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.
Slide 21
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
Slide 22
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.
Slide 29
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.
Slide 30
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.
Slide 31
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
Slide 35
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
Slide 36
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
Slide 37
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
Slide 38
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
Slide 39
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
Slide 40
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
Slide 41
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
Slide 42
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
Slide 43
Identified Future Needs Kentucky State-Owned Behavioral Health
Facilities
Slide 44
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