Common Gateway Use Cases

The MiHIN Common Gateway itself consists of a CONNECT Gateway together with a Broker as depicted below:

Common gateway main pic

The CONNECT Gateway utilizes Nationwide Health Information Network (NwHIN) SOAP based messaging to send and receive Patient Discovery (PD), Document Query (DQ),  and Document Retrieve (DR) messages to other eHeatlh Exchange participants, such as the federal agencies (SSA, VA, CMS).

The Broker manages message transformation and routing not only to and from the eHealth Exchange but also to and from MiHIN’s Qualified Organizations (QO).  The transformation services allow QOs to send and receive in a number of protocols whether it is NwHIN SOAP, NwHIN Direct or the more widely used XCA.  While the routing services direct messages to applicable QOs and eHealth Exchange participants based on the Use cases a QO has signed up for.

When QOs agree to exchange via MiHIN they will chose from a number of possible Common Gateway Use Cases:

  1. QO to QO – exchanging health information with the MiHIN
  2. VA – exchanging health information between their QO providers and the Veterans Administration (VA)
  3. SSA – Responding to Social Security Administration  (SSA) eligibility claims for patients with a MiHIN QO(s) network of providers
  4. CMS esMD – Submitting documents to the Centers for Medicare and Medicaid Services Electronic Submission of Medical Documentation System (CMS esMD)  in support of eligibility determinations for patients within a MiHIN QO(s) network of providers
  5. Non-federal eHealth Exchange Participant(s) – exchanging health information between their QO providers and other non-federal out of MiHIN networks

As can also be seen from the diagram above MiHIN has also developed two simulators to aid QOs onboarding into the MiHIN Exchange by simulating either the Federal Agency Use Cases (FedSim) or other QOs (EdgeSim).  Therefore this allows MiHIN and the QO to test and gain confidence that their systems will work alongside the existing MiHIN participants when then go to production with their chosen Use Case(s).

These MiHIN Common Gateway Use Cases are described further below.

1) QO to QO

i) QO Requests Patient Information from another MiHIN QO

QO TO QO JPG

A QO within MiHIN discovers a patient within one or more of MiHIN’s other QOs, and queries and retrieves documents related to that patient. This use case provides a common way for QOs to query for documents across the state of Michigan. The communication for this use case between QOs via the MiHIN Common Gateway may be via differing protocols (XCA, NwHIN, Direct).

ii) QO Receives Request(s) for Patient Information from another MiHIN QO

QO to QO JPG Two

Converse to Use case 1i) a QO within MiHIN has patient information and related documentation that is being requested by another QO within MiHIN.  This use case provides a common way for QOs to respond to document requests across the state of Michigan. The communication for this use case between QOs via the MiHIN Common Gateway may be via differing protocols (XCA, NwHIN, Direct).

2) VA

i) MiHIN QO requesting patient information of the VA via the eHealth Exchange

QO to eHealth JPG

A QO within MiHIN has a patient who is a Veteran, and queries the VA to retrieves documents related to that patient. This is similar in nature to Use Case 5i), just a specific eHealth Exchange participant, VA. While the communication for this use case between the QO and the MiHIN Common Gateway may be via differing protocols (XCA, NwHIN, Direct), the communication between the MiHIN Common Gateway and VA will use only the NwHIN protocol PD, DQ, DR services.

i) VA requesting patient information of a MiHIN QO via the eHealth Exchange

eHealth to QO JPG

The VA discovers one of their Veteran’s within one or more MiHIN QOs, and queries and retrieves documents related to that patient.  This is similar in nature to Use Case 5ii), just a specific eHealth Exchange participant, VA. While the communication for this use case between the MiHIN Common Gateway and the QO may be via differing protocols (XCA, NwHIN, Direct), the communication between the VA and the MiHIN Common Gateway will use only the NwHIN protocol PD, DQ, DR services.

3) SSA

i) SSA requesting patient information of a MiHIN QO via the eHealth Exchange

eHealth to QO JPG

For SSA’s Disability Eligibility program, the SSA will request specific documentation for a patient within a MiHIN QO that has requested disability. This is similar in nature to Use Case 5ii), just a specific eHealth Exchange participant, SSA. While the communication for this use case between the QO and the MiHIN Common Gateway may be via differing protocols (XCA, NwHIN, Direct), the communication between the SSA and MiHIN Common Gateway will use only the NwHIN protocol PD, DQ, DR services.

4) CMS

i) Send Medicare clinical documentation to CMS esMD

cms jpg

For CMS’s Electronic Submission of Medical Documentation (esMD) program, a QO within MiHIN will receive a request for medical documentation.  Currently, CMS does this via postal mail, but later phases will include electronic request for documentation.  The QO submits the requested documents to CMS esMD. The communication between the QO and the MiHIN Common Gateway may be via differing protocols (XCA, NwHIN, Direct), while the communication between the MiHIN Common Gateway and CMS esMD will use only the DS NwHIN protocol service.  Currently this communication will be directly between the MiHIN Common Gateway and CMS esMD.  Later phases will pass this communication via the eHealth Exchange.

5) Non-federal eHealth Exchange participant

i) MiHIN QO requesting patient information of a eHealth Exchange participant

QO to eHealth JPG

A QO within MiHIN discovers a patient within one or more organizations on the eHealth Exchange, and queries and retrieves documents related to that patient. While the communication for this use case between the QO and the MiHIN Common Gateway may be via differing protocols (XCA, NwHIN, Direct), the communication between the MiHIN Common Gateway and eHealth Exchange participant will use only the NwHIN protocol PD, DQ, DR services.

ii) eHealth Exchange participant requesting patient information of a MiHIN QO

eHealth to QO JPG

An organization on the eHealth Exchange discovers a patient within one or more of MiHIN QOs, and queries and retrieves documents related to that patient. While the communication for this use case between the MiHIN Common Gateway and the QO may be via differing protocols (XCA, NwHIN, Direct), the communication between the eHealth Exchange participant and the MiHIN Common Gateway will use only the NwHIN protocol PD, DQ, DR services.