1. MiHIN 101 Copyright 2014 Michigan Health Information Network Shared Services 1 November 2015

2. What Does HIE (verb) Do? 2 Adapted from Hripcsak et al. (2007) Copyright 2015 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)

4. MiHIN is a network for sharing health information statewide for Michigan 4 Copyright 2015 Michigan Health Information Network Shared Services

5. “One and Done”- Easier, Simplified, Predictable Data Sharing 1.Sign once Common legal framework across the state Transparent data usage for each use case 2.Connect once MiHIN network includes all of health care: HIEs, HISPs, health plans, the state and the federal agencies 3.Publish once Patient and provider delivery preferences easily registered and centrally managed 4.Report once Messages can be routed to multiple destinations – no duplicate interfaces or repeat reports 5.Log-on once Single sign-on across patient/member and provider portals 5 Copyright 2015 Michigan Health Information Network Shared Services

6. Scalable Data Sharing 1.Legal Interoperability Common legal framework across the state Transparent data usage for each use case 2.Technical Integration MiHIN network includes all of health care: HIEs, HISPs, health plans, the state and the federal agencies 3.Authoritative Sources Patient and provider delivery preferences easily registered and centrally managed 4.Reuse & Reduced Duplication of Effort High quality messages can be routed to multiple destinations – no duplicate interfaces or repeat reports 5.Identity & Program Integrity Single sign-on across patient/member and provider portals Common linking & patient matching 6 Copyright 2015 Michigan Health Information Network Shared Services

7. 7 MiHIN Statewide Shared Services MDHHS Data Hub Chronic Diseases MSSS State LABS Doctors & Health Systems HIE Qualified Organizations (QOs) Network of Networks : Data Warehouse Health Plan QOs (more coming) Single point of entry/exit for state Virtual QOs Pharmacies (more coming) Immunizations Mi Syndromic Surveillance System Mi Disease Surveillance System Consumer QOs (more coming) Federal PIHPs (10) Sponsored Organizations Copyright 2015 Michigan Health Information Network Shared Services Simple Data Sharing Organizations MyHealthPortal MyHealthButton

8. Types of Qualified Organizations HIE QO (HQO) Meets the QO requirements Plans to participate in at least 2/3 of Use Cases Voice in the MiHIN Advisory Committee (MOAC) Plan/Payor QO (PQO) Health Plan licensed in the state of Michigan Blue Cross, Michigan Association of Health Plans, & Priority Health have MOAC & Board eligibility Government QO (GQO) Government Qualified Organization (i.e. Michigan Department of Community Health) Federal Agency (i.e. Social Security Administration, CMS, Veterans Affairs, DoD, CDC, etc.) Tribal Nations in Michigan Consumer QO (CQO) Participate in consumer-focused Use Cases (i.e. MiWay Consumer Directory) Supported & authorized consumer facing services (i.e. Patient Health Record, Patient Portal) an example would be Peace of Mind Registry Data Aggregator QO (DAQO) Receives data from certain statewide Use Case (e.g. Statewide ADT) for the purpose of creating a statewide repository of the information Designed to support near-time analytics that can be shared back into the ecosystem as a statewide resource May function as a query able resource on the network 8 Copyright 2015 Michigan Health Information Network Shared Services

9. MiHIN’s Role as Curator of the Statewide “HIE” Ecosystem Manage statewide legal trust fabric Maintain statewide “master data” in Active Care Relationship Service, Health Provider Directory, Trusted Identities, Consumer Preferences Connect HIEs, Payers, Pharmacies, DHHS, Federal Government, others Align incentives and/or regulations to fairly share data and promote data standardization (via Use Cases) Convene groups to identify data sharing barriers, reduce provider burdens, engage consumers, and enable population health 9 Copyright 2015 Michigan Health Information Network Shared Services

10. Maximize SOM Resources 10 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 2015 Michigan Health Information Network Shared Services

11. 11 MiHIN Governance Copyright 2015 Michigan Health Information Network Shared Services

12. 12 Copyright 2015 Michigan Health Information Network Shared Services

13. 13 Copyright 2015 Michigan Health Information Network Shared Services

14. ORGANIZATION AGREEMENT (QDSOA,VQDSOA, CQDSOA, SSOA, SSSOA, DDSOA, SDSOA) Basic Connection Terms & SLA HIPAA Business Associate Terms Dispute Resolution Contracting & Payment Definitions Term & Termination Cyber Liability Insurance Data Sharing Agreement Use Case #1 Use Case #2 Use Case #3 Legal Infrastructure for Trusted Data Sharing Organizations (TDSOs) 14 Copyright 2013 - Michigan Health Information Network Indemnification & Liability Use Case #N

15. Trusted Data Sharing Organization Clear Chain of Trust 15 Covered Entity Business Associate Business Associate Business Associate Covered Entity Copyright 2015 Michigan Health Information Network Shared Services

16. Constituent Transparency 16 Use Case Health Plans Physicians Specialty Providers Hospitals & Clinics Patients & Families Laboratories & Diagnostic centers Pharmacies Public Health & CMS Policy Makers Communities Employers Copyright 2015 Michigan Health Information Network Shared Services

17. What is a USE CASE? Data sharing scenario with specific: purpose type of data exchanged description of interactions between people/systems Each Use Case may have different: access restrictions rules for using the data cost recovery fees or charges technical requirements 17 Use Case Factory™ Copyright 2015 Michigan Health Information Network Shared Services

18. Use Case Components 18 Use Case Summary - explains purpose and value proposition/business case for sharing data Use Case Agreement - legal document covering expected rules of engagement (Trusted Data Sharing Organizations sign Use Case Agreements) Use Case Implementation Guide - technical specification that outlines standard format details for data transmission & content Copyright 2015 Michigan Health Information Network Shared Services

19. Benefits of Use Case Approach 19 Copyright 2015 Michigan Health Information Network Shared Services Manageable chunks so competitive or confidentiality concerns can be addressed without “boiling the ocean” Reduces Complexity Standardized mechanism for scoping purpose, technical requirements, costs, and limits on how data is used Consistent Pattern Use Cases can be combined to create more extensive stories for data sharing Modular (like LEGO® blocks) Incentives, regulations or policies can target specific Use Cases to foster or accelerate adoption Aligns Priorities Constituents can understand expected use of their data and follow common chain of trust across organizations Transparent Aids focused monitoring and measurement of progress Measureable Reduces variability and enables scalability Faster & Cost Effective

20. http://mihin.org/about-mihin/resources/use-case-submission-form/ Use Case Factory TM 20 Anyone can submit ideas for use cases:

21. Public Health Reporting Immunizations Chronic disease registries Disease surveillance Syndromic surveillance Birth & death notifications 41 new use cases identified Use Case Assembly Lines 21 Copyright 2015 Michigan Health Information Network Shared Services Results Delivery Lab results Diagnostic imaging Other tests Hospital discharge summaries Care Coordination & Patient Safety Referrals Care summaries for treatment history & allergies Notification of transitions of care (Admission, Discharge or Transfer) Medication reconciliation & therapy change notices Clinical decision support alerts Quality & Administrative Reporting Registry Updates Physician Quality Reporting measures Meaningful Use reporting Electronic verification Patient satisfaction Eligibility Authorization Claims audit Patient/Consumer Engagement Instructions Health risk appraisals Medication Compliance Therapy Compliance Patient activation and self determination Health literacy & numeracy Consumer Preferences and Consents

22. Use Case Factory Hierarchy 22 Persona combined with collection(s) to illustrate a health-related event Combination of Use Cases that interact to create a higher-level service A functional data-sharing unit Data Standards Copyright 2015 Michigan Health Information Network Shared Services Episode of Care Story Collection Use Case Scenario Major life event consisting of multiple stories (birth of child, chronic condition, etc.) Granular examples of data sharing (submit vs.. receive, etc.)

23. Accelerating Use Cases 23 Policy & Regulatory Levers Clinical Endorsement & Evidence Financial Incentives or Disincentives Use Case Copyright 2015 Michigan Health Information Network Shared Services

24. Payer Incentives for Statewide HIE -Physician Group Incentive Program (PGIP) -Hospital value-based contracts 24 2014 2015 2016 Data flow Hospitals – Send ADT notifications to statewide service via MiHIN Providers – Send Patient-Provider Attribution (PPA), receive ADT alerts Integrate ADT, begin Medication Reconciliation Hospitals – Conformance with ADT spec, send Medications Providers – Integrate ADTs into workflow, receive Medications TBD Medications, potentially quality measures But wait… there’s more $ Copyright 2015 Michigan Health Information Network Shared Services

25. Use Cases & Learning Health System Copyright 2015 Michigan Health Information Network Shared Services 25

26. Major Building Blocks Copyright 2015 Michigan Health Information Network 26 Statewide Health Provider Directory Active Care Relationship Services MiWay Consumer Directory TOC Notification Service Single- Sign On (Linked to MiCAM) Query (IHE-XCA Connect) Common Key Service

27. Statewide ADT Use Case Example 27 Active Care Relationship Service (ACRS) Statewide Health Provider Directory (HPD) + + Copyright 2015 Michigan Health Information Network Shared Services

28. Patient Provider Attribution Service (in Michigan we call this ACRS™) Active Care Relationship Service (ACRS) - enables providers to declare active care relationships with patients – this attributes to a patient the providers who are active members of their care team Accurately routes information (e.g. Admission-Discharge-Transfer messages, medication reconciliations, medication adherence) Enables alerts to providers in active care relationships with patients Coordinates entire care team with changes to patient status in real time Allows searches by authorized persons or organizations: Health systems and provider/physician organizations Care coordinators Health plans Consumers (who can dispute asserted relationships) 28 Copyright 2015 Michigan Health Information Network Shared Services

29. Active Care Relationship Service TM Copyright 2015 Michigan Health Information Network Shared Services 29 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

30. Expand Active Care Relationship Service TM Copyright 2015 Michigan Health Information Network Shared Services 30 Patient 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 NPI First Name Last Name Practice Unit ID Practice Unit Name Physician Org ID Physician Org Name Care Coordinators NPI (or New#) First Name Last Name Practice Unit ID Practice Unit Name CC Org ID CC Org Name

31. Important Horizontal View 31 Eligible Hospitals Eligible Providers & PCMH Care Coordinators Specialty Providers Behavioral Health Specialists Critical Access Hospitals Patients & Families Copyright 2015 Michigan Health Information Network Shared Services

32. +6 Million Active Care Relationships Copyright 2015 Michigan Health Information Network Shared Services

33. Active Care Relationships Providers Copyright 2015 Michigan Health Information Network Shared Services Statewide Provider Coverage

34. Copyright 2015 Michigan Health Information Network Shared Services Admit Discharge & Transfer (ADT) Use Case 34

35. Statewide Health Provider Directory 35 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 2015 Michigan Health Information Network Shared Services

36. ACRS™ Update – Version 2.0 Additional patient information to minimize false positives 36 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 2015 Michigan Health Information Network Shared Services

37. Trusted Data Sharing Organization (TDSO) Trusted Data Sharing Organization (TDSO) Trusted Data Sharing Organization (TDSO) Trusted Data Sharing Organization (TDSO) ADT Example – Current Workflow Patient to Provider Attribution Health Provider Directory 1) Patient goes to hospital which sends message to TDSO then to MiHIN 2) MiHIN checks patient-provider attribution and identifies providers 3) MiHIN retrieves contact and delivery preference for each provider from HPD 4) Notifications routed to providers based on electronic address and preferences Primary Care Specialist Care Coordinator 37 Patient Copyright 2014-2015 Michigan Health Information Network Shared Services MiHIN Confidential Information – Proprietary – Restricted

38. Statewide ADT Use Case Example Copyright 2015 Michigan Health Information Network Shared Services 38 Active Care Relationship Service (ACRS) Statewide Health Provider Directory (HPD) + +

39. Other “LEGO®” Combinations 39 Active Care Relationships Statewide Health Provider Directory + + Active Care Relationships Statewide Health Provider Directory + + MED REC Care Plan Copyright 2015 Michigan Health Information Network Shared Services