The Countdown to the Golden Spike

On October 15, the Massachusetts Statewide Health Information Exchange goes live.   The "Golden Spike" for HIE in the Commonwealth is just 3 weeks away and we're all busy doing three things:

1. Modifying our clinical systems to read the statewide provider directory and public key infrastructure certificate repository

2.  Planning our workflows so that we generate continuity of care document/consolidated CDA XML clinical summaries for transitions of care

3.  Installing appliances in our data centers that will transmit our clinical summaries to among providers in the state

Many HIEs have struggled.  Many have closed.   Why is Massachusetts so excited about what we're doing?

We have a sustainability model based on the distribution of stakeholders we have in each category - large provider organization, medium provider organization, small provider organization, solo provider organization, payer, third party service provider, sub network etc. and their willingness to pay a subscription fee.

We have policies that support a trust fabric among all our trading partners.

We have technology that is inexpensive, easy to implement, and standards-based.

In my previous blogs about our State HIE efforts, I promised to provide updates.

Last week Partners Health care sent the first test transaction ("the Golden thumbtack")  by exporting a CCD from their LMR clinical system and placing the XML file with appropriate metadata in a directory on the HIE appliance installed inside their data center.   The file was sent via the state HIE gateway to a test recipient appliance.      We also validated that a receiving hospital could display the CCD within their EHR in human readable form (all certified EHRs can already do this since it's a stage 1 certification criteria).

BIDMC is installing its HIE appliance today.   Our plan is to export CCDs and Consolidated CDAs from our clinical system in response to specific triggers i.e. a discharge event, a consult event, an encounter note signing event etc.   and place these files with metadata in a directory so that the HIE appliance can send it via the Direct protocol to the designated recipient organization.

Thus far, most of the Golden Spike group of early adopters has elected to install an appliance in there data center to support standards-based transmission via Direct.   Since Meaningful Use Stage 2 requires Direct standards (SMTP/SMIME is required, XDR is optional), EHRs in the next year will be able to connect to the HIE without appliances.

The project is proceeding well, on time and on budget.   The technology works.   The participants trust each other and the anticipation for breaking down data silos is high.

And now off to a planning call to make sure we're "laying track" in perfect alignment with other participants.   We're getting the spikes ready for successful participants.