HealthInfoNet’s Behavioral Health Information Technology Reimbursement Initiative September 15, 2015 Dial: Enter access code #

Q & A During the Presentation: The call is muted to ensure good sound quality. We are using the ReadyTalk chat feature to facilitate questions during the presentation. Please send your questions to “All Panelists” or privately to the Chairperson. Q & A will follow the presentation You can continue to submit questions via chat Or you can press (*7 Unmute) (*6 MUTE) to ask a question. 2

Meeting Objectives 1.Introduction & Goals (Katelyn Michaud) 2.Discuss SIM Grant targets remaining for 2015 & new Payment for Milestone 3 (Katie Sendze) 3.Introduction to HIN Quality Improvement Project (Katie Sendze & Gemma Cannon) 4.Clinical Report from the Field: How CHCS Leverages the CP to Provide Quality Care (Brenda Mailman, CHCS) 5.Technical Report from the Field: Testing the Crisis Report (Margaret Longsworth, OHI) 3

Goals for Today’s Meeting Focus on targets: All BHOs will move forward with Milestones 2.1, 2.2, and 2.3 ( Go-live with “View Only,” Send test data to HIN’s Test Environment, Send test data to HIN’s Production Environment) All BHOs will plan Quality Improvement project (Milestone 3.1) 4

Focus on 2015 Deadlines: Milestone 2 and Milestone 3.1 Katie Sendze 5

Data Collection Progress 20 have bi-directional data sharing connection to the HIE. o VPN/network connections are in place o 16 out of 20 are viewing HealthInfoNet 14 have confirmed data integration capability with HIN o Installed interfaces o Underway with data testing validation--- focus on testing 2 are finalizing production data validation 5 have live client data in the HIE o Completed HL7 data integration testing o Transmitted live data to HIN’s production environment 6

Focus on September Goal: The data validation process involves two major steps: –Test Data Validation: EMR will send data to the HIN Test environment. You perform a scenario in your EMR on a test patient (registering the patient, adding diagnoses, etc.) and you will verify that the data carries over properly to HIN. –Production Data Validation: Your EMR will send data to the HIN Production environment. We have filters in place that prevent live data from flowing into HIN at this stage. You would perform the same scenario that you used in test validation. 7

2015 Fall Targets Milestone 2 MilestoneDeadlineMilestone DetailsPayment Milestone 2.24/1/2015HL7 data integration testing completed for ADT and CCD messages. Test data validation for ADT or CCD messages should be completed by this stage. Work should start on production data validation at this point. (6 of 20 have met this Milestone) Milestone 2.39/30/2015HL7 data is live in the HIE production environment. By this Milestone, production data validation should be completed and the organization should be sending live patient data to the HIN production environment. $10,000 (5 of 20 have met this Milestone) 8

Reduce Delays Communicate with your vendor about testing/ technical delays or barriers Request and check in on the timeline for solving delays. Attend regular scheduled calls per Rob’s guidance. Assure your vendor is engaged with recurring calls. Carve out the weekly time needed to perform testing activities. 9

Final Milestone Quality Improvement: Milestone 3.1: Quality Measure is selected for implementation Milestone 3.2: Quality Measure Data has been tested in measure environment at HIN Milestone 3.3: Quality Measure is produced and reported by HIN to participants 10

HIN Quality Improvement Project Quality Improvement Project for all SIM-HIN BHOs: Using HIN tools to reduce unnecessary utilization* Aligns with SIM focus areas: –Health Homes –Utilization (ED, inpatient)* –Transitions of care (Hospital to community, PCP) –Chronic Disease management 11

HIN Quality Improvement Project Leveraging HIN Tools to Reduce Utilization HIE Clinical Portal –Real-time patient information portal gives BHO Providers access to results and information from outside of the EHR HIE Notifications Service –Real-time electronic “notifications” about specific events of care (i.e., ED & inpatient admin/discharge, new lab results) supports intervention and follow up with clients 12

Delays 13

The HealthInfoNet Quality Improvement Project Gemma Cannon 14

HIN’s BH Quality Goal To support BH goals in reduction of healthcare waste & unnecessary costs & improving the health clients served by: Using HIE tools that provides real time access to medical information across systems of care Responding to real-time notifications for ED and Hospital Admissions 15

The Quality Measure- Draft Objective: To determine if real-time HIE tools available to BHOs can reduce ED/Hospital admissions for BH patients at high risk of ED/hospital utilization. HIN Measure: Compare ED/hospital admission reports for two 6-month periods: o A 6-month period without BH intervention utilizing real-time HIN notifications o A 6-month period with BH intervention utilizing real- time HIN notifications HIN Deliverable: Compare the two reports and analyze the difference 16

Quality Improvement Project: Reducing ED/Hospital Admissions All BHOs will: Receive & implement HIN ED and Hospital Admission notifications for a specific patient panel for 6 month period (Dec – May) (those ready can start sooner) Report the staff intervention plan that uses the notification service (can be aligned with QC) HIN will: Compare admissions during 6 mo. reporting period w/ 6 months in CY

You Choose how to Receive Notifications Steps you will take: 1.Determine which “panel” of clients you aim to intervene with to meet the goals of the project 2.Decide which staff/roles will be receiving the notifications (e.g. BHH RN) o Options for example, a team vs. single address can be used to receive the notifications 3.Determine how you want the information to be sent & what your intervention plan will be? o In real time (i.e., during ED/hospital admission) or a daily summary of all events from the prior day 18

You Choose the Clinical Portal Interventions Examples: Assist with care transitions Conduct Medication Reconciliation Coordinate care Encourage self-management of chronic disease Make referrals to appropriate resources Educate patients about appropriate use of ED Provide an onsite visit at time of ED/Hospital Admission or same-day services post-discharge 19

Choose your Patient Panel You choose the size o Minimum of patients o You know your clients best You decide who to include o BHH patients, o ACT Team clients, o Individuals with SMI & chronic physical health needs o Those with high hospital utilization patterns Inclusion limitations o Client must have MaineCare insurance 20

Shared Requirements All BHOs will leverage HIN Notification Tools All BHOs have same goals and tasks All BHOs have same panel requirements All BHOs have same timeline All BHOs will send a Clinical Portal audit and quality report 2x per month 21

Milestone $10,000 Milestone Payment upon receipt of first Audit and Quality Report showing project has successfully begun

Primary Goal Use HealthInfoNet Notifications to: Reduce ED visits Prevent Hospital Re-admissions 23

Primary Goal Tasks Identify your patient panel and verify that each individual : o Has MaineCare insurance o Patients who have opted-out of the HIE will be removed by HIN’s measure Select workflow for receiving and responding to HIN Notifications Identify quality interventions your BHO will implement Determine what staff to include in the project. 24

Goal #1 “ Use Health Information Exchange to efficiently share information and communicate patient information across systems of care.” 25

Goal #1 Tasks Leverage Usage of Data in HIN CP to: Identify the medical providers for your patient panel Increase use of HIN tools to support care- coordination o Notifications o Patient Record Get real-time clinical data to inform best care plan & follow-up 26

Goal #2 “ Establish accountability and team roles.” 27

Goal #2 Tasks Identify roles & responsibilities of team members o Quality Specialist, Auditor, Clinical Staff, Support staff, etc. Select the interventions you will implement o Who, what, where and when 28

Goal # 3 “ Engage with patient, family, caregivers and guardians to reduce ED and hospital admissions and improve transitions of care.” 29

Goal #3 Tasks Develop prevention plan with your clients by: Meeting with patient/caregivers before and after ED/Hospital admissions Using the CP to review reasons for past admissions Problem-solving any barriers to medical care and optimal health Including your interventions as part of your contract with your clients (i.e., communication with PCP) 30

Project Requirements BHO must have a “View-Only” connection with HIN Staff on Quality Improvement Project must have active CP Accounts. o Must be educated about their role and specific responsibilities o Must have training to support the project as needed Notifications must be set up and in place. Consent Education must be “live” for departments with patient panel 31

Project Requirements (cont.) Quality officer and Auditor will send reports to HIN 2x per month BHO will complete HIN QI forms and return by October 15, 2015 Quality Improvement Project team leads will meet with HIN o Phone meetings to discuss submitted Quality Project Plan details 32

For October, HIN will provide: Template for Quality Improvement Project (The completed template is your Quality Improvement Project plan) Quality Improvement Project Manual Phone calls with Gemma & Katelyn and your Quality Team Audit Report and Quality Report templates 33

Next steps for QI Project Determine your project interventions & select the patient panel for receiving notifications (ED/Inpatient utilization) Due end of October Submit names of your Auditor and your Team Lead on the Quality Improvement Project (same as HH?) to Gemma Due ASAP Schedule a Quality Improvement Project Planning Meeting with Gemma & Katelyn Due 9/25 Must implement or expand “View-Only” access to staff who will work on QI 34

Alignment with Maine Quality Counts Mary T Beyer, MA Behavioral Health Homes Quality Improvement Specialist Office: , ext

Using HealthInfoNet to Reduce ED Use and Improve Quality Care Brenda Mailman, RN Nurse Care Manager Community Health and Counseling Services 36

Maximize the Potential for Better Outcomes How Community and Counseling uses the Clinical Portal to care for clients with SMI and chronic disease: Coordinate care Mitigate medical issues that contribute to Mental Illness Identify prescriptions Provide a safety-net while honoring the client’s autonomy Provide integrated BH intervention to address medical issues and reduce ED visits 37

Realized Clinical Benefits Able to see client medical history Able to see prescription fill history & activity Access to lab results Access to treatment summaries from ER Able to reconcile reports from other sources Able to replace hours spent in getting permission to view a client’s record to provide care for clients 38

Clinical Portal Case Study #1 Reducing ED Visits & Increasing Quality of Care Before Connection to HealthInfoNet: Diabetic Client admitted to ED 12 times in last calendar year o In-dwelling catheter contributed to multiple UTIs After Connection to HealthInfoNet: Nurse Care Manager can track his ED visits, his A1C counts and his UTIs o Used education to change his response to his medical needs o Only 2 ER visits in last quarter (due to an accident) o A1Cs have come down and UTIs have been reduced 39

Clinical Portal Case Study #2 Integrating BH and Medical Care Before Connection to HealthInfoNet: Client presents with high BP at the BHO o BP measured & meds prescribed by PPC not known to the BH Provider After Connection to HealthInfoNet: BHO is able to reconcile BP Measures & meds from PCP and provide effective follow up with the client o Used nutrition education to decrease client’s salt intake o Provided information and instruction on effective use of meds o BP measures have improved post BHO intervention 40

Summary Decreased ED Use Increased integration of BH and Medical Care Real-time data resulting in improved quality care “It’s amazing what you can do when you have the information. With HealthInfoNet, I have the information to do my job better and faster.” Brenda Mailman, RN 41

Sending Data to the HIE: Updates from OHI Margaret Longsworth, LCPC Director of Mental Health & Clinical Services OHI 42

Innovations: Testing the Crisis Prevention Plan State has requirements for Providers of Community Integration Services (Case Management) o Must have crisis plans and treatment plans o Must make these plans available to crisis providers when there is a need. OHI is test-sending their Crisis Prevention Plan to HealthInfoNet (HIN) o Needs to determine & prioritize what primary care providers and BH providers wants OHI to send to HIN o Needs to consider how regulatory requirements re: re- assessments and subsequent re-diagnoses present challenges in transferring information 43

Discussion What information would you see as most important to send from the Behavioral Health Record to HealthInfoNet? 44

What Would Best Support Improved Outcomes if Available in the HIE? Adult Needs Strength Assessment (ANSA) Children’s Habilitation Assessment Tool (CHAT) Crisis Prevention Plan Diagnostic Summary (DSM 5, DSM-IV, ICD-10, ICD-9, SNOWMED) Discharge Summary Individualized Treatment Plan Level of Care Utilization System (LOCUS) Mental Status Evaluation Progress Notes Psychological Evaluation Psychosocial/Bio- psychosocial Assessment Other Note: Substance abuse restriction 45

Clinical Portal Usage FAQs Gemma Cannon 46

Why Is There An “Error Message” When I Break the Glass? 47 An “Error Message” shows when there’s no BH Data in the system.

No More “Error” Message 48

How Can I Correct Inaccurate Client Demographic Information? All Data in HIN comes from participating hospital and provider EHRs o Data needs to be corrected from the source EHR o Data corrected in the source EHR will concurrently be corrected in the HIN Portal However, if critical information is incorrect, please securely 49

Why Does My Client’s Name Appear Twice in the Portal? HIN needs enough data in the system to confirm that two separate records in the system belong to one individual o HIN will not merge two distinct records without enough data to support linkage Call us if you have additional identifying information that can link two separate records. o Contact Deb Wilson for assistance ) 50

Is the “Auditor Role” a Requirement? The “Auditor Role” is a requirement for all participating organizations. –The Auditor ensures that only authorized staff use the Clinical Portal –Access is limited to audit reports to see who has accessed patient records and the reasons they gave for accessing those records. –Role often filled by Security Officers or Quality Specialists Each facility that participates in HIN should have at least one, preferably two people designated as the “auditor.” 51

Questions? 52