1. MiPCT/MiHIN Clinical Data Summary Progress Briefing May, 2015

2. AGENDA A Look Back: The MiPCT ADT PO Partner Timeline
A Look Forward: Adding Clinical Information
Discussion and Next Steps

3. ADTs: From Alert to Care Delivery
Alert appears in web-based member listing
Care Manager acknowledges
Repeat reminders to prompt activity
Care Mgr Receives Electronic Alert
Care Manager accesses EMR, discharge summary, or any available clinical information, (and if none, contacts patient if appropriate
Care Manager communicates with facility discharge planning contacts or via call to patient
Care Manager accesses available patient info.
Medication reconciliation and TOC activities
Identification of patient needs and initiation of follow-up care
Bill (G/CPT) if applicable
Initiate Near Real Time Transition of Care Activity
ADTs: From Alert to Care Delivery

4. A Look Back: The MiPCT ADT PO Partner Timeline

5. A Brief History: The MiPCT/MiHIN ADT PO Partner Timeline Recap

6. MiPCT/MiHIN ADT Notification
MiPCT Vendor (Crimson)
Health Systems
Health Provider Directory
Primary Care
Care
Coordinator
Patient
Patient to Provider Attribution (ACRES)
Care Manager Mapping
POs
1) Patient goes to hospital which sends ADT message via substate to MiHIN
2) MiHIN checks MiPCT patient-provider attribution file (ACRES) and matches with ADTs received
3) MiHIN sends matched ADT to MiPCT Vendor (Crimson)
4) MiPCT Vendor (Crimson) matches MiPCT ADTs with PO-provided Care Manager mapping
5) MiPCT Vendor (Crimson) sends ADT to mapped Care Manager

7. Current Functionality
1) Web-based access to MiPCT member lists 2) Near real-time alerts when patients are hospitalized or discharged

8. ADT Progress –Alert Contents
Beaumont HS
Henry Ford HS
Message Types
All
Patient ID / Medical Record (MR) X
Patient Name
Date of Birth
Administrative Sex
Address
If Available
Phone number – home
Patient Account Number
Patient Death Indicator
If Applicable
Primary Care Physician (ID, Name)
Patient Class
IP, ER
OBS, IP, ER
Assigned Patient Location (Room / Bed)
Prior Patient Location
N/A
Attending Physician (ID, Name)
IP Only
Referring Physician (ID, Name)
Consulting Physician (ID, Name)
Admit Source
Admitting Physician (ID, Name)
Patient Type
Discharge Disposition
Admit Date
Discharge Date
Plan ID / Name
Group Number
Policy Number

9. Desired Functionality
Web-based access to MiPCT member lists
Near real-time alerts when patients are hospitalized or discharged
Clinical information to facilitate prompt transitions of care

10. MiPCT PO ADT Users Group Discussion Findings - What Clinical Elements are Key to Successful Care Transitions?
Facility (hospital)
Length of stay(LOS) with admission and discharge dates
Diagnosis code (number and text)
Home health agency (name/location of sub-acute facility) if applicable
Medications (discharge med list)
Recommended follow up from hospital stat/critical labs), outpatient diagnostic testing needed, Specialist follow-up and timeframe(appt date and time if scheduled post discharge, Community referrals made
Department/contact phone number of discharge facility to call for detail if needed

11. A Look Forward: Adding Clinical Information for patients in the MiPCT/MiHIN ADT Partner Project
a. MiHIN
i. Conformance Reporting
ii. Medication Reconciliation
b MDHHS Integrated CareBridge Record

12. A Look Forward a. MiHIN i. Conformance Reporting
ii. Medication Reconciliation

13. Conformance Reporting

14. Statewide ADT Notification
Trusted Data Sharing Organization
(TDSO)
Trusted Data Sharing Organization
(TDSO)
Specialist
Patient to Provider Attribution
Health Provider Directory
Patient
Primary Care
Care
Coordinator
1) Patient goes to hospital which sends message to TDSO then to MiHIN
2) MiHIN checks patient-provider attribution and identifies providers
3) MiHIN retrieves contact and delivery preference for each provider from HPD
4) Notifications routed to providers based on electronic address and preferences
Copyright 2015 Michigan Health Information Network Shared Services
MiHIN HIE QO Day March 17, 2015

15. Copyright 2015 Michigan Health Information Network Shared Services
ADT Message Quality
ADT notification usage has brought attention to the known fact that all ADTs are not created equally
ADTs are created with the HL7 specification as a guide, but each ADT source is unique to business needs that may require deviation from the HL7 specification
ADT notification usage has increased the request for consistent quality of the message
Is your organization getting the request to “Standardize” the ADT messages?
Copyright 2015 Michigan Health Information Network Shared Services

16. Why Conformance Reporting?
Reimbursement Driven
Improve the quality of the ADT messages
Helps users understand and use the message
Copyright 2015 Michigan Health Information Network Shared Services

17. Quality Matters: Enforcing Conformance
Hospitals must be ‘all green’ to receive full incentive payments
Copyright 2015 Michigan Health Information Network Shared Services

18. Completeness Matters Too!
Certain fields MUST be populated for recipients to utilize
Copyright 2015 Michigan Health Information Network Shared Services

19. Decoding and Mapping Also Matter!
Recipients need to understand how to interpret codes in key fields
Copyright 2015 Michigan Health Information Network Shared Services

20. Medication Reconciliation

21. Payer Incentives for Statewide HIE
2014
2015
2016
Data flow
Hospitals – Send ADT notifications to statewide service via MiHIN
Providers – Send Patient-Provider Attribution (PPA), receive ADT alerts
Integrate ADT, begin Medication Reconciliation
Hospitals – Conformance with ADT spec, send Medications
Providers – Integrate ADTs into workflow, receive Medications
TBD
Medications, potentially quality measures
Hospital value-based contracts
Physician Group Incentive
Program (PGIP)
Copyright 2015 Michigan Health Information Network Shared Services

22. Medication Reconciliation value proposition
Approximately 1.5 million preventable adverse drug events (ADE’s) occur annually as a result of medication errors, at a cost of more than $3 billion per year.
ADEs account for 2.5% of estimated emergency department visits for all unintentional injuries and 6.7% of those leading to hospitalization.
Poor communication of medical information at transition points is responsible for:
50% of all medication errors
20% of all adverse drug events
66% of all medication errors resulting in death or major injury
Copyright 2015 Michigan Health Information Network Shared Services

23. Submit-Receive Medication Reconciliation
Upon Admission
Hospital sends admission notification to care team
Care team responds with known medications
Upon Discharge
Hospital sends discharge notification to care team
Hospital sends discharge medication notification to care team
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24. Discharge Medication Reconciliation Data FlowMR
Data Sharing
Organization
(DSO)
Data Sharing
Organization
(DSO)
Care
Coordinator
Patient to Provider Attribution
Health Provider Directory
Primary Care
Specialist
1) Patient discharged, hospital sends message to DSO / MiHIN
2) MiHIN checks patient-provider attribution and identifies providers
3) MiHIN retrieves contact and delivery preference for each provider from HPD
4) Medication reconciliation routed to providers based on contact info, preferences
Copyright 2015 Michigan Health Information Network Shared Services
Copyright 2013 Michigan Health Information Network. All rights reserved. MiHIN Confidential--Proprietary--Restricted

25. A Look Forward
a. MDHHS CareBridge Integrated Record

26. CareBridge Integrated Record
Secure web-based portal where documents and messages can be posted and pushed
Operated by ICO with access granted to enrollee and Integrated Care Team (ICT)
Components History, issues list, lab results, medications, assessments
IICSP (Individual Integrated Care and Supports Plan)
Progress notes and status change

27. 3. Discussion and Next Steps

28. QUESTIONS?
On MiPCT ADT User Group: Diane Bechel Marriott
On MiHIN Conformance Reporting or Medication Reconciliation Data
Rick Wilkening, MiHIN Director, Business Development,
Marty Woodruff, MiHIN Director, Production and Operations,