Health Information Exchange: It Gets Real in the Field
eSolutions: Health Information Exchange
Feature: Health Information Exchange: IT Gets Real in the Field
Grantee Profile: The Providence Center
Charlie Hewitt, MBA, Director of HIE Product Delivery, Rhode Island Quality Institute, and Michael Lardiere, LCSW, Vice President of HIT & Strategic Development, National Council for Community Behavioral Healthcare
In the past, the specialty behavioral health system operated independently from primary care in a paradigm that drove it along a completely separate path of systems development. But today, healthcare leadership has identified an urgent need to integrate primary and behavioral healthcare to improve the healthcare system in general.
Primary and behavioral healthcare providers agree that participation in health information technology and health information exchange — with client informed consent — is essential to realizing true integration. This is why the SAMHSA Strategic Initiative #6 for Health Information Technology seeks to ensure that “the behavioral health system, including states, community providers, and peer and prevention specialists, fully participates with the general healthcare delivery system in the adoption of Health Information Technology (HIT) and interoperable Electronic Health Records (EHR).”
As part of the SAMHSA-HRSA Primary and Behavioral Health Care Integration initiative and the SAMHSA National Prevention Strategy to link primary and behavioral healthcare needs, the SAMHSA-HRSA Center for Integrated Health Services (CIHS) provided technical assistance and training to 47 behavioral health provider organizations and five state health information exchanges (HIEs) or their state designated entities (SDEs) to identify the barriers to this participation and help them discover and implement real-world solutions.
These providers and the HIEs/SDEs addressed the challenges by adopting EHR technology and working together to find avenues for participation in health information exchange.
Peek Inside Rhode Island’s State Designated Entity
Rhode Island Quality Institute (RIQI) and the Rhode Island community mental health organization partners have enabled Rhode Island behavioral health providers’ ongoing health information exchange. Access to CurrentCare — Rhode Island’s health information exchange (HIE) — enables integration of behavioral health into the exchange between primary care physicians and other clinical specialists.
CurrentCare is a secure electronic network that collects health information from across the care continuum, and now includes behavioral health. Healthcare providers access the information to help deliver safe, appropriate care.
“CurrentCare is particularly valuable in behavioral health care because providers can effectively monitor medications dispensed and picked up at pharmacies throughout the state, coordinate appropriate follow-up care after hospitalizations, and track lab results from the major diagnostic lab services across Rhode Island,” said Dr. Jonathan Leviss, chief medical officer at RIQI. “Aligning behavioral health with primary care is essential to patient-centered care. Providing access to clients’ health information through CurrentCare is a big step in this effort.”
Behavioral health sites join over 200 existing enrollment partners through which patients can “opt-in” to participate in CurrentCare (in the “opt-in” model, patients volunteer to participate in health information exchange). From the date of enrollment, health data is deposited into CurrentCare and available for a person’s treating providers.
CurrentCare presently collects results from most hospital laboratories in the state and from national partners. They also collect admission/discharge information from nine hospitals and emergency departments and EHR “Clinical Summaries” (Core Objective #13 of Meaningful Use) from a growing list of practices.
Patient medical history can be accessed through the CurrentCare Viewer, an online portal, along with a medication history that includes prescriptions dispensed in Rhode Island pharmacies. As one behavioral health physician noted, “With CurrentCare, I don’t experience the frustration of not having the medication history that clients don’t — or can’t — always provide. Client care and safety are improved with CurrentCare.” By November 2012, 100% of the targeted Rhode Island community mental health organizations had access to patient data via the CurrentCare Viewer.
RIQI will also help behavioral health providers establish Direct Secure Messaging accounts and integrate their use into workflows through RIQI’s Direct Adoption Program. Direct Secure Messaging, launched by the Office of the National Coordinator (ONC), is the new national standard for secure emailing of personal health information over the Internet.
Direct is currently available to primary care providers and specialists in the Rhode Island, providing a mechanism for behavioral health and physical health providers to share the personal health information of shared patients on a point-to-point basis during the care coordination process. Rhode Island is similar to other states and in line with ONC expectations that both models of sharing information, (through a combination of accessing the state HIE and point-to-point exchange using Direct), will exist side by side as tools for providers to improve care coordination.
In the state, 77% of community mental health organizations and more than 90% of other behavioral health providers have adopted Direct Secure Messaging. At one community mental health organization, Direct allows for secure and easy exchange of personal health information. Previously, staff would often have to physically transport data from one location to another. Now, they can send this information easily and securely. The Kent Center and Kent Ambulatory Care (Warwick, RI) use Direct to coordinate care. Butler Hospital (Providence, RI) has initiated a campaign to have its referral partners use Direct messaging to coordinate care and securely exchange critical patient data.The combined use of the CurrentCare Viewer and Direct messaging provide a major advance toward the goal of an integrated behavioral and medical health care delivery system.
Rhode Island, along with Kentucky, is the first state HIEs in the nation to share mental health and substance use information. These are significant accomplishments and provide a roadmap for other states to move forward to provide better quality care and care coordination for people with behavioral health disorders.
Two other states — Maine and Oklahoma — share mental health information through their HIEs. Illinois, Maine, and Oklahoma use Direct to share substance use information.
An HIT Grant Provides a Roadmap for All States
The Providence Center in Rhode Island works with Providence Community Health Centers (PCHC) and Blackstone Valley Community Health Care to provide integrated primary and behavioral healthcare. Last year, SAMHSA awarded them a PBHCI Health Information Technology Supplement grant and the agency identified two goals to help realize a single overarching outcome.
- Upgrade from multiple separate uncertified electronic health record (EHR) modules to a certified complete electronic health record (EHR) with integrated modules to meet the Centers for Medicare and Medicaid’s Stage 1 Meaningful Use standards and related HIT supplement grant expectations
- Participate in the Rhode Island Quality Institute’s “CurrentCare” health information exchange (HIE).
The Providence Center believed that achieving these goals would lead to improved health outcomes for the people they serve enrolled in the “Whole Health Partnership", the name that they gave to their integrated primary and behavioral health project.
Their first action steps involved developing and implementing a project plan that allowed them to transition their entire organization to a certified Complete EHR (Ambulatory) by August 2012, and to meet the standards for participating in the “Meaningful Use Eligible Professional Incentive Program” by September 2012. The Providence Center completed the necessary steps, and today the organization projects that through participation in “meaningful use,” they will earn as much as $1 million dollars in incentive program payments over the next 6 years.
Although The Providence Center already engaged in e-prescribing, this upgrade meant a transition to a new e-prescribing product that they implemented fully by the end of the PBHCI HIT Supplement grant period, reporting an e-prescribing rate of 90-95% of all prescriptions.
Like many PBHCI grantees, the Providence Center struggled with the grant requirement to accept structured lab results electronically. In the absence of an electronic interface to push lab results, they implemented the SAMHSA-approved workaround developed by CIHS to follow the specifications for meeting Menu Objective #2, which allows the grantees to achieve the requirement by entering the structured lab results manually. They reported that structured lab results for more than half of all PBHCI enrollees are currently available in the EHRs.
The Providence Center was fortunate in that, from the very beginning, their state HIE had support from a grant intended to help inclusion them in state HIE planning and implementation. Although they worked closely with the Rhode Island Quality Institute throughout the grant to participate in CurrentCare, progress was difficult and The Providence Center realized they would be unable to test this exchange within the grant duration. To meet the grant requirements they obtained four Nationwide Health Information Direct (NwHIN Direct) secure messaging accounts through the health information service provider Impriva, and began exchanging the continuity of care record ? the standard patient health information data set ? with their primary care partner. They continued to work with CurrentCare and successfully tested the exchange of confidential patient information to ensure protection by 42 CFR Part 2 on March 8, as planned.
With the exception of their early involvement with the Rhode Island Quality Institute, The Providence Center’s experience with this project is typical of most of the PBHCI grantees involved in implementing the HIT Supplement grant. As a result, there are now models for community behavioral health provider participation in health information exchange.
But this success can only serve as a foundation. As Bill Cadieux recently noted in his testimony to representatives of Congress (“Behavioral Health Information Technology: Saving Money and Improving Care,” 3/12/2013): “The Providence Center is fortunate we received incredible technical assistance and financial support from SAMHSA to move us to Meaningful Use [of patient information] on…a certified EHR.” This support must continue in order to ensure the inclusion of health care for people with mental illnesses, which many see as vital to the advancement of healthcare for the entire country. As Bill also noted, “Without support, our clients use the highest cost services in the state including emergency room visits, hospitalization, and the criminal justice system. By using the EHR and acting as our clients’ health home, we are rapidly creating efficiencies that produce better care at a significant cost savings.”
Learn more about The Providence Center and the PBHCI grant program.
As behavioral health provider organizations and state designated entities (SDEs) work together to address the challenges of adopting technology and find avenues for participation in health information exchanges (HIEs), it’s important that:
- Behavioral health providers engage with the state HIE in developing the processes for sharing behavioral health information in your state.
- Behavioral health providers purchase a certified electronic health record system or a system that meets the national standards for health information exchange.
- Behavioral health providers obtain a Direct Secure Messaging Address, which is usually available through the state HIE, that will allow them to exchange information with any other provider in a secure manner.
- HIEs engage medical and behavioral health providers in discussions and plans for behavioral health information exchange.
- HIEs engage consumers in discussions around the benefits of exchanging information for improving the quality of their care.
- HIEs program their systems to allow patients to authorize specific providers to have access to their care information.
Did you miss CIHS’ March webinars on Health IT for Primary and Behavioral Healthcare Integration and Suicide Prevention Tools for Primary Care Providers? You can access them on the website, along with a host of webinars on a range integrated health topics.
Visit often so you don’t miss any upcoming webinars.
National Rural Health Resource Center Releases Health Information Exchange Resources
The National Rural Health Resource Center has a toolkit of practical health
information exchange (HIE) resources for rural health stakeholders, including state offices of rural health and flex programs, rural hospitals and clinics, critical access hospitals, rural health networks, and other invested parties.
New Funding Opp: Effectiveness Testing of Health Interventions
The National Institute of Mental Health issued a request for applications for effectiveness testing of innovative services interventions designed to reduce the prevalence and magnitude of common, modifiable health risk factors related to shortened lifespan in adults with severe mental illness and youth with serious emotional disturbances.
March is National Nutrition Month
National Nutrition Month, sponsored by the Academy of Nutritionists and Dietetics, focuses on the importance of making healthy food choices, developing sound eating habits, and maintaining a healthy level of physical activity. This year’s theme is "Eat Right, Your Way, Every Day." Spread the word in your community.
Tobacco-Free Toolkit for Community Health Facilities
The Smoking Cessation Leadership Center, in partnership with the University of Colorado Behavioral Health and Wellness Program, the County of Los Angeles’ Tobacco Control and Prevention Program, and Project Trust, developed a toolkit for a broad continuum of health care providers and treatment facilities, particularly those serving people with mental illness and addictions. They designed materials for administrators, direct providers, and support staff of organizations considering or implementing tobacco-free policies.
New Spanish Language Resources from Million Hearts
Latino Americans often die from heart disease, stroke, and other cardiovascular diseases. The Department of Human Services through their aggressive Million Hearts campaign designed the following Spanish-language resources to help Spanish-speaking individuals get the resources they need to improve their heart health.