Q and A With Micky Tripathi

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Massachusetts eHealth Collaborative

The best strategies for creating health information infrastructures thatconnect providers across the state can be determined through communityinitiatives.

Healthcare Technology: Can you please tell us a bit about the Massachusetts eHealth Collaborative?

Micky Tripathi: The eHealth Collaborative is a collaborative organization backed by 34 members of every part of the healthcare delivery value chain in Massachusetts, from healthcare professionals such as physicians and nurses, therapists, to large institutional providers such as hospitals and clinics, large clinics, payers, patient groups and ancillary health services types of organizations. They’re all represented on the board. The mission is to improve quality and safety of patient care through universal adoption of healthcare technology in clinical office settings, and in particular EHRs (electronic health records), with embedded decision support in clinical settings.

The company was launched in September 2004 by those 34 organizations. It was spearheaded by the American College of Physicians, the Massachusetts chapter of the American College of Physicians that set as their No. 1 priority having universal adoption of electronic health records in all primary care physician offices in Massachusetts. They got together with Massachusetts Blue Cross and Blue Shield, which put up $50 million to fund this initiative. So the company launched in September of 2004 and I came on board the very early part of this year, January of 2005.

HCT: Who are some of the participants?

MT: We decided to invest the money in three pilot communities: Greater Brockton, Greater Newburyport and North Adams, which is in the western part of the state.We decided to fund pilot projects because there are a lot of barriers out there to adoption of EHRs and it’s our sense and certainly the sense of all the members of the board, that before we go out and spend a lot of money we need to understand in a practical way what the best strategies are for getting that type of universal adoption of health records and the connectivity on top of it; the creation of a health information infrastructure that could connect all providers across the state. So the idea of the pilots is to get some market research on what the adoption barriers are, what the good strategies are for overcoming those barriers as well as a much clearer and hopefully more granular perspective on what the real costs and benefits are of these systems once they’re implemented on a communitywide basis.

There is a lot of information out there that’s been published by a number of academics who are participants in the collaborative now, like Drs. Blackford Middleton and David Bates. They have done several studies on the relative costs and benefits of EHRs, but in relatively small laboratory-like settings, one or two offices or within one provider network like Partners Network here. In terms of being able to see what it’s like on a communitywide basis, no one in the country has done it on a high-profile, communitywide basis in a way that gets all the members of the community involved.

HCT: What do you think is the greater barrier? Do you think it’s privacy?

MT: Security and privacy are obviously a huge part of it. I don’t think there has been a barrier to adoption of the systems up until now, and I think that things like HIPAA define what the security standards are to protect that privacy. I think those things are more a help than they are a hindrance because they define what the rules are.When you’re rolling out systems like this — I think it’s much more helpful to have a set of rules that can be a touchstone that says here is at least the minimum, the widest set of guardrails that you really go outside of.

HIPAA is the lowest threshold to meet because Massachusetts state law is actually more restrictive than HIPAA. It turns out the community convention is even more restrictive than that; at least in the experiments that we’ve had in Massachusetts, where we have some of these community IT projects. There’s one called MedsInfo- ED, which delivers medication histories in emergency departments, regardless of the source of that information. There were a number of agreements that had to be made with providers and the payers in the state to get that out there. They ended up with a set of privacy and security standards that are higher than even Massachusetts state required because the organizations said that they knew what the state law was but that their company policy was stricter than that.

The privacy part is also something that you have to engage patients in. There’s an educational process that has to happen because there are a lot of distorted impressions out there of what’s involved with this type of network. I think it is important to get a more balanced perspective of exactly what the changes are. Are we more secure in the future world or are we more secure now? It’s one set of questions to ask.

There are also questions around what the relative costs and benefits are. Perhaps the ability to say at any given time, I don’t want one provider to have this certain information because of a personal preference. Let’s say you want to get a second opinion from another physician, and you don’t want your first physician to know because you don’t want them to feel bad about it.Well it’s an invasion of privacy if the first physician is able to log on to a system that says oh, gee, I didn’t know that you went to that other physician to get that test done or to get that second opinion.

On the other hand, one might argue that for best clinical care, that’s valuable information for your physician to have, and indeed your practitioner can’t give you the best care if they don’t have all the information that’s there; at least all the information — meaning the clinically relevant information — that’s appropriate for the kind of care that the patient is asking for.

HCT: Do you think an initiative like this is going to happen in other states?

MT: Absolutely — it’s happening all over the place. Indiana and Massachusetts are much further along than any other states in the country. California has a number of initiatives going on as well. But there are a variety of other states that just have some funding from the federal government or even if they don’t have funding, they’re just trying to put the groups together and just trying to move ahead with this, because it’s really kind of a movement now across the country.My colleagues and I, here and in Indiana, get a number of calls from around the country asking us if we can speak here or there. Off the top of my head, Minnesota has given me a call; I was in New York last week; I just got a request today to come to Pennsylvania — I mean there are a number of states that are putting this together because it’s so unique. They’re really trying to forge their way in what’s pretty new territory, because you’re asking organizations that aren’t used to working together, and they’re usually rivals in the market. You’re basically saying, lay down your arms and let’s figure out together how we’re going to work collaboratively on something that will be the tide that lifts all boats, that’s not going to advantage you in a relative way versus your competitors, but it will be something that lifts everyone to a higher level for the benefit of the most cost-effective care and higher quality of safety.

I think in the next five to 10 years we’re going to see a tremendous amount of activity across the country. There is a tremendous amount of activity now — there are a lot of organizational kinds of formation that has to happen and frankly more funding that have to get freed up. We’re lucky because Blue Cross came forward with this money — the amount of money we have here just for Massachusetts is basically equal to what’s available for health IT at a national level for the whole federal government. We happen to be in a very fortunate position and hopefully there will be a number of other states that are either able to get federal money, should that become available, or other organizations — either state government or health plans in other states — will come forward and start funding some of these activities. I think in California the California Health Care Foundation has been pretty active in funding some of these activities as well as Kaiser.