Overused buzzwords like "digital transformation" and "disruption" dominate healthcare discourse. While these terms are alluring and attention grabbing, they often lack substance and obscure the realities of true innovation. One health information exchange (HIE) serves as a case study for true digital transformation in action. No marketing jargon – just tangible results.
The Michigan Health Information Network (MiHIN) serves as Michigan’s statewide HIE. Breaking down disparate and siloed data systems, the digital infrastructure provides critical and comprehensive patient information to the state’s network of care providers and routes information for more than 13 million patients.
Traditionally, HIEs function as public health data brokers – and for years, MiHIN did too. However, the organization embarked on a remarkable journey, evolving into a fundamentally different model that prioritizes patient-centered care while remaining both scalable and replicable for other HIEs nationwide.
Prior to 2015, MiHIN hardly had cloud on its radar. It was operating out of two collocated data centers and heavily focused on scaling to handle the millions of patient messages that passed through its network each week so it could service its growing user base of health systems in Michigan.
But there were several problems.
One, the on-premise servers struggled to keep pace with the ever-increasing volume of patient data flowing through the network each week. This resulted in frequent outages, disrupting critical data exchange for healthcare providers in Michigan. Furthermore, adding new servers was a slow and laborious process, taking months to complete. This limited MiHIN's agility in responding to stakeholder requests for new features and services, hindering the organization’s ability to meet the evolving needs of the healthcare community.
Two, healthcare is addicted to VPNs – and, at the time, MiHIN was not an exception to that rule. VPNs are a double-edged sword. While they provide access, they also open up direct network connections into your environment. Each VPN connection acts like a chink in the armor, a potential vulnerability that can be exploited. It’s what one MiHIN Executive refers to as a “cybersecurity quagmire.”
Third, looming hardware refresh cycles presented a financial hurdle. Upgrading existing data centers or expanding to accommodate growth would require significant capital expenditures for new hardware and additional personnel for ongoing management.
It was time to make a pivotal decision: either MiHIN would invest in more hardware and more people or move to the cloud.
Cloud adoption in healthcare was nascent at the time. The industry's risk-averse nature, fueled by the inherent sensitivity of managing protected health information (PHI) and the persistent threat of ransomware attacks, made many hesitant to move away from data centers.
Rich Fish, MiHIN's Chief Information Security Officer, brought a different perspective. Having recently witnessed the migration from an on-premise data center to the cloud at a different HIE, Fish had the firsthand experience – and the cold, hard ROI data – to make the case.
Fish argued that the cloud offered solutions to their existing problems. Moving from a capital expenses model to an operating expenses model meant that they could pay for resources on demand and break the exhaustive cycle of hardware upgrades and refreshes. With this type of flexibility, they would be able to develop new features much faster and keep up with stakeholder demands. Plus, they could continuously consume new technologies and offer new capabilities to users.
Then, there was getting out of the “quagmire.” In the cloud they could leverage APIs and secure API tools like Transport Layer Security certificates, significantly reducing the need for VPNs and reducing the attack surface area.
The MiHIN team was sold on the solution. The only thing it was missing was expertise: someone who’d already been through the trials and tribulations of moving to the cloud that could lead the way.
When I met the MiHIN team they were already sold on Amazon Web Services (AWS). It was, and still is, the undisputed leader in cloud computing. This aligned perfectly with my expertise – five years prior, I'd launched a consulting firm focused on helping healthcare organizations thrive on AWS. When they reached out seeking my assistance, I knew it was a perfect fit.
Our first order of business was migrating their servers to the cloud using a "lift and shift" approach. We also streamlined operations by replacing their complex web of VPN connections with a modern API-driven architecture. We architected for high availability, robust security monitoring, and implemented critical processes like backups, redundancies, and incident response plans. But that was the boring stuff.
MiHIN wasn't content with just migrating to the cloud; they aspired to become a truly cloud-native organization. This meant embracing cutting-edge technologies like serverless and Platform-as-a-Service (PaaS) to develop cloud-optimized applications.
My team introduced them to novel technologies like graph databases, powered by Amazon Neptune. This allowed them to extract more granular insight from fragmented healthcare data, ultimately translating to better data for their customers and improved clinical care.
Additionally, we introduced them to DevOps, showcasing the dramatic increase in development speed and agility the cloud enables. Experimentation became not only possible but virtually risk-free, allowing them to invest resources in innovation rather than simply "keeping the lights on."
MiHIN has shattered the mold of traditional HIEs, evolving from a basic data exchange into a comprehensive health information powerhouse. Not only does it develop proprietary applications and offer a diversified product portfolio of solutions, but its robust infrastructure has the power and potential to handle nationwide event volume. Prior to its cloud transformation, this would’ve been unthinkable.
This isn't just a technological success story, it's one with a profound impact on patient care. As a result of its cloud migration, MiHIN has expanded its reach beyond traditional medical settings, integrating data from schools, correctional facilities, social services and state and local governments, allowing it to function as a health data utility (HDU) instead of a traditional HIE. It’s able to integrate these data points in order to serve up more holistic, detailed medical records on patients to the providers that care for them, fostering a more comprehensive approach to care.
MiHIN's transformation also prompts deeper questions about patient-centric care. How do we ensure that we respect the preferences and consent of all the patients? How do we empower patients to actively participate in their healthcare journey? By addressing these critical issues, MiHIN paves the way for a future where patients are truly at the center of their care.
Just like Steve Jobs revolutionized personal technology with the iPod and Elon Musk sparked a shift towards electric vehicles, MiHIN is reshaping the landscape of HIE and leading the way on the evolution to HDU. They've disrupted the traditional model, pioneering a new standard that emphasizes robust infrastructure, cutting-edge applications, and expansive data integration.
Not every HIE will replicate MiHIN's success – but its transformation serves as a powerful testament to the industry's potential for innovation. It marks the beginning of big changes in the industry – and big possibilities for healthcare systems that rely on HIEs to provide actionable and valuable data at the point of care, improving both patient and community health outcomes.