This roadmap reflects the experiences and expertise of leaders in Michigan and across the country. Thank you for your commitment to improving the health and well-being of Michiganders.

Debbie Aldridge, Northern Michigan Community Health Innovation Region ● Theresa Anderson, Michigan Department of Health and Human Services (MDHHS) ● Alison Arnold, Central Michigan University College of Medicine ● Kimberly Bachelder, Michigan Health Information Network (MiHIN) ● Ellie Bai, Center for Health Research and Transformation (CHRT) ● Briaa Baldwin, Michigan Medicine ● Phillip Barnhart, Michigan Public Health Institute (MPHI) ● Dara Barrera, Michigan State Medical Society ● Dawn Bishop, Altarum Institute ● Jennifer Black, CHRT ● Caira Boggs, MPHI ● Carrie Butt, Altarum Institute ● Ayse Büyüktür, CHRT ● Esperanza Cantu, United Way for Southeastern Michigan ● Jeff Chin*, Michigan Medicine ● Katie Commey, MDHHS ● Rachel Copeland, MDHHS ● Samantha Cornell, Access Health ● Helen Dawson, Altarum Institute ● Catherine Distelrath, Center for Supportive Housing ● Amanda Drew, Region IV Area Agency on Aging ● Linda Gordon, MPHI ● Heidi Gustine, Flack Consulting, LLC ● Arthur Hampton, Southeastern Michigan Health Association ● Kristin Hanks, Brightstreet Group ● Elizabeth Hartig, MDHHS ● Natalie Holland, MDHHS ● Liz Jones, Altarum Institute ● Edward Jones III, Grand Valley State University ● Nadia Khan, MDHHS ● Sarah Kile, Michigan 211 ● Sharon Kim, CHRT ● Mike Klinkman, MiHIN ● Bob Kreha, Brightstreet Group ● Kaitlynn Lamie, Michigan Association of United Ways ● Rachel Landauer, Health Law Lab, Center for Health Law and Policy Innovation, Harvard Law School ● Janan Landsiedel, CHRT ● Shannon Lijewski, Everyday Life Consulting ● Abigail Lindsay, CHRT ● Shelby Lummis, Michigan 211 ● Bruce Maki, Michigan Primary Care Association (MPCA) ● Lee Marana, Informa Markets ● Diane Marriott, Michigan Multipayer Initiative ● Shauna McDonald, MDHHS ● Ben McGuire, Meadow Brook Medical Care Facility ● Sue McGuire, United Way for Southeastern Michigan ● Lynda McMillin, CHRT ● Sally Mellema, District Health Department #10 ● Jeff Miles, United Way for Southeastern Michigan ● Melissa Moorehead, Data Across Sectors for Health ● Drew Murray, Michigan Health Endowment Fund ● Lisa Nicolaou, MiHIN ● Dawn Opel, Food Bank Council of Michigan ● Todd Osbeck, Children's Healing Center ● Darla Parsons, Altarum Institute ● Jennie Pollak, Michigan 211 ● Michelle Ratchford, MPHI ● Fayana Richards, MPHI ● Pete Richardson, Brightstreet Group ● Eric Richmond, MDHHS ● Vicki Riddick, MDHHS ● Ninah Sasy, MDHHS ● Nadeem Siddiqui, Wayne Metro Community Action Agency ● Mira Smith, Access Health ● Deana Smith, CHRT ● Corey Smith, Corewell Health ● Faiyaz Syed, MPCA ● Britney Tipler, MPHI ● Kayla Traxel, MiHIN ● Joshua Traylor, CHRT ● Janée Tyus*, Impact Care, Inc. ● Theresa Uhrich, Region IV Area Agency on Aging ● Jason Werner, MDHHS

A Special Thank You to the Learning Network of Regional Health Collaboratives supported by the Center for Health and Research Transformation:

Access Health                                                                Greater Flint Health Coalition

Health Net of West Michigan                                   Jackson Care Hub

MI Community Care                                                    Northern Michigan Public Health Alliance

Southeastern Michigan Health Association

*Chairs of the Community Information Exchange Advisory Committee, a committee of the Health IT Commission

MDHHS, guided by the Health Information Technology Commission (Commission), began implementing its first IT strategic plan in 2006. In 2010, the Commission established the Michigan Health Information Network (MiHIN). Over the last 15 years, Michigan has become a national leader in health information exchange, with strong uptake of mature use cases by core health care providers.

During the COVID-19 pandemic, the Commission began a community engagement process to update its strategic plan. Integrating input from more than 300 organizations across the state, the community engagement process identified that unmet, non-medical health needs were impacting Michigan’s most vulnerable community members, including Medicaid beneficiaries. In 2022, the Commission responded to these findings by releasing Michigan’s Health IT Roadmap: Bridge to Better Health. The health IT roadmap recommended collaborating across sectors, onboarding non-traditional providers, and adopting standards for social care data fields. In 2022, MDHHS also launched the statewide social determinants of health (SDOH) strategy: Roadmap to Healthier Communities. Phase two of the strategy focused on structural interventions, exploring how health information exchange could engage social care providers through community information exchange.

The aligned recommendations in the Bridge to Better Health Roadmap and Roadmap to Healthier Communities led the Commission to create the Community Information Exchange (CIE) Task Force (August 2022 – August 2023) and the CIE Advisory Committee (December 2024 – present). These advisory bodies have provided critical subject matter expertise for developing statewide CIE infrastructure, including the recommendations in this roadmap. 

Guiding Documents

MDHHS guiding documents shaped MiTAHIE roadmap recommendations:

• Health IT Roadmap: Bridge to Better Health
  Michigan’s health IT roadmap was developed to modernize the existing health IT ecosystem, with an emphasis on engaging non-traditional providers. The roadmap is organized around six initiatives.
• Statewide Social Determinants of Health Strategy: Roadmap to Healthier Communities
   The 2022-2024 MDHHS Social Determinants of Health (SDOH) Strategy builds upon existing efforts to address SDOH, with a focused approach to align state and local levels for a greater impact in communities.

• CIE Task Force Final Report 
  The CIE Task Force Final Report details findings from the task force and its recommendations for the development of a statewide CIE strategy. The 33 recommendations are organized across seven domains, including the Coordinating Entities Capacities domain.

Prior to and throughout the planning project, MDHHS has continued to learn from efforts addressing non-medical health needs.   

Emerging Statewide Governance

The Health IT Commission’s CIE Advisory Committee is charged with implementing the CIE Task Force Final Report recommendations and developing statewide CIE infrastructure. The CIE Advisory Committee completed a workgroup sprint in 2024 resulting in a two-year governance development proposal. This governance proposal will shape how community information exchange evolves in Michigan, including how local and regional leaders can continue to share their experiences and center the needs of their communities.

• Community Voice Subgroup: Forum for communities to share experiences and shape statewide decision-making.
  The Community Voice Subgroup ensures that community member experiences are central to CIE decision-making and implementation. Recommendations from the Community Voice Planning Team will shape this Subgroup. The Subgroup will launch in late calendar year 2025.
• Coordinating Entity Subgroup: Forum for improving training and technical assistance implementation and capacity building practices.
  The Coordinating Entity Subgroup will be responsible for identifying and supporting coordinating entities, analyzing aggregated data, and surfacing gaps or needs in CIE infrastructure across Michigan. Recommendations from the FY25 Coordinating Entity Initiative and the MiTAHIE planning project will shape this subgroup. The subgroup will launch in fiscal year 2026.
• Data Exchange Subgroup: Forum for expanding use cases and ensuring quality information exchange within and across CIE initiatives. The Data Exchange Subgroup will monitor data process flow, user stories, data standards, and data conformance. Recommendations from the MiTAHIE planning project, interoperability pilot projects, and MiHIN Operations Advisory Committee will shape this subgroup. This subgroup will launch in fiscal year 2026.

Established Statewide Infrastructure

Michigan has experiences providing technical assistance and established statewide infrastructure that supports both health information exchange and community information exchange.

•        Michigan Center for Effective IT Adoption

  Michigan has a strong history of providing onboarding and technical assistance, as demonstrated through the successful implementation of the Michigan Center for IT Adoption (M-CEITA). M-CEITA educated, trained, and engaged more than 6,000 providers on the “meaningful use” of electronic health records through the CMS Electronic Health Record Incentive Program. M-CEITA, however, was limited to primary care providers and hospitals, leaving many essential Medicaid providers behind, including community-based organizations.
  
  

•        Michigan Health Information Network (MiHIN)
  MiHIN is Michigan’s non-profit statewide entity legally, technically, and privately providing critical and comprehensive patient information to doctors, clinics, federally qualified health centers, hospitals, pharmacies, health insurance providers, and public health.
  
  
•        Michigan 211
  Michigan 2-1-1 is a free service that connects Michigan residents with help from thousands of health and human services agencies and resources right in their communities. As a statewide resource directory with integration capabilities, Michigan 211 is a foundational CIE element.

Local and Regional Pilots

MDHHS has supported pilot projects to ensure statewide recommendations reflect the needs and experiences of communities. Project teams from the following initiatives have provided feedback to the CIE Advisory Committee, its workgroups, and the MiTAHIE planning project:

Regional Health Collaboratives

Regional Health Collaboratives act as intermediary organizations, connecting residents with complex needs to critical health and social care resources. Supported by MDHHS and the Center for Health and Research Transformation (CHRT), Regional Health Collaboratives are established health and social care providers serving communities across the state.

SDOH Hubs

In January 2024, communities across Michigan began piloting SDOH Hubs. Local organizations and community members defined exactly how to structure their hubs, with several sites prioritizing community information exchange.

Physician Organization Pilot Project

The 18-month physician organization pilot project explored how physician organizations, as existing health care entities designed to coordinate administrative functions and aggregate practice-level data, could be leveraged to serve community members more holistically.

MDHHS received approval from CMS for a one-year planning project to strengthen Michigan’s health IT ecosystem. The planning project objectives were consistent with the principles of a learning system, a patient-centric development approach, and the interoperability priorities of simplification, protecting privacy and security, scalability, and universal access.

Defining the need

While health information exchange has begun to expand into other service sectors through community information exchange, these connections are inconsistent and not fully integrated. Community-based organizations experience: 

• Unclear Standards: Standards for exchanging data related to non-medical health needs and interoperable referrals between Health Insurance Portability and Accountability Act (HIPAA) covered entities and non-HIPAA covered entities are unclear, difficult to navigate, and, in some cases, non-existent. 

• Lack of Training and Technical Assistance: Where standards are clear and can be used by health care providers, community-based organizations receiving referrals and providing services often do not have the technical expertise or training necessary to participate in the electronic exchange of information. 

•  Limited Funding: Too often community partners are asked to do more without additional resources. Health care is incentivized to increase screening for social drivers, but those same incentives do not reach community-based organizations.
• Administrative Burden: Community-based organizations are often required to document information in multiple systems, depending on the community member’s needs and the service funding source.

Defining the Scope

This roadmap is designed to improve health by closing gaps in the health IT ecosystem through CIE Coordinating Entities. CIE Coordinating Entities have the capacities, or interest in building the capacities, necessary to support CIE initiatives; meet network members where they are; and ensure compliance with human, organizational, and technological standards. CIE Coordinating Entity standards, and implementation funding to support achievement of these standards, are required to build the foundational infrastructure necessary for community-based organizations to engage with health care as equal partners.

MiTAHIE’s focus on the capacities necessary for health care contracting reflects the priorities of CMS and the call for a modernized digital health ecosystem that centers Medicaid beneficiaries. CIE Coordinating Entities support community care planning by ensuring 1) patients can access community-based supports through its network organizations and 2) network organizations can receive payment for services. 

Defining Success

The planning project focused on meaningful standards development for CIE Coordinating Entities. Modeled after the “meaningful use” approach, the capacity building framework outlines structures, principles, and functions with clear, measurable, and interoperable standards. By building capacity to meet standards, community-based organizations will be positioned to manage contracts from a variety of referral sources, including health care.

Defining CIE Coordinating Entity

The CIE Coordinating Entity definition is the foundation of the MiTAHIE capacity building framework and describes how MDHHS will implement standards to support a more integrated health IT ecosystem. This definition draws from local and regional experiences implementing CIE in Michigan as well as competencies, recommendations, and ideas from national thought leaders.

The MiTAHIE planning project team completed outreach and engagement in three phases:

• Surveys: Community-based organizations across Michigan received a survey to help the project team understand the current landscape. The survey was intentionally brief, with 23 multiple choice questions and instructions that indicated the survey could be completed in 15 minutes. 
• Focus groups: Community-based organizations that completed the survey were then invited to participate in virtual focus groups. Focus group facilitators provided an overview of the planning project before moving participants to small group discussions.
• Key informant interviews: Community-based organizations that completed the survey and identified as coordinating entities, including additional community partners engaged in CIE initiatives, were invited to participate in key informant interviews. Interviews were virtual and no more than 60 minutes.

Survey Results & Themes

The MiTAHIE survey invited 4,200 organizations to participate and received more than 1,300 responses, with 817 complete responses. At least one community-based organization from every county in Michigan responded to the survey. Survey findings reflected the diversity of the social service sector and established how community-based organizations rate themselves in terms of administrative functions and CIE knowledge or interest. 

Themes

The survey provided a helpful baseline for how community-based organizations currently operate in the health IT ecosystem. The comprehensive outreach list ensured that a wide range of community partners were invited to engage, not only organizations previously connected to MDHHS or already participating in CIE initiatives. 

Through data analysis and sensemaking conversations, the following key themes emerged:

• Provide Education: Despite interest in sending or receiving referrals, many community-based organizations were not familiar with CIE or how the health IT ecosystem could benefit the communities they serve. Education is necessary to build a shared understanding of CIE in Michigan.
• Tailor Training and Technical Assistance: Community-based organizations self-reported a range of technical starting points and knowledge about administrative functions. These existing capacities reflect organization types (e.g., coordinating entity, grassroots). Training and technical assistance must mirror these starting points to ensure MiTAHIE implementation strategies are meeting organizations where they are.
• Leverage Coordinating Entities: Many organizations self-identified as hubs or coordinating entities, indicating robust infrastructure exists in Michigan. As network leaders, these community partners are well-positioned to understand the needs of smaller organizations and connect community partners to CIE initiatives in ways that make sense for them.
  
  

Focus Group Themes

MiTAHIE project partners invited community-based organizations to participate in virtual focus groups. 100 individuals joined the focus group calls, with 60 participants actively engaging in breakout sessions.

The following focus group themes complement survey findings: 

• Widespread Interest in CIE: Most community-based organizations see clear value in leveraging CIE initiative infrastructure to manage referrals and improve client outcomes.
• Significant Barriers: Community-based organizations also noted significant barriers to participating in CIE initiatives, including limited technology capacity, funding constraints, privacy concerns, and lack of consistent or reliable resource directory data.
• Need for Technical Assistance: Community-based organizations expressed a desire for hands-on support, including training, financial resources, and clear guidelines on data sharing.
• Desire for Stronger Partnerships: Many organizations expressed enthusiasm for collaborating with statewide entities (e.g., MiHIN, Michigan 211, United Way) but often needed more clarity on how to engage them effectively and how to ensure these entities understand their service offerings and capacity.

Key Informant Interview Themes

MiTAHIE planning project team members conducted 14 key informant interviews with organizations that identified as hubs or coordinating entities. Key findings included:

• Diverse network models still present common challenges: There is no uniform model for governance or operations, and entities often adapt their models based on community needs. All entities face common challenges in sustaining operations, including heavy reliance on grant funding and insufficient mechanisms to support administrative functions.

• Differences in IT and data infrastructure maturity: Data exchange capabilities and IT infrastructure vary widely, with many organizations managing complex systems in-house or via close collaboration with vendors. While most organizations are exploring closed-loop referral systems, challenges remain – particularly for partners with low digital capacity or limited system access. Tracking focuses more on outputs than true outcomes, reflecting limitations in data standards and reimbursement processes.
• Need exists for standardized operational tools and support functions: There is a critical need for standardized tools, templates, and technical assistance to strengthen contract administration, compliance practices, and billing readiness.
• Workforce capacity is a universal limitation: Staffing constraints limit the ability to expand operations, highlighting the need for sustainable staffing models. Even mature entities typically function with under 2.0 full-time equivalent employees dedicated to hub operations.
• Entities with more mature operational models show strong potential to support others: Several entities have built advanced functionalities, including secure data sharing, IT integrations, governance frameworks, and strong backbone capabilities, that position them well to serve as technical assistance leaders for smaller and less resourced partners.

What Were Key Findings

Outreach and engagement themes reinforced the need for, and interest in, community-based organization training and technical assistance to support a more integrated health IT ecosystem. Sensemaking sessions with the CIE Advisory Committee and MiTAHIE Alignment Committee members led to the following key findings for developing roadmap recommendations:

• Incorporate the human, organizational, and technological components for implementing effective CIE initiatives.
• Build from existing infrastructure by leveraging more mature models to support more emerging efforts.
• Provide tools, templates, and resources to support consistent implementation.
• Ensure community-based organizations of all types have the opportunity to participate in CIE in ways that meet their needs and interests.

Assessments establish a baseline for understanding current capacities of a CIE Coordinating Entity, including what the coordinating entity and its networks do well and where there may be opportunities for improvement. Regular assessments track progress, assist in prioritizing network actions and investments, and help determine when a coordinating entity is ready to implement advanced standards.

Assessing Structures

Assessing the CIE Coordinating Entity’s structure requires deep knowledge of organizational practices and organization type (e.g., legal standing, articles of incorporation). Structural assessment will start with organizational leadership, with inputs from the CIE Coordinating Entity’s strategic plan and business plan. Any decisions to shift or change structures will follow network agreements and decision-making protocols and must reflect the collective vision of the CIE Coordinating Entity and its key partners.

Assessing Network Principles and Administrative Functions

The process of assessing CIE Coordinating Entities against network principles and administrative functions standards develops a shared understanding of what’s working and what’s not working—and how to prioritize next steps. 

The five steps of this assessment process are adapted from the Institute for Healthcare Improvement’s 100 Million Healthier Lives mapping tool. This methodology invites diverse perspectives from organizations or networks to work together to implement standards.

For each Network Principle or Administrative Function, complete the following steps:

1. Identify Participants: Invite CIE Coordinating Entity staff members and network partners with diverse roles and perspectives to participate in the assessment process.
   
   
2. Complete Assessment Individually: Each Network Principle or Administrative Function has accompanying standards. Every participant selects a score (0 – 9) for each standard based on the individual’s experience, positions, or role with the CIE initiative.
   
   
3. Analyze Scores: CIE Coordinating Entity staff members or assessment leaders average the scores for each standard, highlighting areas of discrepancy between scores and noting high or low scores.

    

4. Discuss Scores Collectively: CIE Coordinating Entity staff members or assessment leaders discuss findings to develop consensus around the score for each standard. Total the standard scores to determine overall Network Principle or Administrative Function score. 

    

5. Determine Next Steps: CIE Coordinating Entity staff members or assessment leaders facilitate discussion to: 1) determine which areas to prioritize for improvement and why, and 2) decide how to share out assessment results with the full network and interested parties.  

The MiTAHIE roadmap and capacity building framework will be implemented in phases, with the following activities prioritized for immediate action.

Phase One Priority Activities (2026 – 2028)

The following activities will be implemented in partnership with CIE Coordinating Entities across Michigan.

• CIE Coordinating Entity Assessment: CIE Coordinating Entities will complete assessments, identify opportunities for growth, and develop workplans to evolve organizational structures, network principles, and/or administrative functions.
• CIE Network Engagement: CIE Coordinating Entities provide training and technical assistance aligned with community-based organizations’ roles in the CIE initiative.  
• CIE Coordinating Entity Subgroup: The Coordinating Entity Subgroup will review implementation experiences, analyze aggregated data, and surface gaps or needs in CIE infrastructure across Michigan. The subgroup will be responsible for evolving CIE Coordinating Entity standards—and aligning standards with additional intermediary types, as appropriate.

The MiTAHIE planning project provided MDHHS critical resources to understand the unique assets and needs of community-based organizations. Providing training and technical assistance to these left-behind providers will address gaps in Michigan’s health IT ecosystem and move toward holistic, person-centered care.

While the capacity building framework reflects the best thinking of state, regional, and local leaders right now, these standards will continue to evolve. CIE Coordinating Entity experiences and CIE Coordinating Entity Subgroup analysis will shape how the training and technical assistance strategies are implemented.      

Future Opportunities

A roadmap for training and technical assistance, including standards for CIE Coordinating Entities, increases alignment across initiatives in Michigan and with emerging federal guidance:

• Network-to-Network Coordination: CIE Coordinating Entity standards provide opportunities for statewide networks to map their existing capabilities to CIE initiatives. Physician organizations, Area Agencies on Aging (AAAs), Community Action Agencies, and other statewide associations that provide services, manage contracts, and/or support health and social care partners can see how the work they do well aligns with community information exchange. 
• Related MDHHS Priorities: As CIE Coordinating Entities build foundational capacities, the infrastructure can be leveraged to support additional MDHHS priorities, including in lieu of services implementation, health data utility development, and community health worker support.
• National Direction: Community information exchange continues to evolve under the leadership of San Diego 211, with an anticipated accreditation processes coming soon. Implementation of Medicaid waivers in New York, North Carolina, and Washington are surfacing important lessons that align with Michigan’s CIE Coordinating Entity standards—and will continue to inform future work. Emerging guidance from CMS to support patient-centric health IT ecosystem reflects the priorities of community information exchange’s community first approach.