Michigan’s HIE’sPanel Discussion

Moderator: Jeff Livesay, MiHIN Associate Director

Michigan – a Network of Networks• Eleven (11) organizations have become

“qualified” to share data through MiHIN for statewide health information exchange:

• Seven Health Information Exchanges (HIEs)• Michigan Department of Community Health• Blue Cross Blue Shield of Michigan

• PCE Systems• Carebridge Systems

Michigan HIE Community

HealthPlans

More to Come…

State of Michigan

Public Health

Federal Use Case

Transitions of Care

HPD

Let’s look at one simple example of an HIE working with MiHIN

• Connected Nation: Michigan Health Information Network:

https://www.youtube.com/watch?feature=player_embedded&v=XSjEEeIclzs

Introducing today’s panelists

• Carol Parker, Executive Director, GLHIE• John Vismara, President, Ingenium• Aaron Wootton, Director, JCMR• Doug Dietzman, Executive Director, MHC• Terrisca Des Jardins, Director, SEMBC• Helen Hill, Board Member, SEMHIE• Paula Hedlund (Johnson), Director, UPHIE

Great Lakes Health Information Exchange

• Non-profit, 501(c)3• Community Collaborative• Priorities

• Patient health and safety• Quality improvement• Administrative efficiency• Cost Reduction

• Pilot 2/15/11-5/14/11• Fully operational 5/15/11

GLHIE by the Numbers

Clinical Results ADT

Lab

Radiology

Transcripts

Master Patient Index

VHR Queries

Annual Numbers – 2012 (2013 estimates)

31.1M (50M)

7.3M (11M)

1.2M (1.7M)

2.3M (3M)

2.6 M

170,000/month

Current GLHIE Use Cases

Connect physicians and other health care providers electronically to facilitate clinical messaging and sharing encounter reports

Results Delivery (Lab as discrete data, Radiology, Clinical Documentation such as discharge summaries and consultations, Cardiology Reports)

Immunization Submission to MCIR – CDC standards compliant

ADT notifications – notifications are pushed into providers’ EMRs

Query patient’s community-wide longitudinal health record - Print or forward (with an interface) pertinent clinical docs to EMR

Subscribe to a patient (push all available clinical data to practice EMR)

Push practice EMR data to patient’s longitudinal health record and distribute to patient’s identified care team

Clinical Messaging – both through interfaces, clinical inbox and DIRECT; No more gmail, yahoo mail, texting… Also useful for referral routing and consultative report routing.

Current GLHIE Use Cases (cont’d)

Use Cases in Progress Immunization Query Capability – 3Q2013 Public Health Reporting – reportable labs – 3Q2013 Lab Order Gateway – in progress and go live TBD Radiology Images – by the end of June 2013 Disease Registry Connections – by the end of July 2013 Business analytic support for MU, PCMH and ACOs – by

the end of August 2013 EMS – 3Q2013 Telehealth – 4Q2013

Sharing Data

• GLHIE Board fully supports sharing across providers.

• First use case – electronic referrals using DIRECT• Future – query-based exchange using IHE

protocols• GLHIE’s informatics structure includes federated clinical

data repositories for each participating provider, an enterprise Master Patient Index, Record Locator Service, and Provider Directory

• Implemented IHE standards in May 2013.

MiHIN Participation

• Public Health reporting (immunizations, reportable labs, syndromics, etc.)

• Statewide Admit-Discharge-Transfer (ADT) and Transitions of Care (TOC) service

• Federal use cases with SSA, VA, CMS via MiHIN’s HealtheWay eHealth Exchange (NwHIN) node – under review

• Health Provider Directory – under review by the Board of Directors

Contact Information

• (517) 347-3373• cparker@glhie.org• www.glhie.org

Connecting Michigan for Health

June, 2013

Ingenium Background • Focus on networks of physicians

• Physician based and governed• Enable networks of physicians to manage populations of

patients • Shared IT infrastructure• Build upon previous work

Ingenium Goals• Leveraging Shared Infrastructure and Data

• With Large amounts of Ambulatory Data• Providing a Path to Readily Accessible and Actionable

Information• Focus on physician access at point of care

• Enabling change by empowering Physicians• Enabling Population Management and Care Coordination

programs• Physician Oversight / Representation

United Physicians Use Case• Using Platform to enable

• Point-of-Care Access to Information– Community Record– Registry Applications

• Care Coordination– Facility Census– Specialty Referrals

• Network-based Quality Improvement Programs• Application Access• Communication

Transmission of Data(MHC)

Aggregation of Data

(Ingenium)

H

Dr

Dr

Dr

Beaumont/UP HIE World

May 21, 2013 18

Ingenium, LLC

Data SourcesPO – UNITED PHYSICIANS, LPOPHYSICIAN EMR– ATHENA, EPICHOSPITALS – BEAUMONT, CRITTENTON, ST.

JOSEPH OAKLAND, BOTSFORD, GARDEN CITYLABS – BRL, BOTSFORD, GARDEN CITY, DMC,

JVHL, QUEST, BIO-TECH, LABCORP (IN PROCESS)

HEALTH PLANS – BCBSM, BCN, HAP, PRIORITY, HEALTHPLUS, MAHP

MIHIN (MCIR)APPLICATIONS – DOCSITE, WELLCENTIVE,

DRFIRST, OTHERS

Ingenium Metrics• Over 1.3 million Patients• 1,357 Physicians

– 310 access Community Record• All Physicians by October

– 213 access facility census• Message Types (approx 150,000 per day)

– ADT (over 180,000 per month)– Demographic (2.5 million per year)– Conditions (600,000 per year)– Labs (3.5 million per year)– Immunizations (750,000 per year)– Procedures (400,000 per year)– Vitals (3.25 million per year)– Reports/Notes (825,000 per year)

MiHIN Participation• Board and Committees• Current Use Cases

– Immunizations (MU)– Security– ADT

• Future Use Cases– Sharing data between HIEs– Medication Reconciliation– Other

JCMR Overview Connecting Michigan

June 5, 2013

Jackson Community Medical Record

• An EHR/HIE in the Jackson area since 2005• Connects ~50% of all providers

• AllegianceHEALTH employed providers• Many private practice providers• Federally Qualified Health Center• Jackson County Health Department• AllegianceHEALTH clinics

• Tightly integrated with AllegianceHEALTH• One shared EHR for the community of providers

JCMR

One Integrated Patient Chart

Medication lists, reconciliations and drug interactions across practices.

Lab Results automatically assigned to the appropriate physician and patient independent of an electronic order.

All allergies are shared across practices.

• Shared patient ID, demographics, med list, allergies, problem list, notes, etc.

• Closed-loop ordering – referrals, tests, procedures

• Uniform decision support

• Advanced clinical information sharing

• Support in achieving meaningful use

• Real-time interfaces

• Local payer pay for performance reporting

• Local support

All social, family and past medical history is available.

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JCMR

Current Interfaces

• Demographics & insurance• Lab orders and results (closed loop)• Radiology Results• Discharge summaries• Operative Notes• Histories & Physicals• ePrescribing • Tasks across practices• Referrals across practices (as tasks)• Enterprise Chart – eliminates the need for many other interfaces• Auto populates JCMR and NextGen report systems• Auto populates Phytel population management registries • Phytel calls to remind patients to make appointment for overdue care

JCMR Statistics

• Providers• 257 Practice Management• 196 Electronic Health Record• >1,000 users

• Patient Volumes• 190,000 shared active patients• 50,000 + encounters / month• 35,000 Surescripts e-prescriptions / month

• Monthly Interface VolumesInterface Volume

Lab Orders 60,000

Lab Reports 111,000

Radiology Reports 45,000

AH Unsolicited Results Received 100,000

Total 316,000

JCMR

Care Coordination Opportunities

50%

25%

25%

Practice Utilization by Patients

One Practice

Two Practices

>= ThreePractices

Half of our 190,000 active community patients have visited more than one practice. By being connected to one enterprise database, our doctors and caregivers simply have more valuable and accurate data to take care of these patients.

JCMR

Benefits Achieved So Far• Patient Centered Medical Home certified practices• Provider incentives

• PQRI/PQRS from Medicare• e-Prescribing from Medicare• PCMH from Blue Cross & Medicare• PGIP from Blue Cross• Meaningful Use - stage 1 certified from Medicare

• Reduced duplication of tests (est. 15-20%)• Patient safety: medication interactions, pain contracts, doctor hopping

for meds… unknowable.• It’s Your Life in JCMR to coordinate goals with Primary Care

Physicians.• One click smoking cessation referrals and documented in chart.• Diabetes tracking.• Automated outreach & new chronic disease registries are getting

patients in to see their physicians for overdue care (Phytel)

• Public Health reporting (immunizations, reportable labs, syndromics, etc.)

• Statewide Health Provider Directory• Statewide Admit-Discharge-Transfer (ADT) and

Transitions of Care (TOC) service• Patient Secure Pilot

Planned & Current Participation with MiHIN

Connecting Michigan Conference

June 5th, 2013

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Who is Participating?• 68 total hospital facilities

• 14,700 licensed beds• 15,200+ combined medical staff

• 1,608 office locations• 8,000+ providers

• 14 other member orgs:• Provider organizations• Health plans• Home health/DME• Community mental health• Local public health• Employer Clinics• Diagnostic centers

• 3 HIE Direct agreements:• OHIP – State of Ohio• GLHIE – Lansing • MHIN– South Bend, IN

What is MHC Actually Doing?

Live Solution Summary (“the tracks”)– Results Delivery (1,500,000 / month)

– Lab Orders (6,600 / month)

– Radiology Orders (1,500 / month)

– EMR Interfaces (267 interfaces, 40 different systems)

– Referrals - Physical (5,500 / month, 534 offices, 37 counties)

– Referrals - Behavioral (14 offices, 2 counties)

– Virtual Integrated Patient Record - VIPR (1,555,000 CMPI)

– State Immunization Registry (to State via MIHIN) (300+ offices)

– Reportable Lab Registry (to State via MIHIN)

– Direct HISP (*@mhc.medicity.net)

– Admission & Discharge Notifications (MHC direct or via MIHIN) (~660,000 / month)

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Connecting Michigan for Health Update

Wednesday June 5, 2013

Southeast Michigan Beacon Community

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The Beacon Community Program:Where HITECH Comes to Life

Taken from: Blumenthal, D. “Launching HITECH,” posted by the NEJM on 12-30-2009.

BEACON

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Microcosms of Wired Communities Across America

“We’ve learned that that’s an incredible gift, to have very specific goals, not for a hospital or for a clinic, but for an entire community.”

Farzad Mostashari, The National Coordinator

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HIT-Enabled Clinical Transformation: ResultsEmergency Department Diabetic Patient Identification

Through 4/30/2013

Patients Tested 19,794

Pre-Diabetics 4,467

Diabetics 1,221

PHN Referrals 1,409

Patient Health Navigators: Ambulatory ActivityThrough May 10, 2013

Patients Referred 3,986

Patients Engaged 1,707

Patients: Outreach Queue 1,221

Patients Declined 1,409

mHealth Pilot: txt4healthFebruary 22, 2012 – February 28, 2013

Total Engaged 1,023

% set initial weight loss goal 78%

% made knowledgeable about risk for diabetes 89%

% enjoyed the program 94%

High Impact Clinical Measures~ 80% of patients included for 9-month intervention

SEMBC Ambulatory Care Practices• 178,000 Lives• 18,000+ Patients with

Diabetes

SEMBC Provider Survey

Improved receptiveness to EHR

Improved staff comfort level with technology and computers

Increased familiarity with HIE

SEMBC Survey of Patient Health Navigator Patients

Significant improvement in medication adherence

Significant improvement in patient readiness to change: healthy food choices, physically active, check blood sugar, manage stress, keep appts., stop smoking, ID self-mgt. goals

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Technical Framework

Community Registry

SecurityServices

eMPI

CommunityPatient Record

Viewer

CareCoordinators

HIE Framework

Query forDocuments

Service

Care Gaps& Alerts

EdgeSecurityServices

SAMLAssertion

Physician Organizations

Private Practices

Hospitals Community Health Centers

Free ClinicsPublic Health Departments

PayersEdgeUsers

Edge EHR

IHE-XDSRegistry & Repository

Population Health

Reporting& Analytics

Data Audit& Logging

State HIE

Sub-State HIEs

Provider Organizations

Other Data Sources

Cloud-Based Data Sources

Health Systems or ACOs

EMS Services

Edge Data Sources

The Power of Collaboration:Working with the State of Michigan and Beyond

• MiHIN - BeaconLink2Health is a Qualified Data Sharing Organization

(QDSO)- BL2H has a certified connection to MiHIN

• MDCH- MCIR testing underway

- Started April 9, 2013

• ONC - EHR Affinity Work Group

- Participants: ONC, select Beacon Communities, EHR vendors- Purpose: Data Standardization, Alignment for MU2

- Active Pilots- CDA Clinical Document Architecture- MU2 Transport for Transitions of Care

- Collaborative Writing and Publication - Subject Matter: Data Governance, HIT-Enabled Care Mgt.,

mHealth

- Beacon Nation Dissemination- Collective development and publication of “Change Packages” for

sister communities

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Hard Work. Rewarding Work.

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“We took each of those challenges that the Beacons illuminated and the Beacons lived through and we made it a part of our mission, nationally, to try to improve. And, boy, was it hard, but despite that the Beacons have all improved quality and safety in their communities, those lessons are relevant to a lot more people who are trying to navigate this transformation of American healthcare that is more fundamental, more profound, more exciting than anything we have seen in five decades past.”Dr. Farzad Mostashari and Herbert

Smitherman, M.D, Assistant Dean of Community and Urban Health at Wayne State University, and SEMBC Board Co-Chair.

Dr. Farzad Mostashari, National Coordinator for Health Information Technology at the U.S. Department of Health and Human Services, May 22, 2013.

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Thank You

CONTACTTerrisca Des JardinsDirectorSoutheast Michigan Beacon Community

P: 313-638-2156E: tdesjardins@semha.org

sembc.org

Advancing Quality Healthcare Through National, State and Local Community Collaboration

Connecting Michigan for Health 2013

Radisson Lansing at the Capitol

Lansing, MI

June 5-7, 2013

SEMHIE Officers, Board, & Advisors

Officers Group • President: Robert Jackson, MD,

CMM (Western Wayne Physicians)• Vice-President: Jeanette Klanow,

(St. John Providence Health System)• Treasurer: Michael (Mick)Talley,

Treasurer (University Bank)• Helen Hill, MiHIN Board Rep.,

Director Public-Private Initiatives• Howard Burde, Legal Counsel

Board Members

• Julie Moran (Trinity Health)

• Gary Petroni (SEMHA)

• Adam Jablonowski (Wayne County Medical Society)

• Gary Assarian (JVHL)

• Carla Smith (HIMSS)

Advisors

• Jackie Rosenblatt, MPRO

• Stephen Lange Ranzini, University Bank

SEMHIE History

• Founded in 2006; incorporated as MI non-profit 2008; filed for 501(c)(3) status 2012

• HIMSS-GSA e-Authentication Six-State Pilot & White Paper 2006-2007

• Conduit to Care• Conduit to Care (I) participant 2005-2007• State of Michigan $1.2 Million planning grant 2007-2009

• Conduit to Care (II) participant 2008-2010

• Designated Sub-State HIE by Michigan HIT Commission Aug 2010

• Participant in founding MiHIN and working on ONC State-level HIE Cooperative Agreement 2010

• Presentations to OMG and HL7 Conferences (Arlington VA, Cambridge MA) 2011

• Invited to NIST NSTIC Workshop Baltimore MD March 2012

SEMHIE Recognition• Social Security Administration (SSA) e-Disability Claims Contract

• Awarded $2.988M Feb 2010 – one of 15 national contracts awarded• Achieved NwHIN production status for SEMHIE SSA Aug 2011• Completed SSA contract June 2012• Designated Pay-for-HIT program by SSA July 2012

• HealtheWay eHealth Exchange Anchor Participant December 2012

• Transitions of Care• Designated as Transitions of Care reference implementation pilot for ONC

Standards & Interoperability Framework Nov 2011• Demonstrated in HIMSS-ONC Interoperability Showcase at HIMSS AC 2012 in

Las Vegas NV Feb 2012• Selected to demonstrate at S&I Framework Face-Face Alexandria VA Apr 2012

• ONC $14.9M SE MI Beacon award Sept 2010 • One of 17 national ONC Beacon Cooperative Agreements • SEMHIE led coalition through award & startup; transitioned to Beacon 2011

SEMHIE Receives Largest of 15 National SSA e-Disability Contract Awards

1. Cal RHIO, San Francisco, CA - $1,625,0002. CareSpark, Kingsport, TN - $1,363,0003. Center for Healthy Communities, Wright

State University, Healthlink, Dayton, OH - $999,000

4. Central Virginia Health Network / MedVirginia, Richmond, VA - $1,139,000

5. Community Health Information Collaborative (CHIC), Duluth, MN - $977,000

6. Douglas County Individual Practice Association, Roseburg, OR - $502,000

7. EHR Doctors Inc., Pompano Beach, FL $1,000,000

8. HealthBridge, Cincinnati, OH - $1,400,0009. Lovelace Clinic Foundation (LCF),

Albuquerque, NM - $1,083,000

10. Marshfield Clinic Research Foundation, Marshfield, WI - $998,000

11. Memorial Hospital Foundation & Memorial Hospital of Gulfport Foundation, Inc., Gulfport, MS - $1,100,000

12. Oregon Community Health Information Network (OCHIN), Portland, OR - $284,000

13. Regenstrief Institute, Inc, Indianapolis, IN - $350,000

14. Science Applications International Corporation (SAIC), Reston, VA - $1,587,000

15. Southeastern Michigan Health Assoc., Detroit, MI - $2,988,000

Shortening the Determination Cycle With SSA e-Disability Claims Process: 459 Days to Under 1 Week

HIE Core Services Delivered to SEMHIE thru SSA Contract

Portal (patient search, workflow processing, system monitoring)

Transaction engine

RLS and MPI

NHINConnect gateway

CCD creation capability (extract and share clinical data: results, allergies, problem lists, medications, care summaries, etc.)

Semantic interoperability engine

Clinical terminology mapping engine/tools

XDS A&B repositories, registries

Service Oriented Architecture (SOA)

Hosting services w/24x7 support, security, backup/recovery

Secure message routing

Secure, encrypted exchange with NwHIN and a federal agency

Open source interoperability standards and run time software (model driven messaging interoperability)

48 2008 PHIN Conference 25 August 2008

eHealth ExchangeHealth Bank or

PHR Support Organization

Community #1

IntegratedDelivery System

Community Health Centers

Community #2

State and Local Gov

Labs

Pharmacies

VA

CMS

DoD

SSA

The Internet

Standards, Specifications and Data Use & Reciprocal Support Agreement (DURSA) for Secure Connections

Shared trust framework and rules of the road

Source: Mariann Yeager, Executive Director HealtheWay, HIMSS HIE Symposium, March 2013

eHealth Exchange Anchor Participants

49Source: Mariann Yeager, Executive Director HealtheWay, HIMSS HIE Symposium, March 2013

Connecting Michigan for Health ConferenceJune 5, 2013

UPHIE Value Proposition

• Unique demands of rural healthcare• Distance, weather, access to specialty services• Small practices distributed over a large geographic

area• Financial resources limited

• Implementation from a “Community View” perspective• 80% of the care in rural communities stays in the

community• How can we bring the most value to each community

UPHIE – Provider Participation

20122013

Aspirus Grandview

Aspirus Keweenaw

Aspirus Ontonagon

Portage Health

Baraga County Memorial Hospital

Marquette General Health System

Bell Memorial

Northstar Health System

Dickinson County Healthcare System

OSF St. Francis Hospital

Munising Memorial Hospital

Schoolcraft Memorial Hospital

Helen Newberry Joy Hospital

Mackinac Straits Hospital

War Memorial Hospital

• 9 Hospitals• 35 Physician Clinics• 3 Tribal Health Clinics

UPHIECommunity

Virtual Health Record

UP-Wide eMPI/RLS

Data Management

& Access

Population Health Data Aggregation

Outreach/ Connectivity

Where we are…

•MCIR Immunization Submission/Query•MSSS/MDSSS•Statewide Provider Directory (HPD)

Hospital•EHR•Results/CCD Exchange•Secure Messaging•Referrals

PCP /Specialist•EHR•Results/CCD Exchange•Secure Messaging•Referrals

Enables effective communication with those outside your enterprise, community and State

UPHIE manages certificates & role based access across entire UPHIE enterprise

ANCILLARY•EHR•Results/CCD Exchange•Secure Messaging•Referrals

• ADT, Lab, Radiology and Transcription data integrated into Community-Wide Virtual Health Record (ICA’s CareAlign platform)

• Collaboration with critical rural health care providers including:• Health Departments, Tribal Health Centers, VA Health

Centers, Medicaid/Medicare Payer• Direct Messaging Exchange Hub• MiHIN Use Case Participation

• Public Health Reporting (Immunizations, reportable labs, syndromics)

• Statewide Health Provider Directory• Statewide ADT and Transitions of Care Service• Federal Use Cases (SSA, VA, CMS, NwHIN)

UPHIE Use Cases

UPHIE Pilot Projects• Northcare Behavioral Health Pilot – enables the exchange of

electronic health data between behavioral and physical health providers. Enables better case management and continuity of care between the behavioral health community, providers and the UP Health Plan for Medicaid/Medicare members.

• Medicaid/Medicare Health Plan Data Pilot – project would populate health plan medical and pharmacy claims into the community virtual health record. Allows providers to see historical procedures, diagnosis, inpatient/outpatient visits, current/past medications, and a list of providers the patient has seen in the past 2 years.

• Oscar G. Johnson VA Medical Center – project would allow data exchange and Direct secure messaging between VA staff and provider community in the UP. Allows for health data to be shared between VA providers and community providers to allow for better continuity of care.

Thank you for your participation

Contact us:

Jeff Livesay

Associate Director

livesay@mihin.org