Frequently Asked Questions

Health information technology refers to all of the computer programs and tools that store, organize, and exchange medical information electronically. Electronic health records and e-prescriptions are just a few examples of what could be stored. Mobile health apps and remote monitoring are some of the tools that could be used to access this information.

When a doctor sees a patient, they will usually make a record of the patient’s medical information on a tablet or laptop computer. That record is called an electronic health record (EHR).

There is currently a nationwide push for health care providers to adopt EHR technology for patient record-keeping, eliminating the inefficiencies caused by paper-based record keeping.

MiHIN’s public health reporting services either directly or indirectly assist healthcare providers to achieve Promoting Interoperability and continue their follow-on reporting. The term Promoting Interoperability is used often in modern healthcare, but it’s still new enough that many healthcare professionals don’t understand it.

Put simply, “Promoting Interoperability” represents the accepted practices for providers to demonstrate they are using certified Electronic Health Record (EHR) technology in ways that can be measured significantly in quality and quantity.

In support of the nationwide effort to adopt Electronic Health Record technology, Medicare and Medicaid are offering incentive programs to any eligible health care entity (professionals, hospitals, critical access hospitals) who adopt, implement, upgrade or demonstrate Promoting Interoperability of certified EHR technology.

The benefits of promoting interoperability of EHRs include:

• Complete and accurate information. With electronic health records, providers have the information they need to provide the best possible care. Providers will know more about their patients and their health history before they walk into the examination room.
• Better access to information. Electronic health records facilitate greater access to the information providers need to diagnose health problems earlier and improve patient health outcomes. Electronic health records also allow information to be shared more easily among providers.
• Patient empowerment. Electronic health records will help empower patients to take a more active role in their health and in the health of their families. Patients can receive electronic copies of their medical records and share their health information securely over the Internet with their families.

The term “health information exchange” (HIE) actually encompasses two related concepts:

• Verb: The electronic sharing of health-related information among organizations. There are two kinds of information exchange – ‘push’ and ‘query’.
• Noun: An organization providing services to enable the electronic sharing of health-related information

Push exchange is initiated by the sender. For instance, when you emailed a friend a news article about flu shots that you believe she would be interested in, you ‘pushed’ that information to your friend. Your friend may not have been looking for the news article, but you sent it to her anyway. That is an example of a ‘push’ exchange.

The alternative to push exchange is query exchange. An example of query is when you want to find a specific news article on flu shots and you use an internet search engine to find it. You are looking for a specific piece of information and ‘pulling’ it from a large pool of information.

A Health Information Network is a set of standards, services, legal agreements, and governance that enable the Internet to be used for secure and meaningful exchange of health information to improve health care.

Currently there are seven Health Information Exchange providers in Michigan (known as sub-state HIEs, or Exchanges) that will be linked to the MiHIN backbone. These sub-state HIEs are generally regionally focused, and work with the health care providers in their regions to implement systems for electronically exchanging health information. For more information on these organizations, see the Exchanges page.

MiHIN is a public and private non-profit collaboration that has been formally designated as Michigan’s statewide health information exchange by cooperative agreement between the Michigan State Health Information Exchange program and the Office of the National Coordinator for Health Information Technology.

MiHIN has been developed by and for physicians, hospital systems, health insurers and privacy officers throughout Michigan.  Its governance structure is intended to be broad and inclusive, and relies on input from stakeholders from more than 20 organizations.  The state and federal government are promoting the creation of HIEs in a movement toward national standards for secure electronic exchange of health information.

A Qualified Organization (QO) is one that has performed all necessary steps to become part of Michigan’s network of entities participating in official statewide health information exchange through MiHIN. Many types of organizations can become QOs including Health Information Exchanges, Health Plans, and certain Departments of the State government.

Steps to become a Qualified Organization include:

a) engaging in health information sharing sufficient to be considered a sub-state health information exchange network and

b) full execution of a Qualified Data Sharing Organization Agreement for statewide, bi-directional data sharing and participation in a large number of Use Cases subject to predetermined conditions of use.

There are 3 types of HL7 acknowledgements: AA, AE, and AR.

“AA” is a positive acknowledgement that means everything was fine.

“AE” is used to say there was a nonfatal error, in other words, the message got to the destination but there was something wrong with the message content (missing field, wrong code, etc.).

“AR” is used for a fatal error, the destination was down or unresponsive and the message could not be delivered or the message was of such poor quality it was rejected (missing a key field, the wrong message type, etc.).

Example Scenario: Michigan Care Improvement Registry (MCIR) Immunization Messages (VXUs)

The Michigan Care Improvement Registry (MCIR) will acknowledge all messages. MCIR’s preference is that the HL7 acknowledgements make it back to the original sender/source. It is not technically a requirement yet, but QOs should implement or plan to implement this capability as soon as possible because it will become a requirement in the near future (for example, you will not be able to send a MCIR Query without it). Most of the up and coming Use Cases will require it. MCIR sends back detailed “AE” messages that tell the sender what was wrong with the message content. MCIR also has an error report page on their website that the senders can use to fix any “AE” type errors. MCIR Staff will train the sender’s staff on how to use this new page when they go live with MCIR.

At the HIE level, QOs have to be concerned with the AR messages, since that might mean that the message could not be delivered and needs to be re-sent. This is one of the things MiHIN tests in the HIE-to-HIE testing.

To reach that goal, however, standards must be established for interoperability between the various systems in use for capturing clinical data. Interoperability is a means for these health information systems to work together within and across organizational boundaries. The development of these interoperability standards is being driven by the American Recovery and Reinvestment Act and the meaningful use incentives outlined by the federal Office of the National Coordinator.

Patients are protected through several laws, including the Health Insurance Portability and Accountability Act, or HIPAA. HIPAA requires that providers, health plans and similar entities observe certain rules for privacy, and gives patients the right to access their information, restrict access by others, request changes to their record, and learn how their health information has been accessed. For more information on privacy regulations, see The Office of the National Coordinator for Health Information Technology.

These laws have been strengthened and adapted to conform to the use of technology in storing and exchanging health information. MiHIN uses state of the art security features that include multiple levels of password protection to ensure restricted access through the use of authentications for authorized users, strong encryption and other security measures as defined by HIPAA.

Currently there are seven Health Information Exchange providers in Michigan (known as sub-state HIEs, or Exchanges) that will be linked to the MiHIN backbone. These sub-state HIEs are generally regionally focused, and work with the health care providers in their regions to implement systems for electronically exchanging health information. For more information on these organizations, see the Exchanges page.

Hospitals, physician practices, reference labs, radiology centers and more providers in Michigan have committed to process clinical information through MiHIN using the sub-state HIEs.

The sub-state HIEs are working with electronic health record vendors and individual physician practices to enable connectivity with all providers in the state. In addition, many small practices will gain connectivity by working with Michigan’s Center for Effective IT Adoption, Michigan’s Health Information Technology Regional Extension Center, to implement certified electronic health record systems.

A healthcare provider directory is a statewide address book that contains providers’ general information (e.g., name, telephone, address, type), a Direct address where a referring provider can securely send patient information, and information about the provider’s preferred method for receiving messages. The provider directory is very important to health information exchange because it is the source of trusted provider information for secure routing and HIE information. Ultimately the provider directory is the map that helps information get to where it is supposed to go.

Many groups (payers, patients, providers, and others) realize that with the secure, electronic exchange of clinical data health care delivery will improve with respect to safety, quality, cost, and efficiency. Secure HIE has the ability to deliver the right health information to the right place at the right time, providing safer, more timely, efficient, and patient-centered care.

To reach that goal, however, standards must be established for interoperability between the various systems in use for capturing clinical data. Interoperability is a means for these health information systems to work together within and across organizational boundaries. The development of these interoperability standards is being driven by the American Recovery and Reinvestment Act and the meaningful use incentives outlined by the federal Office of the National Coordinator.

MiHIN works closely with all of Michigan’s sub-state HIEs and other state organizations to establish guidelines and programs to assist providers in qualifying for meaningful use, initially in the area of public health reporting related to immunizations and reportable labs, and in the ability to push structured Continuity of Care documents electronically.