What Does Interoperability Mean at the Local County Level

1
What Does Interoperability Mean at the Local
County Level?

• CHMDA IT Committee members
• Duane Henderson, Memo Keswick, David White

2
Overview

• Emerging Interoperability Components
• Relationship of Interoperability Components
• Counties Interoperability Needs
• ADP / DMH ADP directions
• What needs to be built
• Process Examples / Discussion
• How do we get there ?
• Recommendation
• Summary

3
Emerging Interoperability Components

• Process Defining what and how human activities
  and/or knowledge are integrated into a work
  environment while assuring user system usability,
  usefulness, AND efficiency
• Semantic communication of meaning
• Technical physical conveyance of a payload

4
Relationship of Interoperability Components
Process
Semantic
Technical
5
Relationship of Interoperability Components

• Clearly, there are dynamic relationships between
  Process, Semantic, and Technical
• Each can influence the other in new directions

6
Counties Interoperability needs

• Process Defined standards in administrative and
  clinical best practices which assure efficient
  service delivery.
• Technical - Defined platforms and/or IT options
• Semantic - Understandable clinical, financial,
  IT, and administrative communication protocols

7
Counties Interoperability needs

• IMPROVED EFFICIENCY
• AND ...

8
Counties Interoperability needs

• Full participation in the design of interoperable
  systems
• A COMPREHENSIVE approach to interoperability
  design
• (Not bit by bit)
• Acceptable timelines for both design and
  implementation

9
Counties Interoperability needs

• Policy decisions must be made regarding
  systematic approaches to interoperability
• Are counties full partners in design, or not?
• Which interoperability components are a higher
  priority than others?
• To what degree will stakeholders, especially
  county and vendor engineers influence design?

10
Counties Interoperability needs

• Policy decisions must be made regarding
  measurable statewide outcomes
• Past examples POQIs, AB2034 data, CSI/DIG
  data, and MHSA data
• Wheres the cost or funding related outcomes,
  etc., etc.?

11
ADP / DMH directions

• Examples of engaged Interoperability
• Excel or Paradox DB Cost Reporting
• DMH Webpage data / info transfers
• CSI / DIG modifications
• SD-MC claim file changes
• DCS, DCR, Void Replace incremental improvements
• MMEF / Meds modifications
• HIPAA Transaction protocols
• (mostly 837 835)
• Etc

12
ADP / DMH directions

• Following two slides are past examples of DMH
  vision on Interoperability

13
A Transformational Mental Health Information
System

• Technology, content and functionality standards
• Secure interoperability and integration
• Flexibility for business changes

14
Proposed DMH Mental Health Information Exchange
Architecture
Allied Agencies
County C
County B
County A
Reporting Data Repositories
Agent For MH Information Exchange Houses
consumer demographic information County
locations of previous services For continuity of
care purposes.

• County Systems
• Upload info to the agent
• Query the agent
• Receive info from other county systems via the
  agent

Hospital
Laboratory
Info passes through agent from one county to
another using standard data and exchange
protocols. With the agent, different EHR systems
do not need to create exchange protocols with
every other system. Rather, each communicates
through the agent in a standard way to share
information.
My Health Folder
Pharmacy
County D
15
Counties needs regarding Interoperability

• IMPROVED EFFICIENCY
• Oops! Did we already say this?

16
What Needs to Be Built

• A COMPREHENSIVE approach to interoperability
  design (Not bit by bit)
• Beginning examples exist, i.e., CBS Coalition,
  county RFPs
• Interoperability designs built on the previous
  discussed components of Process, Semantic, and
  Technical
• Concentrate first on Interoperable Processes

17
Process Examples / Discussion

• Current county view of State priorities
• HIPAA transactions 837 835
• Fraud management (eg., Void Replace)
• EHR PHR
• Mostly federal or grant related financial
  clinical data

18
Process Examples / Discussion

• In following slides
• E-xxxx implies both electronic data interchange
  AND integration into other processes

19
Process Examples / Discussion

• Needed processes
• E-Data between county and pharmacy
• E-client eligibility information must be
  e-verifiable for statewide use. This may include
  national verification techniques as well. Should
  not be done in multiple un-interoperable formats
  in county
• Client addresses must be e-verifiable

20
Process Examples / Discussion

• Needed processes
• E-client identifiers
• Client UMDAP data must e-flow between county
  systems
• E-grievance systems
• E-Human Resources
• E-Payroll

21
Process Examples / Discussion

• Needed processes
• E-services sharing
• E-laboratory and other tests sharing
• E-reconciliation of data between stakeholders

22
State
Client
County
County
E-Reconciliation HIPAA and beyond
County
Auditor
Federal
Vendor
Payor
23
Probation
Admin
Health
Auditor
E-Reconciliation HIPAA and beyond
County
Sheriff
Mental Health
Alcohol Drugs
Collection
24
Counties needs regarding Interoperability

• IMPROVED EFFICIENCY
• Oops! Did we already say this?

25
Process Examples / Discussion

• Needed processes (continued)
• E-Licensing data
• E-Cost data
• E-scheduler systems
• E-reconciliation of data between stakeholders

26
Process Examples / Discussion

• AB3632 / 26.5 Interoperability is woefully
  addressed
• DMH/DOE MOU current State of the Art
• Need Enrollment dates that drive data
• Need e-IEPs, etc.
• Need e-tables of allowable Mode/SF claiming

27
How Do We Get There?

• Create State / County task force to design
  Interoperable systems
• Eliminate legal barriers to Interoperable systems
• Continue bit by bit defacto approach with
  eventual target of emergent best practice,
  priority funded, or required interoperable
  systems

28
Recommendations

• More standards requirements like XML,HL7, HIPAA,
  implementation
• EHR and PHR rated systems
• Top Management Involvement
• Support from DMH, ADP, DHS, DSS, Board of
  Supervisors, CMHDA, CADPAAC, Director, MHB,
  Consumer and Family Groups etc. etc

29
Recommendation

• IMPROVED EFFICIENCY

30
Summary

• Emerging Interoperability Components
• Relationship of Interoperability Components
• Counties Interoperability Needs
• ADP / DMH ADP directions
• What needs to be built
• Process Examples / Discussion
• How do we get there ?
• Recommendations