Utilizing New Technology to Facilitate Home Visiting, Data Collection, and Quality Assurance

1. Utilizing New Technology to Facilitate Home Visiting, Data Collection, and Quality Assurance Mitch Coates Healthy Start, Inc. Pittsburgh/Allegheny County and Fayette/Westmoreland Counties MCHB Webcast September 12, 2012

2. Health Information Technology Health Center Controlled Network grant awards totaling $27.8 million have been awarded under the American Recovery and Reinvestment Act of 2009. • Eighteen grants totaling more than $22.6 million support electronic health record implementation. • Four grants totaling more than $2.6 million support health information technology innovation. • Five grants totaling more than $2.5 million support electronic health record quality improvement. http://www.hrsa.gov/healthit/

3. Adoption of Electronic Health Records Office-Based Physicians Hospitals https://healthmeasures.aspe.hhs.gov/topic/D

4. HRSA and HIT Health Information Technology is the use of information and communication technology in health care. Health Information Technology can include: • electronic health records • personal health records • e-mail communication • clinical alerts and reminders • computerized decision support systems • hand-held devices • other technologies that store, protect, retrieve and transfer clinical, administrative, and financial information electronically within health care settings. • http://www.hrsa.gov/healthit/

5. HRSA Goals • Develop a strategy and supportive policy that leverages the power of health information technology and telehealth to meet the needs of people who are uninsured, underserved and/or have special needs. • Identify, disseminate and provide technical assistance to health centers and other HRSA grantees in adopting model practices and technologies. • Disseminate appropriate information technology advances, such as electronic medical records systems or provider networks. • Promote grantee health information technology advances and innovations as models. • Work collaboratively with foundations, national organizations, the private sector, and other Government agencies to help HRSA grantees adopt health information technology. • Ensure that HRSA health information technology policy and programs are coordinated with those of other U.S. Department of Health and Human Services components. • http://www.hrsa.gov/healthit/

6. Phase I • Converting paper forms into digital format and catering the system to your needs. • Simple to use and mimics previous forms. • Creation of Participant Information Management System (PIMS). -Contract or hire in-house programmer

7. Participant Information Management System -PIMS

8. Phase II • Adding PIMS to Thinkpad system • Conforms to HIPAA rules and standards – refer to an attorney or specialist. • Random number generator • Training staff (create a manual) • Adding Quality Assurance piece

9. Hardware • Portable computers range in price from $1,000-$2,500. • Vary in sizes, ruggedness, docking stations, finger print readers, etc. • www.tabletpc2.com

10. How rugged are they?

11. Wireless Network • Wireless network allows staff to connect Thinkpad with the server, which hosts the PIMS database. • Complete participant charts can be searched for and uploaded onto Thinkpad prior to home visit.

12. Storage

13. Safety - Discrete and comfortable carrying bags. - Store items in trunk. - Create a code word for emergency calls to the office from Healthy Start cell phones. - Do not compromise safety for thinkpad.

14. Is my system safe? Confidentiality Can someone who shouldn’t be on the system access it? (Create different usernames/passwords for managers/data abstractors and staff) Integrity Can information be modified or destroyed without your knowledge? (Add a last date modified) Availability Is your system available when needed? (Online querying, live data)

16. QA Process

17. Phase II Discovery • Protective sleeve to protect against drops and spills. • Backup battery – ensure the system will have enough battery through all home visits. • Find a reliable programmer for the system.

18. Phase III • Desktop referral list • Adding referrals for resources. • Scanning pamphlets . • Adding additional studies or research. • Medical glossary. • Educational Movies • BMI Calculator • Edinburgh Depression Scale

19. Signature Recognition • Signature capture for consent and release of information form for OEA staff.

20. Tracking of Thinkpads

21. Laptop GPS Facts • A laptop is stolen every 53 seconds or 2.6 million per year. • In 2011, according to a Verizon Business report, a record 285 million records were compromised. • Only 3% of laptops are ever returned. • According to the Ponemon Institute's 20011 study, "The Cost of a Lost Laptop," the average cost of losing a laptop is $49,246. Data represents 80% of this cost.

22. Laptop Incidents • A Veterans Administration laptop containing the data of 26.5 million vets. Notification letters alone cost nearly $8 million. Add in the cost of credit monitoring services offered by VA and untold other costs, and the VA case may have reached billions of dollars in overall damage—from a single laptop theft. • In April 2009, a laptop belonging to the Oklahoma Department of Human Services (DHS), containing private information of 1 million citizens, was stolen from an employee's car. Within a month, DHS had spent over $150,000 on notification letters to half the people exposed. • Two laptops were stolen from Roosevelt Early Childhood Center in St. Cloud, Minnesota, which contained private student information for 754 students. The data included information about student behavioral issues, names, internal ID numbers, and number of discipline referrals. • BlueCross BlueShield Association employee’s laptop was stolen. The laptop had the personally-identifying information (PII) of about 850,000 doctors–every physician in the USA contracted with a Blues-affiliated insurance plan, all completely unencrypted.

23. Laptop GPS Resources • ActiveTrakMobile • AsseTrax by Authentic Venture • BackStopp by Virtuity, Ltd • Computrace by Absolute Software • The CyberAngel w/ Wi-Trac by CyberAngel Security Solutions, Inc. • FailSafe by Phoenix Technologies • GadgetTrak's PC-Trak for Windows • LaptopSentry by E.E.Soft • LoJack for Laptops • MacTrak: Privacy Safe Anti-Theft for OS X • MyLaptopGPS • nTracker by SyNet Electronics, Inc. • PC PhoneHome by Brigadoon Software, Inc • ExoTrack and Remote Kill by EXO5 • Undercover for Mac OS X and iPhone by Orbicule

24. GPS Mapping

25. Warning

26. Flagging Stolen Thinkpad

27. Retrieving Files from Thinkpad

28. Benefits • Saves money in the long run. - Up to $10,000 a year. • Accuracy of data entered increases from 90%-99% from paper system to paperless. • Efficiency of data entry process that simplifies field staff processes. • Field Managers can accurately track and review charts through quality assurance page. • Data is entered directly into the database, creating live data that can instantly be queried by staff for reports. • Data protected by firewalls, passwords, GPS, etc.

29. Telehealth Monitor

30. Telehealth Monitor • The Telehealth monitoring system was implemented in order to improve outcomes for our participants, reduce medical costs, and improve participant satisfaction in the program. • Typically seen in the elder care/veterans field to monitor chronic diseases, but it can be modified to monitor anyone. • Healthy Start, Inc. Pittsburgh will monitor high risk participants in the behavioral health department for depression, asthma, diabetes, high blood pressure, and weight. • Under the supervision Joanne White, LSW, and Dr. Gloster, the Pediatrician/Medical Director, the participants will answer questions, enter readings, and receive messages that will monitor their wellbeing. • A study by the manufacturer has shown that rate of rehospitalization was 45% in the “routine care” group, whereas it reduced sharply to 20% in the group monitored with telemonitors.

31. Monitor Tracking • Blood Pressure • Blood Sugar • Weight • Blood Oxygen • Temperature • Peak Flow • Pain Level

32. Benefits • Promote patient self-management with “advice” and encouragement messages. • Instant e-mail notifications to Doctor and Behavioral Health Department for any results that fall outside of the designated range, along with daily evaluation. • Enhance adherence with the schedule function for medication reminders, doctor’s visits and vital sign readings. • Take prompt action by viewing risk stratified patient data with full security and take care of your participants from anywhere with access to a web browser.

33. Contact Information Mitch Coates IT Liaison 400 N. Lexington Avenue Pittsburgh, PA 15208 412-247-4009 mcoates@hsipgh.org www.healthystartpittsburgh.org

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