mihin brief overview

Copyright 2013 - Michigan Health Information Network 1

Michigan Health Information NetworkOverview


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


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


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)


MiHIN Background


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


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


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


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


MiHIN Community


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


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

21

State-wide Shared Services

DIRECTHISP

Virtual Qualified

Organizations

Health Plans


Production Activities


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



Vaccination Reporting

25

MDCH Data Hub

HIE(QOs, VQOs or sub-state HIEs)


State-wide Shared Services


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


Current Activities

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Qualified Sub-state HIE

or VQO

Qualified Sub-state HIE

or VQO

Transition of Care Notification


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


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


QUERY-BASED USE CASES

State-wideRecord Locator

Service

Query for Patient History


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


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


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


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


Tim Pletcher [email protected]

mihin brief overview

Health & Medicine