MiHIN Health Provider Directory Demo Slides with CQMRR v43 02 18-15

Michigan Statewide

Health Provider Directory

Scalable, standards-based, extensible solution for storing and making accessible electronic service

information for providers and provider organizations recording providers’ delivery,

notification, and routing preferences for accurateand secure exchange of health information

Copyright 2014 Michigan Health Information Network Shared Services 1

What You Are About To See


• Key benefits of the Michigan Statewide Health Provider Directory (HPD) service

• Strategic focus of the HPD service:

• Route health records via Electronic Service Information

• Overview of architecture:

• advanced data model

• relationships to standards

• Ability to easily integrate with Direct HISPs

• Support for Transitions of Care (TOC) Use Cases

• Demonstration of Health Provider Directory service

• Quality portal(s) for Clinical Quality Measurements

HPD Key Benefits• Standard: Michigan’s ‘superset-model’ extends Provider Directory standards:

• Supports all three leading standards: HPD+ 1.1, ModSpec, IHE/IHR

• Supports Use Cases for Meaningful Use and beyond

• Populated: Data from multiple sources imported, mapped and de-duplicated:

• State and federal provider data

• Sub-state HIE / RHIO / PO / NPPES / Payer provider data

• Commercial data sources (no longer used)

• Deployed: Force.com platform provides production-quality deployment:

• Familiar GUI is global and ubiquitous, including mobile devices

• Architecture allows easy integration via SOAP & REST APIs

• Reliable 24x7 production in Salesforce.com cloud

• Robust security augmented by MiHIN additions:

• Single-Sign-On with other services (Direct HISPs, EHRs, etc.)

• Trusted identity federation at NIST 800 LoA 3)

• Extensible and scalable based on provider/user feedback


Michigan’s HPD is in Production• Michigan’s HPD is in use and is ready for others to use

• Production service deployed in Salesforce cloud > 2 years

• Federated with other large provider directories (e.g. Florida HIE

and Surescripts via ONC Exemplars Snowbird Pilot)

• HISP-neutral directory supports simple integration with HISPs

• Multiple states’ provider data in one HPD instance (no federation)

• Installable application via Salesforce AppExchange

• Others can deploy and administer

• No up-front cost to use Michigan’s HPD solution

• SaaS subscription model – pay per account as you grow

• Accounts range from $25/year (individual )to $3600/year (unlimited)

• API accounts allow easy system-system integration (no federation)

• Integrated with modernized NPPES for real-time updates

• Soon: real-time credentialing transactions


HPD Strategic Focus

• Electronic Service Information (ESI) is:

• “Information for delivering PHI by secure electronic means”

• HPD supports multiple types of ESI today:

• Most commonly discussed: Direct Secure Messaging

• Secure email account id

– Example: “[email protected]”

• In more widespread use: IHE/EHR routing information

• HL-7 LLP protocol endpoints

– Example: “data.hfhs.org:22356”

• Future forms of ESI are forthcoming:

• Patient preferences for where their PHI is stored (e.g. PHR)

• Other federally defined forms of ESI (e.g. VA, SSA)


MiHIN Service Oriented ArchitectureDirect HISP, Search Service, MiDiGate™

TOC (ADTs, MedRecs), Immunizations,

Reportable Labs, Syndromics, etc.

Context for HPD Use Cases

Statewide

Health

Provider

Directory

Organization

Admins

Individual

Providers

SoM

Payers, DSOs

Commercial

HISPEMR

HIE

Other

Entities

Salesforce.com

SOAP, REST, https, ModSpec APIs

Informatica

ETL + MDM

HPD

Admins

Other States

Copyright 2014 Michigan Health Information Network Shared Services

Population

Admins

6

API

Readers

API

Writers

Organization

“Account”Name

Identifier

Specialty

CredentialCare Team

Electronic

Service

Provider

“Contact”Provider

Affiliation

0..n 0..1

HPD Object Model

Organization

AffiliationAddress

1..n


HPD Integration Capabilities

• HPD API for HISP Integration:

• High level, efficient, Restful, query API

• Supports ModSpec 7 HPD query definitions

• In production and in use by multiple organizations

• Health Provider Search Service

• Allows any Direct HISP to query Michigan Statewide HPD

• Plug-in consists of one page of simple code

• Easily inserted to and integrated with HISP client code

• Encapsulates HPD query capability using REST API calls

• Integrating with other services for full transactional updates

• NPPES (NPI) database, credentialing, other services

• Monitoring/tracking HPD federation protocols



Provider Index

MCIR

Immunizations

MDCH Data

Hub

HSTR

Meaningful Use

CHAMPS/MMIS

Medicaid

Submit/Request

Submit/Request

Submit/Request

Submit/Receive/

Request/Review

The Open Directory™

LARA

Licensing

Submit/Request

EHR Labs

HISP

Z

directory

HISP

A

directory

Health Provider

Search Service

Request

…

Qualified

Organizations,

Network of

Networks, HIEs,

HINs, RHIOs

Submit/

Request

MIDIGATE®

Credentialing

Service

Direct Trust

Directory

Active Care

Relationship &

Transitions of

Care

Services

NPPES

&

NPPES Redux

Health Provider

Directory

Other

Repositories

State of

Michigan

Health Provider Search Service


Industry Approach: Federated Directories


Michigan

HPD

Florida

HPD

Surescripts

HPD

Michigan

Provider

1. Michigan HISP user searches for a Florida provider

2. Orchestration service negotiates queries to relevant PDs

3. HPDs return search results and orchestrator merges into single response

4. Michigan HISP user sends Direct message to Florida provider

Florida

Provider

Query

Orchestration

Service

11

Challenges:

1.Not scalable (too many directories to federate)

2.Standards not fully defined and are inconsistent

Qualified

Sub-state HIE

or VQO

Qualified

Sub-state HIE

or VQO

How HPD Infrastructure supports

Transitions of Care Service


Patient to Provider

Attribution

Delivery

Preference

Lookup

1) Patient goes to the hospital, hospital sends an ADT message to MiHIN

2) MiHIN checks patient attribution lists and identifies three providers

3) Retrieve from HPD the ESI and delivery preference for each provider

4) Notification is routed to the providers based on their ESI and preference

Primary Care

Specialist

Care

Coordinator

Alerts &

Notification

DSM

12

MiHIN Transitions of Care Service (TOC)


• MiHIN TOC service has been in production since Nov 2013

• 19 Physician Organizations in production

• Additional 43 Physician Organizations targeted to go-live

• Over 600 hospital & practice organizations in production

• Over 1500 providers receiving real-time TOC notifications

• Over 3 million TOC notifications transmitted per week

• Over 80% of Michigan statewide admissions are shared currently

• Over 90% of Michigan Statewide admission expected to be shared by the end of 2014

• Onboarding more hospitals and practices weekly

• Excellent source of accurate provider & organization data & affiliations

• Processing monthly updates to ACRS data sets in production

• Working towards transactional updates

MiHIN Health Provider Directory


HPD Search


JCMR Providers


Windward General Example


Windward ESI


Windward Care Teams


Windward Diabetes Care Team


Dr. Eastman


Dr. Eastman’s CV


Care Team Connect ESI


Clinical Quality Measurement

• A new way of assessing the success of medical care

• Meaningful Use (MU) Stage 2 requires Medicaid providers to report Clinical Quality Measurements (CQMs) from a certified EHR

• A new strategic direction for the HPD

• CAT-I reports assess individual patient encounters

• CAT-III reports assess organization efficiency & enable cross-clinic comparisons

• MiHIN Patient Generator creates test data for large, simulated populations without PHI

• Report-once capability for Medicaid and Medicare

• Direct submission of CQM reports in pre-production


Clinical Quality Measures in HPD:

Super Stickiness!• Medicaid providers are required to submit CQMs

• Non-Medicaid providers may want to report and analyze their CQMs also, given the appropriate powerful tools

• HPD will display CQM data via Clinical Quality Measurement Recovery and Repository (CQMRR) service

• All providers and organizations can access reports, dashboardsand comparisons for self-analysis to improve outcome trends for their patients/clinics

• Allows real-time feedback on clinical and organizational trends

• Continuous Process Improvement / Clinical Quality Improvement


Reports and Data Analysis:

Real-time Quality Comparisons


• CQMRR: skimming ‘la crème de la crème’

Standard report generation (varies by user)

Cross clinical comparisons (Medicaid, Medicare)

Self-comparisons (providers)

• Can identify best (and worst)

Graphical dashboards using Tableau™

• Gartner rated top business intelligence tool

• Real-time feedback for Clinical Quality Improvement

26

MIDIGATE

OutboundInbound


CQMRR – current capability

State of Michigan

Data Hub

Eligible

Providers

Eligible/Critical

Access Hospitals Data Peeler

CDA

Schema

DQA

SOM Data

Warehouse

eCQM

Data Mart

(Final)

[email protected]

[email protected]

Health

Provider

Directory

Medicaid

Reports,

Dashboards,

Comparisons,

Mining,

QRDA

QRDA

popHealth CAT I

to CAT III

QRDA

QRDA

(CAT I & III)

Check NPI

MiHIN®

MIDIGATE

OutboundInbound

State of Michigan

Data Hub


Eligible

Providers

Eligible/Critical

Access Hospitals Data Peeler

CDA

Schema

DQA

SOM Data

Warehouse

eCQM

Data Mart

(Final)

[email protected]

[email protected]

Health

Provider

Directory

Medicaid

Reports,

Dashboards,

Comparisons,

Mining,

QRDA

QRDA

popHealth CAT I

to CAT III

QRDA

QRDA

CQMRR - future state

QRDA

(CAT I & III)

Check NPI

Provider Quality

Portal

Provider

Reports,

Dashboards,

Comparisons,

Mining,

any provider

(any state)

®

CMS

Repository

Medicare

Reports,

Dashboards,

Comparisons,

Mining,

Payer Quality

Analysis

QRDA

Payer

Reports,

Dashboards,

Comparisons,

Mining,

PQRS

QRDA

MiHIN

MiHealth

Portal

QRDA


Live eCQM data


Live eCQM data


Live eCQM data

What You Have Seen


• Key benefits of the Michigan Statewide Health Provider

Directory (HPD) service

• Strategic focus of the HPD: Electronic Service

Information & health information routing

• Architectural overview including the data model and

relationships to standards

• HISP integration capabilities

• Transition of Care (TOC) integration

• Health Provider Directory service demonstration

• Clinical Quality Measurement capabilities

Questions?


Healthcare

MiHIN Health Provider Directory Demo Slides with CQMRR v43 02 18-15