December 12th PCMN Design Team Record

Medical Neighbor Project December 16, 2014 Design Team Meeting Record of Learning Project Purpose: Improve referral infrastructure across the medical neighborhood in Greater Columbus Meeting Objectives  Review infrastructure tool selected by the design team--CliniSync  Discuss lessons learned and best practices of implementing referral infrastructure  Collaboratively identify necessary components for the pilot’s referral agreement  Collaboratively identify measures of success for the pilot phase Meeting Participants  Stephanie Baker, Clintonville-Beechwold  Colleen O’Brien, The Ohio State University Wexner Community Resource Center Medical Center  Roy Bobbitt, Central Ohio Diabetes Association  Lauren Paluta, United Way of Central Ohio  David Ciccone, United Way of Central Ohio  Christine Patella, The Breathing Association  Neal Edgar, Mental Health America of Franklin  Dana Vallangeon, MD, Lower Lights Christian Health County Center  Isi Ikharebha, Physicians CareConnection  Matthew Yannie, United Way of Central Ohio Healthcare Collaborative of Greater Columbus  Sherry Inskeep, AIDS Resource Center Ohio  Jeff Biehl  Tricia Kincaid, OhioHealth  John Leite  Richele MacDowell, OhioHealth Group  Krista Stock  Heather McCormick, LifeCare Alliance  Marty Miller, Heart of Ohio Family Health Centers Review infrastructure tool selected by the design team—CliniSync  

Dan Paoletti and Karen Bishop from the Ohio Health Information Partnership (OHIP) reviewed how a referral and secure message are sent through CliniSync.

Key takeaways from the discussion o The process for using the referral tool is determined by the status of the organization as either a covered or non-covered entity. Typically covered entities are those that bill Medicare/Medicaid and/or have a HIPAA plan in place for protecting client data. o For those organizations that are covered entities, they will need to sign a Business Associate (BA) Agreement with OHIP. o Organizations will be designated as covered and non-covered entities. This designation will determine the level of clinical data that organization has access to. Pilot project may start with organizations that are already covered entities in order to reduce complexity. o Organizations with multiple sites could create a referral page for each site, or have a single organization page. Will be determined by the needs of each organization. o Both sides of referral need to perform an action in order for a referral to be accepted/denied. If a referral is denied the organization will be prompted to include a reason. o Participants of the pilot will have the opportunity to decide what client information is used in the search function. o OHIP has taken a conservative approach to receiving patient consent relative to other states creating Health Information Exchanges. All patients/clients are required to give organizations written consent before they can be entered into the system. o Secure messaging capability could be used by local organizations to communicate with providers outside of our region. Providers across the country using CliniSync and/or most major EMRs will be reachable via secure messaging. o Organizations will have the opportunity to list the services that they provide. The system currently is not sophisticated enough to perform a search by a certain service. o There is a collaborative initiative in Michigan that has been working on a similar project for a few years and could be a valuable resource moving forward. Learning from their work will be shared at upcoming Medical Neighborhood Learning Group meetings.

Collaboratively identify necessary components for the pilot’s referral agreement Referral agreements serve as the framework for how referrals will be made within the medical neighborhood. Meeting participants spent time discussing sample components of other communities’ referral agreements and identified the elements they felt were most important.

Sample components used in other communities Clarify who is responsible for certain elements of care (patient follow-up, education, monitoring, etc.)

Most Important 8

Establish expectations around appointment availability

7

Establish expectations for referral response time

7

Establish what patients are appropriate to be referred

7

Maintain accurate and up-to-date record of patient/client

7

Provide reasonable feedback regarding how referral was made/completed

7

Agree on organization’s practice for providing and obtaining informed consent from patient/client

3

Agree on type of care/service that best fits the patient/client’s needs

3

Determine what information should be shared via referral infrastructure and when the direct messaging tool should be used.

3

Set guidelines for what patient information should and should not be shared when making a referral.

3

Set timeline for reassessing referral agreement

3

Other/Comments  Identify common expectations once system capabilities are established.  Informed consent aspects/customization by organization  Looping in the PCMH provider.  Outcomes—can we define information that can be shared for reporting such as demographics, risk behaviors, etc.

To determine if we can participate I need further clarification on managing confidentiality of client info. AIDS Resource Center Ohio by name would alert other service providers to a client’ HIV status. Protecting this info is a priority. I’d like to learn more about covered/non-covered entities, BAA, etc. and how this impacts this proposed system.

Collaboratively identify measures of success for pilot phase of project Meeting participants were asked to complete the electronic measurement form that will be included in follow up email and return it to John Leite (john@hcgc.org).

Next Steps 

Goals for 1st Quarter 2015 o Finalize referral agreements and measures of success o Establish implementation timeline with CliniSync o All organizations participating on design team invited to participate in pilot and learning group o At least five social service agencies and at least one healthcare provider organization committed to participate in pilot. o Anticipate hosting series of work sessions in Q1 2015 for organizations committed to the pilot. o Estimated first learning group meeting in April

Thank you for your participation on the Medical Neighborhood Design Team!