2. What is Health Information Exchange?
The term "health information exchange" (HIE) actually
encompasses two related concepts:
• Verb: The electronic sharing of health-related information
among organizations
• Noun: An organization that provides services to enable
the electronic sharing of health-related information
Source: http://www.healthit.gov/providers-professionals/health-information-
exchange?utm_source=google&utm_medium=cpc&utm_campaign=technology
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3. Health Information Exchange Benefits
• Improved patient safety &
outcomes
• Fewer adverse events
• Better quality of life for people
who are sick
• Reduced unnecessary
utilization
• Reduce total admissions
• Shorten time in the hospital
• Fewer duplicate diagnostic
tests
• Lower costs to find, transmit,
and analyze information
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Health
Plans
Physicians
Specialty
Providers
Hospitals & Clinics
Patients
& Families
Lab tests &
XRAYs
Medications
Public Health
4. Major HIE Use Cases
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 (
Admit Discharge or
Transfer)
• Medication
reconciliation &
therapy change
notices
Quality &
Administrative
Reporting
• Registry Updates
• Physician Quality
Reporting
measures
• Meaningful Use
reporting
• Electronic
verification
• Patient satisfaction
• Eligibility
• Authorization
• Claims audit
Patient
Engagement
• Instructions
• Health risk
appraisals
• Medication
Compliance
• Therapy
Compliance
• Patient activation
and self
determination
• Health literacy &
numeracy
4Copyright 2013 - Michigan Health Information Network
5. Types of HIE (Verb): Push or Pull
• Push: The ability to send data automatically to a
provider, such as replacing the fax machine with an
electronic message. Analogy: getting a text message or
email (requires that other’s know your email or text
address)
• Pull: The ability to request on demand that data be
instantly returned to you. Analogy: doing a Google
search (requires lots of searchable websites)
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7. What is Michigan’s Strategy for HIE?
The Michigan approach:
• employs a public-private model vs. only complete state control
• emphases common data sharing use cases and multi-
stakeholder participation (hospitals, physicians, health plans,
state government)
• promotes the use of national standards & public transparency
(via HIT commission)
• leverages public health & meaningful use
• established a designated nonprofit entity to interconnect
networks of networks (MiHIN Shared Services)
• relies on qualified health information organizations such as
Michigan’s seven sub-state HIEs to connect providers
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8. Governance
• MiHIN is an independent not-for-profit with a board of
directors
• MiHIN works very closely with Michigan’s Department of
Community Health and the State’s HIT Commission
• MiHIN has an Operation Advisory Committee that
address day-to-day operations, HIE planning, privacy
and security items
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9. Examples of Statewide Shared
Services Across the Nation
• Security services
• Health Provider Directory (Master Clinicians Index)
• Message routing
• Identity management
• Transaction logging & Universal Audit Repository
• Consent management
• Terminology services
• Transformation services
• Master Person Index
• Record Locator Service & Patient Directory Services
• NwHIN gateway
• Sub-scribe to Alerts & Notifications
• DIRECT HISP
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10. Qualified Data Sharing Organizations (QO’s)
• Health Information Exchanges
• Beacon, Great Lakes HIE, Ingenium, Michigan Health
Connect, Jackson Community Health Record, South
East Michigan HIE, Upper Peninsula HIE
• Health Plans
• Blue Cross Blue Shield of Michigan
• Michigan Association of Health Plans
• Health Alliance Plan*
• Priority Health*
• State of Michigan
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11. Virtual Qualified Data Sharing
Organizations (VQO’s)
• Independent entities that primarily utilize MiHIN provided
services or participate in a very limited number of Use
Case or pilot activities also subject to predetermined
conditions of use. VQO’s are not formally involved in the
Board or other governance activities. VQO’s are not
expected to support more that 1/3 of the Use Cases.
• Health Information Service Providers (HISP)
• Health Information Organizations (HIO)
• Pilot Organizations
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13. ORGANIZATION AGREEMENT
(QDSOA or VQDSOA)
Basic Connection Terms
Basic BAA Terms
Minimal Operational SLA
Contracting & Payment
Definitions
Termination
Cyber Liability Insurance
Data Sharing Agreement
Use Case
#1
Use Case
#2
Use Case
#3
Legal Infrastructure for Data Sharing
18Copyright 2013 - Michigan Health Information Network
14. MDCH Data Hub
Medicaid
MSSS
State
LABS
Doctors & Community
Providers
HIEs
(QOs, VQOs or sub-
state HIEs)
Basic Data Flow
Data
Warehouse
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State-wide
Shared Services
DIRECT
HISP
Virtual
Qualified
Organizations
Health
Plans
16. Public Health Reporting
• First MiHIN Use Case
• Uses the same technology and data flow for reporting to:
• Michigan Care Improvement Registry (MCIR) for
collecting immunization information
• Michigan Disease Surveillance System (MDSS) for
reportable labs and conditions
• Michigan Disease Surveillance System (MSSS) for
public health situational awareness
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Public Health
Reporting
17. Vaccination Reporting
25
MDCH Data Hub
HIE
(QOs, VQOs or
sub-state HIEs)
Copyright 2013 - Michigan Health Information Network
Public Health
Reporting
State-wide
Shared Services
18. Health Provider Directory
• Source of trusted provider
information for secure routing and
HIE information
• State-wide provider address book
• Direct
• Referrals
• Sets the stage for provider
relationship management
27Copyright 2013 - Michigan Health Information Network
HPD
Direct Address
Book
Directory
Services
Provider Relationship
Management
Routing
Preferences
20. Qualified
Sub-state HIE
or VQO
Qualified
Sub-state HIE
or VQO
Transition of Care Notification
Copyright 2013 - Michigan Health Information Network
Patient to Provider
Attribution
Delivery
Preference
Lookup
1) Patient goes to the hospital, hospital sends a registration message
2) MiHIN checks for Patient to Provider Attribution and identifies three providers
3) Using the HPD, MiHIN identifies a Delivery Preference for each provider
4) Notification is routed to the providers based on their preference
Primary Care
Specialist
Care
Coordinator
Alerts &
Notification
29
Animation
21. Transition of Care Notification
• Can be expanded to other message types
• HL7 lab results
• Discharge summaries
• Continuity of Care Documents (CCD)
• Care Gap Alerts
• Both Patient to Provider Attribution and Delivery
Preference Lookup services can be reused
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Alerts &
Notification
23. State-wide
Record Locator
Service
Query for Patient History
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HIE
HIE
HIE
1) Doctor see’s a new patient in the Emergency
Department (ED)
2) ED sends out a “patient discovery” request
for information about the patient
DoctorPatient
3) Sources that know the patient respond
4) ED queries for patient clinical information
5) Sources respond with clinical document(s),
typically CCDs
Care
Summary
Patient Found
Patient Found
Patient Not Found
Animation
24. State-wide
Record Locator
Service
Query for Patient History
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HIE
HIE
HIE
• Requester can be in many settings
• Primary care provider
• Health plan doing eDetermination
• Out-of-state provider
• Federal agencies
Care
Summary
• Responders can vary as well
• State of Michigan
• Federal agencies and out-of-state providers
MDCH
Data Hub
Animation
25. HIE #2
Cross HIE Message Routing
38Copyright 2013 - Michigan Health Information Network
HIE #1
Provider
ID?
Referral
HPD
Routing
Primary
Care Physician
Specialist
Animation
26. Still on 2011Road Map
39Copyright 2013 - Michigan Health Information Network
Link
OperationalActivities
PlanningActivities
2011
Staging
Activities
MU & Public Health Part II (Query)
Health Provider Directory
Pharmacy Planning
VA Linkage
Patient Facing Services & PHR Gateway
NwHIN Node (Connect & Direct)
ADTPilotIm
plem
entation
Planning & Policy Development
Security and Consent Management
VAVLEHRPilot
CCD Gateway (Push)
HISPFunction
Mi Health Market Place Integration Planning
Master Patient Index
ConsentM
anagement&
SecurityPilots
Use Case Prioritization (ADT Pilot)
MedicationReconcilation
Patient Consent Management
CommonAuthenticationPrototyping
27. More information about MiHIN
Questions?
WWW.MIHIN.ORG
40Copyright 2013 - Michigan Health Information Network
Tim Pletcher
pletcher@mihin.org
Editor's Notes
“Find Dr. Waldo” and find out where does Dr. Waldo want information sent & howAdditional Use CasesGiant address book for HIT applicationsIdentity & role-based access supportMechanism to advertise services for referral or any information routingCore data for other provider centric tracking (program participation like ACO affiliation, workforce, credentialing, etc.)
Healthcare payers frequently request that providers submit additional medical documentation for a specific claim, to support claims processing and other administrative functions, such as the identification of improper payments. Currently, Medicare Review Contractors request approximately 2 million medical documents per year by mailing a paper request letter via US Postal Service to healthcare providers.