EHR BASICS. Presenters: Presentation Overview. Electronic Health Records and Health Information Exchange: Advice for Small Practices 4/8/14

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1 Electronic Health Records and Health Information Exchange: Advice for Small Practices Annual Convention Minnesota Psychological Associations April 12, 2014 Presenters: James Jonas, MSS, LICSW, LMFT Executive Director The Jonas Center Joe Kalaidis, CPHIT Health IT Consultant Stratis Health and REACH Cheryl Stephens, Ph.D. CEO Community Health Information Collaborative Trisha A. Stark, Ph.D., LP, MPA Chair, MPA Electronic Health Records Task Force Presentation Overview Introduction EHR Basics What is Health Information Exchange A Real-World Experience Community Updates and Opportunities EHR BASICS Joe Kalaidis, CPHIT 1

2 Why EHR? Requirements The world of health care delivery is changing Changes in payment and delivery models for mental health are advancing quickly A key aspect used to tie care together, is the use of interoperable electronic health records In 2007, the MN state legislature passed a state-wide mandate for interoperable electronic health records. This mandate, which requires all providers of health services to have interoperable electronic health records by January 2015, provides an opportunity and resources for mental health providers. Purpose Electronic Health Records, or EHRs, create the foundation that will allow the electronic exchange of information, across the full continuum of care Advantages E-health gives us an opportunity for the health system to truly advance some core tenets Need to consider the whole person Help to overcome the mind body split Mental health on equal footing in importance of the care provided and its interaction with physical concerns 2

3 Achieving e-health Minnesota Model for Adopting Interoperable Electronic Health Records Developed by the Minnesota e-health Initiative to Provide guidance for providers in achieving the Minnesota mandate and improving care Minnesota 2015 Interoperable EHR Mandate Requires all providers of health services to have interoperable electronic health records by January What Can EHRs Do? Minnesota 2015 Interoperable EHR Mandate includes Behavioral Health: mental health centers group/private practice chemical dependency services In addition to Direct Benefits for Providers and Clients, Electronic Health Records (EHRs) facilitate the electronic exchange of information across the full continuum of care hospitals clinics behavioral health providers social services, home health, public health, and long term care 3

4 What is in an EHR? Electronic Health Records include: Diagnoses Procedures Medications Visit/Progress Notes Care Treatment Plan Patient Portal (usually an add-on) Practice Management Systems include: Patient Registration Appointment Scheduling Insurance & Patient Billing & Accounts Receivable Tying it All Together Trend is to Integrated Suites that Include Both EHR and Practice Management Easier to Use More Cost-Effective More Reliable Consider Outsourced Billing & Accounts Receivable if appropriate Behavioral Health EHRs in Action Simplified data collection throughout the treatment process At intake, clients will be able to complete forms prior to the first visit Clients can securely upload homework assignments increasing accountability and improving outcomes Administration of quality measures is simplified to provide the best information about clients progress in treatment. But What About Concern #1 - How to make the right choice of an electronic health record product? Resources are scarce and no one wants to buy a product only to find out that it won t meet your needs. Talk to Your Peers SoftwareAdvice.com Use the Stratis Health Toolkit Assessà Planà Selectà Implementà Exchange 4

5 And Then There is And Also Concern #2 - privacy and security of information, given the sensitive nature of Behavioral Health information Addressed by the 4 P s: Program (EHR) People Policy Processes not all information in the EHR will be exchanged with other providers. The most common information to be exchanged would be a diagnosis, procedure code, a problem list, and treatment plan Concern #3 Cost Competitive Market Works for You Web ( Cloud ) Based EHRs typically pay-as-you go Little or No Technology Infrastructure except Internet connection, workstations & printers Little or no upfront cost Easier implementation and training Funding Available? The Meaningful Use Incentive programs don t apply to Behavioral Health providers except Psychiatrists State of Minnesota interest-free EHR Loan Program is closed now but is likely to reopen later this year or early 2015 Stratis Health Behavioral Health Tool Kit Developed with funding from Minnesota Department of Health Behavioral Health faces a number of challenges associated with using interoperable electronic health records Tools in the kit address many of those challenges Tools teach you how to fish (But they don t fish for you) 5

6 Methodology: 3 Sections 6 Steps Emphasis is on Adopt Tools Adopt Assess Plan Select Use Implement Maintain Optimize Optimize 23 tools Number of Tools in Each Section 10 tools 33 (50% of all tools just to get started!) Adopt tools Use tools Optimize tools Tool kit has tools for each of these steps Go Slow to Go Fast Implemented and Supported Productivity Little or No HIT Implement HIT Leadership and management determine how long you re in the valley of despair. Preferred Future Good choices and management determine level of productivity and satisfaction Choices, planning, and execution determine extent of slide Possible Future Time Beware of Puppies! Slide from Terry Hill of NRHRC, derived from Dr. Norman Okamoro, University of Hawaii

7 Favorite Adopt Tools Due Diligence Helps you analyze vendor responses Allows you to compare apples to apples Provides a matrix that you can use Half Done! Onward à Implement and use! Vision à strong enough Leadership à in place Plans à set and communicated Management à demonstrated Choices à well made Execution à possible Conditions set to move quickly through the Valley of Despair 26 Favorite Use Tools Issues List Acknowledge that there will be issues Provides a consistent method to track issues Give you a matrix so you can get started Favorite Use Tools Training Plan Helps with the most essential task of go-live Helps you make sure everyone is trained Provides a matrix for you to use 5 Training Rights Right person (role-based) Right content (workflow, not functions) Right time (as close to go live as possible) Right amount (modules, not end-to-end) Right way (webinar, classroom, shoulder-toshoulder) 7

8 It s All About Training 85% Done! Optimize System à Working Staff à trained Clients à informed and comfortable Exchange à enabled You re part of the ehealth world! Good implementation of sufficient product beats a bad implementation of a great product Getting to ehealth Three Takeaways Navigate to the Tool Kit 1. It s about change the biggest hurdle will be changing the way people work 2. Don t look at puppies until you know what kind of dog you want healthit/behavioralhealth/index.html 3. A strong implementation of an OK product is better than a poor implementation of a great product 8

9 Getting Started 1) On the home page, read the intro text, or just get going. Overview Document Table 1) Scroll down to the Overview Section 2) In the Overview Section, Click View the link to gain access to the documents in this section. The Overview Table gives a list of the documents (tools), available for viewing, in the Section. For each tool in the section, you ll find a description of its: 1) Use 2) Purpose (Action or Inform) 3) Experience Level 9

10 Understanding Experience Level It s Easy Start with Assess; proceed onward to Optimize Click on a tool Use the Experience Level symbols to decide if a document is appropriate for your type of organization: Skiers will recognize these symbols. Everyone should consider all tools with a green circle. Larger organizationsand those with more IT experience may want to use tools with marked with the blue square or the black diamond Save it Use it Move on to the next tool Wrap Up and Takeaways Questions? Find the tools you need and use them Some folks like to print the whole tool kit and save it in a binder Others are successful with finding the tools they need just in time Only bad way to use the tool kit is to not use it Joe Kalaidis Health IT Consultant or

11 Small Practice Experience Jim Jonas, MSS, LICSW, LMFT Electronic Health Records for the Individual and Small Private Practice What to look for when thinking about purchasing an EHR. Good Questions to Ask Yourself Does this fit my practice? Is it clunky? (do regular tasks require multiple steps?) Is it intuitive for me? Do I trust this vendor? Questions for Your Colleagues Who did you look at? Who did you choose and why? What do you like about the system? What don t you like about the system? How is the customer service? Would you pick them again? 11

12 Questions for Vendors Do you have plans for your EHR to be interoperable? Are you HIPAA compliant? (Do you have a Business Associate Agreement) What level of support do you offer? Phone? /Ticket only? Are there premium support options? Questions for Vendors How many training hours are there and how is that training administered? Who owns the data and how would I export it if I needed to? Questions for Vendors Questions for Vendors What are the up-front and ongoing costs? Will there be any other potential costs outside of the agreement? What s included in implementation costs? How often are new features introduced? How does your system work with or replace current systems I m using? Do you have any references? 12

13 Questions for Vendors Questions for Vendors What security measures do you have enacted for data in transit and on the server? Is the data located on servers you own or do you contract with another company? What is your average uptime? What happens if there is a disaster at your data center? Health Information Exchange Cheryl Stephens, PH.D. Community Health Information Collaborative Building Bridges to Quality Health Care Creating Accountable Communities for Health April 12, 2014 Cheryl M Stephens, PhD President and CEO 13

14 Agenda 1. Overview of CHIC history of community work that has informed health information exchange (HIE) 2. HIE Governance representation of the stakeholder continuum 3. HIE Privacy and Security Policies and procedures protecting patient/client information 4. HIE Services Use Cases for community a record 5. PHR vulnerable populations and care coordination Community Health Information Collaborative Our mission is to provide regional access and utilization of health care information through collaboration. CHIC is a nonprofit collaborative of hospitals, clinics, long-term care facilities, tribal health organizations, higher education institutions and public health departments in Northeastern Minnesota. CHIC leverages information technology and collaborative relationships to help members improve care and save precious healthcare dollars through the following programs. Building bridges to quality healthcare MIIC USAC HIE GMTBI The Minnesota Immunization The Rural Health Care Program of HIE-Bridge is a system that speeds up The new Healthcare Connect Fund Information Connection (MIIC) is the Universal Service Fund (USF), access to medical information by Program Goals: confidential, computerized network of which is administered by the connecting doctors, nurses, and Increase access to shared immunization records. It Universal Service Administrative emergency staff to the facilities holding broadband for health care provides clinics, schools, and parents Company (USAC), is a support patients medical records. providers (HCPs), especially with accurate, complete, and up-todate immunization records. Benefits of HIE-Bridge: those serving rural areas. program authorized by Congress and designed by the Federal Foster development and Communications Commission (FCC) MIIC offers: Receive the quality of care you deployment of broadband to provide reduced rates to rural deserve as a result of transfer of health care networks. Clinical decision support on what health care providers (HCPs) for electronic medical record/ccd Maximize impact of the antigens and vaccine products are telecommunications services and documents FCC s universal service optimally due for given patient. Internet access charges related to the Military-grade security protects your health care funding use of telemedicine & telehealth. Reduced medical errors related to privacy The Healthcare Connect Fund is over- and under-immunization For heath care providers this means expected to bring thousands of new that support is available for Access to your medical information providers across the country into the Improved immunization rates through telecommunications services and reduces unnecessary medical retesting upgrade their connections. program, and allow thousands more to reminder and recall notices monthly Internet access charges used Assurance that you will know about for the provision of health care. Access reduces prescription errors Using lessons learned from these pilots, shots given to your patients in other CHIC provides administrative and alerts providers to any allergies the Healthcare Connect Fund could cut settings the cost of robust broadband health care assistance in document preparation CHIC is an Anchor Participant in the networks in half, through group Aids schools by providing complete between USAC and the healthcare ehealth Exchange, formerly known purchases by consortia and other accurate immunization records for providers for this program. and the Nationwide Health Information efficiencies. children enrolling in Early Childhood Network. Family Education (ECFE) and other preschool programs. Building Bridges to Quality Health Care Local Governance The ehealth Exchange / Healtheway PHR Support Organization State and Local Gov Community Health Centers SSA HIE Community #1 Labs Mobilizing Health Information Community-wide HIE VA CMS CDC Integrated Delivery System The Internet Pharmacies Standards, Specifications and Agreements PHIN Conference for Secure Connections HIE Community #2 25 August

15 Summary of HIE-Bridge Operating Policies and Procedures Policy # Name Purpose Policy Procedure Participation Review and To define the processes for becoming a P.O. Only providers that meeting criteria of Defines eligibility requirements, Disposition of Application of HIE- Bridge DESA may become P.O. receipt of aps, and evaluation of aps. Privacy and Security in HIE Protection Against Disclosure of To define the expectations by all on PHI protection of PHI within HIE- Bridge Prohibiting Storage of To define the expectation of never storing DESA: 4.02, 12.01, DESA Section 6 Signed BAAs and DESAs prior to implementation and biannual notification of obligations. Signed Technical BAAs with CHIC vendors. MN Health Records Act Record Locator Service Upload of ADT feeds without consent Unencrypted PHI on Portable Devices Requirements for Threat and Vulnerability Assessments Required Training on Privacy, Confidentiality, and Security PHI on portable devices To ensure there are plans to identify and address any vulnerabilities to HIE- Bridge To Identify the people and training required for HIPAA to protect patient privacy and confidentiality n/a Quarterly internal assessments and Internal Form completed, presented notice to Board; Annual external to board, action plans defined and in assessment; Annual form signed by PO minutes with status at next meeting, attesting to their assessment. (Form if action plans. Form for PO, annual Included) and kept for 7 years. Annual coursework through Annual certification of completion, MN.TRAIN; at least 4 hours include in personnel files or condition of on- going engagement for non- employees Consent Management Opt-outs, every patient must be asked Query first, prior to exchanging All exchange requires consent, unless medical emergency Addressing Reported Security To ensure that reported security breaches Incidents within the HIE- Bridge are handled within the HIE- Bridge network network so as to clearly notify all affected parties Authorized Access Rights To ensure role- based access is implemented and effective for all users Managing Complaints from Ensure consistent and appropriate conduct Participating Organizations and when addressing complaints Consumers Compliance with All Applicable Ensure CHIC remains compliant with state Law and federal laws DESA 12.03: Breach Notification Signing of DESA Requires all users to be assigned Complete form; submit to MEDNET; privileges for accessing PHI as per their install digital certificates. responsibilities. Defined Identify Proofing for Primary authentication for Primary Contact(s) Contact(s) Arrive at CHIC; CHIC forwards to 1. Receipt acknowledged and id MEDNET or Governing Committee, or who should respond keeps, based on type of complaint. 2. CHIC contacts complainer Acknowledgment to person within 2 3. Complainer notified weekly of business days progress 4. New policies/procedures developed and communicated as necessary. DESA defines this requirement All sign DESA; Gov. Committee reviews periodically Opt Out Policy and Procedure Ensure timely updates to CMS to add or PO are the patient interface, staff to POs train and prepare staff; Policy # Name Purpose Policy Procedure Opt Out Policy and Procedure Ensure timely updates to CMS to add or PO are the patient interface, staff to POs train and prepare staff; revoke patient requests to opt out be trained, all requests to CHIC to be materials are available, see diagrams processed within one business day of receipt Safeguards to Limit To ensure the identity and location of patient Requirements to ApeniMED in Annually, ApeniMED will document Unauthorized Disclosure of PHI records is protected at all times. addition to Safeguards in DESA their current technologies (Sections 6 Security and implemented to meet this policy. Safeguards) Also will discuss with GC and Technology group Requirements for Audits on To identify any unreported breaches, or help CHIC will conduct quarterly and annual CHIC will audit 20 random log Appropriate Use of HIE- Bridge verify any reported breaches of patient (external) audits of its HIE- Bridge use; entries against opt outs quarterly information across the HIE- Bridge exchange PO s are required to annually attest and report to the board with written that their audits align with written or explanation of any issues; CHIC will emergency encounters. engage outside auditors to do this annually; PO s will complete form attesting that they had tested at least 10% of their queries annually Expectations for Security To establish a process to continuously CHIC shall establish appropriate Annually, CHIC s Security Officer will (CHIC Internal Policy) monitor and perform an annual technical processes within its business review and assess CHIC s existing and non- technical security evaluation based operations to review all policies and security policies and procedures for on applicable Federal and State regulations procedures affecting the security of consistency with laws, relevance, and standards and subsequently respond to electronic PHI. These reviews must be and consistency with DESA and changes affecting the security of Electronic conducted at least annually if initiated Technical BAA s. PHI that demonstrates the extent to which by a known change or incident. CHIC s security policies and procedures meet the requirements of Federal and State regulations Annual Review of Authorized To ensure that only authorized Participant Participating Organizations should notification and annual review Users Users of the HIE- Bridge network, who are notify CHIC/ApeniMED when new and update of list of Authorized currently in a position to use HIE- Bridge only users are to be added to or users are Users. for Permitted Purposes, continue to have removed from the HIE- Bridge system access to HIE- Bridge and to establish a in accordance with other policies. process by which Participant Users no longer requiring access are removed from the system. HIE-Bridge Services and Offerings HIE- BridgeDIRECT Secure, encrypted Shared directories HIE-BridgeConnect Continuity of Care Document Exchange Minnesota Immunization Information Connection (MIIC) Medications History Claims Eligibility Lab Results Delivery HIE-BridgeConnect with connection to the ehealth Exchange Social Security Administration (SSA) Veteran s Administration - Virtual Lifetime Electronic Record (VLER) 15

16 Managed PHR Web-based Easy-to-Use HIPAA Compliant Secure, data downloaded from systems Relevant to Vulnerable Populations Life-long Clinician, Caregiver, Case Manager & Family Access Community Health Information Collaborative Building Bridges to Quality Health Care Questions? and Thank you! Cheryl M Stephens, PhD President and CEO Community Developments Trisha A. Stark, Ph.D., LP, MPA Extra challenges for mental health First mental health EHR developed in attempts to create a standard mental health data set 16

17 Extra challenges for mental health Great variability in what and how different mental health organizations enter information into a patient record More use of narrative as opposed to discrete data elements Greater need for care continuity Who s Working on This? SAMHSA Office of the National Coordinator State of Minnesota e-health Initiative Payers Private Sector Other States Multidisciplinary Efforts Use of DIRECT Model to increase access and exchange prior to full implementation of EHR Distinct Behavioral Health HIE that either segregates data or links with additional permissions to State HIE. Community training Grant activities Exploration of vendor contracting 17

18 State Innovation Model Minnesota e-health Summit E-Health Grant from CMMI Focus on Settings such as behavioral health Developing a community behavioral services data set June 11-12, 2014 Opportunity for broad learning about Health Information Technology Vendor Fair Behavioral Health Workshop Minnesota e-health Advisory Committee Mental Health representation Participation in workgroups Privacy and Security Health Information Exchange Standards and Interoperability Contact Information Jim Jonas, MSS, LICSW. LMFT The Jonas Center Director, The Jonas Center Joe Kalaidis, CPHIT Health IT Consultant Stratis Health and REACH - Regional Extension Assistance Center for HIT office mobile 18

19 Contact Information Trisha A. Stark, Ph.D., LP, MPA EHR Task Force Chair, Minnesota Psychological Association Cheryl Stephens, Ph.D. Community Health Information Collaborative President and Chief Executive Officer

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