2. Series 1: “Meaningful Use” for Behavioral Health Providers 9/2013 From the CIHS Video Series “Ten Minutes at a Time” Module 9: A Closer Look at Exchanging the Continuity of Care Record (CCR) and Clinical Summary

3. Overview National data and technology standards for exchanging information What information is shared When it is shared How it is shared (HIPAA compliant, 42 CFR Part 2 compliant) Who it is shared with Developing health information exchange processes and procedures – the Referral Loop

4. Behavioral Health Role in PBHCI Jeffrey - 33 year old male, presents at Stepping Stones BH Center Patient psychiatric and medical conditions need to be stabilized BH screens and admits, develops psychosocial summary, collects information on Active Medications, enters initial diagnosis, preliminary treatment plan Referral to psychiatrist generates psychiatric medications Referral to PCP to address physical health issues, initiate engagement in Wellness Activities (warm transfer) BH primary ensures the patient is adequately supported in attending appointments, conducts follow up on referrals outcomes and ensures any additional support

5. Primary Health Role in PBHCI Jeffrey - 33 year old male, presents at the Community Cares FQHC, referred by Behavioral Health partner Nurse Care Manager conducts health screenings, collects vital signs Primary Care Provider refers to patient data collected by nurse AND to patient data from the referral source, conducts physical exam Orders diagnostic tests, places medications orders and makes referrals for specialty care Patient engaged in Wellness activities BH Provider routinely receives information on outcome and Wellness Plan, plays supporting role in patient medications compliance, participation in Wellness as part of treatment plan

6. Continuity of Care Document / Continuity of Care Record (CCR/CCD) Minimum Data Set 1) Allergies and other adverse reactions 2) Medications (including current meds) a. Admission medications history b. Hospital Discharge Medications (hospital) c. IV Fluids administered (hospital) d. Medications administered 3) The problem list (diagnoses) a. Active problems b. History of past illness c. Hospital Admission Diagnosis (hospital) d. ED diagnosis (hospital) e. Discharge diagnosis 4) List of surgeries (if hospital) 5) Diagnostic results (i.e., labs, imaging, etc.) Originating Entity Information Patient Information http://www.healthit.gov /providers- professionals/achieve- meaningful-use/menu- measures/transition- of-care

7. http://www.corepointhealth.com/sites/def ault/files/whitepapers/understanding-the- continuity-of-care-record-ccr.pdf CCR/CCD May Also Contain -Vital signs -Insurance information -Health care providers -Encounter information -Procedures -Necessary medical equipment -Social history -Family history -Care plan

8. Everything in the minimum CCR/CCD data set PLUS Immunizations or medications administered during visit topics covered/considered during the visit things to do before the patient leaves the building when next appointment is recommended other appointments/testing patient needs to schedule patient decision aids recommended appointments/testing already scheduled test results symptoms personalized instructions/notes considerations (i.e., timing of meds with work/school schedule) health information related to topics discussed Clinical Summary http://www.cms.gov/Regulations-and- Guidance/Legislation/EHRIncentivePrograms/downloads/13_Clinical_Summaries.pdf

9. Clinical Summary Full Clinical Summary is given to the patient at end of visit Can also be used to follow up with referring entities HRSA Guidelines for engaging patients and family can be helpful in conceptualizing information exchange http://www.hrsa.gov/healthit/toolbox/HealthITAdo ptiontoolbox/MeaningfulUse/intro2meaningfuluse andpatientandfamily.html

10. How is Critical Information Shared? State or Regional Health Information Exchange http://www.healthit.gov/providers-professionals/health-information- exchange/getting-started-hie Nationwide Health Information Network “Direct” http://wiki.directproject.org/User+Stories http://wiki.directproject.org/User+Stories Simple, secure, scalable (a type of email system) Point-to-point transmission / receipt on network of verified providers Supports policies and procedures that ensure adherence to HIPAA and 42 CFR Part 2 More info http://nwhin.siframework.org/Direct+Project+Basicshttp://nwhin.siframework.org/Direct+Project+Basics

11. Integrated Care Referral Loop Scenario 5. Critical information is communicated to BH provider and the the patient, using built-in social support 2. Critical information is effectively communicated to the patient 3. PCP receives referral, BH ensures patient presents for appointment 4. PCP conducts exam, orders tests and medications; Wellness Coordinator engages in activities 1. BH Provider: psychosocial services, medications management; refer to PCP 1. Transmit CCR/CCD data to PCP, via NwHIN Direct / or other means 2. Patient receives “Clinical Summary” from BH, and social support is engaged 3. PCP integrates BH data into patient record. Low “no-show” rate due to warm transfer and use of social support 5. BH also receives PCP Clinical Summary, plays ongoing supportive role in patient care 4. Results and referrals from PCP visit are in the Clinical Summary that the patient receives at the end of the visit.

12. Summary Exchange of patient information is the “new normal” in health care. Adoption of EHRs and implementation of “Meaningful Use” is happening all over the country. The data and technology standards are well-established and thoroughly endorsed by a host of federal and international agencies. There is no question that “Meaningful Use” will continue to evolve and expand over time. Behavioral health providers can and should participate in “Meaningful Use” and the exchange of patient information. It is possible to do so while remaining in full compliance with applicable federal and state regulations.

13. We Have Solutions for Integrating Primary and Behavioral Healthcare Contact CIHS for all types of primary and behavioral health care integration technical assistance and training needs 1701 K Street NW, Ste 400 Washington DC 20006 Web: www.integration.samhsa.govwww.integration.samhsa.gov Email:integration@thenationalcouncil.orgintegration@thenationalcouncil.org Phone:202-684-7457 Prepared and presented by Colleen O’Donnell, MSW, PMP, CHTS-IM for the Center for Integrated Health Solutions