Health Information Exchange: Substance Abuse Patient Records March 3, 2016

Health Information Exchange: Substance Abuse Patient Records March 3, 2016 Jody Denson, MPA, PMP, Kansas Health Information Network Cristine Deibler, LMSW, CHC, Johnson County Mental Health Center

Conflict of Interest Jody Denson, MPA, PMP and Cristine Deibler, LMSW, CHC Have no real or apparent conflicts of interest to report.

Agenda Learning Objectives Jody Denson, KHIN Value of Health IT KHIN Overview HIO and Community Mental Health Center Collaboration 42 C.F.R. Part 2 Security Override Procedures Managing Patient Consent Community Mental Health Perspective JCMHC Overview JCMHC Collaboration with KHIN 42 C.F.R. Part 2 Concerns Educating Staff and Clients Operating Practices Cristine Deibler, JCMHC

Learning Objectives Analyze the 42 CFR Part 2 regulations as it pertains to HIE and the restrictions on the disclosure of substance abuse patient records Explain the responsibilities of health care providers and HIOs regarding substance abuse patient consent, disclosure of records and opting these patients out of HIE Identify what types of providers hold themselves out as providing substance abuse treatment, which are considered programs and what programs are considered federally-assisted and meet the definition of a program under 42 CFR Part 2.11. and therefore must adhere to the Part 2 regulations

A Summary of How Benefits Were Realized for the Value of Health IT Satisfaction = Patient and providers satisfied data is available in event of medical emergency or if patient gives consent Treatment/Clinical = Making substance abuse patient data available in a HIO for medical purposes or with patient consent, helps providers with treatment planning and improved patient outcomes Electronic Secure Data = Blocking substance abuse patient data at HIO level ensures compliance with 42 CFR Part 2 Patient Engagement/Population Management = Blocking sensitive data at HIO level allows substance abuse patients to give consent for records to be disclosed Savings = Costly medical errors reduced when providers have access to all of patient s data including behavioral health http://www.himss.org/valuesuite

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Kansas Health Information Network Over 2 million + unique patients in KHIN exchange Access to 5 million + patients across exchange connections 1,230 + KHIN member organizations 193 organizations in production (504 facilities) 133 testing Average 100,000 queries per month Personal health record 41 organizations Public Health Transmissions Syndromic Surveillance Immunizations Electronic lab reporting Cancer State infectious disease registry 6

18 KHIN Mental Health Center Members KHIN Members with SA services, 15 KHIN Members without SA Services, 3

Approach: KANHIT Legislation Collaboration with State Legislature, State Department of Health and Environment, State Medical Society and Hospital Association Opt-out state patient consent managed at the state level 2011 Passage of State Legislation normalizing all patient consent requirements with HIPAA - Provides measure of immunity for KHIN participants - Shields providers from state and criminal action and regulatory boards State Department of Health and Environment authorized to provide oversight 7

Approach: KANHIT Legislation State Department of Health and Environment technology functionality requirement for security override - Patient consent - Life threatening emergency Enabling legislation and corresponding regulations http://www.kanhit.org/organizational_docs.htm 7

Approach: Notice of Privacy Practice Update to show participation in Health Information Exchange Facility website must be updated 30 days before go-live Update hard copy of NPP and provide to patients Display posters and brochures

Approach: Security Override Policy Obtaining health information from other Participants for care and treatment of patients that have: - opted-out of including their health information in KHIN - records and information accessible through KHIN that are protected under 42 C.F.R. Part 2 KHIN does not disclose opt-out patient s health information and/or a health information protected under Part 2, unless: - a medical emergency exits - patient consent is obtained pursuant to a Part 2- compliant consent form at the point-of-care

Challenges: 42 CFR Part 2 Blocking Substance Abuse Patient Data Who Must Comply Providers and Medical Facilities that are BOTH: federally assisted and meet the definition of a program under 42 CFR Part 2.11 and hold themselves out as providing and provides alcohol or drug abuse diagnosis, treatment or referral for treatment (42 CFR Part 2.11)

42 CFR Part 2: What does Federally Assisted Mean? authorized, licensed, certified, or registered by the federal government receives federal funds of any kind assisted by IRS through a grant of tax exempt status or allowance of tax deductions for contributions authorized to conduct business by the federal government (e.g., Medicare provider, conduct methadone maintenance treatment, or registered with the Drug Enforcement Agency to dispense a controlled substance used in the treatment of substance abuse) is conducted directly by the federal government

Challenges: 42 CFR Part 2: Patient Consent for Data Sharing Two Options 1. Block data at the EHR level Concerns = Data is NOT available in emergency Data is NOT available when patient gives consent 2. Block data at the HIE level Concerns = On going communication between providers and HIE Notification of security override without patient consent

Outcomes: Identifying Substance Abuse Patients to be Blocked How are patients blocked: CMHCs send patient opt out list to KHIN; KHIN blocks patients Who is blocked: Primary diagnosis Secondary diagnosis Patients enrolled in substance abuse programs When are they blocked: At intake At billing

Opt Out Form Kansas Health Information Network KHIN Substance Abuse Opt Out Form, please return to the KHIN Helpdesk via DIRECT at khin.group@khindirect.org Date: Facility Name: Facility Address: Facility NPI Number: Phone Number: Authorized Submitter: Submitter's Email: For assistance please contact the KHIN Support Desk 877-520-5448 Patient Information KHIN Internal Use Only Opt Out Last Name First Name Middle Initial Date of Birth Sex SSN Address City State Zip Code Date of Opt Out Administrator

Outcome: 6,621 Total Patients Opted Out JCMHC Opt Out, 1,412 SA Opt Out, 5,209

Outcomes: Mental Health Centers Who is using HIE? 18 Mental Health Centers are KHIN members and have QSOAs Health Care Home Staff Hospital Diversion Staff Management Medical Records Emergency Services

Outcomes: Why are Mental Health Centers Using HIE? Patient seen recently at hospital and why Patient alerts Lab values Medications Emergency situations Find diagnosis to qualify for certain programs Find diagnosis to update diagnoses for ICD10/DSM5 (for clients that don t see a doctor at the MHC) Patient referrals Verify patient home addresses and insurance

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Johnson County Mental Health Originally established in 1962 by the Board of County Commissioners (BOCC) Operated as an agency of County government governed by a nine member Governing Board appointed by the BOCC and under State licensing regulations until 2014 Currently operates as a department of County government, governed by the BOCC, with an appointed Advisory Board and under State licensing regulations

JCMHC Core Service Divisions Adult Services Children and Family Services MNH Operations Medical Services Prevention Services Emergency Services Addiction Services

Johnson County Mental Health In 2014 JCMHC provided services to 8,741 individuals In 2014 JCMHC provided crisis services to 5, 618 individuals JCMHC has a $29 million budget and 334 FTEs

JCMHC Substance Abuse Programs JCMCH provides three SUD programs: Adolescent Center for Treatment (20-30 day residential) Adult (Social) Detoxification (3-7 day residential) Outpatient Individual and Group

JCMHC Substance Abuse Programs Annually, JCMHC SUD programs serve roughly 1700 individuals SUD 900 admissions ACT 250 admissions Outpatient 550 admissions

Collaboration with Kansas Health Information Network 2013 planning group which consisted of Operations, Quality & Integrity and Emergency Services Initial decision to opt out at the Center level-42 CFR concerns Business Associate Agreement Access for Clinical Staff Auditing Functions Breaking the Glass May 2014 MyAvatar Implementation

KHIN and Johnson County MHC Modifications required for the Notice of Privacy Practices Approved by Center Mgmt., County Legal Department & County HIPAA Opt Out Information provided to Clients Issues identified after implementation: Opting out at the Center level... Break the Glass not functional Qualified Service Organization Agreement required Lack of use & look up issues

Outcomes: KHIN and Johnson County MHC Operating Practices - Weekly list of clients sent to KHIN - Conduct monthly audits - Included in patch testing - Updating approved user list - Breaking the Glass Collaboration with other County Departments (JCDS, Health Home) Over 3,100 patient queries in 2015

A Summary of How Benefits Were Realized for the Value of Health IT Satisfaction = Patient and providers satisfied data is available in event of medical emergency or if patient gives consent Treatment/Clinical = Making substance abuse patient data available in a HIO for medical purposes or with patient consent, helps providers with treatment planning and improved patient outcomes Electronic Secure Data = Blocking substance abuse patient data at HIO level ensures compliance with 42 CFR Part 2 Patient Engagement/Population Management = Blocking sensitive data at HIO level allows substance abuse patients to give consent for records to be disclosed Savings = Costly medical errors reduced when providers have access to all of patient s data including behavioral health http://www.himss.org/valuesuite

Questions?? Jody Denson, MPA, PMP Kansas Health Information Network Project Manager 785-438-0098 jdenson@khinonline.org Cristine Deibler, LMSW, CHC Johnson County Mental Health Center Manager of Quality and Integrity 913-826-2550 Cristine.Deibler@jocogov.org