HealthierHere – the Accountable Community of Health for King County Performance Measurement & Data Committee May 14, 2018, 10:30 – 12:00 King County Chinook Building, 401 Fifth Avenue, Seattle – Chinook Building, Room 115 Online option: Registration URL: https://attendee.gotowebinar.com/register/3035677227046307843 Webinar ID: 548-239-491 Call-in Option: 1 (415) 655-0052 Code: 550-808-111 Meeting objective: Sharing and discussion of the results of HealthierHere’s HIE/HIT Assessment. AGENDA 10:30 -10:40 Introductions Marguerite Ro, Public Health 10:40-12:00 Results of HealthierHere’s HIE/HIT Assessment Bob Hawkinson and Susan Kanvik, • PointB Findings • Themes Next Meeting: Monday, June 11 th , 10:30-12:00 Seattle Foundation Board Room (19 th floor), 1601 5th Ave, Ste. 1900
The Accountable Community for Health of King County HIE/HIT Assessment Findings May 14, 2018 PMD Committee Meeting 1
Meeting Goals 1 Set context for HIE/HIT investment journey 2 Understand HIE/HIT Assessment findings Solicit feedback on themes and preliminary 3 prioritization of needs 2
Agenda • Set context o HIE/HIT Investment Journey o 2018 HIE/HIT Assessment • HIE/HIT Assessment o Findings and themes o PMD team discussion • HIE/HIT Needs Summary and Prioritization (Initial view) o PMD team discussion 3
ACH Project Plan November 2017: Data Needs Summary Transitional Care Bi-directional Integration Client lookup EHR expansion, particularly in BH setting Shared care plan between health and social Client lookup service partners Shared care plan Measurement-based treatment-to-target (client registry) Care Coordination Opioid Use Crisis Chronic Disease Client lookup Integrate Prescription Monitoring Program with EHRs EHR and registry data used to identify, treat Link members with OUD to health homes and track members (client registry) and integrated care team Cohesive and non-duplicative referral system for health and social service providers (centralized referral system) 4
ACH Project Plan November 2017: Data Themes & Challenges One theme that cut across the four project areas is leveraging the Medicaid demonstration to accomplish the following three HIT/data-related goals: • Make one-time investments in critical IT/data infrastructure to overcome financial and infrastructure barriers limiting use of care coordination and integrated care. This catalyst funding could be used to develop/fund a variety of activities, including EHR expansion, particularly among behavioral health providers. Cross- o IT infrastructure needed for care coordination components (e.g. shared care plan through PreManage) cutting o Integration of Prescription Monitoring Program (PMP) with EHRs Data o Implementation of centralized referral system for clinical and social services (e.g. eConsult) Themes • Leverage the broad participation among providers, government agencies, payers, and community-based organizations to build the trusting and mutually beneficial relationships needed for care coordination and sharing of sensitive client and provider information. • Leverage the shift towards Fully Integrated Medical Care (FIMC) to ensure that ongoing operating costs for critical HIT/data services needed for care coordination are funded by future VBP arrangements through Managed Care Organizations (MCOs). Cross-cutting challenges that the Medicaid demonstration will struggle to address across all four project areas include: • Race, place, and income-based health and social disparities Cross- • Insufficient affordable housing stock, and barriers to affordable housing related to cutting substance use and/or involvement with criminal justice system Challenges • Inadequate health and social service provider workforce • Institutional racism • Relationship between behavioral health, substance use, and criminal justice system 5
HIE IE/HIT Assessment 6
HIT/HIE Assessment – Context Objectives Understand current state of Health Information Exchange and Health Information Technology of organizations in King County. Review survey findings with stakeholders to solicit feedback. Make decisions locally cognizant of national and regional trends. Use HIE/HIT approved recommendations and decisions to inform investment and project plans that contribute to transformation. Assessment Topics Covered • General organization information • Telehealth / Mobile Applications • Electronic Health Record (EHR) • Other Technologies • Exchanging Health Information • Population Health Management & Registries Survey • Conducted in April 2018 • Designed to be completed by the organization’s Chief Technology Officer (CTO), Chief Information Officer (CIO), Health Information Exchange (HIE) lead, or similar leadership role • Separately, solicited a Provider/Clinical perspective on a subset of questions to ensure technology meets the needs at the clinical delivery level Respondents • Hospitals – 9 of 13 • FQHCs – 6 of 7 • BHAs / Other – 22 of 24 7
HIE IE/HIT Assessment – Fin indings & Themes 8
Exchanging Health Information – Types of Info Tip : Read this chart from left to right by provider type • Most health information exchanged outside an organization currently occurs manually (paper, fax etc.). • Common types of information exchanged: o Hospitals and FQHCs exchange more clinical, referral, and diagnostic data. o BHAs exchange more care management, referral, diagnostic, and claims data. 9
HIT/HIE Assessment – EHRs Electronic Health Record (EHR) systems • 100% of the Hospitals and FQHCs report using an EHR and about 75% (17) of the BHAs. • Common EHRs for Hospitals are Epic, Cerner and Greenway, for FQHCs NextGen, and for BHAs a wide variety of others. Appendix slide has details. • Of BHAs not currently using an EHR, most plan to add one in the next 12-18 months. • Approximately half of Hospitals and BHA and a third of FQHCs plan to switch their EHR, in the next 6-12 months. How HealthierHere might help with EHR Challenges • While there were several funding related requests largely from BHAs and FQHCs several organizations saw a role for HealthierHere in providing leadership and encouraging health care organizations to participate in the national standard around health information exchange to allow improved interoperability between electronic health record systems. 10
HIE/HIT Assessment – HIE Pain points that might be solved with better exchange of health information through HIE or related networks • Half the Hospitals suggested greater transparency for areas such as image sharing, medication lists and data integration. • Several FQHCs suggested improved record management capabilities. Methods of information exchange • Direct Exchange is used by most Hospitals and FQHC with limited use in BHAs. • Query-Based Exchange is used less often. • Those not using these methods already would like to. • Most Hospitals, all FQHCs and 1 BHA are participating in a national, regional or State HIE. • OneHealthPort is the most common HIE and services used are the Clinical Data Exchange, Single sign-on to access health plans and Access to PMP in that order. 11
HIE/HIT Assessment – HIE Barriers Barriers to increased use of Health Information Exchanges (HIEs) • Hospitals cited training (mapping data and ongoing support) and a national HIE platform that works with most EHR vendors. • FQHCs cited funding to improve the EHR, increased capability and system improvements. • BHAs cited funding, but also employee training for policy development and best practice standards surrounding HIPAA and various data security requirements. 12
Exchanging Health Information – External Orgs (10) (7) (7) (6) (2) 13
Exchanging Health Information – External Access Are there any community based organizations or social service agencies who have access to your organization's EHR? (5) (4) (3) (3) (2) (2) 14
HIE/HIT Assessment – Telehealth Telehealth • 63% of Hospitals and 67% of FQHCs report using telehealth or mobile applications now to communicate with clients but only 29% of BHAs currently do. Appendix slide has details. • All provider types using telehealth cited the same top three benefits , namely: Convenience, reduced travel time; More efficient health care delivery; and Enhanced client access to providers. Also popular was the Ability to treat urgent symptoms and Regular communication to monitor chronic conditions. • Interest in telehealth and related tools is high for all provider types while current ability varies. In the next 6 months one Hospital system is expanding their telehealth program to jails. In the coming 12-18 months pilot projects at the FQHC level include improved access to psychiatric and drug use treatment; for BHA’s, telepsych conferencing and exploring telehealth with branch offices. • A wide variety of systems are used. Zoom was mentioned by all three provider types. Others include AMD Telehealth, Allscripts EHR, Blue Jeans, CareMessage (to text patients), Carena, Cerner Patient Portal, Epic, PP Direct, Skype (HIPAA compliant), and TruClinic. One BHA mentioned Qualifacts Carelogic will have a mobile component allowing clinicians to access treatment plans, safety plans, and medication lists. 15
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