mihin overview - health information exchange meet and greet v7 10 22-14
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MiHIN OverviewHIE Meet and Greet
October 2014
MiHIN is a
network for sharing health information statewide
for Michigan
2Copyright 2014 - Michigan Health Information Network Shared Services
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Statewide Coordination
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 Shared Services
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“One and Done”- Easier, Simplified, Predictable Data Sharing
1. 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
Copyright 2014 - Michigan Health Information Network Shared Services
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
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Health Plan QOs (more coming)
Single point of entry/exit for state
Virtual QOs
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Pharmacies (more coming)
Immunizations
Mi Syndromic Surveillance System
Mi Disease Surveillance System
Consumer QOs (more coming)
Federal
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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
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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
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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
Use Case Factory™
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Use Case ComponentsUse 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
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http://mihin.org/about-mihin/resources/use-case-submission-form/
Use Case Factory
Idea with Champion
Idea with Sponsor
Plan & Develop
Pilot & Refine
Technical 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 Status
Metrics
Adoption
Critical Mass
Mass Marketing &
OutreachMiHIN Board
SuccessfulAdoption
ContinuousImprovement
Functional Data-Sharing
Widget
10Copyright 2014 - Michigan Health Information Network Shared Services
Use Case Assembly Lines
Results Delivery• Lab
results• Diagnosti
c imaging• Other
tests• Hospital
discharge summaries
Public Health Reporting• Immunizatio
ns• Chronic
disease registries
• Disease surveillance
• Syndromic surveillance
• 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
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Infrastructure Services
Secure Transport Layer Services and Digital Credentials
Master Person Index(Common Key Service)
Active Care Relationship
Service
Patient Opt-In Preferences
Identity Management
FederatedIdentity Management
(FiDM)
Health Provider Directory
Gateway Services (e.g. XCA)
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Accelerating Use Cases
Policy & Regulatory
Levers
ClinicalEndorsement &
Evidence
FinancialIncentives or Disincentives
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Use Case Pipeline Example
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Benefits of Use Case Approach
Reduces Complexity •Manageable chunks so competitive or confidentiality concerns can be addressed without “boiling the ocean”
Consistent Pattern •Standardized mechanism for scoping purpose, technical requirements, costs, and limits on how data is used
Modular (like Lego blocks) •Use Cases can be combined to create higher and higher levels of functionality
Aligns Priorities •Incentives, regulations or policies can target specific Use Case to foster or accelerate adoption
Transparent •Constituents can understand expected use of their data and follow the common chain of trust across organizations
Measureable •Aids focused monitoring and measurement of progress
Faster & Cost Effective •Reduces variability and enables scalability
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Monitoring Public Health Use Cases
-
500,000
1,000,000
1,500,000
2,000,000
2,500,000
3,000,000
3,500,000
4,000,000
Syndromic Surveillance (SS)
Clinical Quality Measures (CQM)
Reportable Labs (ELR)
Immunizations (VXU)
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Monitoring Transitions of Care
0
2000000
4000000
6000000
8000000
10000000
12000000
14000000
16000000
Admit-Discharge-Transfer (ADT)
Outbound (ADT)
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Statewide ADT Use Case Example
Active CareRelationship Service
(ACRS)
Statewide Health ProviderDirectory (HPD)+ +
Copyright 2014 - Michigan Health Information Network Shared Services
Statewide Health Provider Directory
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• 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
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ACRS™ Update – Version 2.0
Additional patient information to minimize false positives
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Patient InformationSource Patient ID First Name Middle InitialLast NameSuffix Date of Birth GenderSSN – Last 4 digitsAddress 1 & Address 2City, State, Zip Home & Mobile Phones
Physician InformationNPI First NameLast NamePractice Unit ID Practice Unit NamePhysician Organization IDPhysician Org Name Physician DIRECT AddressDIRECT Preferences
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Important Horizontal View
Eligible Hospitals
Eligible Providers &
PCMH
Care Coordinators
Specialty Providers
BehavioralHealth Specialists
Critical Access Hospitals
Patients & Families
Copyright 2014 - Michigan Health Information Network Shared Services
Qualified Organization
Qualified Organization
Statewide ADT Notification
Active CareRelationship
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
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Animation
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Other “Lego” Combinations
Active CareRelationships
State-wide Health Provider
Directory+ +
Active CareRelationships
State-wide Health Provider
Directory+ +
MED REC
CarePlan
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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 (MiDiGateTM)• 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
Ready Now!
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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
labs@direct.hieqo.orgdeaths@direct.hieqo.org
immunizations@direct.hieqo.orgusecasename@direct.hieqo.org
birthdefects@direct.hieqo.orgcqms@direct.hieqo.org adts@direct.hieqo.org
fostercarehealth@direct.hieqo.orgccdas@direct.hieqo.org
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
Maximize SOM Resources
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State o
f Mich
igan
In
ternal
ExternalSTATEWIDESHARED SERVICES
MDCH Data Hub MiHIN & the Qualified Data Sharing Organizations
Transparency via HIT
Commission Monitoring
Shared Governance via
MiHIN Board
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MiHIN GovernanceMiHIN 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
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MiHIN Board of Directors
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
VacantRepresenting Pharmaceutical Manufacturers
Irita B. MatthewsRepresents Health Information Technology
Meridian Health Plan Thomas Lauzon
HIT CommissionerNick Lyon
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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, Kevin 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, Kevin 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
Upper Peninsula Health Information Exchange (UPHIE)
Paula Hedlund
Jackson Community Medical Record (JCMR)
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, Patt y 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
Upper Peninsula Health Information Exchange (UPHIE)
Paula Hedlund, Dan Boyle
Great Lakes Health Connect Doug Dietzman
Upper Peninsula Health Information Exchange (UPHIE)
Paula HedlundDan Boyle (alt.)
Jackson Community Medical Record (JCMR)
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
Jackson Community Medical Record (JCMR)
Jeanne Wymer
Ingenium John Vismara, Rusty Mandle
SEMHIEVacant
Blue Cross Blue Shieldof MI (BCBSM)
Vacant
Health Alliance Plan of Michigan (HAP)
Vacant
SEMHIEVacant
Blue Cross Blue Shieldof MI (BCBSM)
Vacant
Health Alliance Plan of Michigan (HAP)
Vacant
Blue Cross Blue Shieldof MI (BCBSM)
Vacant
Health Alliance Plan of Michigan (HAP)
Jane Harper, Robert Keefer
Upper Peninsula Health Information Exchange (UPHIE)
Paula Hedlund
Jackson Community Medical Record (JCMR)
Aaron Wootton
Ingenium John Vismara
SEMHIEHelen Hill
Blue Cross Blue Shieldof MI (BCBSM)John Bialowicz
Health Alliance Plan of Michigan (HAP)
Vacant
Upper Peninsula Health Information Exchange (UPHIE)
Paula Hedlund, Dan Boyle
Jackson Community Medical Record (JCMR)
Aaron Wootton, Jeanne Wymer, Rick Warren
Ingenium Diane Slon, Wendy Linkimer
SEMHIEHelen Hill, Mick Tal ley
Blue Cross Blue Shieldof MI (BCBSM)John Bialowicz
Health Alliance Plan of Michigan (HAP)
Deborah Spencer
Ingenium Rusty MandleKen O’Brien
Privacy
Upper Peninsula Health Information Exchange (UPHIE)
Paula Hedlund
Jackson Community Medical Record (JCMR)
Jeanne Wymer
MDCH/DTMBLeslie Asman,
John Donovan-Co-Chair, Phil Kurdunowicz- Co-Chair
MiHIN Sh ared Service Jeff Livesay
Brandi Briones
SEMHIEMick Tal ley
Blue Cross Blue Shieldof MI (BCBSM)
Vacant
Health Alliance Plan of Michigan (HAP)
Vacant
Ingenium Rusty MandleKen O’Brien
Great Lakes Health Connect Rich Fish
Priority Health Lee VanWagner
Priority Health Vacant
Priority Health Vacant
Priority Health Vacant
Priority Health Vacant
Priority Health Vacant
Priority Health Vacant
Meridian Health Plan Tony Randolph Thomas Lauzon
Meridian Health Plan Vacant
Meridian Health Plan Vacant
Meridian Health Plan Vacant
Meridian Health Plan Vacant
Meridian Health Plan Vacant
Meridian Health Plan Vacant
Great Lakes Health Connect Adam GeeMike Ayers
MiHIN Operations Advisory Committee (MOAC)
Copyright 2014 - Michigan Health Information Network Shared Services
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Challenges• Communicate effectively• Maintain stability in the rapidly growing
ecosystem• Understand how to better support our
stakeholders
Copyright 2014 - Michigan Health Information Network Shared Services
Questions?Dr. Tim Pletcher
Executive Director
pletcher@mihin.org
Jeff Livesay
Associate Director
livesay@mihin.org
Shelley Mannino
Senior Project Manager
mannino@mihin.org
31Copyright 2014 - Michigan Health Information Network Shared Services
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