Exciting things are happening in Michigan, where a broad, regional health information exchange (HIE) has been steadily evolving forward. Michigan Health Connect was officially incorporated in March 2010, and has been eliciting interest across disparate parts of the state. Doug Dietzman is executive director of the Grand Rapids-based information exchange organization. He spoke recently with HCI Editor-in-Chief Mark Hagland regarding Michigan Health Connect’s development and progress. For more detailed information on Michigan Health Connect, see HCI ’s previous coverage.
Healthcare Informatics: Where are you right now in the development of Michigan Health Connect?
Doug Dietzman: Since we incorporated in March of last year, we’ve brought in seven anchor organizations that include 34 distinct hospitals, spread across the state. Right now, we’re focused on the clinical messaging platform. We have over 500 physician offices connected, receiving results, and if they’re a paper-based office, those results are going into an electronic drop-box, eliminating their faxing; as well as 30 interfaces we’ve developed, representing 19 different vendors.
HCI: Could you explain a bit more about the drop-box mechanism?
Dietzman: Yes, it’s an electronic tool on their desktop; they can decide what and when to print, rather than receiving faxes all day long. The offices receiving the drop-box results are still paper-based. And we’re doing laboratory ordering through us also, and we’ll route those into the lab. We’ve got one of the hospitals primarily focusing on that.
HCI: Please tell us a bit about the origins and foundational strategies of Michigan HealthConnect.
Dietzman: The state of Michigan, going back a few years, had provided planning grants and had given each of several regions planning dollars, and west Michigan, centered around Grand Rapids, was one of those several regions designated as ‘medical trading areas.’ That concept has since been superseded by the HIEs. And Spectrum Health, MetroHealth, and St. Mary’s Hospital (part of the Trinity Health system), each of those key organizations had independently selected Novo Innovations as its HIE vendor; Novo Innovations is now a part of [the Salt Lake City-based] Medicity.
HCI: So there was a fortunate confluence, as three of the anchor hospital systems had chosen the same vendor?
Dietzman: That’s right; and they were going to independently send results to physicians, and everyone agreed that it would be crazy to do so. These competitors agreed it would make the most sense to collaborate on clinical data exchange, which ultimately coalesced into the HIE concept.
And as those informal conversations were happening, Lakeland Health System in the St. Joseph area in the far southwest part of the state, chose the same vendor, and said they wanted to join. And then Northern Michigan Regional Health System in Petoskey had, through their planning grant, come to the decision to choose Medicity; but the state didn’t have any money. So they stepped off the curb and joined the HIE as well. And since then, we added McLaren Health System in Flint, and the five ministries of Ascension Health that are in Michigan as well.
HCI: Tell us about the go-live dates on the different functionalities.
Dietzman: I mentioned the sharing of laboratory orders—with 121 locations, which could include a community hospital or a physician office, and there are about 8,300 orders being transmitted every month. Another solution involved in the HIE is a scheduled-orders application, primarily focused right now on radiology. And right now, there are 64 offices that have been rolled out, and there are about 610 orders a month being created. And lastly, we’re just getting started with physician referrals, and we’ve got six physician offices live so far.
HCI: What will happen in the next couple of years, as Michigan Health Connect evolves forward?
Dietzman: So far, we’ve talked exclusively about pushing data. Now we’re beginning to talk about the ‘pull’—so if I show up in an emergency room, what do they know about me, Doug? And they could create a query. So sometime in 2011, we’ll have our community master person index started. Each organization is pursuing this in their own way. But we’re not forcing organizations to move in lockstep. One hospital might say, yes, that community viewer is extremely important to us; while another might say it’s not their top development priority. So we’ll have a few of the hospitals up on the viewer, and others will catch up based on their strategic priorities.
HCI: What lessons have been learned so far in this initiative?
Dietzman: I think from an overall standpoint, one of the things we’ve tried to do and that has been a good lesson for us, has been to stay focused on the basics. I think there’s so much swirl in HIE-land, with the bells and whistles and trying to solve world peace and such, that it’s important to focus on the basics. And there’s nothing sexy about providing a basic results interface, but making progress in that area is huge. And focusing on the basics keeps it simple. And when it’s kept simple, and the business model is kept simple, you can avoid some of the problems that some of the other exchanges might have run into.
What’s more, from a momentum standpoint, we’ve hit the right timing. I think health information exchange has always been seen as an incremental, extra expense, to hospitals; and what we’ve been trying to explain to the hospitals is that you have to build this infrastructure to exchange clinical data and to meet the requirements of meaningful use. So you can either take a pile of money, and either spend it in isolation, or collaborate together for results. And as more and more physicians are implementing EMR, and they’re saying, I don’t want to deal with the paper anymore, I want that data electronically in my system. So it’s forcing hospitals to move forward anyway. And we can say to the hospitals, do this in collaboration—it’s cheaper, and you’re reaching out to your community, and participating in HIE activity. We’ve also been very focused at this point on hospitals and health systems. But we’ve been having conversations with health plans. And I would say that in the next year or so, we’ll find some real op
portunities working with health plans and working with public health organizations at the state level. So you’ll see us expanding beyond the core participation we have right now.
HCI: Tell us a bit about the business model for transactions.
Dietzman: It’s a subscription-based model, and right now, the hospitals are paying the costs—so the referrals module, the ordering module, the results module, are all free to the providers.
HCI: Do you have any explicit advice for others as they begin to develop HIEs?
Dietzman: People don’t want to spend money unless there’s value. So we’ve really tried to define very basic and defined value propositions. And also, we’ve been working with our regional health extension center. And we’ve been able to keep our HIE staff relatively small, because we’ve been leveraging our relationships with people in the hospitals. So I’m not putting people all over the state for this. We’re better leveraging our relationships, and in addition, building greater credibility with the participating hospital organizations. So that’s something that I would recommend as well for others.
HCI: Have there been advantages in working with a single core vendor?
Dietzman: I’ve been happy working with Medicity. I had been at Spectrum Health as manager of community physician services, before the inception of the HIE. So I’ve been working with them for quite a while now, and we’ve been building a lot of things together, including ordering capabilities. And I think there are two basic models that vendors have: either a central repository, where physicians log in; and there’s a second model, which involves more of a grid, where it’s more distributed, and you’re pushing the data out to the physician offices. I believe the second model will be more successful. Because anytime you have a physician working in a particular vendor’s EMR, and you’re forcing that physician to go outside their system and access a portal, you’re dead. There will always be a need for portals, but I don’t believe they’ll be successful at the core of HIEs. So I’ve been pleased with the model that Medicity uses, and I think it’s the right horse to ride, if you will.