Michigan Health Information Network Shared Services

Michigan Health Information Network

Shared Services

Beth Nagel, HIT Manager Michigan Department of Community HealthNovember 10, 2010

www.michigan.gov/mdch

Vocabulary TestHealth Information Technology (HIT)

Health Information Exchange (HIE)

Regional Health Information

Exchange (RHIO)

Software and hardware that processes health care information electronically within a health care organization. Examples include:• EMR• EHR• CPOE• E-Prescribing

The electronic movement of any and all health-related data according to an agreed-upon set of interoperability standards, processes and activities across non-affiliated organizations in a manner that protects the privacy and security of that data; and the entity that organizes and takes responsibility for the process

A health information organization that brings together health care stakeholders within a defined group/area and governs health information exchange among them for the purpose of improving health and care.

Motivation for HIE

Clinicians have incomplete knowledge of their patients Relevant patient data not available in 81% of

ambulatory visits 18% of medical errors that lead to ADEs due to

missing patient information.

Medicare patients see an average of 5.6 different providers each year= 5.6 silos of data

“CARFAX Vehicle History Reports™ are available on all used cars and light trucks model year 1981 or later…”

“CARFAX receives information from more than 20,000 data sources including every U.S. and Canadian provincial motor vehicle agency plus many auto auctions, fire and police departments, collision repair facilities, fleet management and rental agencies, and more…”

Healthcare’s Unique Challenges Only industry that is truly ‘life and death’

Constantly changing key factors of; Patient needs Treatment choices Patient mobility Community health environment/challenges

An industry where accuracy, flexibility and dynamic (live) information is vital

An industry that is inefficient due to variability of care and cost.

Why is government involved? Reducing costs & Increasing quality of

healthcare is an economic issue

Ability to determine health status and track health outcomes is essential to effective public policy

Government is a purchaser, a payer and a provider

Government can be a neutral convener and arbiter of public good

“In Michigan, we will help our health care industry stop depending on your memory and their paper records as databanks. We are going to use technology to vastly improve the system.”

- Governor Granholm, 2006 State of the State Address

MiHIN: The History

2005 – Michigan kicks off a multi stakeholder, all inclusive approach to completing a statewide HIE roadmap

2006 – The Michigan’s HIE roadmap - MiHIN Conduit to Care - is completed and released

2006 – Legislation is signed to create the Michigan HIT Commission

2007 & 2008 – Michigan invests $10 million in regional HIE planning and implementation

2009 – “ARRA” changed the HIT and HIE world

ARRA: HIT Game Changer

The biggest investment in

HIT in the U.S. EVER

ARRA HIT Programs

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Regional HIT Extension CenterEHR Incentives Beacon Community

State HIE Cooperative Agreement

MiHINMichigan

Medicaid EHR Incentives

M-CEITA SEMHIE

ARRA HIT Programs in Michigan

Michigan’s Corresponding Initiatives

$14.99 MILLION

$200 MILLION??

$19.6 MILLION

$16 MILLION

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State HIE Cooperative Agreement Issued by the Office of the National Coordinator for HIT

Michigan’s Award: $14,993,085

Four year cooperative agreement Matching funding requirements escalate (0%

first year, 10% second, 14% third, 33% fourth)

Goal: an interoperable statewide health information exchange

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Michigan’s Approach Convene Stakeholders

Kick-off event in November with over 300 organizations represented

Organized five workgroups with over 100 organizations directly involved

All workgroups open to the public

All information (schedule, agendas, materials) posted

Voting members elected by peer voting process

Co-chairs: 1 public and 1 private

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Governance Work Group

Business Operations

TechnicalPrivacy & Security

Finance

MDCH & DTMB

HIT Commission

Stakeholder Input Structure

State HIE Cooperative Agreement Applicant

Office of the National Coordinator for HIT

Federal Administrative Office of the State HIE Cooperative Agreement Program

Workgroup Structure

Workgroup Deliverables

Strategic & Operational Plans submitted on April 30 to the ONC

8 States approved Awaiting approval for MiHIN plans

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Technology Guiding Principles:

Cost-effective to build and maintain

Interoperable with HIE systems that are already used in Michigan

Technical architecture must be EHR and HIE vendor agnostic

Consistent with national industry standards Maintain the privacy of patient data and have the highest

level of security

Incremental approach

Build only the minimum necessary

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Technical ArchitectureArchitecture funded by State HIE Cooperative Agreement

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Technical Architecture Benefits

Builds upon sub-state HIEs

“Skinny” set of technologies that can scale up over time

Connects public health reporting and surveillance

Functionality provides value at a low cost

“Behind the scenes” service that allows providers to have multiple HIE choices

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Governance Guiding Principles

Multi-stakeholder collaboration is needed to implement achievable and measurable initiatives

The MiHIN will leverage existing and planned information technology

Those that benefit should participate in paying the cost

Adoption and use of the MiHIN is critical to success

The MiHIN will conform to applicable federal guidelines

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Governance

MiHIN Shared

Services Governance

Board

Governs the Business & Technical Operations of MiHIN Shared Services

“State Designated Entity”

Authority of the MiHIN Shared Services

Implements financing structures

HIT Commission

Statewide & National Vision

Monitors statewide progress of HIT & HIE

Facilitates public discussion

Recommends public policy

Provides the voice of the public

• Coordination & Collaboration

• Public & Private

Coordinated Governance Model relies on two distinct entities that have unique responsibilities

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Coordinated Governance Model Benefits

Built in coordination State maintains accountability Legislature maintains oversight Balances transparency, openness, efficiency and

agility Leverages existing HIT Commission experience Non-profit entity attracts diverse funding sources Customers governing long-term sustainability Aligned with other state models and national best

practices Fulfills expectations of the State HIE Cooperative

Agreement

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Creating the Non-profit Entity Defined Board

10 seats for direct customers 7 sub state HIEs 3 Payers

2 seats for state government Medicaid Public Health

1 HIT Commissioner

Open, transparent process for seating initial board Bylaws drafted by MiHIN Governance Workgroup Criteria laid out in public forum HIT Commission assists in nomination review

Expenses by Source

0

2

4

6

8

10

12

Mill

ions

Fed Grant

State Match

Member Fee

Expenses

2010 2011 2012 2013 2014 2015

Estimated expenses from 4/30/10 - subject to change

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Long-Term Sustainability Strategy

Keep costs at a minimum Leverage existing technology Maximize the use of federal one-time funding Customers will support long-term costs Customers must be involved in technology and business

decisions that will affect the costs Direct customers are the majority on the MiHIN Shared

Services Governance Board Set savings and quality metrics for Medicaid and all payers

Business Plan Due February 2011

There is nothing funny about privacy

A Balancing Act of Privacy Policies

• Patient Privacy Risk

• Patient Concern

• False security in paper

Patient Privacy Policies: Authentication, Authorization, Access, Audit, Breach

Patient Privacy Policies: Authentication, Authorization, Access, Audit, Breach

• Urgent Need for Patient Data at the Point of Care

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Next Steps Plan approval from the ONC

ONC guidance focused on ensuring all Michigan providers have at least one option for HIE in 2011

Ensuring all Eligible Providers can meet meaningful use

Create the non-profit entity Articles of Incorporation First Meeting

Update public health systems MCIR and MDSS interoperability with bi-directional

communication