Health Information Technology Oversight Council December 7 th , 2017 - - PDF document

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Health Information Technology Oversight Council

December 7th, 2017

This public meeting is being recorded

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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

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OHPB Update

Karen Joplin, Board Liaison to HITOC

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Behavioral Health HIT/HIE Scan: Final Results

Marta Makarushka

Lead Policy Analyst

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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

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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

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Survey Response Demographics: Size and Population Density

133 out of 275 agencies completed a survey (48%) Represents 522 programs out of 874 total (60%)

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*Agency size is determined by a count of programs within the agency Program size is unknown and can vary greatly from program to program

Agency Size # of Agencies Response Rate Single Program 57 44% Two Program 28 51% Small (3-5 Programs) 25 56% Medium (6-10 programs) 14 56% Large (11+ Programs) 9 60% Total Respondents 133 48% Population Density # of Agencies Response Rate Frontier only 6 67% Frontier; Rural 2 100% Frontier; Rural; Urban 1 100% Rural only 34 47% Rural; Urban 18 49% Urban only 72 48% Total Respondents 133 48%

Response Demographics: Program Types

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Program Type # of Programs Response 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%

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Federal/State Program Participation and Other Priority Agencies

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Total # Agencies* Surveys Completed Response Rate CMHP 30 20 67% CCBHC 13 9 69% Behavioral Health Home 10 8 80% ACT 33 21 64% Tribal 7 6 86% FQHC 16 8 50% Other Physical Health Affiliation 23 11 52%

CMHP: Community Mental Health Program; CCBHC: Certified Community Behavioral Health Clinic; ACT: Assertive Community Treatment team; FQHC: Federally Qualified Health Center *Agencies can fall under more than one category (e.g., CMHP and CCBHC).

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.

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Current EHR Use (n=133)

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Almost all agencies with no EHR are small (1-5 programs)

24% 76% No (n=32) Yes (n=101)

50% 49% 1%

Status of EHR Implementation (n=101)

Fully Implemented (n=51) Partially Implemented (n=49) Currently Changing Vendors (n=1) 13% 13% 32% 42%

For those without an EHR: Stage of EHR Adoption (n=31)

Development or Selection Stage (n=4) Information Gathering Stage (n=4) Plan to in the Future (n=10) No Plans to Implement an EHR (n=13)

EHR Challenges and Barriers

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EHR challenges for those who have an EHR Count Response Rate 1 Financial costs 71 70% 2 Unable to exchange information with other systems 55 54% 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 the investment 21 66% 3 Lack of staff resources 15 48% 4 Lack of technical infrastructure 15 48%

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Type of Data Captured Electronically

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87% 85% 84% 83% 82% 81% 80% 79% 78% 78% 76% 76% 71% 68% 46% 13% 15% 16% 17% 18% 19% 20% 21% 22% 22% 24% 24% 29% 32% 54% Diagnoses (n= 121) Demographics (n= 117) Encounters (n= 118) Clinical Summary (n= 113) Care Plan Fields (n= 114) Progress Reports (n= 113) Problem List (n= 115) Social Information (n= 110) Discharge/Transfer Reports (n= 115) Medications (n= 117) Care Team Member Info (n= 106) Allergies (n=107) Continuing Care Document (n= 105) Lab Results (n= 107) ED Visit Alerts (n= 92) Captured Electronically Not Captured Electronically

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.

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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
• f 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.

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Agency Data Sharing Need by Purpose

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80% 70% 66% 68% 54% 20% 30% 34% 32% 46% Care Coordination (n=126) Referrals (n=123) Reporting (n=128) Payment (n=118) Other (n=13) Moderate/High Low/None

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Frequency of Need to Share Data by Trading Partner

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80% 74% 70% 60% 59% 55% 51% 50% 37% 36% 31% 20% 26% 30% 40% 41% 45% 49% 50% 63% 64% 69% Federal, State, or Local Agencies (n=128) Payers (n=121) Affiliated Mental Health Programs (n=106) Affiliated Substance Use/Addiction Programs (n=91) Laboratories (n=118) Physical Health Providers (n=128) Social Service Agencies (n=125) Pharmacies (n=114) Non-Affiliated Mental Health Programs (n=119) Hospitals and Emergency Departments (n=121) Non-Affiliated Substance Use/Addiction Programs… Regularly/Very Often Never/Infrequent

Importance of Sharing Information by Type

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89% 89% 88% 88% 87% 85% 84% 84% 78% 78% 77% 75% 73% 69% 59% 11% 11% 12% 12% 13% 15% 16% 16% 22% 22% 23% 25% 27% 31% 41% Discharge/Transfer Report (n=123) Treatment or Care Plan Fields (n=119) Diagnoses (n=128) Continuity of Care Document (n=118) Clinical Care summary (n=120) Progress Reports (n=123) Medications (n=127) Problem List (n=120) ED visit (n=106) Encounters (n=112) Demographics (n=120) Care Team Member Information (n=104) Lab Results (n=115) Social Information (n=121) Allergies (n=105) Important Not Important

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Frequency of Methods Used for Information Exchange

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18% 55% 17% 20% 8% 9% 7% 3% 7% 73% 42% 40% 69% 41% 23% 6% 17% 19% 10% 3% 43% 11% 51% 68% 87% 81% 74% Paper (n=125) Fax (n=126) eFax (n=103) Secure Email (n=122) Direct (n=95) Shared EHR (n=91) Epic Care Everywhere (n=82) Health Information Exchange (n=77) PreManage (n=74) Most of the time Some of the time None of the time

More Robust

Interest in Expanding Exchange Capabilities with Trading Partners

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89% 88% 86% 86% 86% 85% 82% 76% 60% 11% 12% 14% 14% 14% 15% 18% 24% 40% Payers (n=117) Physical Health Clinics (n=118) Affiliated Behavioral Health Clinicians/Staff (n=119) Hospitals (n=116) Pharmacies (n=111) Non-Affiliated Behavioral Health Clinicians/Staff (n=120) Laboratories (n=115) Clients (n=116) Family Members (n=110) Interested Not Interested

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Agency Interest in Accessing and Sharing Client Information Via an HIE

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Interest in Sharing client information with other entities (n=104) Accessing client information from

• ther entities (n=96)

For those reporting lack of interest in HIE – top reasons cited include:

• Lack of financial resources
• Confidentiality/privacy concerns

15% 85% No (n=16) Yes (n=88) 11% 89% No (n=11) Yes (n=85)

Conclusion 2: Behavioral health agencies need HIE

• pportunities, which are presently nascent and evolving.
• Need 2a: HIE tools that can serve behavioral health

specific needs. This includes the ability to exchange information with priority information trading partners, including social determinants of health partners.

• Need 2b: Financial support and technical assistance for

HIE participation.

• Need 2c: Robust HIT to support participation in health

information exchange.

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Key Result 2: Conclusions and Needs

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BH HIT Scan: Key Result 3, Conclusion, and Needs

Key Result 3: In addition to resource barriers, privacy and security concerns are a top barrier to electronic information exchange. Conclusion 3: Behavioral health stakeholders need more support and clarity about privacy and security of health information.

• Need 3a: Clear, consistent, reliable, actionable guidance

about information sharing allowed under the law

• Need 3b: Appropriate consent management tools and

data segregation capability integrated into HIT/HIE products

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Top Barriers to Electronic Information Sharing

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8% 10% 17% 24% 30% 33% 35% 38% 39% 48% 64% 64% 78% Organizational policies prevent electronic… Other (n=13) Lack of proper consent forms (n=23) Unable to separate info when sharing client… State/Federal laws prohibit the type of sharing… Internal systems do not capture info appropriately… Challenges navigating technical opportunities… Challenges with navigating regulations (n=50) Technology infrastructure is not enabled to allow… Concerns over liability of redisclosure of… Technical Resources are Limited (n=85) Privacy/security concerns (n=84) Financial cost (n=104)

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Resources to Help Improve Information Sharing Barriers

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9% 40% 45% 51% 53% 55% 57% 57% 71% Other (n=12) Electronic reference guide for EHRs/other HIT (n=53) Template technology contract language (n=61) Technical assistance or support (n=68) Educational webinars about applicable laws (n=70) Template consent forms (n=74) Information on best practicies (n=76) Improved technological capabilities for easier sharing (n=75) Financial assistance with EHR vendor costs (n=94)

BH HIT Scan: Key Result 4, Conclusion, and Needs

Key Result 4: Data analytic tools and capabilities are a necessity for improved patient care, reporting, and practice management. Conclusion 4: Behavioral health agencies could benefit from additional resources and support for data analytic

• Need 4a: Robust HIT and access to critical data to

support data analytics and reporting.

• Need 4b: Data analytics tools and capabilities that meet

behavioral health specific needs.

• Need 4c: Streamlined/consolidated reporting

requirements where possible to decrease burden.s.

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BH HIT Scan: Recommendations and Strategies

• 1. Seek opportunities to provide financial support for

adoption and effective use of robust EHRs and HIE participation that meet the needs of behavioral health agencies, clinicians, and patients.

• EHR: MEHRIP; HIE: HOP
• 2. Provide technical assistance and learning
• pportunities to support EHR adoption and effective

use and HIE participation, as well as privacy and security needs, such as consent management.

• Common Consent Model and BH Information

Sharing Provider Toolkit

• Block Grant TA
• OMUTAP

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BH HIT Scan: Recommendations

• 3. Support agencies’ opportunities for collaboration and

shared learning with other behavioral health agencies around EHR adoption and effective use, HIE participation, and privacy and security issues.

• Shared learning opportunities
• CCBHC Demonstration Program
• 4. Ensure behavioral health agencies can take advantage
• f statewide robust HIT/HIE efforts, and that these

efforts address needs of behavioral health agencies, clinicians, patients, and other stakeholders.

• EDIE/PreManage
• PDMP Gateway
• HIE Network of Networks
• HIT Commons

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BH HIT Scan: Recommendations

• 5. Seek opportunities to reduce reporting burden or
• therwise provide support for behavioral health

agencies’ reporting requirements.

• CQMR

Additional Considerations

• Continue efforts to engage behavioral health agencies

and conduct future environmental scan work.

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Discussion

• Questions and/or clarifications needed about findings
• Recommendations and strategies

– Sufficient to address needs? – What did we miss?

• Feedback on Report

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Addressing Barriers to Behavioral Health Information Sharing

Veronica Guerra Policy Analyst, OHA

Agenda Goals

• Overview of the Behavioral Health Information

Sharing Advisory Group

• Advisory Group work plan
• Toolkit Communication Plan and Feedback
• Resources

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Overview of the Advisory Group

• Need: Lack of understanding of Part 2 and state laws

impacted CCOs’ care coordination ability

• Goal: To develop solutions to support integrated care and

enable sharing of behavioral health information between behavioral and physical health providers

• Members/Partners: Internal staff from across the agency

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Priorities:

• Outreach to stakeholders
• Education
• Leverage existing IT solutions
• Develop tools to facilitate information sharing

Advisory Group Work Plan

• Conduct provider survey and follow-up interviews to

understand barriers to sharing behavioral health information

• Develop resources for providers

– Webpage with federal, state, and Oregon specific resources – Actionline hotline (subscription not available any longer) – Webinar series

• Webinar #1 (9/29/15): Overview of state and federal privacy laws
• Webinar #2 (12/17/15): Deeper dive into federal privacy laws with

use case examples from providers

• Webinar #3 (3/30/16): Oregon Health Information Technology and

the Intersection with Part 2

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Advisory Group Work Plan

• Engage federal partners in discussions about 42 CFR Part 2

barriers

– Several discussions with ONC and SAMHSA through national platforms – OHA Director submitted a letter to Secretary Burwell on August 14, 2015 – OHA submitted comments on April 11, 2016 to SAMHSA’s 42 CFR Part 2 Notice of Proposed Rulemaking

• Develop behavioral health information sharing toolkit

– Model paper-based common consent form, provider and patient instructions – Model Qualified Service Organization Agreement (QSOA) – Comparison of federal and state privacy laws – Use cases of allowable sharing – Frequently Asked Questions addressing state and federal privacy laws

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Toolkit Communication Plan

• Communication channels

– Internal outreach:

• Publications: CCO bulletin, In the Loop, PCPCH newsletter, DHS

provider newsletter

• Forums/venues: QHOC, OHA/DHS Joint Privacy Commission, OHA

workgroups (OHPB, OHIT HITOC, DHS, Public Health), Behavioral Health Collaborative

• Other channels: Innovator agents, Privacy Officers for CCOs, BH

directors, Transformation Center, Office of the Chief Medical Officer

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Toolkit Communication Plan

• Communication channels

– External outreach:

• Professional associations (OMA, ONA, OAFP, OAHHS, Association
• f Oregon Community Mental Health Programs), Disability Rights

Oregon, Mental Health Alliance of Oregon

• Advocate groups (NAMI, MHAP, OFSN, Youth MOVE, etc)
• List of interested individuals gathered through provider survey and

webinars

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Toolkit Feedback

• Feedback previously received from:

– Reliance Forum Roundtable participants – BHIS Advisory Group

• HITOC feedback on toolkit components

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For more information about the Behavioral Health Information Sharing Advisory Group and access to webinar recordings, please visit:

http://www.oregon.gov/oha/HPA/CSI-BHP/Pages/Behavioral-Health-Info.aspx

Resources

Break

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Discussion: Next Steps

HITOC charged with ensuring we have HIT strategies that support need

• f BH providers including oversight of BHC HIT recommendations

implementation

• Preference regarding role:

– Continue to monitor – Investigate further? – Connect further with stakeholders?

• Additional input from BH agencies

– Panel at future meeting

• Priorities: Who and what topic

– Workgoup

• More focused work and attention on the BHC workplan
• Block Grant TA input for program development
• Communication plan for sharing report and results to stakeholder

groups

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CareAccord Update

Britteny Matero, HIE Programs Manager

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CareAccord Origins

• CareAccord was established in 2012 to help fill gaps in

the health information exchange environment.

– It was offered as a no-fee option with the intent to transition to a fee structure in the future. – CareAccord launched Direct services through a web-portal; later piloted EHR integration with OCHIN

• In 2013, CareAccord became accredited allowing cross

HISP Directed exchange

– The original plans for CareAccord included expanding from Direct secure messaging to include other HIE services – Intended to leverage the flexibility and ubiquity of Direct secure messaging as a baseline statewide HIE for those facing barriers

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CareAccord Current State

• Despite concentrated outreach efforts to engage

additional participants, CareAccord has not experienced the web-portal user-growth originally anticipated for its Direct securing messaging services.

– Web-portal registration has remained at about 120 organizations with roughly 1,000 users since 2015 – Web-portal messaging has varied slightly since 2015, around 300-500 monthly messages – OCHIN (EHR Integration) users have steadily increased use since launch in winter 2015/16 – In 2016, only 10% of CareAccord participants (13 organizations) exchanged more than 50 Direct messages throughout the year

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Top 13 Direct Exchange Organizations in 2016

Messages exchanged (sent and received) in 2016 Organization

More than 2000 Cascade Infectious Disease More than 1000 Polk Count (County Health) More than 800 Salem Clinic Teras Intervention (Addiction/BH) More than 600 Oregon POLST Registry More than 400 Partners in Care More than 300 Liberty House More than 100 Architrave At least 50 WVP Medical Childhood Health Associates of Salem Coastal Family Center Familias en Accion Salem Pediatric Clinic

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Organizations Enrolled with CareAccord

46 Other includes: Acute Lab Public Health Pediatrics OHA Pharmacy Hospice Long-term Care Registry IPA Managed Care Radiology and Imaging Governmental Agency Social Services Naturopath Allopath CCO **Although 36 FQHC/RHC are represented on this chart under OCHIN, OCHIN as a whole is only counted as 1 participating organization

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CareAccord Future State

• Decision to sunset CareAccord:

– OHA evaluated program utilization, required resources, and Oregon’s changing health information technology environment – OHA has decided to realign resources to other health information exchange investments – Ongoing concerns about Direct –

• Largely used for meeting meaningful use, more of an integrated

workflow with potential for “system-to-system” transport

• Not as flexible or widely adopted in other health care environments
• Other, more valuable HIE options for targeted users for CareAccord

The CareAccord program will end on March 31, 2018.

– Direct secure messaging services will end for participants on March 16, 2018

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Next steps

• Outreach to CareAccord participating organizations

– Informed OCHIN, coordinating to ensure their successful transition to a new HISP – Email to all participating organization administrators

• Non-active accounts can follow up with a CareAccord staffer
• Will seek a meeting/call with active accounts

– Developing Fact Sheet for participants outlining account closure steps – Planning a feedback survey to inform transition and future work

• Evaluating state options to facilitate successful transfers

to similar services within the current market-place

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HITOC discussion on Direct from April

• Challenges include –

– giving up the fax; workflows for handling information sent via Direct; some EHRs reject messages without patient information for incorporating CCDs sent via Direct

• Opportunities –

– New uses of Direct for system-to-system transport of information,

• r using a facility-level address or sending messages to a pooled

account

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HITOC discussion from April (cont.)

• CareAccord role –

– Still filling gaps in the short term, but longer term may be less economically viable as HIEs and other efforts fill these gaps, particularly as integration within workflow is ideal; – Consider moving to variable cost investments instead of fixed

• perational costs and reassess use cases and gaps that

CareAccord serves, including whether users have other options available. – Several vendors in the behavioral health and oral health spaces are reluctant to pursure stage 3 certification because of the requirements, which may increase the need for stand-alone services like CareAccord until other exchange options are available.

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HITOC 2018 Work Plan

Sean Carey

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HITOC 2017-2020 Work Plan

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HITOC 2018 Draft Work Plan

Feb- Apr Jun- Aug Sept-Dec Early 2019

Policy Topics

• Social determinants of health -

Care Coordination and Patient Perspective

• Patient Access and Engagement
• Social determinants of health -

Risk Stratification + Quality Measurement

• Behavioral health information

sharing

• Social determinants of

health – Referrals, Patient Perspective, Special Areas (corrections, HIPAA to non- HIPAA)

• Patient Access and

Engagement

Strategic Planning

• HIT Commons – Update
• HIE Networks of Networks
• Strategic plan update: APMs/

milestones

• Behavioral health

collaborative workplan

• HIE Networks of Networks
• HIT Commons – Update,

Relationship to HITOC and Roles

• HIE Networks of

Networks

Oversight

• Regular program updates
• HIE Onboarding Program (HOP)

update

• Regular program updates
• In depth updates on CC, PD,

CQMR

• Regular program updates
• EDIE/ Premanage/ PMP

Gateway update

• Regular program

updates

• In depth updates on

CC, PD, CQMR, HOP

HIT Environment

• Milestones – Initial draft
• Milestones – Baseline and

target development

• Additional scan development
• Scan Report (topic TBD)
• Dashboard development
• Milestones –

adjustment and

Reporting

• Report to OHPB in March
• Report to OHPB in Sept
• State and

Federal Policy

• ONC Trust and Exchange

Framework and Common Agreeement (TEFCA)

• Information Blocking Rule
• Oregon 2018 Legislative session

update

• Monitor Federal environment
• Monitor Federal

environment

• Monitor Federal

environment

• Oregon 2019

Legislative session update

External Policy and Agency Factors

• ONC 21st Century Cures Act

Implementation

• OHA development of value-

based purchasing roadmap

• Medicaid Advisory Committee

(MAC) SDoH definition

• BHC Ongoing Implementation
• MAC work on SDoH high-value

use cases

• CCO 2.0
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Considerations for Discussion

• Some work is dependent on broader OHA policy work:

APMs/ VBP, SDoH

• Other work to be coordinated with HIT Commons:

network of networks, spread and adoption efforts

• Need for short-term workgroups?

– Behavioral health – ONC 21st Century Cures Act Implementation – Other work?

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Program Updates

Susan Otter

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ONC Annual Meeting Update

• 21st Century Cures Act Implementation

– Trusted Exchange Framework and Common Agreement: draft expected late December/ January – Information blocking rule: draft expected early next year

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Public Comment

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Next Meeting

February 1st, 2017 Transformation Center Training Room Lincoln Building, Suite 775 421 SW Oak Street Portland, OR

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