HealthInfoNet’s Behavioral Health Information Technology Reimbursement Initiative October 21, 2014 Dial: Enter access code #

Q & A During the Presentation: The call is muted to ensure good sound quality. We are using the ReadyTalk chat feature to facilitate questions during the presentation. Please send your questions to “All Panelists” or privately to the Chairperson. Q & A will follow the presentation You can continue to submit questions via chat Or you can press (*7 Unmute) (*6 MUTE) to ask a question. 2

Agenda 1.Status of Milestone 1 and Review of Milestone 2 Requirements (Katelyn Michaud 2.HealthInfoNet in a BHH Setting (Kimberlee Lovely, OHI) 3.Milestone 2 Clarifications: Consent Education and Training (Gemma Cannon & Katie Sendze) 4.What’s next 3

Goals for Today’s Meeting Explore how HealthInfoNet supports continuity of care in a BH setting Review Milestone 2 requirements Clarify Milestone 2.1 education requirements on Opt-in and Opt-out Address common concerns and questions Review what’s next 4

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Meeting Milestone /30/2014 Deadlines (May be delayed due to Training schedule) Complete HealthInfoNet’s staff and patient education processes Complete Milestone 2.1 Report o Send completed form to Gemma: 6

Setting up Help Desk User Account follows Milestone 2.1 Milestone 2.1 is incomplete without HIN’s receipt of completed 2.1 Report. Help Desk User Accounts will be set up following receipt of the Milestone 2.1 report. o To set up Help Desk User Account, please send name of Help Desk Staff to Gemma o Request will be processed following receipt of Milestone 2.1 Report 7

Report from the Field: HealthInfonet in a Behavioral Health Home Kim Lovely, RN Clinical Care Coordinator, OHI 8

HealthInfoNet & Continuity of Care The correct medical solution is not always a psych med adjustment. Secondary findings are not always addressed by surgeons. Primary care providers with 10 minute office visits can miss key symptoms (even a 19 lb. weight gain within 2 weeks). 9

HealthInfoNet & Continuity of Care Another set of eyes increases quality of care by primary care providers (such as decreasing blood draws). Hospital Discharge Summaries: What the patient sees on their discharge paper isn’t what the patient needs to know. Our patients are people, not text books, and a “lab” normal may not be “their” normal. 10

Clarifications: Consent Education and Training: Clarification and New Tools Gemma Cannon & Katie Sendze 11

Four Patient Consent Options 1.Share medical information Only. 2.Share mental health, HIV information or both with an individual provider. 3.Share mental health, HIV information or both with all providers participating in HealthInfoNet. 4.Remove all medical information, including mental health and HIV. 12

Consent Overview for Health Information Exchange Consent means something different when information is shared through the health information exchange than it does when behavioral health organizations share information with other providers directly. HealthInfoNet is the gatekeeper of the data that’s in the Health Information Exchange. 13

HIE Consent & Maine State Law The responsibility to manage consent options is HealthInfoNet’s, not the participating organizations. The consent relationship is between the individual and HealthInfoNet Participating organizations are required to educate patients/clients about their consent options. 14

HIE Consent & Maine State Law State law allows behavioral health providers to send data to HealthInfoNet regardless of patient/client consent choice as long as: a.HIN shields the mental health data from view, unless a patient/client provides consent b.Maintains an opt-in mechanism for the patient/client to choose to share their mental health and/or HIV information with a HIE participant. c.Maintains an opt-out mechanism for the patient/client to not share any information. 15

HIE Consent & Maine State Law  Maine law requires participating organizations to: o Inform patients/clients that the organization participates in HealthInfoNet o Educate patients/clients about their consent options. o Provide the opt-out form the first time a patient/client is cared for after the organization begins participation with HealthInfoNet. 16

HIE Consent & Maine State Law Continued- Maine law requires participating organizations to: If a patient signs the opt-out form at the organization, the participating organization must send the form to HealthInfoNet within two business days. Faxing the form to HIN is the most common way to do this. 17

What information is in the HIE? Information evolves over time Patient Identifier, Demographics Encounter (visit) History Laboratory and Microbiology Results Radiology Reports Adverse Reactions/Allergies Medication History (Last 120 days, from Pharmacy’s) Diagnosis/Conditions/Problems (primary and secondary) Immunizations Dictated/Transcribed Documents Continuity of Care Documents “CCD’s” Vitals- new area 18

Mental Health Information Mental Health Information comes into the HIE but is shielded from view. o A Patient can give verbal permission to a treating provider at the point of care to see the shielded information. o A treating provider can “break the glass” and see the shielded information in an emergency. 19

The “Opt-In” Choice Individuals sign the opt-in form when they make the choice to: Un-shield their mental health information Make their mental health information available to their treating providers without “breaking the glass.” 20

The Opt-In Form: Legal and Contractual Requirements If a patient wants to opt-in their mental health and/or HIV data: o The opt-in form needs to be either witnessed by a staff member or Notary Public before sending to HealthInfoNet. o If a staff member witnesses the form, it must be sent by the participating organization, not the patient/client. 21

The Opt-In Form: Clarifications The opt-in form is not a release of information that: o Allows your organization to send an individual’s mental health information to the HIE. o Allows other organizations to send an individual’s mental health information to the HIE. 22

FAQs #1 Question: I thought medical providers hand out the opt-out form and the behavioral health providers hand out the opt-in form. Do I have to give out the opt-out form too? Answer: Yes. All organizations participating in HealthInfoNet must provide education about HealthInfoNet, including the opt-out form. 23

FAQs #2 Question: Does the patient/client need to sign the “Opt-In” form when they give me permission to “break the glass” and see their mental health data? Answer: No. The opt-in form is not used to track permission to “break the glass”. The opt-in form allows an individual’s mental health and/or HIV information to be available to all of their treating providers without “breaking the glass.” 24

FAQs #3 Question: I’m their mental health provider. Do I need to break the glass to see their mental health information in HealthInfoNet? Answer: Yes. Unless your client has opted-in their mental health information, it’s shielded from your view until that individual gives you permission to “break the glass.” 25

FAQs #4 Question: If I’m the mental health provider and my client has not opted-in, but data has come from my EHR to HIN, why can’t I see it? Answer: Mental health data that’s in HIN comes from multiple participants. Unless your patient/client has opted-in their mental health information, you cannot see that information in the HIN clinical portal unless they give you permission to “break the glass.” 26

FAQ #5 Question: Is there a limit to how many times a client can allow me to “break the glass?” Answer: No. A client can allow you to “break the glass” at every visit if that’s what they choose to do. 27

FAQs #6 Question: How do I prove that the client gave me permission to “break the glass?” Answer: In order to “break the glass” while you are viewing an individual’s record in the HIN Clinical Portal, you must provide a reason via a drop-down menu. A client’s verbal consent serves as your permission. 28

FAQ #7 Question: Who tracks the “break the glass” mechanism? Answer: This can be tracked by both HIN and the participant organization. All HIN users who “break the glass” leave an audit trail that is available. This audit report is also available from HIN to patients/clients by their request. This as well as other audit functions helps to assure that data is used appropriately. 29

FAQ#8 Question: Do I need to get my patient/client to sign the opt-in form before my organization can send that individual’s data from my EHR to HealthInfoNet? Answer: No. The opt-in form is not a “Release of Information” form that gives you permission to send that individual’s data to HIN. An individual signs the opt-in form to allow their mental health and/or HIV information to be available to all of their treating providers without “breaking the glass.” 30

FAQ#9 Question: But don’t my patients/clients need to give me permission to send their mental health data to HealthInfoNet? Answer: No. State law allows behavioral health providers to send data to HIN regardless of consent choice. Refer to slide #15 of this presentation. 31

FAQs #10 Question: How often do we need to talk to our patients/clients about HealthInfoNet? Answer: You’re required to inform them about HIN at the point of initial contact after your organization begins participation. You’re not required to repeat it. 32

FAQ #11 Question: If we’re not sending data to HealthInfoNet, and we’re “view-only”, do we need to provide education about HealthInfoNet? Answer: Yes. “View only” is part of participation. Also, this is included in the milestone two activities defined in this SIM initiative. 33

FAQs #12 Question: Am I required to get a signature from the patient? Answer: No. You don’t need to get a signature. In the BH world, you need signatures to send any information anywhere. In the HIE world, consent is managed differently, and no signature is required. 34

FAQ#13 Question: When do I need to get a signature? Answer: If the patient chooses to opt-out all of their information from HIN, they need to sign a form to do that. If the patient chooses to have their mental health information unshielded, they need to sign the opt-in form. 35

Prepare for Staff Consent Training Can be parallel or “back to back” with Clinical Portal Training Identify who in your organization is responsible or required to give consent information in your organization 36

Consent Training Timeline Train Supervisors first o Get their input o Develop plan for training front-line staff Begin Consent training for Staff o Align timing of the “View Only Go-Live” Clinical Portal Use by your staff with performing consent education at the point of care. 37

Consent Workflow and Use of HealthInfoNet’s Clinical Portal Have Consent Education Workflows in place prior to the use of HealthInfoNet’s Clinical Portal. Consent Education can begin slightly ahead of Clinical Portal Use, but use of the Clinical Portal without Consent Education in place is not recommended 38

Consent Training Tools FAQs and Background on HealthInfoNet for leadership and trainers Infographic on Consent process for staff Script for Staff on how to discuss consent options *New* Opt-out and Opt-in forms 39

Any Questions? Un-Mute: *7 Mute: *6 40

What You Need to Do Next Complete Milestone 2.1 Reporting Form and Submit to Gemma Contact Sharon Bearor and schedule training 41

Next Meeting: Tuesday, November 18, 2014 Questions, Answers, Updates 42