mihin overview - health information exchange meet and greet v7 10 22-14

MiHIN OverviewHIE Meet and Greet

October 2014

MiHIN is a

network for sharing health information statewide

for Michigan

2Copyright 2014 - Michigan Health Information Network Shared Services

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Statewide Coordination

Health Plans

Physicians

Specialty Providers

Hospitals & Clinics

Patients & Families

Lab tests &XRAYs

Medications

Public Health

Insurance Companies

Physicians

Specialty Providers

Hospitals & Clinics

Patients & Families

Lab tests &XRAYs

Medications

Public Health

Duplication of effort, waste, & expense(N x N-1 connections)

Shared Services(N connections)

Copyright 2014 - Michigan Health Information Network Shared Services

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“One and Done”- Easier, Simplified, Predictable Data Sharing

1. Sign once• Common legal framework across the state• Transparent data usage for each use case

2. Connect once • MiHIN network includes all of health care: HIEs, HISPs, health

plans, the state and the federal agencies

3. Publish once• Patient and provider delivery preferences easily registered and

centrally managed

4. Report once • Messages can be routed to multiple destinations – no duplicate

interfaces or repeat reports

5. Log-on once • Single sign-on across patient/member and provider portals


State-wide Shared Services

MDCH Data Hub

Medicaid

MSSS

State LABS

Doctors & Community Providers

HIE QOs(Qualified sub-state HIEs)

Network of Networks:

Data Warehouse

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Health Plan QOs (more coming)

Single point of entry/exit for state

Virtual QOs


Pharmacies (more coming)

Immunizations

Mi Syndromic Surveillance System

Mi Disease Surveillance System

Consumer QOs (more coming)

Federal

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MiHIN FAST FACTS

Network of Networks (not an HIE)

Shared network of multiple qualified organizations (QOs) for sharing data

Transparency via Governor’s HIT Commission

Strong state and health plan representation


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MiHIN Stakeholders

HIE QO(HQO)

•Meets the QO requirements•Plans to participate in at least 2/3 of Use Cases•Voice in the MiHIN Advisory Committee (MOAC)

Plan/Payor QO(PQO)

•Health Plan licensed in the state of Michigan•Blue Cross, Michigan Association of Health Plans, & Priority Health have Board eligibility

Government QO(GQO)

•Government Qualified Organization (i.e. Michigan Department of Community Health)•Federal Agency (i.e. Social Security Administration, CMS, Veterans Affairs, DoD, CDC, etc.) •Tribal Nations in Michigan

Consumer QO(CQO)

•Participate in consumer-focused Use Cases (i.e. MiWay Statewide Consumer Directory)•Supported & authorized consumer facing services (i.e. Patient Health Record, Patient Portal) - an example is advance directives stored in Peace of Mind Registry


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What is a USE CASE?• Data sharing scenario with specific:

• purpose• type of data exchanged• description of interactions between people/ systems

• Each Use Case may have different:• access restrictions • rules for using the data• cost recovery fees or charges• technical requirements

Use Case Factory™


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Use Case ComponentsUse Case Summary explains purpose and value proposition for sharing data

Use Case Agreement is a legal document that covers expected rules of engagement (all Qualified Organizations sign the agreements)

Implementation Guide is a technical specification that outlines standard format details for data transmission & content


http://mihin.org/about-mihin/resources/use-case-submission-form/

Use Case Factory

Idea with Champion

Idea with Sponsor

Plan & Develop

Pilot & Refine

Technical Planning

Conceptual

EvaluationDefine Purpose

U se Case Summary Contains The B asic I deas L aid Out in an E asy to R ead Document for the

B oard to A pprove

Implement

Production Status

Metrics

Adoption

Critical Mass

Mass Marketing &

OutreachMiHIN Board

SuccessfulAdoption

ContinuousImprovement

Functional Data-Sharing

Widget




Use Case Assembly Lines

Results Delivery• Lab

results• Diagnosti

c imaging• Other

tests• Hospital

discharge summaries

Public Health Reporting• Immunizatio

ns• Chronic

disease registries

• Disease surveillance

• Syndromic surveillance

• Birth & death notifications

• 41 new use cases identified

Care Coordination & Patient Safety • Referrals• Care summaries

for treatment history & allergies

• Notification of transitions of care ( Admit Discharge or Transfer)

• Medication reconciliation & therapy change notices

• Clinical decision support alerts

Quality & Administrative Reporting• Registry

Updates• Physician

Quality Reporting measures

• Meaningful Use reporting

• Electronic verification

• Patient satisfaction

• Eligibility• Authorization• Claims audit

Patient/Consumer Engagement• Instructions• Health risk

appraisals• Medication

Compliance• Therapy

Compliance• Patient

activation and self determination

• Health literacy & numeracy

• Consumer Preferences and Consents


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Infrastructure Services

Secure Transport Layer Services and Digital Credentials

Master Person Index(Common Key Service)

Active Care Relationship

Service

Patient Opt-In Preferences

Identity Management

FederatedIdentity Management

(FiDM)

Health Provider Directory

Gateway Services (e.g. XCA)


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Accelerating Use Cases

Policy & Regulatory

Levers

ClinicalEndorsement &

Evidence

FinancialIncentives or Disincentives


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Use Case Pipeline Example


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Benefits of Use Case Approach

Reduces Complexity •Manageable chunks so competitive or confidentiality concerns can be addressed without “boiling the ocean”

Consistent Pattern •Standardized mechanism for scoping purpose, technical requirements, costs, and limits on how data is used

Modular (like Lego blocks) •Use Cases can be combined to create higher and higher levels of functionality

Aligns Priorities •Incentives, regulations or policies can target specific Use Case to foster or accelerate adoption

Transparent •Constituents can understand expected use of their data and follow the common chain of trust across organizations

Measureable •Aids focused monitoring and measurement of progress

Faster & Cost Effective •Reduces variability and enables scalability


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Monitoring Public Health Use Cases

-

500,000

1,000,000

1,500,000

2,000,000

2,500,000

3,000,000

3,500,000

4,000,000

Syndromic Surveillance (SS)

Clinical Quality Measures (CQM)

Reportable Labs (ELR)

Immunizations (VXU)


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Monitoring Transitions of Care

0

2000000

4000000

6000000

8000000

10000000

12000000

14000000

16000000

Admit-Discharge-Transfer (ADT)

Outbound (ADT)


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Statewide ADT Use Case Example

Active CareRelationship Service

(ACRS)

Statewide Health ProviderDirectory (HPD)+ +


Statewide Health Provider Directory

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• Contains Electronic Service Information (ESI) used to route information to providers

• Flexibility to maintain multiple distribution points for single provider or single distribution for organization

• Manages organizations, providers and the multiple relationships between them


ACRS™ Update – Version 2.0

Additional patient information to minimize false positives

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Patient InformationSource Patient ID First Name Middle InitialLast NameSuffix Date of Birth GenderSSN – Last 4 digitsAddress 1 & Address 2City, State, Zip Home & Mobile Phones

Physician InformationNPI First NameLast NamePractice Unit ID Practice Unit NamePhysician Organization IDPhysician Org Name Physician DIRECT AddressDIRECT Preferences


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Important Horizontal View

Eligible Hospitals

Eligible Providers &

PCMH

Care Coordinators

Specialty Providers

BehavioralHealth Specialists

Critical Access Hospitals

Patients & Families


Qualified Organization

Qualified Organization

Statewide ADT Notification

Active CareRelationship

HPD Delivery Preference

Lookup

1) Patient goes to the hospital, hospital sends a registration message

2) Check Active Care Relationships and identify three providers

3) Using the HPD, identify delivery preference for each provider

4) Notification is routed to providers based on preferences

Primary Care

Specialist

Care Coordinator

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Animation


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Other “Lego” Combinations

Active CareRelationships

State-wide Health Provider

Directory+ +

Active CareRelationships

State-wide Health Provider

Directory+ +

MED REC

CarePlan


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Some 2015 Use Cases• Query for immunizations• Newborn screening• Social Security eligibility determination• Medication Reconciliation-discharge push of Med Rec• Trusted identities

• Provider single-sign-on• Patient single-sign-on

• Statewide HPD query-direct client integration module• Medication Information Direct Gateway (MiDiGateTM)• Common Key Service– patient matching service• ACRS Services-expose to beneficiaries• Advance Directives - send to Peace of Mind registry• Health Risk Assessment (HRA)• Integrated Care Bridge Record (ICBR) - care plan

Ready Now!


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MDCHData Hub

HIE QO/VQO

MiDiGate

Medical Information Direct GatewayTM MiDiGateTM for HIE QOs and VQOs

CQM Data Mart

Medicaid ADT Repository

MCIR

MDSS

MSSS

SOM Data Warehouse

OutboundInbound

QRDA Cat III

QRDA CAT III

MU Credit

MeaningfulUse

Database

QRDA

Any provider organization

Physicians

Labs

Hospitals

HIEs

CorrectionalFacility

Patients

EDRS

MCDR

MiHIN

Repository

HIE

Other StatesDirect Email Convention Examples Using MiDiGate

& Health Provider Directory Inbox

[email protected]@direct.hieqo.org


[email protected]@direct.hieqo.org [email protected]


Destination(s) .Reportable Labs to MDSSElectronic Death Registry System Michigan Care Improvement RegistryRegistry for that use caseChronic Condition RegistrySOM Data WarehouseVital StatisticsFoster Kids RegistryChronic Disease Registry

DescriptionLab Results

Death NoticesImmunizations

Use Case SpecificBirth Defect Notices

Clinical Quality Measures Admit, Discharge, Transfer

Foster Kids Care SummariesConsolidated Clinical Document Architecture


Maximize SOM Resources

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State o

f Mich

igan

In

ternal

ExternalSTATEWIDESHARED SERVICES

MDCH Data Hub MiHIN & the Qualified Data Sharing Organizations

Transparency via HIT

Commission Monitoring

Shared Governance via

MiHIN Board


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MiHIN GovernanceMiHIN Board of

Directors

MiHIN Management & Core Staff

Executes the Operations Plan

MiHIN Operations Advisory Committee (MOAC) oversees working groups that advise MiHIN

Health Information Technology Commission


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MiHIN Board of Directors

MiHIN Operations Advisory Committee (MOAC)

MiHIN Executive ManagementExecutes the operations plan

Tim Pletcher, Executive Director

Jeff Livesay, Associate Director

Provides monthly MiHIN status report

Health Information Technology Commission(HITC)

The Commission's mission is to facilitate and promote the design, implementation, operation, and maintenance of an interoperable health

care information infrastructure in Michigan.

Pat RinveltRepresenting Purchasers or Employers

Mark Notman, Ph.D.Representing Schools of Medicine

Nick LyonRepresenting MDCH

Nick SmithRepresenting Health Plans or Third Party Payers

Jill Castiglione Representing Pharmacists

Gregory Forzley, M.D.- Chair Representing Doctors of Medicine

Michael G. Chrissos, M.D.Representing Consumers

Robert MilewskiRepresenting Nonprofit Healthcare Corporations

Rod DavenportRepresenting State of Michigan CTO

Orest Sowirka, D.O.Representing Doctors of Osteopathic Medicine

Jim LeeRepresenting Hospitals

MiHIN Board of Directors

Michigan Public HealthJim Collins

Southeast Michigan HIE (SEMHIE) Helen Hill

Michigan Pharmacist Association

Larry Wagenknecht, Chair

Michigan MedicaidCynthia Green Edwards

Ex OfficioTim Pletcher

Priority HealthKrischa Winwright

Blue Cross Blue Shieldof MI (BCBSM)

Dr. Thomas Simmer

Jackson Community Medical Record (JCMR)Rick Warren, Vice Chair

Great Lakes Health Connect Vacant

Ingenium John Vismara, President

Upper Peninsula HealthInformation Exchange (UPHIE)

Dennis Smith

Set Policies

Act

on

the

Policies

VacantRepresenting Pharmaceutical Manufacturers

Irita B. MatthewsRepresents Health Information Technology

Meridian Health Plan Thomas Lauzon

HIT CommissionerNick Lyon


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MOAC Working GroupsOperations/

Production Support

Great Lakes Health Connect Adam GeeMike Ayers

Upper Peninsula Health Information Exchange (UPHIE)

Paula Hedlund, Dan Boyle

Jackson Community Medical Record (JCMR)

Jeanne Wymer

Ingenium John Vismara, E.D., Rusty

Mandle

MDCH/DTMB/SOMDoug Witten – Co-Chair,

Tina Scott, Alan Darl ing, Larry Ruble, Kevin Garnett, Therese

Hoyle, Bea Salada, Dave Wil lhite, Brenda Coleman, Paul Groll, Ed Hartwick, Jeff Shaw,

Doug Saylor, Craig Weaver, Mike Potter, Soma Duppi,

Brendan O’Brien, Jaya Tamrakar

MiHIN Sh ared ServicesBrian Seggie, Rod Mach, Steve

Arnst, Aldan Beaubien

Integration and Architecture

MDCH/DTMB/SOMDoug Witten – Co-Chair,

Tina Scott, Alan Darl ing, Larry Ruble, Kevin Garnett, Therese

Hoyle, Bea Salada, Dave Wi llhite, Brenda Coleman, Paul Groll, Ed

Hartwick, Jeff Shaw, Doug Saylor, Craig Weaver, Mike Potter,

Soma Duppi, Brendan O’Brien, Jaya Tamrakar

MiHIN Sh ared ServicesBrian Seggie, Co-Chair, Steve

Arnst, Rod Mach, Aldan Beaubien

Security

Great Lakes Health Connect Adam Gee, Rich Fish


Paula Hedlund


Jeanne Wymer

MDCH Data Hub/DTMBPaul Groll,

Phil Kurdunowicz, Tairus Taylor

MiHIN Sh ared ServicesBrian Seggie – Co-ChairJeff Livesay, Frank Cass

Issue Remediation

MDCH Cynthia Green-Edwards –

Co-Chair, Meghan Vanderstelt

MiHIN Sh ared ServicesDr. Tim Pletcher – Co-Chair

Use Case

MDCH/DTMBTina Scott– Co-Chair,

Paul Groll, Alan Darl ing, Rick Mathews, Doug Witten, Bob Swanson, Tairus Taylor, Phil

Kurdunowicz, Patt y Clark, Therese Hoyle, Jeff Haskell, Jim Collins,

Brendan O’Brien, Jaya Tamrakar

MiHIN Sh ared ServicesRick Wilkening – Co-Chair

Michael Taylor

SEMHIEMick Tal ley

Great Lakes Health Connect Heidi Newton, Mike Ayers

Great Lakes Health Connect Carol Parker,

Douglas Dietzman



Great Lakes Health Connect Doug Dietzman


Paula HedlundDan Boyle (alt.)


Aaron WoottonRick Warren (alt.)

Ingenium John Vismara

Wendy Linkimer (alt.)

MDCH/MDCH Data Hub Tina Scott, Co-Chair

Cynthia Edwards

MiHIN Shared ServicesJeff Livesay, Co-Chair

Dr. Tim Pletcher

Southeast Michigan HIE (SEMHIE) Helen Hill

Blue Cross Blue Shieldof MI (BCBSM)Wanda Brideau

Health Alliance Plan of Michigan (HAP)

Jane Harper


Jeanne Wymer

Ingenium John Vismara, Rusty Mandle

SEMHIEVacant


Vacant


Vacant

SEMHIEVacant


Vacant


Vacant


Vacant


Jane Harper, Robert Keefer


Paula Hedlund


Aaron Wootton

Ingenium John Vismara

SEMHIEHelen Hill

Blue Cross Blue Shieldof MI (BCBSM)John Bialowicz


Vacant




Aaron Wootton, Jeanne Wymer, Rick Warren

Ingenium Diane Slon, Wendy Linkimer

SEMHIEHelen Hill, Mick Tal ley

Blue Cross Blue Shieldof MI (BCBSM)John Bialowicz


Deborah Spencer

Ingenium Rusty MandleKen O’Brien

Privacy


Paula Hedlund


Jeanne Wymer

MDCH/DTMBLeslie Asman,

John Donovan-Co-Chair, Phil Kurdunowicz- Co-Chair

MiHIN Sh ared Service Jeff Livesay

Brandi Briones

SEMHIEMick Tal ley


Vacant


Vacant

Ingenium Rusty MandleKen O’Brien

Great Lakes Health Connect Rich Fish

Priority Health Lee VanWagner

Priority Health Vacant






Meridian Health Plan Tony Randolph Thomas Lauzon

Meridian Health Plan Vacant






Great Lakes Health Connect Adam GeeMike Ayers

MiHIN Operations Advisory Committee (MOAC)


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Challenges• Communicate effectively• Maintain stability in the rapidly growing

ecosystem• Understand how to better support our

stakeholders


Questions?Dr. Tim Pletcher

Executive Director

[email protected]

Jeff Livesay

Associate Director

[email protected]

Shelley Mannino

Senior Project Manager

[email protected]


mailto:[email protected]



mihin overview - health information exchange meet and greet v7 10 22-14

Healthcare

health care

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use case2

state transparent data

data sharing scenario