Michigan Health Connect got its initial start in July 2009 when a few health systems in West Michigan using Medicity’s Novo Grid (Salt Lake City, Utah) decided to share health information. The collaborative was formalized in March 2010 with five main health systems as stakeholders. Doug Dietzman, at the time a program manager with one of the stakeholders Spectrum Health, worked in the beginning stages to deploy Medicity and helped facilitate the burgeoning collaborative. Once Michigan Health Connect incorporated, Dietzman stepped into the executive director role. He recently spoke with HCI Associate Editor Jennifer Prestigiacomo about his HIE’s value-add strategy, as well as his mantra of not trying to do it all.
Healthcare Informatics: Can you give me a little background on Michigan Health Connect?
Doug Dietzman: The health systems here in west Michigan needed to figure out how to connect electronically to the providers out in the community. As physicians were getting more electronic systems in their office, they wanted more connectivity. So, each went down a path to select technology to do that. Here in west Michigan, three organizations independently selected Noble Innovations for their clinical messaging platform that since has been acquired by [Salt Lake City, Utah-based] Medicity. The three organizations here in Michigan, Spectrum Health [Grand Rapids], Trinity Health [Novi], and Metro Health [Wyoming], got together and said, ‘There’s got to be a better way to do this. Can we agree to not compete on clinical data exchange, but instead collaborate with each other and figure out how we integrate the experience for the provider?’ So that started the conversations here.
Lakeland Health Systems [St. Joseph] in Southwest Michigan also had selected Medicity, and they asked if they could join the conversations, and then Northern Regional Health System in Petoskey. Michigan had handed out nine planning grants to define health information exchange in the state, and when the northern region came to the end of their planning exercise, they selected Medicity as well. But when they went back to the state for their implementation funding, the state didn’t have any money for them. And Northern Michigan decided they weren’t going to wait, so they went with us and developed a contract with Medicity as well. So, those were the five initial anchors, and it was all borne out of collaboration.
As we got into this part of the year, it became pretty clear that we couldn’t become a handshake collaborative anymore; we needed to be an [organization]. That’s when we moved to incorporate Michigan Health Connect in the state of Michigan as a nonprofit going for a 501(c)(3) charitable status. Subsequently, we added McLaren Health System [Flint] and Ascension Health [St. Louis, Mo.] as participants as well.
HCI: What was the thought behind making Michigan Health Connect a non-profit instead of a state agency or public trust?
Dietzman: The state has health information exchange activities going on through the Michigan Health Information Network (MiHIN). They received through the ONC [the federal Office of the National Coordinator for Health Information Technology] HIE funding just under $15 million I think for state activities. So, they are defining core infrastructure for the state of Michigan, connecting the different sub-state HIEs together, and creating some services that they can leverage. That was kind of the public side of things. Frankly, one of the reasons that [Michigan Health Connect] came together initially was they felt like they’d be in a stronger position if they collaborated. That [it was important to] deliver the capabilities that were expected of them, rather than be reactive and have something imposed on them. It was a means to leverage their existing investments, rather than potentially lose them.
HCI: Has your organization received any sort of grant money?
Dietzman: We’re 100 percent privately funded now, and we’ll certainly take advantage of grant opportunities as they become available. We’re putting our sustainability model together, and we’ll do grants on a project basis to help us build components of the exchange—but not depend on state or federal grants for ongoing sustainability.
HCI: I read that you’re leveraging existing investments. Can you go into a little more depth on that?
Dietzman: That’s speaking to each of the organizations having invested in that Medicity platform. We wanted to leverage that, and bring those independent deployments together into a model, and then invite others to participate. And we’re trying to build an integrated exchange based on the investments they already made. So, the uniqueness of Michigan Health Connect is what we mean by the ‘bottom up’ instead of the ‘top down.’ We didn’t come together and have to argue about the millions of dollars that we’re going to throw in the middle, and how we’re going to go through some process to select a vendor. The vendor was selected by nature of the organizations all using it, and they were coming together and saying, ‘How do we build what we’re already deploying up to be an exchange?”
HCI: That’s a unique approach. I’ve talked to many HIEs, but haven’t really heard that kind of story yet.
Dietzman: That’s what I’m hearing as well. It’s very, very difficult for them [healthcare organizations] to get over the competitive nature. They’ve got angst about the hospital across town, and the thought of being able to lay that aside and say, ‘We’re going to do health information exchange,’ is really tough. The other [thing] is that health information exchange is being driven heavily by public and governmental based activities, at least from a funding standpoint.
HCI: What is your relationship with MiHIN and Michigan's federally-designated Health IT Regional Extension Center, the Michigan Center for Effective IT Adoption (M-CEITA)?
Dietzman: With MiHIN we’ve been very involved on the committees that help put together the strategic and operational plans for the governance of MiHIN moving forward. They’re setting up a separate public/private 501(c)(3) organization to manage the MiHIN assets. A key component of that board is going to be the sub-state HIEs, which Michigan Health Connect has a seat on the board and will be very involved in defining what the services the state will offer.
As it relates to M-CEITA, we aren’t in daily contact with them, but the way Michigan Health Connect is carved up is, we don’t need to do it all. There are services already out in the market for providers. One of them being, if you need to figure out what kind of system to set up, M-CEITA is set up to do that. They’ve got funding, that’s what they’re all about. We aren’t trying to compete with that. We’re pointing people to M-CEITA, and saying work with them to help with what you need. As an aside, I don’t want to be competitive with my hospitals that are supporting me because my hospitals will have affiliate programs where they are trying to entice providers to use their practice management and electronic medical records systems [EMRs]. So if Michigan Health Connect had an EMR, I’d be in direct competition with them, and I don’t want to do that either.
Our commitment is that we’re value-add, rather than competitive. Whatever system a provider selects, through affiliate hospitals or regional extension centers, we have to meet them at the door and make sure we can connect that electronic system with the rest of the community. That’s the gap and that’s what we’re intending to fill.
HCI: What other value-add services are you currently offering or going to offer in the future?
Dietzman: All of the organizations that started with Michigan Health Connect are doing very discreet clinical messaging, so results from the provider and lab, orders from the providers’ EMR to the hospital, that’s our base foundation. We’re also now piloting physician to physician referrals across the network, and we’ll be to deploying that more widely in a month or so. As a part of that, there’s a virtual care team record associated with it. So, that if a paper-based practice isn’t yet at a point where they have an electronic record, but they want to start capturing some very basic things like problems, medications, and things like that, [they can] do that within this virtual care team record so data follows along and effectively becomes in sync between the two offices.
The last piece that we’re in the planning stages of is the community viewer, that traditional model where different organizations put the data into the master person index and you have access to it across the community. That’s the piece we’re adding now, and will come into place around first or second quarter next year.
HCI: What type of HIE platform is Medicity? Is it a federated model or central repository?
Dietzman: I think they could do either/or. We’re going to implement it in a highly federated environment. The way I think about it is it’s all about getting data from one system to another. Honestly, I believe that health information exchange is the future of survival, and those that win are going to be experts in getting data from one system all the way into another because doctors don’t want to go to a separate portal to look at information. They want it within their EMR, and if they get pressured more and more to use this community data that’s available, then we’ve got to be really incredibly focused on that space.
The second half is that clinical viewer piece. We’re going to be highly federated to avoid some of the ‘who owns the data’ and those sorts of issues. It will make it easy if an organization gets sold or separates. Each organization has its own data stage, and the infrastructure can pull it all together at the point of needing to be viewed by providers.
HCI: What are some challenges you’re currently facing?
Dietzman: We’ve got the common challenges that we all face. How do we balance all of our agreements? We know we need to have everything very safe and secure on the data exchange perspective, but how do we do that through all of our data use agreements? I think another challenge is when you have seven different organizations and five of them had already started with the Medicity platform and started doing things—bringing those into a seamless and integrated whole is an interesting challenge. One of the challenges with the bottom up approach is you have to marry those independent priorities at an enterprise level.
HCI: What is your goal in terms of provider and healthcare organization inclusion since there are other HIEs in your state?
Dietzman: To this point we have not been aggressive from a marketing standpoint, going out and signing people up, if you will. We’ve been responding to requests as the different health systems are trying to figure out who they’re going to plug in with. Our goal would be, if you look in our primary service area, the hospitals that are participating with Michigan Health Connect now, we’ve got 80 percent of the counties in the lower peninsula, which are the primary service areas of those hospitals. Now, with 145 different hospitals in the state, we have to figure out how we get those smaller community hospitals plugged in, and have a business model that doesn’t have a big upfront cost that allows them to ease in. As we do that, just start to fill in the whole provider community. I have a vision from working in my past life with a couple of consulting firms, spending time in the health plan side as well as the delivery side. My goal is figuring out how to have a single integrated health information exchange that ties together everybody, not just hospitals and providers, but payers, pharmacies, home health care agencies. It’s all about tying everything together in a healthcare process within the state, and so we need to figure out support from a technical infrastructure standpoint, and how the data needs to flow and where it needs to be to support all those components of healthcare.
HCI: Back to the question of sustainability, I assume you have a subscription model in place, how will it evolve as you add more functionalities to the HIE?
Dietzman: Year one budget that goes till June 2011 had dollars that were committed by each of those seven organizations. In year one we also have to figure out what that ongoing model is, and it will be subscription-based. We’re building it so organizations can pick a la carte solutions that they need based on their specific needs, and layer it over time so they’re only paying for what they’re using. If someone just wants results delivery, then there’s a subscription price just for that.
HCI: What are some of the lessons learned so far?
Dietzman: I think one that we’ve touched on a little is not feeling the need to do it all. I think sometimes we get caught up in that if we know that the perfect world we want to get to is 10 steps away, that we have to take all nine or 10 steps at one time. Then we get caught up in all the analysis paralysis associated with getting all 10 steps done. I think the lesson we’ve learned is if we know what the first two steps are, and if they add value, let’s take those two steps, and get further down the road. If we’re truly adding value then we win the right to have people engage with us for additional things. One example I’ll give you is results delivery to a paper based practice. There is absolutely nothing sexy about sending results to a practice and putting them in a drop box for them to print. But if the fax machine is going all day long, and they don’t have control of what’s coming over that fax machine, with things all mixed up that have to be sorted through—to be able to give them a tool that allows them to print what they want, when they want, adds value. I think incrementally adding value was a key lesson.
One of the other things I hope that organizations will learn is that it’s much better to be in a proactive, collaborative position, than to be in a reactive, isolated position. Being able to get past the competitive stuff and say, ‘It’s better for us as an enterprise to collaborate within our community, rather than being in a precarious position having to react to whatever the states or the feds bring down.’
One more is how we talk about trust in the health information exchange. Trust is much more easily established when you are filling a gap and not competing with things already in the market. It’s much easier to talk a health system into participating with us if they know I don’t have an EMR solution that’s going to be competing with their solution. I think we found we can get a lot more people to the table when we’re trying to do the things that people aren’t doing, rather than do it all.
