0 Overview of E-Health

Section 0.2 Overview Overview of e-Health

This document provides an overview of e-Health both broadly and in the context of So cial Services. Read the sections below to understand more about these topics.

Time needed: 1 hour Suggested other tools: NA

The Essential Role of Social Service Agencies in Improving Health If you work in a social service agency, you know the services you provide are essential to keeping people healthy. Unmet social needs (housing, jobs, nutrition, mental health, legal issues, etc.) can contribute to medical problems and prevent people from obtaini ng or adhering to medical therapies. An increasing number of communities are leveraging the interdependence of clinical medicine and social services. Studies show that these efforts can drive down cost and i mprove outcomes. We provide three examples below:  An Accountable Care Organization in Minnesota: In an 2013 article in that is posted on HealthyAmericans.org, Nancy Garrett, Ph.D., Chief Analytics Officer, Hennepin County Medical Center, describes how Hennepin Health is serving: “over 6,000 enrollees who face some stark health realities: 45 percent have chemical dependencies, 42 percent have mental health needs, 32 percent have unstable housing and 30 percent suffer from at least two chronic diseases1”. The article makes the point that coordination of social services and medical services is the essential element of success in this emerging care model.  Reducing Unnecessary Hospitalization in Camden NJ: An initiative in Camden NJ is reducing cost and improving care by developing a: “Citywide Collaborative of primary care, behavioral health, social service and other supportive service providers to improve care for this patient population2.”  Involving Communities in Health: The state of Oregon is engaged in a large demonstration project designed to lower Medicaid cost while improving care. A 2013 New York Times article states: “Local, interventionist, hands-on attention — reducing health problems before care is warranted or billed — means breaking deep tradition in a system that thinks mostly about treatment and response.3”

1 http://healthyamericans.org/health-issues/prevention_story/how-a-social-accountable-care-organization-improves-health-and-saves-mo ney-and-lives

2 : http://www.camdenhealth.org/programs/care-management-program/

3 http://www.nytimes.com/2013/04/13/us/oregon-experiments-with-localized-medicaid.html?_r=0

Section 0 Overview—Overview of e-Health - 1 As efforts to integrate clinical medicine and social services grow, e-health will play a p owerful and essential role in gathering, interpreting, and exchanging the information n eeded to ensure clients get the assistance they need to live healthy, productive lives. T his document provides an introduction to key e-health concepts.

Defining e-Health This section provides definitions for the terms used throughout the toolkit. E-health is the adoption and effective use of electronic health record (EHR) systems an d other health information technology (HIT), including health information exchange, t o improve health care quality, increase patient safety, reduce health care costs, and ena ble individuals and communities to make the best possible health decisions. Across the nation, e-health has emerged as a powerful strategy to transform access, care delivery, patient experiences, and healthcare outcomes. Furthermore, e-health is essential in sup porting the exchange of information necessary for health reform initiatives such as acc ountable care. The subsections below define important elements of e-health.

Electronic Health Record (EHR) An EHR is the tool that replaces the paper record that has been used to track a patient’ s health. Specifically, we are using the following definition: EHR is a real-time patient health record with access to evidence-based decision suppor t tools that can be used to aid clinicians in decision-making. The EHR can automate an d streamline a clinician's workflow, ensuring that all clinical information is communic ated. It can also prevent delays in response that result in gaps in care. The EHR can als o support the collection of data for uses other than clinical care, such as billing, quality management, outcome reporting, and public health disease surveillance and reporting. EHR is considered more comprehensive than the concept of an Electronic Medical Re cord (EMR). Reference: http://www.hhs.gov/healthit/glossary.html

EHR and Social Services Many social services professionals have encountered EHRs, either in parts of their age ncies that provide clinical services or in the office of their own physician. So in gener al, you know that EHRs take the place of outmoded paper records. One of the key features of an EHR is that health information can be created and manag ed by authorized users in a digital format capable of being shared with authorized user s across more than one health care organization. EHRs are built to share information w ith other health care providers and organizations involved with a patient’s care – such as specialists, hospitals, and pharmacies but also with home health, school nurses, loca l public health workers, and, where appropriate social workers. The general description of an EHR, however, doesn’t take into account the specific ne eds of social service agencies to use support tools and exchange information. As such, there may not currently be effective EHR vendor solutions for social services agencies. These offerings are expected to evolve over time, and in the meantime these agencies c an plan for implementation by understanding the potential uses and opportunities for i nformation exchange.

Section 0 Overview—Overview of e-Health - 1 Health Information Technology (HIT) HIT is the overall category we use to describe the hardware, software, devices, etc. tha t are used to manage and improve health. Specifically, we are using the following defi nition: HIT is the application of information processing involving both computer hardware an d software that deals with the storage, retrieval, sharing, and use of health care informa tion, data, and knowledge for communication and decision making. Reference: http://www.healthit.gov/policy-researchers-implementers/glossary

Health Information Exchange (HIE) Health information exchange or HIE means the electronic transmission of health relate d information between organizations according to nationally recognized standards [Mi nn. Stat. §62J.498 sub. 1(f)]. Reference: https://www.revisor.mn.gov/statutes/?id=62J. 498

Social Services and HIE Social service agencies have special concerns about exchanging information about thei r clients. First, many of their clients may experience conditions that carry significant s tigma (mental health, chemical dependency, crime, etc.). Many clients want their conc erns, diagnosis, treatment plans, and medications kept private. Protecting privacy prefe rences is mandated under the HIPAA regulations, as is privacy with other types of heal th care. Special data privacy rules extend to substance abuse treatment. CFR 42, part 2 require s that clients provide written permission any time any personally identifiable informati on is released to another party. Here is a table that shows the differences between HIP AA protection of health information and CFR 42, part 24.

The good news is that technology is helping to create solutions that allow EHR users t o segment data and to apply various rules or conditions to information that is covered by the mandates cited above and the ethical guidelines of your profession. Some key id eas in these solutions involve:

4 Substance Abuse and Rehabilitation, Dec 6, 2011, Hu, Sparenborg, and Tai

Section 0 Overview—Overview of e-Health - 1 1. Segmenting data so that a client has control over different elements. In this way, a client can restrict access to chemical health information while permitting access to primary care data. 2. Developing robust permissions functions that are based on federal privacy requirements. These systems allow behavioral health and substance abuse services providers to capture the detailed permissions required by federal privacy rules. 3. Using established exchange mechanisms, like Direct (Direct is a simple, scalable, secure, and standards-based way for participants to send authenticated, encrypted health information directly to known, trusted recipients over the Internet), to reduce faxing, scanning and reentering important health information. See below for links to examples: 1. Brooklyn, New York has a health information exchange that alerts behavioral health providers to key events in their patients’ lives (like hospitalization). Read details here: http://www.healthit.gov/buzz-blog/state-hie/hie-bright-spots- supporting-mental-health-care-coordination-part-3/ 2. EHR vendors have created technology that ensures that 42 CFR Part 2 requirements are met in a way that allows for rapid approval of information sharing (or restriction of sharing) based on client preferences. View a video demo here: http://www.satva.org/ 3. The federal government, through its BEACON Grants gathered providers together to demonstrate how data in an electronic record can be segmented, so that a client can grant permission to share some data and not other. View a YouTube video here: https://www.youtube.com/watch?v=4lMG96nmWS0

Benefits of e-Health The use of electronic systems to manage client information and deliver care has been i ncreasing and will continue to increase. Tremendous benefits can be realized if we ca n electronically and securely exchange client health information with appropriate care givers. We can help ensure this transformation is positive for clients, their families and loved ones, and for caregivers if we focus on benefits. In general, electronic health records (EHR) and health information exchange (HIE) ca n:  Improve the quality and safety of care delivered to social services patients.  Enable creation of electronic patient registries that track care patterns and healt h care use.  Achieve greater efficiency and improve use of resources.  Communicate in transitions of care and across the health care continuum.  Promote sound decision making and evidence-based practices.  Strengthen privacy and data protection.

Section 0 Overview—Overview of e-Health - 1 Glossary As you work through the tools, there may be terms or abbreviations that are unfamiliar or for which you want to be sure of the meaning. To help clarify terms or abbreviations, we have provided the link below:

The Minnesota e-Health Glossary, (http://www.health.state.mn.us/e-health/gloss ary.html)

Conclusion Though there are undoubtedly hurdles to jump for any organization that is transitionin g to a comprehensive e-health system with EHR and HIE, such as placating client fear s about their privacy, or a user learning curve, the benefits that social services professi onals and their clients can gain from adoption of an e-health system that is well-planne d, carefully selected and properly implemented far outweigh any potential downsides. E-health enables greater efficiency, accuracy and speed in every aspect of patient care and accounting, as well as in organizational administration. These improvements ultim ately translate to more favorable patient outcomes, streamlined operations, and capture d higher revenues for the social services agency. There is sound reasoning the behind s tate and government-mandated push for adoption of e-health practices: They simply pe rform better than the old systems do.

Section 0 Overview—Overview of e-Health - 1