What Does HIE (verb) Do?

Overview of the Michigan Health Information Network Use Case Factory 3rd Annual MPA Pharmacy Law & Policy Symposium Tim Pletcher, DHA Executive Director Michigan Health Information Network Shared Services pletcher@mihin.org 1 What Does HIE (verb) Do? Adapted from Hripcsak et al. (2007) 2 Statewide Coordination Duplication of effort, waste, & expense (N*(N-1)/2 connections) Shared Services (N connections) Patients & Families Physicians Public Health Patients & Families Physicians Public Health Lab tests & XRAYs Specialty Providers Lab tests & XRAYs Specialty Providers Hospitals & Clinics Medications Insurance Companies Hospitals & Clinics Medications Health Plans 3 1

MiHIN is a network for sharing health information statewide for Michigan 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 5 Network of Networks: Federal PIHPs Health Plan QOs (more coming) Immunizations MSSS Consumer QOs (more coming) HIE QOs (Qualified sub-state HIEs) State-wide Shared Services Mi Syndromic Surveillance System MDCH Data Hub Mi Disease Surveillance System Data State Warehouse LABS Medicaid Doctors & Community Providers Virtual QOs Pharmacies (more coming) Single point of entry/exit for state 6 2

Types of Qualified Organizations 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) Health Plan licensed in the state of Michigan Plan/Payor QO Blue Cross, Michigan Association of Health Plans, & Priority Health have MOAC & Board eligibility (PQO) Government Qualified Organization (i.e. Michigan Department of Community Health) Federal Agency (i.e. Social Security Administration, CMS, Veterans Affairs, DoD, CDC, etc.) Government QO Tribal Nations in Michigan (GQO) Participate in consumer-focused Use Cases (i.e. MiWay Consumer Directory) Supported & authorized consumer facing services (i.e. Patient Health Record, Patient Portal) an example would be Peace of Mind Consumer QO Registry (CQO) Receives data from certain statewide Use Case (e.g. Statewide ADT) for the purpose of creating a statewide repository of the information Designed to support near-time analytics that can be shared back into the ecosystem as a statewide resource Data Aggregator QO (DAQO) May function as a query able resource on the network Copyright 2014 - Michigan Health Information Network Shared Services 7 MiHIN FAST FACTS Network of Networks (not an HIE) Statewide Approach Accomplishments (established 2010) Shared network of multiple qualified organizations (QOs) for sharing data Driven by Use Cases From zero to 170M+ production messages since inception Transparency via Governor s HIT Commission Leverages public health code & Meaningful Use 27 QO connections: 9 HIEs, 8 payers, 5 pharmacies, state, 4 others Strong state and health plan representation Public-private model vs. complete state control Statewide Provider Directory, certified ehealth Exchange node, EHNAC-DTAAP Direct 8 MiHIN Governance 9 3

State of Michigan Internal Maximize SOM Resources MDCH Data Hub Transparency via HIT Commission Monitoring MiHIN & the Qualified Data Sharing Organizations STATEWIDE SHARED SERVICES External Shared Governance via MiHIN Board 10 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 11 Use Case Factory TM Anyone can submit ideas for use cases: http://mihin.org/about-mihin/resources/use-case-submission-form/ 12 4

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 (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 13 Critical Infrastructure Components Patient Provider Attribution Service Patient Consent Preferences Federated Identity Management (FiDM) Gateway Services (e.g. XCA) Master Person Index + Common Key Service Identity Management Health Provider Directory Secure Transport Layer Services and Digital Credentials 14 Personas & Stories What are they? Personas are fictitious people whose personalities and circumstances are based on interviews and observations conducted with real consumers. Why use them? It s important to provide real, meaningful details for testing and demonstrations to better develop a shared picture amongst all project stakeholders when communicating consumer needs and goals. 15 5

About Persona Maps What are they? Visual representations showing priorities for addressing consumer needs. Stakeholders start with 20+ personas and narrow their focus to six, creating a shared framework for decision-making based on which personas were chosen and how they were prioritized. Why use them? Using persona maps allows all parties to talk contextually about target populations instead of making design and functional decisions based on what someone thinks a persona s ideal state should be. While the needs of all chosen personas will be considered, no feature can hinder the goals of the primary persona. 16 Persona Map Example Primary Persona Tricia Franklin Secondary Personas Joan Chen Jerry Goodwall Tertiary Personas Ryan Paulson Alex Gonzalez Jessica Campbell ) 17 18 6

Use Case Factory Hierarchy Episode of Care Major life event consisting of multiple stories (birth of child, chronic condition, etc.) Story Persona combined with collection(s) to illustrate a health-related event Collection Combination of Use Cases that interact to create a higher-level service Use Case A functional data-sharing unit Scenario Granular examples of data sharing (submit vs.. receive, etc.) Data Standards 19 Use Case Components Use Case Summary - explains purpose and value proposition/business case for sharing data Use Case Agreement - legal document covering expected rules of engagement (Trusted Data Sharing Organizations sign Use Case Agreements) Use Case Implementation Guide - technical specification that outlines standard format details for data transmission & content 20 Benefits of Use Case Approach Reduces Complexity Consistent Pattern Manageable chunks so competitive or confidentiality concerns can be addressed without boiling the ocean 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 more extensive stories for data sharing Aligns Priorities Transparent Measureable Incentives, regulations or policies can target specific Use Cases to foster or accelerate adoption Constituents can understand expected use of their data and follow common chain of trust across organizations Aids focused monitoring and measurement of progress Faster & Cost Effective Reduces variability and enables scalability 21 7

Legal Infrastructure for Organization Agreements DATA SHARING (QDSOA,VQDSOA, CQDSOA, SSOA, SSSOA) Definitions Basic Connection Terms Basic BAA Terms Minimal Operational SLA Contracting & Payment Cyber Liability Insurance Termination QO Data Sharing Agreement Use Case #1 Use Case #2 Use Case #3 Use Case 22 Clear Chain of Trust Covered Entity Covered Entity Trusted Data Sharing Business Organization Associate Business Associate Trusted Data Sharing Business Organization Associate Covered Entity 23 Constituent Transparency Patients & Families Communities Physicians Use Case Public Health & CMS Laboratories & Diagnostic centers Specialty Providers Policy Makers Health Plans Hospitals & Clinics Pharmacies Employers 24 8

Use Case Prioritization Statewide Use Case Evolution Conceptual Planning & Development Implementation (Operational Adoption) Mature Production (>65% Utilization) Medication Reconciliation Medication Fill Status Death Notifications Care Plans Share State Lab Results Clinical Quality Measures Social Security Determination Veterans Affairs Query Find Patient Records Cancer Notifications Newborn Screening Reports Statewide Admission, Discharge, Transfer Notifications Active Care Relationships Syndromic Surveillance Immunizations Reportable Labs Stage Advance Directives Immunization History / Forecast 25 26 27 9

Accelerating Use Cases Clinical Endorsement & Evidence Financial Incentives or Disincentives Policy & Regulatory Levers Use Case 28 Statewide ADT Use Case Example + + Active Care Relationship Service (ACRS) Statewide Health Provider Directory (HPD) Use Case Collection: Statewide ADT Notification Service 29 Admit Discharge & Transfer (ADT) Use Case 30 10

Transitional care management Medicare & BCBSM fees Jan 2013 99495 - Communication (direct contact, telephone, electronic) with the patient and/or caregiver within 2 business days of discharge Medical decision making of at least moderate complexity during the service period Face-to-face visit, within 14 calendar days of discharge 99496 - Communication (direct contact, telephone, electronic) with the patient and/or caregiver within 2 business days of discharge Medical decision making of high complexity during the service period Face-to-face visit, within 7 calendar days of discharge Payer Code Non-Facility Facility Locality Medicare 99495 $120.39 $99.38 Detroit Medicare 99496 $169.65 $145.70 Detroit BCBSM 99495 $233.43 $191.79 All BCBSM 99496 $329.33 $281.38 All 31 Payer Incentives for Statewide HIE - Physician Group Incentive Program (PGIP) - Hospital value-based contracts But wait there s more $ 2016 2014 2015 TBD Medications, potentially quality measures Integrate ADT, begin Medication Reconciliation Hospitals Conformance with ADT spec, send Medications Providers Integrate ADTs into workflow, receive Medications Data flow Hospitals Send ADT notifications to statewide service via MiHIN Providers Send Patient-Provider Attribution (PPA), receive ADT alerts 32 Statewide Health Provider Directory 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 33 11

ACRS Update Version 2.0 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 Additional patient information to minimize false positives 34 Patient Centric View Eligible Providers & PCMH Eligible Hospitals Critical Access Hospitals Behavioral Health Specialists Specialty Providers Care Coordinators Patients & Families 35 Types of Relationships Declared Assigned Reported Contested By patient By provider 36 12

Data Sharing Organization Submit/Receive Statewide ADT Notifications Use Case Animation Data Sharing Organization Care Coordinator Active Care Relationship Statewide Health Provider Directory Primary Care Specialist 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 37 ADT Conformance Report - Overview Alignment to BCBSM 2015 Infrastructure Incentives Message is populated Values are mapped Appropriate codes Evaluation of ADT messages from each participant Tailored to participant Actionable feedback Monthly progress 38 ADT Conformance Report Summary Example Source ACME Health System Accurate Routing Data 100% Complete Mapping 100% Adherence to Coding 66% Achieve full incentive points Source BETA Health System Accurate Routing Data 75% Complete Mapping 95% Adherence to Coding 0% Achieve zero incentive points 39 13

ADT Conformance Report Detail Example Gender Race PID Ethnicity Death Indicator Patient Class PID 8 10 PID 22 PID 30 PV1 2 F 1 1 N A M 2 2 Y E U 3 3 I 4 4 O 5 P 6 7 8 Achieve full incentive points Gender Race PID Ethnicity Death Indicator Patient Class PID 8 10 PID 22 PID 30 PV1 2 A 1 N Amb ZZ 2 Y Emer 1A 3 In 1 4 Out 2 101 3 112 4 5 Achieve zero incentive points 1. Missing Gender 2. Race, Ethnicity values not mapped 3. Patient Class not mapped 40 Other LEGO Combinations MED REC + + Active Care Relationships Statewide Health Provider Directory Care Plan + + Active Care Relationships Statewide Health Provider Directory 41 Statewide Medication Reconciliation Use Case Share patient medication information at multiple points of care, including pharmacies, physician offices, hospitals, and transitional facilities such as outpatient tertiary and skilled nursing facilities Leverages Active Care Relationship Service (ACRS ) to notify all care team members of changes to patient s medication status 42 14

Summary of Care Statewide Medication Reconciliation Use Case Data Sharing Organization Animation Active Care Relationships Data Sharing Organization MEDs MEDs Statewide Health Provider Directory (HPD) GMPHO MNO MEDs OSP 1) Hospital sends Medication Reconciliation message 2) Check Active Care Relationships and identify three providers 3) Using Statewide Provider Directory identify delivery preference for each provide 4) Medication reconciliation is routed to providers based on preferences 43 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 (MiDiGate TM ) 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 44 Questions? Thank you Tim Pletcher, DHA Executive Director pletcher@mihin.org 45 15