[{"innerBlocks":[],"name":"core\/freeform","postId":4852,"blockType":{"name":"core\/freeform","keywords":[],"attributes":{"content":{"type":"string","source":"raw"},"lock":{"type":"object"}},"providesContext":[],"usesContext":[],"selectors":[],"supports":{"className":false,"customClassName":false,"reusable":false},"styles":[],"variations":[],"apiVersion":3,"title":"Classic","description":"Use the classic WordPress editor.","category":"text"},"originalContent":"The Michigan Health Information Network has found a route to indispensability for health information exchanges: a \u201cuse case factory\u201d that enables providers to adopt HIE one transaction type at a time, starting with the ones that help them either comply with regulations or protect their revenues.

The approach makes a solid business case for using an HIE while enabling users to go at their own pace, the network\u2019s organizers say.

\u201cThe problem is that [HIEs] have said to providers, \u2018Connect to us and good stuff will happen,\u2019 \u201c says Tim Pletcher, M.D., executive director of MiHIN, a state-chartered organization. \u201cWe think people only do what they\u2019re paid to do or punished for not doing.\u201d

MiHIN supplies infrastructure and consulting services to Michigan\u2019s regional health information exchanges and helps them link their resources to provide statewide information sharing.

MiHIN first established several specific transactions\u2014for example, immunization reports and syndromic surveillance reports\u2014that help participating providers meet both state public health reporting requirements and Meaningful Use requirements. It also has instituted admission\/discharge\/transfer (ADT) reporting, along with the capability of pushing those reports to physicians who have an active care relationship with the patient and want to be aware of hospital stays with which they were not involved. That capability will be increasingly essential for providers who participate in accountable care arrangements and also for those who are paid for managing care transitions.

\u201cWe have some participating practices that get paid to do care transitions but didn\u2019t even know their patients were hitting those revolving doors,\u201d Pletcher says. \u201cThey did 10 times more care transitions\u201d after they started receiving ADT notifications from MiHIN. One practice discovered that one of its patients was going to an emergency department every Saturday afternoon, Pletcher says. \u201cThey called her and reminded her that she had an appointment on Monday, and that the office was open every Saturday until noon,\u201d he says. \u201cShe stopped going to the ER.\u201d

Use of the network has climbed steadily. Last week, it carried more than 9 million messages. Providers submitted more than 6 million ADT notifications, representing about 97 percent of the state\u2019s hospital admissions, Pletcher estimates, and the system pushed 1.7 million ADT notifications to providers who have requested to receive them.

Almost 1 million of the messages contained syndromic surveillance data submitted to the state, and more than 240,000 immunization reports were submitted as well.

As of the end of January, MiHIN had carried a total of 414 million messages since its inception in 2010. Pletcher estimates that every provider in the state uses the network to submit data for at least one transaction, and almost 10,000 physicians are set up to receive ADT information on about 9 million patients.

MiHIN\u2019s participating exchanges including Great Lakes Health Connect, Ingenium, Michiana Health Information Network, Northern Physicians Organization, Southeast Michigan Health Information Exchange, and Upper Peninsula Health Information Exchange. The National eHealth Exchange is also a member.

Legal connectivity is every bit as important as technical connectivity.<\/bsp-quote>Sharing information can be not only technically daunting, but legally and financially risky for providers, who historically have found competitive advantages in controlling access to their patients\u2019 information. While the transparent flow of information has great potential to improve patients\u2019 care, it also makes them less beholden to the providers who create and compile that information. It also may pose security and privacy risks that providers may be reluctant to take without a compelling reason.

Creating governance for MiHIN\u2019s use cases is a two-step process, Pletcher says. The first step is an overarching agreement between the exchange and the provider that includes general guidelines for HIE participation and establishes that the provider is a trusted source of information.

Once that\u2019s in place, there are sub-agreements for each use case, so that the general agreement doesn\u2019t need to bear the burden of every detail. \u201cThe use case agreement defines the rules of sharing the information,\u201d Pletcher says. Those rules are particularly important in situations where the participants are not under a single ownership, for example, when a hospital system needs the cooperation of physicians who operate independently.

\u201cLegal connectivity is every bit as important as technical connectivity,\u201d Pletcher says.

Prioritizing the use cases depends on the enthusiasm of the user community, Pletcher says. The current queue includes advance directive information, discharge medication reconciliation, and a common key service\u2014an additional method of identifying patients in Michigan\u2019s statewide master patient index that is expected to improve patient matching.

\u201cThe use cases are modular, like Legos,\u201d Pletcher says. \u201cEach one reuses all the pieces of the ones before, and with each one we get better, faster and more efficient.\u201d","saveContent":"The Michigan Health Information Network has found a route to indispensability for health information exchanges: a \u201cuse case factory\u201d that enables providers to adopt HIE one transaction type at a time, starting with the ones that help them either comply with regulations or protect their revenues.

The approach makes a solid business case for using an HIE while enabling users to go at their own pace, the network\u2019s organizers say.

\u201cThe problem is that [HIEs] have said to providers, \u2018Connect to us and good stuff will happen,\u2019 \u201c says Tim Pletcher, M.D., executive director of MiHIN, a state-chartered organization. \u201cWe think people only do what they\u2019re paid to do or punished for not doing.\u201d

Legal connectivity is every bit as important as technical connectivity.<\/bsp-quote>Sharing information can be not only technically daunting, but legally and financially risky for providers, who historically have found competitive advantages in controlling access to their patients\u2019 information. While the transparent flow of information has great potential to improve patients\u2019 care, it also makes them less beholden to the providers who create and compile that information. It also may pose security and privacy risks that providers may be reluctant to take without a compelling reason.

Creating governance for MiHIN\u2019s use cases is a two-step process, Pletcher says. The first step is an overarching agreement between the exchange and the provider that includes general guidelines for HIE participation and establishes that the provider is a trusted source of information.

Once that\u2019s in place, there are sub-agreements for each use case, so that the general agreement doesn\u2019t need to bear the burden of every detail. \u201cThe use case agreement defines the rules of sharing the information,\u201d Pletcher says. Those rules are particularly important in situations where the participants are not under a single ownership, for example, when a hospital system needs the cooperation of physicians who operate independently.

\u201cLegal connectivity is every bit as important as technical connectivity,\u201d Pletcher says.

Prioritizing the use cases depends on the enthusiasm of the user community, Pletcher says. The current queue includes advance directive information, discharge medication reconciliation, and a common key service\u2014an additional method of identifying patients in Michigan\u2019s statewide master patient index that is expected to improve patient matching.

\u201cThe use cases are modular, like Legos,\u201d Pletcher says. \u201cEach one reuses all the pieces of the ones before, and with each one we get better, faster and more efficient.\u201d","order":0,"get_parent":{},"attributes":[],"attributesType":{"content":{"type":"string","source":"raw"},"lock":{"type":"object"}},"dynamicContent":""}]

MI network building its business case one transaction at a time

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