Q&A: Tim Pletcher discusses the future of health care technological implementation

Dr. Tim Pletcher is the executive director of the Michigan Health Information Network Shared Services (MiHIN). He was previously the founding director of the Institute for Health and Business Insight at Central Michigan University where he provided data science services to companies to extract insight and value from their data.

In this Q&A, Pletcher discusses the active care relationship service and how that can better connect providers with patients and promote value-based care and health care equity within Michigan.  


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PJ: What do you think is the biggest problem facing healthcare technology right now?

TP: “The number one problem [in healthcare technology] is the number one problem in healthcare. It’s solved by something we call the active care relationship service. It’s been a foundational and key ingredient of our success throughout the last decade. That active care relationship service solves, what I think most people will actually recognize as the number one problem. Nobody really understands all the pieces touching the patient. Fragmentation healthcare in the United States is just a killer. You don’t know what you don’t know.” 

“What we have adopted in the United States is a very provider, more payer-centric mindset. Our focus with the automation digitization has really been, ‘Hey, we need to create a longitudinal record.’ It sort of gets way narrow and says, ‘what we need is just one record’, and that’s not what we need. What we need is a patient centric approach. It’s not the data, it’s the human being in the center, and all the connections that they have. So what we see as the most important thing that needs to happen is this map of all the ways that a patient is connected to the health care ecosystem. Who’s your doctor? Who are the care coordinators who are seeing you? What programs are you eligible for from the state? How do you fit into this ecosystem? And once you have that map, you can begin to make a lot of very intelligent decisions.” 

PJ: What is MiHIN doing right now to actively create this map? What do you think is the next step?

TP: “Many things. Essentially we’re really working to build out this active care relationship service. It’s really solving three things. The first component is what we call linkages. How are you connected? The way you’re connected is [to] declare [your] doctor or you doctor[s] can declare [their] patients. But another way that can happen is you can go to the emergency department and that linkage can be reported, because you were in an ADT message. We know you went to that doctor and who went to that emergency department so we can connect you to that hospital. We can get a roster of these folks who are at risk for housing and security, and we can begin to move from linkages to what we call attributes. 

Attributes are not your medical record, but important characteristics that you need to navigate that care map. Those would be things like [being] at risk for certain social determinants of health (SDoH) or having a high probability of being readmitted. 

The third category under this active care relationships service are what we call active care relationship choices. Those are the choices that individuals have made about their care, and [can show] how one feels about consent or specially protected consent for specially protected information.

All of that stuff needs to be put together in this care map that provides context around the person. We use that for transitions of care. We use that for granting access to longitudinal views. We use that for quality holes and gaps in care. We use that in each one of those FHIR things. It has a person, and either a linkage choice or attribute. But then there’s a pointer, which is basically a FHIR endpoint, or a direct secure mail address or an IG kind of endpoint. And basically what that does is it allows us to create an incredibly sophisticated and scalable record locator infrastructure that’s truly sort of next generation. Because if a person just shows up in the emergency department, the current model without that care map is [that] I ask everybody in the country. Does anybody know anything about Tim Pletcher and have any data? That’s not very scalable. And so what we’re really looking to do is sort of build this care map, and begin to persist.” 

PJ: How do you think the active care relationship service can eliminate health disparities and promote health equity in Michigan?

TP: “We just initiated a large project called Health Equity Project that is trying to build out those attributes in the active care relationships service that allow you to begin to sort of capture some of the things like the social determinants of health, security, housing security, job security and those kinds of SDoH things. This project is working with the infrastructure around the state, that is behind the walls of the hospital. 

[For example], it’s not always clear that your cardiologist knows when a patient comes in that they took the bus, and that they are planning to take the bus after the procedure. Cardiologists are very busy and they’re doing a lot of things. How do we make it very easy for them to know that there are some of those other kinds of challenges for particular patients? They’re trying to provide the best care possible, but their window is not maybe exposing them to a lot of other things that are going on in the patient’s life. We’re trying to begin to automate the data collection for folks who fall into those categories, so that we can facilitate building a registry around diabetes [for example] and a deeper registry around some of these other chronic conditions that affect the Medicaid population.”

This interview was edited for clarity and length.