The Obama Administration on May 21 approved Massachusetts' "master plan" for the Delivery System Transformation Initiatives (DSTI) program. Half of the money to be spent on DSTI--$314 million--will come directly from the state, according to the Massachusetts Department of Health and Human Services.
Massachusetts has been in the forefront of national healthcare reform since 2006, when then Gov. Mitt Romney signed into effect the state's healthcare reform law. That statute led to near-universal insurance coverage in Massachusetts, but failed to curb cost growth. Currently, the state legislature is debating a bill that would cap healthcare spending, impose a tax on hospitals that charged too much, and encourage prepayment for healthcare, among other things.
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Seven safety net hospitals have been designated to receive DSTI funds, including Boston Medical Center, Cambridge Health Alliance, Holyoke Medical Center, Lawrence General Hospital, Mercy Medical Center, Signature Healthcare Brockton Hospital, and Steward Carney Hospital. All of these organizations have agreed to pursue one or more projects in the following areas:
-- Development of a fully integrated delivery system.
-- Implementation of innovative care models to improve quality of care and health outcomes.
-- Development of capabilities necessary to implement alternative care models.
-- Population-focused health outcomes improvements.
All of these healthcare transformation initiatives require a robust health IT foundation. So it's not surprising that the safety net providers plan to use some of the DSTI funds to develop their IT capabilities.
Holyoke Medical Center in Holyoke, Mass., intends to build a community health information exchange (HIE) "that will allow us to share information between the hospital and our community physicians," said Carl Cameron, IT director for Holyoke Medical Center, in an interview with InformationWeek Healthcare. "We're going to make more of the patients' records available to the physicians for diagnoses, to extend the continuity of care, and to improve safety and patient care."
A Holyoke sister company employs 28 doctors, Cameron noted, and the hospital also is helping about 60 private-practice physicians implement electronic health records (EHRs). The medical center would like all of these doctors to participate in the exchange, he said, and eventually wants to include other hospitals and doctors, too.
In addition, Holyoke plans to deliver lab results and radiology reports electronically to community physicians. If a practice has an EHR, the results will go directly into that office's electronic record. The two-way interface will also transmit clinical summaries from the practice's EHR back to the exchange. Doctors who don't have EHRs can view the information on the HIE portal.
The government financed HIE will also help Holyoke turn primary care practices into patient-centered medical homes. "One of the keys to the medical home is the sharing of information between entities on patients who have chronic conditions," Cameron noted. "This technology will allow us better track patients with chronic diseases."
Brockton Hospital in Brockton, Mass., a Boston suburb, is part of a healthcare system that employs 150 physicians. Brockton is using a Meditech EHR, and its ambulatory care practices have an Allscripts EHR. Brockton CMIO Paul Pettinato told InformationWeek Healthcare that DSTI funds will be used to build an internal information exchange that will tie together the inpatient and the outpatient systems.
"We're trying to take care of patients across the inpatient-outpatient continuum. We're trying to get the data to the people who need it so that inpatient data can get to the primary care doctors and vice versa. So a lot of it is about communication, taking information from one EHR and passing it to another EHR."
Brockton provides full care to only about 20% of its patients, Pettinato noted. The rest receive some of their care at other area and Boston hospitals. Consequently, he said, a community HIE would benefit patient care by providing more information to Brockton providers and vice versa. But since that HIE doesn't appear to be coming anytime soon, Brockton is building its own.
He emphasized that DSTI is not designed to expand health IT directly. "The purpose of the program is to transform the way you take care of patients, which IT needs to support across the spectrum. So this money is supporting where we think healthcare is going. It's preventive care, it's the medical home and all the infrastructure that goes with that. It includes more nurses, outreach, telehealth, home monitoring. You need to be able to support hardware, software, communication, and people."
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