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Sharing information on our shared clients: Is the juice worth the squeeze?

This article discusses the challenges and approach to sharing information on shared clients, specifically in the context of the San Francisco Department of Public Health's Coordinated Care Management System. It explores the purpose of data integration, how data from the system are being used to improve clinical care and systems of care, and highlights the different domains and programs included in the system.

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Sharing information on our shared clients: Is the juice worth the squeeze?

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  1. Sharing information on our shared clients: Is the juice worth the squeeze? SF Department of Public Health Coordinated Care Management System Maria X Martinez

  2. Situation Maria X Martinez, SF DPH, 415-554-2877, maria.x.martinez@sfdph.org

  3. MIS Challenges Maria X Martinez, SF DPH, 415-554-2877, maria.x.martinez@sfdph.org

  4. Approach to Solution Maria X Martinez, SF DPH, 415-554-2877, maria.x.martinez@sfdph.org

  5. Purpose of Data Integration Maria X Martinez, SF DPH, 415-554-2877, maria.x.martinez@sfdph.org

  6. Coordinated Case Management System Maria X Martinez, SF DPH, 415-554-2877, maria.x.martinez@sfdph.org

  7. Maria X Martinez, SF DPH, 415-554-2877, maria.x.martinez@sfdph.org

  8. Maria X Martinez, SF DPH, 415-554-2877, maria.x.martinez@sfdph.org

  9. How data from CCMS are being used to understand and improve clinical care and systems of care. Maria X Martinez, SF DPH, 415-554-2877, maria.x.martinez@sfdph.org

  10. CCMS by Domains Maria X Martinez, SF DPH, 415-554-2877, maria.x.martinez@sfdph.org

  11. Home Page Maria X Martinez, SF DPH, 415-554-2877, maria.x.martinez@sfdph.org

  12. Community Care Plan Maria X Martinez, SF DPH, 415-554-2877, maria.x.martinez@sfdph.org

  13. Death Registry (State of California) Maria X Martinez, SF DPH, 415-554-2877, maria.x.martinez@sfdph.org

  14. Health Service Summary Maria X Martinez, SF DPH, 415-554-2877, maria.x.martinez@sfdph.org

  15. Health Services Detail Maria X Martinez, SF DPH, 415-554-2877, maria.x.martinez@sfdph.org

  16. Understanding Populations Served • Identify risk factors and acuity based upon all health and human service systems • Profile utilization of urgent/emergent services • Determine span of time with homeless history • Compare programs, clinics, panels, populations • Determine overlapping/shared populations maria.x.martinez@sfdph.org, 415-554-2877

  17. EMS High Users Maria X Martinez, SF DPH, 415-554-2877, maria.x.martinez@sfdph.org

  18. Maria X Martinez, SF DPH, 415-554-2877, maria.x.martinez@sfdph.org

  19. Maria X Martinez, SF DPH, 415-554-2877, maria.x.martinez@sfdph.org

  20. Maria X Martinez, SF DPH, 415-554-2877, maria.x.martinez@sfdph.org

  21. Maria X Martinez, SF DPH, 415-554-2877, maria.x.martinez@sfdph.org

  22. High Users of Multiple Systems (HUMS) Maria X Martinez, SF DPH, 415-554-2877, maria.x.martinez@sfdph.org

  23. Urgent/Emergent Care in SFDPH Medical System • EMS transports • ED medical • Inpatient – 24hr • Medical Respite (hospital offset) • Urgent care clinics at TWHC, hospital *Programs in red are the only ones studied in other communities. Psychiatric Sytem • PES, Dore St (PES offset) • Psych Inpatient – 24hr • Acute Diversion Units (hospital offset) – 24hr • Crisis clinics at Westside, Mobile Crisis Substance Abuse System • Sobering Center • Res Medical Detox – 24hr • Res Social Detox – 24hr Maria X Martinez, SF DPH, 415-554-2877, maria.x.martinez@sfdph.org

  24. Maria X Martinez, SF DPH, 415-554-2877, maria.x.martinez@sfdph.org

  25. Generate shared vision and leadership …this is going to take time. Iron-out privacy and security issues for sharing data. Assure you have IT bandwidth. Engage the provider community…what do they need at the moment of truth to improve the patient experience? What do they need to manage their panels or caseloads better? Engage the epidemiology community…what data do they need to evaluate outcomes? Develop protocols for how providers are expected to use integrated data. • Keys Maria X Martinez, SF DPH, 415-554-2877, maria.x.martinez@sfdph.org

  26. Thoughts? Questions? Maria X Martinez, SF DPH, 415-554-2877, maria.x.martinez@sfdph.org

  27. San Francisco Department of Public HealthMaria X MartinezOffice of the Director of Health415-554-2877maria.x.martinez@sfdph.org Maria X Martinez, SF DPH, 415-554-2877, maria.x.martinez@sfdph.org

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