Enabling Robust Management of Healthcare Providers and Their Complex Affiliations

Jeff Livesay, Associate Director,Michigan Health Information Network

The Michigan Health Information Network Shared Services (MiHIN) is Michigan’s initiative to reduce costs and improve healthcare quality, efficiency, and patient safety by sharing electronic health information. MiHIN is the official state-designated entity for health information exchange across Michigan.

The healthcare industry–and the health information exchange sector in particular–are complex, information-rich environments. The industry is also changing quickly as it adapts to Internet-based and new device technologies.

In 2011, MiHIN was tasked by the Michigan Department of Health and Human Services to create a statewide healthcare provider directory. Traditionally in healthcare there has been no standard one-stop solution for healthcare professionals to find who, where, and how to contact healthcare providers and care team members. In fact, each state typically has dozens of “silos” containing isolated information on healthcare professionals, and nationally there are literally hundreds of focused “Provider Directories.” Michigan wanted to leverage the growing national push to enable electronic health information exchangeand interoperability as an opportunity to create a standardized statewide provider directory.

In Michigan, the Health Directory has supported more than a billion messages successfully passing through MiHIN’s statewide network since 2012

To add real value in the complex healthcare ecosystem, a provider directory must be easily accessible to all users at all times. Data in an ideal provider directory must be current, trustworthy, validated and robust, containing comprehensive information about each healthcare provider, their multiple affiliations with different organizations, and their secure electronic addresses or “Electronic Service Information” (ESI) including how and where the provider wishes to receive data electronically. There are many options for secure electronic exchange in healthcare that vary from private networks to encrypted forms of email–the modern equivalent of a “phone book” containing the electronic addresses for providers is necessary.

MiHIN chose Salesforce as the platform for Michigan’s Statewide Health Directory service because of Salesforce’s advanced data modeling capabilities for capturing complex affiliations and relationships, its 24x7 cloud reliability, ubiquity and ease of use, and its operational efficiencies and rich capabilities for oversight and insight through virtually unlimited reporting. The highly-scalable, secure, flexible Salesforce environment allows users multiple options to support essential use cases, and allows MiHIN to support a hybrid network, offering both centralized and federated capabilities.

The Health Directory, made possible by funding from the Michigan Department of Health and Human Services, is a scalable, standards-based, extensible solution for managing healthcare provider information and enables the accurate and secure exchange of health information using any of today’s healthcare standards. The Salesforce platform allows maximum flexibility and is easily configured to support or extend data models, leading to efficient and timely implementation of new business requirements.

The contact and account structure native to Salesforce allows MiHIN to adapt customer relationship management to healthcare provider relationship management to support new levels of advanced payment models in healthcare.

The MiHIN Health Directory has evolved rapidly over the years from a relatively straightforward service with linear relationships and endpoint addresses to a rich, complex service that supports multiple, flexible relationships amongst providers, payers, patients, physician organizations, practices, and more.

The Health Directory centers on providers and organizations. Providers can be affiliated with as many organizations as needed, with different types of simultaneous affiliations available including “member of,” “accepts benefits of,” “practices in,” etc. Likewise, organizations can be affiliated with as many other organizations as needed with various simultaneous affiliations, including “member of,” “part of,” and “service provider to.”

Used as infrastructure for many valuable use cases, the Health Directory is easily integrated with other infrastructure services. In Michigan, the Health Directory has supported more than a billion messages successfully passing through MiHIN’s statewide network since 2012, including public health reporting messages for immunizations, syndromic surveillance, reportable labs, clinical quality measures and other use cases for public health reporting and Meaningful Use, along with care coordination messages such as Admission-Discharge-Transfer notifications, Medication Reconciliation, and Laboratory Test Results.

Teamed with MiHIN’s unique Active Care Relationship Service™, the Health Directory offers a robust ability to attribute patients to their team of healthcare providers (the “care team”) and ensure those providers are notified of patient events in near real-time. This powerful, next-generation patient attribution mechanism enables patient-level management and care coordination features that are used throughout the state of Michigan by healthcare organizations of all types and sizes.

Today, MiHIN’s Health Directory: Tracks and helps maintain simple and complex relationships between physicians and practices, physician organizations, health systems, and health plans, with multiple relationships and addresses allowed at various levels in the taxonomy

• Maintains all provider information from clinic to health system to payer
• Finds or reports provider information manually or automatically
• Features accurate provider information updated monthly including:
◦ Provider demographics
◦ Provider affiliations (practice, organization, health system, payer/program)
◦ Provider electronic addresses and preferences for receiving electronic health information