The Michigan Health Information Network has found a route to indispensability for health information exchanges: a “use case factory” 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’s organizers say.

“The problem is that [HIEs] have said to providers, ‘Connect to us and good stuff will happen,’ “ says Tim Pletcher, M.D., executive director of MiHIN, a state-chartered organization. “We think people only do what they’re paid to do or punished for not doing.”

Michigan state capitol building
Michigan state capitol building

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

MiHIN first established several specific transactions—for example, immunization reports and syndromic surveillance reports—that 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.

“We have some participating practices that get paid to do care transitions but didn’t even know their patients were hitting those revolving doors,” Pletcher says. “They did 10 times more care transitions” 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. “They called her and reminded her that she had an appointment on Monday, and that the office was open every Saturday until noon,” he says. “She stopped going to the ER.”

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’s 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’s 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.

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Legal connectivity is every bit as important as technical connectivity.

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’ information. While the transparent flow of information has great potential to improve patients’ 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’s 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’s in place, there are sub-agreements for each use case, so that the general agreement doesn’t need to bear the burden of every detail. “The use case agreement defines the rules of sharing the information,” 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.

“Legal connectivity is every bit as important as technical connectivity,” 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—an additional method of identifying patients in Michigan’s statewide master patient index that is expected to improve patient matching.

“The use cases are modular, like Legos,” Pletcher says. “Each one reuses all the pieces of the ones before, and with each one we get better, faster and more efficient.”

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