MiHIN 101
November 2015
Copyright 2014 Michigan Health Information Network Shared Services
1
What Does HIE (verb) Do?
Benefits
Prevent future or
fill known and unknown
knowledge
deficits
·
Avoiding repeat diagnostic tests
·
Enables a clinician to add or
remove a differential diagnosis
in a timely fashion
·
Optimal choice of tests and
therapy
·
More rapid response to a
contraindication or any
necessary refinements to a
given therapy
·
Care coordination: helps ensure
that the next clinician involved
in the patient’s care will see the
relevant information about the
patient!
Adapted from Hripcsak et al. (2007)
Copyright 2015 Michigan Health Information Network Shared Services
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Statewide Coordination
Duplication of effort, waste, & expense
(N x N-1 connections)
Shared Services
(N connections)
Physicians
Physicians
Patients
& Families
Patients
& Families
Public Health
Specialty
Providers
Lab tests &
XRAYs
Hospitals & Clinics
Medications
Public Health
Specialty
Providers
Lab tests &
XRAYs
Insurance
Companies
Health
Plans
Hospitals & Clinics
Medications
Copyright 2015 Michigan Health Information Network Shared Services
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MiHIN is a
network for sharing health
information statewide
for Michigan
Copyright 2015 Michigan Health Information Network Shared Services
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“One and Done”- Easier, Simplified,
Predictable Data Sharing
1. Sign once
• Common legal framework across the state
• Transparent data usage for each use case
2. Connect once
• MiHIN network includes all of health care: HIEs, HISPs,
health plans, the state and the federal agencies
3. Publish once
• Patient and provider delivery preferences easily registered
and centrally managed
4. Report once
• Messages can be routed to multiple destinations – no
duplicate interfaces or repeat reports
5. Log-on once
• Single sign-on across patient/member and provider portals
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Scalable Data Sharing
1. Legal Interoperability
• Common legal framework across the state
• Transparent data usage for each use case
2. Technical Integration
• MiHIN network includes all of health care: HIEs, HISPs, health
plans, the state and the federal agencies
3. Authoritative Sources
• Patient and provider delivery preferences easily registered and
centrally managed
4. Reuse & Reduced Duplication of Effort
• High quality messages can be routed to multiple destinations –
no duplicate interfaces or repeat reports
5. Identity & Program Integrity
• Single sign-on across patient/member and provider portals
• Common linking & patient matching
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Network of Networks:
Federal
PIHPs (10)
Health Plan QOs
(more coming)
Simple Data Sharing
Organizations
MSSS
MiHIN
Statewide
Shared Services
Consumer QOs
(more coming)
MyHealthPortal
MyHealthButton
Mi Syndromic
Surveillance System
Immunizations
MDHHS Data Hub
Mi Disease
Surveillance System
HIE
Data
Warehouse
Qualified Organizations (QOs)
State
LABS
Chronic
Diseases
Virtual QOs
Pharmacies
(more coming)
Doctors &
Health Systems
Single point of
entry/exit for state
Sponsored Organizations
Copyright 2015 Michigan Health Information Network Shared Services
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Types of Qualified Organizations
HIE QO
(HQO)
Plan/Payor QO
(PQO)
Government QO
(GQO)
Consumer QO
(CQO)
Data Aggregator
QO (DAQO)
• Meets the QO requirements
• Plans to participate in at least 2/3 of Use Cases
• Voice in the MiHIN Advisory Committee (MOAC)
• Health Plan licensed in the state of Michigan
• Blue Cross, Michigan Association of Health Plans, & Priority Health have MOAC & Board eligibility
• Government Qualified Organization (i.e. Michigan Department of Community Health)
• Federal Agency (i.e. Social Security Administration, CMS, Veterans Affairs, DoD, CDC, etc.)
• Tribal Nations in Michigan
• Participate in consumer-focused Use Cases (i.e. MiWay Consumer Directory)
• Supported & authorized consumer facing services (i.e. Patient Health Record, Patient Portal) an example would be Peace of Mind
Registry
• Receives data from certain statewide Use Case (e.g. Statewide ADT) for the purpose of creating a statewide repository of the
information
• Designed to support near-time analytics that can be shared back into the ecosystem as a statewide resource
• May function as a query able resource on the network
Copyright 2015 Michigan Health Information Network Shared Services
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MiHIN’s Role as Curator of the
Statewide “HIE” Ecosystem
• Manage statewide legal trust fabric
• Maintain statewide “master data” in Active Care
Relationship Service, Health Provider Directory,
Trusted Identities, Consumer Preferences
• Connect HIEs, Payers, Pharmacies, DHHS, Federal
Government, others
• Align incentives and/or regulations to fairly share data
and promote data standardization (via Use Cases)
• Convene groups to identify data sharing barriers,
reduce provider burdens, engage consumers, and
enable population health
Copyright 2015 Michigan Health Information Network Shared Services
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Maximize SOM Resources
Transparency
via HIT
Commission
Monitoring
MDCH Data Hub
State of Michigan
Internal
MiHIN & the Qualified
Data Sharing Organizations
STATEWIDE
SHARED SERVICES
External
Shared
Governance via
MiHIN Board
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MiHIN Governance
MiHIN Board of
Directors
Health Information
Technology Commission
MiHIN Management &
Core Staff
Executes the Operations Plan
MiHIN Operations Advisory Committee (MOAC)
oversees working groups that advise MiHIN
Copyright 2015 Michigan Health Information Network Shared Services
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MiHIN Governance
MiHIN Board of Directors
Health Information Technology Commission
(HITC)
The Commission's mission is to facilitate and promote the design,
implementation, operation, and maintenance of an interoperable health
care information infrastructure in Michigan.
S
e
t
Michael G. Chrissos, M.D.
Representing Doctors of Medicine
P
o
l
i
c
i
e
s
Randall Ritter
Representing Consumers
Robert Milewski
Representing Nonprofit Healthcare Corporations
Pat Rinvelt
Representing Purchasers or Employers
Mark Notman, Ph.D.
Representing Schools of Medicine
Tim Becker
Representing MDHHS
Nick Smith
A
c
t
o
n
t
h
e
P
o
l
i
c
i
e
s
Blue Cross Blue Shield
of MI (BCBSM)
Dr. Thomas Simmer
Ex Officio
Tim Pletcher
Great Lakes Health Connect
Sue Schade
HIT Commissioner
Pat Rinvelt
Ingenium
John Vismara
Jackson Community
Medical Record (JCMR)
Rick Warren, Vice Chair
Michigan Association of
Health Plans
Tom Lauzon
Michigan Health and Hospital
Association (MHA)
Jim Lee
Michigan Medicaid
Cynthia Green Edwards
Michigan Osteopathic
Association (MOA)
Dr. Taylor Scott
Michigan Pharmacist
Association
Larry Wagenknecht, Chair
Michigan Primary Care
Association
Dr. Faiyaz Nusrath Syed
Michigan Public Health
Jim Collins
Michigan State Medical Society
Dr. Arthur J. Ronan
Priority Health
Krischa Winwright
Southeast Michigan HIE
(SEMHIE)
Helen Hill
Trinity Behavioral Health
Dr. Scott Monteith
Upper Peninsula Health
Information Exchange (UPHIE)
Dennis Smith
Representing Health Plans or Third Party Payers
Orest Sowirka, D.O.
MiHIN Executive Management
Executes the operations plan
Representing Doctors of Osteopathic Medicine and Surgery
Provides monthly
MiHIN status report
Peter Schonfeld
Representing Hospitals
Tim Pletcher, Executive Director
Rodney Davenport
Representing Department of Technology, Management and B udget
Jeff Livesay, Associate Director
Jill Castiglione
Representing Pharmacists
Rozelle Hegeman-Dingle
Representing Pharmaceutical Manufacturers
MiHIN Operations Advisory Committee
(MOAC)
Irita B. Matthews
Represents Health Information Technology
Copyright 2015 Michigan Health Information Network Shared Services
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MiHIN Operations Advisory Committee (MOAC)
Administrative
Network Technology Se rvices (ANTS)
Nate Teller
AmeriHealth
Joe Miller
Blue Cross Blue Shield
of MI (BCBSM)
Wanda Brideau
Blue Cross Complete (BCC)
Joe Miller
Detroit Wayne Mental H ealth Authority
(DWMHA)
Bill RIley
Fidelis
Lisa Barton
Great Lakes Health Connect (GLH C)
Doug Dietzman
Health Alliance Plan of Michigan (HAP)
Annette Marcath
Henry Ford Health System (HFHS)
Jim Scherphorn
Ingenium
Wendy Couturier
Jackson Community
Medical Record (JCMR)
Linda Howell
Meridian Health Plan
Tony Randolph
Michiana Health I nformation Network (MHIN)
Hannah King
Michigan Ass ociation of Health Plans (MAHP)
Richard Murdock
Michigan Pharmacists As sociation (MPA)
Dianne Malburg
Michigan State Medical Society (MSMS)
Joe Neller
MiHIN Shared Services
Jeff Livesay, Co-chair
Molina Healthcare
Tonya Wardena
Northe rn Physicians Organization (NPO)
Ed Worthington
PatientPing
Van essa K uhn
Priority Health
Tim Ivy
Region 10
Kelly VanWormer
Southeast Michigan HIE (SEMHIE)
Helen Hill
State of Michigan (SOM)
Jas on Werner, Co-chair
Total Health Care (THC)
Linda Alexander
Upper Penins ula Health I nformation Exchange
(UPH IE)
Paula Hedlund
Upper Penins ula Health Plan (UPH P)
Paula Hedlund
MOAC Working Groups
Use Case (UCWG)
Privacy (PWG)
Security (SWG)
Administrative Network Technology
Services (ANTS)
Administrative Network Technology
Services (ANTS)
Administrative Network Technology
Services (ANTS)
Production & Operations, Integration
& Architecture
(PROPS I&A WG)
Administrative Network Technology
Services (ANTS)
AmeriHealth
AmeriHealth
Blue Cross Blue Shield
of MI (BCBSM)
Clinton, Eaton, & Ingham County
CMH (CEICMH)
Detroit Wayne Mental Health
Authority (DWMHA)
Fidelis
Great Lakes Health Connect (GLHC)
Health Alliance Plan of
Michigan (HAP)
Henry Ford Health Systems (HFHS)
Great Lakes Health Connect (GLHC)
Health Alliance Plan of
Michigan (HAP)
Health Alliance Plan of
Michigan (HAP)
Henry Ford Health Systems (HFHS)
Meredith Phillips, Co-chair
Ingenium
Ingenium
Jackson Community
Medical Record (JCMR)
Jackson Community
Medical Record (JCMR)
Northern Physicians Organization
(NPO)
PatientPing
MiHIN Shared Services
Brian Seggie, Co-chair
Northern Physicians Organization
(NPO)
PatientPing
MiHIN Shared Services
Marty Woodruff, Co-chair
Northern Physicians Organization
(NPO)
PatientPing
Priority Health
Priority Health
Priority Health
Southeast Michigan HIE (SEMHIE)
Southeast Michigan HIE (SEMHIE)
Southeast Michigan HIE (SEMHIE)
Southeast Michigan HIE (SEMHIE)
State of Michigan (SOM)
Tina Scott, Co-chair
Trinity Health
State of Michigan (SOM)
Phil Kurdunowicz (Co-chair)
John Donovan (Co-chair)
State of Michigan (SOM)
State of Michigan (SOM)
Upper Peninsula Health
Information Exchange (UPHIE)
Upper Peninsula Health
Information Exchange (UPHIE)
Trinity Health
Upper Peninsula Health
Information Exchange (UPHIE)
Trinity Health
Upper Peninsula Health
Information Exchange (UPHIE)
Ingenium
Jackson Community
Medical Record (JCMR)
Michigan Association of Health Plans
(MAHP)
Michigan State Medical Society
(MSMS)
MiHIN Shared Services
Shelley Mannino, Co-chair
Northern Physicians Organization
(NPO)
PatientPing
Henry Ford Health Systems (HFHS)
Ingenium
Jackson Community
Medical Record (JCMR)
MiHIN Shared Services
Issue Remediation (IRWG)
Administrative Network Technology
Services (ANTS)
AmeriHealth
Blue Cross Blue Shield
of MI (BCBSM)
Blue Cross Complete (BCC)
Detroit Wayne Mental Health
Authority (DWMHA)
Fidelis
Great Lakes Health Connect (GLHC)
Health Alliance Plan of
Michigan (HAP)
Ingenium
Jackson Community
Medical Record (JCMR)
Meridian Health Plan
Michiana Health Information
Network (MHIN)
Michigan Pharmacists Association
(MPA)
Michigan State Medical Society
(MSMS)
MiHIN Shared Services
Tim Pletcher, Co-chair
Molina Healthcare
Northern Physicians Organization
(NPO)
Oakland County Community Mental Health
Authority (OCCMHA)
PatientPing
Priority Health
Region 10
Southeast Michigan HIE (SEMHIE)
State of Michigan (SOM)
Kim Bachelder, Co-chair
Total Health Care (THC)
Upper Peninsula Health
Information Exchange (UPHIE)
Copyright 2015 Michigan Health Information Network Shared Services
Copyright 2015 Michigan Health Information Network Shared Services
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Legal Infrastructure for Trusted Data
Sharing Organizations (TDSOs)
ORGANIZATION AGREEMENT
(QDSOA,VQDSOA, CQDSOA,
SSOA, SSSOA, DDSOA, SDSOA)
Definitions
HIPAA Business Associate Terms
Basic Connection Terms & SLA
Cyber Liability Insurance
Indemnification & Liability
Data Sharing Agreement
Use Case
#1
Use Case
#2
Use Case
#3
Use Case
#N
Contracting & Payment
Dispute Resolution
Term & Termination
Copyright 2013 - Michigan Health Information Network
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Clear Chain of Trust
Covered
Entity
Covered
Entity
Trusted Data
Sharing
Business
Organization
Associate
Business
Associate
Trusted Data
Sharing
Business
Organization
Associate
Covered
Entity
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Constituent Transparency
Communities
Patients
& Families
Physicians
Public Health & CMS
Use Case
Laboratories &
Diagnostic centers
Specialty
Providers
Policy Makers
Health
Plans
Hospitals & Clinics
Employers
Pharmacies
Copyright 2015 Michigan Health Information Network Shared Services
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What is a USE CASE?
• Data sharing scenario with specific:
• purpose
• type of data exchanged
• description of interactions between people/systems
Use Case Factory™
• Each Use Case may have different:
• access restrictions
• rules for using the data
• cost recovery fees or charges
• technical requirements
Copyright 2015 Michigan Health Information Network Shared Services
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Use Case Components
Use Case Summary - explains purpose and value
proposition/business case for sharing data
Use Case Agreement - legal document covering
expected rules of engagement (Trusted Data
Sharing Organizations sign Use Case Agreements)
Use Case Implementation Guide technical specification that
outlines standard format details
for data transmission & content
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Benefits of Use Case Approach
Reduces Complexity
Consistent Pattern
Modular (like LEGO® blocks)
Aligns Priorities
Transparent
Measureable
Faster & Cost Effective
Manageable chunks so competitive or confidentiality
concerns can be addressed without “boiling the ocean”
Standardized mechanism for scoping purpose, technical
requirements, costs, and limits on how data is used
Use Cases can be combined to create more extensive
stories for data sharing
Incentives, regulations or policies can target specific Use
Cases to foster or accelerate adoption
Constituents can understand expected use of their data and
follow common chain of trust across organizations
Aids focused monitoring and measurement of progress
Reduces variability and enables scalability
Copyright 2015 Michigan Health Information Network Shared Services
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Use Case FactoryTM
Conceptual
Use Case Summary
Contains The Basic Ideas
Laid Out in an Easy to
Read Document for the
Board to Approve
Idea with
Champion
Define
Purpose
Evaluation
Continuous
Improvement
Idea with
Sponsor
Plan & Develop
Adoption
Critical
Mass
Successful
Adoption
Mass
Marketing &
Outreach
Technical
Planning
Pilot &
Refine
Implement
Production
Status
Metrics
MiHIN Board
Functional
Data-Sharing
Widget
Anyone can submit ideas for use cases: http://mihin.org/about-mihin/resources/use-case-submission-form/
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Use Case Assembly Lines
Results
Delivery
Public Health
Reporting
Care Coordination
& Patient Safety
• Lab results
• Diagnostic imaging
• Other tests
• Hospital discharge
summaries
• Immunizations
• Chronic disease
registries
• Disease surveillance
• Syndromic
surveillance
• Birth & death
notifications
• 41 new use cases
identified
• Referrals
• Care summaries for
treatment history &
allergies
• Notification of
transitions of care
(Admission, Discharge
or Transfer)
• Medication
reconciliation & therapy
change notices
• Clinical decision support
alerts
Quality &
Administrative
Reporting
Patient/Consumer
Engagement
• Registry Updates
• Physician Quality
Reporting measures
• Meaningful Use
reporting
• Electronic verification
• Patient satisfaction
• Eligibility
• Authorization
• Claims audit
• Instructions
• Health risk appraisals
• Medication Compliance
• Therapy Compliance
• Patient activation and
self determination
• Health literacy &
numeracy
• Consumer Preferences
and Consents
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Use Case Factory Hierarchy
Episode
of Care
Major life event consisting of multiple stories (birth of child, chronic condition, etc.)
Story
Persona combined with collection(s)
to illustrate a health-related event
Collection
Combination of Use Cases that interact
to create a higher-level service
Use Case
A functional data-sharing unit
Scenario
Granular examples
of data sharing
(submit vs..
receive, etc.)
Data
Standards
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Accelerating Use Cases
Clinical
Endorsement &
Evidence
Financial
Incentives or
Disincentives
Policy &
Regulatory
Levers
Use
Case
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Payer Incentives for Statewide HIE
- Physician Group Incentive Program (PGIP)
- Hospital value-based contracts
But wait…
there’s more $
2016
2015
2014
TBD
Medications, potentially quality measures
Integrate ADT, begin Medication Reconciliation
Hospitals – Conformance with ADT spec, send Medications
Providers – Integrate ADTs into workflow, receive Medications
Data flow
Hospitals – Send ADT notifications to statewide service via MiHIN
Providers – Send Patient-Provider Attribution (PPA), receive ADT alerts
Copyright 2015 Michigan Health Information Network Shared Services
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Use Cases & Learning Health
System
Clinician
Clinician
Patient
Clinician
Learning
Cycle
Story with
Persona
Investigator
Population
Health
Management
& Research
Investigator
Investigator
Use Case
Collection/s
Use
Case
Use
Case
Use
Case
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Major Building Blocks
Statewide Health
Provider Directory
TOC
Notification
Service
Active Care
Relationship
Services
SingleSign On
(Linked to
MiCAM)
MiWay Consumer
Directory
Common Key
Service
Copyright 2015 Michigan Health Information Network
Query
(IHE-XCA
Connect)
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Statewide ADT Use Case Example
+
Active Care
Relationship Service
(ACRS)
+
Statewide
Health Provider
Directory (HPD)
“Use Case Collection:
Statewide ADT
Notification Service”
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Patient Provider Attribution Service
(in Michigan we call this ACRS™)
•
Active Care Relationship Service (ACRS) - enables providers to declare
active care relationships with patients – this attributes to a patient the
providers who are active members of their care team
•
Accurately routes information (e.g. Admission-Discharge-Transfer
messages, medication reconciliations, medication adherence)
•
Enables alerts to providers in active care relationships with patients
•
•
Coordinates entire care team with changes to patient status in real time
Allows searches by authorized persons or organizations:
• Health systems and provider/physician organizations
• Care coordinators
• Health plans
• Consumers (who can dispute asserted relationships)
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Active Care Relationship Service TM
Patient Information
Source Patient ID
First Name
Middle Initial
Last Name
Suffix
Date of Birth
Gender
SSN – Last 4 digits
Address 1 & Address 2
City, State, Zip
Home & Mobile Phones
Physician Information
NPI
First Name
Last Name
Practice Unit ID
Practice Unit Name
Physician Organization ID
Physician Org Name
Copyright 2015 Michigan Health Information Network Shared Services
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Expand Active Care Relationship
ServiceTM
Patient
Physician
Source Patient ID
First Name
Middle Initial
Last Name
Suffix
Date of Birth
Gender
SSN – Last 4 digits
Address 1 & Address 2
City, State, Zip
Home & Mobile Phones
Care Coordinators
NPI
First Name
Last Name
Practice Unit ID
Practice Unit Name
Physician Org ID
Physician Org Name
Copyright 2015 Michigan Health Information Network Shared Services
NPI (or New#)
First Name
Last Name
Practice Unit ID
Practice Unit Name
CC Org ID
CC Org Name
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Important Horizontal View
Eligible
Providers &
PCMH
Eligible
Hospitals
Critical Access
Hospitals
Behavioral
Health Specialists
Specialty
Providers
Care
Coordinators
Patients & Families
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+6 Million Active Care Relationships
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Active Care Relationships Providers
Statewide Provider Coverage
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Admit Discharge & Transfer (ADT)
Use Case
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Statewide Health Provider Directory
• Contains Electronic
Service Information
(ESI) used to route
information to
providers
• Flexibility to maintain
multiple distribution
points for single
provider or single
distribution for
organization
• Manages
organizations,
providers and the
multiple relationships
between them
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ACRS™ Update – Version 2.0
Patient Information
Source Patient ID
First Name
Middle Initial
Last Name
Suffix
Date of Birth
Gender
SSN – Last 4 digits
Address 1 & Address 2
City, State, Zip
Home & Mobile Phones
Physician Information
NPI
First Name
Last Name
Practice Unit ID
Practice Unit Name
Physician Organization ID
Physician Org Name
Physician DIRECT Address
DIRECT Preferences
Additional patient information to minimize false positives
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ADT Example – Current Workflow
Trusted Data
Sharing
Organization
(TDSO)
Trusted Data
Sharing
Organization
(TDSO)
Health
Provider
Directory
Specialist
Primary Care
Patient to Provider
Attribution
Patient
Care
Coordinator
1) Patient goes to hospital which sends message to TDSO then to MiHIN
2) MiHIN checks patient-provider attribution and identifies providers
3) MiHIN retrieves contact and delivery preference for each provider from HPD
4) Notifications routed to providers based on electronic address and preferences
Copyright 2014-2015 Michigan Health Information Network Shared Services
MiHIN Confidential Information – Proprietary – Restricted
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Statewide ADT Use Case Example
+
Active Care
Relationship Service
(ACRS)
+
Statewide
Health Provider
Directory (HPD)
“Use Case Collection:
Statewide ADT
Notification Service”
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Other “LEGO®” Combinations
MED
REC
+
Care
Plan
+
Active Care
Relationships
Active Care
Relationships
+
+
Copyright 2015 Michigan Health Information Network Shared Services
Statewide
Health Provider
Directory
Statewide
Health Provider
Directory
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