals and the electronic health records of providers, to the maximum extent possible for certified EHR technology. The use of such decision support tools shall meet the privacy and security standards promulgated pursuant to the federal Health Insurance Portability and Accountability Act of 1996 (Public Law 104-119).

  In addition, the institute shall advance the dissemination of innovative technologies, including, but not limited to, those technologies that would allow diagnostic imaging exams to be seamlessly processed and transferred electronically through means that may include, but shall not be limited to, cloud-based technologies.

  (K) The institute shall file an annual report, not later than January 30, with the joint committee on health care financing, the joint committee on economic development and emerging technologies and the house and senate committees on ways and means concerning the activities of the institute in general and, in particular, describing the progress to date in implementing interoperable provider electronic health records systems and recommending such further legislative action as it considers appropriate.

  (f) The institute shall identify companies and organizations that are engaged in the development of emerging new technologies associated with health information technology, including web-based and personalized care delivery. The institute shall promote the growth and development of such companies and organizations by supporting the formation of regional health information technology clusters, coordinating the promotion and dissemination of information regarding such companies and organizations, identifying and addressing obstacles to the growth of such companies and organizations and helping to identify alternative funding sources for such companies and organizations for the implementation of their business and marketing plans.

[ Subsection (g) added by 2016, 219, Sec. 34 effective August 10, 2016.]

  (g) The institute shall, in consultation with the secretary of housing and economic development and informal advisers from the public and private sectors, develop strategies and action plans to facilitate the continued development and accelerating growth of the e-health cluster in the commonwealth involving a range of products, services and systems at the intersection of medicine, healthcare and information technology including, but not limited to: (i) electronic health records; (ii) consumer wearable devices; (iii) care systems; (iv) payment management systems; (v) healthcare robotics; (vi) telemedicine; and (vii) big data analytics, for the purpose of improving health care quality, reducing costs and supporting the expansion of economic opportunities for the citizens of the commonwealth. Without limiting the generality of the foregoing, the institute may: (A) develop a market access program connecting provider and payer needs with ideas and products through pilot programs; (B) undertake a healthcare big data initiative designed to improve healthcare data transparency and availability; (C) create opportunities for e-health cluster stakeholders, including investors, entrepreneurs and healthcare providers, to convene to exchange ideas and make connections; and (D) encourage the adoption of open-source software principles, which may include recommendations toward the establishment of procurement rules that enable major technology systems, platforms and products purchased by the state to remain open for the development of third party end-user software and application designs that improve ease of access and utilization of those major technology systems. In furtherance of the purposes of this subsection, the institute shall coordinate and collaborate with such other agencies, authorities and public instrumentalities as the secretary of housing and economic development may suggest and shall endeavor to identify moneys and resources that could be made available for those purposes. The corporation may expend moneys credited to the e-Health Institute Fund established in section 6E for the purposes of this subsection, without compliance with any further restrictions contained in section 6E, and to expend for the purposes of this subsection any other moneys available to the corporation that are not expressly restricted by law.