Michigan Health Information Network Shared Services

1. Michigan Health Information Network Shared Services Beth Nagel, HIT Manager Michigan Department of Community Health November 10, 2010 www.michigan.gov/mdch

2. Vocabulary Test

3. 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

4. “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…”

6. 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.

7. 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

8. “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

9. 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

10. ARRA: HIT Game Changer The biggest investment in HIT in the U.S. EVER

11. ARRA HIT Programs

12. ARRA HIT Programs in Michigan State HIE Cooperative Agreement EHRIncentives Regional HIT Extension Center Beacon Community Michigan’s Corresponding Initiatives M-CEITA SEMHIE MiHIN Michigan Medicaid EHR Incentives $14.99 MILLION $200 MILLION?? $19.6 MILLION $16 MILLION

13. 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

14. 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

15. Governance Work Group Finance Business Operations Technical Privacy & Security Workgroup Structure Federal Administrative Office of the State HIE Cooperative Agreement Program Office of the National Coordinator for HIT State HIE Cooperative Agreement Applicant MDCH & DTMB Stakeholder Input Structure HIT Commission

16. Workgroup Deliverables • Strategic & Operational Plans submitted on April 30 to the ONC • 8 States approved • Awaiting approval for MiHIN plans

17. 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

18. Technical Architecture Architecture funded by State HIE Cooperative Agreement

19. 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

20. 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

21. MiHIN Shared Services Governance Board • Coordination & Collaboration • Public & Private HIT Commission Governs the Business & Technical Operations of MiHIN Shared Services Statewide & National Vision Monitors statewide progress of HIT & HIE “State Designated Entity” Facilitates public discussion Authority of the MiHIN Shared Services Recommends public policy Provides the voice of the public Implements financing structures Governance Coordinated Governance Model relies on two distinct entities that have unique responsibilities

22. 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

23. 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

24. 2010 2011 2012 2013 2014 2015 Expenses by Source Estimated expenses from 4/30/10 - subject to change

25. 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

26. There is nothing funny about privacy

27. A Balancing Act of Privacy Policies • Urgent Need for Patient Data at the Point of Care • Patient Privacy Risk • Patient Concern • False security in paper Patient Privacy Policies: Authentication, Authorization, Access, Audit, Breach

28. 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 28