Connecting Michigan for Health 2013 http://mihin.org/

1. Michigan’s HIE’s
Panel Discussion
Moderator: Jeff Livesay, MiHIN Associate Director

2. Michigan – a Network of Networks
• Eleven (11) organizations have become
“qualified” to share data through MiHIN for
statewide health information exchange:
• Seven Health Information Exchanges (HIEs)
• Michigan Department of Community Health
• Blue Cross Blue Shield of Michigan
• PCE Systems
• Carebridge Systems

3. Michigan HIE Community
Health
Plans
More to
Come…
State of Michigan
Public Health
Federal Use Case
Transitions of Care
HPD

4. Let’s look at one simple example of
an HIE working with MiHIN
• Connected Nation: Michigan Health
Information Network:
https://www.youtube.com/watch?feature=pla
yer_embedded&v=XSjEEeIclzs

5. Introducing today’s panelists
• Carol Parker, Executive Director, GLHIE
• John Vismara, President, Ingenium
• Aaron Wootton, Director, JCMR
• Doug Dietzman, Executive Director, MHC
• Terrisca Des Jardins, Director, SEMBC
• Helen Hill, Board Member, SEMHIE
• Paula Hedlund (Johnson), Director, UPHIE

6. Great Lakes
Health Information Exchange
• Non-profit, 501(c)3
• Community Collaborative
• Priorities
• Patient health and safety
• Quality improvement
• Administrative efficiency
• Cost Reduction
• Pilot 2/15/11-5/14/11
• Fully operational 5/15/11

7. GLHIE by the Numbers
Clinical Results
ADT
Lab
Radiology
Transcripts
Master Patient Index
VHR Queries
Annual Numbers – 2012 (2013 estimates)
31.1M (50M)
7.3M (11M)
1.2M (1.7M)
2.3M (3M)
2.6 M
170,000/month

8. Current GLHIE Use Cases
 Connect physicians and other health care providers
electronically to facilitate clinical messaging and sharing
encounter reports
 Results Delivery (Lab as discrete data, Radiology, Clinical
Documentation such as discharge summaries and
consultations, Cardiology Reports)
 Immunization Submission to MCIR – CDC standards
compliant
 ADT notifications – notifications are pushed into providers’
EMRs

9.  Query patient’s community-wide longitudinal health
record - Print or forward (with an interface) pertinent
clinical docs to EMR
 Subscribe to a patient (push all available clinical data to
practice EMR)
 Push practice EMR data to patient’s longitudinal health
record and distribute to patient’s identified care team
 Clinical Messaging – both through interfaces, clinical
inbox and DIRECT; No more gmail, yahoo mail,
texting… Also useful for referral routing and
consultative report routing.
Current GLHIE Use Cases (cont’d)

10. Use Cases in Progress
 Immunization Query Capability – 3Q2013
 Public Health Reporting – reportable labs – 3Q2013
 Lab Order Gateway – in progress and go live TBD
 Radiology Images – by the end of June 2013
 Disease Registry Connections – by the end of July 2013
 Business analytic support for MU, PCMH and ACOs – by
the end of August 2013
 EMS – 3Q2013
 Telehealth – 4Q2013

11. Sharing Data
• GLHIE Board fully supports sharing across
providers.
• First use case – electronic referrals using DIRECT
• Future – query-based exchange using IHE
protocols
• GLHIE’s informatics structure includes federated
clinical data repositories for each participating provider,
an enterprise Master Patient Index, Record Locator
Service, and Provider Directory
• Implemented IHE standards in May 2013.

12. MiHIN Participation
• Public Health reporting (immunizations,
reportable labs, syndromics, etc.)
• Statewide Admit-Discharge-Transfer (ADT) and
Transitions of Care (TOC) service
• Federal use cases with SSA, VA, CMS via
MiHIN’s HealtheWay eHealth Exchange
(NwHIN) node – under review
• Health Provider Directory – under review by the
Board of Directors

13. Contact Information
• (517) 347-3373
• cparker@glhie.org
• www.glhie.org

14. Connecting Michigan for
Health
June, 2013

15. Ingenium Background
• Focus on networks of physicians
• Physician based and governed
• Enable networks of physicians to manage populations of
patients
• Shared IT infrastructure
• Build upon previous work

16. Ingenium Goals
• Leveraging Shared Infrastructure and Data
• With Large amounts of Ambulatory Data
• Providing a Path to Readily Accessible and Actionable
Information
• Focus on physician access at point of care
• Enabling change by empowering Physicians
• Enabling Population Management and Care Coordination
programs
• Physician Oversight / Representation

17. United Physicians Use Case
• Using Platform to enable
• Point-of-Care Access to Information
– Community Record
– Registry Applications
• Care Coordination
– Facility Census
– Specialty Referrals
• Network-based Quality Improvement Programs
• Application Access
• Communication

18. Transmission
of Data
(MHC)
Aggregation of
Data
(Ingenium)
H
Dr
Dr
Dr
Beaumont/UP HIE World
May 21, 2013
1
8
Ingenium, LLC

19. Data Sources
 PO – UNITED PHYSICIANS, LPO
 PHYSICIAN EMR– ATHENA, EPIC
 HOSPITALS – BEAUMONT, CRITTENTON, ST.
JOSEPH OAKLAND, BOTSFORD, GARDEN CITY
 LABS – BRL, BOTSFORD, GARDEN CITY, DMC,
JVHL, QUEST, BIO-TECH, LABCORP (IN
PROCESS)
 HEALTH PLANS – BCBSM, BCN, HAP, PRIORITY,
HEALTHPLUS, MAHP
 MIHIN (MCIR)
 APPLICATIONS – DOCSITE, WELLCENTIVE,
DRFIRST, OTHERS

20. Ingenium Metrics
• Over 1.3 million Patients
• 1,357 Physicians
– 310 access Community Record
• All Physicians by October
– 213 access facility census
• Message Types (approx 150,000 per day)
– ADT (over 180,000 per month)
– Demographic (2.5 million per year)
– Conditions (600,000 per year)
– Labs (3.5 million per year)
– Immunizations (750,000 per year)
– Procedures (400,000 per year)
– Vitals (3.25 million per year)
– Reports/Notes (825,000 per year)

21. MiHIN Participation
• Board and Committees
• Current Use Cases
– Immunizations (MU)
– Security
– ADT
• Future Use Cases
– Sharing data between HIEs
– Medication Reconciliation
– Other

22. JCMR Overview
Connecting Michigan
June 5, 2013

23. Jackson Community Medical Record
• An EHR/HIE in the Jackson area since 2005
• Connects ~50% of all providers
• AllegianceHEALTH employed providers
• Many private practice providers
• Federally Qualified Health Center
• Jackson County Health Department
• AllegianceHEALTH clinics
• Tightly integrated with AllegianceHEALTH
• One shared EHR for the community of providers

24. JCMR
One Integrated Patient Chart
Medication lists, reconciliations
and drug interactions across
practices.
Lab Results automatically assigned to
the appropriate physician and patient
independent of an electronic order.
All allergies are shared across
practices.
• Shared patient ID, demographics, med list, allergies,
problem list, notes, etc.
• Closed-loop ordering – referrals, tests, procedures
• Uniform decision support
• Advanced clinical information sharing
• Support in achieving meaningful use
• Real-time interfaces
• Local payer pay for performance reporting
• Local support
All social, family and past
medical history is available.
24

25. JCMR
Current Interfaces
• Demographics & insurance
• Lab orders and results (closed loop)
• Radiology Results
• Discharge summaries
• Operative Notes
• Histories & Physicals
• ePrescribing
• Tasks across practices
• Referrals across practices (as tasks)
• Enterprise Chart – eliminates the need for many other interfaces
• Auto populates JCMR and NextGen report systems
• Auto populates Phytel population management registries
• Phytel calls to remind patients to make appointment for overdue care

26. JCMR
Statistics
• Providers
• 257 Practice Management
• 196 Electronic Health Record
• >1,000 users
• Patient Volumes
• 190,000 shared active patients
• 50,000 + encounters / month
• 35,000 Surescripts e-prescriptions / month
• Monthly Interface Volumes
Interface Volume
Lab Orders 60,000
Lab Reports 111,000
Radiology Reports 45,000
AH Unsolicited Results Received 100,000
Total 316,000

27. JCMR
Care Coordination Opportunities
50%
25%
25%
Practice Utilizationby Patients
One Practice
Two Practices
>= Three
Practices
Half of our 190,000 active community patients have visited more than
one practice. By being connected to one enterprise database, our
doctors and caregivers simply have more valuable and accurate data
to take care of these patients.

28. JCMR
Benefits Achieved So Far
• Patient Centered Medical Home certified practices
• Provider incentives
• PQRI/PQRS from Medicare
• e-Prescribing from Medicare
• PCMH from Blue Cross & Medicare
• PGIP from Blue Cross
• Meaningful Use - stage 1 certified from Medicare
• Reduced duplication of tests (est. 15-20%)
• Patient safety: medication interactions, pain contracts, doctor
hopping for meds… unknowable.
• It’s Your Life in JCMR to coordinate goals with Primary Care
Physicians.
• One click smoking cessation referrals and documented in chart.
• Diabetes tracking.
• Automated outreach & new chronic disease registries are
getting patients in to see their physicians for overdue care
(Phytel)

29. • Public Health reporting (immunizations, reportable labs,
syndromics, etc.)
• Statewide Health Provider Directory
• Statewide Admit-Discharge-Transfer (ADT) and
Transitions of Care (TOC) service
• Patient Secure Pilot
Planned & Current Participation with MiHIN

30. Connecting Michigan
Conference
June 5th, 2013
30

31. 31
Who is Participating?
• 68 total hospital facilities
• 14,700 licensed beds
• 15,200+ combined medical staff
• 1,608 office locations
• 8,000+ providers
• 14 other member orgs:
• Provider organizations
• Health plans
• Home health/DME
• Community mental health
• Local public health
• Employer Clinics
• Diagnostic centers
• 3 HIE Direct agreements:
• OHIP – State of Ohio
• GLHIE – Lansing
• MHIN– South Bend, IN

32. What is MHC Actually Doing?
Live Solution Summary (“the tracks”)
– Results Delivery (1,500,000 / month)
– Lab Orders (6,600 / month)
– Radiology Orders (1,500 / month)
– EMR Interfaces (267 interfaces, 40 different systems)
– Referrals - Physical (5,500 / month, 534 offices, 37 counties)
– Referrals - Behavioral (14 offices, 2 counties)
– Virtual Integrated Patient Record - VIPR (1,555,000 CMPI)
– State Immunization Registry (to State via MIHIN) (300+ offices)
– Reportable Lab Registry (to State via MIHIN)
– Direct HISP (*@mhc.medicity.net)
– Admission & Discharge Notifications (MHC direct or via MIHIN) (~660,000 / month)
32

33. Connecting Michigan for Health Update
Wednesday June 5, 2013
Southeast Michigan Beacon Community
33

34. The Beacon Community Program:
Where HITECH Comes to Life
Taken from: Blumenthal, D.
“Launching HITECH,” posted
by the NEJM on 12-30-2009.
BEACO
N
34

35. Microcosms of Wired Communities Across America
“We’ve learned
that that’s an
incredible gift,
to have very
specific goals,
not for a
hospital or
for a clinic,
but for an
entire
community.”
Farzad
Mostashari,
The National
Coordinator
35

36. HIT-Enabled Clinical Transformation: Results
36
Emergency Department Diabetic Patient Identification
Through 4/30/2013
Patients Tested 19,794
Pre-Diabetics 4,467
Diabetics 1,221
PHN Referrals 1,409
Patient Health Navigators: Ambulatory Activity
Through May 10, 2013
Patients Referred 3,986
Patients Engaged 1,707
Patients: Outreach Queue 1,221
Patients Declined 1,409
mHealth Pilot: txt4health
February 22, 2012 – February 28, 2013
Total Engaged 1,023
% set initial weight loss goal 78%
% made knowledgeable about risk for diabetes 89%
% enjoyed the program 94%
High Impact Clinical Measures
~ 80% of patients included for 9-month intervention
SEMBC Ambulatory Care
Practices
• 178,000 Lives
• 18,000+ Patients with
Diabetes
SEMBC Provider Survey
 Improved receptiveness to EHR
 Improved staff comfort level with
technology and computers
 Increased familiarity with HIE
SEMBC Survey of Patient Health
Navigator Patients
 Significant improvement in
medication adherence
 Significant improvement in patient
readiness to change: healthy food
choices, physically active, check
blood sugar, manage stress, keep
appts., stop smoking, ID self-mgt.
goals

37. Technical Framework
37
Community Registry
Security
Services
eMPI
Community
Patient Record
Viewer
Care
Coordinators
HIE Framework
Query for
Documents
Service
Care Gaps
& Alerts
Edge
Security
Services
SAML
Assertion
Physician
Organizations
Private
Practices
Hospitals Community
Health Centers
Free ClinicsPublic Health
Departments
Payers
Edge
Users
Edge EHR
IHE-XDS
Registry &
Repository
Population
Health
Reporting
& Analytics
Data Audit
& Logging
State HIE
Sub-State HIEs
Provider Organizations
Other Data Sources
Cloud-Based Data Sources
Health Systems or ACOs
EMS Services
Edge Data Sources

38. The Power of Collaboration:
Working with the State of Michigan and Beyond
• MiHIN
BeaconLink2Health is a Qualified Data Sharing
Organization (QDSO)
BL2H has a certified connection to MiHIN
• MDCH
MCIR testing underway
Started April 9, 2013
• ONC
EHR Affinity Work Group
Participants: ONC, select Beacon Communities, EHR vendors
Purpose: Data Standardization, Alignment for MU2
Active Pilots
CDA Clinical Document Architecture
MU2 Transport for Transitions of Care
Collaborative Writing and Publication
Subject Matter: Data Governance, HIT-Enabled Care Mgt.,
mHealth
Beacon Nation Dissemination
Collective development and publication of “Change
Packages” for sister communities
38

39. Hard Work. Rewarding Work.
39
“We took each of those challenges that the Beacons
illuminated and the Beacons lived through and we
made it a part of our mission, nationally, to try to
improve. And, boy, was it hard, but despite that the
Beacons have all improved quality and safety in their
communities, those lessons are relevant to a lot more
people who are trying to navigate this transformation of
American healthcare that is more fundamental, more
profound, more exciting than anything we have seen in
five decades past.”Dr. Farzad Mostashari and Herbert
Smitherman, M.D, Assistant Dean
of Community and Urban Health at
Wayne State University, and
SEMBC Board Co-Chair.
Dr. Farzad Mostashari, National Coordinator for Health Information
Technology at the U.S. Department of Health and Human Services, May
22, 2013.

40. Thank You
CONTACT
Terrisca Des Jardins
Director
Southeast Michigan Beacon Community
P: 313-638-2156
E: tdesjardins@semha.org
sembc.org
40

41. Advancing Quality Healthcare
Through National, State and Local Community Collaboration
Connecting Michigan for Health 2013
Radisson Lansing at the Capitol
Lansing, MI
June 5-7, 2013

42. SEMHIE Officers, Board, & Advisors
Officers Group
• President: Robert Jackson, MD,
CMM (Western Wayne Physicians)
• Vice-President: Jeanette Klanow,
(St. John Providence Health System)
• Treasurer: Michael (Mick)Talley,
Treasurer (University Bank)
• Helen Hill, MiHIN Board Rep.,
Director Public-Private Initiatives
• Howard Burde, Legal Counsel
Board Members
• Julie Moran (Trinity Health)
• Gary Petroni (SEMHA)
• Adam Jablonowski (Wayne County
Medical Society)
• Gary Assarian (JVHL)
• Carla Smith (HIMSS)
Advisors
• Jackie Rosenblatt, MPRO
• Stephen Lange Ranzini, University
Bank

43. SEMHIE History
• Founded in 2006; incorporated as MI non-profit 2008; filed for
501(c)(3) status 2012
• HIMSS-GSA e-Authentication Six-State Pilot & White Paper 2006-
2007
• Conduit to Care
• Conduit to Care (I) participant 2005-2007
• State of Michigan $1.2 Million planning grant 2007-2009
• Conduit to Care (II) participant 2008-2010
• Designated Sub-State HIE by Michigan HIT Commission Aug 2010
• Participant in founding MiHIN and working on ONC State-level HIE
Cooperative Agreement 2010
• Presentations to OMG and HL7 Conferences (Arlington VA,
Cambridge MA) 2011
• Invited to NIST NSTIC Workshop Baltimore MD March 2012

44. SEMHIE Recognition
• Social Security Administration (SSA) e-Disability Claims Contract
• Awarded $2.988M Feb 2010 – one of 15 national contracts awarded
• Achieved NwHIN production status for SEMHIE SSA Aug 2011
• Completed SSA contract June 2012
• Designated Pay-for-HIT program by SSA July 2012
• HealtheWay eHealth Exchange Anchor Participant December 2012
• Transitions of Care
• Designated as Transitions of Care reference implementation pilot for ONC
Standards & Interoperability Framework Nov 2011
• Demonstrated in HIMSS-ONC Interoperability Showcase at HIMSS AC 2012 in
Las Vegas NV Feb 2012
• Selected to demonstrate at S&I Framework Face-Face Alexandria VA Apr 2012
• ONC $14.9M SE MI Beacon award Sept 2010
• One of 17 national ONC Beacon Cooperative Agreements
• SEMHIE led coalition through award & startup; transitioned to Beacon 2011

45. SEMHIE Receives Largest of
15 National SSA e-Disability
Contract Awards
1. Cal RHIO, San Francisco, CA - $1,625,000
2. CareSpark, Kingsport, TN - $1,363,000
3. Center for Healthy Communities, Wright
State University, Healthlink, Dayton, OH -
$999,000
4. Central Virginia Health Network /
MedVirginia, Richmond, VA - $1,139,000
5. Community Health Information
Collaborative (CHIC), Duluth, MN -
$977,000
6. Douglas County Individual Practice
Association, Roseburg, OR - $502,000
7. EHR Doctors Inc., Pompano Beach, FL
$1,000,000
8. HealthBridge, Cincinnati, OH - $1,400,000
9. Lovelace Clinic Foundation (LCF),
Albuquerque, NM - $1,083,000
10. Marshfield Clinic Research
Foundation, Marshfield, WI -
$998,000
11. Memorial Hospital Foundation &
Memorial Hospital of Gulfport
Foundation, Inc., Gulfport, MS -
$1,100,000
12. Oregon Community Health
Information Network (OCHIN),
Portland, OR - $284,000
13. Regenstrief Institute, Inc,
Indianapolis, IN - $350,000
14. Science Applications International
Corporation (SAIC), Reston, VA -
$1,587,000
15. Southeastern Michigan Health
Assoc., Detroit, MI - $2,988,000

46. Shortening the Determination Cycle
With SSA e-Disability Claims
Process: 459 Days to Under 1 Week

47. HIE Core Services Delivered to SEMHIE thru SSA Contract
Portal (patient search, workflow processing, system monitoring)
Transaction engine
RLS and MPI
NHINConnect gateway
CCD creation capability (extract and share clinical data: results,
allergies, problem lists, medications, care summaries, etc.)
Semantic interoperability engine
Clinical terminology mapping engine/tools
XDS A&B repositories, registries
Service Oriented Architecture (SOA)
Hosting services w/24x7 support, security, backup/recovery
Secure message routing
Secure, encrypted exchange with NwHIN and a federal agency
Open source interoperability standards and run time software (model
driven messaging interoperability)

48. 48 2008 PHIN Conference 25 August 2008
eHealth Exchange
Health Bank or
PHR Support Organization
Community #1
Integrated
Delivery
System
Community
Health Centers
Community #2
State and
Local Gov
Labs
Pharmacies
VA
CMS
DoD
SSA
The Internet
Standards, Specifications and Data Use & Reciprocal Support
Agreement (DURSA) for Secure Connections
Shared trust framework and
rules of the road
Source: Mariann Yeager, Executive Director
HealtheWay, HIMSS HIE Symposium, March
2013

49. eHealth Exchange Anchor Participants
49Source: Mariann Yeager, Executive Director HealtheWay, HIMSS HIE Symposium, March
2013

50. Connecting Michigan for Health Conference
June 5, 2013

51. UPHIE Value Proposition
• Unique demands of rural healthcare
• Distance, weather, access to specialty services
• Small practices distributed over a large geographic
area
• Financial resources limited
• Implementation from a “Community View”
perspective
• 80% of the care in rural communities stays in the
community
• How can we bring the most value to each community

52. UPHIE – Provider Participation
2012
2013
Aspirus Grandview
Aspirus Keweenaw
Aspirus Ontonagon
Portage Health
Baraga County Memorial Hospital
Marquette
General Health
System
Bell Memorial
Northstar Health
System
Dickinson County
Healthcare
System
OSF St. Francis
Hospital
Munising
Memorial Hospital
Schoolcraft
Memorial Hospital
Helen Newberry
Joy Hospital
Mackinac Straits Hospital
War Memorial
Hospital
• 9 Hospitals
• 35 Physician Clinics
• 3 Tribal Health Clinics

53. UPHIE
Community
Virtual Health
Record
UP-Wide
eMPI/RLS
Data
Management
& Access
Population
Health Data
Aggregation
Outreach/
Connectivity
Where we are…
•MCIR Immunization
Submission/Query
•MSSS/MDSSS
•Statewide Provider
Directory (HPD)
Hospital
•EHR
•Results/CCD Exchange
•Secure Messaging
•Referrals
PCP /Specialist
•EHR
•Results/CCD Exchange
•Secure Messaging
•Referrals
Enables effective
communication with
those outside your
enterprise,
community and
State
UPHIE manages
certificates & role
based access across
entire UPHIE enterprise
ANCILLARY
•EHR
•Results/CCD Exchange
•Secure Messaging
•Referrals

54. • ADT, Lab, Radiology and Transcription data integrated into
Community-Wide Virtual Health Record (ICA’s CareAlign
platform)
• Collaboration with critical rural health care providers including:
• Health Departments, Tribal Health Centers, VA Health
Centers, Medicaid/Medicare Payer
• Direct Messaging Exchange Hub
• MiHIN Use Case Participation
• Public Health Reporting (Immunizations, reportable labs,
syndromics)
• Statewide Health Provider Directory
• Statewide ADT and Transitions of Care Service
• Federal Use Cases (SSA, VA, CMS, NwHIN)
UPHIE Use Cases

55. UPHIE Pilot Projects
• Northcare Behavioral Health Pilot – enables the exchange of
electronic health data between behavioral and physical health
providers. Enables better case management and continuity of
care between the behavioral health community, providers and
the UP Health Plan for Medicaid/Medicare members.
• Medicaid/Medicare Health Plan Data Pilot – project would
populate health plan medical and pharmacy claims into the
community virtual health record. Allows providers to see
historical procedures, diagnosis, inpatient/outpatient visits,
current/past medications, and a list of providers the patient has
seen in the past 2 years.
• Oscar G. Johnson VA Medical Center – project would allow
data exchange and Direct secure messaging between VA staff
and provider community in the UP. Allows for health data to be
shared between VA providers and community providers to
allow for better continuity of care.

56. Thank you for your participation
Contact us:
Jeff Livesay
Associate Director
livesay@mihin.org