Michigan Health Information Network (MiHIN)
Shared Services
HIE Qualified Organization (HQO)
Application Guide
Version 1.0
Prepared for: Michigan Health Information Network Shared Services (MiHINSS)
Qualified Organizations
Prepared by: MiHIN Staff
December 14, 2013
Copyright 2013 Michigan Health Information Network Shared Services About this Guide* Michigan Health Information Network Shared Services (MiHIN) is publishing this guide to help organizations
better understand requirements and choices that are available when electing to participate in Michigan’s
statewide exchange of health information.
MiHIN will continue to update the information in this guide to ensure accuracy and timeliness. Portions may
change or no longer be current. This guide should be used as a high level planning tool but is not a
replacement for the Qualified Data Sharing Organization Agreement, Data Sharing Agreement, Use Case
Agreements, or any other official contractual requirements for Qualified Organizations (QOs).
If you have questions or would like to receive further information, please send your request to info@mihin.org.
Additional information is also available on our website: www.mihin.org
*MiHIN wishes to recognize and thank the North Carolina Health Information Exchange who
permitted the use of their Qualified Organization Onboarding documentation as a baseline for this
document.
Copyright 2013 Michigan Health Information Network Shared Services TableofContents
Michigan’sInformationExchangeStrategy..............................................................................................................4
TypesofQualifiedOrganizationsEnvisioned..........................................................................................................5
BecomingaQualifiedOrganization..............................................................................................................................5
CommonRequirements................................................................................................................................................5
AdditionalRequirementstobecomeanHealthInformationExchangeQualifiedOrganizations
(HQO)inMichigan..........................................................................................................................................................6
Business....................................................................................................................................................................................6
BusinessRequirements................................................................................................................................................6
MiHINLegalFramework..............................................................................................................................................7
StandardAgreementDescriptions...........................................................................................................................7
LegalAgreementsbyTypeofQualifiedOrganization.....................................................................................8
PricingforAnnualMembershipandServiceFees............................................................................................8
UseCases..................................................................................................................................................................................9
HealthInformationExchangeQualifiedOrganizationApplication.............................................................11
NextSteps.............................................................................................................................................................................13
ListofAbbreviations…………………………….………………………………………………………………………………14
Copyright 2013 Michigan Health Information Network Shared Services Michigan’s Information Exchange Strategy MiHINoperatesasasharednetworkforexchanginghealthinformationstatewide.TheMiHIN
networkissharedbyanevolvingecosystemofqualifiedorganizations,approvedHIE’sthat
typicallyconnectproviders,licensedHealthPlans,orStateandFederalgovernmentagenciesthat
sendandreceivehealthinformation.Becauseofthemassivehealthcareindustry
transformationsandtheacceleratingevolutionofhealthinformationtechnology,theMichigan
approachhasbeendesignedtobeinclusive,ultimatelyincorporatingspecialtynetworksor
functionssuchasinnovativenewmobileorInternetconsumercontrolleddataservicesand
capabilitiesthatemerge.Atahighlevel,Michigan’sstatewidedatasharingapproach:
1. Employsapublic‐privatemodelthatemphasizesdatasharingthroughdefinedUseCases
andensuringmulti‐stakeholderparticipationamongunaffiliatedorganizations(hospitals,
physicians,healthplans,stateandfederalgovernment,etc.)
2. ReliesonMichiganHealthInformationNetworkSharedServices(MiHIN)asthe
designatednon‐profitexchangeentitytointerconnectqualifiedorganizationsandoperate
thesharedgovernancemodelforstatewidedataexchange
3. Dependsonqualifiedhealthinformationorganizations(HIEQOs)suchasMichigan’s
existingsevensub‐stateHealthInformationExchangestoconnectproviders
4. PromotestheuseofnationalstandardsandpublictransparencyviaMichigan’sHealth
InformationTechnologycommission.
5. BuildsuponMichigan’spublichealthcodeandthestagesofMeaningfulUse
Basedontheuniqueneedsofourstate,Michiganhasatwo‐tieredorganizationalstrategythat
utilizesanetworkofQualifiedOrganizations(QOs)toassistinthedeploymentofastatewide
healthinformationsharinginfrastructure.ThismodelallowsMichigantobenefitfromthehealth
informationnetworksalreadyorganizedandtoleverageasetofcoreandvalue‐addedservices
thatbenefitstheentiretyofthestate’shealthcareecosystem.
VariouspotentialstatewideHealthInformationExchangestrategiesareshownbelow,
highlightingMichigan’schoice:
StatewideHIEcentrally
runbyStateGovernment
 StatewideHIEbuilds
Infrastructure
 HIE’sfocusonlocal
adoption/governance
Regionalormedical
tradingareabased
HIEs
 Dividesastateinto
territories
 StatewideHIEprovides
governance,manages
monopolies
Statewidenetworkof
Diversequalified
organizations
 RangeofQOsmake‐up
corestructure
 MiHINgovernanceprocess
providespolicyguidance,
statewidecoreshared
servicesand
interoperability
 Value‐addedservices
benefittherangeof
participants
Purelymarketdriven‐ no
coordinationofservices
 Nocoreservices
 Privatemarketaddresses
interoperability
 Focusesoneducationand
policyguidance
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Types of Qualified Organizations Envisioned InMichigan’smodel,theroleoftheQOistohelporganizeandmanageParticipantsinstatewide
healthcareexchange.Participantscanbehospitals,physicianpractices,seniorcarecenters,
laboratories,publichealthentities,and/ormanyotherdiversemembersofthehealthcare
industry.QOorganizationsaretheconduitforparticipatinginMiHINservices.AQO
organizationmaychoosetoprovideuniqueservicestothemembersoftheircommunityaswell.
MiHINusesa“diverseQO”structurebecauseitprovidesasetofuniqueandinterrelated
benefits:
 Providesthecorecapabilitiestoenableandpromotetheexchangeofhealthinformation
acrossthemanydifferententitiesinthestate
 Recognizesandsupportsthediversesetofhealthcareenvironmentsinthestateand
allowsforeachParticipanttoseekthelevelandnatureofservicerequiredbytheir
organization
 Promotestheefficientuseofresourcesbyleveragingcoreorcommonsharedservices
acrossabroadcommunityofQOs
 ProvideshealthcareorganizationstheflexibilitytodecidewhichQObestservestheir
specificneeds
 Recognizesthathealthcareisdeliveredthroughlocalcommunitieswherecommunitycan
bedefinedinmanydifferentways,yetcreatesaseamlessbackboneforstatewidesharing
ofinformation
ThefollowingcriteriaensurethatMiHIN’sclassificationofaHealthInformationExchange
QualifiedOrganizationidentifiesorganizationsthatcanreliablyandconsistentlysupportefforts
toelectronicallyexchangeclinicalinformationregardlessofthesending/receivingHIS/EMR
systemand/orHIEpartner.
Becoming a Qualified Organization Currently,MiHINisacceptingnominationsfromHealthInformationExchangesandHealthPlans
licensedinMichiganseekingtobecomeanHIEQualifiedOrganizationsorHealthPlanQualified
organizations.
Common Requirements TobecomeaQualifiedDataSharingOrganization(QO),acompanyorentitymust:
Copyright 2013 Michigan Health Information Network Shared Services 5
•
ExecuteandcomplywiththetermsincorporatedwithintheMiHINQualifiedDataSharing
OrganizationAgreement(QDSOA),DataSharingAgreement,andappropriateUseCase
Agreements;
•
UtilizeMiHINSharedServicesandencourageotherentitiestodoso;
•
ProvideanelectronicgatewayconnectionwithMiHINtoallowcross‐QOtransactions;
•
Ensureprivacyandsecurityrequirementsaremet,includingFederalandStatelawsand
MiHINgovernance‐approvedpoliciesrelatedtosecurity,privacy,andaudit;and
•
MaintainproductionabilitytosendandreceivestructuredHL7messagesviaaMiHIN
serviceortheDIRECTand/orothernationaltransportstandardsthatemergeinthe
future.
Additional Requirements to become an Health Information Exchange Qualified Organizations (HQO) in Michigan TobecomeanHIEQualifiedDataSharingOrganization(HQO),acompany/entitymustfulfill
thefollowingrequirementsinadditiontothegeneralrequirementslistedpreviously:
• MaintainoperationsinthestateofMichigan;
•
Demonstratemeaningfulstakeholderinvolvementingovernancestructure;
•
Produce,transmit,andreceivediscrete,structuredmessagesthathavebeensufficiently
mappedandnormalizedtoallowexchangewithotherQOs;
•
Demonstratebidirectionalinteroperabilityamongconnectedsystemsservingatleast250
providers;
•
SupportQueryforDocumenttransactionsviaastandards‐compliantdocument
repository;
•
Committoandimplementnationaldirectives,standards,andrequirements(asreleased
bynationalgovernmentagencies;and
•
ProvideregularreportingthroughMiHINtotheHealthInformationTechnology
Commission(HITC)andtheStateofMichigan.Additionalstatusinformationmaybe
requesteddirectlybytheHITCandStateofMichigan.
Business Business Requirements A key role of a Qualified Organization is to contract with its Participants (e.g. organizations,
employees, subsidiaries, providers, etc.) who wish to participate in the statewide exchange of
healthinformationusingMiHINSharedServices.
Tosuccessfullyperformthisrole,aQOmustdothefollowing:
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


DemonstratetoMiHINthatitisalegalentityingoodstandingwithMichigan’sSecretary
of State and has sufficient resources and governance structure to monitor and provide
oversightofeachQOParticipant'suseofMiHIN.
Providerelevanthistoricalfinancialinformationaswellasorganizationalinformation.
AttestthattheQOhasafinanciallystablebusinessmodelwithpositivefinicalreturnsand
has sufficient resources to pay annual participation and service fee requirements if and
when required, or be positioned to offer in‐kind contributions sufficient to justify their
continuedparticipation.TheMiHINBoardofDirectorsmayrequestdocumentationofthe
financialhealthoftheorganizationperiodically.
MiHIN Legal Framework AQOwillbeapartytoseveralAgreements:
1.TheQualifiedDataSharingOrganizationAgreement(QDSOA)betweenMiHINandQO
(includesaDataSharingAgreement,aHIPAABusinessAssociateAgreement(BAA),a
ConfidentialityAgreement,ProtectionofIntellectualProperty,federalflowdown,andpayment
terms);
2.TheMiHINEndUserLicense
Agreement(EULA)foruseofMiHIN
softwareandservices;
3.EachQOmayhaveseveralQO
ParticipationAgreements,whichallow
passedthroughandpassthrough
provisionsofvariousservicesamong
QOs.TheseAgreementscontainQOand
Participantacknowledgementoftheir
commitmenttoabidebytheQDSOA
termsandtheassociatedUseCase
AgreementsforMiHINServices;and
MiHIN
QualifiedDataSharing
Organization
Agreement(QDSOA)
Sponsored
Sharing
Organization
Agreement
QualifiedOrganization
4.AppropriateUseCaseAgreements
relatedtotheQO’sparticipationin
variousUseCases.
MiHIN
EndUser
License
Agreement
QOParticipation
Agreement
Standard Agreement Descriptions 1. QualifiedDataSharing
OrganizationAgreements
(QDSOA)–Legaldocuments
betweenoneormoreentities
andMiHINthatsetthestagefor
theorganizationstoconnect.
QOParticipants&
Members
Figure1MiHINLegalFramework
2. DataSharingAgreement–Thespecificationsforgeneraldatasharingtermsandprovision
oftheframeworkforimplementingUseCasespecificagreements.
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3. UseCaseAgreements–Thespecificationsthatprescribethedatacontent,technical
connection,use,audit,andsecurityrequirementstheQualifiedDataSharingOrganization
mustfollowtoparticipateinagiventypeofdatasharing(e.g.publichealth,transitionsof
care,medicationhistory,etc.).TheseagreementsarebetweentheQOandtheir
participatingorganizationsandcontainacknowledgementofbothpartiescommitmentto
abidebytheQDSOAtermsandtheassociatedusecase.
Legal Agreements by Type of Qualified Organization Agreement
Purpose
When signed
MiHIN Qualified Data Sharing
Agreement (QDSOA)
This is the primary document used for
organizations that wish to become full MiHIN
data sharing organizations. QDSOA
signatories will take part in at least 2/3 of the
Use Cases and will hold a seat on the MiHIN
Board of Directors.
Within 60-90 days of QO
participating in MiHIN Shared
Services
QO Participant Agreements
This agreement defines the business
relationships between the Participants and the
QO. Each QO is responsible for managing this
process and may include QO specific
requirements and services in the agreement.
Prior to sharing data with MiHIN via
the QO
Pricing for Annual Membership and Service Fees MiHIN’spricingstrategythatincludesanannualParticipation/MembershipFeeforeachtypeof
QO.Thisfeeincludescoreservices.Additionalserviceswillbechargedseparately.Forthe
integrationofaQO,aone‐timeconnectionfeemaybechargedtocovertheintegrationcosts.If
theQOneedssupportwiththeimplementation,MiHINcanofferthoseservicesonacase‐by‐case
basis.Serviceswillbedeployedandpricedonaperservicebasis.
Service
Category
Annual
Participation
Membership
Fees
AllQOs
In‐kindService
AllQOs
Pricing
•
•
HIEQO–Evaluatedcasebycase
HealthPlanQO‐
.05/member/month
In‐kindservicesas
permitted
Copyright 2013 Michigan Health Information Network Shared Services Terms
Annual
Determinedon
individualbasis
8
ServiceFees
AllQOs
SpecifictoeachUseCase
Examples:
• StatewideADTNotification
Service
• ActiveCareRelationshipService
• ProviderDirectoryServices
• DIRECTGatewayServices
• Labs,ADT,Medications,etc.
• ImmunizationQueryforHistory
andForecast
• SecurityServices
• ConsumerDirectoryServices
Ifapplicable,
specifictoeach
UseCase
Custom
Technologyor
Services
AllQOs
SpecialtyEngagementsorContracted
SupportServices
Examples:
• Customdatahandlingservices
• DIRECTfeeds
• Uniquequeryordata
standardization
Standard
MiHINpricing
ortimeand
materials
Use Cases AUseCaseisadatasharingscenariowithaclearpurpose,type/sofdataexchanged,and
descriptionsoftheinteractionsamongthemainpeopleand/orcomputers.EachUseCasemay
havedifferent:
 accessrestrictions
 datausagerules
 costrecoveryfeesorcharges
 technicalrequirements
MiHINUseCasesfallwithinsixbroadcategories:ResultsDelivery,PublicHealthReporting,
PatientSafetyandCareCoordination,QualityandAdministrativeReporting,Consumer
Engagement,andanothercategoryofUseCasesthatfallintothecategoryof“infrastructure”.
Thesecanbedefinedas:
1. ResultsDelivery:Activitiesthatenabletheorderinganddeliveryofthediagnosticstests
andassociatedresults.
2. PublicHealth:Thecaptureanddistributionofinformationsupportingtheactivities
relatedtopublichealth.
3. CareCoordination&PatientSafety:Communicationcollaborationamongmultipleentities
tofollowbestpracticestoobtainmaximizedhealthoutcomes.
4. Quality&Administrative:Theactivitiesrelatedtopaymentandoperationsandqualityor
performancereporting.
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5. PatientEngagement:Theactivitiesrelatedtoinforming,engaging,empowering,and
partneringwithconsumersintheirhealth.
6. Infrastructure:Thecommontechnical,legal,policy,financial,process,functionsnecessary
tosupporttheothercategories.
EachUseCasehasacorrespondingUseCaseAgreement,whichisalegaldocumentthatissigned
byMiHINandtheQO.Thepurposeofthedocumentistodefinetheprimaryandsecondaryuses
ofthedataandmessages,servicefees,servicelevels,auditingrequirements,responsibilitiesof
theparties,andthedataformatandtransmissionspecifications.ImplementationGuidesare
oftenreferencedinUseCaseAgreementsandarelocatedontheMiHINwebsite.
UseCaseAgreementsaredevelopedincoordinationwiththeMiHINOperationsAdvisory
Committee(MOAC)UseCaseWorkingGroup,whichmeetsonamonthlybasis.MIHINmaintains
aUseCaseTracker,adocumentthatlistsallUseCases,theirdescriptions,andthecurrentstage
oftheUseCaseAgreementwithinthelifecycleprocess(draftthroughfullyexecuted).
Figure1UseCasesbyCategory
ActiveCare
Relationship
Services
PatientOpt‐In
Preferences
MasterPersonIndex
FiDM
Gateway
Services(e.g.
XCA)
Identity
Management
HealthProvider
Directory
SecureTransportLayerServicesandDigitalCredentials
Figure2InfrastructureUseCases
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HealthInformationExchangeQualifiedOrganizationApplication
1. OfficialLegalName:
2. OfficialBusinessContact:
a. Name:
b. Title:
c. Phone:
d. Email:
3. TypeofLegalEntity(LLC,501c3,etc.):
4. YearFormed:
5. FederalIdentificationNumber:
6. Corporatewebsite:
7. Please briefly describe your organization and the types of health information sharing
servicesofferedalongwiththeprimarycommunityserved:
8. Howmanyprovidersdoyoucurrentlyserve?
9. HowmanyEHRvendorsdoyoucurrentlyconnectorinteractwith?
10. Pleasedescribeyourproceduresfordataqualityanddatanormalization.
11. PleasebrieflydescribetheMiHINservicesandUseCaseyouwishtoparticipatein:
12. Pleaserespondwithyesornotoeachofthefollowing:
a. AreyouabletoexecuteandcomplywiththetermsincorporatedwithintheMiHIN
QualifiedDataSharingOrganizationAgreement(QDSOA),DataSharingAgreement
andappropriateUseCaseAgreementswithwhichyouintendtoparticipate?(YES
orNo)
b. ItisyourintenttoutilizeMiHINSharedServicesandencourageotherentitiestodo
so?(YESorNo)
c. Is your organization technically capable of providing an electronic gateway
connectiontoMiHINtoallowcross‐QOtransactions(inbound&outbound)?(YES
orNo)
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Michigan Health Information Network Shared Services d. Isyourorganizationabletoensurethattheprivacyandsecurityrequirementsare
fully met, including Federal and State laws and MiHIN governance‐approved
policiesrelatedtosecurity,privacyandauditrequirements?(YESorNo)
e. Is your organization able to maintain production ability to send and receive
structured messages via a MiHIN service or the DIRECT and/or CONNECT
transports?
i. VPN&HL7toMiHIN(YESorNo)
ii. IHEXCAtoMiHINandtheQOCommunity(YESorNo)
iii. DoyousupportDIRECTSecureMessaging?(YESorNo)
1. If you support DIRECT is your HISP Direct Trust certified? (YES or
No)
f. DoesyourorganizationmaintainoperationsinthestateofMichigan?(YesorNo)
g. Does your organization currently enable bidirectional interoperability among
connectedsystemsservingatleast250providers?(YesorNo)
h. Can your organization support Query for Document transactions (XCA) via a
standards‐compliantdocumentrepository?(YesorNo)
i. Ifno,whendoesyourorganizationplantohavethiscapability?
i. Isyourorganizationwillingandabletocommittonationaldatasharingdirectives,
standards, and requirements such as released by ONC, CMS, etc. in a reasonable
timeframe?(YesorNo)
j. IsyourorganizationwillingtoprovideregularreportingtoMiHINonparticipant
level adoption, Use Cases supported, or transaction volumes and allow MiHIN to
reportthisinformationtotheHITCommissionandStateofMichigan?(YesorNo)
13. Pleasedescribehowyourorganizationallowsmeaningfulstakeholderinvolvementinits
governancestructure:
Copyright 2013 Michigan Health Information Network Shared Services 12
Next Steps LearnmoreaboutMiHINSharedServicesUseCasesandopportunitiesat
http://mihin.org/about‐mihin/resources/
BecomeaMiHINHIEQualifiedOrganizationbycontactingusat
info@mihin.org
Copyright 2013 Michigan Health Information Network Shared Services 13
ListofAbbreviations
ACRS–ActiveCareRelationshipService
ADT–Admit,Discharge,Transfer
BAA–BusinessAssociateAgreement
BCBSM–BlueCrossBlueShieldofMichigan
BOD–BoardofDirectors
CCD–ContinuityofCareDocument
CDC–CentersforDiseaseControlandPrevention
CMR–ComputerizedMedicalRecord
CMS–CenterforMedicareandMedicaidServices
CQDSOA–ConsumerQualifiedOrganizationDataSharingAgreement
CQO–ConsumerQualifiedOrganization/MiHINConsumerQualifiedDataSharing
Organization
DoD–DepartmentofDefense
DQ–DocumentQuery/DocumentQueryMessage
DR–DocumentRetrieve/DocumentRetrieveMessage
DURSA–DataUseandReciprocalSupportAgreement
EdgeSim–SimulatorofMiHINQualifiedOrganizationUseCases
EHR–ElectronicHealthRecord
EMR–ElectronicMedicalRecord
esMD–ElectronicSubmissionofMedicalDocumentationSystem
EULA–End‐UserLicenseAgreement
FedSim–SimulatorofMiHINFederalAgencyUseCases
GLHIE–GreatLakesHealthInformationExchange
GQO–GovernmentQualifiedOrganization/MiHINGovernmentQualifiedDataSharing
Organization
HIE–HealthInformationExchange
HIPAA–HealthInsurancePortabilityandAccountabilityAct
HISP‐HealthInformationSystemsProgram
HIT–HealthInformationTechnology
HITC–HealthInformationTechnologyCommission
HL7–HealthLevel7
HQO–HealthInformationExchangeQualifiedOrganization/HIEQualifiedDataSharing
Organization
Https–Post‐to‐URLTransportconnectivity(HypertextTransferProtocolSecure)
IDN–IntegratedDeliveryNetwork
IHE‐IntegratingtheHealthcareEnterprise®(integratedhealthinformationprofiles)
JCMR–JacksonCommunityMedicalRecord
LLP–LowerLayerProtocol(HL7)
MDCH–MichiganDepartmentofCommunityHealth
MHC–MichiganHealthConnect
MiHIN–MichiganHealthInformationNetwork
MiHINBOD–MichiganHealthInformationNetworkBoardofDirectors
MiHINSS–MichiganHealthInformationNetworkSharedServices
MOAC–MiHINOperationsAdvisoryCommittee
MPI–MasterPatientIndex
MTM–MedicationTherapyManagement
Copyright 2013 Michigan Health Information Network Shared Services 14
ListofAbbreviations(continued)
MU–MeaningfulUse
NwHIN–NationwideHealthInformationNetwork
NwHINSOAP–NationwideHealthInformationNetworkSimpleObjectAccessProtocol
OID–OrganizationID/UniqueIDoftheOrganization
ONC–OfficeoftheNationalCoordinator
PD–PatientDiscovery/PatientDiscoveryMessage
PHI–ProtectedHealthInformation/HIPAA‐ProtectedHealthInformation
PO–PayerOrganization/HealthPlanQualifiedOrganization
PQO–HealthPlanQualifiedOrganization/MiHINHealthPlanQualifiedDataSharing
Organization
QA–QualityAssurance
QATesting–QualityAssuranceTesting
QDSOA–QualifiedDataSharingOrganizationAgreement
QO–QualifiedOrganization/MiHINQualifiedDataSharingOrganization
SEMHIE–SoutheastMichiganHealthInformationExchange
SO–SponsoredOrganization/MiHINSponsoredSharingOrganization
SOAP–SimpleObjectAccessProtocol
SOM–StateofMichigan
SSA–U.S.SocialSecurityAdministration
SSO–SponsoredSharingOrganization
TBD–ToBeDetermined
UPHIE–UpperPeninsulaHealthInformationExchange
URL–UniformResourceLocator(Internetwebsiteaddress)
VA–VeteransAdministration/U.S.DepartmentofVeteransAffairs
VPN–VirtualPrivateNetwork
VQDSOA–VirtualQualifiedOrganizationDataSharingAgreement
VQO–VirtualQualifiedOrganization/MiHINVirtualQualifiedDataSharingOrganization
XAML–ExtensibleApplicationMarkupLanguage
XCA–Cross‐CommunityAccess
XCPD–Cross‐CommunityPatientDiscovery
Copyright 2013 Michigan Health Information Network Shared Services 15