Health Information Technology: Building the Bridge Between Correctional and Community Based Care

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Eleanore Powell
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1 Health Information Technology: Building the Bridge Between Correctional and Community Based Care NYS Correctional Medical and Behavioral Healthcare Workshop December 9, 2014

2 Who s in jail? Massachusetts Sheriffs Association reported that 42 percent of inmates in the county jail system have mental illness and 26 percent have major mental illness * Cook County Sheriff Tom Dart on the CBS news magazine "60 Minutes," called jails "the new insane asylums"* "We have seen the collapse of the mental health system show up in our local jails. Everyone agrees that's not the best place for many of these people," --New Hanover County District Attorney Ben David of North Carolina. * *Excerpts from COCHS MediaScan: 2

mental illness * Cook County Sheriff Tom Dart on the CBS news magazine "60 Minutes," called jails "the new insane asylums"* "We have seen the

3 Widespread Interest in Diversion Many jurisdictions would like to divert the mentally ill out of jail Correctional healthcare providers are poorly equipped to treat these individuals Correctional institutions are often overcrowded Behavioral health organizations are motivated to assist in diversion programs 3

equipped to treat these individuals Correctional institutions are often

4 Sequential Intercept Map Many jurisdictions employ the Sequential Intercept Map Identifies different paths a person with mental illness takes through the criminal justice system Identifies where and what diversion can occur so that people with mental illness have alternatives to incarceration 4

takes through the criminal justice system Identifies where and what

5 Arrest Common Intercept Points -- possible programs and responses -- Police receive crisis intervention training (CIT) Person diverted to crisis center instead of jail Incarceration Connect with case manager or peer counselor Release contingent on appearing at court hearing Release Re-entry planning Enrollment in insurance: Medicaid Expansion 5

Incarceration Connect with case manager or peer counselor Release contingent on

6 The Critical Role of Data Many of the mentally ill who come into contact with public safety have multiple exposures to the criminal justice system Likewise these individuals usually have had involvement with behavioral health providers Both public safety and behavioral providers are likely to have data about such individuals in their different systems Many jurisdictions have begun to bridge these systems to take advantage of data from both silos by building electronic systems that create data sharing to create more effective ways to divert the mentally ill out of corrections 6

likely to have data about such individuals in their different systems Many jurisdictions have begun to bridge these systems to take advantage of

7 What Does Bridging Data Systems Require? Technology locate data agree on data interoperability standards implement the mechanism of data sharing Consent identify laws and regulations that require consent to share health information address these laws and regulations so that data can be shared Assistance determine what funding sources or technical advice are availableto implement data sharing 7

sharing Consent identify laws and regulations that require consent to share health information

8 Technology: Data Sources Jail management System (JMS*) Correctional and community electronic health records (EHR) Medicaid Management Information Systems (MMIS) *For more information about acronyms and definitions see COCHS glossary: 8

Information Systems (MMIS) *For more information about acronyms and

9 Technology: Data Interoperability Multiple standards for data exchange Justice and Medical (JMS and EHR) Common data elements National Information Exchange Model (NIEM) Medical to Medical (Correctional EHR with Community Systems) Vocabulary standards (ICD/9 and ICD/10, SNOWMED, LOINC, CPT, RxNorm) Messaging standards (HL/7) Document standards for transition of care (CCD) 9

Medical (Correctional EHR with Community Systems) Vocabulary standards (ICD/9 and ICD/10,

10 Technology: Sharing Data Between Systems Crosschecking manually Interfaces between different systems, such as EHR with JMS Health Information Exchange (HIE) 10

11 Consent: HIPAA Corrections has a right to medical records for the safety and security of the institution. However, this is not well understood and is often ignored To address consent issues some organizations embed personnel within public safety, other organizations recognize that a sharing of care relationship exists between two covered entities 11

However, this is not well understood and is often ignored To address consent issues

12 Consent: 42 CFR Part 2 42 CFR Part 2 is much more restrictive than HIPAA. Consent to share is granular: patient gives consent to specific providers; consent is time limited; consent can be revoked at anytime; and providers cannot share information with other provider who are sharing care To address consent issues some organizations avoid 42 CFR Part 2 data and some have implemented technological solutions that manage to address the complex consent issues 12

revoked at anytime; and providers cannot share information with other provider who are sharing care To address

13 Assistance: Monetary and Technical Organizations specifically interested in public safety Bureau of Justice Assistance (BJA) National Consortium for Justice Information and Statistics (SEARCH) Organizations with a broader scope PEW SAMHSA s GAINS Center Jacob & Valeria Langeloth Foundation Council of State Governments (CSG) HITECH Programs Meaningful Use Incentive Programs 13

(SEARCH) Organizations with a broader scope PEW SAMHSA s GAINS Center Jacob & Valeria

14 Bridges Built: Four Examples Wyandot Center and Community Partners, Wyandotte County, Kansas City, KS Salt Lake County, Utah Pima County, Tucson, Arizona New York City 14

15 Wyandot Center and Community Partners CIT Implementation: Embedded Wyandot Center co-responder within police department BJA grant funded laptop for co-responder to view health records in Wyandot center s Behavioral Health Record. Since co-responder was a Center provider no consent issues are violated BJA grant expanded crisis center hours to a 24/7 schedule Data Sharing with Jail Embedded liaison at jail who crosschecks jail management system with Wyandot Center's Behavioral Health Record to identify clients who are booked into the jail Liaison alerts case managers when clients are identified Metro Kansas City Safety Net Information Exchange: a safety net provider HIE. Some discussion of jail being identified as safetynet provider 15

Since co-responder was a Center provider no consent issues are violated BJA grant expanded crisis center hours to a 24/7 schedule Data Sharing with Jail Embedded liaison at jail who

16 Salt Lake County Integrated Justice Information System (IJIS): Initiated by Salt Lake County s Criminal Justice Advisory Council (CJAC) Goal to use data to divert people from corrections due to overcrowding at the jail Data from multiple agencies presented in a web portal, the Summary Offender Profile (SOP) --including data from jail management system and data from behavioral health providers in the community. Incorporated 42 CFR Part 2 mechanism of EHR (UWITS System) to meet consent requirements Parole and probation and behavioral health providers have accessto SOP in order to manage interventions Working with Council of State Government to create dashboard to identify effectiveness of interventions Planning to connect jail s EHR with Utah s HIE (chie) 16

17 Pima County, Tucson, Arizona Pima County Justice-Health Information Data Exchange(PC-JHIDE): Health care provider in jail required to identify and separate inmates with mental illness First solution was to access Arizona s Medicaid Management System but unsuccessful due to connectivity and data reliability issues. Health providers resorted to phoning the Regional Behavioral Health Authority to identify inmates with past behavioral health histories SEARCH funded the PC-JHIDE. A real-time system using booking data to query behavioral health EHR to identify previous clients. PC-JHIDE is an HIE that populates a correctional EHR with data from the behavioral health EHR PC-JHIDE has NIEM based architecture to create interoperability between systems sharing data Planning to use PC-JHIDE for pre-trial services to divert people with a behavioral health history Arizona Health-e Connection (AzHeC) For somatic health, jail health providers have access to statewide HIE 17

Health providers resorted to phoning the Regional Behavioral Health Authority to identify inmates with past behavioral health histories SEARCH funded the PC-JHIDE.

18 New York City Medicaid Meaningful Use Incentive Program Change in CMS regulation for Medicaid meaningful use opened the door to some correctional institutions participating in the incentive program Medicaid patient volume requirements now based on enrollment status instead of claims Baseline criteria for participation: a state suspends instead ofterminates Medicaid upon incarceration; Medicaid status available; state has expanded Medicaid; and jail has certified electronic health record technology (CEHRT) New York State has expanded Medicaid and suspends Medicaid upon incarceration; New York City s Rikers Island has access to Medicaid enrollment data from the Office of Health Insurance Services; and Rikers Island has a CEHRT. So far New York City has received $21,250 for each provider deemed eligible (currently 63). For more information see: SHIN-NY (HIE) Coordination of care with community providers Receiving consent from persons incarcerated to access health data; when medically necessary, access health data without consent (break the glass) 18

status available; state has expanded Medicaid; and jail has certified electronic health record technology (CEHRT) New York State has expanded Medicaid and suspends Medicaid upon incarceration; New

19 Noteworthy Developments* 42 CFR Part 2 Rhode Island s HIE, Current Care, has implemented a consent mechanism that permits inclusion of substance use disorder data NIEM Hampden County, Massachusetts: Hampden Inmate Re-entry Exchange (HIRE) shares data from Hampden County s JMS with community providers using NIEM framework HIE The jail in Lexington Kentucky is sending ADT messages to the state s HIE, the KHIE Multnomah County, Portland, Oregon and Hennepin County, Minneapolis, Minnesota both use Epic systems at their jails and share data via Epic Care Everywhere, Epic s HIE *For more information on health information technology in jails see: 19

Kentucky is sending ADT messages to the state s HIE, the KHIE Multnomah County, Portland, Oregon and Hennepin County, Minneapolis, Minnesota both use Epic systems at their jails

20 Best Practices? From the multiple examples presented, it is obvious that there is no boiler plate best practices that can be applied to each jurisdiction to create data sharing bridges between justice and health. Rather, the examples show that each jurisdiction has its own landscape and its own imperatives. How these jurisdictions implement data sharing is a process of identifying how and where technological solutions would have the most benefit: either to divert people from the justice system or to provide a more informed transition of care during and after incarceration. 20

create data sharing bridges between justice and health.

21 Questions? Ben Butler 21

Trends in Health Information Technology Impacting Correctional Health

Trends in Health Information Technology Impacting Correctional Health Presented on Friday, March 21, 2014 at the 7th Academic and Health Policy Conference on Correctional Health Prepared by Disclosure