Michigan s Statewide Health Information Network November 9, 2017 Marty Woodruff Associate Director Marty.Woodruff@mihin.org 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 2 Information Network Shared Services 1
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 3 Network of Networks PIHPs (10) Federal Health Plans Consumer-facing Organizations MiHIN Statewide Shared Services Immunizations MDHHS Data Hub MyHealthPortal MyHealthButton MSSS State Labs MI Syndromic Surveillance System MI Disease Surveillance System Other Data Sharing Orgs Health Information Exchanges (HIEs) Providers & Health Systems Pharmacies State Innovation Models (SIM) --- 43 Provider Organizations Data Warehouse Medicaid Single point of entry/exit for state Chronic Diseases 4 Information Network Shared Services 2
Statewide Network Requires Efficiency Duplication of effort, waste and expense (N x N-1 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 5 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 6 Information Network Shared Services 3
One and Done Easier, Simplified, Predictable Data Sharing 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 Chain of Trust to Reduce Risk Covered Entity Trusted Data Sharing Business Organization Associate Business Associate Covered Entity Trusted Data Sharing Business Organization Associate Covered Entity 8 Information Network Shared Services 4
Legal Infrastructure Among Trusted Organizations Linked to Use Cases ORGANIZATION AGREEMENT (QDSOA or SSOA) Definitions Basic Connection Terms Basic BAA Terms Minimal Operational SLA Contracting & Payment Cyber Liability Insurance Master Use Case Agreement Termination Use Case Exhibit #1 Use Case Exhibit #2 Use Case Exhibit #3 Use Case Exhibit #n 9 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 Use Case Factory Examples of use cases: Immunizations Admission, Discharge, Transfer (ADT) Notifications 10 Information Network Shared Services 5
Use Case Factory Process Stage 1 Conceptual Idea with Champion Continuous Improvement Use Case Summary Contains The Basic Ideas Laid Out in an Easy to Read Document for the Board to Approve Define Purpose Evaluation Idea with Sponsor Adoption Plan & Develop Stage 4 Stage 2 Critical Mass Technical Planning Pilot & Refine Successful Adoption Implement Mass Marketing & Outreach Production Status Metrics Stage 3 MiHIN Board Functional Data-Sharing Widget 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 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 12 Information Network Shared Services 6
Shared Services Working Together to Enable Use Cases 13 Patient-Provider Attribution 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. Linkage Patient Provider 14 Information Network Shared Services 7
Active Care Relationships Health Plans Primary Care Provider Physician Organizations & ACOs Specialist Hospital or SNF Community Based Services Patient Pharmacist Foster Care Program Care Coordinator 15 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) 16 Information Network Shared Services 8
ACRS Attribution Record Patient Information Unique 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 Info NPI First Name Last Name Practice Unit ID Practice Unit Name Managing Organization ID Managing Org Name Service Delivery Preferences 17 ACRS Delivery Record Provider Information NPI 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 Info Organization 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 18 Information Network Shared Services 9
Health Directory Service 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 Master record includes: Name Specialty Practice Unit Managing Organization Related Organizations Electronic Addresses additional attributes 19 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. 20 Information Network Shared Services 10
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 Every organization using the Health Directory Service contributes to Michigan s goal for statewide interoperability 21 Example: ADT Notifications Health Plan Trusted Data Sharing Organization (TDSO) Trusted Data Sharing Organization (TDSO) Specialist Active Care Relationship Service Health Directory (HD) Primary Care Patient 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 Care Coordinator 4) Notifications routed to recipients based on electronic address and preferences 22 Information Network Shared Services 11
Other LEGO Combinations MED REC + + Active Care Relationships Statewide Health Directory Care Plan + + Active Care Relationships Statewide Health Directory 23 Thank You! Marty Woodruff Associate Director Marty.Woodruff@mihin.org 24 Information Network Shared Services 12