MiHIN 101 Overview v4 04-08-15

MiHIN Overview

April 2015

What Does HIE (verb) Do?

2

Adapted from Hripcsak et al. (2007)

Benefits· Avoiding repeat diagnostic tests

· Enables a clinician to add or remove a differential diagnosis in a timely fashion

· Optimal choice of tests and therapy

· More rapid response to a contraindication or any necessary refinements to a given therapy

· Care coordination: helps ensure that the next clinician involved in the patient’s care will see the relevant information about the patient!

Prevent future or fill known and unknown

knowledge deficits

Copyright 2014 - Michigan Health Information Network

Shared Services

Statewide Coordination

3

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

MiHIN is a

network for sharing health

information statewide

for Michigan

4Copyright 2014 Michigan Health Information Network

“One and Done”- Easier, Simplified,

Predictable Data Sharing1. 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

6

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

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

Statewide Approach

Driven by Use Cases

Leverages public health code &

Meaningful Use

Public-private model vs. complete state

control

Accomplishments (established

2010)

From zero to 100M+ production

messages since inception

22 *O connections:

8 HIEs, 6 payers,

4 pharmacies, state,

3 others

Health Provider Directory, certified eHealth Exchange

node, EHNAC-DTAAP Direct

Copyright 2014 Michigan Health Information Network7

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


Maximize SOM Resources

9

Sta

te o

f Mic

hig

an

Inte

rnal

ExternalSTATEWIDE

SHARED SERVICES

MDCH Data Hub MiHIN & the Qualified

Data Sharing Organizations

Transparency

via HIT

Commission

Monitoring

Shared

Governance via

MiHIN Board


10

MiHIN Governance

MiHIN 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


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

MiHIN Governance

VacantRepresenting Pharmaceutical Manufacturers

Irita B. MatthewsRepresents Health Information Technology

2014Copyright 2011 - Michigan Health Information Network Shared Services

Meridian Health Plan Thomas Lauzon

HIT CommissionerNick Lyon

Copyright 2014 - Michigan Health Information Network 11

MiHIN Governance

Copyright 2014 - Michigan Health Information Network 12

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, Kev in 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, Kev in 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, Patty 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



2014Copyright Michigan Health Information Network Shared Services

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


Data Sharing Agreement

Use Case

#1

Use Case

#2

Use Case

#3

Legal Infrastructure for Data Sharing

13Copyright 2014 - Michigan Health Information Network

ORGANIZATION AGREEMENT

(QDSOA,VQDSOA, CQDSOA, SSOA,

SSSOA, PIHP QDSOA, other “OA”)

Basic Connection Terms

Basic BAA Terms

Minimal Operational SLA

Contracting & Payment

Definitions

Termination

Cyber Liability Insurance

Qualified

Sub-state HIE

or VQO

Qualified

Sub-state HIE

or VQO

Clear Chain of Trust


Shared Services 14

Covered

Entity

Business

AssociateBusiness

Associate

Business

Associate

Covered

Entity

Covered

Entity

Constituent Transparency


Shared Services 15

Use Case

Health

Plans

Physicians

Specialty

Providers

Hospitals & Clinics

Patients

& Families

Laboratories &

Diagnostic centers

Pharmacies

Public Health & CMS

Policy Makers

Communities

Employers

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

16

Use Case Factory™


Use Case Components

17

Use 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 &

RefineTechnical

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

StatusMetrics

Adoption

Critical Mass

Mass Marketing &

Outreach

MiHIN Board

SuccessfulAdoption

ContinuousImprovement

Functional Data-Sharing

Widget


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

Use Case Assembly Lines

Results Delivery

•Lab results

•Diagnostic imaging

•Other tests

•Hospital discharge summaries

Public Health Reporting

• Immunizations

•Chronic disease registries

•Disease surveillance

•Syndromicsurveillance

•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


Infrastructure Use Cases

Secure Transport Layer Services and Digital Credentials

Master Person Index(Common Key Service)

Active Care Relationship

Service

Patient Opt-In Preferences

Identity Management

Federated

Identity Management

(FiDM)

Health Provider Directory

Gateway Services (e.g.

XCA)


Accelerating Use Cases

21

Policy &

Regulatory

Levers

Clinical

Endorsement &

Evidence

Financial

Incentives or

Disincentives


Use Case Pipeline Example


Statewide Use Case Evolution

Planning & DevelopmentConceptualImplementation

(Operational Adoption)Mature Production(> 65% Utilization)

Statewide ADT-IN

Submit Syndromics

Request Immunization History/Forecast Submit Immunizations

Submit Data to Active Care Relationship Service

(ACRS)

Death Registry

Advanced Directives Health Provider Directory

Basic Query

Submit Data to Health Provider Directory

Medication Reconciliation

Chronic Disease Registry

Health Provider Directory Advanced Query

MiHealth Link (ICBR)

Provider Submission

Birth Registry

Convert Syndromics

Submit Newborn Screening -CCHD

Health Provider Directory Search Service

Single Sign On

Federated Identity Management

Common Key Service

Health Risk Assessment (HRA)

Submit Clinical Quality Measures

Send/Receive Lab Results/Orders

Submit Birth Defect Notifications

eHealth Exchange Patient Query

Cross-QO Patient Query

Submit Reportable Labs

VA Patient Query

CMS Electronic Submission of Medical Documentation

SSA Disability Determination

Patient Look Up (Cross Community Access XCA)

Benefits of Use Case Approach

23

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

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

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

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

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

• Aids focused monitoring and measurement of progressMeasureable

• Reduces variability and enables scalabilityFaster & Cost Effective


-

2,000,000

4,000,000

6,000,000

8,000,000

10,000,000

12,000,000

14,000,000

MONTHLY MESSAGE COUNT

Admit-Discharge-Transfer (ADT)

Outbound (ADT)



-

500,000

1,000,000

1,500,000

2,000,000

2,500,000

3,000,000

3,500,000

4,000,000

MONTHLY MESSAGE COUNT

Syndromic Surveillance (SS)

Clinical Quality Measures (CQM)

Reportable Labs (ELR)

Immunizations (VXU)

Copyright 2014 Michigan Health Information Network25

26

Monitoring Transitions of Care

0

2000000

4000000

6000000

8000000

10000000

12000000

14000000

16000000

Admit-Discharge-Transfer (ADT)

Outbound (ADT)


Statewide ADT Use Case Example

27

Active Care

Relationship Service

(ACRS)

Statewide

Health Provider

Directory (HPD)+ +


Admit Discharge & Transfer (ADT)

Use Case


Shared Services

Statewide Health Provider Directory

29

• 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

30

Patient InformationSource Patient ID

First Name

Middle Initial

Last Name

Suffix

Date of Birth

Gender

SSN – Last 4 digits

Address 1 & Address 2

City, State, Zip

Home & Mobile Phones

Physician InformationNPI

First Name

Last Name

Practice Unit ID

Practice Unit Name

Physician Organization ID

Physician Org Name

Physician DIRECT Address

DIRECT Preferences


Important Horizontal View

31

Eligible

Hospitals

Eligible

Providers &

PCMH

Care

CoordinatorsSpecialty

Providers

Behavioral

Health SpecialistsCritical Access

Hospitals

Patients & Families


Trusted Data

Sharing

Organization

Trusted Data

Sharing

Organization

Statewide ADT Notification

Active Care

Relationship

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

32

Animation


Other “Lego” Combinations

33

Active Care

Relationships

State-wide

Health Provider

Directory+ +

Active Care

Relationships

State-wide

Health Provider

Directory+ +

MED

REC

Care

Plan


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 (MIDIGATE®)

• 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

34

Ready Now!


The Direct Project

• Simple, secure, scalable, standards-based

way to send encrypted information “directly” to

known, authenticated, trusted recipients

• Messages sent securely between end-points:

• person to person

• person to system

• system to system

• system to person


Shared Services35

Dr. Jones

Dr. Smith

Provider to Provider Email

Definitions

HISP – Health Information Service Provider

HISP

HISP

Federally-bridged digital

security certificate as

trust anchor


Shared Services36

From:

[email protected]

To:

[email protected]

System-to-system messaging

Definitions

HISP – Health Information Service Provider

HISP

HISP

Federally-bridged digital

security certificate as

trust anchor


Shared Services37

The Role of DIRECT & EHRs


Shared Services38

DirectTrust Members


Shared Services

Current DTAAP Accreditation Roster

January 15, 2014

• CareAccord

• Cerner Corporation

• DigiCert

• Infomedtrix

• ICA

• Inpriva

• MaxMD

• Surescripts

• MedAllies

• DataMotion

• Applied Research Works, Inc.

• Athenahealth

• Covisint

• EMR Direct

• GlobalSign, Inc.

• HIXNy

• Health Companion

• Health Connection CNY

• Health Info EXchange of NY

• iMedicor

• IOD Inc.

• Medicity

• NYeC

• RelayHealth

• Rochester RHIO

• Secure Exchange Solutions

• Simplicity Health Systems

• Truven Health Analytics

• Updox

• Utah Health Information Network

• Vitalz, Inc.

• West Virginia HIN

Fully Accredited and Audited Candidate Status


Shared Services4040

MIDIGATE® Purpose

• Simplified & low cost data capture based

on DIRECT Secure Messaging protocols

• Fully secure for handling PHI

• Bridges the gap or “mitigates” transport

challenges, e.g. DIRECT to HL7 LLP

• Designed to support MiHIN Use Cases,

broad quality reporting requirements, and

custom data capture needs


Shared Services41

Key Components

• Configuration of the base service that feeds data into the

existing virtual private network used to send data

• Captures attachments to published DIRECT addresses

• “Peels” off structured data and routes appropriately

• Establishment of one or more “catcher” modules

• Examples of common catcher modules:

• ADT’s

• Electronic clinical quality measures

• HEDIS reports

• Care Plan Updates

• Authorizations

• Etc.


Shared Services42

“Catcher” Modules


Shared Services43

HISP

Doctor offices &

Community

Hospitals

ADT

Catcher

Module

MiDIGATE

Handler ‘peels” off

attachments

Base Gateway

Service

Normal ADT Flow


Shared Services44

MiHIN

TOC

Router

ADT

HIE QOs(Qualified sub-state

HIEs)

Trusted Data

Sharing

Organization

Active Care

Relationships

HPD Delivery

Preference

Lookup

With ADT “Catcher” Module


Shared Services45

MiHIN

TOC

Router

Trusted Data

Sharing

Organization

Active Care

Relationships

HPD Delivery

Preference

Lookup

[email protected]

HISP

MiDIGATE

Base Service

Handler

Lots of Potential “catchers”


Shared Services46

[email protected]

[email protected]

[email protected]

[email protected]

47

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

Copyright 2014 - Michigan Health Information Network Shared Services

Questions?Dr. Tim Pletcher

Executive Director

[email protected]

Jeff Livesay

Associate Director

[email protected]

Shelley Mannino

Director

[email protected]

48Copyright 2014 - Michigan Health Information Network Shared Services

mailto:[email protected]

