mihin health provider directory demo slides with cqmrr v43 02 18-15
TRANSCRIPT
Michigan Statewide
Health Provider Directory
Scalable, standards-based, extensible solution for storing and making accessible electronic service
information for providers and provider organizations recording providers’ delivery,
notification, and routing preferences for accurateand secure exchange of health information
Copyright 2014 Michigan Health Information Network Shared Services 1
What You Are About To See
Copyright 2014 Michigan Health Information Network Shared Services 2
• Key benefits of the Michigan Statewide Health Provider Directory (HPD) service
• Strategic focus of the HPD service:
• Route health records via Electronic Service Information
• Overview of architecture:
• advanced data model
• relationships to standards
• Ability to easily integrate with Direct HISPs
• Support for Transitions of Care (TOC) Use Cases
• Demonstration of Health Provider Directory service
• Quality portal(s) for Clinical Quality Measurements
HPD Key Benefits• Standard: Michigan’s ‘superset-model’ extends Provider Directory standards:
• Supports all three leading standards: HPD+ 1.1, ModSpec, IHE/IHR
• Supports Use Cases for Meaningful Use and beyond
• Populated: Data from multiple sources imported, mapped and de-duplicated:
• State and federal provider data
• Sub-state HIE / RHIO / PO / NPPES / Payer provider data
• Commercial data sources (no longer used)
• Deployed: Force.com platform provides production-quality deployment:
• Familiar GUI is global and ubiquitous, including mobile devices
• Architecture allows easy integration via SOAP & REST APIs
• Reliable 24x7 production in Salesforce.com cloud
• Robust security augmented by MiHIN additions:
• Single-Sign-On with other services (Direct HISPs, EHRs, etc.)
• Trusted identity federation at NIST 800 LoA 3)
• Extensible and scalable based on provider/user feedback
Copyright 2014 Michigan Health Information Network Shared Services 3
Michigan’s HPD is in Production• Michigan’s HPD is in use and is ready for others to use
• Production service deployed in Salesforce cloud > 2 years
• Federated with other large provider directories (e.g. Florida HIE
and Surescripts via ONC Exemplars Snowbird Pilot)
• HISP-neutral directory supports simple integration with HISPs
• Multiple states’ provider data in one HPD instance (no federation)
• Installable application via Salesforce AppExchange
• Others can deploy and administer
• No up-front cost to use Michigan’s HPD solution
• SaaS subscription model – pay per account as you grow
• Accounts range from $25/year (individual )to $3600/year (unlimited)
• API accounts allow easy system-system integration (no federation)
• Integrated with modernized NPPES for real-time updates
• Soon: real-time credentialing transactions
Copyright 2014 Michigan Health Information Network Shared Services 4
HPD Strategic Focus
• Electronic Service Information (ESI) is:
• “Information for delivering PHI by secure electronic means”
• HPD supports multiple types of ESI today:
• Most commonly discussed: Direct Secure Messaging
• Secure email account id
– Example: “[email protected]”
• In more widespread use: IHE/EHR routing information
• HL-7 LLP protocol endpoints
– Example: “data.hfhs.org:22356”
• Future forms of ESI are forthcoming:
• Patient preferences for where their PHI is stored (e.g. PHR)
• Other federally defined forms of ESI (e.g. VA, SSA)
Copyright 2014 Michigan Health Information Network Shared Services 5
MiHIN Service Oriented ArchitectureDirect HISP, Search Service, MiDiGate™
TOC (ADTs, MedRecs), Immunizations,
Reportable Labs, Syndromics, etc.
Context for HPD Use Cases
Statewide
Health
Provider
Directory
Organization
Admins
Individual
Providers
SoM
Payers, DSOs
Commercial
HISPEMR
HIE
Other
Entities
Salesforce.com
SOAP, REST, https, ModSpec APIs
Informatica
ETL + MDM
HPD
Admins
Other States
Copyright 2014 Michigan Health Information Network Shared Services
Population
Admins
6
API
Readers
API
Writers
Organization
“Account”Name
Identifier
Specialty
CredentialCare Team
Electronic
Service
Provider
“Contact”Provider
Affiliation
0..n 0..1
HPD Object Model
Organization
AffiliationAddress
1..n
Copyright 2014 Michigan Health Information Network Shared Services 7
HPD Integration Capabilities
• HPD API for HISP Integration:
• High level, efficient, Restful, query API
• Supports ModSpec 7 HPD query definitions
• In production and in use by multiple organizations
• Health Provider Search Service
• Allows any Direct HISP to query Michigan Statewide HPD
• Plug-in consists of one page of simple code
• Easily inserted to and integrated with HISP client code
• Encapsulates HPD query capability using REST API calls
• Integrating with other services for full transactional updates
• NPPES (NPI) database, credentialing, other services
• Monitoring/tracking HPD federation protocols
Copyright 2014 Michigan Health Information Network Shared Services 8
Copyright 2014 Michigan Health Information Network Shared Services 9
Provider Index
MCIR
Immunizations
MDCH Data
Hub
HSTR
Meaningful Use
CHAMPS/MMIS
Medicaid
Submit/Request
Submit/Request
Submit/Request
Submit/Receive/
Request/Review
The Open Directory™
LARA
Licensing
Submit/Request
EHR Labs
HISP
Z
directory
HISP
A
directory
Health Provider
Search Service
Request
…
Qualified
Organizations,
Network of
Networks, HIEs,
HINs, RHIOs
Submit/
Request
MIDIGATE®
Credentialing
Service
Direct Trust
Directory
Active Care
Relationship &
Transitions of
Care
Services
NPPES
&
NPPES Redux
Health Provider
Directory
Other
Repositories
State of
Michigan
Health Provider Search Service
Copyright 2014 Michigan Health Information Network Shared Services 10
Industry Approach: Federated Directories
Copyright 2014 Michigan Health Information Network Shared Services
Michigan
HPD
Florida
HPD
Surescripts
HPD
Michigan
Provider
1. Michigan HISP user searches for a Florida provider
2. Orchestration service negotiates queries to relevant PDs
3. HPDs return search results and orchestrator merges into single response
4. Michigan HISP user sends Direct message to Florida provider
Florida
Provider
Query
Orchestration
Service
11
Challenges:
1.Not scalable (too many directories to federate)
2.Standards not fully defined and are inconsistent
Qualified
Sub-state HIE
or VQO
Qualified
Sub-state HIE
or VQO
How HPD Infrastructure supports
Transitions of Care Service
Copyright 2014 Michigan Health Information Network Shared Services
Patient to Provider
Attribution
Delivery
Preference
Lookup
1) Patient goes to the hospital, hospital sends an ADT message to MiHIN
2) MiHIN checks patient attribution lists and identifies three providers
3) Retrieve from HPD the ESI and delivery preference for each provider
4) Notification is routed to the providers based on their ESI and preference
Primary Care
Specialist
Care
Coordinator
Alerts &
Notification
DSM
12
MiHIN Transitions of Care Service (TOC)
Copyright 2014 Michigan Health Information Network Shared Services 13
• MiHIN TOC service has been in production since Nov 2013
• 19 Physician Organizations in production
• Additional 43 Physician Organizations targeted to go-live
• Over 600 hospital & practice organizations in production
• Over 1500 providers receiving real-time TOC notifications
• Over 3 million TOC notifications transmitted per week
• Over 80% of Michigan statewide admissions are shared currently
• Over 90% of Michigan Statewide admission expected to be shared by the end of 2014
• Onboarding more hospitals and practices weekly
• Excellent source of accurate provider & organization data & affiliations
• Processing monthly updates to ACRS data sets in production
• Working towards transactional updates
MiHIN Health Provider Directory
Copyright 2014 Michigan Health Information Network Shared Services 14
Clinical Quality Measurement
• A new way of assessing the success of medical care
• Meaningful Use (MU) Stage 2 requires Medicaid providers to report Clinical Quality Measurements (CQMs) from a certified EHR
• A new strategic direction for the HPD
• CAT-I reports assess individual patient encounters
• CAT-III reports assess organization efficiency & enable cross-clinic comparisons
• MiHIN Patient Generator creates test data for large, simulated populations without PHI
• Report-once capability for Medicaid and Medicare
• Direct submission of CQM reports in pre-production
Copyright 2014 Michigan Health Information Network Shared Services 24
Clinical Quality Measures in HPD:
Super Stickiness!• Medicaid providers are required to submit CQMs
• Non-Medicaid providers may want to report and analyze their CQMs also, given the appropriate powerful tools
• HPD will display CQM data via Clinical Quality Measurement Recovery and Repository (CQMRR) service
• All providers and organizations can access reports, dashboardsand comparisons for self-analysis to improve outcome trends for their patients/clinics
• Allows real-time feedback on clinical and organizational trends
• Continuous Process Improvement / Clinical Quality Improvement
Copyright 2014 Michigan Health Information Network Shared Services 25
Reports and Data Analysis:
Real-time Quality Comparisons
Copyright 2014 Michigan Health Information Network Shared Services
• CQMRR: skimming ‘la crème de la crème’
Standard report generation (varies by user)
Cross clinical comparisons (Medicaid, Medicare)
Self-comparisons (providers)
• Can identify best (and worst)
Graphical dashboards using Tableau™
• Gartner rated top business intelligence tool
• Real-time feedback for Clinical Quality Improvement
26
MIDIGATE
OutboundInbound
Copyright 2014 Michigan Health Information Network Shared Services 27
CQMRR – current capability
State of Michigan
Data Hub
Eligible
Providers
Eligible/Critical
Access Hospitals Data Peeler
CDA
Schema
DQA
SOM Data
Warehouse
eCQM
Data Mart
(Final)
Health
Provider
Directory
Medicaid
Reports,
Dashboards,
Comparisons,
Mining,
QRDA
QRDA
popHealth CAT I
to CAT III
QRDA
QRDA
(CAT I & III)
Check NPI
MiHIN®
MIDIGATE
OutboundInbound
State of Michigan
Data Hub
Copyright 2014 Michigan Health Information Network Shared Services 28
Eligible
Providers
Eligible/Critical
Access Hospitals Data Peeler
CDA
Schema
DQA
SOM Data
Warehouse
eCQM
Data Mart
(Final)
Health
Provider
Directory
Medicaid
Reports,
Dashboards,
Comparisons,
Mining,
QRDA
QRDA
popHealth CAT I
to CAT III
QRDA
QRDA
CQMRR - future state
QRDA
(CAT I & III)
Check NPI
Provider Quality
Portal
Provider
Reports,
Dashboards,
Comparisons,
Mining,
any provider
(any state)
®
CMS
Repository
Medicare
Reports,
Dashboards,
Comparisons,
Mining,
Payer Quality
Analysis
QRDA
Payer
Reports,
Dashboards,
Comparisons,
Mining,
PQRS
QRDA
MiHIN
MiHealth
Portal
QRDA
What You Have Seen
Copyright 2014 Michigan Health Information Network Shared Services 32
• Key benefits of the Michigan Statewide Health Provider
Directory (HPD) service
• Strategic focus of the HPD: Electronic Service
Information & health information routing
• Architectural overview including the data model and
relationships to standards
• HISP integration capabilities
• Transition of Care (TOC) integration
• Health Provider Directory service demonstration
• Clinical Quality Measurement capabilities