MiHIN 101 Overview v4 04-08-15

Michigan Health Information Network Shared Services MiHIN overview. HIE in Michigan.

1. MiHIN Overview April 2015

2. What Does HIE (verb) Do? 2 Adapted from Hripcsak et al. (2007) Copyright 2014 - Michigan Health Information Network Shared Services

3. Statewide Coordination 3 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, & expense (N x N-1 connections) Shared Services (N connections) Copyright 2014 Michigan Health Information Network

4. MiHIN is a network for sharing health information statewide for Michigan 4 Copyright 2014 Michigan Health Information Network

5. “One and Done”- Easier, Simplified, Predictable Data Sharing Sign once Common legal framework across the state Transparent data usage for each use case Connect once MiHIN network includes all of health care: HIEs, HISPs , health plans , the state and the federal agencies Publish o nce Patient and provider delivery preferences easily registered and centrally managed Report once Messages can be routed to multiple destinations – no duplicate interfaces or repeat reports Log-on o nce Single sign-on across patient/member and provider portals 5 Copyright 2014 Michigan Health Information Network

6. State-wide Shared Services MDCH Data Hub Medicaid MSSS State LABS Doctors & Community Providers HIE QOs (Qualified sub-state HIEs) Network of Networks : Data Warehouse 6 PIHPs Health Plan QOs (more coming) Single point of entry/exit for state Virtual QOs Copyright 2014 Michigan Health Information Network Pharmacies (more coming) Immunizations Mi Syndromic Surveillance System Mi Disease Surveillance System Consumer QOs (more coming) Federal

7. MiHIN FAST FACTS Copyright 2014 Michigan Health Information Network 7

8. MiHIN Stakeholders 8 Copyright 2014 Michigan Health Information Network

9. Maximize SOM Resources 9 State of Michigan Internal External STATEWIDE SHARED SERVICES MDCH Data Hub MiHIN & the Qualified Data Sharing Organizations Transparency via HIT Commission Monitoring Shared Governance via MiHIN Board Copyright 2014 Michigan Health Information Network

10. 10 MiHIN Governance Copyright 2014 Michigan Health Information Network

11. Copyright 2014 - Michigan Health Information Network 11 MiHIN Governance

12. Copyright 2014 - Michigan Health Information Network 12 MiHIN Operations Advisory Committee (MOAC)

13. Data Sharing Agreement Use Case #1 Use Case #2 Use Case #3 Legal Infrastructure for Data Sharing 13 Copyright 2014 - Michigan Health Information Network ORGANIZATION AGREEMENT ( QDSOA,VQDSOA, CQDSOA, SSOA, SSSOA, PIHP QDSOA, other “OA”) Basic Connection Terms Basic BAA Terms Minimal Operational SLA Contracting & Payment Definitions Termination Cyber Liability Insurance

14. Qualified Sub-state HIE or VQO Qualified Sub-state HIE or VQO Clear Chain of Trust Copyright 2014 - Michigan Health Information Network Shared Services 14 Covered Entity Business Associate Business Associate Business Associate Covered Entity Covered Entity

15. Constituent Transparency Copyright 2014 - Michigan Health Information Network Shared Services 15 Use Case Health Plans Physicians Specialty Providers Hospitals & Clinics Patients & Families Laboratories & Diagnostic centers Pharmacies Public Health & CMS Policy Makers Communities Employers

16. What is a USE CASE? D ata sharing scenario with specific: p urpose type of data exchanged description of interactions between people/ systems Each Use Case may have different: access restrictions r ules for using the data cost recovery fees or charges t echnical requirements 16 Use Case Factory™ Copyright 2014 Michigan Health Information Network

17. Use Case Components 17 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

18. http ://mihin.org/about-mihin/resources/use-case-submission-form/ Use Case Factory 18 Copyright 2014 Michigan Health Information Network

19. Use Case Assembly Lines 19 Copyright 2014 Michigan Health Information Network

20. Infrastructure Use Cases 20 Copyright 2014 Michigan Health Information Network

21. Accelerating Use Cases 21 Policy & Regulatory Levers Clinical Endorsement & Evidence Financial Incentives or Disincentives Copyright 2014 Michigan Health Information Network

22. Use Case Pipeline Example 22 Copyright 2014 Michigan Health Information Network Statewide Use Case Evolution Planning & Development Conceptual Implementation ( Operational Adoption ) Mature Production ( > 65 % Utilization ) Statewide ADT - IN Submit Syndromics Request Immunization History / Forecast Submit Immunizations Submit Data to Active Care Relationship Service ( ACRS ) Death Registry Advanced Directives Health Provider Directory Basic Query Submit Data to Health Provider Directory Medication Reconciliation Chronic Disease Registry Health Provider Directory Advanced Query MiHealth Link ( ICBR ) Provider Submission Birth Registry Convert Syndromics Submit Newborn Screening - CCHD Health Provider Directory Search Service Single Sign On Federated Identity Management Common Key Service Health Risk Assessment ( HRA ) Submit Clinical Quality Measures Send / Receive Lab Results / Orders Submit Birth Defect Notifications eHealth Exchange Patient Query Cross - QO Patient Query Submit Reportable Labs VA Patient Query CMS Electronic Submission of Medical Documentation SSA Disability Determination Patient Look Up ( Cross Community Access XCA )

23. Benefits of Use Case Approach 23 Copyright 2014 Michigan Health Information Network

24. *2/2-3/1

25. Copyright 2014 Michigan Health Information Network 25

26. 26 Monitoring Transitions of Care Copyright 2014 Michigan Health Information Network

27. Statewide ADT Use Case Example 27 Active Care Relationship Service (ACRS) Statewide Health Provider Directory (HPD) + + Copyright 2014 Michigan Health Information Network

28. Admit Discharge & Transfer (ADT) Use Case 28 Copyright 2014 - Michigan Health Information Network Shared Services

29. Statewide Health Provider Directory 29 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

30. ACRS™ Update – Version 2.0 Additional patient information to minimize false positives 30 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

31. Important Horizontal View 31 Eligible Hospitals Eligible Providers & PCMH Care Coordinators Specialty Providers Behavioral Health Specialists Critical Access Hospitals Patients & Families Copyright 2014 Michigan Health Information Network

32. Trusted Data Sharing Organization Trusted Data Sharing Organization Statewide ADT Notification 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 p reference for each provider 4) Notification is routed to providers based on preferences Primary Care Specialist Care Coordinator 32 Animation Copyright 2014 Michigan Health Information Network

33. Other “Lego” Combinations 33 Active Care Relationships State-wide Health Provider Directory + + Active Care Relationships State-wide Health Provider Directory + + MED REC CarePlan Copyright 2014 Michigan Health Information Network

34. Some 2015 Use Cases 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®) 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 34 Ready Now! Copyright 2014 Michigan Health Information Network

35. The Direct Project Simple , secure , scalable, standards-based way to send encrypted information “directly” to known, authenticated, trusted recipients Messages sent securely between end-points: person to person person to system system to system s ystem to person Copyright 2014 - Michigan Health Information Network Shared Services 35

36. Dr. Jones Dr. Smith Provider to Provider Email Definitions HISP – Health Information Service Provider HISP HISP Federally-bridged digital security certificate as trust anchor Copyright 2014 - Michigan Health Information Network Shared Services 36

37. From: r [email protected] To: [email protected] System-to-system messaging Definitions HISP – Health Information Service Provider HISP HISP Federally-bridged digital security certificate as trust anchor Copyright 2014 - Michigan Health Information Network Shared Services 37

38. The Role of DIRECT & EHRs Copyright 2014 - Michigan Health Information Network Shared Services 38

39. DirectTrust Members 39 39 Copyright 2014 - Michigan Health Information Network Shared Services

40. Current DTAAP Accreditation Roster January 15, 2014 CareAccord Cerner Corporation DigiCert Infomedtrix ICA Inpriva MaxMD Surescripts MedAllies DataMotion Applied Research Works, Inc. Athenahealth Covisint EMR Direct GlobalSign, Inc. HIXNy Health Companion Health Connection CNY Health Info EXchange of NY iMedicor IOD Inc. Medicity NYeC RelayHealth Rochester RHIO Secure Exchange Solutions Simplicity Health Systems Truven Health Analytics Updox Utah Health Information Network Vitalz, Inc. West Virginia HIN Fully Accredited and Audited Candidate Status Copyright 2014 - Michigan Health Information Network Shared Services 40 40

41. MIDIGATE® Purpose Simplified & low cost data capture based on DIRECT Secure Messaging protocols Fully secure for handling PHI Bridges the gap or “mitigates” transport challenges, e.g. DIRECT to HL7 LLP Designed to support MiHIN Use Cases, broad quality reporting requirements, and custom data capture needs Copyright 2014 - Michigan Health Information Network Shared Services 41

42. Key Components Configuration of the base service that feeds data into the existing virtual private network used to send data Captures attachments to published DIRECT addresses “Peels” off structured data and routes appropriately Establishment of one or more “catcher” modules Examples of common catcher modules: ADT’s Electronic clinical quality measures HEDIS reports Care Plan Updates Authorizations Etc. Copyright 2014 - Michigan Health Information Network Shared Services 42

43. “Catcher” Modules Copyright 2014 - Michigan Health Information Network Shared Services 43 HISP Doctor offices & Community Hospitals ADT Catcher M odule MiDIGATE Handler ‘peels” off attachments Base Gateway Service

44. Normal ADT Flow Copyright 2014 - Michigan Health Information Network Shared Services 44 MiHINTOC Router ADT HIE QOs (Qualified sub-state HIEs) Trusted Data Sharing Organization Active Care Relationships HPD Delivery Preference Lookup

45. With ADT “Catcher” Module Copyright 2014 - Michigan Health Information Network Shared Services 45 MiHINTOC Router Trusted Data Sharing Organization Active Care Relationships HPD Delivery Preference Lookup [email protected] HISP MiDIGATE Base Service Handler ADT

46. Lots of Potential “catchers” Copyright 2014 - Michigan Health Information Network Shared Services 46 [email protected] [email protected] [email protected] [email protected]

47. 47 Copyright 2014 - Michigan Health Information Network Shared Services

48. Questions? Dr. Tim Pletcher Executive Director [email protected] Jeff Livesay Associate Director [email protected] Shelley Mannino Director [email protected] 48 Copyright 2014 - Michigan Health Information Network Shared Services