michigan health information network shared services beth nagel, hit manager michigan department of...
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Michigan Health Information Network
Shared Services
Beth Nagel, HIT Manager Michigan Department of Community HealthNovember 10, 2010
www.michigan.gov/mdch
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Vocabulary TestHealth Information Technology (HIT)
Health Information Exchange (HIE)
Regional Health Information
Exchange (RHIO)
Software and hardware that processes health care information electronically within a health care organization. Examples include:• EMR• EHR• CPOE• E-Prescribing
The electronic movement of any and all health-related data according to an agreed-upon set of interoperability standards, processes and activities across non-affiliated organizations in a manner that protects the privacy and security of that data; and the entity that organizes and takes responsibility for the process
A health information organization that brings together health care stakeholders within a defined group/area and governs health information exchange among them for the purpose of improving health and care.
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Motivation for HIE
Clinicians have incomplete knowledge of their patients Relevant patient data not available in 81% of
ambulatory visits 18% of medical errors that lead to ADEs due to
missing patient information.
Medicare patients see an average of 5.6 different providers each year= 5.6 silos of data
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“CARFAX Vehicle History Reports™ are available on all used cars and light trucks model year 1981 or later…”
“CARFAX receives information from more than 20,000 data sources including every U.S. and Canadian provincial motor vehicle agency plus many auto auctions, fire and police departments, collision repair facilities, fleet management and rental agencies, and more…”
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Healthcare’s Unique Challenges Only industry that is truly ‘life and death’
Constantly changing key factors of; Patient needs Treatment choices Patient mobility Community health environment/challenges
An industry where accuracy, flexibility and dynamic (live) information is vital
An industry that is inefficient due to variability of care and cost.
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Why is government involved? Reducing costs & Increasing quality of
healthcare is an economic issue
Ability to determine health status and track health outcomes is essential to effective public policy
Government is a purchaser, a payer and a provider
Government can be a neutral convener and arbiter of public good
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“In Michigan, we will help our health care industry stop depending on your memory and their paper records as databanks. We are going to use technology to vastly improve the system.”
- Governor Granholm, 2006 State of the State Address
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MiHIN: The History
2005 – Michigan kicks off a multi stakeholder, all inclusive approach to completing a statewide HIE roadmap
2006 – The Michigan’s HIE roadmap - MiHIN Conduit to Care - is completed and released
2006 – Legislation is signed to create the Michigan HIT Commission
2007 & 2008 – Michigan invests $10 million in regional HIE planning and implementation
2009 – “ARRA” changed the HIT and HIE world
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ARRA: HIT Game Changer
The biggest investment in
HIT in the U.S. EVER
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ARRA HIT Programs
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Regional HIT Extension CenterEHR Incentives Beacon Community
State HIE Cooperative Agreement
MiHINMichigan
Medicaid EHR Incentives
M-CEITA SEMHIE
ARRA HIT Programs in Michigan
Michigan’s Corresponding Initiatives
$14.99 MILLION
$200 MILLION??
$19.6 MILLION
$16 MILLION
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State HIE Cooperative Agreement Issued by the Office of the National Coordinator for HIT
Michigan’s Award: $14,993,085
Four year cooperative agreement Matching funding requirements escalate (0%
first year, 10% second, 14% third, 33% fourth)
Goal: an interoperable statewide health information exchange
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Michigan’s Approach Convene Stakeholders
Kick-off event in November with over 300 organizations represented
Organized five workgroups with over 100 organizations directly involved
All workgroups open to the public
All information (schedule, agendas, materials) posted
Voting members elected by peer voting process
Co-chairs: 1 public and 1 private
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Governance Work Group
Business Operations
TechnicalPrivacy & Security
Finance
MDCH & DTMB
HIT Commission
Stakeholder Input Structure
State HIE Cooperative Agreement Applicant
Office of the National Coordinator for HIT
Federal Administrative Office of the State HIE Cooperative Agreement Program
Workgroup Structure
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Workgroup Deliverables
Strategic & Operational Plans submitted on April 30 to the ONC
8 States approved Awaiting approval for MiHIN plans
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Technology Guiding Principles:
Cost-effective to build and maintain
Interoperable with HIE systems that are already used in Michigan
Technical architecture must be EHR and HIE vendor agnostic
Consistent with national industry standards Maintain the privacy of patient data and have the highest
level of security
Incremental approach
Build only the minimum necessary
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Technical ArchitectureArchitecture funded by State HIE Cooperative Agreement
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Technical Architecture Benefits
Builds upon sub-state HIEs
“Skinny” set of technologies that can scale up over time
Connects public health reporting and surveillance
Functionality provides value at a low cost
“Behind the scenes” service that allows providers to have multiple HIE choices
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Governance Guiding Principles
Multi-stakeholder collaboration is needed to implement achievable and measurable initiatives
The MiHIN will leverage existing and planned information technology
Those that benefit should participate in paying the cost
Adoption and use of the MiHIN is critical to success
The MiHIN will conform to applicable federal guidelines
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Governance
MiHIN Shared
Services Governance
Board
Governs the Business & Technical Operations of MiHIN Shared Services
“State Designated Entity”
Authority of the MiHIN Shared Services
Implements financing structures
HIT Commission
Statewide & National Vision
Monitors statewide progress of HIT & HIE
Facilitates public discussion
Recommends public policy
Provides the voice of the public
• Coordination & Collaboration
• Public & Private
Coordinated Governance Model relies on two distinct entities that have unique responsibilities
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Coordinated Governance Model Benefits
Built in coordination State maintains accountability Legislature maintains oversight Balances transparency, openness, efficiency and
agility Leverages existing HIT Commission experience Non-profit entity attracts diverse funding sources Customers governing long-term sustainability Aligned with other state models and national best
practices Fulfills expectations of the State HIE Cooperative
Agreement
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Creating the Non-profit Entity Defined Board
10 seats for direct customers 7 sub state HIEs 3 Payers
2 seats for state government Medicaid Public Health
1 HIT Commissioner
Open, transparent process for seating initial board Bylaws drafted by MiHIN Governance Workgroup Criteria laid out in public forum HIT Commission assists in nomination review
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Expenses by Source
0
2
4
6
8
10
12
Mill
ions
Fed Grant
State Match
Member Fee
Expenses
2010 2011 2012 2013 2014 2015
Estimated expenses from 4/30/10 - subject to change
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Long-Term Sustainability Strategy
Keep costs at a minimum Leverage existing technology Maximize the use of federal one-time funding Customers will support long-term costs Customers must be involved in technology and business
decisions that will affect the costs Direct customers are the majority on the MiHIN Shared
Services Governance Board Set savings and quality metrics for Medicaid and all payers
Business Plan Due February 2011
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There is nothing funny about privacy
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A Balancing Act of Privacy Policies
• Patient Privacy Risk
• Patient Concern
• False security in paper
Patient Privacy Policies: Authentication, Authorization, Access, Audit, Breach
Patient Privacy Policies: Authentication, Authorization, Access, Audit, Breach
• Urgent Need for Patient Data at the Point of Care
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Next Steps Plan approval from the ONC
ONC guidance focused on ensuring all Michigan providers have at least one option for HIE in 2011
Ensuring all Eligible Providers can meet meaningful use
Create the non-profit entity Articles of Incorporation First Meeting
Update public health systems MCIR and MDSS interoperability with bi-directional
communication