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

1. HIT AND HIE IN THE STATEHIT AND HIE IN THE STATE
OF MICHIGANOF MICHIGAN
Meghan Sifuentes Vanderstelt
HIT Manager
Michigan Department of Community Health
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DEPARTMENT OF COMMUNITY HEALTH
2013 STRATEGIC PRIORITIES
MISSION
MDCH will protect, preserve, and promote the health and safety
of the people of Michigan with particular attention to providing for
the needs of vulnerable and under-served populations.
VISION
Improving the experience of care, improving the health of
populations, and reducing per capita costs of health care.
STRATEGIC PRIORITIES
Improve Population Health
Transform the System of Care
Reform the Health Care System
Transform the Department of Community Health

3. THE SIM OPPORTUNITY
(State Innovation Model)
•Collaborating to create meaningful system change in order
to
Improve Care
Improve Health Outcomes
Reduce Costs
•Create a State Healthcare Innovation Plan (SHIP)
• Funding to bring together a broad base of stakeholders to plan
an innovative, multi-payer and multi-sector health care delivery
system transformation
•Testing and implementation funding anticipated
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Center for Medicare and Medicaid Innovation- CMS

4. State Innovation Model (SIM) &
The State Healthcare Innovation Plan
(SHIP)
• Major deliverable – done by September
• SIM Advisory Committee asked to provide input:
• Consider Michigan’s health system, payment models,
performance metrics “as is” and “to be”
• Develop a roadmap for health system transformation
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5. Michigan’s Plan
• Multi-payer, multi-stakeholder, multi-system approach to develop and
test comprehensive system reform
• Invest in a lifetime of good health for people and communities
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6. Innovations being tested
• MiPCT
• Value Partnerships
• Care Bridge
• Health Information Exchange
• Trailblazers
• Community Linkages
• Strengthen Public Health Infrastructure for Improved
Health Outcomes
• Maternal and Child Health Initiatives
• MI Healthcare Workforce Planning Team
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8. The Health Information
Technology Commission
(HITC)
The Health Information Technology Commission is created
within the department to facilitate and promote the design,
implementation, operation, and maintenance of an
interoperable health care information infrastructure in this
state.
HIT Commission Public Act 137-2006
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9. HITC Job Description
• Develop and maintain a strategic plan to guide implementation
of an interoperable health information technology system
• Perform activities within HIT scope as directed by MDCH and
DTMB
• ID strategies to improve ability to monitor health status
• Provide recommendations on policy to achieve HIT adoption
• ID critical issues that affect private/public adoption
• Technical
• Scientific
• Economic
• Governance
• Other
• Increase public’s understanding of HIT
• Promote effective and efficient communication among health
care providers:
• Hospital, physicians, payers, employers, pharmacies, labs, and other
health care entities
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10. 2013 HITC Objectives
Objective: To recommend and advise the Michigan Department of Community Health on Policy
decisions, business and technical needs, and general oversight for the following HIT activities
essential to the State of Michigan HIT and HIE landscape during 2013.
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11. Role of HIT and HIE Stakeholders
• Identify new and emerging best practices
• Provide input for evolving policy framework
• Collaborate and identify potential crossover opportunities
• Coordinate and further advance HIT and HIE in Michigan
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12. Vision beyond HIT and HIE
• Research
• Quality improvement
• Inspire confidence and trust in health IT
• Empower the consumer to be more actively
involved in their health care
• Improve population health
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13. Roadmap For Reforming The
Healthcare System
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15. Michigan Medicaid EHRMichigan Medicaid EHR
Incentive Program UpdateIncentive Program Update
June 5, 2013June 5, 2013
Jason Werner, MDCHJason Werner, MDCH

16. Program Summary
This ARRA funded program provides financial
incentives (100% Federal) to eligible
Medicaid professionals and hospitals to
meaningfully use (MU) a certified EHR
technology.
Program administration (90% Federal) is the
responsibility of DCH.

17. Eligible Professionals:
(Non-hospital based with at least 30% Medicaid volume)
• Physicians/Pediatricians (20%)
• Optometrists
• Dentists
• Certified Nurse Mid-wives
• Nurse Practitioners
• Physician Assistants (PA) practicing in a PA-led FQHC or
Rural Health Clinic
Hospitals:
• Acute care -- at least 10% Medicaid volume
• Children’s hospitals
• Critical access hospitals
Who Is Eligible to Receive the
Medicaid Incentive Payments?

18. Certified EHR
Technology
Office of National Coordinator (ONC)
maintains the list of complete EHRs and EHR
modules that have been tested and
certified.
There are now 6 certifying bodies and over
3,000 certified products.
Certified = Capable of meeting Meaningful
Use (MU).

19. Meaningful Use Timeline
Meaningful Use Stage
1st year 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
2011 AIU 1 1 2 2 3 TBD TBD TBD TBD TBD
2012 AIU 1 1 2 2 3 TBD TBD TBD TBD
2013 AIU 1 1 2 2 3 TBD TBD TBD
2014 AIU 1 1 2 2 3 TBD TBD
2015 AIU 1 1 2 2 3 TBD
2016 AIU 1 1 2 2 3

20. Stage 1 vs. Stage 2
*Regardless of the stage of MU, all providers will complete this
number of CQMs in 2014
Stage I
15 Core
5 of 10 Menu
6 of 44 CQM’s
Total of 26 Objectives
Stage II
17 Core
3 of 6 Menu
*9 of 64 CQM’s
Total of 29 Objectives
Effective 4/20/2012 Effective 1/1/2014

21. Core Objectives Comparison
Core Objective Stage 1 Stage 2
1 CPOE Use CPOE for >30% of
medications
Use CPOE for > 60% of medications,
30% of laboratory and 30% of
radiology
2 e-Rx e-Rx for >40% e-Rx for >50%
3 Demographics Record demographics for >50% Record demographics for >80%
4 Vital Signs Record vital signs for >50% Record vital signs for >80%
5 Smoking Status Record smoking status for >50% Record smoking status for >80%
6 CDS Interventions Implement 1 clinical decision
support rule. Drug/drug and
drug/allergy is separate Core
Objective in Stage 1
Implement 5 clinical decision
support interventions and drug/drug
and drug/allergy
7 Labs Menu Objective in Stage 1;
Incorporate lab results for >40%
Incorporate lab results for >55%
8 Patient List Menu Objective in Stage 1;
Must generate one report
Generate patient list by specific
condition

22. Core Objectives Comparison
Core Objective Stage 1 Stage 2
9 Preventive Measures Menu Objective in Stage 1;
Reminders for follow up care
for >20% of patients ≤ 5 or ≥ 65
years of age
Reminders for follow up
care for >10% of patients
with two or more office
visits in the last 2 years
10 Patient Access Menu Objective in Stage 1;
Provide online access to health
information for >10% within 4
business days of EHR update
Provide online access to
health information for
>50% with >5% actually
accessing
11 Visit Summaries Provide summaries for >50% of
office visits within 3 business
days
Provide summaries for
>50% of office visits within
1 business day
12 Education Resources Menu Objective in Stage 1;
Provide education resources for
>10% of all unique patients
Provide education
resources for >10% of all
unique patients
13 Secure Messages New for Stage 2 More than 5% of patients
send secure messages to
their EP

23. Core Objectives Comparison
Core Objective Stage 1 Stage 2
14 Medication
Reconciliation
Menu Objective in Stage 1;
Medication Reconciliation for
>50% of transitions of care
Medication Reconciliation for
>50% of transitions of care
15 Summary of Care Menu Objective in Stage 1;
Provide documents for >50% of
transitions of care/referrals
Provide documents for >50% of
transitions of care/referrals
with 10% sent electronically.
At least one is sent to a
recipient with a different EHR
vendor or successfully testing
with CMS test EHR
16 Immunizations Menu Objective in Stage 1;
Perform one successful test
transmission of immunization
data
Successful ongoing transmission
of immunization data
17 Security Analysis Conduct or review security
analysis and incorporate in risk
management process
Conduct or review security
analysis and incorporate in risk
management process

24. Stage 2 – EPs must select 3 our of 6
Menu
Menu Objective Stage 1 Stage 2
1 Imaging Results New for Stage 2 More than 20% of imaging
results are accessible through
CEHRT
2 Family History New for Stage 2 Record Family History for >20%
3 Syndromic Surveillance Successful ongoing
transmission of syndromic
surveillance data
Successful ongoing transmission
of syndromic surveillance data
4 Cancer New for Stage 2 Successful ongoing transmission
of cancer case information
5 Specialized Registry New for Stage 2 Successful ongoing transmission
of data to specialized registry
6 Progress Notes New for Stage 2 Enter an electronic progress
note for >30% of unique
patients

25. CQMs in 2014 and Beyond
CQM Changes in 2014
Provider Prior to 2014 2014 and Beyond*
EPs Complete 6 out of 44
•3 Core or 3 Alternate core
•3 Additional CQMs
Complete 9 out of 64
Choose at least 1 measure
from 3 of 6 NQS domains
*Regardless of the stage of MU, all providers will complete this number of CQMs in 2014

26. Auditing
MDCH is responsible for the auditing
function including Meaningful Use (MU)
To help with the audit function related to
MU Public Health testing, MDCH has created
a MU repository

27. What is this MU Repository?
Tool used by the Michigan Department of
Community Health (MDCH) to track providers
in the State of Michigan that wish to meet
electronic public health reporting meaningful
use requirements.

28. Medicare?
CMS is running a similar program for
Medicare providers.
Professionals can only claim one incentive
program (either Medicaid or Medicare).
Very similar eligibility criteria.
10,991 Medicare providers have registered
with 8,121 having received a payment.

29. Incentive Payment for
Eligible Professionals
First Calendar Year in which the EP receives an Incentive Payment
Calendar
Year
CY 2011 CY 2012 CY 2013 CY 2014 CY 2015 CY 2016
2011 $21,250
2012 $8,500 $21,250
2013 $8,500 $8,500 $21,250
2014 $8,500 $8,500 $8,500 $21,250
2015 $8,500 $8,500 $8,500 $8,500 $21,250
2016 $8,500 $8,500 $8,500 $8,500 $8,500 $21,250
2017 $8,500 $8,500 $8,500 $8,500 $8,500
2018 $8,500 $8,500 $8,500 $8,500
2019 $8,500 $8,500 $8,500
2020 $8,500 $8,500
2021 $8,500
Total $63,750 $63,750 $63,750 $63,750 $63,750 $63,750

30. Incentive Payment for
Eligible Hospitals
Payments are formula driven and will vary
per hospital.
Most hospitals will receive between $1-$3
million.
Payments are made over 3 years at a 50%,
40%, 10% ratio.
MDCH will utilize cost report data in
deriving the incentive amount.

31. Registrations/Payments
As of 5/29/2013
Registered
Paid
Under
AIU
Paid
Under
MU
Total
Payments
Dollars Paid
(In Millions)
EP 3,756 2,516 431 2,947 $55.6
EH 117 93 50 143 $108.6
Totals 3,873 2,609 481 3,090 $164.2

32. What the rest of 2013 holds?
Launching Stage II of MU
Getting Registration System Ready
Getting Public Health Registries Ready
Getting MU Repository Ready (MSSS, Cancer,
CDR)
Increasing MU Adoption Rates
Electronic Clinical Quality Reporting

33. www.MichiganHealthIT.org
Questions?