MiHIN ADT ONC Presentation v10 02-02-15

Admission, Discharge, Transfer (ADT) Service:

An Overview

Transitions of Care Notifications

In Production, Real Time

1

Jeff Livesay Associate Director [email protected]

Rick Wilkening Director, Business Development [email protected]

Michigan Health Information Network Shared Services

Copyright 2015 Michigan Health Information Network Shared Services

mailto:[email protected]


MiHIN Statewide

Shared Services

MDCH Data Hub

Medicaid

MSSS

State

LABS

Doctors & Community

Providers

HIE QOs(Qualified sub-state HIEs)

Network of Networks:

Data

Warehouse

2

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

“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, PIHPs, state and 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 reporting

5. Log-on once

• Single sign-on across patient/member and provider portals

3Copyright 2015 Michigan Health Information Network Shared Services

Data Sharing

Organization

Data Sharing

Organization

Clear Chain of Trust

4

Covered

Entity

Business

AssociateBusiness

Associate

Business

Associate

Covered

Entity

Covered

Entity


Why a Statewide ADT Service?

5

Source: Blue Cross Blue Shield of Michigan (BCBSM)

Physician Group Incentive Program (PGIP)


Payer Incentives for Statewide HIE

- Hospital value-based contracts

- Physician Group Incentive

Program (PGIP)


2014

2015

2016

Data flow

Hospitals – Send ADT notifications to statewide service via MiHIN

Providers – Send Patient-Provider Attribution (PPA), receive ADT alerts

Integrate ADT, begin Medication Reconciliation

Hospitals – Conformance with ADT spec, send Medications

Providers – Integrate ADTs into workflow, receive Medications

TBD

Medications, potentially quality measures

But wait…

there’s more $

Transitional care management

Medicare & BCBSM fees Jan 2013

Payer Code Non-Facility Facility Locality

Medicare 99495 $120.39 $99.38 Detroit

Medicare 99496 $169.65 $145.70 Detroit

BCBSM 99495 $233.43 $191.79 All

BCBSM 99496 $329.33 $281.38 All

7

99495 -

• Communication (direct contact,

telephone, electronic) with the patient

and/or caregiver within 2 business days

of discharge

• Medical decision making of at least

moderate complexity during the service

period

• Face-to-face visit, within 14 calendar

days of discharge

99496 -

• Communication (direct contact, telephone,

electronic) with the patient and/or

caregiver within 2 business days of

discharge

• Medical decision making of high

complexity during the service period

• Face-to-face visit, within 7 calendar days

of discharge


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

8

Use Case Factory™


Use Case Components

9

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

10

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

Critical Infrastructure Components

Secure Transport Layer Services and

Digital Credentials

Master Person Index+

Common Key Service

Patient Provider

Attribution Service

Patient Consent Preferences

Identity Management

Federated

Identity Management

(FiDM)

Health Provider Directory

Gateway Services

(e.g. XCA)


Statewide ADT Use Case Example

12

Patient-Provider

Attribution (PPA) Service

Statewide

Health Provider

Directory

Service+ +


Health Provider Directory

13

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

• Flexibly maintains multiple distribution points for single provider or single distribution for organization

• Manages organizations, providers and the multiple relationships between them


Patient Provider Attribution Service

(in Michigan we call this ACRS™)

• Enables providers to declare active care relationships with patients –this attributes to a patient the active members of their care team

• Accurately routes information (e.g. Admit-Discharge-Transfer messages, medication reconciliations)

• Improves care coordination

• Reduces readmissions

• Allows better outcomes

• Enables alerts to providers in active care relationships with patients

• Coordinates entire care team with changes to patient status in real time

• Allows searches by authorized persons or organizations:

• Health systems and provider/physician organizations

• Care coordinators

• Health plans

• Consumers (who can dispute asserted relationships)


Active Care Relationship Service

(ACRS™)

Additional patient information to minimize false positives

15

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


Types of Relationships

• Declared by Provider

• Declared by Patient

• Assigned/derived by health plan algorithm

• Reported on claim, performance report, or

Meaningful Use (e.g. QRDA Category II/III)

• Can be contested by provider or by patient


Send to Physicians listed in ADT

message

17

Send To

• Attending Doctor

• Referring Doctor

• Consulting Doctor

• Admitting Doctor

• Primary Care Physician

Requires

• Provider NPI #’s in

ADT messages

• Provider delivery

preferences, ESI in

Provider Directory


Quality Matters:

Enforcing Conformance


Conformance Report

Co

mp

lete

Rou

ting

Data

Co

mp

lete

Map

pin

gA

dh

ere

nce

to

Cod

ing

Sta

nd

ard

s

81.8%

46.7%

0.0%

MSH-4 PID-5.1 PID-5.2 PID-5.3 PID-7 PID-8 PID-5 PID-19 PV1-19 IN1-3 IN1-4

79.30%79.30%100.00%99.92%100.00%100.00%100.00%100.00%100.00%100.00%100.00%

Complete Routing Data by Field

PID-8 PID-10 PID-22 PV1-2 PV1-4 PV1-14 IN1-17 DG1-6 OBX-11 IN1-3 IN1-4

0.00%0.00%99.89%99.21%100.00%100.00%20.29%100.00%100.00%

Complete Mapping to Specified Value Sets by Field

MSH-4 PV1-10 PV1-18 PV1-36

99.99%100.00%51.63%99.17%

Complete Hospital-‐DefinedMapping by Field

MSH-4.1 MSH-4.2

100.00%

Facility IDs

OIDs

DG1-3.1 DG1-3.2 DG1-3.3

99.03%

Diagnosis Codes

ICD9 or ICD10

PD1-4.1 PV1-17 PV1-7 PV1-8 PV1-9

99.63%100.00%100.00%91.69%

Physician IDs

NPIs

HospitalHospital X

Adherence to coding Standards by Field

Time PeriodJanuary 19, 2015 to January 19, 2015

See Reverse Side for Explanation and Field Definitions

Copyright 2014-2015 Michigan Health Information Network Shared Services

Hospitals must be ‘all green’ to receive full incentive payments

Completeness Matters Too!

19

Complete Routing Data by Message Type

IN1-3 IN1-4 MSH-4.1 PID-19 PID-5 PID-5.1 PID-5.2 PID-5.3 PID-7 PID-8 PV1-19

Total Blank Count 7141 7141 0 28 0 0 0 0 0 0 0

% Populated All Types 79.30% 79.30% 100.00% 99.92% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00%

A01 Blank Count 140 140 0 0 0 0 0 0 0 0 0

A01 % Populated 81.98% 81.98% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00%

A02 Blank Count 1692 1692 0 0 0 0 0 0 0 0 0

A02 % Populated 0.00% 0.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00%

A03 Blank Count 486 486 0 0 0 0 0 0 0 0 0

A03 % Populated 95.49% 95.49% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00%

A04 Blank Count 175 175 0 0 0 0 0 0 0 0 0

A04 % Populated 86.13% 86.13% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00%

A05 Blank Count 0 0 0 0 0 0 0 0 0 0 0

A05 % Populated 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00%

A06 Blank Count 8 8 0 0 0 0 0 0 0 0 0

A06 % Populated 96.57% 96.57% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00%

A07 Blank Count 0 0 0 0 0 0 0 0 0 0 0

A07 % Populated 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00%

A08 Blank Count 1401 1401 0 13 0 0 0 0 0 0 0

A08 % Populated 91.42% 91.42% 100.00% 99.92% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00%

A11 Blank Count 2 2 0 0 0 0 0 0 0 0 0

A11 % Populated 0.00% 0.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00%

A13 Blank Count 0 0 0 0 0 0 0 0 0 0 0

A13 % Populated 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00%

A14 Blank Count 9 9 0 1 0 0 0 0 0 0 0

A14 % Populated 94.71% 94.71% 100.00% 99.41% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00%

A28 Blank Count 141 141 0 1 0 0 0 0 0 0 0

A28 % Populated 0.00% 0.00% 100.00% 99.29% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00%

A31 Blank Count 3087 3087 0 13 0 0 0 0 0 0 0

A31 % Populated 0.00% 0.00% 100.00% 99.58% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00%

Hospital X

1/19/2015


Certain fields MUST be populated for recipients to utilize

Decoding and Mapping Also Matter!

Copyright 2015 Michigan Health Information Network Shared Services 20

KEY Gender PID-8 Race PID-10 Ethnicity PID-22 Patient Class PV1-2 Admit Type PV1-4 Admit Src PV1-14 Ins Rel IN1-17 Diag type DG1-6

All Mapped Code count Code count Code count Code count Code count Code count Code count Code count

Value not in mapping table M 13383 8 2145 9 5740 E 10057 1 19323 26 0 9 15 A 0

% of non-blanks with data element mapped F 21025 3 635 3 268 O 15468 5 8 74 0 49 1 34492

NA - Field left blank in all messagges U 84 2 74 2 1 I 5739 6 106 40 0 25 70 5 30 8 20189 3228 2 10696 36 0 4 0

7 581 10 2188 3 439 27 7 26 04 19124 7 1226 7 108 9 26 36 06 2018 4880 4 238 25 0 20 31 5002 3574 71 15 100 1

4883 4 0 8 034 0 13 520 0 10 022 0 113 010 1 34 1

8 3 29 1513 10 21 037 0 112 050 27969 114 0

6 0 15 015 5 6 329 0 17 021 3 38 035 0 111 011 143 5 3517 95 48 1138 0 11 372 22 7 073 4 108 065 0 31 0

7 274 12 03 0 3 2282

31 4 2 341261 4 32 1760 5 16 223 0 1 2144916 0 14 0

1 7 106 070 0 33 5814 0 19 039 1358 18 032 0 NG 3124 1 714130 019 033 018 428 075 27

2 2384267

Complete Mapping:

Detail Report

Hospital X

1/19/2015

99.89%

mapped

%NA

99.21%

20.29%

mapped

%100%

mapped

%

mapped

%

100%

mapped

%

mapped

%100%

mapped

%100%

mapped

%

Recipients need to understand how to interpret codes in key fields

Trusted Data

Sharing

Organization

Trusted Data

Sharing

Organization

Supports Seamless Exchange

Alerting Disconnected Entities

Patient to Provider

Attribution

Health

Provider

Directory

1) Patient goes to hospital which sends message to DSO then to MiHIN

2) MiHIN checks patient-provider attribution and identifies providers

3) MiHIN retrieves contact and delivery preference for each provider from HPD

4) Notifications routed to providers based on electronic address and preferences

Primary Care

Specialist

Care

Coordinator

21

Patient


Trusted Health

Plan

Trusted Data

Sharing

Organization

What data do health plans receive?

Only data for their members !

22

IN1 HAP

ADT Message X

ADT

Reporting

Tool


ADT Reporting Tool for Payers

Formatted messages

• Standardized data

• Custom message format

Daily reports

• New Admissions

• New Discharges

• Daily Census

• Member not found

Tailored delivery

• Nightly or real-time

• Secure transport options

Operational impact

• Eliminates data mapping

• Utilizes existing data flow

• Accelerates enterprise adoption


But Providers Need Tools Too!

• Many Physician Organizations need infrastructure:

• ADT-In-A-Box – open source stack from ONC

• Workflow tools to consume ADTs

• Business Process Model Notation (BPMN)

• Ed Daniels will speak more about this today

• Accountable Care Organizations (ACOs)

• Coordination with Skilled Nursing Facilities (SNFs)

• Utilization of commercial tools like PatientPing™


25

Monotonically Increasing Reform


Trusted Data

Sharing

Organization

Trusted Data

Sharing

Organization

Empowers Other Clinical Alerts!

Medication Reconciliation

Patient to Provider

Attribution

Health

Provider

Directory

1) Patient discharged, hospital sends message to DSO / MiHIN

2) MiHIN checks patient-provider attribution and identifies providers


4) Medication reconciliation routed to providers based on contact info, preferences

Primary Care

Specialist

26

Care

Coordinator


MR

Trusted Data

Sharing

Organization

Trusted Data

Sharing

Organization

Empowers MORE Clinical Alerts:

Medication Adherence

Patient to Provider

Attribution

Health

Provider

Directory

1) Patient picks up Rx, pharmacy sends message to DSO / MiHIN

2) MiHIN checks patient-provider attribution in ACRS and identifies providers


4) Medication information routed to providers based on contact info, preferences

Primary Care

Specialist

27

Care

Coordinator

MR

Patient


Questions?

Tim Pletcher

Executive [email protected]

Jeff Livesay

Associate [email protected]

Rick Wilkening

Director, Business [email protected]





Legal Infrastructure with Federated Services

29

Use

Case

#1

Use

Case

#2

Use

Case

Use

Case

Use

Case

#3

DATA SHARING(QDSOA,VQDSOA, CQDSOA, SSOA, SSSOA)

Basic Connection Terms

Basic BAA Terms

Minimal Operational SLA

Contracting & Payment

Definitions

Termination

Cyber Liability Insurance

FEDERATED SERVICES(FSOA)

Basic Connection Terms

Contracting & Payment

Definitions

Termination

Cyber Liability Insurance

ORGANIZATION AGREEMENT

Use

Case

#1

Use

Case

#2

Use

Case

Use

Case

#3

QO Data

Sharing Agreements

Federated Services,

Data Sharing Agreements

Healthcare

MiHIN ADT ONC Presentation v10 02-02-15