Transcript eHealth Initiative Advisory Council on Business and Clinical Motivators

eHealth Initiative
Advisory Council on Business
and Clinical Motivators
April 20, 2016
3:00 p.m. EDT
Reminder
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This call is being recorded
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eHI’s Innovation Showcase is on!
Why Attend?
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Get ready for your “aha” moment at eHI’s Innovation Showcase. Discover new
ideas and the healthcare applications to enable your next leap forward.
Got a problem? Find solutions to administrative, infrastructure, workflow, and
consumer data integration challenges.
Need a partner? Our innovative environment matches solution developers with
healthcare senior executives for results.
We’re bringing back the Innovation Challenge! Informative sessions will highlight best
practices and innovations from leaders in: Data & Analytics, Interoperability, Privacy &
Security and Clinical and Business Motivators.
Space is limited so Register now at http://events.ehidc.org!
Agenda
 Welcome and Overview of Agenda
 Meeting facilitated by:
• Leslie Kelly Hall, Vice President Policy, Healthwise
 Workgroup goals, process and timeline
 Speaker
• Toria Thompson, Behavioral Health Information Exchange Coordinator,
CORHIO
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Next Steps
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Business and Clinical Motivator
Workgroup Process
Process, Timeline and
Deliverables
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Purpose of council: How to create
the business case
 To identify, understand, and communicate successful examples of
innovative uses of technology with emphasis on clinical and
business improvements.
 This group will harmonize efforts to ensure that patients, consumer
tools, devices, and mobile apps are part of the considerations of
best practices and identify, understand, and communicate
successful examples of innovative uses of technology with
emphasis on clinical and business improvements.
– What are organizations doing? Why? What have been the results?
– How have they overcome systemic issues/barriers?
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Goals: Develop Recommendations
and Trends
 Identify key business drivers moving technology
 What was the value proposition
 Explain which technologies are creating momentum
around value-based care
 Describe how the patient’s experience is changing
 Describe how insurance benefits may cover or not cover
innovations
 What is the future of innovation in these areas
 What were the factors that came together
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Deliverables in 2016

To identify, understand, and communicate successful examples of innovative uses of
technology with emphasis on clinical and business improvements
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At least 20 new examples of success stories will be added to online resource center
that demonstrate
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Set of overarching recommendations will be developed by group
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Group will identify priorities that can be recommended for federal partners to take
action, and successful innovation that can be models for all stakeholders. At least 20
new examples of success stories will be added to online resource center that
demonstrate
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We need your input
 Understand from the industry the barriers,
purpose, initial successes, what worked
and why
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Sources of Examples of Successful
Examples of Innovation
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Work Group members
Other eHI work
Work done by other organizations
Others?
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Current Success Stories
 American Heart Association
 LabCorp
 CRISP
Note: Success stories will be added to an
eHI resource page – we will keep you
posted when it goes live.
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Meaningful Data
Exchange
A Key to Integrated Behavioral Health & Physical
Health Care
June 15, 2016; eHI
Toria Thompson
Behavioral Health Information Exchange Coordinator, CORHIO
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Agenda
• Introduction
• Why BH Exchange is needed
• One HIE’s roadmap for BH Exchange
• Discussion
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CORHIO By the Numbers
54 Hospitals
143 Long-Term,
Post-Acute Care
Facilities
4,000+ Office-based
Physicians/Providers
4,000,000+ Patients
Numbers include health care providers/facilities connected and in
implementation
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11 more underway
Participating hospitals
represent 95% of all
hospital beds in our region
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One of the highest LTPAC
connection rates in the
country.
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8,800+ total users have
query access to the
community health record in
CORHIO.
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Unique patients with a
community health record.
Represents 65% of
Colorado’s total population.
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Last updated 5/1/2016
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CORHIO Services Available to Providers
Patient Care 360 – Provider Portal
Results Delivery
(Query)
(Push into EHR)
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Why is there a need for Integrated Care?
50% to 70% of a primary care physician's normal caseload
addresses medical ailments that are primarily related to
psychological factors, yet as few as 4% of these patients
are engaged in psychological care.
(Kaiser Permanente)
Managing BH
symptoms leads to
reduction in
healthcare utilization.
Primary Care is a
great place to get
patients connected to
behavioral health
services.
People with severe mental illness visit the doctor at
50% the rate of people without a severe mental
illness and use the emergency department 6 times
more frequently.
(Prism E)
A 2012 study of veterans attending an integrated primary
care - mental health clinic found that the mean cost per
consumer in the integrated mental health clinic was $1,533
less than in the general VA medical clinic.
(Providence, RI VA Medical Center; 2012)
And dramatic health
improvement for
patients
Which leads to
real savings.
Integrated service models are 38% more successful
in engaging patients in care for depression and 148%
more successful in engaging patients in drug and
alcohol treatment.
(Prism E)
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Patient Perspective
In May, 2012—with the help of nearly a dozen behavioral health providers and professional associates—
CORHIO issued a comprehensive report detailing two years of research to understand the barriers and
opportunities for exchange of behavioral health information within the HIE. The research included
perspectives of both providers and patients with behavioral health conditions. Funding for this project was
provided by the Rose Community Foundation.
“When I started doing Cognitive Behavioral Therapy, my life got
significantly better. It helped my mental health, and, in turn, my
behavior and physical health. I wouldn’t have found my psychiatrist
without my primary care doctor, so it is a two way street.”
“I think it’s important for your medical doctor to know your
medication, there are poisons that result from mixing
medication.”
“I have had negative experiences. Once I told my doctor about my mental condition, every
symptom I have goes with that diagnosis. For example, when I was lethargic, she told me it
was in my head. So, now I’m scared to let my physicians know, because they will begin
attributing everything to my mental condition.”
Click here for full report
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A Framework for Levels of Integrated Care
Point to Point Exchange.
Provider requests a
summary of care on an
irregular or “ad hoc” basis.
Provider
Benefit: “At
a Distance”
Collaboration
Provider
Benefit: Full
Treatment
Collaboration
Provider
Benefit:
Awareness
Encounter Based Exchange:
Summary of the encounter
(CCD) is “delivered” to each
organization that is actively
providing care to the patient.
Consolidated View: Key patient
information across all active
treatment providers consolidated in
a single view (medications, care
plans, etc.) Typically through a
single EHR but also through care
coordination tools and HIEs
Click here for full report
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The following slides are for educational purposes only.
You should seek legal advice regarding your specific
situation and compliance obligations.
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HIPAA and BH Information Exchange
The Health Insurance Portability and Accountability
Act (HIPAA) of 1996 allows sharing of patient health
information under certain conditions:
 To the Patient
 To other entities for purposes of Payment, Treatment or
Operations (PTO)
 Does not include psychotherapy notes without a release
from the client
 Does not include any information on substance use
disorders without a release from client
 Emergency Provision allows the release of information for
purposes other than PTO to avert serious threats to health
and safety.
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42 CFR Part 2: Protection for SUD Patients
 The information protected by 42 CFR Part 2 is:
o data that identifies an individual directly or indirectly
as having a current or past substance use disorder.
o information received from a covered program.
 A 42 CFR Part 2 compliant release is required
to disclose, or re-disclose, the above.
 Exceptions to the requirement for a release:
o Qualified Services Organization Agreement (QSOA)
o A Part 2 program can make disclosures to medical
personnel if there is a determination that a medical
emergency exists.
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State Regulations
 Colorado state statute (Title 12, Article 43)
was updated in 2011.
 This revision allowed behavioral health
professionals to follow the information
sharing best practices utilized by their
colleagues in the medical profession
o Mental health data can be shared the same as
physical health data; generally without the need
for consent.
o Substance Abuse Treatment data must have
signed release in order to share.
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Yet there is still a lack of consensus on:
 If community mental health centers categorically
qualify as 42 CFR Part 2 agencies or programs.
 What information within the EHR is covered
under 42 CFR Part 2
o Only information that identifies someone as receiving
substance abuse services, or;
o All information collected while the patient was receiving
substance abuse services
 Whether it is ethical to share some (mental
health), but not all (substance use) of the
information
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Therefore…..
Obtaining, maintaining and enabling patient
directed consent remains a necessity for
technology mediated exchange.
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HIE Consent Technology Options
Scenario
1 Provider obtains
consent at point of
care; “breaks glass” in
HIE to access
sensitive data.
2 Support for integrated
partnerships
3 Consent managed by
organizations; consent
directive stored at HIE
4 Consent managed by
patient; consent
directive stored at HIE
Analysis
Provider obtains just-in-time patient consent, and then attests (“breaks
the glass”), within the HIE that they have patient consent. HIE does
spot audits to verify signed releases exist and/or requires upload of
release as PDF. HIE does not manage consent.
• Provider Satisfaction –
LOW
• Technical Complexity –
LOW
• Operational Complexity
- LOW
All data from a group of organizations who share the care for a cohort
of patients send that data into a segregated repository. Access is
restricted to only providers from those organizations; virtual HIE within
an HIE model. Patient consent is obtained and managed by the
collective using a multi-party consent form. HIE does not manage
consent
• Provider Satisfaction –
MODERATE
• Technical Complexity –
LOW
• Operational Complexity
– HIGH
Organizations send consent directives via HL-7 to HIE or use HIE
Consent portal to update patient consent. HIE uses consent directives
to restrict/allow access to sensitive records.
• Provider Satisfaction –
HIGH
• Technical Complexity –
MODERATE to HIGH
• Operational Complexity
– MODERATE to HIGH
Consent is managed by patients through a portal available through the
HIE. Portal access and patient education happen at the organization as
part of the HIE notice and disclosure process. Patient can change
consent directives “in the moment of care” without need to work
through the organization that has their data. For instance, patient could
grant access to SUD Tx Data for PCP visit and then rescind upon
completion of that visit.
• Provider Satisfaction –
HIGH
• Technical Complexity –
MODERATE
• Operational Complexity
–HIGH
CORHIO’s Behavioral Health Pilot
Adding Behavioral Health data to a HIPAA Based Exchange
Substance Community HIV Clinic
Mental
Use Tx
Health
Provider
Center
Ambulatory
& LTPAC
CCD
Patient Consent
Portal
Protected, non-HIPAA
Sharable Data
Sharable only via Consent
CORHIO
Provider Portal
(Patient Care 360)
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Questions
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Next Steps
 Next Workgroup Meeting July 18, 2pm ET
 Continue success story interviews and
populate resource center
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Participate as a Council Member
 Join B&C listserv by contacting Claudia at
[email protected]
 Seeing expert panel members to respond
to future presentations
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Thank you!
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