connecting communities workgroup · 2015-05-21 · 4 connecting communities brings together state...

Connecting Communities

Workgroup

Behavioral Health Information

Exchange

March 25, 2014

2:00 – 3:00 pm ET

2

Reminder

Please mute your line when not

speaking

(* 6 to mute, *7 to unmute)

This call is being recorded

3

Agenda

Welcome and introductions

– Laura Kolkman, President, Mosaica Partners

Advancing Behavioral Health Information

Exchange

– Laura Young, Executive Director, Behavioral Health

Information Network of Arizona (BHINAZ)

– Wende Baker, Executive Director, Electronic Behavioral

Health Information Network (eBHIN)

Discussion

Closing remarks – 2014 workplan

4

Connecting Communities

Brings together state and regional HIEs, HIE

technology vendors, and other stakeholders to

contribute and discuss substantive examples of

best practices and educate the industry on issues

related to electronic healthcare data exchange and

interoperability

• Educational webinars

• Case studies

• Collaborative projects

Behavioral Health Information Network of Arizona

eHealth Initiative Connecting Communities Workgroup

March 25, 2014

BHINAZ Private and Confidential

Who is Behavioral Health Information Network of Arizona (BHINAZ)?

Community Stakeholder Owned

Official formed as a Limited Liability Company (LLC) in Arizona – June 2013

Arizona statewide initiative – Behavioral Health Providers, Public Agencies, Health Information Network of Arizona, and consumers


“To develop a statewide behavioral health information network that will improve quality, safety, create efficiencies, reduce health disparities, engage patients and families, improve public health and protect patient information.”

Mission


The Vision

PCP/Specialist Payor

Laboratory

Pharmacy

Hospital/Health Systems

Patient

HINAZ

Rehab/Detox

Counseling Services

Crisis Services

Laboratory


Key Drivers

Health Care Reform / Patient Affordable Care Act (ACA)

Heath Information Technology for Economic & Clinical Health (HITECH) Act

Meaningful Use of Certified Electronic Health Records (EHR)

Integration between physical and behavioral health

Health / Medical Home Models

Outcome and Performance Based Contracting

Arizona – Maricopa County Behavioral Health MCO Contract


Public Availability and efficient

distribution of a large volume of patient data

Efficient exchange of standards-based data (CCD, IHE, etc.)

Gateway to the National Health Information Network

Arizona’s HINAZ

Public Versus Private HIE

Private * Coordination of care among the

providers in a community – workflow improvement

* Connecting systems and users with different technical capabilities and workflow needs

* Access to the community patient chart

* Business intelligence service to optimize pay-for-performance and quality improvement

* Support for emerging integrated delivery networks


Complicated Federal Laws around Privacy - 42 CFR Part 2

We have a unique opportunity here in Arizona

Maintains integrity of Behavioral Health system in Arizona

Provides a platform for emerging business opportunities

Allows behavioral health providers to collectively own new technology

Why a Separate BH HIE Initiative?

HIE Benefits*

Improve patient safety by reducing medication and medical errors

increase efficiency by eliminating unnecessary paperwork and handling

provide caregivers with clinical decision support tools for more effective care and treatment

eliminate redundant or unnecessary testing

improve public health reporting and monitoring

engage healthcare consumers regarding their own personal health information

improve healthcare quality and outcomes

reduce health related costs

*Healthcare Information and Management Systems Society (HIMSS). “Evaluating a Potential HIE Opportunity ”,

HIMSS Guide to Participating in HIE. 2009 November.

Reduced staff time spent on handling lab and radiology

results

Reduced staff time spent on clerical

administration and filing

Decreased dollars spent on

redundant tests

Decreased cost of care for chronic

care patients

Reduced medication errors

HIE Cost Savings*

*eHealthInitiative. “A Report Based on the Results of the eHealth Initiative’s 2009 Sixth Annual Survey of Health Information Exchange”, Migrating Toward Meaningful Use:

The State of Health Information Exchange. 2009 July.


Behavioral Health Providers Public and Private External HIE’s Patients and Consumers Advocacy Groups Public Agencies Primary Care Laboratory Companies (LabCorp, Sonora Quest, etc.) SureScripts/RxHub Specialists Hospital Systems

The BHINAZ Network


Clinical Data Repository (On demand

CCD/CCDA/CCR/HL7)

XCA/XCPD Gateway Services

Master Patient Index

Granular Consent Management

Provider & Resource Directory

Data Analytics & Reporting

Orders & Medication Reconciliation

BHINAZ HIE Solution

Secure, Web-Based Portal Access

Support for Single Sign-on

Security, Auditing & Network Management

Support Core Integrated Healthcare Enterprise (IHE) Profiles

Individual Referral Management between disparate EHRs

Population Management

Direct Exchange


Structured Data Elements

Demographics, Labs, Medications, Allergies, & Diagnosis

Clinical Documents

Psychiatric Evaluations, Assessments, Crisis & Safety Plans, Discharge/Transitions Plans, Individual Service/Recovery Plans, Progress Notes

Exchange & Clinical Information


Current Technology

BHINAZ HIE

NextGen HIE

(BASE)

Mirth Solutions

(Expanded Solutions)

Topaz Information

Solutions

(NextGen EHR)

ClearData (Hosting)


Enrollment and Care Team Assignment

Integrated Care Plan

Centralized Referral Management

Patient Engagement & Communication

Population Management

Reporting and Data Analytics

Goals Around Care Integration- Care Coordination Platform


Consent Management


•Patient must OPT OUT

•Otherwise, they are Opted IN by default

Opt Out

•Patient must OPT IN

•Otherwise, they are Opted OUT by default

Opt In

Opt In vs. Opt Out

©BHINAZ Private and Confidential. Content may not be reused without permission.


The state of Arizona is an “Opt-Out” state.

BHINAZ operates under an “Opt-in” model requiring the client to specifically agree to share their protected data from one provider to another.

The BHINAZ model ensures that data protected under 42 CFR part 2 is not re-disclosed without proper consent.

All BHINAZ data is treated as Part 2 data.

Privacy & Consent


Consent is captured electronically at the point of care

Opt-in consent is valid for 365 days, then a new consent is collected

Patients can revoke at any time

The consent is “all or nothing” per agency/entity. We are not doing data segmentation at this time

BHINAZ Consent Facts


We require the additional consent of minors aged 12-17. Minors can revoke without parents.

Opt-in status reverts to “no consent on file” at the age of 18 or age 12. A new consent is required.

Break-the-Glass is allowed regardless of consent status for valid emergency situations.

BHINAZ Consent Facts


In Network

Participant visits Agency A They sign a consent to allow their Agency A data

to be shared/viewed by ALL BHINAZ organizations Agency A Data now flows to all other BHINAZ

organizations.

Agency A

SMI Clinic

Crisis Center

Detox Center

* Participant visits Detox Center * They choose NOT to share their

detox data * No detox data can be viewed by

any other agency on the network

Opt-In



Viewing Out of Network data

Participant receives services at BHINAZ Agency A

Provider determines need to access out-of-network data and logs into portal through the EHR

Provider searches for data from outside network

Provider views and imports data to their EHR

BHINAZ Agency A

Outside Network

Stage 1 Starting

•Recognition of the need for health information exchange among multiple stakeholders in Arizona Behavioral Health Community.

Stage 2 Organizing

•Getting organized; defining shared vision, goals and objectives; identifying funding sources, setting up legal and governance structures.

Stage 3 Planning

•Transferring vision, goal and objectives to tactics and business plan; defining your needs and requirements; securing funding

Stage 4 Piloting

•Well Under way with implementation – technical, financial and legal.

Stage 5 Operating

•Fully operational health information organization; transmitting data that is being used by behavioral health stakeholder

Stage 6 Sustaining

•Fully operational health information organization; transmitting data that is being used by behavioral health stakeholder and have sustainable business model.

Stage 7 Innovating

•Sustainable and fully operational health information organization. Demonstration of expansion of organization to provide value-add services such as advanced analytics, quality reporting, clinical decision support, and closed-loop referral management.

HIE Development

BHINAZ

42% of HIE participants surveyed by eHealth Initiatives in 2013 have reached Stage 5 or Higher


Partnership with Health Information Network of Arizona (HINAz)

Partnership with Mercy Maricopa Integrated Care (MMIC)

Partnerships


Participating Agencies sign a Qualified Service Organization Agreement (QSOA)

Pay one-time connection fee

Pay monthly subscription fee

BHINAZ will work with organization IT for technical connection and customization

BHINAZ provides workflow analysis and training

Getting Connected


Contact Laura Young, Executive Director

[email protected]

www.BHINAZ.com

602-567-8356


BEHAVIORAL HEALTH HIE IMPLEMENTATION

N O T E S F R O M T H E F I E L D

BH DISPARATE OUTCOMES

SYSTEMIC BEHAVIORAL HEALTH SERVICE DELIVERY PROBLEMS

• Nature of BH illnesses characterized by episodic

need for acute care

• Regular movement of patients from rural to urban

areas to access acute care services

• Big disparities in technology capability between

providers – hospital EMR’s while most provider

organizations paper based

• No organized system for referral of patients

between treatment settings – follow-up inconsistent

• Duplication of testing services

• Time consumed in determining appropriate service

level

HIE SYSTEM CAPABILITIES

Health Information Exchange:

• Shared Record Exchange across Treatment

Settings

• Longitudinal Patient Records

• Closed Loop Referrals

• Wait List Management & Interim Services Tracking

• Medication Reconciliation

• Aggregate Reporting at Provider, Region and State Levels from Centralized Data Repository

SYSTEM ARCHITECTURE

EHR Shared Demographic

Record (All Clients)

HIE Database Shared Behavioral

Health Record

(Opted In Clients only)

Network Participant A Chart

Network

Participant B Chart

Network

Participant C Chart

Network Participant D Chart

Consent is required to access shared

record

CLINICIAN PERSPECTIVES AHRQ RESEARCH STUDY FINDINGS

Theme Description Benefits Barriers

Client Safety and Quality of Care

Care is delivered so as to prevent harm and achieve positive outcomes.

100% 59%

Privacy and Security

Client information is only accessible to those with the need and right.

22% 100%

Delivery of Behavioral Health Services

Behavioral health organizations and providers operate in a time and cost efficient manner.

66% 97%

PRIVACY AND SECURITY INFRASTRUCTURE

• 42 CFR Part 2 Compliance addressed in 2 ways:

– Technical Infrastructure

1) HIE Architecture

2) Organizational MPI

3) Opt-In Workflow

4) Re-disclosure Notice Templates

– Organizational Infrastructure

1) Standardized Agreements & Forms

a. Participation Agreement

b. BAA/QSOA

c. Consent for Release in an HIO/HIE

2) Policies and Procedures

3) Privacy and Security Policies

CFR 42 PART 2 COMPLIANT HIE CONSENT

CFR 42 PART 2 COMPLIANCE

HIPAA COMPLIANT PATIENT LOOK-UP

OPT- IN WORKFLOW

WHAT DATA IS SHARED?

• Demographic Information

including: Name, DOB

and SSN

• Emergency Contact

Information

• Substance Abuse History Summary • Diagnosis Information • Insurance Information • Trauma History Summary

• Current Medications and Allergies • Employment Information • Mental Health Board Disposition • Living Situation and Social Supports • Billing Information

BH WORKFLOW TEMPLATE

EHR DATABASE RECORDS

• Data entry through

EHR Database

allows individual

records to be

created

PATIENT CHART

HIE RECORDS POSTING

IMPROVED PROCESS MEASURES

• Enhanced care coordination and communication across treatment settings

• Economies of scale in equipment, network operations

and applications – acquisition and administration

• Workflow efficiencies and service delivery standardization

• Enhanced data integrity and meaningful reporting

• Integration with physical healthcare to improve access

• Concurrent Documentation – improved patient engagement/retention

• Data analytics for performance improvement and quality assurance

• Improved patient outcomes!

PREPARING FOR THE FUTURE

• HIE Data Capture and analytics will support better Transparency and Accountability

• Consolidated outcomes tracking and payment information will facilitate enhanced service bundling and population management efforts

• Support care coordination and joint ventures to adapt to the ACO market

• Expand data tracking and case management capabilities to include targeting of risk factors and wellness best practices

• Assist in management of the most complex and costly patient care

NEBRASKA FAST FACTS

Total Population: 1. 8 million

65% of population located in Lincoln and Omaha (Regions 5 & 6)

Balance of population spread throughout State

High percentage in west designated “Frontier”

SCALABILITY AND NETWORK EXPANSION

Will the standardized BH CDA bring us to the

point of true interoperability???

How much do we invest waiting for the

technology of the future?

Thanks for listening!

Wende Baker, M.Ed.

[email protected]

www.ebhin.org (402)441-4389

1645 N St.

Lincoln, NE 68508

mailto:[email protected]

http://www.ebhin.org/

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Questions?

What steps should be pursued to make

behavioral HIE more common?

In what ways has health IT fallen short of

enabling behavioral HIE?

What lessons or best practices should

other organizations take away when

pursuing behavioral HIE?

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Get Involved

Interested in speaking on a webinar,

participating in a case study, or advising on

the HIE survey? Please contact

[email protected]

First working group meeting on April 8 @

2:00 pm ET

mailto:[email protected]

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Thank you!