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SAMHSA Grant Kickoff Meeting. March 14, 2012. Kickoff Meeting Agenda. 11:00-11:30 Welcome, Introductions and Roll call Polly Mullins-Bentley, Acting Executive Director, CHFS, Governor’s Office of Electronic Health Information (GOEHI)

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slide2

Kickoff Meeting Agenda

  • 11:00-11:30 Welcome, Introductions and Roll call
  • Polly Mullins-Bentley, ActingExecutive Director, CHFS, Governor’s Office of
  • Electronic Health Information (GOEHI)
        • GOEHI/Kentucky Health Information Exchange
  •  11:30-12:30 SAMHSA Grant Overview
  • Karen Chrisman, Staff Attorney, CHFS, GOEHI
  • - What’s This All About?
  • - GOEHI SAMHSA Project Plan
  • - 42 CFR Consent Model
  • - View of Clinical Information
    • >Continuity of Care Document (CCD)
    • >NetSmart CCD
  • - Feedback Request
  • 12:30-12:35 eHealth Summit Information
  • 12:35-1:00 Questions and Answers
slide3

KHIE Update

  • Polly Mullins-Bentley, ActingExecutive Director,
  • CHFS, Governor’s Office of Electronic Health Information (GOEHI)
        • KHIE /GOEHI Overview
slide4

KHIE Implementation

80 Combined Hospitals/Physicians by County

Updated 04/07/2011

Campbell

Boone

Hospital

Physician

Both

Kenton

Gallatin

Bracken

Pendleton

Carroll

Grant

Mason

Trimble

Owen

Greenup

Robertson

Lewis

Henry

Harrison

Oldham

Fleming

Nicholas

Carter

Franklin

Boyd

Scott

Shelby

Rowan

Bourbon

Jefferson

Bath

Elliott

Woodford

Lawrence

Spencer

Fayette

Bullitt

Montgomery

Anderson

Menifee

Clark

Jessamine

Meade

Morgan

Hancock

Powell

Johnson

Mercer

Henderson

Martin

Nelson

Breckinridge

Washington

Wolfe

Estill

Union

Daviess

Madison

Magoffin

Hardin

Garrard

Boyle

Lee

Larue

Marion

Floyd

Breathitt

Webster

McLean

Pike

Lincoln

Ohio

Jackson

Owsley

Grayson

Rockcastle

Crittenden

Taylor

Knott

Hart

Casey

Perry

Hopkins

Edmonson

Green

Butler

Muhlenberg

Clay

Livingston

Caldwell

Pulaski

Leslie

Laurel

Letcher

Adair

Ballard

McCracken

Metcalfe

Russell

Lyon

Warren

Barren

Carlisle

Marshall

Christian

Knox

Logan

Todd

Cumberland

Harlan

Trigg

Wayne

Whitley

Graves

Simpson

Allen

Hickman

Clinton

McCreary

Monroe

Bell

Calloway

Fulton

slide5

KHIE Implementation Queue

216 Combined Hospitals/Physicians/Labs/Other by County

Updated 06/30/2011

Campbell

Boone

Hospital

Physician

Both

Kenton

Gallatin

Bracken

Pendleton

Carroll

Grant

Mason

Trimble

Owen

Greenup

Robertson

Lewis

Henry

Harrison

Oldham

Fleming

Nicholas

Carter

Franklin

Boyd

Scott

Shelby

Rowan

Bourbon

Jefferson

Bath

Elliott

Woodford

Lawrence

Spencer

Fayette

Bullitt

Montgomery

Anderson

Menifee

Clark

Jessamine

Meade

Morgan

Hancock

Powell

Johnson

Mercer

Henderson

Martin

Nelson

Breckinridge

Washington

Wolfe

Estill

Union

Daviess

Madison

Magoffin

Hardin

Garrard

Boyle

Lee

Larue

Marion

Floyd

Breathitt

Webster

McLean

Pike

Lincoln

Ohio

Jackson

Owsley

Grayson

Rockcastle

Crittenden

Taylor

Knott

Hart

Casey

Perry

Hopkins

Edmonson

Green

Butler

Muhlenberg

Clay

Livingston

Caldwell

Pulaski

Leslie

Laurel

Letcher

Adair

Ballard

McCracken

Metcalfe

Russell

Lyon

Warren

Barren

Carlisle

Marshall

Christian

Knox

Logan

Todd

Cumberland

Harlan

Trigg

Wayne

Whitley

Graves

Simpson

Allen

Hickman

Clinton

McCreary

Monroe

Bell

Calloway

Fulton

slide6

KHIE Implementation Contacts

288 Combined Hospitals/Physicians/Labs/Other by County

Updated 09/28/2011

Campbell

Boone

Hospital

Physician

Both

Kenton

Gallatin

Bracken

Pendleton

Carroll

Grant

Mason

Trimble

Owen

Greenup

Robertson

Lewis

Henry

Harrison

Oldham

Fleming

Nicholas

Carter

Franklin

Boyd

Scott

Shelby

Rowan

Bourbon

Jefferson

Bath

Elliott

Woodford

Lawrence

Spencer

Fayette

Bullitt

Montgomery

Anderson

Menifee

Clark

Jessamine

Meade

Morgan

Hancock

Powell

Johnson

Mercer

Henderson

Martin

Nelson

Breckinridge

Washington

Wolfe

Estill

Union

Daviess

Madison

Magoffin

Hardin

Garrard

Boyle

Lee

Larue

Marion

Floyd

Breathitt

Webster

McLean

Pike

Lincoln

Ohio

Jackson

Owsley

Grayson

Rockcastle

Crittenden

Taylor

Knott

Hart

Casey

Perry

Hopkins

Edmonson

Green

Butler

Muhlenberg

Clay

Livingston

Caldwell

Pulaski

Leslie

Laurel

Letcher

Adair

Ballard

McCracken

Metcalfe

Russell

Lyon

Warren

Barren

Carlisle

Marshall

Christian

Knox

Logan

Todd

Cumberland

Harlan

Trigg

Wayne

Whitley

Graves

Simpson

Allen

Hickman

Clinton

McCreary

Monroe

Bell

Calloway

Fulton

slide7

KHIE Implementation Contacts

374 Combined Hospitals/Physicians/Labs/Other by County

Updated 01/04/2012

Campbell

Boone

Hospital

Physician

Both

Kenton

Gallatin

Bracken

Pendleton

Carroll

Grant

Mason

Trimble

Owen

Greenup

Robertson

Lewis

Henry

Harrison

Oldham

Fleming

Nicholas

Carter

Franklin

Boyd

Scott

Shelby

Rowan

Bourbon

Jefferson

Bath

Elliott

Woodford

Lawrence

Spencer

Fayette

Bullitt

Montgomery

Anderson

Menifee

Clark

Hancock

Jessamine

Meade

Morgan

Powell

Johnson

Mercer

Henderson

Martin

Nelson

Breckinridge

Washington

Wolfe

Estill

Union

Daviess

Madison

Magoffin

Hardin

Garrard

Boyle

Lee

Larue

Marion

Floyd

Breathitt

Webster

McLean

Pike

Lincoln

Ohio

Jackson

Owsley

Grayson

Rockcastle

Crittenden

Taylor

Knott

Hart

Casey

Perry

Hopkins

Edmonson

Green

Butler

Muhlenberg

Clay

Livingston

Caldwell

Pulaski

Leslie

Laurel

Letcher

Adair

Ballard

McCracken

Metcalfe

Russell

Lyon

Warren

Barren

Carlisle

Marshall

Christian

Knox

Logan

Todd

Cumberland

Harlan

Trigg

Wayne

Whitley

Graves

Simpson

Allen

Hickman

Clinton

McCreary

Monroe

Bell

Calloway

Fulton

slide8

KHIE Implementation Contacts

483 Combined Hospitals/Physicians/Labs/Other by County

Updated 03/09/2012

Campbell

Boone

Hospital

Physician

Both

Kenton

Gallatin

Bracken

Pendleton

Carroll

Grant

Mason

Trimble

Owen

Greenup

Robertson

Lewis

Henry

Harrison

Oldham

Fleming

Nicholas

Carter

Franklin

Boyd

Scott

Shelby

Rowan

Bourbon

Jefferson

Bath

Elliott

Woodford

Lawrence

Spencer

Fayette

Bullitt

Montgomery

Anderson

Menifee

Clark

Hancock

Jessamine

Meade

Morgan

Powell

Johnson

Mercer

Henderson

Martin

Nelson

Breckinridge

Washington

Wolfe

Estill

Union

Daviess

Madison

Magoffin

Hardin

Garrard

Boyle

Lee

Larue

Marion

Floyd

Breathitt

Webster

McLean

Pike

Lincoln

Ohio

Jackson

Owsley

Grayson

Rockcastle

Crittenden

Taylor

Knott

Hart

Casey

Livingston

Perry

Hopkins

Edmonson

Green

Butler

Muhlenberg

Clay

Caldwell

Pulaski

Leslie

Laurel

Letcher

Adair

Ballard

McCracken

Metcalfe

Russell

Lyon

Warren

Barren

Carlisle

Marshall

Christian

Knox

Logan

Todd

Cumberland

Harlan

Trigg

Wayne

Whitley

Graves

Simpson

Allen

Hickman

Clinton

McCreary

Monroe

Bell

Calloway

Fulton

slide9

KHIEA Value Added Proposition

Impacting the Healthcare of Kentuckians

  • Use of Policy Levers
    • Medicaid Claims Data
      • KHIE was seeded with two years worth /now three years
    • State Laboratory Results
      • Microbiology LIVE since July 2011/Newborn screenings in TEST
    • Kentucky Immunization Registry
      • KHIE offers a LIVE interface for providers to report vaccinations and populate the immunization registry
    • Managed Care Organizations
      • Medicaid requires providers to connect to KHIE
        • Access provided to Case Managers for comprehensive case management/improved continuity of care
slide10

KHIE A Value Added Proposition

  • Policy Levers, continued..
    • Prescription Drug Monitoring Program (KASPER)
      • Integration of KASPER into KHIE
    • Kentucky Cancer Registry
      • Submit cancer data for providers to the KY Cancer Registry
slide12

KHIECC Coordinating Council

KHIE Coordinating Council serves as an advisory body to the Governor’s Office of Electronic Health Information. Membership includes stakeholders from hospitals, physicians, mental health, public health, health insurance companies, universities and State Government representatives. The Committees include:

KHIECC Accountability and Transparency

KHIECC Business Development and Finance

KHIECC Interoperability and Standards Development

KHIECC Privacy and Security

KHIECC Provider Adoption and Meaningful Use

KHIECC Population Health

KHIECC Clinical Advisory Committee (NEW)

slide15
“Substance abuse and its consequences have grave impacts on our society ‑‑ destroying lives, tearing apart families, and introducing drug‑related violence to our neighborhoods.” 

April 06, 2011

President Barack Obama

president s vision for health it
President’s Vision for Health IT

Medical information will follow consumers so that they are at the center of their own care.

Consumers will be able to choose physicians and hospitals based on clinical performance results made available to them.

Clinicians will have a patient's complete medical history, computerized ordering systems, and electronic reminders.

president s vision for health it cont d
President’s Vision for Health IT (cont’d)

Quality initiatives will measure performance and drive quality-based competition in the industry.

Public health and bioterrorism surveillance will be seamlessly integrated into care.

Clinical research will be accelerated and post-marketing surveillance will be expanded.

slide18

Kathleen Sebelius

Secretary

U.S. Department of Health & Human Services

September 29, 2009

“The increased use of health information technology is a key focus of our reform efforts because it will help to improve the safety and quality of health care generally while also cutting waste out of the system.”

the impact of health reform
The Impact of Health Reform

Prior to implementation of coverage expansion under Health Reform:

39% of individuals served by State Mental Health Authorities did not have insurance

61% of the individuals served by State Substance Abuse Agencies did not have insurance

Many of these individuals will be covered in 2014 (or sooner)—most likely by the expansion in Medicaid

samhsa s strategic initiative health it
SAMHSA’s Strategic Initiative – (Health IT)

Purpose: Ensure the behavioral health provider network, including prevention specialists and consumer providers, fully participates with the general health care delivery system in the adoption of Health Information Technology.

Primary role of SAMHSA’s Health IT effort is to support the behavioral health aspects of the Electronic Health Record based on the standards and systems promoted by the Office of the National Coordinator for Health IT.

samhsa s strategic initiative health it goals
SAMHSA’s Strategic Initiative “Health IT Goals”

Develop the infrastructure for interoperable Electronic Health Records, including privacy, confidentiality, and data standards.

Provide incentives and create tools to facilitate the adoption of Health IT and EHRs with behavioral health functionality in general and specialty healthcare settings.

Deliver technical assistance to state health IT leaders, behavioral health and health providers, patients/consumers, and others to increase adoption of EHRs and health IT with behavioral health functionality.

Enhance capacity for the exchange and analysis of EHR data to assess quality of care and improve patient outcomes.

importance of health information exchange hie
IMPORTANCE OF HEALTH INFORMATION EXCHANGE (HIE)

Secure information sharing between Behavioral Health Care and Primary Care Organizations; State, Federal and Other Payers.

Inclusion and Reporting of Behavioral Health Data within the requirements of the State-wide Strategic and Operational Plans (Committees, Governance, & Workgroups, etc.)

Infrastructure to exchange Behavioral Health and Physical Health Data using Certified EHR Systems in support of Integrated Care Delivery & Performance Reporting

Interoperability – Demonstration of Behavioral Health Care Organizations participation in the Nation-wide Health Information Network (NWHIN)

slide23

SAMHSA Grant Overview

  • State Designated Entity Health Information Exchange Sub Awardee
    • Five states chosen
    • Kentucky
    • Illinois
    • Rhode Island
    • Oklahoma
    • Maine
  • Develop infrastructure supporting the exchange of health information among behavioral health and physical health providers through the development or adaptation of HIE systems
slide24

SAMHSA Grant Overview

  • GOEHI’s Plan
  • Assist the existing PBHCI recipient with KHIE connectivity
  • Provide connectivity for other CMHCs
  • Enhance the capability of the KHIE and the current CCD
  • Develop a 42 CFR 2 compliant consent
  • Develop consent training protocols
  • Inform both healthcare providers and consumers about this process
slide25

SAMHSA KY Plan

  • Kentucky HIE-SDE Sub Awardee Plan
  • Query based model
  • Consent workgroup
  • Interface from behavioral health providers to KHIE
  • Lab results reporting to behavioral health providers using KHIE as the delivery system
  • Training for behavioral health staff in the consent process and with the KHIE portal
  • Continuing education support about this program for both primary care and behavioral health providers
slide27

CCD Components

  • Patient: Given Name Family Name , Jr. or Sr., etc...Street Address City, State, Zip Codetel:+19995551212 MRN: 123456789 Birthdate: January 1, 1954 Sex: Male Guardian:
  • Next of Kin: Given Name + Family Name Street Address City, State, Zip Codetel:(999)555-1212
  • Table of Contents
  • Purpose : Automated Medical History Summary
  • Payers
  • Problems
  • Family history
  • Social History
  • Allergies, Adverse Reactions, Alerts
  • Medications
  • Immunizations
  • Vital Signs
  • Results
  • Procedures
  • Encounters
slide29

Statutes and Regulations

  • 42 USC § 290dd-2 & 42 CFR Part 2
  • The purpose of the statute and regulations prohibiting disclosure of records relating to substance abuse treatment, except with the patient's consent or a court order after good cause is shown, is to encourage patients to seek substance abuse treatment without fear that by doing so their privacy will be compromised
slide30

Statutes and Regulations

  • Q1. Does the federal law that protects the confidentiality of alcohol and drug abuse patient records allow information about patients with substance use disorders to be included in electronic health information exchange systems?
slide31

Statutes and Regulations

  • Yes. The federal confidentiality law and regulations (codified as 42 U.S.C. § 290dd-2 and 42 CFR Part 2 (“Part 2”)) permits patient information to be disclosed to Health Information Organizations (HIOs)and other health information exchange (HIE) systems.
  • However, the regulation contains certain requirements for the disclosure of information by substance abuse treatment programs; most notably, patient consent is required for disclosures, with some exceptions.
  • This consent requirement is often perceived as a barrier to the electronic exchange of health information.
  • It is possible to electronically exchange drug & alcohol treatment information while also meeting the requirements of Part 2.
slide32

Statutes and Regulations-Consent

  • Q11. What are the required elements of a patient consent under Part 2?
slide33

Statutes and Regulations-Consent

  • A written consent to a disclosure under the Part 2 regulations must be in writing and include all of the following items (42 CFR § 2.31):
    • 1) the specific name or general designation of the program or person permitted to make the disclosure;
    • 2) the name or title of the individual or the name of the organization to which disclosure is to be made;
    • 3) the name of the patient;
    • 4) the purpose of the disclosure;
    • 5) how much and what kind of information to be disclosed;
slide34

Statutes and Regulations-Consent

  • 6) the signature of the patient and, when required for a patient who is a minor, the signature of a person authorized to give consent under § 2.14; or, when required for a patient who is incompetent or deceased, the signature of a person authorized to sign under § 2.15 in lieu of the patient;
  • 7) the date on which the consent is signed;
  • 8) a statement that the consent is subject to revocation at any time except to the extent that the program or person which is to make the disclosure has already acted in reliance on it. Acting in reliance includes the provision of treatment services in reliance on a valid consent to disclose information to a third party payer; and
  • 9) the date, event or condition upon which the consent will expire if not revoked before. This data, event, or condition must insure that the consent will last no longer than reasonably necessary to serve the purpose for which it is given.
slide35

Statutes and Regulations-Consent

  • Q12. What must a Part 2 program do to notify the HIO, or any other recipient of Part 2 protected information, that it may not redisclose Part 2 information without patient consent?
  • Part 2 requires each disclosure made with written patient consent to be accompanied by a written statement that the information disclosed is protected by federal law and that the recipient cannot make any further disclosure of it unless permitted by the regulations.
  • Thus, when information is disclosed electronically, an accompanying notice explaining the prohibition on redisclosure must also be electronically sent.
slide36

FAQS

  • References for SAMHSA FAQs
  • http://www.samhsa.gov/healthprivacy/docs/ehr-faqs.pdf
  • http://www.samhsa.gov/HealthPrivacy/
  • http://www.samhsa.gov/about/laws/SAMHSA_42CFRPART2FAQII_Revised.pdf
slide37

KY eHealth Summit

Reminder!

MARK YOUR CALENDAR!

September 17 KHIECC and eHealth Network Board Joint Meeting

5:00 – 6:30 p.m. Hyatt Regency, Lexington, KY

Welcome Reception

6:30 – 9:00 p.m. Hyatt Regency, Lexington, KY

September 18 eHealth Summit

9:00 – 4 p.m.

Invited speakers include:

H. Westley Clark, M.D., J.D., M.P.H., CAS, FASAM Regional Director

Center for Substance Abuse Treatment

Substance Abuse Mental Health Services Administration

U.S. Department of Health and Human Services

Michael R. Lardiere, LCSW

Vice President Health Information Technology and Strategic Development

The National Council for Community Behavioral Healthcare

Keynote Speaker:

Kathleen Sebelius

Secretary

Health and Human Services

slide38

Q & A

Questions and Answers

Polly.Mullins-Bentley@ky.gov

Karen.Chrisman@ky.gov

April.Smith@ky.gov