Health Information Exchange for Providers: Surviving and Thriving in the Evolving Landscape Mark Jones Director SMRTNET AJ Peterson General Manager, CareConnect Netsmart Robert Lacy MIS Director Red Rock Behavioral Health Services
CAREMANAGER TM : Coordina ng care to ensure healthcare access, coordina on, affordability and outcomes CARERECORD TM : A pla orm providing a framework for EMR, billing, scheduling, and clinical workflows CAREPATHWAYS TM : The use of data to drive op mal outcomes and opera onal efficiencies PLEXUS TM : On demand services, technology and delivery providing predictable results as needed, when needed CARECONNECT TM : Beyond interoperability, focused on integra on, a messaging bus ensuring an open and free flowing network CAREPOINTE TM : Person-centric solu ons to enable and empower the consumer, providing a seamless integrated connec on in the pursuit of recovery, health and wellness. CAREVIEW TM : Providing specific needs to extend capabili es, connect disparate communi es and op mize user experiences
Health Information Exchange HIE HIE verb 1. The mobilization of healthcare information electronically across organizations within a region, community or hospital system. HIE noun 1. A formal organization with a governance structure and business model which enables the electronic exchange of healthcare information.
Key findings of the report include the following: 1. A majority of clinicians believe that electronic exchange of health information will have a positive impact on health care 2. Access to medication lists and relevant laboratory and imaging test results are commonly recognized as high priorities for transitions of care 3. More than half of respondents prefer that information they view as essential get pushed to them, with the ability to access the rest of the information through a query
approximately 200,000 Americans die from preventable medical errors including facility-acquired conditions and millions may experience errors. In 2008, medical errors cost the United States $19.5 billion. About 87 percent or $17 billion were directly associated with additional medical cost, including: ancillary services, prescription drug services, and inpatient and outpatient care, according to a study sponsored by the Society for Actuaries and conducted by Milliman in 2010. Additional costs of $1.4 billion were attributed to increased mortality rates with $1.1 billion or 10 million days of lost productivity from missed work based on short-term disability claims. The authors estimate that the economic impact is much higher, perhaps nearly $1 trillion annually when quality-adjusted life years (QALYs) are applied to those that die.
Duplication of testing (repeat within 12 hours) was found in 32% of the cases examined; 20% of cases had at least one duplicate test not clinically indicated. While previous studies document that inaccessibility of paper records leads to duplicate testing when patients are transferred between care facilities, the current study suggests that incomplete electronic record transfer among incompatible electronic medical record systems can also lead to potentially costly duplicate testing behaviors.
What is CareConnect? 6 Beyond Interoperability Focused On Integration A Chassis to support loosely coupled technologies to drive computing in a cloud environment for any point of view Security using encryption and rigorous authentication that protects the private health information of the consumer Ensuring An Open And Free Flowing Network Enables the sharing of information between and among providers (RHIO/HIE/Lab/Hospitals/Ambulatory Facilities/Health Homes/Point-to-Point referrals) CareConnect combines the body and the mind Data is pulled from all sources to show a complete view of the client. (Data Exchange) CareRecords (myavatar, MIS, TIER, Insight,myEvolv) to communicate clinical data from the provider to another entity and back again. Providers can send Continuity of Care Documents (CCDs), secure messages, referrals, or other consumer clinical data to participating organizations. Improve treatment outcomes through increased knowledge of a consumer s entire care plan
BEHAVIORAL HEALTH HIE BENEFITS AND PROCESSES Mark Jones, MS, MBA, LMFT, LPC Director SMRTNET
Today s Disconnected World
Use Cases Crisis intervention Intake/Diagnostics Disorientation Pre-visit updates as needed and efficiency Coordination of Care Physical causes of behavioral health Medication interactions Drug seeking Pattern tracing Health Home and medical care at agency Payment mechanisms Quality Physicians, tribes, community health, mental health, first responders, optometry, universities, physician hospital organization, uninsured clinics
AHRQ Founding Members Hospital University Public Health Federal Tribal Mental Health Community Health Centers Tahlequah City Hospital Northeastern State OSDH/Cherokee County Hastings Medical Center Cherokee Nation Bill Willis Community MHC NEO Community Health
SMRTNET Members Physicians, tribes, community health, mental health, first responders, optometry, universities, physician hospital organization, uninsured clinics 1,400 providers 40 hospitals 68 cities 140 sites Nine sub-networks 2.7 million patients Integrating with MyHealth will double the amount of data!
2.7 Million Patients 100+ Million clinical Data elements
Provider Portal View
eclinical Works EMR view
Direct Inbox
Privacy Security Over 50 attorneys and privacy officers, including mental health and substance abuse 25 privacy guides Local control Technology Governance Experience
Factors for Sharing Data For treatment Sending facility controls data Only SMRTNET members Overseen by governance Opt-in or opt-out models Do not send 42 CFR data via HIE. Use Direct Secure Messaging State law and local policies Agency may also mute drug and alcohol information included in behavioral health records
Typical Opt-Out Model Notice of Privacy Practices defines sharing of data under HIPAA for Treatment, Payment and Operations Use of health information is defined in NPP No data is shared under 42 CFR program through HIE Agency may also mute drug and alcohol data Opt-out process at agency and/or HIO level Acknowledgment of NPP is signed by patient Opt-out materials are made available
Typical Opt-In Model Opt-in form is defined in separate form and signed Data from 42 CFR program is not shared Additional drug and alcohol data may also be muted by the agency by policy HIO opt-out form made available to consumers
Role of SMRTNET Governance Definition and compliance to security and privacy Data use, especially outside of treatment Audits and tracking User support Orientation and training Fees and Marketing Grant applications
SMRTNET Organizational Structure SMRTNET Management Committee (SMC) Oklahoma State Medical Assoc. SMRTSight SMRTNET for Independent Providers Health Alliance for the Uninsured Northeastern Oklahoma Sub-Networks Greater OKC Hospital Council Norman Physician Hospital Org. Inter-Tribal Network Behavioral Health
Role of Technology in Privacy Single sign-on and IHE profiles are very important User permissions and role access levels defines and tracks who can access the data Registers privacy commitments of users Defines and limits data to be shared and data use per governance Demographics matching Data and security monitoring Mutes data the agency is not sharing
CONNECTING TO AN HIE Robert Lacy MIS Director Red Rock BHS
About Red Rock Behavioral Health Services Founded in 1974 as a private, not-for-profit CMHC Used the MIS since 1984 16 offices and serve 23 of the 77 counties in Oklahoma Our programs include 5 housing facilities, 3 crisis stabilization centers, residential SA facility for women with children, outpatient services, SOC programs and 2 PACT teams Employee 500 full time/part time staff In 2013 Red Rock served 9,296 consumers August 2013 first CMHC to connect to an HIE in Oklahoma Current CCD contribution to date is 3252
What is CareConnect? Allows data to be pulled from many sources and provides a complete picture of your client s health. Uses secure encryption and an authentication process that protects the health information of the consumer. Allows for the exchange of data across many providers while maintaining a single connection within the medical record. Provides Mental Health agencies the ability to contribute data into a Physical Health community.
Why Connect? Provides real time data from the physical health community that has been typically difficult to obtain. Provide you with an elevated level of care Improved safety for you consumer Speak for you consumer when they cannot Improves care decisions Allows for the integration of BH and primary care data-treating the whole person Drives down costs. Provides technically difficult interface that is maintained and updated by Netsmart.
Essential Applications eprescribing Immunizations Vitals Electronic Lab Results CCD Allergies Services Demographics Payers Problems
Administrative Planning Administrative Decisions Make sure every one is clear on the CCD and it content. Selection of HIE Opt In or Opt Out agency Changes to your privacy statement Treatment Payment Operations Redistribution of your privacy statement to active consumers What criteria will you agency use to determine who s CCD is uploaded What services will trigger the upload Keep you Administrative staff informed throughout the project. Develop a plan to place the query into your workflow. Give the Lawyers plenty of time!!
Technical Planning Be at a current patch level and at version 4.2 for the MIS Plan to spend some time developing the CCD parm. Develop a CCD parm specifically for the HIE upload Filter SA Problems and Medications from CCD o PROBEXCLRT- Excludes Problems from the CCD(SNOMED) o MEDEXCLRT Excludes Medications from the CCD(RXNORM) How will you process and grant permissions for the CCD uploads to the HIE Obtain an OID o Use ebase_cc_consent- Care Connect Consent o Other- Utilize uscript o http://www.hl7.org/oid/index.cfm o Develop a numbering system within your OID for different office locations. Download and install uscript provided in the documentation. Used to upload your CCD on a CRON. Install Point of Service scanning on every computer that will use the query. Set up a separate Point of Service scanning parm dedicated to the HIE query.
Misconceptions & Fears Security and Privacy Consumers will all opt out Uploads the Complete Medical Record Insurances companies will gain access to the HIE Employers will gain access to the HIE CCD data would upset some clients CCD s left in a waiting room exposure of private MH data
Success A 31 yr. old Native American male was admitted to Crisis Unit for severe depression, with a plan to hang himself or shoot himself. He stated that he primarily wanted to address his alcohol dependency and that he needed help to detox. At the time of admission, he denied he had been a victim of any type of violence or that he felt threatened by anyone. He only indicated mild problems with his primary support group and living situation. After checking the data on the HIE, it became apparent from the emergency room encounters, that the client had been a victim of several domestic violence episodes, one which had resulted in a recent broken nose and head injury. Once the Treatment Team had this information, they were better able to coordinate his care and address the real issues occurring in this young man s life. This included providing him with educational material about healthy relationships, and information about where to get help he needed while he was receiving detox for his alcohol abuse.
Success After hours physician admitted a lady who was very manic and psychotic. She had difficulty focusing on any question asked of her and most of her responses were unreliable. She was asked if she had any allergies to which she responded Iodine. After reviewing her HIE, it was discovered she had numerous drug & food allergies, one of which caused severe renal difficulties. Another patient presented for admission 1 day prior to implementing HIE at Norman RR. After downloading & reviewing his information by the treatment team physician, it was discovered he had presented numerous times to several ER s in the metro area seeking narcotics. It was also found he had been treated for alcohol related problems. None of which he reported to the admitting physician. The integration of information from the HIE into his treatment plan was critical in providing the right treatment, resulting in referral to a Healthcare Stakeholder, a residential drug and alcohol treatment facility that could further address client s unhealthy relationships with the alcohol treatment for an improved outcome.
Success Some quotes from our physicians: A lady told me she was on 4 different blood pressure medications. After I looked at HIE I found out all but 1 had been discontinued and she was not even taking that one right. Patients sometimes don t know what is important to tell us about their medical history and I m glad I had that information to look at.
Q&A Mark Jones Director, SMRTNET markjones@smrtnet.com Robert Lacy MIS Director, Red Rock BHS rlacy@red-rock.com AJ Peterson General Manager, CareConnect apeterson@ntst.com