Tim Pletcher, MiHIN’s executive director, describes the organization’s approach as a “use case factory.” MiHIN has created a methodology to work on bringing new use cases such as admission, discharge and transfer (ADT) notifications into production and add to their portfolio of shared services. “We put the use cases through a pipeline, including working with the state government or commercial payers to align financial or policy incentives. We have had payers involved in every single use case we have,” he stresses.
Once a new use case is in place, MiHIN runs the report cards on how health systems are doing. Are they sending data and how clean is the data and how consistent? “We are like teachers who want everyone to get an A,” Pletcher says. “We send report cards home to Mom and Dad—the payers or the state government. They decide whether they are going to give everyone their allowance. We don’t measure HIE participation, because just being part of a club does not mean you are creating value. But at the use case level, it does. For instance, we have 330 of the long-term care facilities/SNFs sending ADTs in Michigan, which is quite novel, but it is because we were able to create incentives to motivate them to do that.”
To help organizations work through issues with data sharing, MiHIN has a new nonprofit subsidiary called the Interoperability Institute and it has set up a sandbox environment called “Interoperability Land,” described as a shared online environment hosted in the Amazon Web Services Cloud where organizations, developers, and technology providers can engage in simulated interoperability scenarios to develop, test or demonstrate new application capabilities. It uses completely realistic but synthetic patient data.
“We started with immunizations, so people could practice submitting to the state registry,” Pletcher explains. “Very quickly we moved to ADTs and CCDAs, because nobody had any data to start priming the pump and work out all the kinks.”
Interoperability Land also features “FHIR Pits,” which are prototype interoperability testbeds specifically dedicated to FHIR, and Rings, which are complete simulated healthcare ecosystems. “A Ring might have a health plan, a major health system, an EHR for a couple of primary care physicians, a pharmacy and it builds out this complete synthetic healthcare systems,” Pletcher adds.
In 2019, MiHIN created another subsidiary company called Velatura to respond to requests from other states to repeat its model outside of Michigan. “Its whole purpose is to take anything that is useful from Michigan and help other states use it,” Pletcher said. “We want to help them find the right things in their environment but apply the use case factory principles to help them create a sustainable way to get data sharing and interoperability to happen.” Velatura already is working with the states of New Jersey and Oregon.
Pletcher notes how MiHIN plans to integrate telehealth provider Care Convene with other MiHIN services, including Active Care Relationship Service; Common Key Service (to assist with patient matching); ADT Notifications; and Quality Measure Information.
Unlike traditional telehealth solutions, Care Convene says it focuses on longitudinal care rather than episodic care. This model enables self-management by the patient and care coordination from all members of a patient’s care team. The company says this model further supports greater patient health literacy, virtual assessments, targeted patient education and chronic symptom management.
“Care Convene is a Michigan based company that has rolled out a novel, low-drag infrastructure that allows the provider and patient to be in control of the e-visit process,” Pletcher says. “And what is nice about it from our perspective in Michigan is that it ties into and is enabled by our Active Care Relationship Service.” The service enables organizations to identify patient-provider attributions, associating a particular patient with health providers at that organization. “We see Care Convene as a scalable platform for allowing doctors to get into e-visits in a way that they can control their own schedules.”
