hie policy board special session on sustainability august ... policy board_meetin… · 24/08/2017...
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HIEPolicyBoardSpecialSessiononSustainability
August24,2017
HIEStakeholderOutreachFindings&SMHPUpdate
Agenda:StakeholderOutreach&SMHPUpdate
• CalltoOrder(5minutes)– RollCall– AnnouncementofQuorum
• ReviewSpecialSessionMeetingGoals(10minutes)– DCHIEMissionandPurpose– SetGoalsforObtainingMemberFeedback
• PresentSummaryofStakeholderFindings(45Minutes)– BackgroundandMethodology– KeyFindingsfromInterviewsandFocusGroups– DiscussiononFindings
• DiscussSMHPPlan(45Minutes)– SMHPOverviewandStatusUpdate– PreviewSMHPOrganizationandHITRoadmap– GoalsforSeptember21HIEPolicyBoardMeeting
• PublicComment(10minutes)
• NextStepsandAdjournment(5minutes)
2August2017
DCHIE:Vision&MissionStatements
VisionToadvancehealthandwellnessforallpersonsintheDistrictofColumbiaby
providingactionableinformationwheneverandwhereveritisneeded.
MissionTofacilitateandsustaintheengagementofallstakeholdersinthesecure
exchangeofusefulandusablehealth-relatedinformationtopromotehealthequity,enhancecarequality,andimproveoutcomes intheDistrictof
Columbia.
3August2017
StepsTowardsManagingPopulationHealthRisk
4August2017
OurGuidingPrinciplestoIncreasetheValueofHealthcareintheDistrict
• ExpandAccess– Ensureappropriateandadequateaccesstoservicesacrossalleight(8)wards.– Improvepatient-centeredcarecoordinationforallMedicaidbeneficiaries.Thisincludes
effortstocoordinatephysical,behavioral,andlong-termhealthcare,andsupportpreventivehealth.
• ImproveQuality– Enhancehospitalqualityandoutcomes.– PromotepartnershipsbetweenDChospitalsandprimarycareproviderstoimprovecare
deliveryandoutcomes.
• PromoteHealthEquity– DevelopprogramsandservicesfortheDistrict’shigh-needpopulations,particularly
thosewithahigh-burdenofchronicillness,andhomeless.– NeedtounderstandlifecircumstancesbettertoimprovehealthintheDistrict.
• EnhanceValueandEfficiency– Payforvalue,notforvolumeofhealthcareservices.– Promoteefficiency,transparency,andflexibilityofDHCF’sprograms
5August2017
Goals:Monitor4ComponentsofHIE
• Infrastructure:Accesstoanduseofelectronichealthdata
• Exchange:AbilitytoTransmitandReceiveHealth-RelatedData
• ImprovedService atthePointofCare
• HealthImprovement:BetterCare,SmarterSpending,HealthierCommunities
6August2017
HIEP
BOngoingTa
sks&
Roles •SetPriorities
•Gatherfeedbackfromkeystakeholders•Provideresourcesandconnections,includingguestpresenters•ServeasambassadorsofDCHIEprograms
HIEP
BActiv
ities&Deliverables • SMHPand
EnvironmentalScan(September‘17)
• HIEdesignationlegislationguidance&report(July-September‘17)
•MyHealthGPSDatasubgroup&report(ongoing)
• SustainabilityCommitteeoutreach&report(November‘17) HI
EPBRe
commen
datio
ns •Mission,vision,andlong-termgoals(Oct’16)•FY17priorities(Nov’16)•DCHIEdesignationrequirements(Feb’17– July‘17)•FeedbackonHIEToolDDI(April&July2017)•SustainabilitySpecialSession(August’17)•Coresetofusecases(September’17)•FY18/19IAPDprojects(September’17)•Long-termStakeholderEngagementPlan(December‘17)•High-levelSustainabilityPlan(December‘17)
7
ProposedFY17BoardActivitiesandDeliverables
August2017
SMHPisOneOpportunitytoReframetheConversationonHIT/HIEintheDistrict
8
HIT/HIEImplementation
(Process)
PracticeTransformation&Improvement(Outcomes)
August2017
EnvironmentalScan
CommunityNeeds
Assessment
StakeholderOutreach
HITAdoptionSSC&SMHPInterviews FocusGroups
DCHIEHistoricalTimeline:KeyMilestones
9
Children's IQ Network (CIQN) Launched
CIQN Launched -January 2009
Via DC Government Grant for EHRs in Six
Safety-Net Clinics
6 Clinics Live with eCW –
October 2008
DC Hospitals Connectto CRISP HIE –February 2014
DC HIE Policy Board Established by Mayoral Order
DC HIE PolicyBoard Established –
February 2012
Orion Rhapsody Implemented to Connect
Providers to DC DOH (Public Health). IZ, ELR,
SS, Cancer Registry
DC DOH Connection -October 2013
.
Over 800 PCPs Achieve Meaningful Use –
March 2014
eHealthDC Program Reports over 800 Primary Care Providers Achieving
Meaningful Use
DC HIE Grant –March 2017
Capital Partners in Care -Community Health Information Exchange (CPC-HIE) launched connecting Community Health
Centers to Hospitals
CPC-HIE Launched –February 2015
DC HIE Hospital Connection Program Supports 6 DC Hospitals to Connect to
CRISP to Support ADT and ENS -- Encounter
Notification, Encounter Reporting, Provider Portal
DC HIE Grant Awarded to expand CRISP and CPC-HIE Capabilities with development of: 1) Dynamic Patient Care
Profile2) Obstetrics/Prenatal
Specialized Registry3) Electronic Clinical Quality
Measurement Tool and Dashboard
4) Analytical Patient Population Dashboard; and
5) Ambulatory Connectivity and Support
August2017
WhatDoWeNeedfromYouToday?
• DiscussandProvideFeedbackonStakeholderFindings– DothesefindingsalignwithyourknowledgeoftheDChealthsystem?– Areanykeystakeholderperspectivesmissing?– Whereshouldweprioritizethenextstageofstakeholderoutreach?
• DiscussandProvideFeedbackSMHP&RoadmapApproach– Arethereadditionalchallengesandopportunitiestoaddress?– Havewehighlightedtherightopportunitiesbaseduponwhatwe’veheard
fromstakeholderstopreparefortheSeptembermeetingtodiscussFY‘18UseCases?
• ProvideInputtotheSustainabilitySubcommittee– WhatelseisneededtodevelopaLong-TermStakeholderEngagementPlan?– WhatelseisneededtodevelopaHigh-LevelSustainabilityPlan?
10August2017
STAKEHOLDERFINDINGSANALYSIS
SustainabilitySubcommitteeBackground
• TheGoalsoftheSubcommitteeareto:– determineastrategyforDCHIEfinancial
sustainabilitybeyondthesun-settingofHITECHfunds,and
– identifyvalue-driversthatcouldincentivizepublicandprivate-sectorstakeholderstosupporthealthinformationexchangeintheDistrict.
• ObjectivesforStakeholderOutreach:– InformtheBoardaboutthewaysaDCHIE
couldaddvalueforcorestakeholdersintheDistrict.
– Generatestakeholderspecific(e.g.,payer,hospital,clinic)use-casesdemonstratingvaluetotheseorganizations.
• SubcommitteeMembers:– ScottAfzal(CRISP)– AndersonAndrews(DCDepartmentofHealth)– ErinHolve(DCDepartmentofHealthCareFinance)– SamHanna(GWU)*– LaQuandraNesbitt,MD(DCDepartmentofHealth)– JustinJ.Palmer,MPA(DCHospitalAssociation)– DonnaRamos-Johnson(DistrictofColumbiaPrimary
CareAssociation)– AlisonRein(AcademyHealth)– Chair– ClaudiaSchlosberg(DCDepartmentofHealthCare
Finance)– PeteStoessel(AmeriHealth)– AllisonViola(KaiserPermanente)**HIEPBnon-members
12August2017
StakeholderOutreachMethodology
• Concurrentstakeholderoutreachefforts– HIEsustainabilityandSMHPeffortsmerged– ExpandedoutreachtostakeholdersidentifiedbyHIEPolicyBoard
• Utilizedconsistentinterviewguide– OutreachquestionsdevelopedbytheSustainabilitySubcommittee
wereusedasthefoundationforallSMHPinterviews– InterviewswithstakeholdersidentifiedbytheSustainability
Subcommitteeinvolvedamemberofthesubcommitteeortheboard
• Interviewteamincludedaprimaryinterviewer¬etaker– Majorityofinterviewswereconductedin-person
• QualitativeanalysisusingNvivotocodeinterviewfindings
13August2017
StakeholderSummary
TotalCompletedTo-Date:23 interviewsand3 focusgroups*Remaining:2interviewsand2focusgroups
14
Stakeholder SSC SMHP FG Stakeholder SSC SMHP FG
Academic 1 Health Systems/Hospitals 2 2
Associations 1 2 LTPAC 2
Beh.HealthProviders 1 1* MCOs 1
CaseManagers Providers - Large 2
CommunityServices 4 1 Providers- Small 1*
DCAgencies 2* 2 Residents/Patients 2
HIE Organizations 2 CommunityHealthCenters 1
HomeHealthAgencies 1* *TobecompletedinAugust/September
August2017
OutreachTopicsandObjectives
• CurrentState– Strategicgoalsandpriorities– Dataexchangeandpartners– ExamplesofHIEvalue– SDHcollected– Barriersexperienced
• FutureState– Prioritiesfornext5years– Additionaldataexchangeneeds– GreatestopportunitiesforHIEinDC– Anticipatedbarriers
• Conclusion– Othertopicsandrelevantneeds– Otherindividualstocontact
15August2017
Determine:1. Whathealthinformation
needstobeexchanged?2. Whoneedstobeengaged
inthecommunity?3. Whoneedstechnical
assistance?
KeyTakeaways
• HowDoProvidersandCarePartnersFeelAboutDCHIE?– HIEisvaluableandcriticaltodeliveringsafe andeffectivecare– FrustrationwithpriorunfulfilledHIEinitiativesandseekstrongleadershipandresults– Stakeholdersrepeatedlyasked,“WhatisDCHIE?”
• HowDoResidentsandPatientsFeelAboutHIE?– PatientsexpectHIE,butsocialdeterminantsdatacausesconcernsabouttreatmentbias– Someseemultipleproviders,othershaveseentheirsinglephysicianforyears
• WhatDataNeedstobeConnectedtoHIEforMedicalProviders?– Encounter:Consult/VisitNotes(CCDs);DischargeSummaries;OperativeNotes;BMI– Medications:Compliance,Dose,andDateFilled;PharmacyContactInformation– School:AbsenteeismRatesandInjuries– Other:InsuranceEligibility;CareTeamMembers
• WhatDataDoesthePayer/MCOCommunityNeedand/orContribute?– Alleviateburdentobothprovidersandpayersforchartauditsandreporting– MCOcaremanagersseekaccesstoclinicalencounterandHIEdata
16August2017
KeyTakeaways
• WhatCarePartnersNeedtobeConnectedtoHIE?– BehavioralHealth,Long-TermCare,Fire/EMS(FEMS),CommunityServices
• WhatSpecialFocusAreasareNeededforDCPriorityPopulations?– SocialDeterminantsofHealth,Telemedicine,Registries
• WhatIssuesExistwithCurrentInformationExchange?– NoHIEinfrastructuretosupportcaretransitions– exchangeofconsult/visitnotes– ProvidersareresistanttouseHIEtoolswithoutSSO/contextsharingorEHRintegration– ENSanddatacompletenessvariesacrosshospitalsduetodifferentrulesandtriggers– Claimsdatavaluedforanalytics,butcanbeincompleteorinsufficientinqualityforcare
• WhataretheBarrierstoHIE?WhoNeedsAssistance?– HIEoperationalcosts(e.g.,licensefees,connections)andmaintenancefeesarebarriers– MedicaidproviderswhoresistEHRadoptionneedlow-costHIEalternatives– Providersseekingworkflow&resourcessupporttoeffectivelyuseHITandHIE
• WhatIsNeededtoMakeHIEDataUsable?– Analyticsisnotacurrentfunctionorservice– Someorganizationsseekdataliquiditytoperformanalyticsinhouse,othersseektools
17August2017
HealthInformationExchangeFramework
Access
• Accessibleelectronicallyinproviderworkflowforcaredeliveryandpatients/residentsfordecision-making
Exchange
• Secure,electronicexchangeviastandardizedmessages,documents,andtransportprotocols
Use
• Supportsanalytics,qualitymeasures,alerts,decisionsupport,&value-basedpurchasing
Improve
• Supportsongoingmeasurement&monitoring;canbeusedtoimproveefficiency,caredelivery,andhealth
Canyoucaptureoraccessdata
electronically?
Canyousend &receive data? Canuse thedata? Canyouusedatato
improve health?
18August2017
HealthInformationFramework:Access
Discussion
• DothesefindingsalignwithyourknowledgeoftheDChealthsystem?• Areanystakeholderperspectivesmissing?• Arethereadditionalstakeholderstomeetwith?
Canyoucaptureoraccess healthinformationelectronicallyusingestablishedstandards?
Findings
AmbulatoryEHRAdoptionandHIETechnicalAssistance• Safety-net,healthsystems,largepracticesareadvancedEHRadopters.• HealthITandHIE(maintenanceandoperating)costshinderadoptionforsmallandmediumpractices.• Smallpractices/solopractitionersinunderservedareasareunlikelytoadopt.• Socialdeterminantsofhealthdatacaptureisnascent,butnotstandardized.Long-TermCare• SomeEHRearlyadopters,butmostarenotoncertifiedEHRs.SeekingtechnicalassistancetoconnecttoHIE.BehavioralHealth:• Credible/iCAMSEHRworkflowchallengesandlackofinformationexchange.LackofEHRadoptionorEHRs
capableofexchangeinsomesettings.• ClinicalandbehavioralhealthprovidersseekingclarityonBHinformationexchangepolicy.
19August2017
HealthInformationFramework:Access
Discussion
• DothesefindingsalignwithyourknowledgeoftheDChealthsystem?• Areanystakeholderperspectivesmissing?• Arethereadditionalstakeholderstomeetwith?
Canyoucaptureoraccess healthinformationelectronicallyusingestablishedstandards?
FindingsRespondentswithoutHIEaccess• ProvidersreluctanttoimplementoruseHIEportal(s)/systemswithoutEHRintegrationorSSOwithsharing
ofuserandpatientcontext.• Socialworkers,casemanagers,andpayercarecoordinators(MCOs)seekaccesstoHIEdata.• FEMSisimplementingnursetriagelineandinterestedinusingpatientcareprofileandpatientpopulation
dashboard.FEMSisabletosend/receiveinformationusingDirect.RespondentswithHIEaccess• ProvidersreportchallengeswithCRISPinterfaceusability(responsetime,navigation).• MedStarHealth(inpatient)implementedintegratedCernerviewofCRISPencounterinformation.• MyHealthGPSprovidershaveaccesstobasicdatatosupportcarecoordinationacrossmedicalcare.• CRISPCCDdataavailablegoesback6weeks;providersdesiregreaterhistoryandreal-timeexchange.• Providerswantaccesstobehavioralhealth,long-termcare,andVirginiahospitaldata.
August2017 20
HealthInformationFramework:Exchange
Discussion
• DothesefindingsalignwithyourknowledgeoftheDChealthsystem?• Areanystakeholderperspectivesmissing?• Arethereadditionalstakeholderstomeetwith?
Canyouelectronicallysendandreceive(exchange)high-qualityhealthinformation?
Findings
HIENeeds• Providerswantconsultnotes/CCDexchangedwithintheirEHR.• SomeprovidershavetheabilitytoexchangeinfoviaDirect,butdon’tknowhowtosendittoothers.• Behavioralhealthdataexchangeislargelyconductedbyfax;CCDsfilteroutinformation.• Integratedelectronicplatformsforcommunityservicesthatsupportsbi-directionalexchangewithproviders.ExchangeImprovements• Providerswantsinglealertonpatientadmission,ortransfer,ordischarge(notinternaltransfer).• ProvidersperceiveMarylandhospitaldataasmoredetailedandcompletethanDChospitals.• Providerswantaquickly-established,consensus-drivenprocessondatasharingpractices.• ConsentandpoliciesforbehavioralhealthandSDHdataconfuseprovidersandpatients.• HIPAArequirementsareofteninterpretedstrictly,restrictinginformationexchange.
21August2017
HealthInformationFramework:Use
Discussion
• DothesefindingsalignwithyourknowledgeoftheDChealthsystem?• Areanystakeholderperspectivesmissing?• Arethereadditionalstakeholderstomeetwith?
Whatdoyouneedforexchangedhealthinformationtobeusable?
FindingsHIENeeds• CurrentHIEismovinginformationfromPointAtoPointB– it’snotanalyticsordataforanalytics.• StakeholdersexpressedmixedconfidenceinconsistencyandcompletenessofENSandclaimsinformation.• ProviderswantHIEtofacilitatetransitionsofcareandrelatedreportingforMU/MACRAprograms.• Providersdesiresocialdeterminantsofhealthdatatobetterinformcareplans.• Clinicalexchangedataforcaredelivery.Claimsdatadesiredforregistries,qualitymeasures,analytics.• Claimsdataisnotalwaystimely;mayobtain80%ofthedatawithin2weeks.ExpectedUses• Healthsystemsandlargeprovidersareindividuallypursuinganalytics,withvaryingdegreesofreadiness.• Smallerorganizationsseekanalyticstoolsandresources,largerorganizationsseekdirectaccesstothedata.• DCHospitalAssociationseekingadditionaldatatosupportanalyticalneedsandreportingofmembers.• MCOsseeanopportunitytoreducechartaudit,utilizationreview,andreportingburdenviaHIE.
August2017 22
HealthInformationFramework:Improve
Discussion
• DothesefindingsalignwithyourknowledgeoftheDChealthsystem?• Areanystakeholderperspectivesmissing?• Arethereadditionalstakeholderstomeetwith?
Whatdoyouneedtousedatatoimprove efficiency,caredelivery,andhealth?
FindingsExamplesforImprovementviaHIE• “ThereareoverlappingorduplicativecarecoordinationeffortsbetweenDistrictagencies(i.e.,DHCF,DBH)
andtheMCOs.Interagency coordination andinformationexchangecansupportbettercarecoordination.”• “Ourshelterproviderscoordinatewith911servicesandDHCFtolookat90-daydata.Wereallyneeda1-year
lookbackperiod.Thepeoplewhocomein/outin6monthincrements,theygetlostinthisdatalapse.”• “WeneedtobeabletoseethatapatientwhopresentedatED,wasprescribedmedicationXtopickupfrom
pharmacy,butdoesNOTgetthemed.Weneedthepharmacydatatotrackthismedicationcomplianceinformation.“
• “Wheredohomelesspatientsusuallygo?Whoistheirdoctor?Ourprovidersneedthisinformationtocoordinatecare.”
• “Wehavetoredefinepeople’sjobssotheycanaskthequestionsforhigherriskpoolstobettermanagetheirpatients.Theprocess/datahastogobeyondthecarevisit.”“VitalsdataoutsidetheencounterBP,weight.”
• “Needtoshiftfrommovingdataaroundtoexchangingonlydatathatisimportantorrelevant.”BenefitsandImprovementsviaHIE• “Clinicalcarecoursewasalteredinabsenceoffamilyandwereabletogetcorrectinformation.”
August2017 23
SMHPOVERVIEW&DISCUSSION
SMHPOverviewandStatus
• SMHP=StateMedicaidHealthITPlan• StrategicplanningdocumentforStateMedicaidAgency
healthITinitiatives• EnsuresthatDHCF,CMS,andHIT/EStakeholdershavealigned
goalsandpriorities• EstablishesaRoadmapandplanforHIT/Eprojects• Informedbyaformalenvironmentalscanandstakeholder
engagementprocess– Dataandstatistics(CommunityHealthNeedsAssessment,metrics)– Stakeholderinterviewsandfocusgroups– Analysisofconnectivity,readiness,&resourcestoparticipateinHIT/E
• RequiredbyCMStobeupdatedeverytwoyears
25August2017
OrganizingStructureforSMHP
26
E X P A N DA C C E S S
P R O M O T EH E A LT H E Q U I T Y
I M P R O V EQ U A L I T Y
E N H A N C EV A L U E &
E F F I C I E N C Y
August2017
GuidingPrinciplestoIncreaseValueofHealthcareintheDistrict
Principle#1:ExpandAccess
27
E X P A N DA C C E S S
P R O M O T EH E A LT H E Q U I T Y
I M P R O V EQ U A L I T Y
E N H A N C EV A L U E &
E F F I C I E N C Y
PRINCIPLE #1LEVERAGE HIT & HIE TO EXPAND ACCESS
C U R R E N T A C T I V I T I E S• Increase use of EHRs in physical and behavioral health• SDH screenings in EHRs (e.g., PRAPARE)• Optimizing and improving EHR-enabled workflows
N E A R - T E R M A C T I V I T I E S• Expand adoption of patient-provider secure messaging• Clinical decision support to support preventive health• ENS Alerts and referrals for follow-ups and care reminders• Increase use of EHRs in long-term care• Online access to community resources and electronic referrals• Timely exchange of complete and accurate health information• Consensus and processes for viewable/accessible SDH data• Tools to support provider-to-provider communication and exchange
(e.g., Provider Directory, improve Direct workflows)• Develop use cases and identify opportunities for telehealth
L O N G - T E R M A C T I V I T I E S• Increase use of telehealth and telemental health • Increase availability of mobile technology and tools• Enhance use of technology for patient access to information
T O D AY ’ S C H A L L E N G E S• Health care services are not consistently
timely and available at accessible locations (HPSA, MUA/P)
• Person-centered care – SDH, cultures, diverse care preferences
• Despite health insurance coverage rates, not all DC residents can afford services.
• Insurance renewal and continuity
T O M O R R O W ’ S O P P O R T U N I T I E S
August2017
Principle#2:ImproveQuality
28
P R I N C I P L E # 2LEVERAGE HIT & HIE TO IMPROVE QUALITY
C U R R E N T A C T I V I T I E S• Increase standardized electronic data through EHRs and HIE• Increase capture/reporting of eClinical Quality Measures (eCQMs)• Expand tools and dashboards for eCQM reporting (CAliPHR)• Access to claims information to supplement clinical history• Expand tools to support comprehensive and longitudinal views of
patient care for highest-risk and vulnerable populations (Dynamic Patient Care Profile, Analytical Patient Population Dashboard)
N E A R - T E R M A C T I V I T I E S• Improve and optimize data quality of DC HIE data (ADTs, CCDs)• Enable access to claims data for measure calculation• Refine clinical and claims data to standardize and exchange• Routine exchange of ADTs other clinical documentation• Identify and implement data warehouse architecture to support
registries for high-risk patients, tools for MCOs• Expand HIT and HIT for behavioral health and long-term care
L O N G - T E R M A C T I V I T I E S• Quality measures to report to DHCF and the public• Government agency, health care provider, and community
organization consent and trust to share data
T O D AY ’ S C H A L L E N G E S• Providers deliver care without access to
patient history or access to care teams• Quality of care varies across organizations• Quality measure capture and reporting is
a burden for providers and struggle to make it actionable and credible
• Payers need data to operate efficiently and achieve strategic goals (e.g., MCOs, DHCF)
T O M O R R O W ’ S O P P O R T U N I T I E SE X P A N DA C C E S S
P R O M O T EH E A L T H E Q U I T Y
I M P R O V EQ U A L I T Y
E N H A N C EV A L U E &
E F F I C I E N C Y
August2017
Principle#3:PromoteHealthEquity
29
P R I N C I P L E # 3LEVERAGE HIT & HIE TO PROMOTE HEALTH EQUITY
C U R R E N T A C T I V I T I E S• Medicaid EHR Incentive Program (MEIP) support for EHR adoption• Tools for providers to manage patients with multiple chronic
conditions (My Health GPS toolset)• Implement Obstetrics/Prenatal Specialized Registry• SDH screenings in EHRs (e.g., PRAPARE)
N E A R - T E R M A C T I V I T I E S• Identify and develop tools and programs focused on maintaining
health vs. treating illness – registries for high-needs populations• Ease and improve display of evidence to inform care • Online access to community resources and electronic referrals• HIE to support transitions of care for high-needs populations• Implement and expand HIT/E to support care transitions with
behavioral health, long-term care, and FEMS• Patient and provider preferences, rights, and education needs to
develop policies and protocols for SDH exchange
L O N G - T E R M A C T I V I T I E S• Resident consent to exchange SDH data • Government agency, health care provider, and community
organization consent and trust to share data
T O D AY ’ S C H A L L E N G E S• Access to services is varied• Disparities in priority populations: severe
mental illness, chronic conditions, homeless, FEMS super-utilizers, high risk moms/babies, sickle cell, asthma
• Evidence is not routinely used to treat conditions for priority populations
• Widespread and routine attention to social determinants of health lags and varies
T O M O R R O W ’ S O P P O R T U N I T I E SE X P A N DA C C E S S
P R O M O T EH E A LT H E Q U I T Y
I M P R O V EQ U A L I T Y
E N H A N C EV A L U E &
E F F I C I E N C Y
August2017
Principle#4:EnhanceValue&Efficiency
30
P R I N C I P L E # 4LEVERAGE HIT & HIE TO ENHANCE VALUE & EFFICIENCY
C U R R E N T A C T I V I T I E S• Ongoing technical assistance and education to providers and
support workflow redesign (MEIP, improve SLR)• DC Govt systems coordination (MITA/DHS/DOH/DBH/BoMed)
N E A R - T E R M A C T I V I T I E S• Tools and workflows to exchange basic information with provider
populations that are unlikely to fully adopt EHRs • Expanding tools for broader audiences, MCO/payer mixes, etc. • Improve and enhance ADTs, other clinical documentation display for
existing and expanded providers (e.g., SSO, EHR integration, APIs)• Address provider trust, engagement, and usage of HIE • Registries and electronic tools to monitor and report trends• Investigate policy levers for HIE participation• Analytics tools/package to support ACO participation• Implement and expand HIT/E to support care transitions with
behavioral health, long-term care, and FEMS
L O N G - T E R M A C T I V I T I E S• Govt, provider, and community consent and trust to share data• Quality measures to report to DHCF and the public• Enhanced tools to support VBP expansion and ACO participation
T O D AY ’ S C H A L L E N G E S• Paying for volume vs. prevention • Lags in EHR adoption impact delivery of
efficient care – small practices/solo practitioners in underserved areas resistant
• Data quality and completeness of exchanged data needs improvement
• Seeking integrated tools vs. more tools• Need for robust tools for quality
measurement, monitoring and reporting
T O M O R R O W ’ S O P P O R T U N I T I E SE X P A N DA C C E S S
P R O M O T EH E A LT H E Q U I T Y
I M P R O V EQ U A L I T Y
E N H A N C EV A L U E &
E F F I C I E N C Y
August2017
DevelopingaDCHIERoadmap
31
• Ambulatory, Hospital EHRs• DC HIE Hospital Connection• ENS Notifications• Public Health HIE Integration• Organizational/Community
HIEs Established
ACCESS EXCHANGECARE TRANSITIONS
• Care Profile• CAliPHR for CQMs• Pt Population Dashboard• OB/Prenatal Registry• Medicaid Claims Data• Ambulatory EHR
Technical Assistance
ACCESS& EXCHANGE
EXCHANGE & USEBASIC ANLAYTICS
IMPROVEEXPANDED VBP
USEADV. ANALYTICS
PAST‘15-’17
TOC
TODAY’17-’18
FY ‘18 FY ‘19 FY ‘20 FY ‘21
• Improve Data Quality• LTPAC, Behavioral Health,
FEMS Connectivity• Document Exchange• SDH Planning• Registry Planning
• Expand DC HIE Tools to LTPAC, Beh Health, FEMS
• Analytics Tools for ACOs• Implement and Connect
to Registries• Collect & Exchange SDH• Telemedicine
• Advanced Analytics and Tools for Providers, Payers, and Patients
• HIE Policy Levers• Integration of DC Govt
Systems Data
ExamplesOnly– RequiresAnnualProcesstoDeterminePrioritiesandIAPDRequests
• Expand Advanced Analytics and Tools
• Data Liquidity• TBD Projects
TOC
August2017
FY’18Planning:DCHIERoadmap
P L A N N I N GS E P T E M B E R 2 4 P O L I C Y B O A R D M E E T I N G
• Discuss shift from work to-date (supporting exchange, access, and care coordination) to supporting care transitions
• Transitions of Care (TOC) Use Cases• Behavioral Health• Long-Term Post Acute Care• Fire/EMS• Enabling Document Exchange
• Data Quality and Population Health Use Cases• Improving HIE Data Quality• Social Determinants of Health • Registries
FY’18
32
TOC
TOC
TOC
August2017
SeptemberHIEPolicyBoardMeeting
• Use-Cases
• FFY18/FFY19IAPDRequests
• Materials&SMHPDrafttoHIEPBonSept14
• HIEPBMeetingonSept21– FeedbackDueSept21
• SMHPUpdateTeam/CGHOfficeHours
• SMHPComments/Questions:[email protected]
33August2017
NextStepsforSustainabilitySubcommittee
• Concludinginitialoutreachtounderstandcurrentstateandneeds
• Maintainrelationshipsandcontinueoutreach
• Definecore/commoninfrastructureneeds
• DeliverableDue:December2017– Long-TermStakeholderEngagementPlan
– High-LevelSustainabilityPlan
34August2017
PUBLICCOMMENT
NEXTSTEPS
BOARDACTION– MotiontoAdjourn
• VotetoAdjournToday’sMeeting
37August2017
NEXTMEETING:SEPTEMBER21,20173PM– 5PM
APPENDIX
DCResidentFocusGroupQuestions
Firstsetofquestions:• Whathealthandwellnessgoalsmattermosttoyou?toyourfamily?toyourneighborhood?• Whatfactorsmakeadifferencethosegoals?Whatfactorsstandintheirway?• Forthechallengeswejusttalkedabout,whichonescouldbemosteasilyfixed?Whichonesarehardto
fix?Why?
Secondsetofquestions:• Whatdoyouexpectyourdoctortoknowaboutyouwhenyouarriveatthedoctor’soffice?• Whatkindofinformationaboutyourlifeandyourneighborhooddoyouwantyourdoctortoknowand
havewrittendowninyourelectronichealthrecord?• Fortheinformationwejusttalkedabout,whatinformationdoyouthinkisOKfordoctorsandhospitalsto
sharewithotherdoctorsandhospitals?• Doyouhaveanyquestionsabouttheinformationwejusttalkedabout?
40August2017
SafetyNetProviderFocusGroupQuestions
Firstsetofquestions:• Whatpracticetransformationinitiativesandgoalsmattermosttoyourorganization,nowandinthenext
fiveyears?• WhatroledoeshealthITplayinsupportingyourorganization’sinitiativesandgoals?• HowcouldHIEsupportyourorganization’sgoalsandinitiatives?
Secondsetofquestions:• Arethereanysocialdeterminantsofhealth(SDoH)informationthatismissingfromthislistthatyou
currentlycollect?[listprovidedforfocusgroupparticipants]• [inreferencetotheDHCFcompilationofSDoH]Whatinformationisactionableandmakesadifferenceto
patientcareprocessesandpatienthealthoutcomes?• Doyoushare(ordoyouwanttoshare)SDoHandclinicalinformationwithotherorganizationsinsideor
outsidetheDistrict?• HowcouldanHIEinfrastructureintheDistrictsupportelectronicexchangeofSDoHandclinical
information?• ArethereanyothertopicsrelatedtoSDoHandHIEthatwehavenotyetaddressedinthisforum?• Whatshouldweaskyourpatients?
41August2017
StakeholderInterviewQuestions
CurrentState:1. What areyourorganization’scurrentstrategicgoalsandprioritiesthatcanonlybeachievedthroughthe
effectiveuseofdatacaptureandexchange?– Wheredohealthdataexchangeandanalyticsfitintoyourorganization’sstrategy?
2. HowwouldyoucharacterizethecurrentstateofHIEwithintheDistrictofColumbia?– Whattypesofdataareyousharingand/orreceiving?– Whichorganizationalpartnersand/orserviceprovidershavebeenpartofyourdata
sharing/receivingefforts?3. Canyoudiscuss2to3currentexamplesofvaluegeneratedbyHIEanddatasharingeffortstoyour
organization?4. Which,ifany,socialdeterminantsofhealthdatadoesyourorganizationcollect?
– Howdoyoucapturethisinformation?– Howisitused?
5. [forDCgovernmentalagenciesonly]Howdoesinformationexchangeimpactyouragency’sstrategicgoals,reportingandmanagementrequirements,andabilitytoperformservicesfortheDistrictresidentsyouserve?
6. WhatarethebarrierstoinformationexchangewithinyourorganizationandacrosstheDistrict?
42August2017
StakeholderInterviewQuestions
FutureState:1. Whatareyourprioritiesforinformationexchangeinthenext5years?
– Whatinfrastructuredoyouneedtosupportthesegoals?– Whatareyouplanningtoimplementwithinyourownorganization?– WhereandhowcouldDistrict-levelHIEsupportyourorganization’sstrategicandinformationexchange
goals?WhatarethebarrierstoinformationexchangewithinyourorganizationandacrosstheDistrict?2. Wherewouldadditionaldataexchangehelpyoutosolvecurrentand/oranticipatedchallenges?
– Whatareyourcurrentpainpointsthatcouldpotentiallyberemediatedthroughbetterdatasharing?– Inthelastfewyears,givenrecentreforminitiatives,how,ifatall,doyouseeyourhealthinformation
exchangeneedsevolving?3. WheredoyouseethegreatestopportunitiesforexpandedhealthinformationexchangewithintheDistrictof
Columbia?– Forexample:behavioralhealth;mentalhealthandsubstanceuse;carecoordinationforhigh-riskpatients
andpatientswithmultiplechronicconditions;qualitymeasurement;patientengagement;coordinationwithFire&EMS
4. WhatdoyouanticipateasbarrierstoinformationexchangewithinyourorganizationandacrosstheDistrict?
Conclusion:1. Arethereanytopicsyouwishtodiscussthathavenotbeenraisedinthisdiscussion?2. Isthereanyoneelseyourecommendwespeakwithaboutcurrentandfuturehealthinformationexchange
needswithinyourorganization?
43August2017
KeyTakeaways- Detail
• HIEworkflowintegrationforprovidersiscritical.Providertrust,engagement,andusageofHIEwillbetiedtovalue,whichiscurrentlyaconcern.– Ambulatoryproviderswantaccesstonotes(consult,d/csummaries,etc.)withintheirEHR.– Safety-netprovidersaremostinterestedindatatosupportcarecoordination,primarilyconsultnotes.(Others
includeddischargesummaries,CCDs,meds,labs.)– AwealthofinformationmaybeavailableviavariousHIEviews,butcliniciansareseekingaccesstothisinformationin
amoreusablemanner.
• Hospitaldatacanprovidevalue,butisinconsistentandincomplete.– RulesandtriggersforsendingdatatoCRISPlikelyvariesacrosssendingorganizationsanddataislikelysentbeforeitis
available(e.g.labordersthathavenotresulted,notesthathavenotyetbeencompleted/signed,diagnosesnotavailable,medicationsmaynotbepopulated).
– Sending/suppressingofdataisbaseduponeachorganization’sownguidelines– thereisnotconsensusorrulesonwhatissharedandwhenandwithwhom.
• Safetynetproviders,communityorganizations,DCresidents/patientsrecognizetheimportanceofdocumentingandexchangingSDH.– Consensusrequiredtoestablishsharingparametersfor(1)whentoshareand(2)whattoshare(actionabledata).– DisparitiesarewideamongsthealthsystemreadinesstomovetowardsroutineHIEforsupportingVBP.
• Currentsystemsaremovingdatafrom“pointatopointb”.Analyticsisnotacurrentfunctionorservice.– Largerproviderorganizationscannotperformanalyticsin-housewithoutaccesstoclaimsdata.– CRISPdatadoesn’tcomeinawayforthemtoattributeoranalyzeit.Dataforoutcomes,healthcaredelivery,VBPis
largelyunavailable.
• Thereisatendencytocollecteverything,regardlessofwhetheryoucandosomethingaboutit.– FQHCprovidersweresupportiveofcollecting“moredata”bynon-physicians:encouragingfrontdesk,MA,nurses,
NPs,caremanagerstocollect/maintainthisdata.
44August2017
KeyTakeaways- Detail
• SomeMedicaid(ambulatory)providersarenotgoingtoadoptEHRs– needlow-cost,easy-to-usetoolsforthispopulationtoparticipateinHIE.
• Clinicalcommunityandhospitalsareseekingforavenuetohaverealconversations (candidandinformally)amongsteachother(includingDCgovernment)aroundHIEanddataforVBP.
• Stakeholdersarefrustratedbypriorunfulfilledinitiativestoexchangehealthinformationandneedstrongleadershipandresults.– Thereisastrongdesiretohaveconsensusanddirectionvs.conversation.Thesentimentamongmanyisto,“Puta
stakeinthegroundandseehowthatgoes.Thenchangeasneeded.”
• HealthITReadinessofbehavioralhealth,long-termcare,Fire/EMSforHIEislow.– Directassistanceisneeded,asaccesstoinformationiscitedascriticalandthedemandforthisinformationandtools
isthere.– Behavioralhealthdataaccessinparticulariscitedbysafety-netprimarycareprovidersandhealthhomeprovidersas
themostimportantinformationgap.Behavioralhealthdataintegrationishighpriority,butcomeswithahighneedforeducationandconsensusforexchange.
• PatientsandprovidersexpectHIE– theydonotwanttoreportthesameinfoeverytimeateverylocation.• DCgovernmentinterestishigh,coordinationandcollaborationhistoryislow.
– LotsofvaluabledataacrossDHCF/MMIS,DOH-publichealth,DBH,DHS,etc.– Thereisaneedforstrategyandaroadmapfordataavailabilityandexchange.
• Stakeholdersareseekingclarityandunderstandingabout“WhatisDCHIE?”.– WhatdoesitmeantobeaDCparticipantinanotherstate’sHIE?Whoisit?Whatisit?IsthereaDCHIE?– ShouldparticipantsbesigningagreementswithDCHIE?OrwithCRISP,CIQN,&CPC-HIE?Whatdoes“DC”own?
45August2017
8categories ofgroupedcodestosummarizefindings(appendix)
DataNeeds HIEIssues&DataQuality
HIEPartnersand
Organizations
HIEBarriersandCosts
HIEData:Use
DCResidentsandPatients
SocialDeterminantsofHealth
Special FocusAreas
(BH,LTC,FEMS)
60discretecodes appliedtoqualitativeanalysis
ADT/ENS CIQN-HIE DataAccessibility
DataMiningandMapping Direct HIEOutsideDC Infrastructure
ParticipationService
AgreementsReporting StrategicGoals
andPriorities
BehavioralandMentalHealth CPC-HIE DataAnalytics DataValidation DOH HealthIT
ReadinessImpactofData
Exchange Partnerships ResourceAvailability Telemedicine
CareCoordination CRISP-HIE DataCapture,
ExchangeDataSharingPartners
EHRVendorsandAdoption
HealthITSustainability Interoperability Patient
MatchingSchoolSystemInformation
TransitionsofCare
CaseManagement
DataAccessibility
DataCompleteness DataTypes Funding
HIEValueCaseandBusiness
Case
Laws,Policies,and
Regulations
PrivacyandSecurity
SocialDeterminantsofHealth
UseCase
ClaimsData ChallengesandBarriers DataIntegrity Data
Warehouse Governance HospitalConnectivity MeaningfulUse PublicHealth Stakeholder
EngagementValueBasedPurchasing
Costs CultureData
Integration DBH HealthDisparities
ImpactofDataExchange
OpportunitiesforExpanded
HIE
QualityandHealth
OutcomesStandards Workflow
MethodtoPresentStakeholderFindings
46
Mappedto4HIEFrameworkCategories(TODAY)
Access Exchange Use Improve
August2017
Observations• Providersunabletoaccesslabresultsfrom
hospitals duetodifferingsystemsandinterfaces.• Claimsdataisnotup-to-date.• Providersdonothaveaccesstopatientsummary
dataforallhospitals.• Entirecareteamrecordscannotbeaccessed
readily.• Dischargedataonlyusedtotellifpatientwasin
thehospital.• ENSnotificationsareusedfrequently,but
inconsistent,nottimelyandsometimesinaccurate.
• Challengeishowquicklytousedatatopreventandtreat(nothowtogetthedata).
Needs• Dischargesummaries;BMIdata;Claims;
Diagnoses;Operativenotes;Patientprofile;Absenteeismratesandinjuries;Insuranceeligibility;Lastoutpatientprogressnote;LastEDvisit;Medications;Medicationcompliance,dose,anddatefilled;Pharmacycontactinformation;Careteam.
• Real-timeintegrationforprovidersandsocialworkers.
• SSO forsinglesignonandsharingofpatientcontext.
• Datasegmentationforbehavioralhealth.• Timely,clean,accurate,complete data for
delivery,reimbursementandoutcomesopportunities.
• Dataneedstobeactionable.• Results(lab,rad)thatarepartoftheChildren’s
HealthNetwork.Wedonothaveaccesstothisinformation.
DataNeeds
AnalysisCodes:DataAccessibility;DataCompleteness;DataIntegrity;DataTypes;Claims;andADTsStakeholders: HIE,Associations,DCAgencies,HealthSystems,Providers,LTPAC
47August2017
Observations• Importanttoevaluatedataintegrity,filterandget
intotherightworkflow forthosewhowilluseit.• EnhancedHIEToolsdonotprovidealldata,but
includesbasicdataneeds.• Providersarechasingdataandneedtoclosethe
loopwithconsultnotes.• Real-timeEHRquerywouldassistdataexchange.• Complicateddealingwith3states(DC,MD,VA).• Forsome,CRISPpullsdataautomaticallyfromEHR
orwhat’ssentisn’tfiltered(suchasBHinfo).• “Admissiondiagnosisisnotcomingoverwith
initialADTalertfromCRISP;Itmaybeacoupleofdayslater.WhenwetalkedwithCRISP,theysaidsomeoftheinterfaces atdifferenthospitalswereolder.WithHoward,forexample,ourdatahasmoreblanksandweweretoldtheirdatamappingisnotuptodateandthatiswhysomedataisbeinglostintransmission.”
Needs• Decisiontrees,proceduresandpracticesfor
externaldatacomingintoEHR.• Policiesontimelydatacollectionand
transmission.• Avoidanceofunintentionaldatasiloswhen
collectingdatasetsonpatients.• DeterminationofbenefitandROItoavoid
informationoverload.• ENSalertsthroughmobiledevices,smartphone.• Datadrivensolutionsareneeded.Needtodefine
workflowandinformationexchangestandards.• Pediatricscreeningquestionstransferredto
schoolsfromprovideroffices• Patientmatchingiscriticalandimportantthatno
duplicatechartsexist.
HIEIssuesandDataQuality
AnalysisCodes:CaseMgmt;CareCoordination;TransitionsofCare;DataMiningandMapping;OutsideDC;ValueStakeholders:CommunityServices,Associations,DCAgencies,Providers,LTPAC
48August2017
Observations• Integrationisachallengewithamultitudeof
systemsinthemarketplace,andHIEencompassesmanyvendorproducts.
• Communityservicesproviderslacktheabilitytocommunicatewithproviders;converselyelectronicreferralstocommunityservicesisnotavailable.
• ExtensiveburdenofdataexchangebetweenproviderorganizationsandMCOs(e.g.,NCQA,HEDIS)coulduseHIEtoleverageburdenandexchangedatadirectlydirectlywithMCOs.
• FQHCQIdepartmentresourcesspentrespondingtoauditrequests;individualpatientinformationrequests– MCOshavecasemanagersthatarecallingandaskingfordata.Theyask“how’sthispatientdoing”becausetheycan’tseethedata.
• MCOsinterestedinaccesstodatatoalleviatecasemanagerandutilizationreviewburden.
Needs• Establishingdatagovernancetoeliminate
redundantsystemsoradditionalsystems.• Consolidateandcoordinateeffortstomaintain
electronicreferralsandcommunicationstocommunityservices(foodbanks,housingservices,faith-basedorganizations,etc.)
• ContinuedconversationsandcollaborationswithMCOs toreducedataexchangeburden.
• ENS/CRISPprovidesalotofdata- needtoidentifywhatis“important”.Suchas,“WhendoweneedtohavetheCareManagerfollowup?”
• OpportunityfortheDistricttoincludeadditionaldataelementsasstandardcomponentsincareplans thatarepartofHealthHomesmodelswithpayers.
HIEPartnersandOrganizations
AnalysisCodes:DataSharingPartners;Governance;HIEValueandBusinessCase;PublicHealthStakeholders:HIE,CommunityServices,DCAgencies,HealthSystem,Hospitals,Associations,MCO
49August2017
Observations• SomeprovidersarenotgoingtoadoptEHRsdue
tocostsandprimarilyMedicaidpatientvolume.• Providersseekingworkflowsupporttoeffectively
send,receive,anduseHIEdata.• CostsofHIEareconsideredabarrier.• CostversusROIisimportanttoemphasize.• Fundingto support socialservices,case
management,andcarecoordinationisscarce.• Adoption ofcertifiedhealthITinbehavioral
healthandLTPACvaries.OrganizationsthathaveEHRsarechallengedtofundtheirHIEconnections.
• Clarityaroundmentalhealth/behavioralhealthdatasharingpoliciesisneeded.
• HIPAAisofteninterpretedtoostrictlywheninformationneedstobesharedamongstcarepartners.
• WehaveaccesstoDirect,butit’seithernotenabledforotherprovidersorwedon’tknowhoworwheretosendittothem.
Needs• Wantaforumformoredialoganddiscussions
aboutHIE:whatishappening,whatareothersfinding,howtotackleissues.
• MedicaidproviderswhoresistEHRadoptionneedlow-costHIEalternatives
• TheoperationalcostsofHIE(e.g.,licensefees,connections)requirefundingforclinicalandnon-clinicaltradingpartners.
• Abilitytofilter forthedesireddata.LargeprovidersgettensorhundredsofthousandsofENSalertseachmonth.Needtobeabletofilteronthosethatarerelevant.
HIEBarriers&Costs
AnalysisCodes:Cost,FundingStakeholders:HIE,Associations,Providers,CommunityServiceProviders
50August2017
Observations• Analyticsareimperative,butrare.• Everyhealthsystemisworkingonitsown
analyticsstrategy.• Notalldatareceivedisuseful.• UseofhealthdataforVBPwillrequire
participantstopayfordata/serviceslong-termsustainability.
• Goalistoreducecostsaroundqualityimprovement.
• HIEinformationisusefulintrackingfrequentusersofhospitals– eliminatedphonetimetotrackdowninformation.
• Someprovidersexcitedtouseclaimsdata,othersfeelitisnotalwayscompleteandisbestusedforanalyticsandstrategicinitiatives.
• Donothaveasystemtoeffectivelymanagechroniccarepatientsandneedadata-drivensolutionforthis.Wanttohavetoolstorisk-stratifypatients.
Needs• Payerdatatopopulateregistries.• Claimsdatatointegratewithpatientpanelsand
provideinformationforqualitymeasures.• HIEtofacilitatereportingMeaningfulUse
measuresforTransitionsofCare.• Multipledatasourcesforvaluebasedpurchasing.• Informationexchangewith communitygroupsfor
coordinationofservicesisveryimportant.• Mapdataelementsonschoolhealthformsto
includementalhealthinformationtosharebetweenschoolsandproviders.
• Datamappingfor qualitymeasures.
HIEDataUsability
AnalysisCodes:DataAnalytics;DataCapture,ExchangeandTransmission;DataMiningandMapping;SustainabilityStakeholders: HIE,MCO,Providers,HealthSystem,DCAgencies,Associations
51August2017
Observations• PatientsexpectHIEtobeoccurringanddonot
wanttorepeattheirclinicalhistory.• Residentsexpressedmixedviewsonsocial
determinantsofhealth(SDH)captureandexchange
• ManyfocusgroupparticipantsacknowledgedthatSDHaffecttheirhealth,butcommunicatedconcernthatthedatacouldbeusedagainstthem.
• SomeresidentsexpectprimarycareproviderstoknowSDHinformationbasedontheirpatient-providerrelationshipandhistory.
• Residentsexpecttheirphysicianstoknowiftheywerehospitalized,butalsowantthechancetotell“theirside”oftheencounter.
• VeryfewpatientshaveoptedoutofHIE (FromSafetyNetProviderFocusGroup).
Needs• ConsensusprocessestodecideSDHtocapture
andexchange• Visibleoutreachandeducation• Strongconsentprocessesandforms• Continuedoutreachandpatientengagement• MCOsandproviderorganizationshaveexisting
patientgroupsandengagementforumstoleverageonanongoingbasis.
• “Ifyouhavemultipledocs,yourprimarydocshouldgetalltheinformationfromtheotherdocs.Somedoctorswillnotforwardthatinformationtoyourprimarycaredoctor.Wehavetodothatforthem.Onetime,Ihadtoremindoneofmydoctorstosendtheinformationtomyprimarydoctors.WhenIwenttomyprimarydoctormeeting,hetoldmeheneverreceivedit.Igotonthephonetomyspecialistandhadhimfaxtheinfotomyprimarycarethesameday.Thatisademandyoushouldhave.“
DCResidentsandPatients
AnalysisCodes:StakeholderEngagementandBuy-InStakeholders:DCResidents,CommunityServiceProviders
52August2017
Observations• Mentalhealthdata,income,transportation,
utilities,dataprovidestheabilitytodiscustheseissueswiththepatientduringtreatment.
• SDHdataexchangeoccursviafaxorviaphone.• InteragencyCouncilonHomelessnessare
trackinghomeless data.• Someinformationiscapturedinassessments
(PRAPARE)orasunstructureddata,butnotallpatientsarewillingtoshareinformation.
• CertainSDHinformation(likehousingstatus)changesfrequently.
• ImportantSDHtocapture:– Housing– Food– Transportation– Insurancecoverage/enrollment– Language– Countryoforigin(documentation)– Stress– Crime– Discrimination– Financialstability
Needs• WorkflowsandbestpracticesforcapturingSDH
informationandvalidatingitregularlywithpatients.
• HIEshouldhaveauditing anddatasegmentationcapabilities.
• Organizedandroutinelyupdatedcommunityservices information.
• Participationagreementsondatasharingdefinitionsandtimeframes.
• ConsensusondischargeplanningprocessesinconsiderationofSDH.
• BuildSDHandHIEintoexistingsystems;takeadvantageofreferralsandportalmessagetechnology.
• HIEcanbeconnectedtoCMSandSSAtodetermineincomethresholdsordisadvantagedstatus.
• Leveragetelemedicine,remotemonitoring,toalleviatetransportationissues.
SocialDeterminantsofHealth
AnalysisCodes:SocialDeterminantsofHealthStakeholders:HIE,Providers,CommunityServiceProviders;SchoolSystems;MCOs;Govagencies;Associations
53August2017
SDHDataNeeds:MAPingSummit
MAPing(Measuring,Assessing,Planning)theUseofSocialDeterminantsofHealth(SDH)DataintheDistrictonApril18th and19th
54
0
5
10
15
20
25
30
35
40
MAPingMeeting4/19 MCACHealthSystemRedesign5/3 DCPACT5/24
August2017
Observations• Datafromoutsidethehealthcaresystemis
importantforcareplanning,butdifficulttointegrateintoHIEworkflows.
• Behavioral/Mentalhealthdataissiloed acrossCredible(iCAMS),SADO,DataWits,andothersthatstoreredundantinformation.
• DCInteragencyCouncilonHomelessnessisdevelopingstandardstoprovideservicestohomelesspopulations.
• PertheDCNA,patientportalwasunsuccessfulasmostpatientsdon’thaveaccesstocomputers.
• OpendatapolicyisfocuswithOCTO andmayor’sofficetounderstanddatasetsthattheagencieshavecanbepublicvs.confidential.
• FEMSandDCPSandotherstakeholderscommittedtotelehealth solutions.
Needs• FEMS patientcareprofileanddashboard.• LTPACexchangeinfrastructure• Exchangeandconsentpoliciesonbehavioraland
mentalhealthdata.
SpecialFocusAreas
AnalysisCodes:Cost,Funding;Infrastructure;Laws,PoliciesandRegulations;TelemedicineStakeholders:HIE,Associations,Providers,CommunityServiceProviders
55August2017
LTPACTransitionsofCare(TOC)Examples:OtherStates
DataSource:https://www.healthit.gov/playbook/pdf/factors-contrib-hie-ltpac.pdf
56August2017