101 CMR 20.04 - Definitions

As used in 101 CMR 20.00, unless the context requires otherwise, terms have the following meanings.

Admission Discharge and Transfer Messages (ADTs). Types of messages that can track a patient's transitions in or out of a site of care such as admissions, discharges, or transfers. The focus of ADT messages is to convey data related to patient demographics and/or to health care encounters.

Business Associate. Has the meaning assigned to it in 45 CFR 160.103 (Health Insurance Portability and Accountability Act (HIPAA) regulations).

Certified Event Notification Service Vendor or Certified ENS Vendor. An ENS vendor that is certified by EOHHS.

Direct or the Direct Standard. Refers to the specifications developed by the direct project, a nationally recognized organization that develops specifications for a secure, scalable, standards-based way to establish universal health addressing and transport for participants (including providers, laboratories, hospitals, pharmacies, and patients) to send encrypted health information directly to cryptographically validated recipients over the Internet. For purposes of 101 CMR 20.00, references to direct, the direct standard, or the direct project will include any other national, open, industry standard supported by the Mass HIway.

Electronic Health Record (EHR). A digital version of a patient's paper chart. EHRs are real-time, patient-centered records that make information available instantly and securely to authorized users, often including a patient's medical history, diagnoses, medications, treatment plans, immunization dates, allergies, radiology images, and/or laboratory and test results. EHR systems are able to share patient information with other authorized health care providers and organizations.

ENS Recipient. A provider that has a contractual relationship including, but not limited to, a business associate agreement, with a certified ENS vendor(s) for treatment or care coordination in accordance with 101 CMR 20.11.

EOHHS. The Executive Office of Health and Human Services, established under M.G.L. c. 6A.

Event Notification Service (ENS). A service that provides real-time alerts about certain patient medical service encounters, for example, at the time of hospitalization, to a permitted recipient with an existing treatment relationship to the patient, such as a primary care provider.

Health Information Exchange (HIE). The transmission of health care-related data among providers and payers of personal health records according to national standards; the reliable and secure transfer of data among diverse systems and access to and retrieval of data. HIE incorporates many forms of communication methods including, but not limited to:

(a) directed exchanges;

(b) queried exchanges; and

(c) consumer exchanges.

The Mass HIway operates a statewide health information exchange in accordance with M.G.L c. 118I, and 101 CMR 20.00. More detailed information regarding the functions and services provided by the Mass HIway can be found in the Mass HIway Policies and Procedures.

Health Information Service Provider (HISP).

(a) HISP. An entity that, as part of or all of its business, performs the following:

1. verifies participant identities;

2. issues and manages security keys;

3. issues direct addresses; and

4. processes messages to and from those addresses using the direct standard.

(b) HIway Trusted HISP. A HISP with which the Mass HIway has a direct contractual arrangement, or a HISP that belongs to a third-party organization that acts as a trust framework aggregator with which the Mass HIway has a direct contractual arrangement, to securely exchange Direct Messages, through a means typically referred to as a HISP-to-HISP connection.

(c) HISP-to-HISP Connection. A technical connection between two or more HISP systems for the purpose of delivering Direct Messages to and from authorized participants of the HISPs that contains clinical or administrative health information about a specific patient. Contractual agreements establish the HISP-to-HISP terms and may be between two HISPs or may be between a HISP and a third-party organization that acts as a trust framework aggregator.

HIway Direct Messaging. A secure method for Mass HIway users, including provider organizations, to transmit a message with information about a patient to other users, where the Mass HIway does not analyze, use, or share the contents of the message except as required to deliver it and to make it available for use by the intended recipient. HIway Direct Messaging follows the direct standard for encryption technology, or its successor standard, and provides a more secure method of transmitting information than other modes of transmission such as sending a fax, or sending information by postal mail.

HIway-facilitated Service. A service whereby the Mass HIway creates a framework for protected health information exchange through governance, promotion, certification, and/or contracts with a vendor or vendors to support treatment or care coordination.

HIway-sponsored Services. A service for HIway participants whereby the Mass HIway operates and manages a technology platform that allows the HIway to may use, analyze, and/or share protected health information and/or personally identifiable information on behalf of participants.

Mass HIway Integrator. An organization that connects HIway participants to the Mass HIway. Mass HIway integrators are business associates of participants and may include electronic health record (EHR) vendors, technical integrators, and regional health information organizations (RHIOs). Mass HIway integrators use Mass HIway for HISP services.

Mass HIway User. A user includes:

(a) HIway Participant. A provider organization, a health plan, or a business associate of either a provider organization or health plan or other entity approved by EOHHS. HIway participants must execute a Participation Agreement.

(b) Non-participant User. An organization that is granted access to the Mass HIway through a HIway trusted HISP.

Patient Matching Process. A certified ENS vendor's proprietary algorithmic process(es) used to match ADTs with patients.

Reflection or Reflect. The process certified ENS vendors use to disclose ADTs with all other certified ENS vendors for treatment or care coordination.

Statewide Event Notification Service (ENS) Framework. An event notification service framework created as a HIway-facilitated service by the EOHHS under 101 CMR 20.11.

Trust Framework Aggregator. A trust framework aggregator manages a bundle of security certificates, or "Trust Anchors", to facilitate interoperable direct exchange between HISPs in a uniform and scalable manner that is consistent with industry best practices for security and trust, thereby avoiding the need for further one-off negotiations between relying parties who are participants in the bundle.

Use Case. A narrative that describes how to accomplish a business goal and sets forth the functional requirements including scope of the activity, people and organizations involved, expected inputs and data, processing steps, and anticipated results. The use case informs the technical and process planning for development of a solution, and can be implemented between two provider organizations or multiple provider organizations based on the business need, clinical workflows, and technical and operational readiness. Categories of use cases will be detailed in the Mass HIway Policies and Procedures as updated from time to time, and may include, but not be limited to, the following categories:

(a) Provider-to-provider Communications;

(b) Payer Case Management;

(c) Quality Reporting; and

(d) Public Health Reporting.


101 CMR 20.04
Adopted by Mass Register Issue 1332, eff. 2/10/2017. Amended by Mass Register Issue 1401, eff. 10/4/2019.

State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.

No prior version found.