“Reducing the Cost for Data Sharing” Connecting Michigan for Health 2017 Tim Pletcher, DHA Executive Director Michigan Health Information Network Shared Services pletcher@mihin.org Copyright 2015-2017 Michigan Health Information Network Shared Services

Infrastructure Copyright 2015-2017 Michigan Health Information Network Shared Services Proprietary – Confidential – Do not copy or redistribute

Basic Model Receive Data From MiHIN Via ACRS & HD Send Data for Use Case to MiHIN Receive Data From MiHIN Via ACRS & HD Common Key Service A Active Care Relationship Service Declare linkages Provider Info Health Directory Copyright 2015-2017 Michigan Health Information Network Shared Services Proprietary – Confidential – Do not copy or redistribute

Reducing Provider Burdens Copyright 2015-2017 Michigan Health Information Network Shared Services Proprietary – Confidential – Do not copy or redistribute

MiHIN Use Case Factory: Operational Governance A modular, highly standardized legal framework Implementation guides and conformance Synthetic data, personas and simulation tools A four-phase stage gate process to prioritize and incentivize use case adoption Cost recovery and sustainability linked to mature use cases & value Copyright 2015-2017 Michigan Health Information Network Shared Services Proprietary – Confidential – Do not copy or redistribute

Use Case Financial Incentives Health plan pays incentives $$$$ Use Case MiHIN Statewide Shared Services Provider agrees to use case terms and sends data to MiHIN based on use case requirements MiHIN shares conformance report Copyright 2015-2017 Michigan Health Information Network Shared Services Proprietary – Confidential – Do not copy or redistribute Copyright 2015-2017 Michigan Health Information Network Shared Services

Copyright 2015-2017 Michigan Health Information Network Shared Services Proprietary – Confidential – Do not copy or redistribute

IT’S ABOUT A PROCESS TO CLEAN UP THE DATA The Model Works Now more than 13 million Active Care Relationships/mo Near 100% of the State’s Admission, Discharge, Transfers (6.1 million each week) received and over 3.6 million sent back out to appropriate care team members Similar level of adoption occurring for Care Summaries (CCDs) --------------------- But it’s not all about adoption ------------------ IT’S ABOUT A PROCESS TO CLEAN UP THE DATA Copyright 2015-2017 Michigan Health Information Network Shared Services Proprietary – Confidential – Do not copy or redistribute

Conformance to ADT standard ADT data quality: April 2015 ADT data quality: December 2015 Fields populated Fields mapped Enhanced fields Fields populated Fields mapped Enhanced fields Hospital Systems December 2015 snapshot shows one health system by individual hospitals resulting in additional rows Copyright 2015-2017 Michigan Health Information Network Shared Services Proprietary – Confidential – Do not copy or redistribute

Active Care Relationships Provider Linkage Patient Copyright 2015-2017 Michigan Health Information Network Shared Services Proprietary – Confidential – Do not copy or redistribute

~ 13 Million Active Care Relationships Copyright 2015-2017 Michigan Health Information Network Shared Services Proprietary – Confidential – Do not copy or redistribute Copyright 2015-2017 Michigan Health Information Network Shared Services

View Active Care Relationships Health Plans Primary Care Provider Specialist Physician Organizations & ACOs Hospital or SNF Pharmacist Community Based Services Patient Foster Care Program Care Coordinator Copyright 2015-2017 Michigan Health Information Network Shared Services Proprietary – Confidential – Do not copy or redistribute

Data for the Common Key Service Patient Demographics Used by Common Key Service Patient Primary Care Provider First Name Last Name Date of Birth Last 4 SS# Local MRN# Gender Linkage (plus other demographic data) Copyright 2015-2017 Michigan Health Information Network Shared Services Proprietary – Confidential – Do not copy or redistribute

Common Key Service (CKS) What: An additional common identifier to include in patient demographics when sharing or merging data Built upon: Active Care Relationship Service MiHIN legal trust framework Leverages the State of Michigan MPI Goal: Improve match rates when linking patient records Link individuals across multiple organizations, applications and services Copyright 2015-2017 Michigan Health Information Network Shared Services Proprietary – Confidential – Do not copy or redistribute

Core Data Flow Model Common Key Service Data clean-up services Patient Matching Accelerator (very high performance MPI) Active Care Relationship Service Common Key Service Declare linkages Data clean-up services Patient Demographics + Common Key Common key returned with cleaned demographics Copyright 2015-2017 Michigan Health Information Network Shared Services Proprietary – Confidential – Do not copy or redistribute

Provider & Affiliation Data for HD Patient Practice Physician Group Practice Unit Primary Care Provider Direct Address or ESI Used for the Health Directory Copyright 2015-2017 Michigan Health Information Network Shared Services Proprietary – Confidential – Do not copy or redistribute

Confirm and Enforce Conformance Push Data Push Data To MiHIN Confirm and Enforce Conformance Admission, Discharge, & Transfer Use Case Care Summary (CDA CCD) Use Case Lab Results Use Case Quality Measure (QRDA) Use Case Copyright 2015-2017 Michigan Health Information Network Shared Services Proprietary – Confidential – Do not copy or redistribute

Quality Control & Routing Specialist HD Primary Care Physician ACRS STANDARDIZED Data to MiHIN CKS Care Coordinator Hospital & SNF Copyright 2015-2017 Michigan Health Information Network Shared Services Proprietary – Confidential – Do not copy or redistribute

An Iterative Approach ACRS ADT’s Care Summaries Specialist HPD CKS STANDARDIZED CKS Care Summaries Care Coordinator CCD Problems Allergies MEDs Hospital & SNF CCD +Care Plan “pain plan” CCD Diagnostics CCD +Advance Directives Copyright 2015-2017 Michigan Health Information Network Shared Services Proprietary – Confidential – Do not copy or redistribute

Promote the CCD HL7 C-CDA Lowest Cost!! Direct Small Provider CCD Copyright 2015-2017 Michigan Health Information Network Shared Services Proprietary – Confidential – Do not copy or redistribute

Disease, Health Risk or Exposure Registry New Types of ACRS Linkage Disease, Health Risk or Exposure Registry Patient Copyright 2015-2017 Michigan Health Information Network Shared Services Proprietary – Confidential – Do not copy or redistribute

Supports Provider Awareness Trusted Data Sharing Organization (TDSO) Trusted Data Sharing Organization (TDSO) Specialist Active Care Relationships Health Provider Directory Primary Care Patient Added to Registry Care Coordinator 1) When patient added to registry a public health ADT alert sent to MiHIN 2) MiHIN checks Active Care Relationship Service and identifies providers 3) MiHIN retrieves contact and delivery preference for each provider from HPD 4) Notifications routed to providers based on electronic addresses and preferences Copyright 2015-2017 Michigan Health Information Network Shared Services Proprietary – Confidential – Do not copy or redistribute Copyright 2015-2017 Michigan Health Information Network Shared Services

Alert & Query ACRS Prescription Drug Monitoring Program Report delivered to multi-purpose inbox MiHIN attaches report to message MiHIN queries Prescription Drug Monitoring Program ADT (A01) Message from ED ACRS Prescription Monitoring Indicator (person active in system) Copyright 2015-2017 Michigan Health Information Network Shared Services Proprietary – Confidential – Do not copy or redistribute

ACRS Informed Query Active Care Relationship Service Specialist Primary Care Physician Hospital & SNF Health Plan Pharmacist Copyright 2015-2017 Michigan Health Information Network Shared Services Proprietary – Confidential – Do not copy or redistribute

What About The EHR Vendors? Push Everyone Else ACRS CKS CORPORATE CONFIDENTIAL MIHIN 2017

Tim Pletcher Executive Director pletcher@mihin.org Thank you! Tim Pletcher Executive Director pletcher@mihin.org Copyright 2015-2017 Michigan Health Information Network Shared Services Proprietary – Confidential – Do not copy or redistribute