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HIE-SDE Sub Award Kentucky Progress Karen Chrisman Governors Office of Electronic Health Information

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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 Commonwealths 14 CBHCs but does not have direct control of the centers Kentucky HIE Background

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Kentucky HIE-SDE Sub Awardee Plan December 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

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Sub Award Press Release

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Parallel Tracks Development of Consent Form Development of Technology

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Created Consent Form Workgroup Input from the Kentucky Cabinet for Health and Family Services Protection and Advocacy Multi-State Consortium Adopted the CIHS HIE workgroup form with modifications for the KHIE environment Consent Form

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KHIE required modifications Must release all patient data Must release all patient data to all providers in the HIE Must release all types of data Must release all data for all uses TPO TPO is also required by the GOEHI participation agreement Requires a 6 month consent period If another consent is not signed within 6 months the consent expires Consent Form

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GOEHI Executive Director KHIE Project Manager Behavioral Health Project Lead and other members as required Objectives Developed: Business requirements Consent requirements Considered additions to CCD CCD Components CCD Technology Workgroup

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> Patient: Given Name Family Name, Jr. or Sr., etc... Street Address City, State, Zip Code tel:+19995551212 MRN: 123456789 Birthdate: January 1, 1954 Sex: Male Guardian: > Next of Kin: Given Name + Family Name Street Address City, State, Zip Code tel:(999)555-1212 > Table of Contents > Purpose : Automated Medical History Summary Purpose : Automated Medical History Summary > Payers Payers > Problems Problems > Family history Family history > Social History Social History > Allergies, Adverse Reactions, Alerts Allergies, Adverse Reactions, Alerts > Medications Medications > Immunizations Immunizations > Vital Signs Vital Signs > Results Results > Procedures Procedures > Encounters Encounters CCD Components

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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

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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 never connected 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

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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

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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 entitys system who accessed that record in their EMR. Security

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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 providers treatment relationship. Security

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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

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Training

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SAMHSA-HRSA Center for Integrated Solutions PowerPoint Presentation Michael R. Lardiere, Vice President Health Information Technology and Strategic Development The National Council for Community and Behavioral Healthcare Introduction Patient Consent and Authorization Form for Disclosure Of Certain Health Information to the Kentucky Health Information Exchange Consent Explanation Health Information Exchange Services Behavioral Health Assessment CCD Examples: KHIE CCD Screen Shot KHIE example CCD Behavioral Health example CCD

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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 Presentation Maureen Boyle, PhD SAMHSA KHIE Update KHIE Training PowerPoint

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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 patients 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.

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KHIE Patient Consent The Plan A. Incorporate KHIE Consent Form into providers 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

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M aking 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

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Aid in treatment and care coordination Purpose At any time with written notice Doesnt 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 M aking Sense of Consent

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Behavioral Health Education Center Partnership UK HealthCare CECentral Mission Statement University 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 Statement UK 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. Purpose UK 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.

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UK HealthCare CECentral KHIE will be hosting Behavioral Health Education Center modules on the University of Kentucky HealthCare CECentral.com website. UK HealthCare CECentral plans to issue statements for up to 1 hour of credit per module for AMA PRA Category 1 Credit, Social Work and Psychology to eligible participants completing the CE Activity.

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Planned Modules for Behavioral Health CE Credit include: I.An Overview II.Integrated Care I III.Integrated Care II IV.Consent Form Overview V.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.

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Activity Modules UK HealthCare CECentral Overview What is KHIE? Medicaid Patient PCP and BH Case Study National Perspectives Behavioral Health Overview 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 I Overview of IC Reflection from a Primary Care perspective on IC MCO Implications for BH Integrated Care II Traditional IC Pennyroyals Story Non Traditional IC Integrated Care II Traditional IC Pennyroyals Story Non Traditional IC Consent Form I Overview Why, Who, When? Form Details Screen Demo Consent Form I Overview Why, Who, When? Form Details Screen Demo Consent Form II Cases in Consent Patient Situations Options Refusal? 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.

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SAMHSA Stakeholders Kickoff MeetingMarch 12, 2012 Pennyroyal/Netsmart Weekly Status CallWeekly KHIE/REC by-weekly touch pointBi-Weekly (March July 2012) SAMHSA Grantee Status CallMonthly KHIE Monthly Update CallMonthly (March October 2012) National Council for Comm Behav Healthcare Conf April 14-17, 2012 Pathways - Official Intake CallMay 1, 2012 KY Health Info Management Association MeetingJune 4, 2012 Site Visit Pennyroyal CenterJune 13, 2012 SAMHSA - UK CECentral Meeting July 16, 2012 National Council Sub Award Consent meeting July 17, 2012 KHA Advisory Committee MtgJuly 26, 2012 SAMHSA Consent Mtg-Washington DCAugust 7, 2012 REC/QIO/KHIE Joint Training SessionAugust 15, 2012 GOEHI Privacy and Security MeetingAugust 20, 2012 PAIMI Consumer GroupAugust 28, 2012 UK CeCentral/KHIE Behavioral Health MtgSeptember 13, 2012 Bost Forum-HIE-SDE PresentationSeptember 17, 2012 SAMHSA Stakeholders Statewide Mtg/TrainingSeptember 18, 2012 Voices for Healthy KentuckySeptember 28, 2012 Multi-State Coordination and Communication WebinarOctober 9, 2012 Kentucky Primary Care Association ConferenceOctober 15, 2012 PC-BH Collaboration Universal ConsentOctober 16, 2012 KHIE/Pathways Site VisitOctober 18, 2012 Outreach

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Kentucky Health Information Exchange Outreach Coordinator Regions Adair Allen Anderson Ballard Barren Bath Bell Boone Bourbon Boyd Boyle Bracken Breathitt Breckinridge Bullitt Butler Caldwell 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 Hancoc k Hardin Harlan Harrison Hart Henderson Henry Hickman Hopkins Jackson Jefferson Jessamine Johnson Kenton Knott Knox Larue Laurel Lawrence Lee Leslie Letcher Lewis Lincoln Livingston Logan Lyon McCracken McCreary McLean MadisonMagoffin Marion Marshall Martin Mason Meade Menifee Mercer Metcalfe Monroe Montgomery Morgan Muhlenberg Nelson Nicholas Ohio Oldham Owen Owsley Pendleton Perry Pike Powell Pulaski Robertson Rockcastle Rowan Russell Scott Shelby Simpson Spencer Taylor Todd Trigg Trimble Union Warren Washington Wayne Webster Whitley Wolfe Woodford Region 1 Laura Shonk Region 2 Teresa Poff Region 3 Ann OHara Region 4 Dawn Gasser Region 5 Pat Robinson

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Kentucky Regional Extension Center Service Area Map

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Kentucky REC (Counties with * are served by Kentucky REC under Tri-State REC)Tri-State REC / NeKY RHIO ADAIRGRAYSONMCLEANBATH ALLENGREENMEADEBOONE ANDERSONHANCOCK* MERCERBOYD BALLARDHARDINMETCALFEBRACKEN BARRENHARLANMONROECAMPBELL BELL* HARRISONMUHLENBERGCARTER * BOURBONHARTNELSONELLIOTT * BOYLEHENDERSONOHIOFLEMING BREATHITTHENRYOLDHAMGALLATIN BRECKINRIDGEHICKMAN* OWENGRANT BULLITTHOPKINSOWSLEYGREENUP BUTLERJACKSONPERRYKENTON CALDWELLJEFFERSONPIKELAWRENCE CALLOWAY* JESSAMINEPOWELLLEWIS CARLISLEJOHNSONPULASKIMAGOFFIN CARROLLKNOTTROCKCASTLEMASON CASEYKNOXRUSSELLMENIFEE CHRISTIANLARUE* SCOTTMONTGOMERY * CLARKLAURELSHELBYMORGAN CLAYLEESIMPSONNICHOLAS CLINTONLESLIESPENCERPENDLETON CRITTENDENLETCHERTAYLORROBERTSON CUMBERLANDLINCOLNTODDROWAN DAVIESSLIVINGSTONTRIGGWOLFE EDMONSONLOGANTRIMBLE ESTILLLYONUNION * FAYETTE* MADISONWARREN FLOYDMARIONWASHINGTON * FRANKLINMARSHALLWAYNE FULTONMARTINWEBSTER * GARRARDMCCRACKENWHITLEY GRAVESMCCREARY* WOODFORD Regional Extension Center County Listing

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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

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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

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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

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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 results 10-25-2012 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

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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 Kings Daughters Medical Center, Fleming County Hospital, St. Claire Regional Medical Center 01-31-2013

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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 liveprovider lab results to these providers

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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

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Psychiatric Hospitals in KentuckyBedsCounty Central State Hospital192Jefferson Cumberland Hall91Christian Eastern State Hospital323Fayette Kentucky Correctional Psychiatric Center97Oldham Lincoln Trail Behavioral Health System140Hardin Northkey Community Care-intensive Services57Kenton Our Lady of Peace396Jefferson Ridge Behavioral Health System110Fayette Rivendell Behavioral Health Services125Warren River Valley Behavioral Health80Daviess The Brook - Dupont88Jefferson The Brook Hospital - KMI98Jefferson Western State Hospital495Christian Behavioral Health in Kentucky Community Mental Health Centers (CMHC)CityCounty Adanta SomersetPulaski Bluegrass LexingtonFayette Communicare, Inc. ElizabethtownHardin Comprehend, Inc. MaysvilleMason Cumberland River CorbinWhitley Four Rivers Behavioral Health PaducahMcCracken Kentucky River Community Care, Inc HazardPerry Lifeskills, Inc. Bowling GreenWarren Mountain Comp. Care Center PrestonsburgFloyd NorthKey CovingtonKentucky Pathways, Inc. AshlandBoyd Pennyroyal Regional Center HopkinsvilleChristian River Valley Behavioral Health OwensboroDaviess Seven Counties Services, Inc. LouisvilleJefferson The MORE Center LouisvilleJefferson Transitions, Inc. BellevueCampbell

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Identified Future Needs Kentucky State-Owned Behavioral Health Facilities

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Summary Infrastructure 1. 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 questions 4. 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 state 5. 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

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For additional information contact: Karen.Chrisman@ky.govKaren.Chrisman@ky.gov or Polly.Mullins-Bentley@ky.gov