MiHIN establishes HIE in Michigan

MiHIN establishes HIE in Michigan

Featured May 29, 2012 | ehrintelligence.comKyle Murphy, PhD, EHR Intelligence 

Exchange of health information occurs at all levels among providers, organizations, and institutions. While the widespread adoption of health information technology (IT) mandated under the Health Information Technology for Economic and Clinical Health Act (HITECH) begins with capturing health data, it reaches its climax in the meaningful sharing of health information through health information exchange (HIE). The foundation for national and interstate exchange is currently being built state by state.


Earlier this month, the Michigan Health Information Network (MiHIN) announced that it had gone live with its network. For Executive Director Tim Pletcher, the launch of MiHIN represents a culminating moment for a state typically ahead of the curve. “The MiHIN process kicked off seven years ago where the emphasis was on creating regional initiatives,” Pletcher explains, “It’s the perfect timing now to connect the dots for those sub-states as well as the state of Michigan.”


In March 2010, the Office of the National Coordinator for Health Information Technology established the State Health Information Exchange Cooperative Agreement Program that awarded 56 states and other entities $548 million to develop the infrastructure necessary for efficient and scalable exchange of health information.  As of 2011, the Michigan Department of Community Health had received close to $15 million dollars and helped establish MiHIN Shared Services as well as cover its operational costs.



The goal that we’re after is simplification

So what is MiHIN? Apparently, there’s a bit of confusion around what the HIE is and does. “Some people call it a network of networks and that’s not entirely true — although that’s not an inaccurate description as well,” says Pletcher. In reality, MiHIN is a cloud service that connects the state’s healthcare constituents in a single place. “We’re creating that trusted fabric where all these sub-states and the state of Michigan can interact to support multiple use cases,” continues Pletcher, “As the state-designated HIE, we’re the meeting place.”


Not only is it the mechanism to exchange health information, but MiHIN is also the means for connecting the state’s stakeholders: “They all have representation on our Board as well as the insurance companies, the state of Michigan, and the Health Information Technology Commission.”  The existence of the latter underscores the state’s commitment to meaningful exchange, and one of its central role is overseeing the HIE to ensure that not-for-profit MiHIN pays off. “While we’re a separate, not-for-profit entity, we are basically monitored by that HIT Commission and they have a seat on our Board,” add Pletcher.


MiHIN serves as the state’s technical nexus, providing support to connect and soon-to-be connected providers and organizations. “MiHIN has adopted more of a technical orientation just because we are not trying to run a public utility that goes out to the doctor’s office,” the director elaborates, “What MiHIN is doing is fielding fairly deep technical expertise in the core.”


What’s exciting is that momentum builds upon itself

The healthcare industry has reached a tipping point where HIE is a necessary rather than peripheral feature of health IT. “We’re actually engaged in the flow of where things are going for a change,” says Pletcher. But that’s not to say MiHIN has moved forward without challenges.


Chief among them is a pessimistic view of health IT in healthcare as a result of previous failures to implement it correctly or adequately: “That cynicism, while in many cases deserved in healthcare, has often overshadowed the fact that what we’re talking about imminently doable now. And it just takes the will.” The next biggest challenge is the fragmentation pervasive in the healthcare industry “that has led to a divisive culture,” continues Pletcher, “People constantly want to pit folks against each other. It’s remarkable.”


We have something we call the pit

Instead of allowing this pessimism and divisiveness to threaten its success, MiHIN is pitting groups together in a productive way in what is dubbed “the pit,” which is the testing ground for everything and anything that the HIE encounter. “We throw all of our stuff into the pit and we work to stand up our testing library, so people can go and test stuff. We do a lot of things in the pit to learn,” Pletcher remarks.


Formally known as the Vendor-Neutral Rapid Prototyping and Interoperability Test Bed, the pit is a testing group with one aim in mind:

Our whole goal for HIE is to create a rapid learning environment where we can get people onboard quickly and recognize that there’s a whole bunch of stuff that none of technology people really know yet. It’s not that there not smart enough to figure out; it’s not that we don’t have good technology to do it. It’s that nobody knows the proper sequence to really get the biggest bang.


MiHIN relies on the pit and the rest of the organization to troubleshoot bugs and errors in the system as helpdesk. Without it, added complexity could prove uncontrollable and jeopardize attempts to scale up. You have to know how to ask the right questions, especially from the perspective of the provider used to point-to-point solutions: “How do we create a sustainable infrastructure that nobody feels like they got handed off to nowheresville?”


In the end, it’s all about consistency. The most stable structure are built on the sturdiest foundation. “The goal that we’re after is simplification at a higher level even though we’re adding complexity into the mechanisms for how things get done. It becomes scalable; it becomes predictable,” observes Pletcher.


And what’s next? MiHIN began its work with immunizations, providing a report of public health. Next is identifying where all the data should and will end up:

The next big thing for MiHIN is what we call the Health Provider Directory. The penultimate goal is to be able to push around data. That seems pretty natural. Well, if you think about it, if you don’t know where all providers are and how they receive their electronic information, it’s very hard to push data around to them.

What seems simple often requires more complexity than anticipated. But it would seem that developing solutions is much simpler when all the key players have a seat at the table.