2. Series 1: “Meaningful Use” for Behavioral Health Providers 9/2013 From the CIHS Video Series “Ten Minutes at a Time” Module 7: Meeting the PBHCI Grant HIT-Related Expectations in the Bulleted List of Requirements

3. Module 4 Outline Overview of grant expectations and some key terms Meeting the bulleted list of requirements What the requirements mean Lessons learned for implementation SAMHSA-approved “work-arounds” when the ability cannot be demonstrated as written in the grant (implemented in consultation with GPO).

4. Grant Expectations* SAMHSA expects PBHCI grantees to achieve Meaningful Use Standards, as defined by CMS, by the end of the grant period; to that end, applicants must propose how they will develop and demonstrate the ability to: Submit at least 40% of prescriptions electronically (as allowable given state-specific laws regarding the use of e-prescriptions for controlled substances); Receive structured lab results electronically; Share a standard continuity of care record between behavioral health providers and physical health providers; and Participate in the regional extension center program. *Page 9 of Request for Applications (RFA), No. SM-12-008, “PBHCI”

5. Key Term Electronically – Describes the computer- based transmission and/or receipt of data. Used in discussion of prescriptions; receipt of lab results; and the transmission/receipt of patient information. Https://questions.cms.gov/faq.php?id=5005&faqId=2857

6. ePrescribing Submit at least 40% of prescriptions electronically (as allowable given state-specific laws regarding the use of e-prescriptions for controlled substances) Closely related to Meaningful Use Core Objective #4 Objective: “Generate and transmit prescriptions electronically” Measure: “More than 40 percent of all permissible prescriptions written by the EP are transmitted electronically using certified EHR technology” http://www.healthit.gov/providers-professionals/achieve-meaningful-use/core- measures/e-prescribing

7. ePrescribing Drug Interaction Checks (CORE) Allergy List includes Medication Allergies (CORE) Medication Reconcilia- tion (MENU) Drug Formulary Checks (MENU) Active Medication List (CORE) Computerized Physician Order Entry (CPOE) (CORE) Stage 1 Meaningful Use Improve Quality, Safety, Efficiency 5 Core and 2 Menu Objectives related to medication Systemic strategy for medication management

8. Lab Results and Meaningful Use Diagnostic test results are part of the minimum data set for the CCR/CCD and are included in two Core Objectives re: Patient Summaries. They are also included in patient summary data for two Menu Objectives Lab Results Data Standard Developed for Meaningful Use LOINC – Logical Observation Identifiers Names and Codes Not mandated by CMS!

9. Lessons Learned EHR may have capacity to receive results (as required for certification), but lack functionality to utilize the results May lack interface May have interface “but” It is limited to working with only one or two labs It costs more than anticipated It lacks other necessary utility such as the ability to comment on out-of-range results, signing off on single or batched results, etc. Labs may not be willing May not want to invest in interface functionality May not have resources available to work with BH providers, who usually have low order volume

10. Lab Results “Workaround” Refine cohort and data parameters - applies only to (a) PBHCI enrollees (b) who are entered into the EHRS (c) PBHCI grant Health Risk Assessment lab results Access Guidance for Implementation Menu Objective #2: Incorporate clinical lab test results into EHR as structured data http://www.healthit.gov/providers-professionals/achieve-meaningful- use/menu-measures/clinical-lab-test-results “A Case for Manual Entry of Structured, Coded Laboratory Data…” www.ncbi.nlm.nih.gov/pmc/articles/PMC1380191

11. Continuity (or Transition) of Care Record (CCR) Minimum Data Set 1) Allergies and other adverse reactions 2) Medications (including current meds) a. Admission medications history b. Hospital Discharge Medications (if hospital) c. IV Fluids administered (if hospital) d. Medications administered 3) The problem list (diagnoses) a. Active problems b. History of past illness c. Hospital Admission Diagnosis (if hospital) d. ED diagnosis (if hospital) e. Discharge diagnosis 4) List of surgeries (if hospital) 5) Diagnostic results (i.e., labs, imaging, etc.) Originating Entity Information Patient Information http://www.healthit.gov /providers- professionals/achieve- meaningful-use/menu- measures/transition- of-care

12. Example of the Continuity (or Transition) of Care Document (CCD) Minimum Data Set (See Module 5 for more information) http://www.corepointhealth.com/sites/def ault/files/whitepapers/understanding-the- continuity-of-care-record-ccr.pdf

13. Exchanging the CCD and Meeting the Requirement for Joining the Regional Extension Center Regional Extension Centers (RECs) BH involvement varies state by state – but can still access assistance through Web sites http://www.healthit.gov/providers-professionals/regional-extension-centers-recs State Health Information Exchanges BH involvement varies state-by-state http://www.healthit.gov/providers-professionals/state-health-information-exchange Nationwide Health Information Network Direct (NwHIN Direct) Point-to-point secure messaging system for the transmission and receipt of patient information over a network of providers http://www.healthit.gov/policy-researchers-implementers/nationwide-health-information-network- nwhin

14. Summary Community Behavioral Health Providers can (and the grant requires the grantees to) participate in Health Information Exchange and meet the standard for “Meaningful Use” It also requires the active demonstration of the ability to meet this standard by the implementation of the bulleted list of activities Obstacles and delays caused by external factors are not unusual. Remember that in most cases, a SAMHSA- approved work around can be applied

15. We Have Solutions for Integrating Primary and Behavioral Healthcare Contact CIHS for all types of primary and behavioral health care integration technical assistance and training needs 1701 K Street NW, Ste 400 Washington DC 20006 Web: www.integration.samhsa.govwww.integration.samhsa.gov Email:integration@thenationalcouncil.orgintegration@thenationalcouncil.org Phone:202-684-7457 Prepared and presented by Colleen O’Donnell, MSW, PMP, CHTS-IM for the Center for Integrated Health Solutions