The Regional Perspective: SE MI-HIE Brian McPherson January 8, 2007

1. The Regional Perspective: SE MI-HIE Brian McPherson January 8, 2007

2. SE Michigan Healthcare Information Exchange (SE-MI HIE) Overview

3. SE-MI HIE Overview • The SE MI HIE is a developing Healthcare Information Exchange (HIE) comprised of stakeholders in the following counties in SE Michigan: Oakland, Wayne, Macomb, Washtenaw, St. Clair, Livingston and Monroe. • Covisint along with employer, provider, insurer, public sector and others stakeholders have been working since March 2006: • to define potential functionality • determine value obtained from various use cases and which constituents will receive the value • Determine initial costs (individual and central) to develop the use cases • Build the foundation for the establishment of a formal governance structure • Build the foundation for developing a funding model which will include operational as well as start up funding

4. SE MI-HIE Overview • The two main objectives of the SE MI HIE are: • To improve patient care by providing physicians across the region clinical data relating to their patients so that they can make decisions about care delivery based upon all available information; and • To reduce the cost of health care delivery in the region by providing more complete information earlier in the care delivery process resulting in tests or studies that do not need to be repeated, inpatient stays that may be avoided and other areas where treatment may be less costly due to having more complete information available earlier in the process.

5. SE-MI HIE Current Status

6. SE-MI HIE Current Status • Phase 1: • - Community Stakeholder Involvement • - Define What “It” Is • - Begin to Establish Trust Across Community Members • Determine Initial Willingness to Move Forward • Multiple Community Work Groups Formed • Phase 2: • Governance Planning • Funding Planning • Value Prop/Cost Determination • Phase 3: • Transition to formal governance (planning) structure (1/1/07) led by Altarum • * Note: The SE MI-HIE also was represented on every MiHIN Work Group

7. SE-MI HIE – How Did We Get There? What is “It”?

8. Function to Outcome v1.1

10. Solution Road Map: High Level Prioritization Stage Short Term Mid Term Long Term • Document Retrieval/Distribution • PHR (patient entered) • Data Retrieval/Distribution • Performance reporting • PHR - education • Administrative Streamlining • Provider to payer portal • Claims attachments • Eligibility messaging • Un/Structured data (ProviderLink) • Upfront Request/Orders(Support • Patient ID) • Referral to Specialist • E-Prescribe • Data Retrieval/Distribution • POC decision support • Public health reporting • Clinical research • Administrative Streamlining: • Medical ATM • PHR (provider entered) • RLS (links labs, rads, etc • Centralized History (eg. allergies, • problem lists, medication lists) • Results Delivery • Lab report results • Radiology report results • Consult results/Referral Reports • Document Retrieval/Distribution • Lab report results • Radiology report results • Admission/ED visit notification • Drugs/Medication List • Allergies • Un/Structured data (Provider Link) • Discharge Summary • Problem List • Third Party Data Sharing Functionality • Initially, focused on: • Employer Groups • SE MI Providers • Hospitals • Physician/Clinician practices • Radiology centers • Labs centers • PBMs/Pharmacies • Clinics • Application Vendors • Third Party Companies (e.g. Disease management for the employer groups) • Additional Participants • Additional employer groups • Additional providers • Additional application vendors • Additional third parties • Other MI RHIOs/Regions • Payers/Carriers • Additional participants • Additional employer groups • Additional providers • Additional application vendors • Additional third parties • Additional payers • Government agencies • Banks • Other State’s RHIOs/Regions Participants Version 1.1

11. SE-MI HIE – How Did We Get There? Who is participating?

12. Stakeholder Participation Employers Providers Key: Bold = In Community Effort Plain = Contacted/Interested GM Ford DCX Compuware DTE Kelly Services Health Systems ACS Covansys City of Detroit Comerica Federal Employees SE-MI Medical Societies/Clinics Oakland County MS Wayne County MS MSMS Genesee County Health Dep’t Washtenaw County MS Early Solutions Clinics Community Care Centers Behavioral Health Health Systems/Hospitals Oakwood DMC U of M Henry Ford Trinity St. John/Ascension Mt Clemens General Crittenton North Oakland MC Garden City Botsford Karmanos Cancer Institute Beaumont Foote Physician Groups/Practices United Physicians DMC Physicians Group Wayne State Physicians Integrated Health Assoc. St. John Medical Group Huron Valley Physicians Group Olympia Medical Svcs. U of M Physicians Henry Ford Medical Group United Oakwood Physicians Infinity Primary Care Michigan Primary Care Assoc.

13. Stakeholder Participation Key: Bold = In Community Effort Plain = Contacted/Interested Others Insurers Vendors RXHub, SureScripts Quest, JVHL LabCorp, Initiate Misys, NextGen Cerner, Epic, IDX PBM’s / Pharmacies MCARE Humana Aetna/PPOM Cigna- TBD BCBSM BCN United Healthcare HAP CareChoices Community Representatives GDAHC MI-HIMSS State of MI MiHIN MHA Altarum Detroit Wayne County Health Authority Detroit Regional Chamber CHT Voices of Detroit Veteran’s Administration Medicare/Medicaid

14. SE-MI HIE – How Did We Get There? Now What?

15. How do we get it off the ground? • “We do not want this effort to be like those with the CHINs” • Do not allow excuses to get in the way • HIPAA is not an excuse. • Technology is not an excuse.

16. HIE Technology Components • MPI is working across the country (Initiate, RXHub, etc.) • Centralized/Decentralized Models are Available • Privacy & Security can be implemented (however defined) • Federated Identity and Access Management (FIAM) • Real-time any-to-any message translation and delivery engine • Portal framework • ASP/subscription models

17. How do we get it off the ground? • What if we do not have an EMR?

18. I've already sent it over twice! That fax must have been lost or picked up by the wrong person. I've been on hold for forty minutes! We never got your request. I have requested this several times! It will take three to six weeks to get that to you. I cannot do my job until you do yours!

19. But what about my Provider…Managing Unstructured Data

20. Private Payor Hospital Phone Email Fax Postal Mail Proprietary Portal EDI DME Provider Skill Facility Medicaid/TPA Home Agency Pharmacy PCP Physician Specialist Unplanned Community Approach (before)

21. Private Payor Hospital Home Health/SNF MH Provider Your Facility PCP Physician Specialist Medicaid/TPA DME Provider Pharmacy Planned Community Approach (After)

22. Adoption Strategy Composite Applications Application Interoperability (Messaging Web Based Data (Portal) Unstructured Data (Fax) Fax-Only Communication Any to Any Messaging

23. Physician/Clinician Desktop Portal

24. How do we get it off the ground? • “We do not want this effort to be like those with the CHINs” • RHIOs/HIEs up and running across the country • Trading Areas in Michigan defined via MiHIN • 4. Items that need to be addressed • a) Participation / Politics • 1) all interested clinicians and service providers • 2) focus on healthcare exchange of data (and the value of it) • b ) Value / Desire to Participate • c) Governance • d) Funding • e) Standards (clinical, technical) • f) Finding the take off point (functionality & organizations) • g) Go (pilot, limited functionality, etc.)

25. Final Thoughts • Michigan has several RHIO initiatives underway • Some organizations are involved in multiple efforts • Following standards will be critical so inter-connecting RHIOs and connecting to them is not a science project each time • The focus of each RHIO is different so while there will be consistencies there also will be major differences in the use cases, technology and value obtained • You do not need an EMR to participate in a RHIO

26. Final Thoughts • MANY efforts are underway by organizations who want to implement interoperability-based solutions prior to the RHIO in their area actually going live (as this may be 2+ years or more in some cases) • Not limited to major health systems and physician groups. Many service providers (ambulance companies, mental health, dentists, pharmacies, radiology, lab, clinics, etc.) all need to be included • Cannot just cover the insured population. The HIE must include the uninsured and underinsured. • There are many excuses not to make an HIE work, those that look for them find them. Those that address them have made some great strides.

27. SE-MI HIE – How Did We Get There? Questions? Thank you! For copies of my presentation or to contact me please call (248) 821-3023 or email me at brian.mcpherson@covisint.com

28. Thank you! For copies of my presentation or to contact me please call (248) 821-3023 or email me at brian.mcpherson@covisint.com