Reduce d rug seeking by Drug Court clients: Collaboration with hospital Emergency Departments

1. Reduce drug seeking by Drug Court clients: Collaboration with hospital Emergency Departments Presentation to WSADCP Friday October 18, 2013 Sandra J. Altshuler, Ph.D., L.I.C.S.W., Coordinator Tony McBride, B.A., C.D.P., Clinical Director

2. The Problem • Drug Court clients use multiple Emergency Departments (EDs) to obtain pain medications by reporting chronic pain. • Our policy is not to interfere with medical prescriptions, but clients do lose clean date. • Clients are not forthcoming regarding their addiction and/or current participation in TDC program to EDs.

3. Core Principles of Consistent Care • Always what is best for the patient. • Coordinate care. • Keep the primary care provider in control. • Support Drug Court efforts. • Enable patient to make good medical decisions. • Protect from prescription overmedication and abuse. • Provide information for ED provider to make a good medical decision.

4. What is Consistent Care • Program to reduce inappropriate drug seeking and high utilization of ED visits (5+ visits in 12 month period). • Develops individualized Patient Restriction Coordination (PRC) Guidelines for all program enrollees. • Decreases controlled substance prescribing and administration in the ED. • Provides individuals with quality care. • Provides real-time treatment plans and PRC to the ED. • Individualized PRCs accessible by all ED physicians city- and county-wide. • Immediate alert to ED physicians of client’s participation in TDC program and addiction history.

5. All Four Spokane Hospitals Providence Holy Family INHS Deaconess (CHS) Valley Hospital (CHS) Providence Sacred Heart

6. ED Visit Process No controlled substances Patient’s ED chart flagged for doctor medical screening exam by ED physician Usual Triage Registration Reveals Patient on Consistent Care ED case manager talks to patient prior to discharge Auto-Notification ED case manager called. Medical Director sent text message PCP emailed *planned* Insurance Company emailed *planned* ED Care Guidelines Faxed to ED and ED Called *planned* Physician reviews ED care guidelines Patient Discharged EDIEAuto-Notification

7. The Process EMR on INHS network Consistent Care Staff ED Care Guidelines PCP Office ED Care Guidelines Patient Notification Letter Insurance Emergency Department Information Exchange www.ediecareplan.com Mailed to patient’s home Consistent Care Staff

9. TDC Collaboration with Consistent Care

10. ED Care Guidelines as displayed in shared EMR (Meditech PCI)

11. TDC Collaboration with Consistent Care • Provides immediate information about client visits to the ED and/or the hospital. • Verification of visit information (e.g., date/time, reason, outcome) • Medications sought and medications ultimately provided • Provides in-depth medical information, as needed. • Verifies accuracy of information and/or written documentation client provides. • Altering prescriptions • Falsified documents

12. Falsified Documents

13. Which One is False?

15. The Consistent Care Program Darin Neven MS, MD, Medical Director Linda Marsh RN, BSN, CCM, Program Manager Genevieve Green, Staff Support For further information contact Linda MarshLinda.marsh@providence.org www.consistentcare.com Providence Sacred Heart Medical Center & Holy Family Hospital Spokane, Washington

17. What is EDIE? The Emergency Department Information Exchange (EDIE) is a web-based application that enables care providers to better identify and treat high-utilization and special needs patients, as well as track those patients across the EDs and other care settings they present to. EDIE provides: • A flexible framework for case management programs. • Notifications to all stakeholders when high-utilization or special needs patients visit an ED. • Secure access to participating facility visit information regarding clients/patients. • A communication platform between all interested parties.

18. How EDIE Works: System Workflow The Patient registers at a Hospital. The Hospital auto-transmits the patient’s information to EDIE (HL7 feed). EDIE evaluates the patient data against customizable trigger criteria. If any of the hospital’s criteria are met, EDIE then sends the Hospital a Notification—by any of the available Notification Methods—within 3 to 5 minutes of Patient Registration, with actionable information compiled from other EDIE facilities visited by the patient, including: ED Care Guidelines Known Care Providers 3-Month Visit History, with Location and Diagnoses 12-Month Aggregate Visit History by Location Any other EDIE-participating involved stakeholders will also be sent a Notification and can log-in to the EDIE Web Application to view any of the patient’s most recent visits, as well as view and contribute to the patient’s EDIE record, including: Created Care Guidelines for any facility Other Care Providers Notes on the patient from other Providers Insurance, Medication and Diagnoses information from all providers Historical Visit Data, including frequency and mobility Notification Methods: Patient Event Notification Patient Data EDIE Regional Hospital PCP, Mental Health Provider, Specialists Other Provider Facilities Care Managers or Coordinators

19. HIPAA Compliance Collective Medical Technologies (CMT) has made every effort to ensure EDIE’s HIPAA compliancy, and goes to great lengths to ensure that security standards are maintained and EPHI is properly protected. • On a front-end level, a facility in EDIE is only able to view those patients that they have an established treatment relationship with. • On a back-end level, CMT sets up a secure interface with a hospital to receive its ED data in real-time. This data is encrypted for transfer and is then stored in our secure, SOC 2, HIPAA, HITECH, FISMA compliant data centers.

20. TDC Collaboration with EDIE • Provides immediate, real-time information about client visits to the ED. • Verification of visit information (e.g., date/time, reason, outcome). • Medications sought and medications ultimately provided. • Non-disclosed overdoses and narcotics prescriptions obtained. • Allows for 24/7 alerts and access regarding client ED visits. • Provides in-depth medical information, as needed. • Verifies accuracy of information and/or written documentation client provides. • Summary of history of all ED visits for every client (diagnosis, treatment and discharge).

21. TDC Collaboration with EDIE

22. TDC Collaboration with EDIE

23. EDIE Web Application Portal

24. EDIE Report on TDC Client (pg. 1)

25. EDIE Report on TDC Client (pg. 2)

26. EDIE Report on TDC Client (pg. 4)

28. For information about implementing EDIE at your facility, contact Collective Medical Technologies: Kristina Keene Client Relations Manager 509.590.2353 Kristina.keene@collectivemedicaltech.com

29. Superior Court Behavioral Health Adult Felony Therapeutic Drug Court For further information: Sandra Altshuler, saltshuler@spokanecounty.org 509-477-6355 Tony McBride, tmcbride@newta.org 509-326-7740