Tim Pletcher is Executive Director of the Michigan Health Information Network Shared Services (MiHIN, pronounced “my-hin”), a public-private nonprofit organization based in East Lansing, Michigan. Tim will be a featured panelist on the Data Governance panel of the Chilmark Convergence conference in Boston, Oct 4-6, where he will be speaking about how MiHIN is working with payers, providers and other stakeholders to improve health care quality, efficiency, and patient safety.
Tell us about MiHIN and how it is different from most Health Information Exchanges (HIEs)
We have more of a focal point of health care transformation. We are a meeting place for public and private entities – a community of stakeholders where data and trust come together. We look at how to deal with silos and different stakeholder objectives – whether they be about capital, managing risk, providing care, etc. We take the conversation about sharing information to its essence by identifying and articulating the value stream of specific information-sharing “use cases.” We utilize these use cases to help us tap into resources to advance new and key types of data sharing.
It’s better for everyone when a limited amount of good data is shared rather than a large amount of poor data. MiHIN is working with participants in a determined way towards improving specific use cases for data reporting – we focus on the minimal amount of data exchanged that can provide value.
How are you funded?
From day one we were against charging providers for data exchange infrastructure. We look to see what payers and regulators want and ask them to underwrite the model. They have been primarily the entities that are taking financial risk. To do so, they must place reporting burdens on providers. Providers are not looking to take on new work, and asking them to pay to do so doesn’t work.
What we do is help payers and regulators tee up the data-sharing use cases for what is valuable for them in terms of data exchange. For example, we perform conformance testing on provider reporting – we generate a report card on how good and consistent the data quality is on a provider by provider basis. These report cards are used by payers and the state to help determine to what degree to release incentives to providers. The challenge is less about access to data from providers – the magic is in better integrity and conformance. We can show payers and regulators how data quality and completeness looked before and after conformance testing – there is a measurable value in that.
How are providers viewing this?
The response has been good and continues to expand. We have 13 health information exchanges in the state participating in data-sharing. A number of them are exchanges associated with specific health systems or provider organizations. Providers welcome our approach in that instead of them having to provide large amounts of different data to many different payers and reporting agencies, they can work towards a more standardized “report once” ability. It’s better for everyone when a limited amount of good data is shared rather than a large amount of poor data. MiHIN is working with participants in a determined way towards improving specific use cases for data reporting – we focus on the minimal amount of data exchanged that can provide value.
What are your views on the longitudinal medical record?
We don’t believe in the myth of a longitudinal medical record – we’re certainly not trying to store all patient data in one place which has all kinds of challenges, including the expense and the vulnerability to cyberattack. We do believe in just-in-time data. For this, you need a record-locator infrastructure that works. It’s not efficient to ask everyone in a network if they know something about a patient (that may or may not be relevant). Or to get thousands of pages worth of Continuity of Care Documents (CCDs). We offer an active care relationship service – a next generation concept based on linkages that are patient-centric with situational awareness – that allows data to be pushed or pulled in a smart manner so the right providers get usable information when and where they need it.
How are you working to close gaps in care?
Our emphasis is on getting gaps in care reports into a consistent format and timing cycle. Reports have had too much missing information – many can be dismissed. This can create unnecessary burdens and waste in the system. Unfortunately, there is no national standard for representing gaps in care. This is a major area of focus in Michigan currently, with numerous organizations working together to identify efficiencies and standard processes.
How do you see convergence of payers and providers influencing your business model?
We have a use case working group as part of our governance structure that helps us keep up with these converging trends. While we are not trying to boil the ocean, we are continually looking for new ways to provide value – we make use of pilots to help determine scopes and bounds and then work to formalize these pilots into implementation guides and other formal use case documentation. This can include any participation incentives. We also conduct workshops – we are just finishing one workshop series for care coordinators. From a funding model regarding convergence, we charge based on how much risk an organization takes on – for example, an accountable care organization (ACO) takes on a large amount of risk and is charged accordingly.
How is data governance handled in converging entities?
We’ve been an early member of Carequality and CommonWell. In Michigan, we use a master use case agreement that provides an overarching set of legal guidelines for all data-sharing use cases, then add details for specific use cases in exhibits which help modularize the risk. We also have a normal board advisory structure – you need this in any multi-stakeholder organization.
Any final thoughts?
Every state has their own vehicle to achieve goals – a major goal in Michigan is to get good content for specific use cases – not assemble the longitudinal health record. Interoperability is not just a medical record content game. We are enabling an ecosystem aimed at improvement to emerge with robust trust and viable financial mechanisms.