12/7/2017 Health Information Technology Oversight Council December 7 th , 2017 This public meeting is being recorded 1 Agenda • Welcome, Introductions & HITOC Business • Oregon Health Policy Board Update • Behavioral Health HIT – Report on HIT/HIE in Oregon’s Behavioral Health System – Behavioral Health Provider Toolkit – HITOC Discussion • CareAccord Update • HITOC workplan 2 1
12/7/2017 OHPB Update Karen Joplin, Board Liaison to HITOC 3 Behavioral Health HIT/HIE Scan: Final Results Marta Makarushka Lead Policy Analyst 4 2
12/7/2017 BH HIT/HIE Scan: Purpose and Scope • Understand current status of HIT and HIE within Oregon’s behavioral health system, including use, needs, and challenges • Establish priorities for potential federal and state funding to support HIE • Inform the State’s HIT/HIE policies and strategies to best support behavioral health system needs Scan components • Online survey • In-depth interviews 5 BH HIT/HIE Scan: Process Overview Online Survey • Survey sent to 275 agencies with at least one licensed program (represent 874 programs) • Overall excellent engagement – Most survey completed thoroughly – Many wrote in ‘other’ responses – Over 75% of agencies agreed to be contacted for follow-up In-depth Interviews • Agencies selected based on need to maximize the diversity and representativeness of the sample • 22 agencies were invited to participate 6 3
12/7/2017 Survey Response Demographics: Size and Population Density 133 out of 275 agencies completed a survey (48%) Represents 522 programs out of 874 total (60%) Response # of Response # of Agency Size Population Density Rate Agencies Rate Agencies 57 44% 67% Single Program Frontier only 6 100% 28 51% Frontier; Rural 2 Two Program 1 100% Frontier; Rural; Urban 25 56% Small (3-5 Programs) 47% Rural only 34 Medium (6-10 14 56% 49% programs) Rural; Urban 18 48% Large (11+ Programs) 9 60% Urban only 72 48% 133 48% Total Respondents 133 Total Respondents *Agency size is determined by a count of programs within the agency Program size is unknown and can vary greatly from program to program 7 Response Demographics: Program Types # of Response Program Type Programs Rate Outpatient Alcohol and Drug 195 54% Outpatient Mental Health 182 63% Adult Mental Health Residential 101 75% Alcohol and Drug Residential 24 45% Intensive Treatment Services 15 60% Alcohol and Drug Correctional Residential 5 45% Total Programs Represented in Responses 522 60% 8 4
12/7/2017 Federal/State Program Participation and Other Priority Agencies Total # Surveys Response Agencies* Completed Rate CMHP 30 20 67% CCBHC 13 9 69% Behavioral Health Home 10 8 80% ACT 33 21 64% 86% Tribal 7 6 FQHC 16 8 50% Other Physical Health Affiliation 23 11 52% *Agencies can fall under more than one category (e.g., CMHP and CCBHC). CMHP: Community Mental Health Program; CCBHC: Certified Community Behavioral Health Clinic; ACT: Assertive Community Treatment team; FQHC: Federally Qualified Health Center 9 BH HIT Scan: Key Result 1 Key Result 1: Most behavioral health agencies are investing in HIT. However, the systems are often insufficient to adequately support the full spectrum of behavioral health’s HIT/HIE needs. • Result 1a. Nearly a quarter of agencies do not have an EHR; they tend to be smaller and face greater resource barriers. • Result 1b. Behavioral health agencies are electronically capturing a broad array of information that is critical to care coordination and integrated care. However, many of the systems are unable to capture all needed data and/or lack critical capabilities for processing and meaningfully using stored information. 10 5
12/7/2017 Current EHR Use (n=133) Yes (n=101) 76% No (n=32) 24% Status of EHR Implementation (n=101) 1% Fully Implemented (n=51) Partially Implemented (n=49) 49% 50% Currently Changing Vendors (n=1) Almost all agencies with For those without an EHR: Stage of EHR no EHR are Adoption (n=31) 13% small (1-5 Development or Selection Stage (n=4) 13% programs) 42% Information Gathering Stage (n=4) Plan to in the Future (n=10) 32% No Plans to Implement an EHR (n=13) 11 EHR Challenges and Barriers EHR challenges for those who have an EHR Count Response Rate 1 Financial costs 71 70% Unable to exchange information 2 55 54% with other systems EHR barriers for those who do not have an EHR Count Response Rate 1 Financial cost 25 78% 2 Agency size is too small to justify 21 66% the investment 3 Lack of staff resources 15 48% 4 Lack of technical infrastructure 15 48% 12 6
12/7/2017 Type of Data Captured Electronically Captured Electronically Not Captured Electronically Diagnoses (n= 121) 87% 13% Demographics (n= 117) 85% 15% Encounters (n= 118) 84% 16% Clinical Summary (n= 113) 83% 17% Care Plan Fields (n= 114) 82% 18% Progress Reports (n= 113) 81% 19% Problem List (n= 115) 80% 20% Social Information (n= 110) 79% 21% Discharge/Transfer Reports (n= 115) 78% 22% Medications (n= 117) 78% 22% Care Team Member Info (n= 106) 76% 24% Allergies (n=107) 76% 24% Continuing Care Document (n= 105) 71% 29% Lab Results (n= 107) 68% 32% ED Visit Alerts (n= 92) 46% 54% 13 Key Result 1: Conclusions and Needs Conclusion 1: Most behavioral health agencies could benefit from additional HIT support. • Need 1a: Robust HIT tools available in the marketplace that serve behavioral health specific needs. • Need 1b: Financial support and technical assistance for EHR adoption, implementation, maintenance, or upgrade. • Need 1c: Opportunities for collaboration and shared learning around EHR adoption. 14 7
12/7/2017 BH HIT Scan: Key Result 2 Key Result 2: Most behavioral health agencies have a need to exchange information with other entities however, few are doing so using modern electronic methods. • Result 2a. Behavioral health agencies reported that all types of patient information is important for exchange. • Result 2b. Behavioral health agencies are currently exchanging Information mostly via fax, paper, secure email, efax, and Direct secure messaging, influenced by the HIE capabilities of information trading partners. • Result 2c. Almost all respondents reported an interest in expanding their ability to exchange information electronically with a wide array of trading partners. 15 Agency Data Sharing Need by Purpose Moderate/High Low/None 20% 30% 32% 34% 46% 80% 70% 68% 66% 54% Care Referrals Reporting Payment Other (n=13) Coordination (n=123) (n=128) (n=118) (n=126) 16 8
12/7/2017 Frequency of Need to Share Data by Trading Partner Regularly/Very Often Never/Infrequent Federal, State, or Local Agencies (n=128) 80% 20% Payers (n=121) 74% 26% Affiliated Mental Health Programs (n=106) 70% 30% Affiliated Substance Use/Addiction Programs (n=91) 60% 40% Laboratories (n=118) 59% 41% Physical Health Providers (n=128) 55% 45% Social Service Agencies (n=125) 51% 49% Pharmacies (n=114) 50% 50% Non-Affiliated Mental Health Programs (n=119) 37% 63% Hospitals and Emergency Departments (n=121) 36% 64% Non-Affiliated Substance Use/Addiction Programs… 31% 69% 17 Importance of Sharing Information by Type Important Not Important Discharge/Transfer Report (n=123) 89% 11% Treatment or Care Plan Fields (n=119) 89% 11% Diagnoses (n=128) 88% 12% Continuity of Care Document (n=118) 88% 12% Clinical Care summary (n=120) 87% 13% Progress Reports (n=123) 85% 15% Medications (n=127) 84% 16% Problem List (n=120) 84% 16% ED visit (n=106) 78% 22% Encounters (n=112) 78% 22% Demographics (n=120) 77% 23% Care Team Member Information (n=104) 75% 25% Lab Results (n=115) 73% 27% Social Information (n=121) 69% 31% Allergies (n=105) 59% 41% 18 9
12/7/2017 Frequency of Methods Used for Information Exchange Most of the time Some of the time None of the time PreManage (n=74) 7% 19% 74% Health Information Exchange 17% 81% 3% (n=77) Epic Care Everywhere (n=82) 7% 6% 87% Shared EHR (n=91) 9% 23% 68% Direct (n=95) 8% 41% 51% More Robust Secure Email (n=122) 20% 69% 11% eFax (n=103) 17% 40% 43% Fax (n=126) 55% 42% 3% Paper (n=125) 18% 73% 10% 19 Interest in Expanding Exchange Capabilities with Trading Partners Interested Not Interested Payers (n=117) 89% 11% Physical Health Clinics (n=118) 88% 12% Affiliated Behavioral Health Clinicians/Staff 86% 14% (n=119) Hospitals (n=116) 86% 14% Pharmacies (n=111) 86% 14% Non-Affiliated Behavioral Health 85% 15% Clinicians/Staff (n=120) Laboratories (n=115) 82% 18% Clients (n=116) 76% 24% Family Members (n=110) 60% 40% 20 10
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