community information exchangeciesandiego.org/wp-content/uploads/2019/05/driving... · driving...

Camey Christenson2-1-1 San Diego

Driving Collaboration & Cross-Sector Data Sharing with a Community Information Exchange

Alana Kalinowski

2-1-1 San Diego

Peter Battistel

2-1-1 San Diego

Driving Collaboration & Cross-Sector Data Sharing with a

Community Information Exchange

The 2-1-1 San Diego Story & CIE Toolkit

Camey Christenson

Senior Vice President

Introductions

Alana Kalinowski

Director of Partner Integration

Peter Battistel

Chief Technology Officer

• Free, 24/7 service, 3-digit dialing code

• Access to community, health, social and disaster

services

• Tailored programs take the client beyond just a

referral—movement towards Navigation

211 San Diego/Imperial

• Systems change that fosters true collaboration

across networks

• Moving towards person-centered interventions

and interactions across healthcare and human

services

• Goal is to improve health and wellness for

individuals and populations

Community Information Exchange

Why a Toolkit?

• Share San Diego’s long history developing,

growing, and maintaining its CIE

• Support the nationwide movement around

capture and use of social determinants of

health data to promote individual well-

being as a foundation for more holistic

approach to community health

• Provide communities across the country

with insights and strategies on how to

approach development of a local CIE

This toolkit was made possible through a generous

grant from the Schultz Family Foundation

www.ciesandiego.org/toolkit

Toolkit Sections

Section 2:

State of the Field

Section 3:

Insights and Strategies

Section 1:

What is a Community

Information Exchange

Learn about the features and benefits of

developing a CIE, including how the CIE creates community

impact.

Discover the influences that shaped the conceptualization

and evolution of the CIE.

Explore the six strategies essential to developing an effective and sustainable

CIE.

What is a Community Information Exchange?

A community information exchange (CIE) is an ecosystem comprised of

multidisciplinary network partners that use a shared language, a resource

database, and an integrated technology platform to deliver

enhanced community care planning. Care Planning tools enable partners to

integrate data from multiple sources and make bi-directional referrals to

create a shared longitudinal record. By focusing on these core components,

a CIE enables communities to shift away from a reactive approach to

providing care toward proactive, holistic, person-centered care.

Core Components of a CIE

Community Information Exchange Partners

Healthcare SectorHealth Plans

Hospitals

Emergency Medical Services

Health Centers

Health Information Exchange

Behavioral Health

Public Health

Network Partners

Social Services SectorNetwork Partners

Housing

Multi-Service

Human Development& Aging

Employment

Nutrition

Legal

Primary

Care and

Prevention

Housing Stability Health

Management

Nutrition & Food

Security

Legal &

Criminal

Justice

Safety &

Disaster

Transportation Employment

Development

Personal Care &

Household

Goods

Financial

Wellness and

Benefits

Education &

Human

Development

Social &

Community

Connection

Activities of

Daily Living

Utility &

Technology

14 Domains: Risk Rating Scale

CRISIS CRITICAL VULNERABLE STABLE SAFE THRIVING

KNOWLEDGE AND UTILIZATION

BARRIERS AND SUPPORTS

IMMEDIACY

Shared Language

(SDoH)

Hub for social and health sites and providers

Resource Database and Bi-directional Referrals

• Shared taxonomy language for

referrals (AIRS)

• Dedicated resource staff

• Standards to listings and

requirements

• Inclusion/Exclusion Criteria

• Linked to health conditions

• Tracks resource availability and

unmet needs

Bidirectional Closed Loop

Referrals

Benefits of a CIE

The Impact of a CIE

Toolkit Sections

Section 2:

State of the Field

Section 3:


Section 1:

What is a Community




impact.




CIE.

State of the Field

Proliferation of

Technology

Public Awareness of the Social

Determinants of Health

Evolving Funding Environment

Person-Centered Care

Cross-Sector

Collaboration

Research and

Policy Advocacy

State of the Field

Toolkit Sections

Section 2:

State of the Field

Section 3:


Section 1:

What is a Community




impact.




CIE.

Section 3: Insights and Strategies

Identify the CIE Vision and Governance

Mobilize the Community Network

Prepare a Legally Compliant Framework

Adopt Interoperable and Scalable Technology

Cultivate Sustainability

Transform the Movement

Importance of Establishing CIE Vision and Governance

Collective Impact Model

The Five Conditions of Collective Success

Source: Kania, J. & Kramer, M. (Winter 2011). Collective impact. Stanford Social Innovation Review

Common Agenda

Shared Measurement

Systems

Mutually Reinforcing

Activities

Continuous Communicatio

n

Backbone Organization

Backbone Organization

Guiding the development of a shared vision and strategy

Maintaining a shared identity

Expanding the network of partners and funders

Aligning partners and their activities

Engaging target populations

Establishing shared outcomes and measurement practices to

facilitate ongoing learning and process

Action Checklist

1. Establish the Need for the CIE

2. Clarify the Vision

3. Create a Governance Structure

4. Plan for CIE Oversight

CIE Mission, Vision & Values

Mission: Empower communities to engage with people through a human-centered and data-

driven perspective

Vision: Enabling communities to change systems to improve equity and health

Values:

Movement: Driven by innovation and evolution

Meaningful: Create understanding through an informed and experiential lens

Efficacy: Enhance the power of the individual and the community

Engagement: Establish integrated, tailored and inclusive input and information

Interdependence: Build a Network of trusted, supportive partners

Identify Lead(s) or a Backbone Organization

Qualifications

•Committed to addressing health

and social problems through

technology

•Community reputation

•Involvement in the CIE since

inception

Assets

•Staff capacity and expertise

•Direct provider services

•High volume of callers

•Existing technology resources

•Existing relationships with social

and health service providers

•Experience serving in same role for

SD United

Roles and Responsibilities

•Manage brainstorming for initial

and ongoing use cases for

technology

•Develop and manages

technology platform

•Ensure compliance with

appropriate legal protocols

•Engage new and current partners

•Ensure CIE’s financial stability and

sustainability

2-1-1 San Diego as Backbone Organization:

Governance Structure

Individuals from 2-1-1 San Diego, network partner organizations,

and the advisory board also serve on workgroups that support

various aspects of the CIE’s development and management:

Policy WorkgroupShared Language Review

Workgroup

Healthcare and Housing

Workgroups

Workgroups

Importance of Mobilizing the Community Network

Action Checklist

1. Develop a Partnership Engagement

Strategy

2. Create Shared Values and Language

3. Engage the Coalition of the Willing

4. Create an Individualized Partner Plan

Feasibility Assessment

Determine Initial Participation Level

Client State Target Time to Respond

Referral Status: Accept or Decline Within___hours

Outcome Status: Received services or other referral outcome on service

Within ____days

Support CIE Implementation and Ongoing Participation

Why is this important?

• Sharing data among multiple partners requires a solid

legal framework and protocols that comply with

federal, state and local regulations.

• CIEs that include health providers are required to

meet Health Insurance Portability and Accountability

Act (HIPAA) requirements for sharing Protected

Health Information (PHI).

• Other federal compliance regulations govern the use

of personally identifiable information (PII).

Action Checklist

1. Set Standards for Network Partners

2. Establish Standard Consent

3. Define Roles for Health and Non-Health Partners

4. Establish Standard Security and Privacy

Measures

Business Associates Agreement Participation Agreement Service Level Agreement

Develop Formal CIE Agreements

Privacy Practices

Develop Formal Data-Sharing Agreements

Terms and Services

Partnership Agreements: Data Use Agreement

Action Checklist

1. Analyze Data Systems and Information Sharing Environment

2. Establish a Dedicated Multidisciplinary Design/Technology

Team

3. Set Needs for Technology

4. Select Technology that Supports Interoperability and Shared

Record

Infrastructure/Systems

Platforms

• HMIS (Homeless Management Information System)

• Health Information Exchange (HIE)• ConnectWell (HHSA)• Emergency Medical Services across

cities• Food Bank• Career/Workforce (WIOA funds)• School Systems

• ETO/Social Solutions• Salesforce• Electronic Medical Record

• EPIC, CERNER, NextGen, OCHIN • CC3• Service Point• Excel• Clarity• Oasis • WATER• ACCESS• CommunityOS• CalJobs• STAR• FileMaker• CSTAR• Trilogy

Continuously Explore Opportunities for New Functionality

• Identify situations where real-time upstream alerts

could improve care coordination

• Explore opportunities to integrate data from

prevention efforts

• Monitor trends in using blockchain technology for

service coordination applications

Technology Platform Design

Executive Sponsor Product Owner Project ManagerCall Center Service

Subject Matter Expert

Community Subject Matter Experts

IT / System Subject Matter Experts

Salesforce Administrator

Architect / Developer

During 2-1-1 San

Diego’s the three-

month design phase,

the team invited

potential users to

attend multiple

sessions to test and

provide feedback on the system.

Prioritize Needs and Compare Technology Vendors

Evaluation Criteria RequirementsMaximum Possible Score

Reviewer Score

Qualifications and Expertise

• Organizational experience as it relates to the scope of this

project

• Depth and relevance of staff technical expertise and

experience

• Adequacy of staff to perform work

20

Costs • Reasonableness of costs 20

Record of Past Performance

• Relevant work examples

• Client testimonials and references

• Demonstrated ability to complete work tasks within project

timelines and project budgets

10

Merit of Proposal

• Thoroughness, clarity, and approach of Proposal

• Extent to which the proposed solutions meet the scope and

needs of this project

• Demonstrated understanding of project and requirements

10

Interview Questions

• Appropriateness and quality of responses to questions

• Demonstrated unique or exceptional knowledge of the work

required40

TOTAL 100

Shared Client Record

System Requirements

User Types and Log-Ins

Uniform Data Standards

Longitudinal Record

Bi-Directional Closed-Loop

Electronic Referrals

Care Team Management

Push Communication

ToolsInteroperability Open Source

Security and Privacy

Reporting

Establish Standard Security and Privacy Measures

• Standardize technical requirements

• Provide ongoing privacy monitoring

Security Guidance for Community

Information ExchangePartner IT Privacy and Security

Questionnaire





Adopt Interoperable and Scalable

Technology



Importance

• Communities need to begin developing a plan for the CIE’s financial sustainability

from the very early stages of the process to support the partner network and the

technology platform.

• Government agencies and philanthropic funders have played a major role in

providing communities with the initial grants and investments to create, test, and

implement innovative technologies.

• To ensure the CIE’s relevance and viability, communities need to develop and

secure financial and in-kind resources from diverse sources to guide the CIE from

its start-up phase to sustainable operations.

Action Checklist

1. Start Sustainability Discussions Early

2. Determine Sustainability Costs

3. Create Value Propositions for Key Sectors

4. Explore Different Business Models for Sustainability

Creating Value Propositions

CIE sustainability plan to share

with key funders and partners,

and has held ongoing

discussions with its Advisory

Board on the proposed

strategy.

HealthcareJustice-Involved

Education Public Safety EmploymentUtility and

Technology

Data Research Se l f Se rv ice

Opportunity: Without

addressing whole

person, health

outcomes will not

completely improve

for all

Target: Health Plans,

Hospitals, Health

Centers/Clinics

Impact: Improve

Patient Health

Outcomes

Value: Revenue

structure to support

approach and

intervention

(readmission, value

based care, healthier

members)

Opportunity: Lack of

early intervention

and wrap-around

services for children,

families and students

Target: Adverse

Childhood Effects,

Violence, Foster

Youth, Colleges

Impact:

Coordinated

supports for families

and service

providers

Value: Reduction in

Absenteeism

(increase funding for

schools), Graduation

Rates

Opportunity: Poor

prevention, release

and racial inequities

Target: Parole, Re-

entry, Recidivism

Impact: Early

connections can

prevent arrests and

support post-

incarceration with

whole person care

Value: Reduction in

government

spending by

decreasing jail

recidivism

Opportunity:

Increasing

incidences of

violence and

disconnected

prevention and

support resources

Target: IPV, Gun

Violence,

Neighborhood Safety

Impact: Early

intervention

resources to link

individuals and

families in crisis

Value: Local

capacity to prevent

violence and support

communities

Opportunity:

EAP programs, to

support personnel,

family and

workplace

Target: Workforce

Development,

Government

Impact: Ability to

access resources

and supports to be

successful in work

Value: Healthy,

happy and

productive workforce

Opportunity:

Technology divide

Target: Cell Phone

Carriers/Plans, Apps

Impact: Improve

access to resources

and information

Value:

Communication and

connected to needs

to target markets

OPP

OR

UTU

NIT

Y S

TREA

MS

Explore Different Business Models for Sustainability

• Establish a business model and monetization strategy

• Continually evolve and stay abreast of changing funding

climates and opportunities.

Transform and Shape the Movement

• Nationwide movement influencing local ecosystem of network

partners

• Role in building the field of health care and social service

collaborations:

• Conducting research

• Sharing best practices

• Convening conversations

• Championing efforts to standardize care with lens of achieving equity

and social justice

Importance

1. Nurture the Regional Ecosystem

2. Build the Field

3. Shape the Conversation

4. Champion the Movement

Action Checklist

Thank you!

Questions?

community information exchangeciesandiego.org/wp-content/uploads/2019/05/driving... · driving...

Documents