SIM Steering Committee Report February 24, 2016

1. SIM Steering Committee ReportFebruary 24, 2016

2. Presentation Goals Report on the results of the Blue Button (BB) project Discuss the success and challenges with connecting Behavioral Health (BH) to the Health Information Exchange (HIE) Discuss sustainability

3. Blue Button HIE Results and Project Conclusion

4. SIM Deliverable Target SIM pillar: Patient engagement Timeline: One year pilot project (4/01/2014 – 5/31/2015) Project Goal: Provide Maine patients with access to their HIE summary of care document using “CCD” (Continuity of Care Document) standards, via local provider community’s patient portal.

5. Project Process Competitive Request for Information (RFI) established pilot partner in 2014 Applicants had to be a health care provider with an established “patient portal” implemented across their primary care services Together HealthInfoNet and the health care provider would design an implementation that would “test” the HIE Blue Button within their EHRs Patient Portal

6. What is the Blue Button? “Blue Button” is a term used for a movement toward an improved healthcare system where patients and providers used IT to collaborate and improve health The Blue Button symbol signifies that a patient can have easy and secure access to their health information via an electronic portal The Veteran’s Administration (VA) system has championed this technology in their EHR system

7. Pilot Partner: Eastern Maine Healthcare Systems (EMHS) EMHS applied to HIN RFP to pilot this patient engagement technology and volunteered resources Thank you to the staff and consumers who participated EMHS was chosen for this pilot due to their advanced patient portal and technical capabilities HIN thanks EMHS for their innovation and commitment to patient access to electronic health records

8. Eastern Maine Healthcare Systems Pilot Participants • Initial pilot cohort: 760 active myEMHShealth portal users • Across 3 primary care practices: • EMMC Internal Medicine, Husson • EMMC Family Medicine, Brewer • Sebasticook Valley Health (SVH) Family Care, Pittsfield

9. Provider Portal Strategy- myEMHShealth

10. Patient CCD Download File Data included: -Demographics -Allergies -Medication hx (pharmacy claims) -Active Problems -Encounter hx -Procedure hx -Lab Results

11. Patient Engagement Materials

12. Total CCD Downloads: 730

13. Patient Survey Results; Perception of Use Question: How do you plan to use your Continuity of Care Document? N = 169

14. Patient Survey Results Question: What CCD information was the most useful to you? N = 71

15. Patient Survey Results Question: What information was not included in your CCD that you would want to see? N = 71

16. Key Results • Confusion for patients: EMHS Portal vs. HIN CCD • Meaningful Use has required all providers to have a “EHR” Portal, thus patients have multiple portals to manage • Patients were presented with 3 portal data sources; Inpatient, Outpatient and HIN’s CCD • HINs Blue Button was easy to use; patient CCD downloads exceeded the initial goal of 20% or 152 patient accesses • Patients want access to more electronic information, especially their “doctor’s notes” • Having web-based access to the “statewide” record is positive and convenient, helpful when traveling

17. Conclusions The pilot was a patient engagement success; with the opportunity patients will use the HealthInfoNet Blue Button technology HIN can provide a technical solution for patient access using the Blue Button-Patient Health Record strategy Patients want more access to their health information than the current access provides Portal access is fragmented; patients prefer “one place” to access “all” of their records Overall, more education about health information technology and Maine’s health information exchange is needed

18. Behavioral Health HIE Connections Progress & Challenges

19. BH Project Goals • Implement connections between 20 BH organizations and the Health Information Exchange • Train BH staff to leverage HIE services • Build data interfaces and go live with initial data available from each BH organization • Perform one quality improvement measure as a result HIE implementation

20. Project Process • Spring of 2014; Request for Proposal (RFP) was completed • 20 BH organizations that met the criteria were selected for participation • Organizations were favored if participating in MaineCare's Behavioral Health Home (BHH) program • May 2014; Project Kick Off

21. BH Connections as of January 2016 75 Site Locations Connected Live with Data Sharing • OHI • Aroostook Mental Health Services • Charlotte White • Maine Behavioral Health Organization • Pathways (formerly known as Providence) • Assistance Plus • Restorative Health (EMHS) • Northeast Occupational Exchange www.hinfonet.org 21

22. What BH Data is Shared with HIE? As of Y3Q2: Patient Identifiers and demographics Encounter/Visit History Adverse Reactions/Allergies Medication History from Pharmacies & Medicaid Claims Diagnosis (primary and secondary) Procedure codes In testing now: Continuity of Care Documents (CCD) for the vendors that support it (includes 5 of 20 orgs.)

23. BH Milestone AchievementYear 3, Quarter 2

24. BH Milestone Payment ScheduleYear 3, Quarter 2

25. BH Staff Implementation • Most common users: BHH staff, RN’s, Case Managers, ACT teams • Congrats to our highest volume users • Community Health and Counseling • Northeast Occupational Exchange • United Cerebral Palsy • Wings for Families and Children • Catholic Charities • OHI

26. BH Staff Monthly HIE Access 26

27. Population ImpactMay 2015-January 2016 Patient Records Accessed by Behavioral Health Staff 27

28. Value of HIE in Managing Mental Illness and Chronic Disease Reduce fragmentation with medical community Mitigate medical issues that contribute to Mental Illness Identify prescriptions, both unknown and duplicated Provide a safety-net, locate clients and intervene Provide integrated BH intervention to address medical issues and reduce unnecessary ED visits

29. Realized Clinical Benefits with HIE Access Able to see client medical history & current care Able to see prescription fill history & activity Access to lab results for abnormal results Access to treatment summaries from ER Able to replace hours spent in getting permission to view a client’s record to provide care for clients Able to relieve stress and anxiety around medical care

30. BHH Nurse Feedback • Decreases unnecessary ED Use • Increases integration of BH and Medical Care • Real-time data provides timely information that leads to improved quality of care & client experience “It’s amazing what you can do when you have the information. With HealthInfoNet, I have the information to do my job better and faster.” Brenda Mailman, RN Community Health & Counseling

31. BHH Nurse; Patient Story Before Connection to HealthInfoNet • Diabetic client admitted to ED 12 times in last calendar year due to home bound complications causing multiple UTIs After Connection to HealthInfoNet • Nurse Care Manager can track client ED visits, hbA1c counts and UTIs • Used education to change patients’ response to medical needs; patient stopped going to the ED • hbA1c’s values have come down and UTIs have decreased

32. BH Quality Project GoalsJanuary-July 2016 Implement real-time notifications for ED/hospital admissions to intervene with clients with a history of 2 or more ED visits within a 6 month period Access the HIN Portal to coordinate care with both the client & medical community Measure change in ED utilization at the end of 6 month period

33. Ongoing Challenges • BH providers are subject to the timelines and limitations of their EHR vendor • Vendor contracts often do not address interoperability • Even when contracts do deal with HIE – many vendors have no experience • Two vendors that span 4 BH orgs. are over a year behind in their commitments • One vendor that spans 2 BH orgs. is behind yet making progress and will succeed

34. Sustainability Post Year 3 BH orgs do not have funding streams to support ongoing EHR interoperability costs • Ongoing HIE Costs: The estimated annual cost for HIE access is +/-$150,000 for the total 20 organizations participating in SIM. • EHR Vendor Challenges and Costs: • Some EHR vendors charging by data volume sent to HIE; this is unprecedented in Maine ($$$) • Other EHR vendor costs are unknown and unfunded

35. Questions?