Michigan
Health IT
Roadmap
“Bridge to Better Health” Report
June 2022
A COMPILED REPORT BY THE MICHIGAN DEPARTMENT OF HEALTH AND HUMAN SERVICES
FOR THE MICHIGAN HEALTH INFORMATION TECHNOLOGY COMMISSION
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The Bridge to Better Health report is the result of a collaborative effort between
the Michigan Health Endowment Fund
1
, the United States Department of Health
and Human Services, the Michigan Department of Health and Human Services,
Michigan Health Information Technology (IT) Commission, and the CedarBridge
Group – with extensive participation and contributions by members of Michigan’s
health care, community services community, and individual Michiganders.
Appendix 1 includes a full list of participating organizations and individuals.
The Bridge to Better Health report serves as a summary of the engagement and
long-term planning efforts that, from 2019 to 2021, have built new momentum
and synergies in how our care systems can leverage health IT in the State of
Michigan to improve the health and wellness of all Michiganders.
The Michigan Department of Health and Human Services is pleased to offer this
summary report, and we sincerely thank everyone who has dedicated their time,
resources, and ideas to this effort.
⚫ ⚫ ⚫
Thank you to all who participated!
1
1 The Michigan Health Endowment Fund works to improve the health and wellness of Michigan residents and
reduce the cost of healthcare, with a special focus on children and older adults. The foundation has five annual
grant programs. For more information about the Health Endowment Fund and its grantmaking, visit
www.mihealthfund.org.
333 SOUTH GRAND AVENUE
•
PO BOX 30195
•
LANSING, MICHIGAN 48909
www.michigan.gov/mdhhs • 517-241-3740
S
TATE OF
M
ICHIGAN
DEPARTMENT OF HEALTH AND HUMAN SERVICES
L
ANSING
Fellow Michiganders:
The Michigan Department of Health and Human Services is committed to programs that
improve the health, safety, and prosperity of State of Michigan residents. We achieve
this mission by promoting strategies that extend better health and opportunity to all
Michiganders, particularly by addressing health inequities. In partnership with the
Michigan Health Information Technology (IT) Commission, we are happy to share the
“Bridge to Better Health” report with you to articulate how health IT will continue to be
leveraged as a critical tool in meeting residents’ health, wellness, and safety needs.
Through extensive input from Michiganders and stakeholders from communities across
the state, we believe this strategy provides guidance and planning based on the needs
expressed by residents, clinicians, social service organizations, and advocates.
We acknowledge that this strategy was developed amid one of the most challenging
public health emergencies in more than a century. Despite service delivery in health care
and social services being stretched to its limits, our frontline heroes have responded with
grit, perseverance, and innovation. This report is meant to reflect this vigor by proposing
strategies and recommendations that are bold, transformative, and innovative.
Despite rapid technological advancements and ambitious policy changes, there are still
pervasive gaps in how care is coordinated and managed. The Coronavirus pandemic
has illuminated the destructive effects of continuing racial health inequities. While
Michigan has risen as a national leader in its use of interoperable and broadly adopted
health IT solutions to address these challenges, further work is needed to ensure that all
Michiganders have access to equitable, affordable, and high-quality care. This report
offers recommendations we can collectively pursue to reach new innovative horizons.
Thank you to all who participated in developing this report. We acknowledge and
appreciate your dedication to serving residents and improving outcomes in Michigan.
Sincerely,
Elizabeth Hertel
EH:tr
ELIZABETH HERTEL
DIRECTOR
GRETCHEN WHITMER
GOVERNOR
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Contents
Executive Summary ________________________________________________________________ 6
Where We Are Now _______________________________________________________________ 7
Capabilities: Environmental Scan Findings by Stakeholder Domains __________________________ 8
Strategic Recommendations ________________________________________________________ 13
Initiative #1: Identify champions and empower leaders __________________________________ 14
Initiative #2: Enhance health data utility ______________________________________________ 16
Initiative #3: Work to address Michigan’s digital divide ___________________________________ 21
Initiative #4: Improve onboarding and technical assistance programs _______________________ 23
Initiative #5: Protect public health ___________________________________________________ 25
Initiative #6: Adopt standards for social care data fields __________________________________ 28
Where We Are Going _____________________________________________________________ 30
Appendix A: Participating Organizations ______________________________________________ 32
Appendix B: How We Created This Report _____________________________________________ 36
Appendix C: Stakeholder Engagement Summaries_______________________________________ 44
Appendix D: Policy Alignment _______________________________________________________ 62
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Executive Summary
In 2006, the Conduit to Care report, Michigan’s last published strategy for health information
technology (IT), invited medical providers to “use technology to vastly improve the [health care]
system.” At that time, coordination of care and connections between clinicians suffered from
ineffective processes and workflow barriers. Often described as existing in “silos,” paper-based
patient health information was often held disparately between hospitals, laboratories, physician
offices, ambulatory treatment centers, and pharmacy providers. Nearly two decades later, the
principles of the Conduit to Care report have ushered in a health IT environment in Michigan that
has improved health care delivery and care coordination for residents. Additionally, state health IT
strategies have implemented more effective statewide governance over electronic health
information and information exchange. In terms of its capabilities and opportunities, Michigan
stands as a national leader in health IT adoption, interoperable solutions, and innovation with a
robust health information exchange, adoption of shared services, and standard setting.
In 2019, the Michigan Health IT Commission adopted a resolution to reconvene stakeholders to
update the Conduit to Care report into a modern health IT strategic plan. The Health IT Commission
engaged with over 300 organizations virtually from across the state to update Michigan’s health IT
strategy between 2020 and 2021. Despite the strain and challenges of the pandemic, stakeholders
committed their time and attention to the planning process for the updated strategy, and their
anecdotes provided valuable insights into how systems can and should be better prepared for similar
emergencies in the future. In addition to insights about the pandemic, the Health IT Commission also
paid particular attention to how social determinants of health affect health care delivery and
outcomes. Conditions like housing instability, food insecurity, and lack of transportation greatly
affect the health and wellness of residents, particularly for those who experience racial disparities or
other social vulnerabilities. Early in the stakeholder engagement process, the Health IT Commission
acknowledged that an updated health IT strategy must also address how to coordinate care beyond
clinical spaces and integrate health-related social care data. This innovative approach, of leveraging
health IT to address both clinical outcomes and social determinants of health, allowed the Health IT
Commission to elevate the principles of the Conduit to Care report into a new era. The Bridge to
Better Health report recommends the following initiatives:
• Initiative #1: Identify champions and empower leaders
• Initiative #2: Enhance health data utility
• Initiative #3: Work to address Michigan’s digital divide
• Initiative #4: Improve onboarding and technical assistance programs
• Initiative #5: Protect public health
• Initiative #6: Adopt standards for social care data fields
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Where We Are Now
Michigan’s health and human service providers have widely variable experiences with use and
adoption of technology depending on size, functionality of existing technology solutions, health IT
workforce availability, as well as training and support of system users. Access to mobile devices,
high-speed broadband service, and dependable internet connections also has a significant impact,
especially for rural organizations, creating disproportionate negative economic, social, and health
impacts on low-income residents.
In terms of health IT adoption, 100% of Michigan hospitals and 83% of Michigan’s eligible
professionals have taken advantage of the EHR incentive programs through the Centers for Medicare
and Medicaid Services.
2
However, behavioral health and long-term care providers are not deemed
eligible for incentive payments by federal programs and hence lag in adoption. For those
organizations, a certified EHR system can be cost-prohibitive; regional economic circumstances and
broadband availability also factor into adoption variations between provider types, resulting in
disproportionate impacts on rural populations and contributing to health disparities seen in some
rural regions of Michigan.
Governance
One of the significant outcomes of the 2006 Conduit to Care report was the establishment of a
collaborative public-private governance model for health IT. The Michigan Legislature established
Public Act 137 in 2006 to create the Michigan Health IT Commission.
3
The Commission’s purpose,
membership and operations are governed by section 2503 of Public Act 137-2006. Members of the
Commission are appointed by the governor without the advice of the Michigan Senate.
Members of the Health IT Commission represent a diverse range of sectors and expertise in health
care across the State of Michigan. The Commission has 13 members. Commission representation is
comprised of individuals representing both the public and private sectors, with expertise in at least
one of the following areas:
At the time of this report’s creation, all 13 commission appointments were filled. Each member of
the Health IT Commission, as listed below, have provided invaluable thought leadership, cross-sector
coordination, and visioning in this strategic planning effort:
2
According to the 2020 Michigan State Medicaid Health IT Plan (SMHP)
3
Access to PA 137-2006: http://www.legislature.mi.gov/documents/2005-2006/publicact/pdf/2006-PA-
0137.pdf
Health
information
technology
Administration
of health
systems
Research of
health
information
Health finance,
reimbursement
and economics
Health plans and
integrated
delivery systems
Privacy of health
care information
Medical records Patient care
Data systems
management
Mental health
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(a) The director of the department (the Michigan
Department of Health and Human Services
[DHHS]) or his or her designee
Elizabeth Nagel - MDHHS Senior Deputy Director
for Policy, Planning, and Operational Support
(b) The director of the department of information
technology (the Michigan Department of
Technology, Management and Budget [DTMB]) or
his or her designee
Jack Harris - DTMB Chief Technology Officer
(c) One individual representing a nonprofit health
care corporation operating pursuant to the
nonprofit health care corporation reform act,
1980 PA 350, MCL 550.1101 to 550.1703
Marissa Ebersole-Wood, Ph.D. - Blue Cross Blue
Shield of Michigan Vice President of Regulatory
Implementation and Data Governance
(d) One individual representing hospitals
Heather M. Wilson - Michigan Medicine Senior
Director of Revenue Cycle Mid-Service
(e) One individual representing doctors of
medicine
Michael Zaroukian, M.D., Ph.D., M.A.C.P.,
F.H.I.M.S.S. - Sparrow Health System Chief
Medical Information Officer & Chief
Transformation Officer
(f) One individual representing doctors of
osteopathic medicine and surgery
Paul LaCasse, D.O., M.P.H.
(g) One individual representing purchasers or
employers
Camille Walker Banks - NPower Michigan
Executive Director
(h) One individual representing the
pharmaceutical industry
Allison Brenner, Pharm.D. - Pfizer Director of
Medical Outcomes Specialists
(i) One individual representing schools of
medicine in Michigan
Norman Beauchamp, M.D. - Michigan State
University Executive Vice President for Health
Sciences
(j) One individual representing the health
information technology field
Jim VanderMey - Open Systems Technology
Chief Innovation Officer
(k) One individual representing pharmacists
Heather Somand, Pharm.D.
(l) One individual representing health plans or
other third-party payers
Nicholas D'Isa, Esq. - Physician Health Plan Chief
Compliance Officer
(m) One individual representing consumers
Renée Smiddy, M.S.B.A. - Michigan Health and
Hospital Association Policy Director
This strategic planning effort has also involved members of the Health IT Commission who no longer
serve. In providing their time, expertise, and review during processes of this report’s creation, these
previously appointed members of the Commission include:
• Sarah Esty
• Rozelle Hegeman-Dingle, PharmD
• Jack Kufahl
• Pat Rinvelt
• Thomas Simmer, MD
Capabilities: Environmental Scan Findings by Stakeholder Domains
Hospitals and Health Systems
Adoption of enterprise-wide instances of electronic health record systems (EHRs) are ubiquitous
among large hospital and health systems in Michigan with Epic, Cerner, Healthland, and MEDITECH
being the most common EHR vendors. It is increasingly common for hospitals and integrated delivery
systems to have all inpatient, outpatient, emergency department, and local ambulatory primary care
and specialty clinics, as well as diagnostic imaging and labs, using the same enterprise EHR system.
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The critical access and community hospitals in rural Michigan have also all adopted EHRs but are less
likely to be using their EHR system to share information externally.
With the consolidation trend in health care and many larger systems acquiring community hospitals,
skilled nursing facilities, and private practices, several different EHRs may be in use until an
enterprise EHR solution can be adopted. All Michigan hospitals and health systems that participated
in the environmental scan indicated their engagement in at least one data sharing use case (e.g.,
sending admit, discharge, transfer messages). Several hospital systems reported using national
networks (eHealth Exchange, Carequality, and CommonWell) for electronic health information
exchange. Stakeholders with organizations using the Epic EHR platform reported leveraging Care
Everywhere to exchange information with other Epic provider organizations.
Ambulatory (i.e., Internal, Family, and Primary Care) Providers
A large majority of ambulatory provider groups reported having certified EHR technology, and most
have some level of information exchange and interoperability with other providers.
Large practices are less likely to be on enterprise-wide system than large hospital systems. Some
practice groups reported three or more different EHR systems in use. There are wide gaps in the
ability to effectively use health IT tools, between large group practices, provider organizations (POs),
and those in Medicare Accountable Care Organizations (ACOs), versus smaller private practices.
Direct messaging is available for use directly from some EHR systems, but the service is under-
utilized because there is not a reliable source for the direct addresses of provider practices.
Stakeholder input also indicates many smaller private practices do not have technology-savvy
employees who could train and support staff, or the legal resources to negotiate multiple data-
sharing agreements for the point-to-point data exchange relationships.
Approximately three-quarters of stakeholders from this sector reported some level of participation
with health information exchange (HIE), but only one third of responding stakeholders indicated that
data received from an HIE can be integrated into the practice EHR as structured data. The most
common barriers to participation were the cost of participation and the cost of modifications to the
EHR that would be needed to effectively interface with the HIE. Large numbers of ambulatory
providers are still sending clinical information to other providers via phone, fax, and secure email
when referring a patient. Even when information is sent electronically between health care
organizations’ EHR systems, many providers report difficulties trying to sift through volumes of
information because the sending EHR system does not organize the information effectively.
Behavioral Health Providers
The behavioral health survey data indicates most behavioral health practices have adopted an EHR
system, although few if any are certified according to the ONC’s 2015 interoperability standards.
Over 70% of responding organizations reported using an EHR system. Nevertheless, none of the 41
organizations responded affirmatively to the survey question about whether their EHR system is
certified by the ONC and many comments to survey questions were focused on the need for an
electronic consent solution.
Sustained technical assistance and training in the use of technology systems is also dire need for
behavioral health providers. Behavioral health stakeholders reported workforce shortages, lack of
technical resources or funding, constraints to data sharing due to privacy concerns, and like many
other groups in Michigan, limitations due to a lack of reliable internet service in rural areas.
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It is clear there is a shift underway to include behavioral health providers in value-based health care
payment arrangements with primary care, which is creating more demand for data and more
interest in interoperable systems that share health data bidirectionally with other providers and
social service organizations, though direct messaging and other HIE services.
Social Service Organizations
Over the past two decades since the Conduit to Care report was published, the greatest shifts in
health IT capabilities have arguably occurred in terms of how health care and social service agencies
are increasingly beginning to integrate. With many communities wanting to address whole-person
outcomes and social determinants of health (SDoH), innovative approaches have been piloted across
Michigan to foster better care coordination between clinical and community service organizations.
During the State Innovation Model (SIM) in Michigan, holistic approaches were piloted to integrate
how clinical, community, and other support services coordinate to address a range of resident
needs. In addition to changes in how communities collaborate their services, many communities also
launched technology solutions to streamline how resident needs are triaged and managed.
Following these SIM pilot programs, the coordination of resident SDoH has continued to push many
community-based organizations (CBOs) and social service agencies into more advanced technology
capabilities. However, despite the growing interest, many of these organizations have reported
experiencing the greatest challenges of any domain in effectively being able to exchange information
electronically with other members of an individual’s care team. While some CBOs are sharing data
through referral resource platforms such as MiBridges, operated by MDHHS, many other vendors
are meeting the growing technological needs of social service organizations through a variety of care
coordination solutions. In addition to technology solutions, social service organizations are also
interested in more comprehensive data services, such as exchanging data with other organizations
across education and early childhood data systems, justice systems, housing, transportation, job
training and financial assistance programs, child welfare, and foster child data systems.
Emergency Medical Service Providers
Michigan has over 100 Emergency Medical Service (EMS) provider agencies. Each of these agencies
have statutory reporting requirements to enter information into the Michigan Emergency Medical
Information System MI-EMSIS, a state-managed repository developed to assess the need for and
quality of emergency medical services across the state. The 18 EMS software vendors in use by
Michigan EMS agencies are configured to support data submission to MI-EMSIS to meet reporting
requirements. Unfortunately, conformance to the MI-EMSIS data standards is inconsistent on the
part of vendors. The MDHHS Bureau of EMS, Trauma, and Preparedness spends an inordinate
amount of time trying to normalize the data and encouraging vendors to improve their products.
In addition to MI-EMSIS, MDHHS also supports the Hospital Hub system, which provides hospitalists
with a PDF summary of EMS encounters; however, these summaries do not integrate with EHR
systems. In practice, other than verbal reports from EMS personnel at intake, emergency
department clinicians lack integrated and real-time information following emergency transport. EMS
responders report having little to no visibility into other systems for clinical information about a
patient when responding to a call. Some agencies provide access to records of prior EMS calls.
Unfortunately, the quality of the information in these settings is often not deemed useful. With few
exceptions, EMS providers have little access to treatment wishes for life-saving care, such as access
to a registry of Advance Directives, Health Care Power of Attorney forms, and Michigan Physician
Orders for Treatment (MI-POST) forms.
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Finally, the COVID-19 pandemic has had a devastating impact on the local Michigan EMS workforce
and on the state agency staff trying to support the services with inadequate resources and outdated
technology.
Public Health Organizations
While many public health agencies use health information exchange, many more still primarily rely
on phone, fax, and secure email to share patient information with other organizations. Barriers and
challenges to sharing information is an outcome of legacy workflows, system integration needs, and
not having actionable data for clinical decisions. Less than 10% of respondents in public health
engagement surveys expressed that incoming data integrated with their EHR; however, that number
increased to 20% of respondents if static documents that need to be scanned into an EHR are
included. Most notably, engagement results pointed to a need in public health agencies to receive
more complete reports from other providers, with their top priorities for technology investments
being analytic tools and aggregated population-level data to measure the costs and value of
programs.
Survey responses also indicated enthusiasm for the sharing of social services information to better
manage whole person care coordination. Public health agency staff expressed an interest in
connections that would allow access to information in external organizations across the state,
including MDHHS-operated systems, without having to go to several portals to identify desired
information. Among most public health engagement respondents, there was strong consensus that
expanded telehealth services will continue to be widely used after the pandemic wanes. They urged
policymakers to make permanent adjustments to telehealth regulations that would help to address
ongoing health care access issues.
Long-Term Care and Post-Acute Care Providers
Nearly all long-term care providers engaged for this report described having EHR systems
implemented; however, many organizations may not be using certified systems. Approximately half
of the organizations report participating in an HIE; cost of participation and concerns about the
expected value for the investment were cited as the primary reasons for those not yet connected to
an HIE.
Priorities of the long-term care stakeholders include better alignment and standardized use of
Advance Directive registries, access to Veterans Administration (VA) health records, improved
reporting for quality measures, improved access to the state’s Prescription Monitoring Program, and
a statewide system with psychiatric bed availability for placements in addition to clinical data of all
types.
The pandemic hit this stakeholder domain hard, as expressed in survey results. When asked how
organizations have adapted, responses included making modifications to patient interactions, the
addition of video visits, providing devices to patients including touchless thermometers and wireless
nurse call pendants. As workforce demands continue to change in this sector, stakeholders serving
aging and long-term care populations also expressed an interest in receiving training on data
exchange options, including participation in HIEs.
Health Insurance Plans
Across many Michigan commercial and Medicaid health plans, care coordinators and case managers
are users of HIE platforms and receive health information to create and monitor progress on care
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plans. Health plans rely heavily on HIE-shared services for care coordination and report discrepancies
related to the diagnoses in the ADT message, specifically the primary reason for the encounter. At
least one health plan is working to address the errors and has developed a value-based payment
initiative to incentivize providers for accurately completing the diagnosis field when coding in their
EHR to improve data accuracy.
Like other stakeholders, health plan executives in Michigan are concerned about the gaps in reliable
high-speed internet across parts of the state, seeing the digital divide as a barrier to accessing quality
care in some communities.
Health plans have also relied on the state immunization system and are especially reliant on the
system now to meet state COVID vaccination metrics. Many health plans leverage the HIE services to
send and receive immunization data. Into the future, health plan stakeholders request an expansion
of HIE-use cases to add bulk query functionality of immunizations and other electronic health data.
Moreover, health plans are also interested in collecting and analyzing SDoH data on members.
Residents
Today, many consumers only see the portion of information in their record that is captured in the
patient portal provided by health systems, clinics, and health plans. As expressed in forums and
surveys, many consumers would like to see their information integrated into one common platform.
Consumers also expressed interest in seeing consent management capabilities be more accessible
and easier to modify. Consumers are generally unaware what the law provides them in terms of
rights to access and protections of privacy. Consumer advocates called for more transparency
regarding how individual data is used and shared, and for clear information to be made available to
consumers about how to opt-in and opt-out of electronic health information exchange, and how to
revoke or change a prior choice made about data sharing preferences.
The consumer and advocacy stakeholder engagements revealed an increase in remote patient
monitoring and the use of wearables since the beginning of the COVID-19 pandemic. In addition,
there has been a rapid expansion in the availability of virtual visits and telehealth services, with
many states, including Michigan, relaxing some of the regulations for telemedicine licensing during
the pandemic. Many stakeholders would like to see those rule changes become permanent to
expand health care access and lower the burden for rural residents to travel distances for medical
appointments.
For those individuals caring for an individual with special needs, virtual visits were viewed positively,
but their ability to access vital information such as lab results, prescribed medications, and notes
from a previous visit is inconsistent. Consumers and providers highlighted this disparity being most
prominent for elderly patients or those with dementia.
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Strategic Recommendations
This report contains priority initiatives for the next five years, based on stakeholder feedback during
the environmental scan. They include the need for:
• Relevant and easy-to-access clinical information at the point of care for providers across
all stakeholder domains.
• Accurate and timely information in public health systems to protect population health
and to prepare for future public health emergencies.
• A statewide directory for social service organizations and coordination across
organizational networks and state programs.
• Addressing Michigan’s digital divide to help address disparities in health care and social
services in rural parts of the state.
• Key statewide shared services including:
o Statewide health data utility services to connect health and social care data.
o A statewide consent management service to support cross-organizational
information exchange.
o A statewide Advance Care Plan Registry to make end-of-life treatment choices
known in emergency settings.
• Funding and technical assistance to organizations and communities advancing whole
person coordinated care models to support the technology, workflow, and workforce
changes required for integrated health care and social services.
• Engagement of Michigan’s top executives in government and business to ensure
successful implementation of this report
To successfully help Michigan bridge the gap between today’s capabilities and tomorrow’s health IT
innovations, leaders should continue to convene stakeholders in inclusive processes to set priorities
and policies for shared technology investments. Moreover, this engagement should support a
framework for Michigan health care and social service organizations, state and local government
programs, communities, families, and individuals to benefit from the value created using IT solutions
and HIE services.
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Initiative #1: Identify champions and empower leaders
Description
This initiative will provide the representation, cross-functional
collaboration, and executive-level advocacy needed to support
the implementation of this strategy document. Many sectors,
such as behavioral health, school-based providers, and social
services, also need to connect to and share data with the rest of
the delivery system. All voices on a resident’s care team must be
considered for representation on the Health IT Commission to
realize a more complete vision for health IT and health
information exchange in Michigan. During validation and
prioritization, this initiative was determined to be foundational to
the success of the other initiatives.
Purpose
The purpose of this initiative is to empower state leadership,
including the Health IT Commission and MDHHS, to support all
future initiatives with broader and more inclusive representation.
This initiative also compels state leaders to take ownership and an
active advocacy role in implementing the strategies outlined in
this report.
Initiative #1, Objective
A:
Drive implementation
of the roadmap and
future initiatives and
promote a shared
vision
Activity 1A-1: Track, monitor, and evaluate metrics demonstrating
roadmap implementation progress over time.
• The commission will develop implementation dashboards
and accountability mechanisms to transparently share
progress on implementation.
• The commission will publish quarterly reports, outlining
progress made towards strategic initiatives and goals.
Objective #1,
Objective B:
Refresh State health IT
governance
Activity 1B-1: Expand the Health IT Commission to better reflect
all sectors and levels involved in the whole-person care of
residents, such as representation by:
• Community services.
• Behavioral health.
• CHCP Medicaid health plans.
• Local health departments.
• Skilled nursing (e.g., RNs, NPs).
Activity 1B-2: Develop engagement, education, and
communication capacities on the Health IT Commission to inform.
Page 15 of 65
the public on relevant health IT, security, consent, and consumer
access topics.
Timing
Begin as soon as possible. Q1 2022
Potential Funding
Source
N/A
Page 16 of 65
Initiative #2: Enhance health data utility
Description
Health data utility, or the shared data services that support vital
information exchange functions in the state, is a valued public
infrastructure needing continual maintenance and enhancements
to meet the needs of residents. In the coming years, state health
IT leaders, health care payers, and care providers will work more
collaboratively to develop and enhance the shared services
offered across our state. Where practical, the state will leverage
existing investments and will maximize federal funding through
the American Recovery Plan Act (ARPA) and other funding
sources. Michigan stakeholders strongly supported the concept of
health information exchange core services as a public data utility.
The value in this initiative is improving public health response,
coordination of care and services for vulnerable individuals,
referrals, alternative payment models, and other use cases.
Purpose
The purpose of this initiative is to ensure that core shared
services, such as those providing attribution, identity
management, web services, and data interoperability, continue to
be supported and enhanced. This initiative prioritizes the
development of core capabilities, and it requires public-private
collaboration to ensure the stability of care delivery, coordination,
and quality into the future for all Michiganders.
Initiative #2, Objective
A:
Build on the success of
health information
exchange in Michigan
Activity 2A-1: Implement information exchange that leverages
existing public investments wherever possible, such as MDHHS
enterprise data services or through the health information
network.
• Support the implementation of priority MDHHS IT
system developments, such as for:
4
o Michigan Crisis and Access Line (MiCAL).
o MDHHS Public Health system modernization.
o The new Michigan Comprehensive Child Welfare.
Information System (CCWIS).
o Closed loop referral systems.
o Person-data integrations with the MDHHS
Master. Person Index (MPI).
4
According to the 2020 MDHHS IT Strategic Plan
Page 17 of 65
• Stakeholders and funders will be encouraged to
utilize public services and utility in health IT and
health data utility to promote:
5
o Modularity.
o Interoperability.
o Leveraging investments.
o Alignment with industry standards, patterns, and
practices.
• The commission will advocate for and promote widely
adopted health IT and health information exchange
services as core state solutions.
Activity 2A-2: Advance and promote the capabilities of core
health information network infrastructure in the state, such as
admit, discharge and transfer (ADT) messaging, attribution,
identity management and web-based longitudinal record services.
• Stakeholders and funders will commit to leveraging
existing core capabilities wherever possible, to not
duplicate investments, and to leverage common
shared services.
• In continuing to leverage common shared services,
the commission will convene organizations to develop
plans on improving data accuracy and quality.
Activity 2A-3: Enhance interoperable clinical documentation, such
as through standardized document language (e.g., Consolidated
Clinical Document Architecture).
• The commission will provide advisory and advocacy
for the promotion of interoperable document
architecture, such as CCDA, to promote patient safety
and quality care.
Activity 2A-4: Creating an innovation ecosystem for health IT
leveraging HIE
Initiative #2, Objective
B:
Promote standards
and secure
infrastructure
Activity 2B-1: Promote secure health information practices that
protect individual privacy.
• The commission will convene workshops and
committees to discuss and bring visibility to high
priority opportunities and challenges in health IT
system privacy and security, such as:
o Consumer-mediated exchange.
o Consent and consumer preferences.
o Cybersecurity.
o Health information exchange legal infrastructure.
5
Derived from MDHHS Integration Guide design principles
Page 18 of 65
• The commission will adopt a set of guiding privacy
and security principles to inform stakeholders of the
minimum standards for protecting patient identities
and information.
• Develop education and improved resources for opting
out of applicable data sharing.
Activity 2B-2: Empower the Health IT Commission to implement
standards development, such as alignment with the United States
Core Data for Interoperability (USCDI).
• The commission will convene workshops and
committees to provide guidance and advisory on data
standards for Michigan stakeholders, such as for:
o Implementation of required clinical core
standards (e.g., USCDI).
o Developing core standards for social care data
(e.g., such as those being established by the
Gravity Project).
o Working collaboratively with stakeholders to
make recommendations to MDHHS.
• The commission will regularly provide updates in its
annual report on findings and recommendations it
makes on standards development.
Initiative #2, Objective
C:
Build data exchange
that is consumer-
centric and mediated
by each resident
Activity 2C-1: Implement a comprehensive statewide electronic
consent management system, which empowers patients to
control the sharing of their data.
• The commission and MDHHS will provide advocacy
for and priority to the development of consent
management systems that are interoperable,
scalable, and offer optimized security protocols.
• Stakeholders will continue to work collaboratively on
updating and expanding electronic consent
management systems to ensure that:
o Consent preferences can be captured for a variety
of protected data types.
o Methods for providing consent preferences
remain modern, accessible, and easy to modify by
each patient.
Activity 2C-2: Protect patient safety by supporting critical life-
saving data services.
• Certain priority use cases were identified by
stakeholders as having significant benefit to patient
safety and quality of care, including:
o Up-to-date medication information.
o Advanced Directives.
o Statewide identity management.
Page 19 of 65
• The commission, MDHHS, and stakeholders will
advocate and pursue funding for these priority use
cases to meet the safety needs of patients.
Activity 2C-3: Connect all points in the care ecosystem.
• In addition to developing core capabilities for health
data utility, health IT capabilities must be able to
connect all providers on a resident’s care team.
Solutions to connect payers, providers, and care
coordinators must be inclusive, accessible, and
comprehensive. To support these connections, the
commission must continue advocating for health IT
capabilities that securely and easily integrate data
and messaging across platforms into interoperable
solutions.
• Certain data integrations, especially for vulnerable
populations, were identified as priority by
stakeholders engaged for this report. These
populations include:
o Children.
o Justice-involved individuals.
o Behavioral health patients.
Activity 2C-4: Simplify resident access to electronic health
information, using single sign-on portals or interoperable data
exchange to consumer applications.
• Stakeholders will continue to pursue and fund shared
services that promote easy and streamlined patients
access to their health information, their consent
preferences, and care team.
• The commission and MDHHS will promote and
advocate for data services and integrations that
enable patient-mediated exchange and single sign-on
capabilities.
Timing
Fiscal Year 2022 through Fiscal Year 2027
Potential Funding
Source
Collaborative funding models will be necessary to ensure that
development costs, equitable opportunities for broad adoption,
and maintenance funding are possible in this initiative. Possible
funding sources to implement this initiative include, but are not
limited to:
• Federal funding programs (e.g., Centers for Medicare and
Medicaid Services Advanced Planning Documents).
• Congressional funding (e.g., ARPA funds referenced in
Section 2401[5], where funding is available to “enhance
information technology, data modernization, and
reporting, including improvements necessary to support
sharing of data related to public health capabilities”).
Page 20 of 65
• State contracts (e.g., paying Medicaid Managed Care
Organizations to provide “whole person, coordinated
care”).
• Commercial health payers.
• Private philanthropy.
Page 21 of 65
Initiative #3: Work to address Michigan’s digital divide
Description
Currently, the digital divide in Michigan leaves many without high-
speed internet connections and unreliable wireless service. These
gaps impact broad areas of rural Michigan, acutely affecting the
Upper Peninsula region. Many areas across Michigan will be
eligible for enhanced funding to bridge the digital divide,
especially those defined as:
• An “unserved location” lacks access to reliable
broadband service offered with speed of not less than
25 Mpbs/3 Mbps.
• An “underserved location” lacks access to reliable
broadband service offered with speed of not less than
100 Mbps/25 Mbps.
• A community institution (e.g., hospitals, schools,
libraries public housing organizations, community
support organizations), lacking access to 1 Gbps
service.
The program will be administered by the U.S. Department of
Commerce's National Telecommunications and Information
Administration (NTIA). Michigan’s digital divide demonstrates the
stark contrast between the “haves” and the “have nots,” as
evidenced by the mapping project NTIA commissioned to
demonstrate evidence of broadband need across the United
States and its territories, although a new mapping exercise is
taking place at the Federal Communications Commission with
more detailed and precise information on the availability of fixed
and mobile broadband services. It is expected to be completed in
2022. The COVID pandemic heightened the impacts on regions
with slow or non-existent internet service.
Purpose
This initiative will work collaboratively with stakeholders and
advocates across the state to close service gaps and create more
equitable access to internet for both providers and residents. The
coordination and delivery of health care for Michiganders,
especially for remote or emergency medical service providers,
relies upon reliable and accessible internet access; this initiative
will work to close that gap and ensure safer and more quality
services are provided equitably to all residents.
Initiative #3, Objective
A:
Activity 3A-1: Build on and leverage work already occurring.
• The commission will remain engaged and coordinated
with State efforts to leverage and develop greater
broadband infrastructure capabilities in Michigan.
Page 22 of 65
Support digital
connectivity efforts
• The State health IT community will work to advise and
advocate for equitable access to internet services for
providers and residents. At the time of this report, the
Michigan High-Speed Internet (MiHI) Office leads the
statewide facilitation and coordination efforts of
broadband access for the state.
Initiative #3, Objective
B:
Pursue strategic
partnerships that
enable greater
federal, state, and
private investments in
connectivity
Activity 3B-1: Support and advocate for funding opportunities
that bring high-speed broadband, public Wi-Fi, and cellular service
to all census tracts, statewide:
• The commission will remain engaged and advocate
for health care providers and stakeholders who are
either unserved or underserved by adequate
broadband services.
• The commission will produce recommendations and
guidance on how its stakeholders’ needs can be met
through available broadband expansion funding.
Timing
As soon as possible. Q1 2022
Potential Funding
Source
Nationally, there are historic opportunities for broadband
investments, and the health IT community must take steps to ensure
that all needs are met in Michigan. When President Biden signed the
Infrastructure Investment and Jobs Act into law on November 15,
2021, he approved $65 billion in funding to ensure that every
American has access to reliable high-speed internet service – the
largest U.S. investment in broadband in history. An unprecedented
amount of funding – $42.5 billion of that budget – will be allocated
to states through the Broadband Equity, Access, and Deployment
(BEAD) Program, with a minimum of $100 million to each state. The
remaining $37.356 billion will be distributed to states using a formula
concerning a state’s percentage of nationally unserved locations.
Initial planning funds are available from NTIA to support the five-year
action plan, which is a requirement for implementation funding.
Reflecting the federal government’s strong emphasis on equity,
additional funding will be available through two grant programs
under the “Digital Equity Act of 2021.” The State Digital Equity
Capacity Grant Program authorizes $60 million for planning grants to
be made available to States for the development of State Digital
Equity Plans, and $650 million over five years for grants to States to
support the implementation of State Digital Equity Plans and digital
inclusion activities. The Digital Equity Competitive Grant Program
makes available $650 million over five years for grants to a wide
variety of public-sector and not-for-profit entities. Funds may be
used for a range of digital inclusion and broadband adoption
activities.
Page 23 of 65
Initiative #4: Improve onboarding and technical assistance
programs
Description
Although widespread adoption of certified health IT systems (e.g.,
electronic health record [EHR] systems, case management
systems, health information technology, etc.) has been
accomplished since the Conduit to Care report was published,
many small or independent clinical practices, behavioral health
providers, long term care facilities, emergency medical service
providers, local public health agencies, and social service entities
are not yet able to leverage a comprehensive or certified EHR or
HIE. Moreover, not all EHR users have access to comprehensive
HIE or other integrated services. To ensure optimized care
delivery, safety, and coordination for patients, all providers must
have equitable access to health IT systems and shared services.
Purpose
Several categories of health care providers and all types of social
service organizations were not eligible for the Medicare and
Medicaid incentive payments for adopting and using EHR systems.
This initiative would help the providers left behind (i.e.,
ambulatory, behavioral health, long-term care, emergency
medical services, local public health, social services, and others),
with financial incentives for connecting with a data exchange
organization and with technical assistance and training for using
technology to provide better, more coordinated care.
Initiative #4, Objective
A:
Sponsor onboarding at
higher levels of
statewide leadership
Activity 4A-1: Support statewide technical assistance programs
that optimize use of health IT by physical and behavioral health
clinicians, support staff, and public health professionals.
• MDHHS will pursue funding opportunities and a
technical assistance program framework to enable
this initiative and its goals.
• Into the future, the commission and MDHHS will:
o Establish a statewide EHR User Workgroup, to
ensure that all providers have access to technical
and systems planning resources.
o Explore collaborative regional efforts to pursue
better technical assistance, such as through
regional extension centers or physician
organizations.
o Continue to engage providers on their needs and
barriers in accessing and leveraging optimized
Page 24 of 65
health IT capabilities, such as for local health
departments
Initiative #4, Objective
B:
Support the continued
implementation of
telemedicine
Activity 4B-1: Provide policy and advocacy support to statewide
efforts to expand, integrate and better utilize telemedicine
resources.
• MDHHS and the commission will continue to partner with
existing efforts, such as the MI Healthy Communities Plan
and the Coronavirus Racial Disparities Taskforce, to
provide visibility, recommendations, and planning for
telemedicine across Michigan.
• Annually, the commission will report on its progress and
recommendations on how providers can better optimize
their use of and expand access to telemedicine.
Timing
Starting Fiscal Year 2023
Potential Funding
Source
Collaborative funding models will be necessary to ensure that
development costs, equitable opportunities for broad adoption,
and maintenance funding are possible in this initiative. Possible
funding sources to implement this initiative include, but are not
limited to:
• Federal funding programs (e.g., Centers for Medicare and
Medicaid Services Advanced Planning Documents).
• Congressional funding (e.g., ARPA funds referenced in
Section 2401[5], where funding is available to “enhance
information technology, data modernization, and
reporting, including improvements necessary to support
sharing of data related to public health capabilities”).
• State contracts (e.g., paying Medicaid Managed Care
Organizations to provide “whole person, coordinated
care”).
• Commercial health payers.
• Private philanthropy.
Page 25 of 65
Initiative #5: Protect public health
Description
Greater access by public health entities to electronic health
information and case reporting data will enable end users with
high quality, bidirectional population health information. The
capabilities enabled by this data sharing would ensure centralized
data access and streamlined reporting in public health crises and
ease the administrative burden experienced by local public health
departments and providers due to manual data entry, redundant
reporting, and difficulty querying public health data systems.
Purpose
This initiative will unite intentions around the development and
maintenance of priority public health IT services and capabilities.
The innovations enabled by this initiative will lead to greater
public health emergency preparedness, population health and
disease management capabilities.
Initiative #5, Objective
A:
Accurate and timely
information in public
health systems
Activity 5A-1: Enable bi-directional data flow of accurate and
timely information, such as for immunizations, death
notifications, and electronic case reporting.
• The commission and MDHHS will prioritize the
development and maintenance of use cases that
support bidirectional data flow of accurate and timely
information to and from local health departments.
Activity 5A-2: Support statewide registries and analytics that
develop complete data.
• The commission and MDHHS will prioritize the
development and maintenance of public health
registries that elevate the work of MDHHS public
health programs and their monitoring needs.
Initiative #5, Objective
B:
Support quality
improvement of
resident care
Activity 5B-1: Enhance data services that build capacity for more
complete insight into utilization, quality improvement, and
evidence-based intervention design.
• The commission and MDHHS will continue to engage
stakeholders to assess the business needs and
feasibility of population health evaluation systems
that would meet the goals in this activity.
• The commission and MDHHS will pursue funding and
advocate for statewide resources that allow greater
business insights and analysis into resident whole-
person wellness and population health outcomes.
Page 26 of 65
Activity 5B-2: Focus on improving data quality shared in the
health information exchange.
• The commission will establish workgroups or
committees to discuss and address any identified data
quality challenges in shared data leveraged across the
state.
• The commission will provide updates on its efforts to
improve data quality.
Initiative #5, Objective
C:
Bolster public health
preparedness systems
Activity 5C-1: Provide extensive training and education for local
public health agencies and other key stakeholders.
• In alignment with Initiative #4, the commission and
MDHHS will pursue funding opportunities and a
technical assistance program framework to enable
this activity and its goals.
Activity 5C-2: Modernize state public health systems and improve
functionality for syndromic surveillance, vital records, disease
registries, and electronic lab reporting systems.
• MDHHS will pursue and maximize the impact of
funding that modernizes and integrates its public
health data systems.
• The commission and MDHHS will prioritize HIE use
cases and health IT capabilities that optimize public
health system interoperability.
Suggested Initiative
Owner(s)
• Health IT Commission
• Michigan Department of Health and Human Services
Timing
Fiscal Year 2022 through Fiscal Year 2027
Potential Funding
Source
In the past, public health agencies have struggled to keep their
technical infrastructures up-to-date, and most systems have been
very siloed because they were typically established through
legislative or regulatory mandates as standalone programs tied to
specific funding. Public health agencies across the country,
including in Michigan, are planning modernization efforts that will
upgrade their capabilities and support integration and sharing of
the data. In fact, the federal Centers for Disease Control and
Prevention (CDC) requires states to demonstrate interoperability
and connectivity between public health systems that are being
upgraded or replaced though Cares Act funds and through other
CDC funding allocations. Funding Initiative #5 to establish
bidirectional data flow between public health registries and the
rest of the ecosystem can be provided by the CDC sources or
could be funded through ARPA.
Page 27 of 65
Increasingly, public health programs that show benefit to state
Medicaid programs may also be eligible for federal funding
programs through the Centers for Medicare and Medicaid
Services. This funding, as defined in Advanced Planning
Documents, could be leveraged for project development and
maintenance costs.
Page 28 of 65
Initiative #6: Adopt standards for social care data fields
Description
Many opportunities exist to improve health outcomes and
improve the lives of vulnerable individuals and families in
Michigan when information can be securely shared between
agencies and programs that are serving different needs of the
same people. Social needs assessments collected by community-
based organizations are varied and the information collected
through assessments is not easily integrated into electronic health
record systems. Significant work is being done at the federal,
state, and organizational level on standardizing and even
incentivizing health-related social care data.
Purpose
This initiative will bring momentum to efforts occurring that
Michigan that seek to address whole-person outcomes. By
leveraging clinical, social care, and other data, the outcomes of
this initiative will lead to greater care coordination, need
identification, and resource allocation for vulnerable communities
across the state. Moreover, given the extensive work already
underway in many Michigan organizations, this initiative will seek
to do an environmental scan and assess alignment across current
SDoH efforts being pursued by organizations across the state.
Initiative #6, Objective
A:
Develop policies to
accompany new
standards that
promote easy sharing
of social care
information
Activity 6A-1: Charter a commission workgroup to assess the
extensibility of current national and state work being done to
develop standards for social care data.
• The commission and MDHHS will engage stakeholders
through workgroups or committees to ensure that an
aligned approach is taken across the state to develop
standards for social care data and compliance. The
goal of this workgroup would be to align SDoH data
program efforts across sectors.
• The commission will provide updates in its annual
report on the strategies and alignment that it is able
to identify related to using health IT to address SDoH.
Initiative #6, Objective
B:
Support systems that
promote better care
Activity 6B-1: Advance individual and population-level transfer of
health and social care data that supports whole-person care
management.
• The commission and MDHHS will work collaboratively
with stakeholders to determine the business needs,
privacy implications, and end uses of analytic
resources that would provide insight into the whole-
person care of residents.
Page 29 of 65
coordination and
integration of services
• Once solutions have been identified, the commission
and MDHHS will pursue funding and advocate for
solutions that meet the goals of this activity.
Activity 6B-2: Align stakeholders and SDoH strategies to enable
data solutions that support interoperability and integration.
• The commission will facilitate workshops and
committees to make recommendations to MDHHS on
the sharing and use of social care data, such as
advising MDHHS on its implementation of the State
SDoH strategy.
• Stakeholders will commit to aligning around
statewide findings, recommendations, and strategies
to collectively address SDoH as one Michigan health
IT community.
Activity 6B-3: Take advantage of aggregate data opportunities and
analytics.
• Once agreeable and scalable data sharing solutions
have been implemented, the commission and MDHHS
will work collaboratively with stakeholders to identify
business needs and opportunities with leveraging
analytic resources to optimize the evaluation and
management of resident care outcomes and
evidence-based intervention design.
• Explore opportunities to leverage aggregated HIE data
for innovation and business development.
Timing
As soon as possible. Q1 2022
Potential Funding
Source
Collaborative funding models will be necessary to ensure that
development costs, equitable opportunities for broad adoption,
and maintenance funding are possible in this initiative. Possible
funding sources to implement this initiative include, but are not
limited to:
• Federal funding programs (e.g., Centers for Medicare
and Medicaid Services Advanced Planning
Documents).
• Congressional funding (e.g., ARPA funds referenced in
Section 2401[5], where funding is available to
“enhance information technology, data
modernization, and reporting, including
improvements necessary to support sharing of data
related to public health capabilities”).
• State contracts (e.g., paying Medicaid Managed Care
Organizations to provide “whole person, coordinated
care”).
• Commercial health payers.
• Private philanthropy.
Page 30 of 65
Where We Are Going
Michigan has the benefit of a high-functioning statewide health information exchange model that has
demonstrated value to various state programs and initiatives for nearly two decades. Michigan also
has highly qualified leadership and staff working in the state Department of Health and Human
Services who develop innovative solutions to health care problems. Stakeholder relationships are
strong and stakeholder participation is high, with strong interest running through the state for
expanding activities started during the State Innovation Model and developing additional
transformational models of whole-person coordinated care across communities. Identifying and
empowering champions in state government and considering changes to the Health IT Commission’s
role and activity will provide statewide leadership that is needed for strategic initiatives over the next
five years and ongoing.
The commission has remained intensely engaged in strategy development since the effort was first
proposed in 2019. In 2020, having considered a strategic direction for planning activities, the
commission identified the following principles to convey key objectives to stakeholders ahead of
engagement:
As this strategic plan is implemented, these guiding principles will remain a foundational element.
These principles will also provide continuity, even though legislative priorities, executive goals, and
administration objectives may change as this report is implemented. While this report is intended to
provide a set of actionable activities and goals to attain over the next five years, the spirit of
collective action, collaboration, and continued system improvement will continue long after the
activities of this report are completed. The commission seeks to avoid letting another decade pass
Build capacity for data
availability and sharing
Identify new and innovative
digital tools to assist providers
Shape the future of technical
assistance for patients and
providers
Secure future public and private
funding for IT and data sharing
projects
Overcome collective action
dilemmas to better share data
for care coordination and patient
support
Bridge digital divides to serve the
whole person
Ease paperwork and reporting
burdens on providers
Allow patients better access to
their own information to
manage their health
Page 31 of 65
without updating Michigan’s health IT strategies and thus is taking steps to ensure new strategies
are embraced and integrated into a living statewide planning document.
To provide oversight and accountability, the commission will work to update the metrics and
tracking it uses to gauge success of this report’s implementation. In 2022, the commission will begin
pursuing actionable criteria and make progress toward objectives transparent to stakeholders and
the public. Given that this report’s success will require cooperation from both public and private
entities, implementation metrics will provide clear goals for collective action.
MDHHS looks forward to partnering with the commission, public and private stakeholders, and
Michigan residents to ensure that we continue to improve health and wellness outcomes for all,
leveraging the capabilities of health IT and interoperable data exchange.
MDHHS Nondiscrimination Policy: The Michigan Department of Health and Human Services will not
exclude from participation in, deny benefits of, or discriminate against any individual or group
because of race, sex, religion, age, national origin, color, height, weight, marital status, partisan
considerations, or a disability or genetic information that is unrelated to the person’s eligibility.
Page 32 of 65
Appendix A: Participating Organizations
• AARP
• Adaptive Counseling and Case
Management
• Aetna Better Health Plan of Michigan
• Alcona Health Center
• Allegan County Community Mental
Health
• Alliance Health
• Altarum
• Alternatives for Girls
• American Cancer Society of Michigan
• American Lung Association
• AmeriHealth
• Answer Health
• ANTS Health
• Arab Community Center for Economic
and Social Services (ACCESS)
• Area Agencies on Aging Association of
Michigan
• Ascension Medical Group
• Aspirus
• August Optical
• AuSable Valley Community Mental
Health
• Baldwin Family Health Care
• Baraga County Memorial Hospital
• Barry County Community Mental
Health Agency
• Barry-Eaton Health Department
• Bay County Health Department
• Bay County Medical Care Facility
• Bay Mills Indian Community
• Bay-Arenac Behavioral Health
• Beacon Health Options
• Beacon Specialized Living
• Beaumont Health
• Beaver Island Rural Health Center
• Benton Harbor Health Center
• Berrien County Sheriff’s Office
• Berrien County Corrections
• Blue Cross Blue Shield of Michigan
• Blue Cross Complete
• Branch County Corrections
• Branch Hillsdale St. Joseph
Community Health Agency
• Bronson Healthcare
• Calhoun County Sheriff’s Office
• Capital Area Literacy Coalition
• Capital Area United Way
• Carriage Town Ministries
• Cassopolis Family Clinic Network
• Catholic Charities of Southeast
Michigan
• Center For Family Health Inc
• Center for Health and Research
Transformation and Michigan
• Centra Wellness Network
• Chelsea Senior Center
• Cherry Health
• Child Care Network
• CHRT
• City of Detroit Health Department
• Community Mental Health Agency of
Central Michigan
• Commission on Aging
• Community enCompass
• Community Housing Network
• Community Mental Health
Association of Michigan
• Community Mental Health for Central
Michigan
• Community Mental Health of Ottawa
County
• Community Mental Health
Partnership of Southeast Michigan
• Concerto Healthcare
• Cook and Hayden Vision Care Center
• Corner Health Center
• Covenant
• CSI Support & Development
• Deckerville Community
Hospital/Marlette Regional Hospital
• Delta Dental of Michigan
• Detroit Medical Center
• Detroit Public Schools Community
District
• Detroit Wayne Integrated Health
Network
• Diameter Health
• Dickinson Memorial Health Care
System
• Disability Network/Michigan
• District Court Probation & Community
Corrections
• District Health Department #10
• East Jordan Family Health Center
Page 33 of 65
• Easterseals Michigan
• Eaton County Sheriff’s Department
• Eaton Rapids Medical Center
• Ecenbarger Eye Care
• Elder Law of Michigan
• EPIC Primary Care
• Fairview Nursing and Rehab
• Food Bank Council of Michigan
• Food Bank of Eastern Michigan
• Garden City Hospital
• Genesee Health Plan
• Genesee Health System
• Genesee Intermediate School District
• Genesys PHO
• GMPNetwork
• Good Shepherd Coalition
• Great Lakes Bay Health Center
• Great Lakes Physician Organization
• Greater Detroit Area Health Council
• Greater Flint Health Coalition
• Hamilton Community Health Network
• HAP Empowered Plan of Michigan
• Harbor Health
• Health Care Association of Michigan
• Health Net of West MI
• Helen Newberry Joy Hospital
• Henry Ford Health System
• Henry Ford-Allegiance Health System
• Hills and Dales General Hospital
• Hillsdale Hospital
• Holland Community Hospital
• Hurley Medical Center
• Huron Valley Physician Association
• InCompass Michigan
• Ingenium/United Physicians
• Ingham County Health Center
• Ingham Health Plan
• Integrated Health Partners
• Isabella County Sheriff’s Department
• Jackson Community Medical Record
• Jackson Health Network
• Jewish Family Services of Washtenaw
County
• Kalamazoo Community Mental Health
& Substance Abuse Services
• Kalamazoo County Health &
Community Services Department
• Kalamazoo County Sheriff’s Office
• Kalkaska Memorial Health Center
• Kent County Health Department
• Lakeshore Regional PIHP
• Lapeer County Sheriff’s Department
• Leading Age Michigan
• Legal Services of Eastern Michigan
• LifeWays Community Mental Health
• Livingston County Jail
• Livingston Physician Organization
• Macomb County Community Mental
Health
• Matrix Human Services
• McKenzie Memorial Hospital
• McLaren
• MedNetOne
• Mel Trotter Ministries
• Memorial Healthcare
• Mental Health Association in
Michigan
• Mercy Health
• Meridian Health Plan of Michigan
• MI Bridges Partner Network
• Michigan 211
• Michigan Academy of Family
Physicians
• Michigan Association for Local Public
Health
• Michigan Association of Air Medical
Providers
• Michigan Association of Ambulance
Services
• Michigan Association of Counties
• Michigan Association of Fire Chiefs
• Michigan Association of Health Plans
• Michigan Association of Senior
Centers
• Michigan Association of Treatment
Court Professionals
• Michigan Behavioral Health Advisory
Council
• Michigan Center for Rural Health
• Michigan Chapter of Internal
Medicine
• Michigan Coalition Against
Homelessness
• Michigan College of Emergency
Physicians
• Michigan Commission on Services to
the Aging
• Michigan Community Action
Page 34 of 65
• Michigan Community Health Worker
Alliance
• Michigan Coronavirus Racial
Disparities Task Force
• Michigan Council of Nurse
Practitioners
• Michigan County Medical Care
Facilities Council
• Michigan Data Collaborative
• Michigan Dental Association
• Michigan Department of Corrections
• Michigan Department of Education
• Michigan Department of Health and
Human Services
• Michigan Department of Licensing
and Regulatory Affairs
• Michigan Dept of Tech, Management,
and Budget
• Michigan Directors of Services to the
Aging
• Michigan Disability Rights Coalition
• Michigan Ear, Nose Throat and Allergy
Specialists, P.C.
• Michigan Emergency Medical Services
Coordination Committee
• Michigan Health and Hospitals
Association
• Michigan Health Council
• Michigan Health Endowment Fund
• Michigan Health Improvement
Alliance
• Michigan Health Information Network
• Michigan HomeCare and Hospice
Association
• Michigan Indigent Defense
Commission
• Michigan Medicine
• Michigan NENA
• Michigan Non-Profit Association
• Michigan Nurses Association
• Michigan Optometric Association
• Michigan Oral Health Coalition
• Michigan Osteopathic Association
• Michigan Pharmacists Association
• Michigan Primary Care Association
• Michigan Protection & Advocacy
Service, Inc.
• Michigan Public Health Association
• Michigan Public Health Institute
• Michigan Rural Council
• Michigan School Nurse Association
• Michigan Sheriffs’ Association
• Michigan State Medical Society
• Michigan State Police, Michigan 911
• Michigan State University
• Michigan State University Center for
Rural Health
• Michigan State University College for
Health Sciences
• Michigan State University THRIVE
• Mid State Health Network
• MidMichigan Health
• Molina Healthcare
• MPRO
• Munising Memorial Hospital
• Munson Health System
• Mycare Health Center
• National Alliance on Mental Health
Michigan
• National Alliance on Mental Illness
(NAMI) Michigan
• National Association of Social
Workers - Michigan Chapter
• National Kidney Foundation -
Michigan Chapter
• National Network of Depression
Centers
• NextGen Healthcare
• North Ottawa Community Hospital
• NorthCare Network
• Northern Community Health
Innovation Region
• Northern Michigan Regional Entity
• Northern Physician Organization
• Northwest MI Health Services
• Northwest Michigan Health
Department
• Nurse-Family Partnership
• Oakland County Community
Corrections
• Oakland County Health Network
• Oakland Physician Network Services
• Okemos Allergy Center
• Open Systems Technologies
• OSF St. Francis Hospital
• Packard Health
• PatientPing
• PCE Systems
• Pfizer
• Physician Health Plan
Page 35 of 65
• Physician Healthcare Network
• Physician Organization of Michigan
ACO
• Physicians Health Plan
• Pine Rest
• Planned Parenthood of Michigan
• Pontiac General Hospital
• Prime Health
• Priority Health
• ProMedica
• Saint Joseph Mercy Health System
• Scheurer Hospital
• Schoolcraft Memorial Hospital
• Sheridan Community Hospital
• Southeast Michigan Health
Association
• Southeast Michigan Health
Information Exchange
• Southwest Michigan Behavioral
Health
• Sparrow Health System
• Spectrum Health
• St. Joe's Health System
• St. Vincent Catholic Charities
• State Court Administrative Office,
Statistical Research
• Sterling Area Health Center
• Straith Hospital
• Sturgis Hospital
• tbdSolutions
• The Arc Michigan
• The Right Door for Health, Recovery &
Wellness
• The United Way for Southeast
Michigan
• The Wellness Plan
• Three Rivers Health
• Thunder Bay Community Health
Services
• Total Health Care
• Traverse Health Clinic
• Trinity Health
• United Health Care
• United Physicians
• University of Michigan
• Upper Peninsula Health Care
Solutions
• Upper Peninsula Health Information
Exchange
• Upper Peninsula Health Plan
• Van Buren-Cass District Health
Department
• Vernor Urgent Care PLLC
• Veterans Administration
• Volunteers of America Michigan
• War Memorial Hospital
• Washtenaw County Community
Mental Health
• Washtenaw County Community
Corrections
• Wayne County Corrections
• Wayne County Health Authority
• Wayne Metropolitan Community
Action Agency
• Wayne State University Center for
Behavioral Health and Justice
• Western Upper Peninsula Health
Department
• Wolverine Human Services
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Appendix B: How We Created This Report
Michigan's strategic plan for health information technology, The Conduit to Care Report, was
developed in 2006 under the direction of the Health Information Technology (IT) Commission. The
report sets Michigan on track to be a leader in health IT and health information exchange (HIE)
strategies; it provided incremental processes to develop a legal, technical, and business framework
of shared services for a statewide HIE infrastructure.
A decade after the Conduit to Care Report was last updated, Michigan Department of Health and
Human Services (MDHHS) and the Health IT Commission set a priority to update and modernize the
state’s strategic health IT plan. MDHHS requested funding to engage consulting resources from
Michigan Health Endowment Fund (“Health Fund”). The initiative was announced at the Health IT
Commission’s November 2019 meeting, and planning commenced soon after for the Five-Year
Statewide Health Information Technology Roadmap, beginning with an extensive engagement effort
and environmental scan of the health care and social services stakeholder ecosystems.
Roadmap Planning
The roadmap will align with several key state strategies, including Governor Gretchen Whitmer’s 5-
Year Priorities for MDHHS. At the time of publishing this report, these strategies included:
• Improving maternal and infant health outcomes.
• Integrating and share data on social determinants of health to reduce health disparities
and social inequities.
• Improving data sharing with local communities to respond to lead exposure risk.
• Developing robust performance management tools that support the agency's focus on
evidence-based decision-making.
The health IT roadmap will establish a framework for clear communication, governance, and central
planning to encourage public and private sector organizations to partner on expanding and utilizing
previous and future investments made in HIE. The roadmap will help ensure HIE investments meet
the needs of stakeholder organizations, and more importantly, the needs of individuals receiving
health careand/or social services in Michigan. Principles of writing a health IT roadmap include:
• Inclusive and transparent decision-making processes at the state and local level for
organizations providing HIE/CIE services.
• Oversight and accountability mechanisms to protect publicly funded technology
investment.
• Industry-leading standards for technology and data.
• Performance measurement processes for contractors and vendors.
• Policies to guard against inappropriate use of data and/or insufficient security and
privacy measures to ensure data fidelity, consumer trust, and stakeholder confidence in
data services supported with taxpayer funds.
Fundamental to roadmap implementation strategies, there will be the expectation for decision-
makers to leverage existing investments in health IT infrastructure and HIE tools whenever possible
and practical.
The roadmap will identify opportunities for improving the health and care of individuals; creating
operational efficiencies at government agencies and in private-sector organizations; providing
strategies and tactics for spurring innovation through new partnerships; and developing more
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coordinated planning processes across entities. Longer term, the roadmap will ensure continued,
sustainable progress toward Michigan's goals for improving the health and wellbeing of individuals
and communities in Michigan with clearly defined processes for iterative updates, effective use of
public and private funding, and continual assessment of outcomes against metrics.
Environmental Scan Activities
The primary goal of the environmental scan was to engage a broad representation of stakeholders
across Michigan's health care and community service ecosystem in a comprehensive assessment to
gather input in two main categories This work was implemented by the CedarBridge Group. The
current state of health IT initiatives in Michigan was examined, alongside stakeholders' views of HIE
business and technology services, including policies, regulations, sustainability strategies, technical
assistance and user education/training needs, communications, and other inputs.
The desired future state priorities for health IT and HIE/CIE services to meet the needs of Michigan's
Health IT Strategic Plan was captured in the 2006 Conduit to Care Report, identifying policies,
governance, operational and technical improvements, opportunities for creating efficiencies across
entities, and developing innovative partnerships.
Defining Stakeholder Domains and Modes of Discovery
To reflect the diverse and varied perspectives on health IT and HIE services in Michigan, the roadmap
project teams collaborated to develop stakeholder domains representative of sectors and groups
within the Michigan health care and social service delivery systems. Leaders from government,
private sector, nonprofit and community-based organizations were actively engaged in planning
discussions around the creation of a modernized roadmap to inform the prioritization of health IT
investments, support priority use cases, recommend policies, technical assistance, funding and
sustainability strategies, and oversight to monitor progress of technology implementation, provide
accountability for security and privacy of protected health information (PHI) and other personal data
and ensure services are readily available for Michigan health care and health-related organizations
and the people they serve. Dedicated outreach to hundreds of stakeholder organizations across the
11 public and private sector domains took place, inviting participation in the process. Outreach
efforts included communications on the MDHHS website, regular email communications from
MDHHS and CedarBridge, phone calls to dozens of organizations, and presentations to associations
and advisory groups, informing, seeking input, and soliciting partnerships.
Interactive Forums
Sixteen interactive virtual forums were organized to engage stakeholders across various domains,
with two forums were hosted on each of the eight topic areas.
The first forum of each topic area was focused on statewide information gathering, and the second
interactive forum for each topic focused on regional information. Facilitated discussions with
audience participation took place, with instant polling technology and use of the chat function in the
online conferencing tool as an additional way to encourage discussion and participation among
attendees.
More than 300 participants attended the virtual interactive forums where they discussed the current
state of health IT and HIE in Michigan. Discussions included what is currently working well with
Michigan’s health IT and HIE service infrastructure, and what types of improvements should be
included in the roadmap such as types of data shared, accessed, and used; issues related to consent,
Page 38 of 65
privacy, and security of health IT systems; how to improve the information available at the point of
care; and how technology can be leveraged to improve health outcomes and access to care through
use of data and analytics for planning, budgeting, actuarial analysis, and quality measurement.
Participants were asked about their desires for the future state of health IT and HIE as health care
moves more to value-based reimbursement methodologies and population health management.
During each of the 16 forums, participants contributed thoughts on future state “wish lists” for
technology investments; improvements to functionality; priorities for data types and sources;
policies and standards; and other actions or supports that would improve the adoption, use, and
usability of health IT systems and HIE services in Michigan. An interim report was written on the
virtual forums.
Electronic Surveys
Electronic survey responses numbered more than 200 from stakeholders and organizations
throughout the state. Surveys were sent by association partners to their members, contact lists of
MDHHS departments, participant lists of state HIE organizations, and contacts of Health IT
Commission members. The survey questions focused on how organizations are currently collecting,
sharing, and using data related to the individuals and populations they serve, and the types of
investments and improvements they would like to see in the next five years, including policies,
guidance, technical assistance, regulations, and collaboration. Survey respondents ranked the
barriers to adoption of health IT and exchange of data, including lack of interoperability between
systems and the need for standards, particularly around collecting information about social
determinants of health. Other questions focused on workforce and technical assistance needs,
security, and privacy concerns, and managing consent for sharing sensitive or specially protected
data.
Key Informant Interviews
Interviews took place with more than 100 individuals representing organizations across all identified
stakeholder domains serving health care and social service needs of Michigan residents. CedarBridge
leveraged the expertise of the Health IT Commission to identify key leaders for interviews. In
addition to the stakeholder domains listed above in Table 1, interviews were held with community-
based social service organizations, public safety representatives, advocacy groups, university
officials, Michigan-based health IT vendors, leaders of MDHHS program areas, and HIE service
organizations, including several interviews with leadership and staff of HIE organizations. Interviews
were conducted one-on-one, in small groups, and in focus groups, where representatives and
members of health care professional associations discussed their organizations’ current state and
future needs in the way of health IT and HIE services, including members of Michigan Hospital
Association, Michigan Provider Organizations (Pos), accountable care organizations (ACOs), and large
integrated care organizations (ICOs).
Additional Outreach and Engagement
In addition to the engagement activities described above, the project teams presented to and
collected information from several other groups during regular association meetings and events.
Presentations, discussions, and facilitated focus groups held with groups across Michigan brought
informed insights to the environmental scan, including from members of the Lt. Governor’s
Coronavirus Racial Disparities Taskforce, members of the Community Mental Health Association of
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Michigan (CMHA), attendees of MiHIN Operations Advisory Committee (MOAC) webinars, and the
Michigan council of Tribes, among others.
Specially Protected Health Information
Stakeholder organizations indicated a wide variation in approaches to handling health information
subject to special protection under federal and state regulations. Behavioral health and long-term
care providers acknowledged that, like other provider types, their organizations are subject to
federal privacy regulations related to disclosure of substance use disorder treatment, 42 CFR Part 2.
However, some organizations indicated being unsure of the specific requirements for handling
disclosures and redisclosures of this sensitive information.
6
Stakeholders across all domains provided considerable input on the difficulties around collecting and
managing individual consent authorizations for sharing sensitive information across health care,
social service organizations, and government agencies. Organizations reported a variety of
experiences; some indicated they do not believe there is an effective way to give clients and patients
more choice or control to specify the providers who can access their data, specify purposes for
which individuals are willing to share their data, and have a reliable process to revoke a previous
consent authorization. Several organizations shared concerns regarding the potential for risk
exposure around consent management; some stated that until a better solution for supporting
electronic consent management, their organizations do not share any information that could be
sensitive.
6
https://www.samhsa.gov/about-us/who-we-are/laws-regulations/confidentiality-regulations-faqs
Social Determinants of Health (SdoH)
Addressing disparities in health care access and health outcomes and ultimately achieving health
care and health equity are high priorities of federal, state, and local government leaders from the
White House all the way down to community-based organizations. Like race, ethnicity, language,
geographic, and socioeconomic data, there is a high degree of consensus that screening tools for
identifying needs related to social determinants of health are imperfect in design and inconsistently
applied.
Stakeholders from every domain reported a need for standard assessment tools and measures to
better understand and address SdoH and health care disparities. There is strong support across
stakeholders and domains for federal or state standards and requirements for data elements,
documentation and coding, screening and assessment tools, and quality measures. Most
stakeholders also want to access this data when it is collected by another entity. From a health
information technology perspective, stakeholders across domains expressed a preference for seeing
these data types pushed to them through an HIE infrastructure.
The collection of race and ethnicity data is increasing across Michigan health care and social service
organizations, but the fields or formats used are not standard across IT systems. A common theme
heard from stakeholders across domains was the need for standard representation of data elements
for collection of this data, as well as the need for collection of primary language.
Cybersecurity and Privacy Protection
While health care and social service sectors were slow to move to electronic recordkeeping in
comparison to most other industries, it is clear the federal incentive payments funded through the
HITECH Act of the American Reinvestment and Recovery Act of 2009 (ARRA) were an effective
stimulus for driving EHR adoption and fueling an industry-wide transition from paper to electronic
records, with massive amounts of personally identifiable, sensitive data stored in electronic data
systems.
Exchanging data between systems in electronic formats and combining data in ever-larger data
stores spawn concerns about the privacy and confidentiality of data and the need for organizations
to appropriate resources to ensure appropriate handling of personal information and avoid
unintended disclosures of protected health information (PHI) as well as intentional cyber-attacks.
In aggregate, more than a third of stakeholders who provided input on this topic indicated their
organization had recently taken steps to improve privacy and security policies around the handling
of electronic PHI. A few organizations reported doing this as a routine business activity, some
because their organizations were seeing increased risk around data security and privacy, and a few
organizations reported a recent event where PHI was unintentionally disclosed inappropriately or
because there had been a breach of an electronic data system where PHI or other sensitive
information was stored. The illustration below shows efforts reported by stakeholders to enhance
data privacy protection and improve security of information within electronic systems used by their
organization.
Current Policy Framework
The current policy framework for health information technology, health data collection, and health
data sharing or exchange comes from multiple sources. The sources making up the current policy
framework for health IT in Michigan were reviewed as part of the Discovery phase of the
environmental scan, along with other background sources used in the development of this report.
Health IT in Michigan is governed by public-private partnerships, with MDHHS, the Health IT
Commission, and MiHIN working collaboratively in a cohesive governance model. The evolution of
this governance structure is embedded into MiHIN work and culture, as illustrated by the following
model.
Copyright 2020 - Michigan Health Information Network Shared Services 10
MiHIN Executive Management
Tim Pletcher, Executive Director
Marty Woodruff, Chief Operating Officer
Health Information
Technology Commission
MiHIN Operation Advisory
Committee (MOAC)
MiHIN Board of Directors
Issue Remediation
Privacy
Technical,
Operations,
Cybersecurity
Use Case
MiHINGovernance Model
{
Ad-hoc Working
Groups
Workforce Considerations
Most of the input received from stakeholders related to Michigan’s health care and social service
workforce falls into two issue areas. One topic area involves the need for technical staffing resources
to support state agencies with complex information needs to deliver programs and services and
measure results. For organizations across all domains that have not adopted EHR or care
coordination technology or other health IT tools, and/or have not upgraded outdated technology,
the need for tech savvy resources to provide training and support is well documented, especially for
small practices.
Also impacting the pace of health IT and HIE adoption is the need for ongoing training and technical
assistance support for stakeholder domains known to have high rates of staff turnover and/or
employ older workers such as home health, hospice care, long-term post-acute care. Also impacting
the pace of adoption is the need for entry level staff in any domain, who often have job duties that
include data entry into patient/client records, and data exchange for referral management.
Along with the technical readiness of Michigan’s health care workforce, many stakeholders also
vocalized the need for change in the delivery of health care and social services. While a few
commenters in electronic survey responses questioned whether more information technology would
produce better health outcomes or do much of anything to improve health care, most Michigan
stakeholders understand that information technology and health information exchange services are
enablers for transformation, and when used effectively, can help improve health outcomes, lower
the rate of medical inflation, and reduce the health disparities seen across Michigan’s diverse
populations.
Desired Future State – Stakeholder Priorities
During the Engagement and Discovery phase of the roadmap planning process, stakeholders shared
ideas for standards, creating more community collaboration, and setting policies and/or taking
regulatory actions, among many other topics. A common theme across multiple domains was the
desire for Michigan’s elected officials, MDHHS administrators, Commission members, and business
leaders across the board to step up with stronger engagement and leadership on health IT and HIE
initiatives.
Stakeholders expressed urgency and frustration about the need for leadership in establishing
statewide standards and data exchange requirements, and in structuring more meaningful
opportunities for public/private participation in setting statewide priorities and strategies for health
IT and HIE investments. Many stakeholders indicated a willingness to participate in more active roles
to implement strategies adopted in Michigan’s roadmap, offering to serve on workgroups or
committees that could be set up under the Health IT Commission. The recurring “leadership gap”
theme was often brought up by stakeholders when asked whether there is a state-level shared vision
for a health IT infrastructure and policy framework to support the health improvement goals of the
state. In contrast with the regional initiatives undertaken during the State Innovation Model years,
stakeholders are now looking for much more direct, engaged leadership and guidance from their
state health officials, with more transparent and collaborative planning and policymaking, and more
support from the state in offering technical assistance, training, and education to providers and
consumers touting the benefits of health IT and the value of the right information at the right time
for improving health outcomes.
Two seemingly opposing themes were heard repeatedly from stakeholder discussions; on one hand
there is excitement and commitment for whole-person coordinated care models where data will
need to be exchanged between health care and social service organizations, while simultaneously,
many organizations expressed concerns about resource gaps for IT improvements needed to
coordinate care and services across communities and between diverse organizations. These themes,
heard from many stakeholders across Michigan, are important to highlight together. By focusing
roadmap strategies on addressing resources and workforce competencies and investing in technical
assistance to support practice design and workflow changes enabled by technology, the system will
be more prepared and more successful in adopting whole-person coordinated care models across
Michigan.
The long-standing workforce shortages of practitioners, community health workers, social workers,
patient navigators, and other positions in health care and social services serving as extenders and
coordinators was raised by many Michigan stakeholders as an area of concern. While seemingly
unrelated to a health IT Roadmap, in truth, the workforce challenges facing the health care and
social service industries can be readily improved through technology investments that enable easier
exchange of critical information. A deeper workforce of mid-level and non-licensed professionals is
needed to deliver interventions addressing social and emotional needs. Coordination with health
care clinicians through interoperable technology will reduce the frustrations and lower the burnout
rate of the current workforce.
It is true for both public and private sectors that the ongoing operating costs of an entity can be
considerably reduced when capital and staffing are made to ensure technology systems are meeting
the business and functional needs of organizations and training investments are made to ensure
technology is used effectively. It is reasonable for investments to be combined with expectations,
such as requirements for the use of health IT and for participation in bidirectional health information
exchanges. All Michigan payers—government and commercial—should align such requirements to
prevent a patchwork of policies for organizations to comply with. Health IT vendors, as well as health
care delivery and social service organizations, should be held to standards for data conformance and
data quality, with incentives to reward success. For those organizations for which cost is a barrier to
using information technology and HIE services, an equitable funding source should be identified by
policymakers to ensure Michigan residents can reap the value these investments promise in
improving health outcomes, reducing medical inflation, and lowering the disparities experienced by
marginalized populations in communities across the state.
Stakeholder responses to survey questions, quick polls posed during online forums, and the in-depth
key informant interviews have been analyzed and synthesized by stakeholder domain, described in
more detail.
Key Themes from Engagement
• Relevant and easy-to-access clinical information at the point of care is needed by providers
across all stakeholder domains.
• Accurate and timely information in public health systems is needed to protect population
health and to prepare for future public health emergencies.
• A statewide directory of social service and coordination across organizational networks and
state programs.
• Addressing Michigan’s digital divide will also help address disparities in health care and
social services in rural parts of the state.
• Other statewide shared services are desired by many stakeholders.
o A statewide master person index linked to a statewide health and social services
directory for attributions of individuals to care teams.
o A statewide consent management service to support cross-organizational
information exchange.
o A statewide advance care plan registry to make end-of-life treatment choices known
in emergency settings.
• Funding and technical assistance must be made available to organizations and communities
advancing whole person coordinated care models to support the technology, workflow, and
workforce changes required for integrated health care and social services.
• Engagement of Michigan’s top executives in government and business is essential to ensure
successful implementation of the Statewide Five-Year Health IT Roadmap. Leaders should
convene stakeholders in inclusive processes to set priorities and policies for shared
technology investments and develop a supportive framework for Michigan health care and
social service organizations, state and local government programs, communities, families,
and individuals to benefit from the value created using information technology solutions and
HIE services.
Appendix C: Stakeholder Engagement Summaries
In 2019, the Health IT Commission (HITC) was awarded a grant by the Michigan Health Endowment
Fund to engage with Michigan stakeholders and develop a comprehensive Five-Year Health
Information Technology Roadmap. CedarBridge Group LLC was selected to facilitate this work due to
its expertise in health IT and health policy. In the fall of 2019, plans for in-person community
roundtables were modified in response to the SARS-CoV-2 global pandemic to a series of eight
virtual discovery forums and eight regional forums, defined in more detail in the body of the report.
Virtual forum discussions, facilitated via teleconference and webinar format, were attended by more
than 300 stakeholders and were focused on the following topics:
Findings
The following issues and topics were either recurring themes communicated by multiple stakeholder
groups or key insights into opportunities and risks within the health and social services delivery
systems.
Both statewide and targeted local investments in public health IT infrastructure are needed to
better address both the current pandemic, as well as future public health threats. These include, but
are not limited to, disease surveillance systems, contact tracing systems, and electronic case
reporting systems.
Addressing social determinants of health was reported to be a priority for nearly all the stakeholder
groups. Improved screening protocols for identifying clients’ social risk factors was a common theme
reported by health care providers. With these advancements, the delivery system must now focus
on standardizing SDoH data and improving coordination through more efficient referral capabilities,
preferably using a closed-loop referral platform that allows referring providers to monitor the
outcome and status of referrals.
In response to the pandemic, Michigan providers rapidly expanded their use of telehealth and
other virtual patient engagement technologies. Telehealth is widely recognized as an essential tool
that should continue to expand and evolve.
Reflections on Health IT During a Global
Pandemic
Public Health
Resident and Advocate Perspectives on Health IT
Consumer Focused
Coordinating During Crisis
Emergency Services
Bridging the Digital Divide
Racial Disparities and Social Determinants of Health
(SDoH)
Connecting All Points of Care
Behavioral Health
Coordinating Care for the Vulnerable
Aging and Disability Services
Using Data to Drive Outcomes
Quality Improvement
Giving All Kids a Health Start
Maternal, Infant and Children’s Health
Rural, vulnerable, and underserved populations are at risk of wider health inequities and racial
disparities when they lack consistent access to internet services and cellular phones with data and
text messaging. Investments in these tools for underserved communities, as well as education and
assistance programs for the aging population and the technology-challenged, were identified as key
needs.
Access to broadband internet and cellular services continues to be a significant challenge for many
rural and underserved urban populations. Michigan has made significant investments in health IT
tools, yet many providers and clients lack the ability to consistently connect when needed.
Increasing broadband access is a foundational element to expanding the adoption and use of
existing tools.
Significant gaps remain in health IT and HIE adoption between larger providers (hospitals, physician
groups, health systems, etc.) and smaller independent practices (rural health clinics, behavioral
health clinics, long-term care facilities, aging and disability services, etc.). Additional education,
training, and investments are needed to improve HIE adoption and coordinated data exchange
among smaller provider groups.
Introduction - Stakeholder Forums
In 2019, the Health IT Commission (HITC) acknowledged a need to update the “Conduit to Care”
strategic plan, Michigan’s original health information technology roadmap. To assist in this work, the
Michigan Health Endowment Fund awarded the Commission a grant to expand its capability to
engage with stakeholders and develop a comprehensive Five-Year Health Information Technology
Roadmap.
CedarBridge Group was selected to facilitate this work due to its expertise in health IT and health
policy and experience facilitating these types of initiative. As the pandemic suddenly hit our nation’s
health care systems in early 2020, the HITC acknowledged updating Michigan’s health IT strategy
was especially timely, in that the need for actionable data was more critical than ever. With travel
and in-person gatherings out of the question for the foreseeable future, CedarBridge modified plans
for engaging stakeholders through community roundtables and transitioned to a series of 16 virtual
forums to gather insights on some of Michigan’s shared priorities for improving care through health
IT and more accessible data on patient and population health.
Through September and early October 2020, CedarBridge conducted discovery forums for each of
the eight priority topic areas shown in Table 1. Discovery forums were designed to identify major
barriers, issues, opportunities, and insights within the topic area relative to health IT adoption and
data availability, accuracy, and interoperability. The discovery forums utilized a myriad of tools to
illicit input from the statewide audiences, including interactive polling, online chat, and Q&A
functions, verbal discussions with facilitators and among other audience members, and “stacking”
(putting “+++” in the chat box to emphasize agreement with a statement another stakeholder has
made).
The follow-up regional forums took place during October and early November and utilized the same
virtual meeting technology to engage Michigan stakeholders in conversation on their regional
perspectives on the major themes identified during discovery forums.
Table 1 – Forum Attendee Statistics
Forum Topics
Discovery
Forum
Attendees
Regional
Forum
Attendees
Reflections on Health IT During a Global Pandemic – Public Health
48
21
Coordinating During Crisis – Emergency Services
26
12
Connecting All Points of Care – Behavioral Health
31
26
Using Data to Drive Outcomes – Quality Improvement
39
14
Resident and Advocate Perspectives on Health IT– Consumer Focused
21
8
Bridging the Digital Divide – Racial Disparities and SdoH
42
23
Coordinating Care for the Vulnerable – Aging and Disability Services
33
23
Giving All Kids a Health Start – Maternal, Infant and Children’s Health
24
9
Forum Insights and Findings
Reflections on Health IT During a Global Pandemic – Public Health Forum
The Reflections on Health IT During a Global Pandemic virtual forum series was designed to identify
information technology needs and gaps related to public health. The major themes and consensus
issues that emerged during the discussions are described below.
State Data Sharing for COVID-19 Response and Tracking
While state IT systems for tracking public health are helpful, stakeholders identified areas for
improvement for the Michigan Disease Surveillance System (MDSS) and TraceForce, including the
need for real-time and geographically targeted data. In addition, improved interoperability between
public health agencies and the health care delivery system (i.e., clinics, hospitals, labs) was identified
as an urgent issue, as was the need for better communication and coordination at the community
level between providers, public health agencies and other health and human services providers.
Health IT Investments During the Pandemic
COVID-19 has had a negative impact on health care organizations’ revenue and hindered the ability
for local public health to investment in new health IT tools. As a result, stakeholders are more
dependent than ever on existing public health IT systems such as the MDSS and other registries.
Community Partnerships and Information Sharing
Local communities would benefit from leveraging state systems to receive pandemic-related
targeted regional information, along with more transparent resource coordination across the public
and private sectors.
Systems for Responding to Outbreaks
Additional tools are needed to effectively manage a COVID-19 outbreak including case management,
medical management and proximity tracing systems.
Stakeholder Suggestions for Five-Year Health IT Plan
• Additional statewide investments are needed that can be leveraged by local public health
agencies with the goal of improving existing systems (e.g., MDSS and TraceForce). In
addition, local public health agencies communicated a need for substantial general health IT
investments due to historical underinvestment, including funding for health IT personnel.
• Stakeholders need integrated data reports with targeted regional information from MiHIN.
• Create regional command centers to address PPE needs, COVID testing/reporting and
facilitate better resource coordination across public and private entities.
• Near real-time laboratory reporting is a critical need, further exacerbated by the COVID
pandemic.
• Create statewide standards for electronic case reporting. Widespread implementation of
this capability would improve reporting from providers to public health agencies.
Coordinating During Crisis – Emergency Services Forum
The Coordinating During Crisis virtual forum series was designed to identify information technology
needs and gaps related to emergency medical services (EMS). The major themes and consensus
issues that emerged during the discussions are described below.
Better Coordination Between EMS and Hospitals
Stakeholder’s desire accurate and timely access to medical information at the time of an emergency.
Increasingly, EMS providers are also needing better coordination with mental health and substance
use disorder providers.
A Digital Divide Is Impacting Rural EMS Providers
Connectivity to external information sources during emergency response is a significant issue for
residents of rural areas due to the lack of reliable internet connectivity and cellular service. Access to
patient information is an issue throughout Michigan but is more pronounced in rural areas. Many
urban EMS responders are dispatched by hospitals with access to the hospital EHR. Some regional
EMS provider systems retain patient information to be available on a subsequent response.
Prioritize Connectivity to Leverage Existing Investments
Most rural-based respondents expressed a frustration with not being able to connect to technical
solutions, whether hosted by the state, local agencies, hospitals, or health systems.
Stakeholder Suggestions for Five-Year Health IT Plan
• Funding and support for internet and broadband capabilities in rural areas so that EMS
providers don’t lose connectivity while in the field. Investments are needed to expand
broadband and cellular network services.
• Statewide standards are needed for all dispatch centers as they relate to emergency
medical dispatch.
• Need to connect/report to Michigan Emergency Medical Services Information System
(Mi-EMSIS).
• Update the Michigan Physician Order for Scope of Treatment (MI-POST) rules and create
protocols for emergency medical services to easily access information.
• Funding for EMS providers to utilize digital apps for basic reporting from the field to the
hospital.
Connecting All Points of Care – Behavioral Health Forum
The Connecting All Points of Care virtual forum series was designed to identify information
technology needs and gaps related to behavioral health. The major themes and consensus issues
that emerged during the discussions are described below.
Homelessness Data
There are significant gaps in understanding the needs of homeless populations with behavioral
health conditions. Care coordination for homeless populations with behavioral health conditions
could be improved through data capture and more widespread use of the Homeless Management
Information System (HMIS).
Behavioral Health Data Standardization
Work is needed to define common data fields for capturing and sharing information related to
mental health and substance use disorders.
Connections to Social Services
There is a need to better incorporate information related to social determinants of health, social
needs, history of trauma, and other information likely to be factors for an individual’s health and
well-being into the behavioral health workflow.
Telehealth
The pandemic has facilitated the use of more telehealth for behavioral health conditions. Use of
telehealth has led to reduced no-show rates and improved providers’ ability to coordinate care for
vulnerable populations.
Table 2 – Stakeholders’ Rank Order Health IT Priorities for Behavioral Health Services
Forum Attendee Poll Question
List first and second priorities for focusing data and technology efforts in the Five-Year Health IT
Roadmap
Priority Ranking Options
1. Integrating homelessness data
2. Better defined data standards
3. Adding connections to social services
4. Expanding telemedicine in BH
5. Focus on improving data quality
Highest Ranked Priorities
1st Place: Expanding telemedicine in behavioral health settings – 88% of Respondents
2nd Place: Better defined data standards – 56% of Respondents
3rd Place: Focus on improving data quality – 38% of Respondents
Stakeholder Suggestions for Five-Year Health IT Plan
• Telehealth visits sometimes require patients to be treated on-site, which can be a barrier
to care in some cases. Ideally, patients would be allowed to access telehealth from their
homes with assistance being made available for cultural barriers or technology-related
issues.
• The state could support providers by facilitating the negotiation of a statewide rate for
telehealth application costs.
• Consent remains a barrier. Although the state mandates a universal, statewide consent
form
1
(MDHHS 5515) that must be accepted, its adoption is not widespread, in part,
because it is not mandatory for entities to use the statewide consent form.
Consequently, many organizations are still using their own proprietary consent forms.
• The state could help adoption of common standards for data capture and data sharing of
mental health information.
Using Data to Drive Outcomes – Quality Improvement Forum
The Using Data to Drive Outcomes virtual forum series was designed to identify information
technology needs and gaps related to quality improvement efforts. The major themes and consensus
issues that emerged during the discussions are described below.
Data Extraction
There are significant disparities between large health systems and small and independent practices
for their respective abilities to extract data for quality measures. One barrier is the cost imposed by
EHR vendors, which disproportionately impacts small practices.
Data Standardization
It is important to have data standardized and for providers to be adequately trained in standard
practices for data capture; such work will make data among EHR systems comparable and ultimately,
more useful.
Incorporating Non-Clinical Data
As a state, Michigan needs to better integrate social determinants of health data from claims,
clinical, and non-clinical sources to facilitate a clearer understanding of patient needs.
Reporting Requirements
Providers reported that supporting multiple reporting requirements imposes an administrative
burden.
Table 3 – Stakeholders’ Rank Order Health IT Priorities for Quality Improvement Efforts
Forum Attendee Poll Question
List first and second priorities for focusing data and technology efforts to improve health outcomes
in Michigan.
Priority Ranking Options
1. Affordable data extraction
2. Common data standards
3. Addressing reporting requirements
4. Adding non-clinical data sources
5. More state-led initiatives and resources
6. Focus on improving data quality
Highest Ranked Priorities
1st Place: Focus on improving data quality – 88% of Respondents
2nd Place: Affordable data extraction – 50% of Respondents
3rd Place: Common data standards – 38% of Respondents
Stakeholder Suggestions for Five-Year Health IT Plan
• Incentive funding for small, rural providers to purchase interfaces and other technology
solutions that will better support their capabilities for data extraction and data sharing. This
includes funding for the IT workforce.
• Statewide assistance with practice transformation to incorporate best practices and data
inputs within their EMRs and workflows.
• Vendors need to follow common standards for data extraction. From a policy perspective,
the state can leverage federal standards such as HL7/FHIR with vendors, and in doing so,
reduce the burden on providers.
• The state and HIEs can work more closely with physicians to determine priority use cases as
clinicians can drive adoption more quickly and drive change management.
• A single integrated quality reporting system would be extremely useful and is a
“phenomenal idea.” There are several efforts already under way, but none of them will cut
across all payers. A single system would improve data quality and reduce provider burden,
especially for the smaller practices.
Resident and Advocate Perspectives on Health IT and Person-Centered Care – Consumer Forum
The Resident and Advocate Perspectives on Health IT and Person-Centered Care virtual forum series
was designed to identify information technology needs and gaps from a consumer perspective. The
major themes and consensus issues that emerged during the discussions are described below.
Equitable Access to Internet Technology for Michigan Residents
Michigan residents encounter challenges to accessing personal health data and virtual health
services due to gaps in high-speed internet availability, access to technology, and expanded use of
technological devices.
Health Data and Information Available to Residents
Personal health information is available to Michigan payers and providers, but individuals typically
must go to multiple patient portals to enter, access, and potentially export their own data. In some
cases, individuals may not be granted access to certain portions of their records.
Provider Access to Electronic Health Data
Michigan residents do not have transparency about when personal information about health and
well-being is shared, or how the information may be used. Often, individuals assume more
information is available to their care teams than is the case.
Usability
Multiple technical platforms, patient portals, logins/passwords, and out-of-date information can
hinder individual access to electronic health information. Residents/consumers can be frustrated
with inaccurate information in multiple places and inefficient ways to manage personal health
information and preferences.
Technology to Improve Access to Health Care Services
Virtual visits are increasing and providing safe, socially distanced methods for individuals to receive
health care services.
Table 4 – Consumers Rank Order Health IT Priorities for Access to Services and Health Information
Forum Attendee Poll Question
List first and second priorities for focusing data and technology efforts for improving individuals’
electronic access to health data.
Priority Ranking Options
1. Resident access to ubiquitous high-speed internet (in both rural and urban areas).
2. Email and texting communication between patients/caregivers and care teams.
3. Virtual visits for all care types and settings.
4. Single portal for consumers to access, update, and manage health information across
payers, all providers, care teams, and geography (i.e., out of state).
5. Access to and assistance with tools, such as making online appointments and payments,
and understanding the differences in charges and coverage in advance of scheduled
procedures.
6. Patient-managed data supporting the ability to download a health record to a
smartphone and share it with other providers.
Highest Ranked Priorities
1st Place (tie): Single portal for consumers to access, update, and manage health information – 75%
of Respondents
1st Place (tie): Resident access to ubiquitous high-speed internet (in both rural and urban areas) –
75% of Respondents
3rd Place: Virtual visits for all care types and settings – 25% of Respondents
Stakeholder Suggestions for Five-Year Health IT Plan
• Many patients want to be able to communicate with their providers via text messaging.
The roadmap should educate and clarify standards and criteria for HIPAA-compliant
messaging between patients and providers.
• Generally, patients are not aware of who has access to their data. It was recommended
that transparency should be improved for patients to understand who has access to
their health information and be able to provide informed consent on who is able to
access and share it.
• More efficient exchange of patient information with primary care providers and
onboarding of independent providers onto HIE platforms. More education and training
should be provided to primary care providers to support their ability to seek out patient
data from other systems and providers.
• Expand the use of virtual visits, but not at the expense of patient access to in-person
office visits when their condition(s) necessitate the need, or when it is preferred.
• Provide education and assistance to elderly and technology-challenged clients to
support their use of telehealth technology.
Bridging the Digital Divide – Racial Disparities and Social Determinants of Health Forum
The Bridging the Digital Divide virtual forum series was designed to identify information technology
needs and gaps related to addressing racial health disparities and social determinants of health
(SDoH). The major themes and consensus issues that emerged during the discussions are described
below.
Alignment Related to Racial Disparities
In the context of social needs for communities of color, there is a lack of alignment between the
myriad of initiatives across the ecosystem. This leads to complexity and confusion and diminishes
effectiveness in improving outcomes.
• Workflows and operations
• Data sets and technical systems
• Programs and operations
• Variation between communities
Community Approaches & Data Sharing
A cross-sector, community-wide approach with alignment across SDoH initiatives is needed,
including the reuse of data and technology, and ongoing communication of strategic priorities for
addressing social determinants of health and health inequities. Sharing data across organizations is
already challenging. Connecting EHRs to community data systems, such as the client management
systems of social service organizations, is even harder to achieve.
Privacy and Consent
Managing consent to ensure patient privacy can be a major barrier to sharing data between health
care providers and social services organizations. There needs to be focused planning and action to
address these concerns to foster interoperability.
Table 5 – Stakeholders’ Rank Order Health IT Priorities for Addressing Health Disparities and Social
Determinants of Health
Forum Attendee Poll Question
List first and second priorities for focusing data and technology efforts to reduce health inequities
and address social needs.
Priority Ranking Options
1. More accurate and timely aggregate data and analytics on racial disparities to inform
policymaking
2. Standardized screening and intervention tools
3. Common data standards for social determinants (e.g., common standard for housing
insecurity)
4. Connecting EHRs to community organization data tools
5. Electronic referral tools
6. Resource directory for social service organizations (electronic 211)
7. Data sharing across different types of social services and health care providers
Highest Ranked Priorities
1st Place: Data sharing across different types of social services and health care providers – 75% of
Respondents
2nd Place (tie): Common data standards for social determinants – 50% of Respondents
2nd Place (tie): Connecting EHRs to community organization data tools – 50% of Respondents
Stakeholder Suggestions for Five-Year Health IT Plan
• Oftentimes there is inaccurate race/ethnicity information entered on birth certificates
by hospitals. Training on how to retrieve race information and document accurately may
help.
• Allow individuals the option to select how they self-identify their race and ethnicity.
• Standardize SDoH criteria. Focus on creating community SDoH hubs and electronic
health record (EHR) integration.
• The state should procure and offer a population health tool to lower the costs for
providers. Allow providers to directly access population health data instead of going
through the Prepaid Inpatient Health Plans (PIHPs).
• Create transparent methods for stakeholders to see how SDoH interventions by CBOs
impact costs.
• Develop apps/modules to interpret data coming in. It must be meaningful to the clinical
person coordinating care and providing treatment.
• Develop standard consent protocols across all providers. While there is a universal,
statewide consent form, it’s use is not mandatory. A centralized, electronic consent
repository would also provide significant value.
• Create efficient, timely, and accurate closed-loop referral capabilities.
Coordinating Care for the Vulnerable – Aging and Disabilities Forum
The Coordinating Care for the Vulnerable virtual forum series was designed to identify information
technology needs and gaps related to services for the aging population and people with disabilities.
The major themes and consensus issues that emerged during the discussions are described below.
Technology Adoption and Use
Many providers of aging and disability services have not adopted EHR systems and are limited in
their use of information technology. Stakeholders in the forum agreed that the value proposition for
updated information technology systems and data use has not been clearly and consistently
articulated to this sector of the care delivery system.
Population Health Management
There are challenges in sharing information during transitions of care, in coordinating services and
health care across multiple providers, and in managing populations of high-need individuals.
Incorporating Social Services Data
Incorporating social services and SDoH data into provider workflow would help to improve the
provisioning of care for elderly and disabled populations.
Stakeholder Suggestions for Five-Year Health IT Plan
• A statewide learning network/collaborative is needed for health and social services
professionals working in the aging and disabilities field to communicate the value
propositions for health IT tools and data sharing.
• PCPs and hospitals were targeted through the Promoting Interoperability EHR Incentive
Program, but there is a need to expand incentivization for technology adoption to aging
and disability services and long-term care providers. These sectors need comprehensive
technical assistance throughout the entirety of the process (i.e., understanding
technology needs, technology/vendor selection, implementation, incentives).
• The roadmap should connect all the dots for efficient data sharing (stakeholders, IT
systems and tools, populations, regions, training, funding), and make IT tools and
systems readily available and user-friendly for the providers who can make the greatest
impact.
• MiHIN’s Virtual Integrated Patient Record (VIPR) could provide a foundation for a
statewide centralized “data lake” that could include SDoH data.
• Standardize data conformance measures to improve the quality of source data for
population health analytics.
Table 6 – Stakeholders’ Rank Order of Health IT Priorities on Importance of Data Types to Improve
Outcomes for Aging & Disabled
Forum Attendee Poll Question
List first and second priorities on importance of the following data types to improve health outcomes
for aging and disabled.
Priority Ranking Options
1. ADT data
2. Social determinants of health data
3. Eligibility and enrollment data
4. Aggregate population health data
5. Advanced directive data
6. Clinical data not available in ADT messages
7. Behavioral health data
8. Case management data
9. Family information
Highest Ranked Priorities
1st Place: Social determinants of health data – 100% of Respondents
2nd Place: Aggregate population health data – 50% of Respondents
3rd Place: ADT data – 25% of Respondents
Table 7 – Stakeholders’ Rank Order Priorities for Overall Focus of Health IT Efforts to Improve
Outcomes for Aging & Disabled
Forum Attendee Poll Question
List first and second priorities for focusing data and technology efforts to improve health outcomes
for aging and disabled
Priority Ranking Options
1. Funding for implementation of EHRs
2. Access to population health analytics
3. Access to social history data elements
4. Telehealth
5. Access to advanced directives
6. Closed loop tracking of referral follow-ups
7. Remote monitoring devices with a dedicated nurse call center
Highest Ranked Priorities
1st Place: Access to population health analytics – 83% of Respondents
2nd Place: Telehealth – 67% of Respondents
Giving All Kids a Healthy Start – Maternal, Infant, and Children’s Health Forum
The Giving All Kids a Healthy Start virtual forum series was designed to identify information
technology needs and gaps related to maternal and child wellness and health services. The major
themes and consensus issues that emerged during the discussions are described below.
Data Capture for Screening
Caseworkers, case managers, and providers regularly conduct home visits and routinely use paper
assessment forms, laptops, or tablets for data capture. Typically, home visit data, whether recorded
on paper or on a computer, requires subsequent data reentry to a centralized data repository due to
lack of secure internet connectivity in the client’s home or in the community at large. Organizations
may underestimate the availability of broadband or mobile internet connectivity during home visits.
Access to Broadband and Cell Phones
There is basic technology related obstacles to service delivery.
• Access to broadband and/or high-speed mobile internet is a barrier for providers who are
traveling to a patient/client’s home to provide services, especially in rural areas.
• A lack of financial resources can be a barrier for patients’/clients’ having reliable access to the
internet.
Referrals to Community Services
While the availability of a closed loop referral system would be ideal, referrals are commonly made
through referral directories. As a result, it’s common for providers to have no visibility into the
disposition of their referrals. Organizations commonly use 2-1-1, Help Me Grow, the Salvation Army
"Know Book,”" as well as their own internal directories, which creates a confusing list of community
organizations to try to navigate.
Statewide data systems and resources such as MI Bridges, the Homeless Management Information
System (HMIS), and other health information systems are all separate and “siloed,” allowing only a
limited set of people can view available data (i.e., housing units in HMIS).
Telehealth
Telehealth could be improved upon to meet the needs of sub-populations by providing a “closed
captioning” service and by providing more assistance to those individuals that need help with
technology.
Table 8 – Stakeholders’ Rank Order Health IT Priorities for Maternal, Infant, and Child Health
Services
Forum Attendee Poll Question
List first and second priorities for focusing data and technology efforts in the Five-Year Health IT
Roadmap
1. Investments in broadband
2. Funding to offset clients’ cell phone costs
3. Special functionality for telehealth technology (e.g., closed captioning)
4. Closed loop referral system
5. Creating an electronic system for intake and screening that eliminates manual data entry
Highest Ranked Priorities
1st Place: Investments in broadband – 80% of Respondents
2nd Place (tie): Funding to offset clients’ cell phone costs – 40% of Respondents
2nd Place (tie): Closed loop referral system – 40% of Respondents
Stakeholder Suggestions for Five-Year Health IT Plan
• Laptops, tablets, and mobile phones with broadband internet access or data plans would
aide maternal and infant health providers. Investments are needed to subsidize the costs of
broadband access and/or mobile data plans for vulnerable community members.
• Providers have safety concerns during home visits and would benefit from a digital app for
home visitor safety.
• The state’s Maternal Infant Health Program (MIHP) database needs significant
improvements to reporting capabilities and general updates/upgrades to maintain
useability.
• A recent home visiting needs assessment identified parents’ need for apps that provide a
directory of community resources and ability to connect with community resources.
• Patients/clients must have access to referral and consult status, outcomes reporting, and
ability to make the choice on what services and providers they utilize.
• Statewide resources and data systems should be broadly available to the greatest extent
possible for all members of the patient/client care team to access and utilize.
• Invest in clinical and health IT infrastructure in schools as a common access point in the
community for health care services, counseling, food assistance, and other social needs.
Electronic Surveys
To collect stakeholder input, multiple modes of discovery were deployed. The advantage of
providing stakeholders multiple mechanisms for sharing their experiences of the current state of
health information technology and their preferences and priorities for the future state are:
• Stakeholders at different levels of an organization from staff and management to senior
executives may prefer one way or another to provide input because of schedules, who they need
to consult with internally, or how they best organize their thoughts.
• Interactive online forums were convened with group dynamics and a more public setting as
context and have the advantage of participants thoughts and input being prompted by group
polling questions and discussion spurred by what stakeholders hear others saying.
• Key informant interviews are private and have the advantage of providing less filtered or
prepared responses and allow for follow-up questions based on what is shared, taking the
conversation down any number of unanticipated paths.
• Electronic surveys and key informant interviews both provide a private experience with one
organization, and sometimes one person, providing the input in a setting that can feel safer to
some people due to the interviewer being the only person who hears what is shared.
• Electronic surveys differ from both forums and interviews in that the person completing the
survey can consult internally with others or perform research for confirmation of facts in
drafting responses to represent their organization, whereas in an interview they are responding
via thoughts that occur to them only at the time of the interview.
The electronic survey questions were drafted based on project team experience conducting
environmental scans about health information technology and other types of environments in states
and organizations across the nation over many years. They were modified for this environmental
scan to reflect the current national health IT environment (i.e., policy framework, incentives,
available technology, data types and standards, etc.) and based on information specific to Michigan
obtained from MDHHS, stakeholder forums, and research conducted on Michigan’s current health IT
environment published and available at federal and state websites, the websites of stakeholders and
vendors, and historical background documents such as the SIM Operational plan, the State Medicaid
Health IT plan (SMHP), HITC annual reports to the legislature, and others.
A balance was sought somewhere between asking all stakeholders the same set of questions,
making analysis and comparisons across domains more straightforward, and asking different
questions specific to each domain to account for the different ways people in different roles and
different organizations interact and experience the health IT environment. As a result, some
questions were asked of all stakeholders (e.g., “What kinds of data do you collect?”, and “What is
your role in your organization?”) while other questions were specific to the type of stakeholder
responding (e.g., “Do you use an Electronic Health Record”, and “Are you subject to 42 CFR, Part 2
related to specially protected health information?”). This provided the project team a way to cover
all health IT topics pertinent to a particular stakeholder while permitting comparisons within and
across domains as described in the Environmental Scan and Draft Recommendations document.
A compromise was also sought regarding the length of electronic surveys. With awareness that the
stakeholders in all domains are busy individuals, more so during the COVID-19 crisis than during
business as usual, it was desirable to keep the surveys as short as reasonably possible for the best
chance of a useful number of responses and still address every essential health IT topic. It was also
known that many stakeholders were being surveyed by other entities as part of other projects and
information gathering during the pandemic. Indeed, electronic surveys were administered to some
domains where the number of responses being returned was low enough that an additional shorter
survey containing only the most essential questions was administered to increase the likelihood
more people and organizations would complete a survey.
The questions asked were designed to get a clear picture of:
• The tools and technology in use for collecting, storing, using, and sharing electronic health
information.
• Sources of health information and the methods for accessing, submitting, and sharing data.
• Stakeholder perceptions about the shortcomings or drawbacks of the current environment both
within and external to their organizations.
• Stakeholder perceptions of the current and ideal roles various entities have or should have, such
as federal and state government, the legislature, providers, consumers, vendors, oversight and
governance bodies and commissions, and other entities.
• Stakeholder priorities for investment in the next five years.
• Stakeholder descriptions of characteristics of the ideal future state of health IT in Michigan.
Distribution of the unique surveys for each domain surveyed was through links posted on MDHHS’s
website, the HITC, associations representing different stakeholder groups, and through direct email.
Stakeholders were provided a link to follow to the web-based survey tool. These methods were
chosen to distribute the surveys widely, even to stakeholders in various domains the project team
may not have been aware of, and because these other entities had lists of contacts and contact
information for persons at stakeholder organizations likely to be in possession of knowledge and
information about those entity’s interactions with health information and health information
technology. The number of questions on surveys ranged from eight to 39 -, depending on the
stakeholder domain. Approximately 200 distinct surveys were completed and submitted to the
project team with each domain surveyed being represented in the results.
Note: The project team’s experience has shown that interactions to get the subjective description of
stakeholder experiences with health information technology and data exchange, their pain points
related to what works well and what doesn’t, and their reasons for, and goals, for collection and
sharing of data are the best way to perform the environmental scan. For these purposes, it is
preferable to use empirical data such as the number of consulting and surgical specialist physicians
in Michigan who have adopted a certified EHR for meaningful use, already available from the Office
of the National Coordinator (ONC), and other sources of data about tools and technology, numbers
of transactions, records, encounters, claims, etc. The electronic surveys administered for this project,
therefore, are not intended for statistical or other empirical analysis, but rather as another mode of
collection of the kinds of input sought through forums, focus groups, and interviews and, like those
other methods, serve as a kind of dialogue where questions are answered and responders frequently
had the option of choosing all responses that applied or entering text into fields to collect
perceptions not possible from a multiple choice question.
Standards Used to Collect Social Determinants of Health Data
Provider Domain
Standards Currently in Use by Michigan Stakeholders for SDoH
Ambulatory
Providers
Ambulatory provider stakeholders reported collecting race and ethnicity data
via a mixture of internally determined standards and U.S. Department of
Health and Human Services (USHDDS) standards.
Behavioral Health
Behavioral health stakeholders reported collecting race and ethnicity data
using a mixture of internally determined standards; the federal Office of
Budget and Management (OMB) standards, USDHHS standards.
Forty-five percent of stakeholders reported not knowing the standard being
used.
Hospitals & Health
Systems
Hospitals and health system stakeholders reported collecting race and
ethnicity data using a mixture of internally determined standards, 0MB
standards, and USDHHS standards.
Long-Term Care
Long-term post-acute care stakeholders reported collecting race and ethnicity
data using a mixture of internally determined standards, 0MB standards, and
USDHHS standards.
Fifty-five percent of respondents indicated uncertainty about the standards
being used.
Public Health
Public health stakeholder organizations reported collecting race and ethnicity
data using primarily USDHHS standards, with some using 0MB standards, and
a very few reported using internally determined standards. Most public health
organizations reported using commonly accepted SDoH screening tools;
however, it does not appear that one assessment tool is dominant.
Social Service
Organizations
Social services stakeholder organizations reported collecting race and
ethnicity data using standard categories determined by their funding fiduciary;
USDHHS standards, 0MB standards, internally determined standards, and
school standards were named.
Seventeen percent of respondents were unsure of the standard used.
Appendix D: Policy Alignment
This report is intentionally aligned with key strategies and stakeholder input documents. The following
table depicts each activity in this roadmap and the strategies which correlate to them.
“Bridge to Better
Health” Activity
CMS (CMS-
9115-N2) and
ONC (RIN
0955-AA01)
Interoperability
Rules
ONC 2020-
2025
Federal
Health IT
Strategic
Plan
ONC Strategy on
Reducing
Regulatory and
Administrative
Burden Relating
to the Use of
Health IT and
EHRs
MDHHS IT
Strategy
CedarBridge
Group
Environmental
Scan
Activity 1A-1:
Track progress of
roadmap
X
Activity 1B-1:
Expand the
Health IT
Commission
X
Activity 1B-2:
Health IT
Commission
engagement
X
Activity 2A-1:
Leverages
existing public
investments
X
X
X
Activity 2A-2:
Advance and
promote the
capabilities of
core health
information
network
X
X
X
Activity 2A-3:
Enhance
interoperable
clinical
documentation
X
X
X
Activity 2B-1:
Promote secure
health
information
practices that
protect
individual privacy
X
X
Activity 2C-1:
X
X
Consent
management
system
Activity 2C-2:
Life-saving data
services
X
X
X
X
Activity 2C-3:
Serve children,
inmates, and
behavioral health
patients
X
X
X
X
Activity 2C-4:
Single sign-on
portals
X
X
X
Activity 3A-1:
Support existing
digital access
efforts
X
Activity 3B-1:
Advocate for
digital access
funding
X
Activity 4A-1:
Health IT
technical
assistance
X
X
X
X
Activity 4B-1:
Telemedicine
X
X
Activity 5A-1:
Bidirectional
public health
data flow
X
X
Activity 5A-2:
Public health
registries and
analytics
X
X
Activity 5B-1:
Quality
improvement
use cases
X
X
X
Activity 5B-2:
Data quality
X
X
X
X
Activity 5C-1:
Public health IT
training
X
X
Activity 5C-2:
X
X
X
Public health
modernization
Activity 6A-1:
SDoH data
standards
workgroup
X
X
X
Activity 6B-1:
Whole-person
care
management
X
X
Activity 6B-2:
Aligned SDoH
strategies
X
X
Activity 6B-3:
Utilize analytics
X
X
X
