Behavioral Health Information Network of Arizona HIT Policy Committee Privacy and Security Tiger Team April 16, 2014

BHINAZ Private and Confidential Who is Behavioral Health Information Network of Arizona (BHINAZ)?  Community Stakeholder Owned  Official formed as a Limited Liability Company (LLC) in Arizona – June 2013  Arizona statewide initiative – Behavioral Health Providers, Public Agencies, Health Information Network of Arizona, and consumers

BHINAZ Private and Confidential  “To develop a statewide behavioral health information network that will improve quality, safety, create efficiencies, reduce health disparities, engage patients and families, improve public health and protect patient information.” Mission

BHINAZ Private and Confidential The Vision PCP/Specialist Payor Laboratory Pharmacy Hospital/Health Systems Patient HINAZ Rehab/Detox Counseling Services Crisis Services Laboratory

BHINAZ Private and Confidential Key Drivers  Health Care Reform / Patient Affordable Care Act (ACA)  Heath Information Technology for Economic & Clinical Health (HITECH) Act  Meaningful Use of Certified Electronic Health Records (EHR)  Integration between physical and behavioral health  Health / Medical Home Models  Outcome and Performance Based Contracting  Arizona – Maricopa County Behavioral Health MCO Contract

BHINAZ Private and Confidential Public  Availability and efficient distribution of a large volume of patient data  Efficient exchange of standards- based data (CCD, IHE, etc.)  Gateway to the National Health Information Network  Arizona’s HINAZ Public Versus Private HIE Private *Coordination of care among the providers in a community – workflow improvement *Connecting systems and users with different technical capabilities and workflow needs *Access to the community patient chart *Business intelligence service to optimize pay-for-performance and quality improvement *Support for emerging integrated delivery networks

BHINAZ Private and Confidential  Complicated Federal Laws around Privacy - 42 CFR Part 2  We have a unique opportunity here in Arizona  Maintains integrity of Behavioral Health system in Arizona  Provides a platform for emerging business opportunities  Allows behavioral health providers to collectively own new technology Why a Separate BH HIE Initiative?

HIE Benefits* *Healthcare Information and Management Systems Society (HIMSS). “Evaluating a Potential HIE Opportunity ”, HIMSS Guide to Participating in HIE November.

Reduced staff time spent on handling lab and radiology results Reduced staff time spent on clerical administration and filing Decreased dollars spent on redundant tests Decreased cost of care for chronic care patients Reduced medication errors HIE Cost Savings* *eHealthInitiative. “A Report Based on the Results of the eHealth Initiative’s 2009 Sixth Annual Survey of Health Information Exchange”, Migrating Toward Meaningful Use: The State of Health Information Exchange July.

BHINAZ Private and Confidential  Behavioral Health Providers  Public and Private External HIE’s  Patients and Consumers  Advocacy Groups  Public Agencies  Primary Care  Laboratory Companies (LabCorp, Sonora Quest, etc.)  SureScripts/RxHub  Specialists  Hospital Systems The BHINAZ Network

BHINAZ Private and Confidential  Clinical Data Repository (On demand CCD/CCDA/CCR/HL7)  XCA/XCPD Gateway Services  Master Patient Index  Granular Consent Management  Provider & Resource Directory  Data Analytics & Reporting  Orders & Medication Reconciliation BHINAZ HIE Solution  Secure, Web-Based Portal Access  Support for Single Sign-on  Security, Auditing & Network Management  Support Core Integrated Healthcare Enterprise (IHE) Profiles  Individual Referral Management between disparate EHRs  Population Management  Direct Exchange

BHINAZ Private and Confidential  Structured Data Elements  Demographics, Labs, Medications, Allergies, & Diagnosis  Clinical Documents  Psychiatric Evaluations, Assessments, Crisis & Safety Plans, Discharge/Transitions Plans, Individual Service/Recovery Plans, Progress Notes Exchange & Clinical Information

BHINAZ Private and Confidential Current Technology BHINAZ HIE NextGen HIE (BASE) Mirth Solutions (Expanded Solutions) Topaz Information Solutions (NextGen EHR) ClearData (Hosting)

BHINAZ Private and Confidential  Enrollment and Care Team Assignment  Integrated Care Plan  Centralized Referral Management  Patient Engagement & Communication  Population Management  Reporting and Data Analytics Goals Around Care Integration- Care Coordination Platform

BHINAZ Private and Confidential Consent Management

BHINAZ Private and Confidential Patient must OPT OUT Otherwise, they are Opted IN by default Opt Out Patient must OPT IN Otherwise, they are Opted OUT by default Opt In Opt In vs. Opt Out ©BHINAZ Private and Confidential. Content may not be reused without permission.

BHINAZ Private and Confidential  The state of Arizona is an “Opt-Out” state.  BHINAZ operates under an “Opt-in” model requiring the client to specifically agree to share their protected data from one provider to another.  The BHINAZ model ensures that data protected under 42 CFR part 2 is not re-disclosed without proper consent.  All BHINAZ data is treated as Part 2 data. Privacy & Consent

BHINAZ Private and Confidential  Consent is captured electronically at the point of care  Opt-in consent is valid for 365 days, then a new consent is collected  Patients can revoke at any time  The consent is “all or nothing” per agency/entity. We are not doing data segmentation at this time BHINAZ Consent Facts

BHINAZ Private and Confidential  We require the additional consent of minors aged Minors can revoke without parents.  Opt-in status reverts to “no consent on file” at the age of 18 or age 12. A new consent is required.  Break-the-Glass is allowed regardless of consent status for valid emergency situations. BHINAZ Consent Facts

BHINAZ Private and Confidential In Network  Participant visits Agency A  They sign a consent to allow their Agency A data to be shared/viewed by ALL BHINAZ organizations  Agency A Data now flows to all other BHINAZ organizations. Agency A SMI Clinic Crisis Center Detox Center *Participant visits Detox Center *They choose NOT to share their detox data *No detox data can be viewed by any other agency on the network Opt Out Opt-In ©BHINAZ Private and Confidential. Content may not be reused without permission.

BHINAZ Private and Confidential Viewing Out of Network data  BHINAZ receives a feed of data from out-of-network HIE  Participant receives services at BHINAZ Agency A  A patient match is made with the out-of-network data feed  CCD documents and/or Alerts are routed directly to EHR BHINAZ Agency A Outside Network BHINAZ BHINAZ ID Match

Stage 1 Starting Recognition of the need for health information exchange among multiple stakeholders in Arizona Behavioral Health Community. Stage 2 Organizing Getting organized; defining shared vision, goals and objectives; identifying funding sources, setting up legal and governance structures. Stage 3 Planning Transferring vision, goal and objectives to tactics and business plan; defining your needs and requirements; securing funding Stage 4 Piloting Well Under way with implementation – technical, financial and legal. Stage 5 Operating Fully operational health information organization; transmitting data that is being used by behavioral health stakeholder Stage 6 Sustaining Fully operational health information organization; transmitting data that is being used by behavioral health stakeholder and have sustainable business model. Stage 7 Innovating Sustainable and fully operational health information organization. Demonstration of expansion of organization to provide value-add services such as advanced analytics, quality reporting, clinical decision support, and closed-loop referral management. HIE Development BHINAZ 42% of HIE participants surveyed by eHealth Initiatives in 2013 have reached Stage 5 or Higher

BHINAZ Private and Confidential  Partnership with Health Information Network of Arizona (HINAz)  Partnership with Mercy Maricopa Integrated Care (MMIC) Partnerships

BHINAZ Private and Confidential  Participating Agencies sign a Qualified Service Organization Agreement (QSOA)  Pay one-time connection fee  Pay monthly subscription fee  BHINAZ will work with organization IT for technical connection and customization  BHINAZ provides workflow analysis and training Getting Connected

BHINAZ Private and Confidential Questions

BHINAZ Private and Confidential Contact Laura Young, Executive Director ©BHINAZ Private and Confidential. Content may not be reused without permission.