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 • Findings • Themes

Bob Hawkinson and Susan Kanvik, PointB

Next Meeting: Monday, June 11th, 10:30-12:00 Seattle Foundation Board Room (19th floor), 1601 5th Ave, Ste. 1900

The Accountable Community for Health of King County

HIE/HIT Assessment FindingsMay 14, 2018

PMD Committee Meeting

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Meeting Goals

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Set context for HIE/HIT investment journey

Understand HIE/HIT Assessment findings

Solicit feedback on themes and preliminary prioritization of needs

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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

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ACH Project Plan November 2017:Data Needs Summary

Bi-directional Integration

EHR expansion, particularly in BH setting

Client lookup

Shared care plan

Measurement-based treatment-to-target (client registry)

Transitional Care

Client lookup

Shared care plan between health and social service partners

Opioid Use Crisis

Integrate Prescription Monitoring Program with EHRs

Link members with OUD to health homes and integrated care team

Chronic Disease

Client lookup

EHR and registry data used to identify, treat and track members (client registry)

Cohesive and non-duplicative referral system for health and social service providers (centralized referral system)

Care Coordination

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Cross-cutting

Data Themes

Cross-cutting

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.o IT infrastructure needed for care coordination components (e.g. shared care plan through PreManage)o Integration of Prescription Monitoring Program (PMP) with EHRso Implementation of centralized referral system for clinical and social services (e.g. eConsult)

• 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• Insufficient affordable housing stock, and barriers to affordable housing related to

substance use and/or involvement with criminal justice system• Inadequate health and social service provider workforce• Institutional racism• Relationship between behavioral health, substance use, and criminal justice system

ACH Project Plan November 2017: Data Themes & Challenges

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HIE/HIT Assessment

HIT/HIE Assessment – Context

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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

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

• General organization information • Electronic Health Record (EHR)• Exchanging Health Information

• Telehealth / Mobile Applications• Other Technologies• Population Health Management & Registries

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HIE/HIT Assessment – Findings & Themes

Exchanging Health Information – Types of Info

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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.

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.

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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.

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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.

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Exchanging Health Information – External Orgs

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(7) (7)

(6)

(2)

(10)

Exchanging Health Information – External Access

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Are there any community based organizations or social service agencies who have access to your organization's EHR?

(2)(2)

(3)(3)

(5)

(4)

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.

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HIE/HIT Assessment – Telehealth (continued)

Telehealth• There is strong desire from all provider types for HealthierHere and its partners to support change

in the area of telehealth and mobility. Hospitals (57%), FQHCs (67%) and BHAs (91%).

• The top barrier to increased use of Telehealth by far is “Payments/Reimbursements.”

• How HealthierHere or partners might be able to help, recommendations by provider type include: o Hospitals

– Ubiquitous WIFI access, telehealth parity adoption consistency and device equity– Reimbursement for telehealth and supporting infrastructure for telehealth expansion

o FQHCs– Assistance with telehealth evaluation opportunities, startup analysis and expertise,

facilitation with partners in the community, funding (grants)– Supporting regional payment methodologies, need for regulatory updates to consider

telehealth as a valid FQHC encounter visit by HRSA and the HCA (vs. face-to-face encounter)– Increased access to care in specific languages by prevalence among Medicaid members

o BHAs– Recommendations on how to vet qualified vendors for specific areas– Guidance on best practices when communicating with clients via mobile applications (legal,

ethical) plus considerations to safeguard client privacy– Financial support for counselors using mobile technology– Clear guidance on billing standards for telepsychiatry– Assistance standardizing the technology used in WA, technology appropriate for small orgs

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HIT/HIE Assessment –Prescription Monitoring Program

• Most Hospitals either use PMP through an interface to PMP, current or planned. The remainder use PMP standalone.

• All FQHCs have or plan EHR PMP integration.• More than half of BHAs have no PMP access and no current plans for its use.

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HIE/HIT Assessment – Population Health

• Overall population health is seen as important and a there is desire to share and leverage non/clinical data to improve care, but varying levels of understanding of the tools and best practices and desire for education.

• Most hospitals (89%) and 50% of FQHCs have population health management systems. Few BHAs (18%) have population health management systems.o Vast majority rely on EHR extracts and manual processes.

• Hospitals 87.5%, FQHCs 100%, BHAs 50% use their population health management systems to identify care gaps but less than two-thirds have external data integrated into their EHR to understand the totality of patient care.

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HIE/HIT Assessment – Population Health (continued)

• Many use their system for care management (Hospitals 100%, FQHCs 67%, BHAs 50%), but it was unclear if they have standardized decision tree based care management plans built into systems with active patient engagement or not.

• Majority of respondents from Hospitals (78%) and FQHCs (83%) have patient registries and use registries to improve the quality of patient care. While many are electronic and incorporated into their population health system, many are also using Microsoft applications, data extracts, or paper to manage populations.

• Low percentage of BHAs (27%) have registries and the barriers vary (i.e., training, costs, standardization).

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Population Health Management – Functions

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What are the functions of your organization's Population Health Management system? (Select all that apply.)

HIE/HIT Assessment – Provider/Clinical Responses

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Topic Area Clinical Emphasized Needs

EHR challenges • Guidance on standards and legalities surrounding data protection (3 of 19)• Technical training and assistance (2 of 19)

Working well • NextGen Share (2 of 6) • Epic Care Everywhere (2 of 6)

Barriers to increased participation in HIE

• Cost (13 of 13)• Technology or infrastructure gaps (11 of 13)• Privacy concerns (9 of 13)

How HH might help promote increased exchange of health info.

• Training (11 of 18)

Pain Points • Lack of care continuity, coordination or planning (4 of 13)

Telehealth / mobility needs

• Funding (8 of 10)• Technical training (2 of 10)

Other • Confidentiality concerns surrounding SUD clients (2 of 6)

(Denominator changes based on how many spoke to a specific topic area)

We asked organizations specifically for a Clinician perspective in a couple key areas.

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HIE/HIT Needs Summary & Prioritization

• The Needs & Investment Heat Map synthesizes the HIE/HIT Assessment respondents’ self-reported needs and/or pain points.

• This serves as a starting point for discussion balancing potential partner/assessment respondent’s needs and/or pain points with national/state progress in applicable areas and HealthierHere’s priorities for strategic investment.

• The colors indicated the following:

• The colors were determined based on the number of respondents identifying the area as a need and/or pain point. For example:

• Foundational needs and/or pain points are called out separately they are considered prerequisites.

o Shared Care Plans had 3 of 4 Hospitals, 4 of 4 FQHCs, and 10 of 15 HBAs identify integration of EDIE and/or PreMange as a need hence the red “Highest Need/Pain Point” assignment. (Five BHAs were unsure.)

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HIE/HIT Assessment – Needs & Investments

Highest Need/Pain Point Moderate-Low Need/Pain Point Low-No Need/Pain Point No Responses

Foundational

Foundational

Highest Need/Pain Point Moderate-Low Need/Pain Point Low-No Need/Pain Point No Responses

HIE/HIT Assessment – Needs & InvestmentsHeat map of needs and potential investment focus areas as informed by the HIE/HIT

Assessment by partner type. Next step, include information from other sources.

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HIE/HIT ASSESSMENT NEEDS/PAIN POINTS HOSPITALs FQHCs BHAs

Ability to Share Data Electronically

Consent Process Standardization

Patient Look UpHIE/HIT ASSESSMENT NEEDS/PAIN POINTS HOSPITALs FQHCs BHAs

Ability to share data electronically

Consent process standardization

Patient look up

HIE/HIT ASSESSMENT NEEDS/PAIN POINTS HOSPITALs FQHCs BHAs

Shared care plan

Ability to stratify and track patient risks (registries)

HIE barriers and pain points

Assist with Pop Health best practices

Collect SDOH

Referral database

Provide access to care remotely/digitally

Improve data sharing and standardization

Telehealth

Data sharing and standardization

Access to Population Health tools

EHR use

Early DRAFT for Discussion as of 5/14

(to be considered)

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HIE/HIT Investment Strategy Guiding Principles

Investment Strategy Guiding Principles

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Meeting the needs of users at the point of care is a core value.

Technology is only part of the solution. Consideration of people, process, and incentives is also required.

The investment opportunity will not be deleted by addressing all pain points. Potential solutions will focus on a handful of solutions that address King County

needs and Domain 2 projects in as meaningful a way as possible.

Solutions will need to be implemented and usable within the 12-15 month implementation window.

A variety of implementation approaches are possible. Use test and scale approach instead of waiting for larger infrastructure possibilities.

Out of scope areas include influencing National HIE policy and large vendor strategy. Funding full EHR implementation is unlikely.

DRAFT for Discussion 5/14

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Appendix A – Supporting Material

EHR Systems – Currently In Use

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(Link to top of deck)

EHR Systems – Planned (by BHAs)

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If not currently using an EHR system, does your organization plan to start using any of the following in the next 12-18 months? (Select any that apply.)

Other = Chasers and Kareo

(Link to top of deck)

Telehealth Usage

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Does your organization currently use Telehealth or mobile applications to communicate with clients?

(5)

(Link to top of deck)

(4)

(6)

(3)

(2)

(15)