Health Information Technology Council
Report to the Massachusetts Legislature
Reporting Period: January 2023 to December 2023
Submitted in May 2024
by the Health Information Technology Council
 TABLE OF CONTENTS
Executive Summary.......................................................................................................................................................1
A. Introduction ..........................................................................................................................................................3
B. Mass HIway Operations ........................................................................................................................................4
B.1 HIE Connections..........................................................................................................................................4
B.2 HIE Utilization Data.....................................................................................................................................6
C. Mass HIway Clinical Gateway .............................................................................................................................10
C.1 CG Background .........................................................................................................................................10
C.2 CG Maintenance and Enhancement Activities .........................................................................................12
C.3 CG API-FHIR 2023 Technical Update.........................................................................................................14
C.4 CG API-FHIR 2023 Provider Engagement Update .....................................................................................14
D. Mass HIway Account Management ....................................................................................................................16
D.1 Provider Directory and DirectTrust outreach ...........................................................................................16
D.2 Provider Engagement ...............................................................................................................................17
D.3 Engagement with the Massachusetts Cancer Registry (MCR) ..................................................................18
E. Statewide Event Notification Service Framework ..............................................................................................19
E.1 ENS Program 2023 Activity Update ..........................................................................................................20
E.2 ENS/ADT Reporting Metrics .....................................................................................................................20
E.3 ENS/ADT Landscape Improvement Efforts ...............................................................................................22
F. Federal Developments ........................................................................................................................................25
F.1 Federal Legislation Activity and Milestones .............................................................................................25
F.2 Information Blocking ................................................................................................................................26
G. In Flight Initiatives ...............................................................................................................................................27
H. POLST Program ...................................................................................................................................................28
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 H.1 ePOLST Registry 2023 Update ..................................................................................................................28
I. Budget .................................................................................................................................................................31
I.1 Background & Funding Rates....................................................................................................................31
J. Conclusion...........................................................................................................................................................32
K. Appendix .............................................................................................................................................................33
K.1 Mass HIway Information Blocking Compliance Affirmation .....................................................................33
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EXECUTIVE SUMMARY
The Massachusetts Health Information Highway (Mass HIway) is a health information exchange
program within the Commonwealth of Massachusetts’s Executive Office of Health and Human
Services (EOHHS) and is advised by the Health Information Technology (HIT) Council. The HIT
Council is composed of consumer, provider, legal, policy, and technology stakeholders.
The Mass HIway's main objective is to promote and coordinate health information exchange
(HIE) throughout Massachusetts. To achieve this, the Mass HIway utilizes various policy and
technical strategies, offering services and resources to support healthcare providers and
stakeholders in leveraging HIE. The Mass HIway has over 600 participants and processes over
450 million transactions per year which enables public health reporting, COVID-19 queries,
provider-to-provider exchanges, and quality data exchanges.
Below are the Mass HIway program activity highlights for 2023:
• Mass HIway Operations: In 2023, the Mass HIway advanced its infrastructure for
improved public health reporting and provider engagement, supporting over 600
organizations with Direct Messaging services for seamless health data exchange. This
underscores the Mass HIway's commitment to enhancing healthcare coordination and
quality across Massachusetts.
• HIE Connections & Utilization: The Mass HIway processed over 450 million message
transactions in 2023, predominantly for public health reporting, including substantial
volumes for Massachusetts Immunization Information System (MIIS) and Syndromic
Surveillance reporting. This also includes over 5 million provider-to-provider messages,
illustrating a robust utilization of the HIE for public health and care coordination.
• Clinical Gateway & Technical Updates: The Mass HIway maintained its Clinical Gateway,
enhancing connections to seven public health registries, increasing adoption and use of
new APIs, demonstrating strides toward improving health data interoperability and real-
time access.
• Provider Engagement & Provider Directory Updates: The report highlights the addition
of new Direct Messaging connections, significant efforts to update the Provider
Directory, and proactive outreach to ensure accurate and up-to-date provider listings,
enhancing care coordination capabilities.
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 • Event Notification Service Framework: The Statewide Event Notification Service
Framework saw increased ADT notifications, emphasizing the Mass HIway’s role in
facilitating timely health event notifications across care settings, improving care delivery
and coordination.
• Federal Developments & Compliance: The Mass HIway aligns with federal health IT
initiatives and rules, particularly focusing on interoperability, patient data access, and
compliance with the Information Blocking rule, highlighting its commitment to national
health information exchange standards.
• In-flight Initiatives: The report outlines Mass HIway support for ongoing EOHHS
initiatives like the Behavioral Health Treatment and Referral Platform and direct
oversight of the development of an ePOLST Registry, showcasing efforts to support care
coordination and patient preferences for end-of-life care.
EOHHS has a multi-disciplinary and dedicated team to manage the policy, business, operational
and strategic direction of the Mass HIway and other technology programming to support
EOHHS objectives. EOHHS currently utilizes a combination of staff and vendor contracts to
operate and maintain the Mass HIway programs and Clinical Gateway services.
EOHHS and the Mass HIway would like to acknowledge our partners, Orion Health and the
Massachusetts eHealth Institute (MeHI), for their valuable contributions and efforts to support
the Mass HIway operations and other EOHHS initiatives.
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A. INTRODUCTION
Pursuant to M.G.L. c. 118I, the Massachusetts Legislature authorized the Executive Office of
Health and Human Services (EOHHS) to coordinate and promote the development of a
statewide health information exchange (HIE). EOHHS created the Massachusetts Health
Information Highway (Mass HIway) program to embody those HIE coordination and promotion
efforts. The same enabling statute also created the Health Information Technology Council (HIT
Council) to serve as an advisory body to EOHHS and the Mass HIway program.
This HIT Council Report to the Massachusetts Legislature fulfills the statutory requirement
under M.G.L. Chapter 118I, Section 15, for the HIT Council to file an annual report that: (a)
describes the activities of the HIT Council; and (b) describes the progress made in developing
statewide health information exchange and recommending legislative action, if deemed
appropriate.
This report provides an update on notable accomplishments and activities of the HIT Council
related to the state’s HIE that occurred between January 1, 2023, and December 31, 2023. This
report follows the HIT Council’s previous report, which covered activities through December 31,
2022.
Under the advisement of the HIT Council, the Mass HIway promotes the adoption of HIE
through a variety of policy and technical levers. The Mass HIway’s activities aim to increase the
Commonwealth’s adoption of health information exchange and technology to improve care
coordination, quality, patient satisfaction, and public health reporting, while containing costs.
Currently, it operates a Direct Messaging network (HIway Direct Messaging) and Provider
Directory to enable the exchange of vital health data electronically in a secure and seamless
fashion, regardless of differences in affiliation, location, or technology across users. The Mass
HIway operates a Clinical Gateway designed to accept and transform Public Health Reporting
data submitted by providers to seven (7) of the state’s public health registries. Additionally, the
Mass HIway facilitates a Statewide Event Notification Service (ENS) Framework, leveraging
existing market-based solutions to deliver admit, discharge and transfer notifications to
providers throughout the Commonwealth.
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B. MASS HIWAY OPERATIONS
In 2023, the Mass HIway continued to enhance the technical infrastructure to improve public
health reporting access and data processing and various engagement activities to address
provider health information exchange needs and improve utilization. The Mass HIway
maintained critical operations and continued to monitor and support connections, enhance
services and improve programs, such as the Statewide ENS Framework.
B.1 HIE CONNECTIONS
Who is using the Mass HIway?
The Mass HIway continues to provide Direct Messaging services to providers of all sizes, types
and capabilities across the care continuum. Currently, there are over 600 organizations in the
Commonwealth using the Mass HIway for public health and care coordination exchanges.
The Mass HIway Direct Messaging service enables the directed “push” exchange of clinical data
between parties for care coordination, case management, quality improvement and public
health reporting. Direct Messaging facilitates a secure and reliable exchange of patient health
information from one provider to another provider or healthcare entity.
Existing use cases include the following:
• Exchange of a referral from a primary care provider to a specialist.
• Exchange of a clinical summary record between facilities including medication lists, visit
notes, treatment plans and other data critical to care coordination and case
management.
• Discharge summaries transmitted to nursing homes and skilled nursing facilities upon
patient release from the hospital.
• Public Health data exchanges and reporting with state registries.
Direct Messaging remains a fundamental method for securely sharing information and a
reliable alternative to faxing or using more complex and costly interfaces. For context,
approximately 570,000 provider-to-provider care coordination transactions were conducted
through the Mass HIway in December 2023 alone. Direct Messaging is also an integral
component of every certified EHR system.
While APIs and FHIR have the potential to replace some workflows currently supported by
Direct Messaging, a “mixed” environment is expected to persist for some time, where Direct
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Messaging remains a viable alternative to fax and a primary delivery option for transitions of
care, referrals and event notifications. Directories will play a crucial role in identifying endpoint
exchange preferences and capabilities. Since Direct Messaging is expected to remain a
predominant mode of data transport, the Mass HIway is committed to offering Direct
Messaging services as a secure and cost-effective option for health information exchange.
The Mass HIway is utilized by the largest hospitals and health systems in the Commonwealth,
yet it notably serves a significant number of smaller provider organizations. Over 55% of the
connected organizations are ambulatory practices with fewer than ten licensed providers,
alongside 18 Federally Qualified Health Centers (FQHCs) and 27 Home Health, Long-term
Services, and Supports agencies. This diversity underscores the Mass HIway's crucial role in
supporting smaller provider organizations across the Commonwealth, affirming its value in
facilitating comprehensive care coordination and information exchange.
Figure-1 Mass HIway Participant Organizations
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B.2 HIE UTILIZATION DATA
Why are providers using the Mass HIway?
The Mass HIway processed more than 450 million message transactions in 2023. A vast majority
of those messages were for public health reporting purposes, with over 288 million for the
Massachusetts Immunization Information System (MIIS) and over 150 million messages
dedicated to Syndromic Surveillance reporting.
Figure-2 HIE Utilization-Use Cases: 2023 Transactions
2023
HIE Use Case
Transactions
Public Health Reporting 442,337,449
Massachusetts Immunization Information System (MIIS) 288,381,756
Syndromic Surveillance (Syndromic) 152,874,980
Electronic Case Reporting (eCR) 456,862
Intake Enrollment and Assessment Transfer Service (IEATS) for Opioid Treatment
424,182
Program (OTP)
Massachusetts Cancer Registry (MCR) 66,662
Children’s Behavioral Health Initiative (CBHI) 58,279
Electronic Lab Reporting (ELR) 55,888
Childhood Lead Poisoning Prevention Program (CLPPP) and the Occupational Lead
18,840
Poisoning Program (Adult Lead)
Care Coordination Exchange 5,829,059
Provider to Provider Exchanges 5,829,059
Quality Data Exchange 2,550,611
Provider to Payer Exchanges 2,550,611
Grand Total 450,717,119
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Figure-3 MIIS & Syndromic Monthly Volume - 2023
MIIS & Syndromic CG Nodes - 2023
Syndromic MIIS
35,000,000
30,000,000
25,000,000
20,000,000
15,000,000
10,000,000
5,000,000
0
Figure-4 CG Registry Nodes Monthly Volume - 2023
CG Registry Nodes 2023
IEATS ELR MCR CBHI CLPPP eCR
140,000
120,000
100,000
80,000
60,000
40,000
20,000
0
Additionally, the Mass HIway saw a significant volume of messages for Electronic Case
Reporting (eCR), which is a newly mandated public health reporting requirement per the CDC’s
Data Modernization Initiative (DMI) which was spurred by the COVID-19 pandemic.
Though most of the transactions coming through the Mass HIway are for public health
reporting purposes, in 2023 there were over 5.8 million provider-to-provider messages
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exchanged to support care coordination and over 2.5 million messages supporting quality data
reporting annually.
Figure-5 Care Coordination and Quality Data Exchanges - 2023
Care Coordination & Quality Data Exchange -2023
Provider Org to Provider Org Quality Data Reporting
700,000
600,000