mihin brief overview
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Copyright 2013 - Michigan Health Information Network 1
Michigan Health Information NetworkOverview
Copyright 2013 - Michigan Health Information Network 2
What is Health Information Exchange?
The term "health information exchange" (HIE) actually encompasses two related concepts:
• Verb: The electronic sharing of health-related information among organizations
• Noun: An organization that provides services to enable the electronic sharing of health-related information
Source: http://www.healthit.gov/providers-professionals/health-information-exchange?utm_source=google&utm_medium=cpc&utm_campaign=technology
Copyright 2013 - Michigan Health Information Network 3
Health Information Exchange Benefits• Improved patient safety &
outcomes• Fewer adverse events• Better quality of life for people
who are sick
• Reduced unnecessary utilization• Reduce total admissions• Shorten time in the hospital• Fewer duplicate diagnostic
tests
• Lower costs to find, transmit, and analyze information
Health Plans
Physicians
Specialty Providers
Hospitals & Clinics
Patients & Families
Lab tests &XRAYs
Medications
Public Health
Major HIE Use Cases
Results Delivery• Lab results• Diagnostic imaging• Other tests• Hospital discharge
summaries
Public Health Reporting• Immunizations• Chronic disease
registries• Disease
surveillance• Syndromic
surveillance• Birth & death
notifications
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
Quality & Administrative Reporting• Registry Updates• Physician Quality
Reporting measures
• Meaningful Use reporting
• Electronic verification
• Patient satisfaction• Eligibility• Authorization• Claims audit
Patient Engagement• Instructions• Health risk
appraisals• Medication
Compliance• Therapy
Compliance• Patient activation
and self determination
• Health literacy & numeracy
4Copyright 2013 - Michigan Health Information Network
Copyright 2013 - Michigan Health Information Network 5
Types of HIE (Verb): Push or Pull
• Push: The ability to send data automatically to a provider, such as replacing the fax machine with an electronic message. Analogy: getting a text message or email (requires that other’s know your email or text address)
• Pull: The ability to request on demand that data be instantly returned to you. Analogy: doing a Google search (requires lots of searchable websites)
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MiHIN Background
Copyright 2013 - Michigan Health Information Network 9
What is Michigan’s Strategy for HIE?
The Michigan approach:• employs a public-private model vs. only complete state control• emphases common data sharing use cases and multi-
stakeholder participation (hospitals, physicians, health plans, state government)
• promotes the use of national standards & public transparency (via HIT commission)
• leverages public health & meaningful use• established a designated nonprofit entity to interconnect
networks of networks (MiHIN Shared Services)• relies on qualified health information organizations such as
Michigan’s seven sub-state HIEs to connect providers
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Governance
• MiHIN is an independent not-for-profit with a board of directors
• MiHIN works very closely with Michigan’s Department of Community Health and the State’s HIT Commission
• MiHIN has an Operation Advisory Committee that address day-to-day operations, HIE planning, privacy and security items
Examples of Statewide Shared Services Across the Nation• Security services• Health Provider Directory (Master Clinicians Index)• Message routing• Identity management• Transaction logging & Universal Audit Repository• Consent management• Terminology services• Transformation services• Master Person Index • Record Locator Service & Patient Directory Services• NwHIN gateway• Sub-scribe to Alerts & Notifications• DIRECT HISP
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Qualified Data Sharing Organizations (QO’s)
• Health Information Exchanges • Beacon, Great Lakes HIE, Ingenium, Michigan Health
Connect, Jackson Community Health Record, South East Michigan HIE, Upper Peninsula HIE
• Health Plans• Blue Cross Blue Shield of Michigan• Michigan Association of Health Plans
• Health Alliance Plan*• Priority Health*
• State of Michigan
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Virtual Qualified Data Sharing Organizations (VQO’s)• Independent entities that primarily utilize MiHIN provided
services or participate in a very limited number of Use Case or pilot activities also subject to predetermined conditions of use. VQO’s are not formally involved in the Board or other governance activities. VQO’s are not expected to support more that 1/3 of the Use Cases.
• Health Information Service Providers (HISP)• Health Information Organizations (HIO)• Pilot Organizations
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MiHIN Community
17Copyright 2013 - Michigan Health Information Network
State of Michigan
HealthPlans
More to Come…
ORGANIZATION AGREEMENT(QDSOA or VQDSOA)
Basic Connection Terms
Basic BAA Terms
Minimal Operational SLA
Contracting & Payment
Definitions
Termination
Cyber Liability Insurance
Data Sharing Agreement
Use Case #1
Use Case #2
Use Case #3
Legal Infrastructure for Data Sharing
18Copyright 2013 - Michigan Health Information Network
Copyright 2013 - Michigan Health Information Network
MDCH Data Hub
Medicaid
MSSS
State LABS
Doctors & Community Providers
HIEs(QOs, VQOs or sub-
state HIEs)
Basic Data Flow
Data Warehouse
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State-wide Shared Services
DIRECTHISP
Virtual Qualified
Organizations
Health Plans
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Production Activities
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Public Health Reporting
• First MiHIN Use Case• Uses the same technology and data flow for reporting to:
• Michigan Care Improvement Registry (MCIR) for collecting immunization information
• Michigan Disease Surveillance System (MDSS) for reportable labs and conditions
• Michigan Disease Surveillance System (MSSS) for public health situational awareness
Public Health Reporting
Copyright 2013 - Michigan Health Information Network
Vaccination Reporting
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MDCH Data Hub
HIE(QOs, VQOs or sub-state HIEs)
Public Health Reporting
State-wide Shared Services
Copyright 2013 - Michigan Health Information Network
Health Provider Directory• Source of trusted provider
information for secure routing and HIE information
• State-wide provider address book• Direct• Referrals
• Sets the stage for provider relationship management
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HPD
Direct Address Book
Directory Services
Provider Relationship Management
Routing Preferences
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Current Activities
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Qualified Sub-state HIE
or VQO
Qualified Sub-state HIE
or VQO
Transition of Care Notification
Copyright 2013 - Michigan Health Information Network
Patient to Provider Attribution
Delivery Preference
Lookup
1) Patient goes to the hospital, hospital sends a registration message
2) MiHIN checks for Patient to Provider Attribution and identifies three providers
3) Using the HPD, MiHIN identifies a Delivery Preference for each provider
4) Notification is routed to the providers based on their preference
Primary Care
Specialist
Care Coordinator
Alerts & Notification
Animation
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Transition of Care Notification
• Can be expanded to other message types• HL7 lab results• Discharge summaries• Continuity of Care Documents (CCD)• Care Gap Alerts
• Both Patient to Provider Attribution and Delivery Preference Lookup services can be reused
Alerts & Notification
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QUERY-BASED USE CASES
State-wideRecord Locator
Service
Query for Patient History
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HIE
HIE
HIE
1) Doctor see’s a new patient in the Emergency Department (ED)2) ED sends out a “patient discovery” request for information about the patient
DoctorPatient
3) Sources that know the patient respond4) ED queries for patient clinical information5) Sources respond with clinical document(s), typically CCDs
CareSummary
Patient Found
Patient Found
Patient Not Found
Animation
State-wideRecord Locator
Service
Query for Patient History
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HIE
HIE
HIE• Requester can be in many settings
• Primary care provider• Health plan doing eDetermination• Out-of-state provider• Federal agencies
CareSummary
• Responders can vary as well• State of Michigan• Federal agencies and out-of-state providers
MDCH Data Hub
Animation
Copyright 2013 - Michigan Health Information Network
HIE #2
Cross HIE Message Routing
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HIE #1
Provider ID?
Referral
HPD
Routing
PrimaryCare Physician
Specialist
Animation
Still on 2011Road Map
39Copyright 2013 - Michigan Health Information Network
Link
Opera
tiona
l Acti
vities
Planning Activities
2011 Staging
Activities
MU & Public Health Part II (Query)
Health Provider Directory
Pharmacy Planning
VA Linkage
Patient Facing Services & PHR Gateway
NwHIN Node (Connect & Direct)
ADT Pilo
t Im
plemen
tation
Planning & Policy Development
Security and Consent Management
VA V
LEHR
Pilo
t
CCD Gateway (Push)
HISP Function
Mi Health Market Place Integration Planning
Master Patient Index
Cons
ent M
anag
emen
t & Se
curit
y Pilo
ts
Use Case Prioritization (ADT Pilot)
Med
icati
on R
econ
cila
tion
Patient Consent Management
Com
mon
Aut
henti
catio
n Pr
otot
ypin
g
More information about MiHIN
Questions?WWW.MIHIN.ORG
40Copyright 2013 - Michigan Health Information Network
Tim Pletcher pletcher@mihin.org
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