Using a Knowledge Grid to Enhance Messages in Michigan Allen Flynn, Pharm.D ajflynn@med.umich.edu Jim Edwards, Director of Development jim.edwards@mihin.org Copyright 2017 - Michigan Health Information Network Shared Services

Agenda Statewide Health Directory services Active Care Relationship services Current medication reconciliation workflow Learning Health for Michigan infrastructure Enhanced medication reconciliation workflow Persona stories Enhanced medication reconciliation demonstration

Statewide Health Directory Manages organizations, providers and the multiple relationships between them Contains electronic addresses used to route information to providers Health Directory Name Specialty Practice unit Practice organizations Related organizations Delivery oreferences …additional attributes Insert HD picture Copyright 2017 - Michigan Health Information Network Shared Services

Active Care Relationships Declared active care relationships between patients and providers Primary Care Provider Linkage Patient Active Care Relationships: Providers: 13,535,374 16,466 In Michigan: Copyright 2017 - Michigan Health Information Network Shared Services

Medication Reconciliation Current Workflow Health Plan Trusted Data Sharing Organization (TDSO) Trusted Data Sharing Organization (TDSO) Specialist Patient to Provider Attribution Health Directory Patient Primary Care 1) Patient discharged from hospital, message sent to TDSO, MiHIN Pharmacist 2) MiHIN checks patient-provider attribution and identifies recipients 3) MiHIN retrieves contact and delivery preference for each recipient from directory 4) Notifications routed to recipients based on electronic address and preferences Copyright 2017 - Michigan Health Information Network Shared Services

Can We Make the Workflow Smarter? Copyright 2017 - Michigan Health Information Network Shared Services 6

Learning Health for Michigan Infrastructure Connecting Health for Michigan 2017 Learning Health for Michigan Infrastructure kgrid.org Slides: Allen J. Flynn, 2017 Charles P. Friedman, 2016, 2017

The Knowledge Grid Infrastructure Approach Need: Computable Knowledge ‘FAIRness’ Why? State-wide Learning Depends on Effective Computable Knowledge Sharing How? Knowledge Grid and Its Components kgrid.org Learning Health Sciences

LH4M & Knowledge FAIRness To Make Computable Knowledge a Statewide Resource It Has to Be “FAIR” Findable Accessible Interoperable Reusable Learning Health Sciences

Rapid, Transparent Statewide Knowledge Sharing Digital Library Digital Library Digital Library • Knowledge Grid Learning Health Sciences

Why? Speeding Up Knowledge to Practice Objects 1. Computable Knowledge 2. Knowledge Management Digital Library Corroboratory Mechanisms 3. Maintain Trust ✔ Object Shelf 4. Connect Knowledge to Practice Duplicae and move to beginning EHRs/eHealth Learning Health Sciences

Analytic Results of Interest What is Knowledge Grid, by Components? or Analytic Results of Interest 1. Knowledge Objects 2. Digital Library Digital Library Knowledge Grid 3. FAIRness Mechanisms 4. Activator 5. RESTful services EHRs/eHealth Existing Health IT Learning Health Sciences

1. Computer-Processable Knowledge Objects Description Guidelines Interface Computer-Processable Knowledge “Payload” Articles Knowledge Objects Results of Interest Learning Health Sciences

Example Knowledge Object Source from Oncology Learning Health Sciences

Here Is the Written Knowledge Learning Health Sciences

Types of Knowledge Objects Input Service Output Calculation Individual Features “Do the Math” Numeric Result e.g., predictive models or dosage calculator Interpretation Facts of the Case Apply Best Practice Health Knowledge Written or Verbal Instruction e.g., computable guideline Presentation Image Parameters Apply Communication Best Practice Knowledge Visual Display or Image e.g., iconarray Tailoring Facts & Features About the Output Recipient Apply Psychological and Communication Best Practice Knowledge Individualized, Evidence-Based Multimedia Message e.g., motivational messages of encouragement for an individual who is more likely to respond to them Learning Health Sciences

2. Digital Library to Manage and Share Knowledge Capability to Curate and Manage Online Collections of Knowledge Objects Learning Health Sciences

3. Mechanisms to support Knowledge FAIRness ✔ Links to Knowledge Sources ✔ Records of Knowledge Object Use ✔ Technical Safeguards to Protect Knowledge Objects FAIR means: Findable Accessible Interoperable Reusable Learning Health Sciences

EHRs & Apps Activator Engine Shelf 4. & 5. Connect Linked Knowledge to Practice Shelf Engine Activator Knowledge Objects Payloads People Wanting to Know Best Practices ”Request” eHealth Applications EHRs & Apps ”Response” RESTful Services Learning Health Sciences

Analytic Results of Interest Knowledge Grid by Components or Analytic Results of Interest 1. Knowledge Objects More Info 2. Digital Library Digital Library kgrid.org 3. FAIRness Mechanisms 4. Activator 5. RESTful services EHRs/eHealth Existing Health IT Learning Health Sciences

Enhanced Medication Reconciliation Workflow Health Plan Trusted Data Sharing Organization (TDSO) Trusted Data Sharing Organization Specialist Patient to Provider Attribution Health Directory Patient Primary Care 1) Patient discharged from hospital, message sent to TDSO, MiHIN Pharmacist 2) MiHIN checks Knowledge Grid, enhances message as appropriate 3) MiHIN checks patient-provider attribution and identifies recipients 4) MiHIN retrieves contact and delivery preference for each recipient from directory 5) Notifications routed to recipients based on electronic address and preferences Copyright 2017 - Michigan Health Information Network Shared Services

Persona Stories Christy Munson gets a new opioid prescription which may put her at risk for dependence Alice Vargas gets a new prescription that puts her at risk of respiratory depression Copyright 2017 - Michigan Health Information Network Shared Services

Enhanced Medication Reconciliation Demonstration Copyright 2017 - Michigan Health Information Network Shared Services

Copyright 2017 - Michigan Health Information Network Shared Services Thank You Allen Flynn, Pharm. D Department of Learning Health Sciences, University of Michigan ajflynn@med.umich.edu Jim Edwards Director of Development Jim.Edwards@mihin.org Copyright 2017 - Michigan Health Information Network Shared Services