Michigan’s Statewide Health Information Network · skilled nursing facilities/LTPACs, home health...

11/7/2017

Copyright 2015-2017 Michigan Health Information Network Shared Services 1

Michigan’s Statewide Health

Information NetworkNovember 9, 2017

Marty Woodruff

Associate Director

[email protected]

This work made possible by funding from Michigan Department of Health and Human Services

Copyright 2017 Michigan Health Information Network Shared Services

Today’s Agenda

• Introduction to MiHIN

• Data-Sharing Use Cases

• Shared Services Working Together

• Active Care Relationship Service™

• Health Directory Service

• Admission, Discharge, Transfer Notifications

2This work made possible by funding from Michigan Department of Health and Human Services


mailto:[email protected]

11/7/2017


What We’re Doing at MiHIN

• Enabling statewide exchange of health information

• Making valuable data available at the point of care

• Improving quality

• Decreasing cost

• Improving healthcare experience for patients and

providers

…for the people of Michigan



MiHIN

Statewide

Shared ServicesMDHHS Data Hub

Medicaid

MSSS

State

Labs

Providers

&

Health

Systems

Health Information

Exchanges (HIEs)

Network of Networks

Data

Warehouse

Health Plans

Single point of

entry/exit for state

Pharmacies

Immunizations

MI

Syndromic

Surveillance

System

MI Disease

Surveillance

System

Consumer-facing Organizations

PIHPs (10)

Other Data Sharing Orgs

MyHealthPortal

MyHealthButton

Chronic

Diseases

State

Innovation

Models (SIM)

---

43 Provider

Organizations

Federal



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Statewide Network Requires Efficiency

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 and expense

(N x N-1 connections)

Shared Services

(N connections)



MiHIN created statewide network to:

• Manage statewide legal trust framework

• Connect state and healthcare organizations in Michigan:• Health systems, physician organizations, health plans, HIEs, pharmacies,

skilled nursing facilities/LTPACs, home health agencies, federally qualified

health centers, appropriate federal government agencies, human services,

and 211 services

• Align incentives and/or regulations to fairly share data and

promote data standardization via use cases

• Maintain statewide master data sharing infrastructure

• Convene stakeholder groups to identify data sharing barriers,

reduce provider burdens, engage consumers, and enable

population health



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“One and Done”

• Sign once for legal Interoperability• Common legal framework across the state

• Transparent data usage for each use case

• Connect once for technical integration• MiHIN network includes all of healthcare: HIEs, HISPs, health plans,

state and federal agencies

• Publish once for authoritative sources• Patient/provider delivery preferences easily registered, centrally

managed

• Report once for reuse and reduction of duplicated efforts• Messages can be routed to multiple destinations – no duplicate

interfaces or repeat reports

7

Easier, Simplified, Predictable Data Sharing



Trusted Data

Sharing

Organization

Trusted Data

Sharing

Organization

Chain of Trust to Reduce Risk

8

Covered

Entity

Business

AssociateBusiness

Associate

Business

Associate

Covered

Entity

Covered

Entity



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ORGANIZATION AGREEMENT

(QDSOA or SSOA)

Basic Connection Terms

Basic BAA Terms

Minimal Operational SLA

Contracting & Payment

Definitions

Termination

Cyber Liability Insurance

Master Use

Case Agreement

Use Case

Exhibit #1

Use Case

Exhibit #2Use Case

Exhibit #3

Legal Infrastructure Among Trusted

Organizations Linked to “Use Cases”

Use Case

Exhibit #n



Data-Sharing “Use Cases”

• Use case: One or more scenarios to share specific

information

• Each use case has its own:

• Purpose

• Type of information exchanged

• Description of interactions

between people/systems

• Examples of use cases:

• Immunizations

• Admission, Discharge, Transfer (ADT) Notifications

Use Case Factory®



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Idea with Champion

Idea with Sponsor

Plan & Develop

Pilot &

RefineTechnical

Planning

Conceptual

EvaluationDefine Purpose

Use Case Summary Contains The Basic Ideas

Laid Out in an Easy to Read Document for the

Board to Approve

Implement

Production

StatusMetrics

Adoption

Critical Mass

Mass Marketing &

Outreach

MiHIN Board

SuccessfulAdoption

ContinuousImprovement

Functional Data-Sharing

Widget

Stage 2

Stage 3

Stage 4

Stage 1

Use Case Factory Process



Public Health Reporting

• Immunizations

•Chronic disease registries

•Disease surveillance

•Syndromic surveillance

•Birth & death notifications

Use Case “Assembly Lines”

Results Delivery

•Lab results

•Diagnostic imaging

•Other tests

•Hospital discharge summaries

Care Coordination & Patient Safety

•Referrals

•Care summaries for treatment history & allergies

•Notification of transitions of care (Admission, 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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Shared Services Working Together

to Enable Use Cases



Patient-Provider Attribution

14

Provider

Linkage

Patient

• Active Care Relationship Service™ (ACRS™) enables providers to

declare active care relationships with patients.

• This attributes to a patient the providers who are active members

of their care team.


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Active Care Relationships

Primary Care

Provider

Patient

Specialist

Hospital or SNF

Pharmacist

Care Coordinator

Health Plans

Physician

Organizations &

ACOs

Community

Based Services

Foster Care

Program

15Copyright 2017 Michigan Health Information Network Shared Services

ACRS Benefits• Accurately routes information (e.g. ADT Notifications, medication

reconciliations, continuity of care documents, etc.)

• Enables alerts to providers in active care relationships with

patients

• Coordinates entire care team with changes to patient status in

real time

• Allows searches by authorized persons or organizations:• Health systems and provider/physician organizations

• Care coordinators

• Health plans

• Consumers (who soon will be able to dispute asserted relationships)


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ACRS – Attribution Record

Patient InformationUnique Patient ID

First Name

Middle Initial

Last Name

Name Suffix

Date of Birth

Gender

SSN – Last 4 digits

Address 1 & Address 2

City, State, Zip

Home & Mobile Phones

Patient common key

Attributed Physician InfoNPI

First Name

Last Name

Practice Unit ID

Practice Unit Name

Managing Organization ID

Managing Org Name

Service Delivery Preferences


ACRS – Delivery Record

Provider InformationNPI

First Name

Middle Initial

Last Name

Provider Type

Specialty

DIRECT Address

Practice OID

Practice NPI

Practice Name

Practice Address (City, ST, Zip)

Practice Phone

Practice DIRECT Address

Managing Org InfoOrganization OID

Organization Type

Organization Name

Org Address (City, State, Zip)

Organization Phone

DIRECT Address

Program Eligibility(SIM, MACRA, CPC+, etc.)

Delivery Pref. by use case


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• Up-to-date listing of healthcare providers, their

demographic/contact information and affiliations

• Helps manage organizations, providers and multiple, complex

relationships between them

• Contains electronic addresses used to route information to

providers and organizations

Health Directory

Health Directory Service

Master record includes:

• Name

• Specialty

• Practice Unit

• Managing Organization

• Related Organizations

• Electronic Addresses

• …additional attributes



Why the Health Directory matters

• Helps coordinate care by making it easier to:

• Look up healthcare providers and organizations

• Determine best way to contact a provider or organization

• Find details (e.g. practicing locations, hours of operation, etc.)

• Tracks program participation information

• e.g. CQMR participation, Patient-Centered Medical Homes,

Meaningful Use, etc.



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Why the Health Directory matters

• Identifies most accurate data for each provider/organization

• Supports “report once” capability to ease provider burdens

• Aligns with national standards

21

Every organization using the Health Directory

Service contributes to Michigan’s goal for

statewide interoperability



Trusted Data

Sharing

Organization

(TDSO)

Trusted Data

Sharing

Organization

(TDSO)

Example: ADT Notifications

Active Care

Relationship Service

Health

Directory

(HD)

1) Patient goes to hospital which sends message to TDSO then to MiHIN

2) MiHIN checks patient-provider attribution and identifies recipients

3) MiHIN retrieves contact and delivery preference for each recipient from HD

4) Notifications routed to recipients based on electronic address and preferences

Primary Care

Specialist

Care

Coordinator

Patient

Health

Plan



11/7/2017


Other “LEGO®” Combinations

Active Care

Relationships

Statewide

Health

Directory+ +

Active Care

Relationships

Statewide

Health

Directory+ +

MED

REC

Care

Plan



Thank You!

Marty Woodruff

Associate Director

[email protected]



mailto:[email protected]

Michigan’s Statewide Health Information Network · skilled nursing facilities/LTPACs, home health...

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