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MiHIN Overview 
HIE Meet and Greet 
October 2014
MiHIN is a 
network for sharing health 
information statewide 
for Michigan 
Copyright 2014 - Michigan Health Information Network Shared Services 2
Statewide Coordination 
3 
Health 
Plans 
Physicians 
Specialty 
Providers 
Patients 
& Families 
Lab tests & 
XRAYs 
Hospitals & Clinics 
Medications 
Public Health 
Duplication of effort, waste, & expense 
(N x N-1 connections) 
Insurance 
Companies 
Physicians 
Specialty 
Providers 
Patients 
& Families 
Lab tests & 
XRAYs 
Hospitals & Clinics 
Medications 
Public Health 
Shared Services 
(N connections) 
Copyright 2014 - Michigan Health Information Network Shared Services
“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 4
State-wide 
Shared Services 
MDCH Data Hub 
Medicaid 
MSSS 
State 
LABS 
Network of Networks: 
HIE QOs 
(Qualified sub-state HIEs) 
Doctors & Community 
Providers 
Data 
Warehouse 
5 
Health Plan QOs 
(more coming) 
Single point of 
entry/exit for state 
Virtual QOs 
Pharmacies 
(more coming) 
Copyright 2014 - Michigan Health Information Network Shared Services 
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 Network 
Shared Services 6
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 
Copyright 2014 - Michigan Health Information Network Shared Services 7
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™ 
Copyright 2014 - Michigan Health Information Network Shared Services
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 
Copyright 2014 - Michigan Health Information Network Shared Services
Use Case Factory 
Idea with 
Champion 
Idea with 
Sponsor 
Plan & Develop 
Pilot & 
Refine 
Technical 
Planning 
Conceptual 
Use 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 
Define Evaluation 
Purpose 
Implement 
Production 
Status 
Metrics 
Continuous 
Improvement 
Adoption 
Critical 
Mass 
Mass 
Marketing & 
Outreach 
MiHIN Board 
Successful 
Adoption 
Functional 
Data-Sharing 
Widget 
http://mihin.org/about-mihin/resources/use-case-submission-form/ 
Copyright 2014 - Michigan Health Information Network Shared Services 10
Use Case Assembly Lines 
Results Delivery 
•Lab results 
•Diagnostic imaging 
•Other tests 
•Hospital discharge 
summaries 
Public Health 
Reporting 
•Immunizations 
•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 
11 
Copyright 2014 - Michigan Health Information Network Shared Services
Infrastructure Services 
Master Person Index 
(Common Key Service) 
Federated 
Identity 
Management 
(FiDM) 
Gateway 
Services (e.g. 
XCA) 
Secure Transport Layer Services and 
Digital Credentials 
Active Care 
Relationship 
Service 
Patient Opt-In 
Preferences 
Identity 
Management 
Health 
Provider 
Directory 
Copyright 2014 - Michigan Health Information Network Shared Services 12
Accelerating Use Cases 
13 
Policy & 
Regulatory 
Levers 
Clinical 
Endorsement & 
Evidence 
Financial 
Incentives or 
Disincentives 
Copyright 2014 - Michigan Health Information Network Shared Services
Use Case Pipeline Example 
Copyright 2014 - Michigan Health Information Network Shared Services 14
Benefits of Use Case Approach 
15 
• Manageable chunks so competitive or confidentiality 
Reduces Complexity concerns can be addressed without “boiling the ocean” 
• Standardized mechanism for scoping purpose, technical 
Consistent Pattern requirements, costs, and limits on how data is used 
• Use Cases can be combined to create higher and higher 
Modular (like Lego blocks) levels of functionality 
• Incentives, regulations or policies can target specific Use 
Aligns Priorities Case to foster or accelerate adoption 
• Constituents can understand expected use of their data and 
Transparent follow the common chain of trust across organizations 
• Aids focused monitoring and measurement of progress 
Measureable 
• Reduces variability and enables scalability 
Faster & Cost Effective 
Copyright 2014 - Michigan Health Information Network Shared Services
Monitoring Public Health Use Cases 
4,000,000 
3,500,000 
3,000,000 
2,500,000 
2,000,000 
1,500,000 
1,000,000 
500,000 
16 
- 
Syndromic Surveillance (SS) 
Clinical Quality Measures (CQM) 
Reportable Labs (ELR) 
Immunizations (VXU) 
Copyright 2014 - Michigan Health Information Network Shared Services
16000000 
14000000 
12000000 
10000000 
8000000 
6000000 
4000000 
2000000 
17 
Monitoring Transitions of Care 
0 
Admit-Discharge-Transfer (ADT) 
Outbound (ADT) 
Copyright 2014 - Michigan Health Information Network Shared Services
Statewide ADT Use Case Example 
18 
Active Care 
Relationship Service 
(ACRS) 
Statewide 
Health Provider 
Directory (HPD) + + 
Copyright 2014 - Michigan Health Information Network Shared Services
Statewide Health Provider Directory 
19 
• 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 
Copyright 2014 - Michigan Health Information Network Shared Services
ACRS™ Update – Version 2.0 
Additional patient information to minimize false positives 
20 
Patient Information 
Source 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 Information 
NPI 
First Name 
Last Name 
Practice Unit ID 
Practice Unit Name 
Physician Organization ID 
Physician Org Name 
Physician DIRECT Address 
DIRECT Preferences 
Copyright 2014 - Michigan Health Information Network Shared Services
Important Horizontal View 
21 
Eligible 
Hospitals 
Eligible 
Providers & 
PCMH 
Care 
Coordinators 
Specialty 
Providers 
Behavioral 
Health Specialists 
Critical Access 
Hospitals 
Patients & Families 
Copyright 2014 - Michigan Health Information Network Shared Services
Statewide ADT Notification 
Qualified 
Organization 
Qualified 
Organization 
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 
Care 
Coordinator 
Primary Care 
Specialist 
22 
Animation 
Copyright 2014 - Michigan Health Information Network Shared Services
Other “Lego” Combinations 
23 
+ + 
Active Care 
Directory Relationships 
State-wide 
Health Provider 
+ + 
Active Care 
Directory Relationships 
State-wide 
Health Provider 
MED 
REC 
Care 
Plan 
Copyright 2014 - Michigan Health Information Network Shared Services
Some 2015 Use Cases 
Ready Now! 
• 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 
24 
Copyright 2014 - Michigan Health Information Network Shared Services
MSSS 
25 
MDCH 
Data Hub 
HIE 
QO/VQO 
Medical Information Direct GatewayTM 
MiDiGateTM for HIE QOs and VQOs 
MiDiGate 
CQM Data 
Mart 
Medicaid ADT 
Repository 
MCIR 
MDSS 
SOM Data Warehouse 
Inbound Outbound 
QRDA Cat III 
QRDA 
CAT III 
MU Credit 
Meaningful 
Use 
Database 
QRDA 
Labs 
Patients 
Hospitals 
Physicians 
HIEs 
Correctional 
Facility 
Any provider 
organization 
EDRS 
MCDR 
MiHIN 
HIE 
Repository 
Other States 
Direct Email Convention Examples Using MiDiGate 
& Health Provider Directory 
Inbox 
labs@direct.hieqo.org 
deaths@direct.hieqo.org 
immunizations@direct.hieqo.org 
usecasename@direct.hieqo.org 
birthdefects@direct.hieqo.org 
cqms@direct.hieqo.org 
adts@direct.hieqo.org 
fostercarehealth@direct.hieqo.org 
ccdas@direct.hieqo.org 
Destination(s) . 
Reportable Labs to MDSS 
Electronic Death Registry System 
Michigan Care Improvement Registry 
Registry for that use case 
Chronic Condition Registry 
SOM Data Warehouse 
Vital Statistics 
Foster Kids Registry 
Chronic Disease Registry 
Description 
Lab Results 
Death Notices 
Immunizations 
Use Case Specific 
Birth Defect Notices 
Clinical Quality Measures 
Admit, Discharge, Transfer 
Foster Kids Care Summaries 
Consolidated Clinical Document Architecture 
Copyright 2014 - Michigan Health Information Network Shared Services
Maximize SOM Resources 
26 
State of Michigan 
Internal 
MDCH Data Hub MiHIN & the Qualified 
Data Sharing Organizations 
STATEWIDE External 
SHARED SERVICES 
Transparency 
via HIT 
Commission 
Monitoring 
Shared 
Governance via 
MiHIN Board 
Copyright 2014 - Michigan Health Information Network Shared Services
27 
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 
Copyright 2014 - Michigan Health Information Network Shared Services
28 
MiHIN Board of Directors 
MiHIN Executive Management 
Executes the operations plan 
Tim Pletcher, Executive Director 
Jeff Livesay, Associate Director 
MiHIN Operations Advisory Committee 
(MOAC) 
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. 
Michael G. Chrissos, M.D. 
Representing Consumers 
Gregory Forzley, M.D.- Chair 
Representing Doctors of Medicine 
Robert Milewski 
Representing Nonprofit Healthcare Corporations 
Pat Rinvelt 
Representing Purchasers or Employers 
Mark Notman, Ph.D. 
Representing Schools of Medicine 
Nick Lyon 
Representing MDCH 
Nick Smith 
Representing Health Plans or Third Party Payers 
Rod Davenport 
Representing State of Michigan CTO 
Jill Castiglione 
Representing Pharmacists 
Orest Sowirka, D.O. 
Representing Doctors of Osteopathic Medicine 
Jim Lee 
Representing Hospitals 
MiHIN Board of Directors 
Michigan Public Health 
Jim Collins 
Southeast Michigan HIE 
(SEMHIE) 
Helen Hill 
Michigan Pharmacist 
Association 
Larry Wagenknecht, Chair 
Michigan Medicaid 
Cynthia Green Edwards 
Ex Officio 
Tim Pletcher 
Priority Health 
Krischa Winwright 
Blue Cross Blue Shield 
of 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 Health 
Information Exchange (UPHIE) 
Dennis Smith 
S 
e 
t 
P 
o 
l 
i 
c 
i 
e 
s 
A 
c 
t 
o 
n 
t 
h 
e 
P 
o 
l 
i 
c 
i 
e 
s 
Vacant 
Representing Pharmaceutical Manufacturers 
Irita B. Matthews 
Represents Health Information Technology 
Meridian Health Plan 
Thomas Lauzon 
HIT Commissioner 
Nick Lyon 
Copyright 2014 - Michigan Health Information Network Shared Services
MiHIN Operations Advisory Committee (MOAC) 
29 
Information Exchange (UPHIE) 
MOAC Working Groups 
Operations/ 
Production Support 
MDCH/DTMB/SOM 
Doug Wi tten – Co-Chair, 
Tina Scott, Alan Darl ing, Lar ry 
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 Shared Services 
Brian Seggie, Rod Mach, Steve 
Arnst, Aldan Beaubien 
Great Lakes Health Connect 
Adam Gee 
Mike 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 
Great Lakes Health Connect 
Doug Dietzman 
Upper Peninsula Health 
Paula Hedlund 
Dan Boyle (alt.) 
Integration and 
Architecture 
MDCH/DTMB/SOM 
Doug Wi tten – Co-Chair, 
Tina Scott, Alan Darl ing, Lar ry 
Ruble, Kevin Garnett, Therese 
Hoyle, Bea Salada, Dave Willhite, 
Brenda Coleman, Paul Groll, Ed 
Hartwick, Jeff Shaw, Doug Saylor, 
Craig Weaver, Mike Potter, 
Soma Duppi, Brendan O’Brien, 
Jaya Tamrakar 
MiHIN Shared Services 
Brian Seggie, Co-Chair, Steve 
Arnst, Rod Mach, Aldan 
Beaubien 
Security 
MDCH Data Hub/DTMB 
Paul Groll, 
Phil Kurdunowicz, Tairus Taylor 
MiHIN Shared Services 
Brian Seggie – Co-Chair 
Jeff Livesay, Frank Cass 
Great Lakes Health Connect 
Adam Gee, Rich Fi sh 
Upper Peninsula Health 
Information Exchange (UPHIE) 
Paula Hedlund 
Jackson Community 
Medical Record (JCMR) 
Jeanne Wymer 
Issue Remediation 
MDCH 
Cynthia Green-Edwards – 
Co-Chair, 
Meghan Vanderstelt 
MiHIN Shared Services 
Dr. Tim Pletcher – Co-Chair 
Health Alliance Plan of 
Use Case 
MDCH/DTMB 
Tina 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 Shared Services 
Rick Wilkening – Co-Chair 
Michael Taylor 
SEMHIE 
Mick 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 
Jackson Community 
Medical Record (JCMR) 
Aaron Wootton 
Rick Warren (alt.) 
Ingenium 
John Vismara 
Wendy Linkimer (alt.) 
MDCH/MDCH Data Hub 
Tina Scott, Co-Chair 
Cynthia Edwards 
MiHIN Shared Services 
Jeff Livesay, Co-Chair 
Dr. Tim Pletcher 
Southeast Michigan HIE 
(SEMHIE) 
Helen Hill 
Blue Cross Blue Shield 
of MI (BCBSM) 
Wanda Brideau 
Michigan (HAP) 
Jane Harper 
Jackson Community 
Medical Record (JCMR) 
Jeanne Wymer 
Ingenium 
John Vismara, Rusty Mandle 
SEMHIE 
Vacant 
Blue Cross Blue Shield 
of MI (BCBSM) 
Vacant 
Health Al liance Plan of 
Michigan (HAP) 
Vacant 
SEMHIE 
Vacant 
Blue Cross Blue Shield 
of MI (BCBSM) 
Vacant 
Health Al liance Plan of 
Michigan (HAP) 
Vacant 
Blue Cross Blue Shield 
of MI (BCBSM) 
Vacant 
Health Al liance 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 
SEMHIE 
Helen Hill 
Blue Cross Blue Shield 
of MI (BCBSM) 
John Bialowicz 
Health Al liance 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 War ren 
Ingenium 
Diane Slon, Wendy Linkimer 
SEMHIE 
Helen Hill, Mick Tal ley 
Blue Cross Blue Shield 
of MI (BCBSM) 
John Bialowicz 
Health Al liance Plan of 
Michigan (HAP) 
Deborah Spencer 
Ingenium 
Rusty Mandle 
Ken O’Brien 
Privacy 
MDCH/DTMB 
Leslie Asman, 
John Donovan-Co-Chair, Phil 
Kurdunowicz- Co-Chair 
MiHIN Shared Service 
Jeff Livesay 
Brandi Briones 
Great Lakes Health Connect 
Rich Fi sh 
Upper Peninsula Health 
Information Exchange (UPHIE) 
Paula Hedlund 
Jackson Community 
Medical Record (JCMR) 
Jeanne Wymer 
Ingenium 
Rusty Mandle 
Ken O’Brien 
SEMHIE 
Mick Tal ley 
Blue Cross Blue Shield 
of MI (BCBSM) 
Vacant 
Health Al liance Plan of 
Michigan (HAP) 
Vacant 
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 Gee 
Mike Ayers 
Copyright 2014 - Michigan Health Information Network Shared Services
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 30
Questions? 
Dr. Tim Pletcher 
Executive Director 
pletcher@mihin.org 
Jeff Livesay 
Associate Director 
livesay@mihin.org 
Shelley Mannino 
Senior Project Manager 
mannino@mihin.org 
Copyright 2014 - Michigan Health Information Network Shared Services 31

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MiHIN Overview - Health Information Exchange Meet and Greet v7 10 22-14

  • 1. MiHIN Overview HIE Meet and Greet October 2014
  • 2. MiHIN is a network for sharing health information statewide for Michigan Copyright 2014 - Michigan Health Information Network Shared Services 2
  • 3. Statewide Coordination 3 Health Plans Physicians Specialty Providers Patients & Families Lab tests & XRAYs Hospitals & Clinics Medications Public Health Duplication of effort, waste, & expense (N x N-1 connections) Insurance Companies Physicians Specialty Providers Patients & Families Lab tests & XRAYs Hospitals & Clinics Medications Public Health Shared Services (N connections) Copyright 2014 - Michigan Health Information Network Shared Services
  • 4. “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 4
  • 5. State-wide Shared Services MDCH Data Hub Medicaid MSSS State LABS Network of Networks: HIE QOs (Qualified sub-state HIEs) Doctors & Community Providers Data Warehouse 5 Health Plan QOs (more coming) Single point of entry/exit for state Virtual QOs Pharmacies (more coming) Copyright 2014 - Michigan Health Information Network Shared Services Immunizations Mi Syndromic Surveillance System Mi Disease Surveillance System Consumer QOs (more coming) Federal
  • 6. 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 Network Shared Services 6
  • 7. 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 Copyright 2014 - Michigan Health Information Network Shared Services 7
  • 8. 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™ Copyright 2014 - Michigan Health Information Network Shared Services
  • 9. 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 Copyright 2014 - Michigan Health Information Network Shared Services
  • 10. Use Case Factory Idea with Champion Idea with Sponsor Plan & Develop Pilot & Refine Technical Planning Conceptual Use 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 Define Evaluation Purpose Implement Production Status Metrics Continuous Improvement Adoption Critical Mass Mass Marketing & Outreach MiHIN Board Successful Adoption Functional Data-Sharing Widget http://mihin.org/about-mihin/resources/use-case-submission-form/ Copyright 2014 - Michigan Health Information Network Shared Services 10
  • 11. Use Case Assembly Lines Results Delivery •Lab results •Diagnostic imaging •Other tests •Hospital discharge summaries Public Health Reporting •Immunizations •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 11 Copyright 2014 - Michigan Health Information Network Shared Services
  • 12. Infrastructure Services Master Person Index (Common Key Service) Federated Identity Management (FiDM) Gateway Services (e.g. XCA) Secure Transport Layer Services and Digital Credentials Active Care Relationship Service Patient Opt-In Preferences Identity Management Health Provider Directory Copyright 2014 - Michigan Health Information Network Shared Services 12
  • 13. Accelerating Use Cases 13 Policy & Regulatory Levers Clinical Endorsement & Evidence Financial Incentives or Disincentives Copyright 2014 - Michigan Health Information Network Shared Services
  • 14. Use Case Pipeline Example Copyright 2014 - Michigan Health Information Network Shared Services 14
  • 15. Benefits of Use Case Approach 15 • Manageable chunks so competitive or confidentiality Reduces Complexity concerns can be addressed without “boiling the ocean” • Standardized mechanism for scoping purpose, technical Consistent Pattern requirements, costs, and limits on how data is used • Use Cases can be combined to create higher and higher Modular (like Lego blocks) levels of functionality • Incentives, regulations or policies can target specific Use Aligns Priorities Case to foster or accelerate adoption • Constituents can understand expected use of their data and Transparent follow the common chain of trust across organizations • Aids focused monitoring and measurement of progress Measureable • Reduces variability and enables scalability Faster & Cost Effective Copyright 2014 - Michigan Health Information Network Shared Services
  • 16. Monitoring Public Health Use Cases 4,000,000 3,500,000 3,000,000 2,500,000 2,000,000 1,500,000 1,000,000 500,000 16 - Syndromic Surveillance (SS) Clinical Quality Measures (CQM) Reportable Labs (ELR) Immunizations (VXU) Copyright 2014 - Michigan Health Information Network Shared Services
  • 17. 16000000 14000000 12000000 10000000 8000000 6000000 4000000 2000000 17 Monitoring Transitions of Care 0 Admit-Discharge-Transfer (ADT) Outbound (ADT) Copyright 2014 - Michigan Health Information Network Shared Services
  • 18. Statewide ADT Use Case Example 18 Active Care Relationship Service (ACRS) Statewide Health Provider Directory (HPD) + + Copyright 2014 - Michigan Health Information Network Shared Services
  • 19. Statewide Health Provider Directory 19 • 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 Copyright 2014 - Michigan Health Information Network Shared Services
  • 20. ACRS™ Update – Version 2.0 Additional patient information to minimize false positives 20 Patient Information Source 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 Information NPI First Name Last Name Practice Unit ID Practice Unit Name Physician Organization ID Physician Org Name Physician DIRECT Address DIRECT Preferences Copyright 2014 - Michigan Health Information Network Shared Services
  • 21. Important Horizontal View 21 Eligible Hospitals Eligible Providers & PCMH Care Coordinators Specialty Providers Behavioral Health Specialists Critical Access Hospitals Patients & Families Copyright 2014 - Michigan Health Information Network Shared Services
  • 22. Statewide ADT Notification Qualified Organization Qualified Organization 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 Care Coordinator Primary Care Specialist 22 Animation Copyright 2014 - Michigan Health Information Network Shared Services
  • 23. Other “Lego” Combinations 23 + + Active Care Directory Relationships State-wide Health Provider + + Active Care Directory Relationships State-wide Health Provider MED REC Care Plan Copyright 2014 - Michigan Health Information Network Shared Services
  • 24. Some 2015 Use Cases Ready Now! • 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 24 Copyright 2014 - Michigan Health Information Network Shared Services
  • 25. MSSS 25 MDCH Data Hub HIE QO/VQO Medical Information Direct GatewayTM MiDiGateTM for HIE QOs and VQOs MiDiGate CQM Data Mart Medicaid ADT Repository MCIR MDSS SOM Data Warehouse Inbound Outbound QRDA Cat III QRDA CAT III MU Credit Meaningful Use Database QRDA Labs Patients Hospitals Physicians HIEs Correctional Facility Any provider organization EDRS MCDR MiHIN HIE Repository Other States Direct Email Convention Examples Using MiDiGate & Health Provider Directory Inbox labs@direct.hieqo.org deaths@direct.hieqo.org immunizations@direct.hieqo.org usecasename@direct.hieqo.org birthdefects@direct.hieqo.org cqms@direct.hieqo.org adts@direct.hieqo.org fostercarehealth@direct.hieqo.org ccdas@direct.hieqo.org Destination(s) . Reportable Labs to MDSS Electronic Death Registry System Michigan Care Improvement Registry Registry for that use case Chronic Condition Registry SOM Data Warehouse Vital Statistics Foster Kids Registry Chronic Disease Registry Description Lab Results Death Notices Immunizations Use Case Specific Birth Defect Notices Clinical Quality Measures Admit, Discharge, Transfer Foster Kids Care Summaries Consolidated Clinical Document Architecture Copyright 2014 - Michigan Health Information Network Shared Services
  • 26. Maximize SOM Resources 26 State of Michigan Internal MDCH Data Hub MiHIN & the Qualified Data Sharing Organizations STATEWIDE External SHARED SERVICES Transparency via HIT Commission Monitoring Shared Governance via MiHIN Board Copyright 2014 - Michigan Health Information Network Shared Services
  • 27. 27 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 Copyright 2014 - Michigan Health Information Network Shared Services
  • 28. 28 MiHIN Board of Directors MiHIN Executive Management Executes the operations plan Tim Pletcher, Executive Director Jeff Livesay, Associate Director MiHIN Operations Advisory Committee (MOAC) 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. Michael G. Chrissos, M.D. Representing Consumers Gregory Forzley, M.D.- Chair Representing Doctors of Medicine Robert Milewski Representing Nonprofit Healthcare Corporations Pat Rinvelt Representing Purchasers or Employers Mark Notman, Ph.D. Representing Schools of Medicine Nick Lyon Representing MDCH Nick Smith Representing Health Plans or Third Party Payers Rod Davenport Representing State of Michigan CTO Jill Castiglione Representing Pharmacists Orest Sowirka, D.O. Representing Doctors of Osteopathic Medicine Jim Lee Representing Hospitals MiHIN Board of Directors Michigan Public Health Jim Collins Southeast Michigan HIE (SEMHIE) Helen Hill Michigan Pharmacist Association Larry Wagenknecht, Chair Michigan Medicaid Cynthia Green Edwards Ex Officio Tim Pletcher Priority Health Krischa Winwright Blue Cross Blue Shield of 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 Health Information Exchange (UPHIE) Dennis Smith S e t P o l i c i e s A c t o n t h e P o l i c i e s Vacant Representing Pharmaceutical Manufacturers Irita B. Matthews Represents Health Information Technology Meridian Health Plan Thomas Lauzon HIT Commissioner Nick Lyon Copyright 2014 - Michigan Health Information Network Shared Services
  • 29. MiHIN Operations Advisory Committee (MOAC) 29 Information Exchange (UPHIE) MOAC Working Groups Operations/ Production Support MDCH/DTMB/SOM Doug Wi tten – Co-Chair, Tina Scott, Alan Darl ing, Lar ry 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 Shared Services Brian Seggie, Rod Mach, Steve Arnst, Aldan Beaubien Great Lakes Health Connect Adam Gee Mike 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 Great Lakes Health Connect Doug Dietzman Upper Peninsula Health Paula Hedlund Dan Boyle (alt.) Integration and Architecture MDCH/DTMB/SOM Doug Wi tten – Co-Chair, Tina Scott, Alan Darl ing, Lar ry Ruble, Kevin Garnett, Therese Hoyle, Bea Salada, Dave Willhite, Brenda Coleman, Paul Groll, Ed Hartwick, Jeff Shaw, Doug Saylor, Craig Weaver, Mike Potter, Soma Duppi, Brendan O’Brien, Jaya Tamrakar MiHIN Shared Services Brian Seggie, Co-Chair, Steve Arnst, Rod Mach, Aldan Beaubien Security MDCH Data Hub/DTMB Paul Groll, Phil Kurdunowicz, Tairus Taylor MiHIN Shared Services Brian Seggie – Co-Chair Jeff Livesay, Frank Cass Great Lakes Health Connect Adam Gee, Rich Fi sh Upper Peninsula Health Information Exchange (UPHIE) Paula Hedlund Jackson Community Medical Record (JCMR) Jeanne Wymer Issue Remediation MDCH Cynthia Green-Edwards – Co-Chair, Meghan Vanderstelt MiHIN Shared Services Dr. Tim Pletcher – Co-Chair Health Alliance Plan of Use Case MDCH/DTMB Tina 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 Shared Services Rick Wilkening – Co-Chair Michael Taylor SEMHIE Mick 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 Jackson Community Medical Record (JCMR) Aaron Wootton Rick Warren (alt.) Ingenium John Vismara Wendy Linkimer (alt.) MDCH/MDCH Data Hub Tina Scott, Co-Chair Cynthia Edwards MiHIN Shared Services Jeff Livesay, Co-Chair Dr. Tim Pletcher Southeast Michigan HIE (SEMHIE) Helen Hill Blue Cross Blue Shield of MI (BCBSM) Wanda Brideau Michigan (HAP) Jane Harper Jackson Community Medical Record (JCMR) Jeanne Wymer Ingenium John Vismara, Rusty Mandle SEMHIE Vacant Blue Cross Blue Shield of MI (BCBSM) Vacant Health Al liance Plan of Michigan (HAP) Vacant SEMHIE Vacant Blue Cross Blue Shield of MI (BCBSM) Vacant Health Al liance Plan of Michigan (HAP) Vacant Blue Cross Blue Shield of MI (BCBSM) Vacant Health Al liance 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 SEMHIE Helen Hill Blue Cross Blue Shield of MI (BCBSM) John Bialowicz Health Al liance 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 War ren Ingenium Diane Slon, Wendy Linkimer SEMHIE Helen Hill, Mick Tal ley Blue Cross Blue Shield of MI (BCBSM) John Bialowicz Health Al liance Plan of Michigan (HAP) Deborah Spencer Ingenium Rusty Mandle Ken O’Brien Privacy MDCH/DTMB Leslie Asman, John Donovan-Co-Chair, Phil Kurdunowicz- Co-Chair MiHIN Shared Service Jeff Livesay Brandi Briones Great Lakes Health Connect Rich Fi sh Upper Peninsula Health Information Exchange (UPHIE) Paula Hedlund Jackson Community Medical Record (JCMR) Jeanne Wymer Ingenium Rusty Mandle Ken O’Brien SEMHIE Mick Tal ley Blue Cross Blue Shield of MI (BCBSM) Vacant Health Al liance Plan of Michigan (HAP) Vacant 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 Gee Mike Ayers Copyright 2014 - Michigan Health Information Network Shared Services
  • 30. 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 30
  • 31. Questions? Dr. Tim Pletcher Executive Director pletcher@mihin.org Jeff Livesay Associate Director livesay@mihin.org Shelley Mannino Senior Project Manager mannino@mihin.org Copyright 2014 - Michigan Health Information Network Shared Services 31

Notes de l'éditeur

  1. Watch QO count
  2. Update monthly