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
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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
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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
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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
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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
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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