HIE-SDE Sub AwardKentucky Progress

Karen ChrismanGovernor’s Office of Electronic Health Information

• Query based model• CCD exchange• 127 “Live” facilities• Participation Agreements from 96 of approximately 130 hospitals in the Commonwealth • 26 of 31 Participation Agreements are CAH• No further consent needed state• Kentucky Cabinet for Health and Family Services

(CHFS) funds and provides support to the Commonwealth’s 14 CBHCs but does not have direct control of the centers

Kentucky HIE Background

Kentucky HIE-SDE Sub Awardee PlanDecember 2011

• Query based model• Consent workgroup• Interface from behavioral health providers to KHIE• Lab results reporting to behavioral health providers using

KHIE as the delivery system• Training for behavioral health staff in the consent

process and with the KHIE portal• Continuing education support about this program for

both primary care and behavioral health providers

Kentucky Plan

Sub Award Press Release

Parallel TracksDevelopment ofConsent Form

Developmentof Technology

Created ‘Consent Form Workgroup’Input from the Kentucky Cabinet for Health and Family ServicesProtection and AdvocacyMulti-State ConsortiumAdopted the CIHS HIE workgroup form with modifications for the KHIE environment

Consent Form

KHIE required modificationsMust release all patient dataMust release all patient data to all providers in the HIEMust release all types of dataMust release all data for all uses TPO

TPO is also required by the GOEHI participation agreementRequires a 6 month consent periodIf another consent is not signed within 6 months the consent expires

Consent Form

GOEHI Executive DirectorKHIE Project Manager

Behavioral Health Project Leadand other members as required

Objectives Developed:Business requirementsConsent requirementsConsidered additions to CCD

CCD Components

CCD Technology Workgroup

> Patient: Given Name Family Name , Jr. or Sr., etc...Street Address City, State, Zip Codetel:+19995551212 MRN: 123456789 Birthdate: January 1, 1954 Sex: Male Guardian:

> Next of Kin: Given Name + Family Name Street Address City, State, Zip Codetel:(999)555-1212

> Table of Contents> Purpose : Automated Medical History Summary > Payers > Problems > Family history > Social History > Allergies, Adverse Reactions, Alerts > Medications > Immunizations > Vital Signs > Results > Procedures > Encounters

CCD Components

Behavioral Health

Providers

No Participation Agreement with a behavioral health provider before

March, 2012

Behavioral health providers needed meaningful use

support

Additional attention to 42 CFR Part 2

As a state agency, KHIE required

additional contracting with the community

behavioral health centers

Adapted KHIE processes and

provided site visits

Engaged the Regional Extension Centers within one

week of award announcement

Behavioral Health Providers

There was no standard CCD connection

Began KHIE vendor

onboarding process July 2012

Delivery of the KHIE CCD to

Pennyroyal is in test

Pennyroyal has created a CCD

with a Kentucky Medicaid patient

using vendor software

Behavioral Health Vendor neverconnected to HIE previously

Next steps:

KHIE vendor will provide CCD in

production environment

KHIE vendor will deliver Pennyroyal

CCD in test environment

Onboarding Behavioral Health Vendor

KHIE will only respond to the query from Pennyroyal because KHIE recognizes this security certificate.

This ensures that a known KHIE provider is receiving the information.

Pennyroyal has signed the GOEHI Participation Agreement which requires Pennyroyal to use the data from KHIE only for a permitted use.

NetSmart provides a security certificate that is unique to Pennyroyal

Security

Pennyroyal Center

When a patient requests an accounting of disclosures from Pennyroyal, KHIE can audit the request for the Pennyroyal CCD because KHIE is a Business Associate of all GOEHI participants. When web services technology is used, the requester must be able to confirm the individual within the covered entity’s system who accessed that record in their EMR.

Security

Pennyroyal Center

If the requester uses edge services, the KHIE will be able to audit the user name and facility ID to the individual who accessed the record. KHIE logs the attestation of a provider’s treatment relationship.

Security

What about Consent??

In the beginning unknown process for KHIE

Behavioral health providers are valuable information sources

Behavioral health providers may already have a consent process

KHIE scheduled site visits to study provider workflow

KHIE has reached consensus on the state consent form

Training

 SAMHSA-HRSA Center for Integrated SolutionsPowerPoint Presentation

Michael R. Lardiere, Vice President Health InformationTechnology and Strategic Development

The National Council for Community and Behavioral Healthcare

IntroductionPatient Consent and Authorization Form for Disclosure

Of Certain Health Information to theKentucky Health Information Exchange

 Consent Explanation Health Information Exchange Services

Behavioral HealthAssessment 

CCD Examples:KHIE CCD Screen Shot

KHIE example CCDBehavioral Health example CCD

 

Healthcare IT News “5 Things to Know About CCD” 

KHIE Virtual Health Record VHR Example 

Health Information Exchange and 42 CFR Part 2 Compliant Consent

PowerPoint PresentationMaureen Boyle, PhD SAMHSA

 KHIE Update

KHIE Training PowerPoint

 

KHIE “Patient Consent” Training for Behavioral Health Providers

Objective: To assist behavioral health providers in understanding the consent form created to authorize the disclosure and sharing of behavioral health records with primary care providers via the Kentucky Health Information Exchange.Consent Required: 42CFR Part 2

Federal regulation that requires specific consent by a patient in a federally-assisted drug and alcohol treatment program before the patient’s records can be transferred to another entity.

KRS 210.235 State regulation that requires specific consent by a patient before

a Kentucky Cabinet for Health and Family Services record of a hospitalization can be transferred to another entity.

KHIE “Patient Consent” The Plan

A. Incorporate KHIE “Consent Form” into provider’s existing workflow

Site visit to review provider work flow Additions may be made to the Consent form but no language may be

removed Created “Consent Explanation”

Created to guide the initial training program; use as support for ongoing training and training for new employees

Created Training Guide

B. ‘Train the Trainer’ approach Outreach Coordinators

Assist behavioral health providers with training staff on “consent form” Educate staff on benefits of sharing data through KHIE and how it can be

used to improve the overall healthcare of their patients Focus additional outreach efforts to primary care providers of behavioral

health centers

Making Sense of Consent

• General Rules• Informed

Consent

• Patient• Parent• Legal Guardian

• According to Kentucky statute

Who may consent? • From Whom/To

Whom• Amount & Kind of

Information

Disclosure

• Aid in treatment and care coordination

Purpose

• At any time with written notice

• Doesn’t stop disclosure of info permitted by law

Revocation

• Specified time frame or

• 6 months from date signed

Effective Period

• Patient, parent, legal guardian

• Proof of legal representation required (Court Order)

Signature

Making Sense of Consent

Behavioral Health Education Center Partnership

UK HealthCare CECentral

Mission StatementUniversity of Kentucky HealthCare CECentral delivers high-quality live and enduring continuing professional development activities to health care professionals using evidence-based practice, adult learning principles and innovative web-based technology.

Vision StatementUK HealthCare CECentral aims to be the premier provider of continuing professional development for health care professionals in Kentucky and to establish our educational and technological resources worldwide.

PurposeUK HealthCare CECentral provides health care professionals continuing professional development activities to increase knowledge, competence and performance levels for better patient-centered care, improved patient safety and enhanced clinical outcomes.

UK HealthCare CECentral

KHIE will be hosting Behavioral Health Education Center modules on the University of Kentucky HealthCareCECentral.comwebsite.

UK HealthCare CECentralplans to issue statementsfor up to 1 hour of creditper module for AMA PRACategory 1 Credit™,Social Work andPsychology to eligibleparticipants completingthe CE Activity.

Planned Modules for Behavioral Health CE Credit include:

I. An OverviewII. Integrated Care IIII. Integrated Care IIIV. Consent Form OverviewV. Consent Form Case

Studies

UK HealthCare CECentral

KHIE & UK HealthCare CECentral collaborated in developing a needs assessment, learning objectives, goals, expected outcomes and an evaluation tool for the CE Activity.

Activity Modules

UK HealthCare CECentral

Overview

• What is KHIE?• Medicaid Patient PCP

and BH Case Study• National Perspectives• Behavioral Health

Overview

Integrated Care I

• Overview of IC• Reflection from a

Primary Care perspective on IC

• MCO Implications for BH

Integrated Care II

• Traditional IC• Pennyroyal’s

Story• Non Traditional IC

Consent Form I

• Overview• Why, Who,

When?• Form Details

• Screen Demo

Consent Form II

• Cases in Consent• Patient

Situations• Options

• Refusal?

UK HealthCare CECentral will issue statements of continuing education credits to eligible participants once training has been completed.

• SAMHSA Stakeholders Kickoff Meeting March 12, 2012

• Pennyroyal/Netsmart Weekly Status Call Weekly• KHIE/REC by-weekly touch point

Bi-Weekly (March – July 2012)• SAMHSA Grantee Status Call Monthly• KHIE Monthly Update Call

Monthly (March – October 2012)• National Council for Comm Behav Healthcare Conf April 14-17, 2012• Pathways - Official Intake Call May 1,

2012• KY Health Info Management Association Meeting June 4, 2012• Site Visit Pennyroyal Center

June 13, 2012• SAMHSA - UK CECentral Meeting July 16, 2012• National Council Sub Award Consent meeting July 17, 2012• KHA Advisory Committee Mtg July 26,

2012• SAMHSA Consent Mtg-Washington DC August 7, 2012• REC/QIO/KHIE Joint Training Session August 15,

2012• GOEHI Privacy and Security Meeting August 20,

2012• PAIMI Consumer Group

August 28, 2012• UK CeCentral/KHIE Behavioral Health Mtg September 13, 2012• Bost Forum-HIE-SDE Presentation

September 17, 2012• SAMHSA Stakeholders Statewide Mtg/Training September 18, 2012• Voices for Healthy Kentucky

September 28, 2012• Multi-State Coordination and Communication Webinar October 9, 2012• Kentucky Primary Care Association Conference October 15, 2012• PC-BH Collaboration Universal Consent October 16, 2012• KHIE/Pathways Site Visit

October 18, 2012

Outreach

Kentucky Health Information Exchange Outreach Coordinator Regions

Adair

Allen

Anderson

Ballard

Barren

Bath

Bell

Boone

Bourbon

Boyd

Boyle

Bracken

Breathitt

Breckinridge

Bullitt

ButlerCaldwell

Calloway

Campbell

Carlisle

Carroll

Carter

Casey

Christian

Clark

Clay

Clinton

Crittenden

Cumberland

Daviess

Edmonson

Elliott

Estill

Fayette

Fleming

Floyd

Franklin

Fulton

Gallatin

Garrard

Grant

Graves

Grayson

Green

Greenup

Hancock

Hardin

Harlan

Harrison

Hart

Henderson

Henry

Hickman

Hopkins

Jackson

Jefferson

JessamineJohnson

Kenton

Knott

Knox

Larue

Laurel

Lawrence

Lee

Leslie Letcher

Lewis

Lincoln

Livingston

Logan

LyonMcCracken

McCreary

McLean

Madison Magoffin

Marion

Marshall

Martin

Mason

MeadeMenifee

Mercer

Metcalfe

Monroe

Montgomery

Morgan

Muhlenberg

Nelson

Nicholas

Ohio

Oldham

Owen

Owsley

Pendleton

Perry

Pike

Powell

Pulaski

Robertson

Rockcastle

Rowan

Russell

ScottShelby

Simpson

Spencer

Taylor

ToddTrigg

Trimble

Union

Warren

Washington

Wayne

Webster

Whitley

Wolfe

Woodford

Region 1 – Laura ShonkRegion 2 – Teresa PoffRegion 3 – Ann O’HaraRegion 4 – Dawn GasserRegion 5 – Pat Robinson

Kentucky Regional Extension CenterService Area Map

Kentucky REC (Counties with * are served by Kentucky REC under Tri-State REC) Tri-State REC / NeKY RHIOADAIR GRAYSON MCLEAN BATHALLEN GREEN MEADE BOONEANDERSON HANCOCK * MERCER BOYDBALLARD HARDIN METCALFE BRACKENBARREN HARLAN MONROE CAMPBELLBELL * HARRISON MUHLENBERG CARTER* BOURBON HART NELSON ELLIOTT

* BOYLE HENDERSON OHIO FLEMINGBREATHITT HENRY OLDHAM GALLATINBRECKINRIDGE HICKMAN * OWEN GRANTBULLITT HOPKINS OWSLEY GREENUPBUTLER JACKSON PERRY KENTONCALDWELL JEFFERSON PIKE LAWRENCECALLOWAY * JESSAMINE POWELL LEWISCARLISLE JOHNSON PULASKI MAGOFFINCARROLL KNOTT ROCKCASTLE MASONCASEY KNOX RUSSELL MENIFEECHRISTIAN LARUE * SCOTT MONTGOMERY* CLARK LAUREL SHELBY MORGANCLAY LEE SIMPSON NICHOLASCLINTON LESLIE SPENCER PENDLETONCRITTENDEN LETCHER TAYLOR ROBERTSONCUMBERLAND LINCOLN TODD ROWANDAVIESS LIVINGSTON TRIGG WOLFEEDMONSON LOGAN TRIMBLEESTILL LYON UNION* FAYETTE * MADISON WARRENFLOYD MARION WASHINGTON* FRANKLIN MARSHALL WAYNEFULTON MARTIN WEBSTER* GARRARD MCCRACKEN WHITLEYGRAVES MCCREARY * WOODFORD

Regional Extension Center County Listing

Importance of explaining use of health information for treatment

PowerPoint explaining source and development of the consent form gives it credibility

Importance of explaining form for release of behavioral health records and 42 CFR Part 2 only

Finding

Goal to determine if consumers understood the consent form

Consumer Input

The patient needed assistance from medical office staff, advocate, or mental health mentor to complete the form

Finding

Goal to determine if consumers agreed form needed staff assistance for completion

Consumer Input

Open comments received:

Form should have larger font even if increased number of pages

Signature from guardian only allowed if guardianship order produced

Suggestion that KHIE video Kentucky doctors discussing the use of KHIE and how it helps doctors treat patients

Primary Behavioral Health Care Integration

Pennyroyal Center

received a grant under the PBHCI initiative

Pennyroyal Center has a primary care

license

KHIE delivered KHIE CCD to Pennyroyal

with Medicaid claims data

and all “live” provider lab

results10-25-2012

Pennyroyal will share

consolidated CCD with medical trading

partners 12-15-2012

Current live medical trading

partners Trover Medical

Center, Madisonville,

Lourdes Hospital, Paducah

11-01-2012

Primary Behavioral Health Care Integration

Community Behavioral Health Center

KHIE CCD to Pathways with Medicaid claims

data and all “live” provider lab results

12-01-2012

Pathways shares consolidated CCD with

medical trading partners, primary care

providers currently live King’s Daughters

Medical Center, Fleming County Hospital, St.

Claire Regional Medical Center 01-31-2013

Primary Behavioral Health Care Integration

Community Behavioral Health

Center

Currently teaming with primary care

providers

KHIE CCD to Kentucky River Community

Care with Medicaid claims data, all “live” provider lab results

Kentucky River identified team practices: ARH,

Quantum Healthcare, Mercy Medical Clinic.

Will use KHIE to deliver KRCC CCD consolidated with

Medicaid claims data, all “live”provider lab

results to these providers

Primary Behavioral Health Care Integration

Community Behavioral Health

Center

Partnering with FQHC Primary

Plus

KHIE CCD to Comprehend with Medicaid claims data, all “Live”

provider lab results including

St. Claire Regional Medical Center

and Fleming County Hospital

Comprehend using KHIE to

deliver Comprehend CCD,

Medicaid data and lab results to

Primary Plus

Psychiatric Hospitals in Kentucky Beds County

Central State Hospital 192 Jefferson

Cumberland Hall 91 Christian

Eastern State Hospital 323 Fayette

Kentucky Correctional Psychiatric Center 97 Oldham

Lincoln Trail Behavioral Health System 140 Hardin

Northkey Community Care-intensive Services 57 Kenton

Our Lady of Peace 396 Jefferson

Ridge Behavioral Health System 110 Fayette

Rivendell Behavioral Health Services 125 Warren

River Valley Behavioral Health 80 Daviess

The Brook - Dupont 88 Jefferson

The Brook Hospital - KMI 98 Jefferson

Western State Hospital 495 Christian

Behavioral Health in Kentucky

Community Mental Health Centers (CMHC) City CountyAdanta Somerset PulaskiBluegrass Lexington FayetteCommunicare, Inc. Elizabethtown HardinComprehend, Inc. Maysville MasonCumberland River Corbin WhitleyFour Rivers Behavioral Health Paducah McCrackenKentucky River Community Care, Inc Hazard PerryLifeskills, Inc. Bowling Green WarrenMountain Comp. Care Center Prestonsburg FloydNorthKey Covington KentuckyPathways, Inc. Ashland BoydPennyroyal Regional Center Hopkinsville ChristianRiver Valley Behavioral Health Owensboro DaviessSeven Counties Services, Inc. Louisville JeffersonThe MORE Center Louisville JeffersonTransitions, Inc. Bellevue Campbell

Identified – Future Needs

Centra

l Stat

e Hosp

ital

Centra

l Stat

e ICF-M

R

Del Mari

a ICF-M

R

Easter

n State

Hospital

Glasgo

w SNF

Hazelw

ood ICF-M

R

Kentucky

Correctional P

sychiat

ric Cen

ter

Meadows IC

F-MR

Oakwood

Outwood

Western

State

Hospital

Western

State

Nursing

Windsong ICF-M

R

61

24

8

125

84

118

50

7

121

43

113103

8

Average Daily Census

Kentucky State-Owned Behavioral Health Facilities

Summary

Infrastructure1. Policy Development

KHIE Policy for primary care provider receiving a 42 CFR Part 2 record Behavioral Health Provider Policy requiring the use of Consent Form

2. Workforce Development Training KHIE Intake Coordinator and 5 Outreach Coordinators trained Behavioral Health identified consent resources within CBHC trained Development of web training materials

3. Financing KHIE designated resource to track financing for project and to assist with Medicaid/Meaningful Use

questions4. Organizational change

KHIE Intake Coordinator developed new training manual and training protocol Outreach Coordinators, Staff Attorney, Technical Analyst trained in new manual and protocol

CBHC changed consent form to be consistent across state5. Partnerships/Collaborations

Foundation for a Healthy Kentucky PAIMI Protection and Advocacy Kentucky Voices for Health Kentucky REC, GOEHI, and Department for BHDID

6. Accountability User name, facility ID, attestation Security certificate, pre-fetch the patient record

For additional information contact:Karen.Chrisman@ky.gov or

Polly.Mullins-Bentley@ky.gov