Health Information Technology Council
Report to the Massachusetts Legislature
Reporting Period: January 2020 to December 2020
Submitted in March 2021
by the Health Information Technology Council
Contents
I. Executive Summary ............................................................................................................................... 1
II. Introduction .......................................................................................................................................... 1
III. Mass HIway COVID-19 Response Support ........................................................................................ 2
(A) Clinical Gateway Nodes................................................................................................................. 2
IV. Mass HIway Operations .................................................................................................................... 3
(A) Connection Requirement .............................................................................................................. 3
(B) Mass HIway Development Activity ............................................................................................... 5
(C) Outreach and Account Management ........................................................................................... 7
(D) 2020 HAUS Program Update......................................................................................................... 9
(E) Statewide Event Notification Service Framework ...................................................................... 10
V. Federal developments ........................................................................................................................ 11
(A) Interoperability Rules.................................................................................................................. 11
(B) Privacy Rules ............................................................................................................................... 12
VI. Future initiatives ............................................................................................................................. 13
(A) ePOLST ........................................................................................................................................ 13
(B) FHIR API ....................................................................................................................................... 13
VII. Appendices ...................................................................................................................................... 16
(A) HIway Transactions ..................................................................................................................... 16
(B) HIway Adoption and Utilization Services – 2020 Engagements ................................................. 16
I. Executive Summary
The Massachusetts Health Information Highway (Mass HIway) is a health information exchange program
within the Commonwealth of Massachusetts’ Executive Office of Health and Human Services and
advised by the Health Information Technology Council composed of consumer, provider, legal, policy,
and technology stakeholders.
In 2020, the Mass HIway continued to pursue its primary goal of improving provider interoperability
throughout the state during the COVID-19 pandemic. It supported the state’s need for data to track
COVID-19 through electronic data exchange technologies developed and operated since 2013.
The Mass HIway continued its operations seamlessly throughout the pandemic. It conducted its annual
attestation process to measure provider connections and utilization of HIway Direct Messaging. The first
set of Mass HIway services, including the attestation system and Direct Messaging system, migrated to
Amazon Web Services cloud servers, with other service migrations in progress. Provider outreach and
use case implementation efforts continued throughout the pandemic to help providers increase
interoperability. The Event Notification Service Initiative is moving closer to certification of vendors by
the State in early 2021.
The U.S. Department of Health and Human Services set national standards for providers and payers to
adopt, which would improve interoperability. The Office of the National Coordinator for Health
Information Technology finalized rules that require vendors to adhere to national standards for
certification to remove barriers that result in information blocking. The Centers for Medicare and
Medicaid Services finalized its rules to require MassHealth and its contracted Managed Care
Organizations to develop those standardized technologies. In addition, the Substance Abuse and Mental
Health Services Administration and the Office of Civil Rights updated rules and guidance that promote
increased provider data sharing.
The Mass HIway continued to explore potential future services to provide to the Massachusetts
healthcare community to further enhance interoperability and health information exchange. The Mass
HIway joined a cross-agency initiative to develop a registry for Physician Orders for Life Sustaining
Treatment forms, which capture patient preferences for end-of-life care. With the setting of federal
standards, including Application Programming Interfaces that use Fast Healthcare Interoperable
Resources, the Mass HIway is exploring ways to leverage the aligned technical infrastructure.
II. Introduction
Pursuant to M.G.L. c. 118I, the Massachusetts Legislature authorized 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 the statewide health information
exchange and recommending legislative action, if deemed appropriate.
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This report provides an update on notable accomplishments and activities related to the state’s HIE that
occurred between January 1, 2020 and December 31, 2020. This report follows the previous report,
which covered activities through December 31, 2019.
The Mass HIway promotes the adoption of HIE through a variety of policy and technical levers.
Currently, it operates a Direct Messaging network (HIway Direct Messaging) that offers healthcare
entities the ability to securely and seamlessly transmit vital health data electronically, regardless of
affiliation, location, or differences in technology. The Mass HIway also has a health information
technology change management consulting service, HIway Adoption Utilization and Support (HAUS), to
help MassHealth providers make their systems interoperable by assessing a client’s technology and
workflow, developing a plan to meaningfully exchange health data, and supporting the implementation
of that plan. The Mass HIway is currently working to implement a Statewide Event Notification Service
(ENS) Framework to leverage existing market-based solutions to provide ENS to providers throughout
the Commonwealth. 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.
III. Mass HIway COVID-19 Response Support
In 2020, the rapid spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) causing 2019
Coronavirus Disease (COVID-19) required the need for the state to quickly and effectively respond. The
Commonwealth declared a public health emergency on March 10, 2020 to respond to COVID-19. As part
of this response, the COVID-19 Response Command Center (Command Center), led by Secretary of
Health and Human Services Marylou Sudders, was created to coordinate Massachusetts’ pandemic
response across different areas – from building up testing and tracing, monitoring data and trends on a
daily basis, advising on guidance, and to ensuring we have sufficient PPE.
In its emergency response efforts, the Command Center relies on data to track COVID-19 infection rates,
among many things, to make evidence-based public health and policy decisions. The Command Center
in coordination with the Department of Public Health and the State Public Health Laboratory (State Lab)
continues to use the data submitted for Syndromic Surveillance (Syndromic) and Electronic Lab
Reporting (ELR) to produce the public daily dashboard. In 2021, the state expects to track COVID-19
vaccinations through the Massachusetts Immunization Information System (MIIS) system. The Mass
HIway operates technology enabling providers to electronically transmit data to those public health
systems through HIway Direct Messaging and Clinical Gateway Nodes (CG Nodes).
(A) Clinical Gateway Nodes
Public health reporting is a key use case for HIway Direct Messaging. The public health reporting process
via HIway Direct Messaging is mature, with monthly transaction volumes exhibiting some gradual
growth year to year and some seasonal variability, especially in reports of immunizations. In 2013, the
Mass HIway created CG Nodes to reduce the burdens for providers to submit public health reporting.
These CG Nodes are designed to accept data submitted by the provider through HIway Direct Messaging
and technically transform the data into a format that the state’s public health systems can accept and
analyze. This use case was an early success, with widespread, robust use by providers across
Massachusetts. Every Massachusetts hospital and many other providers implemented HIway Direct
Messaging for public health reporting purposes.
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Relative to the state’s COVID-19 response, the Mass HIway supports the Command Center and DPH
through its previously established CG nodes for Syndromic and ELR reporting. The Syndromic CG node
receives data from hospitals, transforms the data, and submits data to the US Center for Disease
Control’s BioSense Platform for national syndromic surveillance. BioSense aggregates the data from
Massachusetts hospitals and sends the curated data to the State Lab. The State Lab then analyzes the
data to identify COVID-19 cases. The ELR CG node allows hospitals to send COVID-19 test results to the
State Lab through an automated process. Approximately 60% of Massachusetts Hospitals submit their
electronic lab results, including their COVID-19 test results, through HIway Direct Messaging and the CG
nodes.
As COVID-19 vaccinations became available, DPH collected – and will continue to collect – immunization
data using its existing provider connections through the Mass HIway’s MIIS CG node. MIIS is the state
system that holds records of all immunizations provided as well as additional functions like vaccination
reminders that will be critical to ensure individuals receive a second dose (booster shot) of the COVID-19
vaccine. In anticipation of increased immunizations due to COVID-19 vaccinations, the Mass HIway team
coordinated closely with the MIIS application team at DPH to increase the message capacity and
throughput of both systems. The Mass HIway, in this initial increase, tripled capacity of the systems to
transmit data for tracking vaccinations in support of the Commonwealth’s COVID-19 response efforts.
IV. Mass HIway Operations
In 2020, Mass HIway operations included important improvements to provider usage, technical
infrastructure, and adoption of services. The Mass HIway continued to track connections and began
efforts to create new services offerings, such as the Statewide ENS Framework (anticipated in early
2021).
(A) Connection Requirement
As set forth in M.G.L. Chapter 118I, Section 7, and as detailed in the Mass HIway Regulations (101 CMR
20.00), certain healthcare providers in the Commonwealth are required to connect to and utilize HIway
Direct Messaging. This requirement is phased in over a four-year period, which is intended to
incrementally promote the use of HIway Direct Messaging for provider-to-provider communications to
achieve bi-directional exchange of health information.
Every organization subject to the connection requirement is required to submit an annual attestation
form (see Figure 1) indicating how it met the annual requirement to connect to HIway Direct Messaging.
During the 2020 attestation period, Acute Care Hospitals were required to submit a Year 4 Attestation
Form; Medium/Large Medical Ambulatory Practices and Large Community Health Centers were required
to submit a Year 3 Attestation Form; and Small Community Health Centers were required to submit a
Year 2 Attestation Form. If an organization had not fulfilled the connection requirement, it was required
to submit a Health Information Exchange Exception Form stating why it did not meet the connection
requirement and explaining the organization’s plans to comply prospectively.
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 Figure 1
In early 2020, the Mass HIway considered how to improve the process through which organizations
declare to the Commonwealth whether they have fulfilled the connection requirement. To improve the
process, the Mass HIway clarified language on the attestation forms and added a section to the forms
regarding the state’s ENS Initiative. Additionally, the Mass HIway developed a list of unique IDs for every
organization subject to the connection requirement. The Mass HIway will leverage this list to more
accurately measure the connection rates of medium/large medical ambulatory practices in the
Commonwealth and to engage practices that have not made an attestation submission.
In early spring 2020, the Mass HIway began outreach and education efforts, holding regular educational
webinars and sending reminder emails to organizations subscribed to the Mass HIway’s updates.
Additionally, to facilitate attestation submissions among the medical ambulatory practice cohort, the
Mass HIway held coordination calls with several of the largest practice groups in the state.
Recognizing the impact of COVID-19, EOHHS extended the 2020 attestation deadline from August 31,
2020 to December 31, 2020. In addition, the EOHHS waived any penalties for failure to submit a 2020
attestation form to allow providers to focus on the COVID-19 response. Organizations began to submit
their attestation forms on August 1, 2020.
As of January 6, 2021, the Mass HIway had received 111 Attestation Forms and 53 HIE Exception Forms,
for a total of 164 forms (95 of which were submitted in December). As of that date, the HIway had
received submissions from 65 of the Commonwealth’s 67 Acute Care Hospitals, 19 of 40 Community
Health Centers, and about 60% of Medium and Large Medical Ambulatory Practice entities.
The HIway analyzes these submissions to identify trends and potential opportunities for outreach to
provider organizations to improve HIE. After the December 31, 2020 deadline passed, the HIway focused
outreach on organizations subject to the connection requirement that had not completed an attestation
submission. In January 2021, the Mass HIway sent a mass email reminder to all provider organizations
that had not yet submitted forms; and followed up with a direct reply email from the organization’s
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HIway account manager. In late January, the Mass HIway called organizations that still had not
submitted. Finally, in mid-February, the Mass HIway sent reminder letters to organizations that had not
submitted. Based on prior experience where multiple follow-up communications substantially increased
the submissions received, the Mass HIway is confident that this outreach will result in many more
submissions.
(B) Mass HIway Development Activity
The Mass HIway development team focused on consolidating the CG nodes into a single, consolidated
application and migrating that core application and a suite of supporting applications and tools to
Amazon Web Services (AWS) cloud-based servers. While critical changes and fixes were addressed as
needed, most functional changes requested by the backend application teams have either been
incorporated into the new Consolidated Clinical Gateway application (CCG) (described below) or
deferred until after the migration is complete.
(1) Background
The CG nodes are Mass HIway software applications that connect providers securely to DPH and other
state agencies for public health reporting. Providers send public health reports via Direct Message to the
CG nodes, which transform the message into a format useable by the agency’s systems. The CG node
transformation processes include decryption of the original message, validation that the data is correctly
submitted, and transformation of the message into a format acceptable to the receiving system.
Reporting providers and state agencies benefit by allowing each group to keep their existing technology
infrastructure while the CG node does the transformative work to allow for the seamless exchange of
information.
Each of the following CG nodes is a separate application that supports a corresponding public health
reporting back-end application:
 Children’s Behavioral Health Initiative (CBHI)
 Childhood Lead Poison Prevention Program (CLPPP)
 Electronic Lab Reporting (ELR)
 Opioid Treatment and TB Reporting Programs (I-EATS)
 Massachusetts Cancer Registry (MCR)
 Massachusetts Immunization Information System (MIIS)
 Syndromic Surveillance Program (Syndromic)
The architecture for the existing CG nodes was developed in 2013 with the launch of HIway Direct
Messaging. The CG nodes were scaled up by copying the first CG node and recoding it as a separate
application to be able to connect to a respective DPH system. The multiple CG nodes will continue to run
in the EOHHS Private Cloud Data Center, LogicWorks Virtual G