MICHIGAN HEALTH INFORMATION NETWORK SHARED SERVICES
Exchange Care Plan/Integrated Care Bridge Record (ICBR)
USE CASE AGREEMENT
Approve Date:
Effective Date:
Change Control
Version
Number
1
2
3
Revision
Date
09/03/14
09/09/14
09/10/14
4
Author(s)
Section(s)
Ward
Kuzak
Ward
All
3, 4
3, 4
01/14/15
Ward
3, 10
5
01/20/15
Cooper
All
6
04/13/15
Ward
4, 10
7
8
9
4/21/15
4/23/15
4/27/15
Woodruff
Woodruff
Woodruff/Livesay
3
All
All
10
6/16/15
Taylor
3
Summary
Approve
Date
Effective
Date
Initial Draft
Clarified definitions
Merge feedback from
MDCH
Updated based on UCS
updates
and
UCIG
creation
Edit terms based on
JeffL’s documentation
rules
Update definitions to
remove
specific
transactions
types.
Update message and
message content sections
to refer to use case
implementation guide
Updated diagram
Updated formatting
Updated legal language,
definitions, formatting
Updated diagram
This Use Case Agreement (“Use Case”) is one of several Use Cases and is effective and binding
upon the undersigned Participating Organization (“Participating Organization”), and subject to
the Qualified Data Sharing Organization Agreement /Virtual Qualified Data Sharing Organization
Agreement/Consumer Qualified Data Sharing Agreement/Sponsored Shared Organization
Agreement/State Sponsored Sharing Organization Agreement (the “Agreement”) between the
Participating Organization and the Michigan Health Information Network Shared Services
(“HIN”), as of the last date in the signature block hereto. HIN and Participating Organization are
referred to herein collectively as “Parties” and individually as a “Party.”
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1.
GOAL. HIN desires to assist Participating Organizations within HIN to communicate with
other Participating Organizations within HIN, for the purpose of communicating patient data by
electronically communicating with a health agency1 on a Transactional Basis, as defined below.
2.
PURPOSE. The purpose of this Use Case is to set forth the requirements for HIN QOs to
use HIN to provide a means for the Participating Organization to request and provide patient
continuity of care information through HIN (the “Platform).
3.
USE CASE DIAGRAM²
ICO
Primary
Care
Behavioral
Health
(PIHP)
Social
Services
(LTSS)
Social
Services
(LTSS)
Behavioral
Health
(PIHP)
Primary Care
ICO
2
The bidirectional communications reflected in the Use Case diagram include the transmission of acknowledgements
from the HIN. HIN may, depending on the capabilities of a particular Participating Organization, further pass on such
acknowledgements to such organization. The transmission of error messages from the Participating Organization to
the Source System is optional based on individual PO agreements with their participants, and industry best practices.
MI Health Link is an initiative to coordinate care for approximately 200,000 Michigan
residents dually enrolled in Medicaid and Medicare. These consumers often have complex
The Health Information Technology for Economic and Clinical Health Act (“HITECH Act”), created by the
American Recovery and Reinvestment Act of 2009, requires that eligible hospitals and eligible professionals be
“meaningful EHR users” to receive incentive funding.
See generally https://www.cms.gov/ehrincentiveprograms/30_Meaningful_Use.asp.
1
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medical and psychological diagnoses that require cohesive communication and
coordination among the physical, behavioral health and social service organizations that
care for these consumers, such as Integrated Care Organizations (ICOs). With care
management occurring independently within these organizations via Integrated Care
Teams (ICTs) there is a need for a streamlined way to exchange a care plan for the
consumer to ensure the consumer’s needs are being met. This initiative promotes care
coordination through sharing member information in a Care Plan also referred to as an
“Integrated Care Bridge Record” (ICBR) between Integrated Care Organizations and
members of Integrated Care Teams.
The Care Plan contained in an ICBR delivers a comprehensive and detailed overview of a
member’s physical health, behavioral health, long-term care, and relevant services and
supports. Specifically, an ICBR contains a member’s history, conditions list, lab results,
medications, assessments, Individual Integrated Care and Supports Plan (IICSP), specialty
provider reports, referrals, progress notes, and status changes.
Integrated Care Organizations are responsible for coordinating the Integrated Care Teams
and provisioning medical and long term care services and support (LTSS) for eligible
participants. The ICT monitors the ICBR and develops the Individual Integrated Care and
Supports Plan (IICSP). The ICT includes ICO care coordinators, long term supports and
services coordinator, primary care and other treating providers, and Prepaid Inpatient
Health Plans (PIHPs). Every member of the ICT has access to a member’s ICBR through a
care coordination platform. The Michigan Health Information Network Shared Services
(HIN) serves as the transport mechanism for the ICBR. The HIN does not store data. It
simply routes requests for an ICBR from one ICO or PIHP to another and transports the
ICBR from the reporting ICO/PIHP to the requesting ICO or PIHP.
The ICOs create and update ICBRs for eligible participants, and then either grant access to
the ICBR and/or share some or all of the ICBR with the ICT, dependent on the access
control rules in place for that ICO. Therefore, a participant’s ICBR is accessible through a
local ICO platform and can be shared between the ICT members. Please refer to the
diagram above.
Should a consumer move to a different ICO, then the participant’s ICBR is moved
electronically to the new ICO by the appropriate Participating Organization.
4.
DEFINITIONS
4.1
Message Content means information which is requested, received or sent by a
Participant through the HIE Platform, including PHI, de-identified data, pseudonymized data,
metadata, digital credentials, and data schema.
4.2
Network Downtime Means a Party is unable to transmit and receive data from
the Internet for any reason, including but not limited to the failure of network equipment or
software, scheduled or unscheduled maintenance, general Internet outages, and events of force
majeure.
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4.3
Notice Means a message transmission that is not Message Content and which
may include but not be limited to an acknowledgement of receipt or error response.
4.4
Transactional Basis Means, on a per transaction basis, the transmission of
Message Content or a Notice within twenty (20) seconds of delivery or receipt of Message
Content or Notice from a sending or receiving party.
4.5
ICBR means a Care Plan in the form of an Integrated Care Bridge Record. An
individualized enrollee record generated and maintained within the ICO’s electronic Care
Coordination platform. The ICBR contains a member’s history, conditions list, lab results,
medications, assessments, Individual Care and Supports Plan (IICSP), specialty provider
reports, referrals, and progress notes and status changes.
4.6
ICO means Integrated Care Organization. A Health Insuring Corporation (HIC)
contracted with MDCH and CMS to comprehensively manage the full continuum of Medicare
and Medicaid benefits for Medicare-Medicaid enrollees including long term services and
supports.
4.7
ICBR Transaction is defined as the sum of three (3) exchange messages that
are sent in one of two directions:
4.7.1 Participating Organization requests an ICBR care plan from another
ICO,PIHP, provider or other organization (e.g. LTSS) .
4.7.2 Participating Organization receives a request for an ICBR care plan from
another ICO,PIHP, provider or other organization (e.g. LTSS).
4.7.3 Participating Organization submits an ICBR care plan to another ICO,PIHP,
provider or other organization (e.g. LTSS).
4.8
ICT means Integrated Care Team. A team including the enrollee, enrollee’s
chosen allies or legal representative, Primary Care Physician, ICO Care Coordinator, LTSS
Coordinator or PIHP Supports Coordinator (as applicable) and others as needed. The ICT
works with the enrollee to develop, implement, and maintain the IICSP and to coordinate the
delivery of services and benefits as needed for each enrollee.
4.9
IICSP means Individual Integrated Care and Supports Plan. The plan of care
developed by an enrollee, the enrollee's ICO Care Coordinator and the enrollee's Integrated
Care Team which incorporates the following elements: assessment results; summary of the
enrollee’s health; the enrollee’s preferences for care, supports and services; the enrollee’s
prioritized list of concerns, goals and objectives, and strengths; specific services including
amount, scope and duration, providers and benefits; the plan for addressing concerns or goals;
the person(s) responsible for specific interventions, monitoring and reassessment; and the due
date for the intervention and reassessment. The IICSP is also referred to as person-centered
plan or plan of care. The IICSP is maintained in the Integrated Care Bridge Record.
4.10 LTSS means Long Term care Services and Support. A range of supports and
services designed to meet an individual’s needs in the most integrated setting and to enable a
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person to live as independently as possible. LTSS are provided over an extended period,
predominantly in homes and communities, but also in facility-based settings.
4.11 Message means a mechanism for exchanging Message Content, as defined
below, between the Participating Organization through HIN, including query and retrieve.
4.12 Patient Data means any data that is electronically filed in a QO or QO
Participant’s systems or repositories. The data may contain Protected Health Information
(PHI), Patient Credit Information (PCI) or Personally Identifiable Information (PII) data.
4.13 Participating Organization (PO) means the data sharing organization signing
this UCA that has also signed a Trusted Data Sharing Organization Agreement such as a
Qualified Data Sharing Organization Agreement (QDSOA) with HIN.
4.14 PIHP means Prepaid Inpatient Health Plan. PIHPs manage the Medicaid
specialty services under the 1915(b)(c) Waiver Program, consistent with the requirements of
42 C.F.R. Part 401. This benefit plan covers mental health and substance use services for
people eligible for Medicaid who have a need for behavioral health, intellectual/developmental
disabilities services and supports, or substance use services.
4.15 PO or QO Participant means an entity exchanging healthcare information
from an edge system via the PO/QO through to HIN, and on to an eHealth Exchange participant
(and vice-versa).
4.16 Qualified Organization (QO) means an organization that has signed a
Qualified Data Sharing Organization Agreement (QDSOA) with HIN.
4.17 Source System means the computer system, typically and electronic health
record system, at the Participating Organization, that generates the Message Content or Notice.
4.18 Trusted Data Sharing Organization (TDSO) means an organization that has
signed any form of a data sharing organization agreement with HIN.
4.19
Data Sharing Agreement means any form of a data sharing agreement with
HIN.
5.
MESSAGE CONTENT. The Platform “Message Content,” as defined below, submitted
pursuant to this Use Case may be used as follows:
5.1
Primary Use
The Message Content and related Notices are used for reporting to the Platform consistent with
the requirements set forth by Michigan statute and the HIN Administrative Rules (collectively, the
“Platform Requirements”), as may be amended from time to time, for reporting cross exchange
of data.
5.2
Additional Permissible Use
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The Parties may make additional permissible use of the Platform Message Content, provided that
such additional permissible use is consistent with Applicable Laws and Standards, as defined in
Section 1.1 of the Data Sharing Agreement, including, without limitation, the Platform
Requirements, to the extent such requirements are applicable to a Party.
The Parties agree and understand that, to the extent that Message Content is being transmitted on
behalf of a program within the meaning of 42 C.F.R. Part 2, that each Participant Organization is
intended to be a Qualified Service Organization within the meaning of 42 C.F.R. § 2.11 engaged
in data processing activities on behalf of the program and, as such, Participant Organization (1)
acknowledges that in receiving, storing, processing or otherwise dealing with any patient records
from such programs, it is fully bound by 42 C.F.R. Part 2 and (2) if necessary, Participant
Organization will resist in judicial proceedings any efforts to obtain access to patient records
except as permitted by 42 C.F.R. Part 2.
5.3
Additional Terms
The Parties may use the Platform Message Content consistent with the terms herein and as
otherwise permitted by the Data Sharing Agreement, provided, however, that in no case shall
Participating Organization share Message Content in a manner inconsistent with this Use Case, as
applicable. To the extent there is an express conflict between the terms herein and the Data Sharing
Agreements, the Data Sharing Agreements, as applicable, shall prevail.
6.
FEES
HIN shall charge Participating Organization fees for the term of the Agreement for submitting
Platform Message Content into the Platform. Arrangements for fees for this Use Case, if any, are
addressed separately in a Statement of Work (SOW) between the Parties.
7.
SERVICE LEVEL. The Parties desire that the Message Content and Notice exchange
between Participating Organization, HIN and other HIN QOs meet the service levels set forth
below:
7.1
Timeliness of Exchange. The Parties desire that the Message Content and
Notice exchange occur on a Transactional Basis.
7.2
Network Downtime. Notwithstanding Sections 4 (Transactional Basis) and
7.1, if the Parties experience a Network Downtime, Message Content and Notices queued
during the Network Downtime shall be retransmitted as soon as practicable upon network
being available.
Any planned or unplanned Network Downtime must be notified to HIN as defined
Exhibit A – Service Level Interruptions.
8.
AUDITING
8.1
Abilities to Audit. The Parties shall monitor and audit all access to and use of
its system related to this Use Case, for system administration, security, and other legitimate
purposes consistent with each Party’s standard operating procedures.
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8.2
Audit Logs.
8.2.1 Participating Organization. Participating Organization shall, at a
minimum, log the following information: (i) date and time Message Content was accessed and
identity (e.g., unique identifier) of individual or system, as applicable, accessing the Message
Content to the extent such information is available to the Participating Organization; (ii) date and
time Message Content was transmitted through the Participating Organization Platform and
identity of individual or system, as applicable, transmitting the Message Content; (iii) date and
time a Notice was sent or received from or to HIN; (iv) the unique message identifier for the
Message Content accessed, sent, or received; (v) the Message Content accessed to the extent such
information is available to the Participating Organization; and (vi) any Notices, failures, or
network events.
8.2.2 HIN. With respect to its obligations as a business associate, if applicable,
HIN shall, at a minimum, log the following information: (i) date and time Message Content was
transmitted through the HIE Platform, and identity of individual or system, as applicable,
transmitting Message Content; (ii) destination of Message Content; (iii) name of Participating
Organization and/or PO Participant accessing the HIE Platform; (iv) identity (e.g., unique
identifier) of individual or system, if applicable and available, accessing the Message Content; (v)
the date and time the access occurred; (vi) if technically possible, the Message Content accessed;
(vii) if technically possible, a description of Message Content accessed and, if necessary to comply
with Applicable Laws and Standards and, specific Message Content fields accessed; (vii) the
source IP address of the Message Content request; (viii) designation IP address of the Message
Content request; and (ix) any Notices, failures, or network events. Except as provided in the
foregoing, HIN shall not be obligated to maintain and shall not be responsible for, either maintaining
records of the content of any Message exchange between the Parties or inspecting the content of such
Messages.
8.3
Production of Audit Logs. Upon a good faith written request by a Party, the
non-requesting Party shall produce the requested audit logs within five (5) business days from
the date of the request to the requesting Party or a detailed written explanation of why the
requested logs cannot be produced.
8.4
Retention of Audit Logs. The Parties shall retain audit logs in accordance with
any and all requirements set forth in Applicable Laws and Standards2, including but not limited
to the requirements under the Health Insurance Portability and Accountability Act of 1996,
Public Law 104-191, and regulations at 45 CFR Part 160, Part 162, and Part 164, the Michigan
Public Health Code, MCL 333.1101 et seq., the Data Sharing Agreement, and as otherwise
necessary to comply with this Use Case.
9.
RESPONSIBILITIES OF THE PARTIES
9.1
Participating Organization’s Responsibilities
“Applicable Laws and Standards” is a defined term in all forms of Trusted Data Sharing Organizations Agreements
with HIN.
2
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9.1.1 Participating Organization shall transmit to HIN the Message Content and
Notices on a Transactional Basis.
9.1.2 Participating Organization shall retransmit, or make provisions to have
retransmitted, Notices and/or Message Content to HIN, which (i) Participating Organization
failed to deliver to HIN, or (ii) HIN failed to deliver to the other HIN QO, upon Participating
Organization receiving a failure delivery Notice from HIN so long as HIN does not send such
failure delivery notice after having first acknowledged and accepted with no errors the message
from Participating Organization.
Participating Organization may, on a Transactional Basis, transmit any Notices
received from HIN to the PO Participant that submitted the Message Content, as necessary
(e.g., transmitting an acknowledgment of submission received from HIN), if such capabilities
are supported by and enabled on Participating Organization’s system as well as the PO
Participant’s systems. The specifications for the Notices and/or Message Content are set forth
for this Use Case on the HIN web site.
9.1.3 Participating Organization shall transmit data to HIN only from PO
Participant's that have been authenticated by the other HIN QO.
9.1.4 Participating Organization shall optionally validate the Message Content
Header (SAML Assertion) to ensure that the message is properly addressed with both sender
and receiving facility and purpose of use.
9.1.5 Participating Organization shall send the Message Content Header (SAML
Assertion) to ensure that the message is properly addressed with both sender and receiving
facility and purpose of use.
9.1.6 Participating Organization’s shall transmit data to HIN only from
organizations that have agreed to participate in this Use Case Agreement.
9.1.7 Notice of unauthorized send or receipt. In the event Participating
Organization sends or receives Message Content for which Participating Organization is not
authorized to send or receive, Participating Organization immediately informs HIN, delete
such Message Content, and require its PO Participant users to do so.
9.1.8 Participating Organizations shall work with HIN to schedule and coordinate
any changes to the production systems or networks involved in Message sending, filtering,
translating, or forwarding activities so as to ensure the reliability and availability of the
production environments.
9.2
HIN’s Responsibilities
9.2.1 HIN shall transmit to other HIN PO all Message Content and Notices on a
Transactional Basis.
9.2.2 HIN shall transmit to Participating Organization all Message Content and
Notices on a Transactional Basis.
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9.2.3
HIN shall be responsible for protecting Message Content.
9.2.4 HIN shall work with Participating Organizations to schedule and coordinate
any changes to the production systems or networks involved in Message sending, filtering,
translating, forwarding or receiving activities so as to ensure the reliability and availability of
the production environments.
10.
OTHER TERMS
10.1
Data Format, Validation and Transmission Specifications
10.1.1 The Message Content and Notices submitted to the HIN QO from HIN, or
submitted to HIN from the HIN QO platform will be in accordance with the Exchange Care
Plan/ICBR Implementation guide available at http://mihin.org/about-mihin/resources/.
10.1.2 The Message Payload submitted to the HIN Platform from HIN, or
submitted to HIN from the HIN Platform will meet the HL7 C-CDA Release 2 format:


Consolidated Clinical Document Architecture (C-CDA) - HL7 Implementation Guide for
CDA® Release 2: Consolidated CDA Templates for Clinical Notes – within the
implementation guide section (http://www.hl7.org/documentcenter/private/standards/cda/CDAR2_IG_NAMCS_DSTU_R
1_2014DEC.zip)
10.1.3 HIN shall validate all Conforming Messages.
10.1.4 Disclaimers.
(a)
Prior to transmitting files to HIN, Participating Organization shall
ensure that the data is from a Health Professional or provider organization that has entered into all
necessary legal and data sharing agreements, such as a Business Associate Agreement, with the
Participating Organization.
(b)
Participating Organization shall bear sole responsibility for ensuring
that the Health Professional data meets the data integrity, format, security, and timeliness standards
prescribed by this Use Case and the Agreement.
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IN WITNESS WHEREOF, the undersigned have caused this Use Case to be accepted by
their duly authorized representatives effective on the date written below, whichever is later.
MICHIGAN HEALTH INFORMATION
NETWORK SHARED SERVICES
PARTICIPATING ORGANIZATION
Organization Name
By:
By:
Name:
Name:
Title:
Title:
Date:
Date:
EXHIBIT A – SERVICE LEVEL INTERRUPTIONS
Interruption
A PO experiences temporary service level interruptions from time to time. These service level
interruptions may be planned or unplanned. A service level interruption results in a PO having to
temporarily cease exchanging Message Content with all other POs through the HIN. To ensure
that all Participants are aware of a service level interruption, the Participating experiencing the
service level interruption sends a written notice to HIN of the interruption prior to the
interruption, if planned, or as soon as reasonably practicable after the interruption begins if
unplanned. HIN simultaneously notifies all other POs of the interruption. Since a service level
interruption does not involve the suspension of a PO’s Digital Credentials, the PO is responsible
for taking all technical actions necessary to carry out a service level interruption. During a
service level interruption, the PO continues to be responsible for complying with the terms of
this Agreement.
Suspension
If, at any point, a PO decides that it requires a temporary suspension from participation and its
responsibility for complying with the terms of this Agreement, it shall send a written notice to
HIN. The PO must give notice of its need for a temporary voluntary suspension at least twentyfour (24) hours prior to commencing its voluntary suspension. The notice specifies the reason for,
the commencement date of, and the duration of the voluntary suspension. Upon receipt of the
notice of voluntary suspension, HIN forwards the notice to all other POs of the suspension.
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