Panel: Understanding Michigan's HIE Landscape


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Connecting Michigan for Health 2013

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Panel: Understanding Michigan's HIE Landscape

  1. 1. Michigan’s HIE’s Panel Discussion Moderator: Jeff Livesay, MiHIN Associate Director
  2. 2. Michigan – a Network of Networks • Eleven (11) organizations have become “qualified” to share data through MiHIN for statewide health information exchange: • Seven Health Information Exchanges (HIEs) • Michigan Department of Community Health • Blue Cross Blue Shield of Michigan • PCE Systems • Carebridge Systems
  3. 3. Michigan HIE Community Health Plans More to Come… State of Michigan Public Health Federal Use Case Transitions of Care HPD
  4. 4. Let’s look at one simple example of an HIE working with MiHIN • Connected Nation: Michigan Health Information Network: yer_embedded&v=XSjEEeIclzs
  5. 5. Introducing today’s panelists • Carol Parker, Executive Director, GLHIE • John Vismara, President, Ingenium • Aaron Wootton, Director, JCMR • Doug Dietzman, Executive Director, MHC • Terrisca Des Jardins, Director, SEMBC • Helen Hill, Board Member, SEMHIE • Paula Hedlund (Johnson), Director, UPHIE
  6. 6. Great Lakes Health Information Exchange • Non-profit, 501(c)3 • Community Collaborative • Priorities • Patient health and safety • Quality improvement • Administrative efficiency • Cost Reduction • Pilot 2/15/11-5/14/11 • Fully operational 5/15/11
  7. 7. GLHIE by the Numbers Clinical Results ADT Lab Radiology Transcripts Master Patient Index VHR Queries Annual Numbers – 2012 (2013 estimates) 31.1M (50M) 7.3M (11M) 1.2M (1.7M) 2.3M (3M) 2.6 M 170,000/month
  8. 8. Current GLHIE Use Cases  Connect physicians and other health care providers electronically to facilitate clinical messaging and sharing encounter reports  Results Delivery (Lab as discrete data, Radiology, Clinical Documentation such as discharge summaries and consultations, Cardiology Reports)  Immunization Submission to MCIR – CDC standards compliant  ADT notifications – notifications are pushed into providers’ EMRs
  9. 9.  Query patient’s community-wide longitudinal health record - Print or forward (with an interface) pertinent clinical docs to EMR  Subscribe to a patient (push all available clinical data to practice EMR)  Push practice EMR data to patient’s longitudinal health record and distribute to patient’s identified care team  Clinical Messaging – both through interfaces, clinical inbox and DIRECT; No more gmail, yahoo mail, texting… Also useful for referral routing and consultative report routing. Current GLHIE Use Cases (cont’d)
  10. 10. Use Cases in Progress  Immunization Query Capability – 3Q2013  Public Health Reporting – reportable labs – 3Q2013  Lab Order Gateway – in progress and go live TBD  Radiology Images – by the end of June 2013  Disease Registry Connections – by the end of July 2013  Business analytic support for MU, PCMH and ACOs – by the end of August 2013  EMS – 3Q2013  Telehealth – 4Q2013
  11. 11. Sharing Data • GLHIE Board fully supports sharing across providers. • First use case – electronic referrals using DIRECT • Future – query-based exchange using IHE protocols • GLHIE’s informatics structure includes federated clinical data repositories for each participating provider, an enterprise Master Patient Index, Record Locator Service, and Provider Directory • Implemented IHE standards in May 2013.
  12. 12. MiHIN Participation • Public Health reporting (immunizations, reportable labs, syndromics, etc.) • Statewide Admit-Discharge-Transfer (ADT) and Transitions of Care (TOC) service • Federal use cases with SSA, VA, CMS via MiHIN’s HealtheWay eHealth Exchange (NwHIN) node – under review • Health Provider Directory – under review by the Board of Directors
  13. 13. Contact Information • (517) 347-3373 • •
  14. 14. Connecting Michigan for Health June, 2013
  15. 15. Ingenium Background • Focus on networks of physicians • Physician based and governed • Enable networks of physicians to manage populations of patients • Shared IT infrastructure • Build upon previous work
  16. 16. Ingenium Goals • Leveraging Shared Infrastructure and Data • With Large amounts of Ambulatory Data • Providing a Path to Readily Accessible and Actionable Information • Focus on physician access at point of care • Enabling change by empowering Physicians • Enabling Population Management and Care Coordination programs • Physician Oversight / Representation
  17. 17. United Physicians Use Case • Using Platform to enable • Point-of-Care Access to Information – Community Record – Registry Applications • Care Coordination – Facility Census – Specialty Referrals • Network-based Quality Improvement Programs • Application Access • Communication
  18. 18. Transmission of Data (MHC) Aggregation of Data (Ingenium) H Dr Dr Dr Beaumont/UP HIE World May 21, 2013 1 8 Ingenium, LLC
  20. 20. Ingenium Metrics • Over 1.3 million Patients • 1,357 Physicians – 310 access Community Record • All Physicians by October – 213 access facility census • Message Types (approx 150,000 per day) – ADT (over 180,000 per month) – Demographic (2.5 million per year) – Conditions (600,000 per year) – Labs (3.5 million per year) – Immunizations (750,000 per year) – Procedures (400,000 per year) – Vitals (3.25 million per year) – Reports/Notes (825,000 per year)
  21. 21. MiHIN Participation • Board and Committees • Current Use Cases – Immunizations (MU) – Security – ADT • Future Use Cases – Sharing data between HIEs – Medication Reconciliation – Other
  22. 22. JCMR Overview Connecting Michigan June 5, 2013
  23. 23. Jackson Community Medical Record • An EHR/HIE in the Jackson area since 2005 • Connects ~50% of all providers • AllegianceHEALTH employed providers • Many private practice providers • Federally Qualified Health Center • Jackson County Health Department • AllegianceHEALTH clinics • Tightly integrated with AllegianceHEALTH • One shared EHR for the community of providers
  24. 24. JCMR One Integrated Patient Chart Medication lists, reconciliations and drug interactions across practices. Lab Results automatically assigned to the appropriate physician and patient independent of an electronic order. All allergies are shared across practices. • Shared patient ID, demographics, med list, allergies, problem list, notes, etc. • Closed-loop ordering – referrals, tests, procedures • Uniform decision support • Advanced clinical information sharing • Support in achieving meaningful use • Real-time interfaces • Local payer pay for performance reporting • Local support All social, family and past medical history is available. 24
  25. 25. JCMR Current Interfaces • Demographics & insurance • Lab orders and results (closed loop) • Radiology Results • Discharge summaries • Operative Notes • Histories & Physicals • ePrescribing • Tasks across practices • Referrals across practices (as tasks) • Enterprise Chart – eliminates the need for many other interfaces • Auto populates JCMR and NextGen report systems • Auto populates Phytel population management registries • Phytel calls to remind patients to make appointment for overdue care
  26. 26. JCMR Statistics • Providers • 257 Practice Management • 196 Electronic Health Record • >1,000 users • Patient Volumes • 190,000 shared active patients • 50,000 + encounters / month • 35,000 Surescripts e-prescriptions / month • Monthly Interface Volumes Interface Volume Lab Orders 60,000 Lab Reports 111,000 Radiology Reports 45,000 AH Unsolicited Results Received 100,000 Total 316,000
  27. 27. JCMR Care Coordination Opportunities 50% 25% 25% Practice Utilizationby Patients One Practice Two Practices >= Three Practices Half of our 190,000 active community patients have visited more than one practice. By being connected to one enterprise database, our doctors and caregivers simply have more valuable and accurate data to take care of these patients.
  28. 28. JCMR Benefits Achieved So Far • Patient Centered Medical Home certified practices • Provider incentives • PQRI/PQRS from Medicare • e-Prescribing from Medicare • PCMH from Blue Cross & Medicare • PGIP from Blue Cross • Meaningful Use - stage 1 certified from Medicare • Reduced duplication of tests (est. 15-20%) • Patient safety: medication interactions, pain contracts, doctor hopping for meds… unknowable. • It’s Your Life in JCMR to coordinate goals with Primary Care Physicians. • One click smoking cessation referrals and documented in chart. • Diabetes tracking. • Automated outreach & new chronic disease registries are getting patients in to see their physicians for overdue care (Phytel)
  29. 29. • Public Health reporting (immunizations, reportable labs, syndromics, etc.) • Statewide Health Provider Directory • Statewide Admit-Discharge-Transfer (ADT) and Transitions of Care (TOC) service • Patient Secure Pilot Planned & Current Participation with MiHIN
  30. 30. Connecting Michigan Conference June 5th, 2013 30
  31. 31. 31 Who is Participating? • 68 total hospital facilities • 14,700 licensed beds • 15,200+ combined medical staff • 1,608 office locations • 8,000+ providers • 14 other member orgs: • Provider organizations • Health plans • Home health/DME • Community mental health • Local public health • Employer Clinics • Diagnostic centers • 3 HIE Direct agreements: • OHIP – State of Ohio • GLHIE – Lansing • MHIN– South Bend, IN
  32. 32. What is MHC Actually Doing? Live Solution Summary (“the tracks”) – Results Delivery (1,500,000 / month) – Lab Orders (6,600 / month) – Radiology Orders (1,500 / month) – EMR Interfaces (267 interfaces, 40 different systems) – Referrals - Physical (5,500 / month, 534 offices, 37 counties) – Referrals - Behavioral (14 offices, 2 counties) – Virtual Integrated Patient Record - VIPR (1,555,000 CMPI) – State Immunization Registry (to State via MIHIN) (300+ offices) – Reportable Lab Registry (to State via MIHIN) – Direct HISP (* – Admission & Discharge Notifications (MHC direct or via MIHIN) (~660,000 / month) 32
  33. 33. Connecting Michigan for Health Update Wednesday June 5, 2013 Southeast Michigan Beacon Community 33
  34. 34. The Beacon Community Program: Where HITECH Comes to Life Taken from: Blumenthal, D. “Launching HITECH,” posted by the NEJM on 12-30-2009. BEACO N 34
  35. 35. Microcosms of Wired Communities Across America “We’ve learned that that’s an incredible gift, to have very specific goals, not for a hospital or for a clinic, but for an entire community.” Farzad Mostashari, The National Coordinator 35
  36. 36. HIT-Enabled Clinical Transformation: Results 36 Emergency Department Diabetic Patient Identification Through 4/30/2013 Patients Tested 19,794 Pre-Diabetics 4,467 Diabetics 1,221 PHN Referrals 1,409 Patient Health Navigators: Ambulatory Activity Through May 10, 2013 Patients Referred 3,986 Patients Engaged 1,707 Patients: Outreach Queue 1,221 Patients Declined 1,409 mHealth Pilot: txt4health February 22, 2012 – February 28, 2013 Total Engaged 1,023 % set initial weight loss goal 78% % made knowledgeable about risk for diabetes 89% % enjoyed the program 94% High Impact Clinical Measures ~ 80% of patients included for 9-month intervention SEMBC Ambulatory Care Practices • 178,000 Lives • 18,000+ Patients with Diabetes SEMBC Provider Survey  Improved receptiveness to EHR  Improved staff comfort level with technology and computers  Increased familiarity with HIE SEMBC Survey of Patient Health Navigator Patients  Significant improvement in medication adherence  Significant improvement in patient readiness to change: healthy food choices, physically active, check blood sugar, manage stress, keep appts., stop smoking, ID self-mgt. goals
  37. 37. Technical Framework 37 Community Registry Security Services eMPI Community Patient Record Viewer Care Coordinators HIE Framework Query for Documents Service Care Gaps & Alerts Edge Security Services SAML Assertion Physician Organizations Private Practices Hospitals Community Health Centers Free ClinicsPublic Health Departments Payers Edge Users Edge EHR IHE-XDS Registry & Repository Population Health Reporting & Analytics Data Audit & Logging State HIE Sub-State HIEs Provider Organizations Other Data Sources Cloud-Based Data Sources Health Systems or ACOs EMS Services Edge Data Sources
  38. 38. The Power of Collaboration: Working with the State of Michigan and Beyond • MiHIN BeaconLink2Health is a Qualified Data Sharing Organization (QDSO) BL2H has a certified connection to MiHIN • MDCH MCIR testing underway Started April 9, 2013 • ONC EHR Affinity Work Group Participants: ONC, select Beacon Communities, EHR vendors Purpose: Data Standardization, Alignment for MU2 Active Pilots CDA Clinical Document Architecture MU2 Transport for Transitions of Care Collaborative Writing and Publication Subject Matter: Data Governance, HIT-Enabled Care Mgt., mHealth Beacon Nation Dissemination Collective development and publication of “Change Packages” for sister communities 38
  39. 39. Hard Work. Rewarding Work. 39 “We took each of those challenges that the Beacons illuminated and the Beacons lived through and we made it a part of our mission, nationally, to try to improve. And, boy, was it hard, but despite that the Beacons have all improved quality and safety in their communities, those lessons are relevant to a lot more people who are trying to navigate this transformation of American healthcare that is more fundamental, more profound, more exciting than anything we have seen in five decades past.”Dr. Farzad Mostashari and Herbert Smitherman, M.D, Assistant Dean of Community and Urban Health at Wayne State University, and SEMBC Board Co-Chair. Dr. Farzad Mostashari, National Coordinator for Health Information Technology at the U.S. Department of Health and Human Services, May 22, 2013.
  40. 40. Thank You CONTACT Terrisca Des Jardins Director Southeast Michigan Beacon Community P: 313-638-2156 E: 40
  41. 41. Advancing Quality Healthcare Through National, State and Local Community Collaboration Connecting Michigan for Health 2013 Radisson Lansing at the Capitol Lansing, MI June 5-7, 2013
  42. 42. SEMHIE Officers, Board, & Advisors Officers Group • President: Robert Jackson, MD, CMM (Western Wayne Physicians) • Vice-President: Jeanette Klanow, (St. John Providence Health System) • Treasurer: Michael (Mick)Talley, Treasurer (University Bank) • Helen Hill, MiHIN Board Rep., Director Public-Private Initiatives • Howard Burde, Legal Counsel Board Members • Julie Moran (Trinity Health) • Gary Petroni (SEMHA) • Adam Jablonowski (Wayne County Medical Society) • Gary Assarian (JVHL) • Carla Smith (HIMSS) Advisors • Jackie Rosenblatt, MPRO • Stephen Lange Ranzini, University Bank
  43. 43. SEMHIE History • Founded in 2006; incorporated as MI non-profit 2008; filed for 501(c)(3) status 2012 • HIMSS-GSA e-Authentication Six-State Pilot & White Paper 2006- 2007 • Conduit to Care • Conduit to Care (I) participant 2005-2007 • State of Michigan $1.2 Million planning grant 2007-2009 • Conduit to Care (II) participant 2008-2010 • Designated Sub-State HIE by Michigan HIT Commission Aug 2010 • Participant in founding MiHIN and working on ONC State-level HIE Cooperative Agreement 2010 • Presentations to OMG and HL7 Conferences (Arlington VA, Cambridge MA) 2011 • Invited to NIST NSTIC Workshop Baltimore MD March 2012
  44. 44. SEMHIE Recognition • Social Security Administration (SSA) e-Disability Claims Contract • Awarded $2.988M Feb 2010 – one of 15 national contracts awarded • Achieved NwHIN production status for SEMHIE SSA Aug 2011 • Completed SSA contract June 2012 • Designated Pay-for-HIT program by SSA July 2012 • HealtheWay eHealth Exchange Anchor Participant December 2012 • Transitions of Care • Designated as Transitions of Care reference implementation pilot for ONC Standards & Interoperability Framework Nov 2011 • Demonstrated in HIMSS-ONC Interoperability Showcase at HIMSS AC 2012 in Las Vegas NV Feb 2012 • Selected to demonstrate at S&I Framework Face-Face Alexandria VA Apr 2012 • ONC $14.9M SE MI Beacon award Sept 2010 • One of 17 national ONC Beacon Cooperative Agreements • SEMHIE led coalition through award & startup; transitioned to Beacon 2011
  45. 45. SEMHIE Receives Largest of 15 National SSA e-Disability Contract Awards 1. Cal RHIO, San Francisco, CA - $1,625,000 2. CareSpark, Kingsport, TN - $1,363,000 3. Center for Healthy Communities, Wright State University, Healthlink, Dayton, OH - $999,000 4. Central Virginia Health Network / MedVirginia, Richmond, VA - $1,139,000 5. Community Health Information Collaborative (CHIC), Duluth, MN - $977,000 6. Douglas County Individual Practice Association, Roseburg, OR - $502,000 7. EHR Doctors Inc., Pompano Beach, FL $1,000,000 8. HealthBridge, Cincinnati, OH - $1,400,000 9. Lovelace Clinic Foundation (LCF), Albuquerque, NM - $1,083,000 10. Marshfield Clinic Research Foundation, Marshfield, WI - $998,000 11. Memorial Hospital Foundation & Memorial Hospital of Gulfport Foundation, Inc., Gulfport, MS - $1,100,000 12. Oregon Community Health Information Network (OCHIN), Portland, OR - $284,000 13. Regenstrief Institute, Inc, Indianapolis, IN - $350,000 14. Science Applications International Corporation (SAIC), Reston, VA - $1,587,000 15. Southeastern Michigan Health Assoc., Detroit, MI - $2,988,000
  46. 46. Shortening the Determination Cycle With SSA e-Disability Claims Process: 459 Days to Under 1 Week
  47. 47. HIE Core Services Delivered to SEMHIE thru SSA Contract Portal (patient search, workflow processing, system monitoring) Transaction engine RLS and MPI NHINConnect gateway CCD creation capability (extract and share clinical data: results, allergies, problem lists, medications, care summaries, etc.) Semantic interoperability engine Clinical terminology mapping engine/tools XDS A&B repositories, registries Service Oriented Architecture (SOA) Hosting services w/24x7 support, security, backup/recovery Secure message routing Secure, encrypted exchange with NwHIN and a federal agency Open source interoperability standards and run time software (model driven messaging interoperability)
  48. 48. 48 2008 PHIN Conference 25 August 2008 eHealth Exchange Health Bank or PHR Support Organization Community #1 Integrated Delivery System Community Health Centers Community #2 State and Local Gov Labs Pharmacies VA CMS DoD SSA The Internet Standards, Specifications and Data Use & Reciprocal Support Agreement (DURSA) for Secure Connections Shared trust framework and rules of the road Source: Mariann Yeager, Executive Director HealtheWay, HIMSS HIE Symposium, March 2013
  49. 49. eHealth Exchange Anchor Participants 49Source: Mariann Yeager, Executive Director HealtheWay, HIMSS HIE Symposium, March 2013
  50. 50. Connecting Michigan for Health Conference June 5, 2013
  51. 51. UPHIE Value Proposition • Unique demands of rural healthcare • Distance, weather, access to specialty services • Small practices distributed over a large geographic area • Financial resources limited • Implementation from a “Community View” perspective • 80% of the care in rural communities stays in the community • How can we bring the most value to each community
  52. 52. UPHIE – Provider Participation 2012 2013 Aspirus Grandview Aspirus Keweenaw Aspirus Ontonagon Portage Health Baraga County Memorial Hospital Marquette General Health System Bell Memorial Northstar Health System Dickinson County Healthcare System OSF St. Francis Hospital Munising Memorial Hospital Schoolcraft Memorial Hospital Helen Newberry Joy Hospital Mackinac Straits Hospital War Memorial Hospital • 9 Hospitals • 35 Physician Clinics • 3 Tribal Health Clinics
  53. 53. UPHIE Community Virtual Health Record UP-Wide eMPI/RLS Data Management & Access Population Health Data Aggregation Outreach/ Connectivity Where we are… •MCIR Immunization Submission/Query •MSSS/MDSSS •Statewide Provider Directory (HPD) Hospital •EHR •Results/CCD Exchange •Secure Messaging •Referrals PCP /Specialist •EHR •Results/CCD Exchange •Secure Messaging •Referrals Enables effective communication with those outside your enterprise, community and State UPHIE manages certificates & role based access across entire UPHIE enterprise ANCILLARY •EHR •Results/CCD Exchange •Secure Messaging •Referrals
  54. 54. • ADT, Lab, Radiology and Transcription data integrated into Community-Wide Virtual Health Record (ICA’s CareAlign platform) • Collaboration with critical rural health care providers including: • Health Departments, Tribal Health Centers, VA Health Centers, Medicaid/Medicare Payer • Direct Messaging Exchange Hub • MiHIN Use Case Participation • Public Health Reporting (Immunizations, reportable labs, syndromics) • Statewide Health Provider Directory • Statewide ADT and Transitions of Care Service • Federal Use Cases (SSA, VA, CMS, NwHIN) UPHIE Use Cases
  55. 55. UPHIE Pilot Projects • Northcare Behavioral Health Pilot – enables the exchange of electronic health data between behavioral and physical health providers. Enables better case management and continuity of care between the behavioral health community, providers and the UP Health Plan for Medicaid/Medicare members. • Medicaid/Medicare Health Plan Data Pilot – project would populate health plan medical and pharmacy claims into the community virtual health record. Allows providers to see historical procedures, diagnosis, inpatient/outpatient visits, current/past medications, and a list of providers the patient has seen in the past 2 years. • Oscar G. Johnson VA Medical Center – project would allow data exchange and Direct secure messaging between VA staff and provider community in the UP. Allows for health data to be shared between VA providers and community providers to allow for better continuity of care.
  56. 56. Thank you for your participation Contact us: Jeff Livesay Associate Director