Michigan Health Information Network Shared Services Beth Nagel

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

Vocabulary Test Health 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 nonaffiliated 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 n Clinicians have incomplete knowledge of their patients q q n 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 n Only industry that is truly ‘life and death’ q n n Constantly changing key factors of; n Patient needs n Treatment choices n Patient mobility n 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? n Reducing costs & Increasing quality of healthcare is an economic issue n Ability to determine health status and track health outcomes is essential to effective public policy n Government is a purchaser, a payer and a provider n 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

Mi. HIN: The History n 2005 – Michigan kicks off a multi stakeholder, all inclusive approach to completing a statewide HIE roadmap n 2006 – The Michigan’s HIE roadmap - Mi. HIN Conduit to Care - is completed and released n 2006 – Legislation is signed to create the Michigan HIT Commission n 2007 & 2008 – Michigan invests $10 million in regional HIE planning and implementation n 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 • q. Incentives q$40 billion • q. Assistance q$640 million • q. Exchange q$550 Medicare & Medicaid EHR Incentives to providers who adopt and meaningfully use EHR technologies million Regional HIT Extension Centers provides handson assistance to providers to guide through planning, implementation and meaningful use of HIT State HIE Cooperative Agreement funds state level Health Information Exchange and builds toward a National Health Information Network 11

ARRA HIT Programs in Michigan State HIE Cooperative Agreement EHR Incentives Regional HIT Extension Center Beacon Community Michigan’s Corresponding Initiatives Mi. HIN $14. 99 MILLION Michigan Medicaid EHR Incentives $200 MILLION? ? M-CEITA SEMHIE $19. 6 MILLION $16 MILLION

State HIE Cooperative Agreement n Issued by the Office of the National Coordinator for HIT n Michigan’s Award: $14, 993, 085 n Four year cooperative agreement n Matching funding requirements escalate (0% first year, 10% second, 14% third, 33% fourth) n Goal: an interoperable statewide health information exchange 13

Michigan’s Approach n Convene Stakeholders q q Kick-off event in November with over 300 organizations represented Organized five workgroups with over 100 organizations directly involved q All workgroups open to the public q All information (schedule, agendas, materials) posted q Voting members elected by peer voting process q Co-chairs: 1 public and 1 private 14

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 Governance Work Group Finance Business Operations Technical Privacy & Security 15

Workgroup Deliverables n n n Strategic & Operational Plans submitted on April 30 to the ONC 8 States approved Awaiting approval for Mi. HIN plans

Technology n Guiding Principles: q q q 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 q Incremental approach q Build only the minimum necessary 17

Technical Architecture funded by State HIE Cooperative Agreement 18

Technical Architecture n Benefits q Builds upon sub-state HIEs q “Skinny” set of technologies that can scale up over time q Connects public health reporting and surveillance q Functionality provides value at a low cost q “Behind the scenes” service that allows providers to have multiple HIE choices 19

Governance n Guiding Principles q q q Multi-stakeholder collaboration is needed to implement achievable and measurable initiatives The Mi. HIN will leverage existing and planned information technology Those that benefit should participate in paying the cost Adoption and use of the Mi. HIN is critical to success The Mi. HIN will conform to applicable federal guidelines 20

Governance Coordinated Governance Model relies on two distinct entities that have unique responsibilities Mi. HIN 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 Shared Services Governance Board Governs the Business & Technical Operations of Mi. HIN Shared Services “State Designated Entity” Authority of the Mi. HIN Shared Services Implements financing structures 21

Coordinated Governance Model n Benefits q q q q q 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 22

Creating the Non-profit Entity n Defined Board q 10 seats for direct customers n n q 2 seats for state government n n q n 7 sub state HIEs 3 Payers Medicaid Public Health 1 HIT Commissioner Open, transparent process for seating initial board q q q Bylaws drafted by Mi. HIN Governance Workgroup Criteria laid out in public forum HIT Commission assists in nomination review 23

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

Long-Term Sustainability n Strategy q q q q n 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 Mi. HIN Shared Services Governance Board Set savings and quality metrics for Medicaid and all payers Business Plan q Due February 2011 25

There is nothing funny about privacy

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

Next Steps n Plan approval from the ONC q q n Create the non-profit entity q q n 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 Articles of Incorporation First Meeting Update public health systems q MCIR and MDSS interoperability with bi-directional communication 28