Michigan Health Networks Joins eHealth Exchange

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Michigan Health Information Network (MiHIN) Shared Services, a "network of networks" that encompasses Michigan's seven regional health information organizations (HIEs), state agencies, and some health plans,has joined the national eHealth Exchange after undergoing rigorous testing.

Joining the eHealth Exchange -- the successor to the Nationwide Health Information Network (NwHIN) -- will enable MiHIN's participants to exchange health information with federal agencies such as the Department of Veterans Affairs (VA), the Social Security Agency (SSA), and the Centers for Medicare and Medicaid Services (CMS), as well as with other healthcare organizations and statewide HIEs that belong to eHealth Exchange.

MiHIN is not the first state-designated entity (SDE) for health data exchange to join the national network, said Mariann Yeager, executive director of Healtheway, the nonprofit organization that operates eHealth Exchange. But it is the first SDE, and one of the first organizations, to meet a new set of testing criteria to qualify for eHealth Exchange membership, she told InformationWeek Healthcare.

These requirements, which were designed to make health information exchange plug and play, will be applied to all new applicants to the eHealth Exchange, Yeager said. The Certification Commission for Health IT (CCHIT) is performing the tests, using components specified by Healtheway and the EHR/HIE Interoperability Work Group (IWG), which includes many states as well as EHR and HIE vendors.

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Those components are a subset of the criteria that will be used to test the products of EHR and HIE suppliers in the future, Yeager said. The product testing program, which was expected to start earlier this year, has been postponed because the vendors "have a lot on their plates," including certification for Meaningful Use stage 2, she said. Meanwhile, Healtheway wants to allow HIEs to participate in the eHealth Exchange with the interoperability specifications that will be used going forward.

MiHIN said it is also the first organization to join eHealth Exchange using the Consolidated Clinical Document Architecture (C-CDA) to exchange clinical summaries. Although C-CDA is required to meet MU Stage 2 requirements for health information exchange, not many providers yet have EHRs that are capable of generating summary documents in that format.

Tim Pletcher, executive director of MiHIN, which provides services to -- as well as connects -- Michigan's HIEs, said in an interview that the organizations are in various stages of transitioning to C-CDA. The Southeast Michigan Beacon Community is furthest along in this respect, he said. But MiHIN will do whatever it takes, he said, "to make sure our substate HIEs can play, either with each other or with eHealth Exchange" by using MiHIN's Common Gateway.

That portal, used in the process of onboarding to eHealth Exchange, "allows data sharing organizations to send and receive Patient Discovery, Document Query, Document Retrieve and Document Submission messages in multiple protocols," according to the MiHIN announcement.

The use cases for the eHealth Exchange that will be most important to MiHIN members initially will be those that involve federal agencies, Pletcher predicted. These include:

-- The ability to submit electronic disability claim eligibility determination requests from SSA to Michigan data-sharing organizations. This can shorten the time required for eligibility determinations from months to a few days.

-- The ability to get information on veterans electronically from the VA system.

-- The ability to use the Electronic Submission of Medical Documentation System (esMD) to send supporting clinical documents to CMS or its auditors.

Eventually, providers will also find it valuable to be able to request documents from HIEs and provider organizations in other states that belong to eHealth Exchange, Pletcher said. One reason: a lot of elderly Michigan residents are snowbirds who winter in Florida.

But first, he added, providers must get used to the idea of querying for patient information outside their practice or organization, a capability that MiHIN plans to introduce statewide in January.

"The ability to query for information is not a pattern of behavior we're used to in healthcare. It's so different from the fact of even picking up the phone and calling somebody, because you have systems increasingly making those queries automatically for you. We're not used to that model. We don't have the workflow patterns or the processes or even the expectations of how to do that," said Pletcher.

One approach to changing these patterns of behavior, he said, is to use a statewide alerting system that, starting in January, will notify physicians when their patients are admitted or discharged from a hospital. (The Michigan Blues, a MiHIN member, is paying hospitals and physician groups to participate.)

"As soon as you get that alert, the next thing you want to know is what did you do to my patient or what meds did you change? At that point, it becomes interesting to query for the next piece of information or the care summary," he said.

Another motivator will be Meaningful Use Stage 2, which requires both hospitals and eligible professionals to trade care summaries at transitions of care.

Not surprisingly, as the January start date of Stage 2 approaches, interest in the eHealth Exchange is growing. According to Healtheway's Yeager, 800 hospitals, 6,000 medical groups, 800 Walgreens pharmacies, and 750 dialysis centers are online with the national network. She expects the total number of participants to double within six months.