Several attempts to launch a statewide health information exchange in Connecticut ultimately failed. But the current version, Connie, built in partnership with technology vendor CRISP Shared Services, is gaining some momentum. Zachary Dauphinais, clinical informatics manager at United Services, a nonprofit community mental health organization in eastern Connecticut, recently spoke with Healthcare Innovation about the value United Services is already seeing from participating in the HIE.
United Services is a certified community behavioral health center that covers a 22-town area. It has 275 staff members across 30 different programs, including outpatient intensive outpatient therapies, psychiatric services, as well as community support programs and case management. It also runs a large domestic violence program.
HCI: Connecticut has taken several stabs at setting up a statewide HIE over the years and wasn't very successful at it. Were you aware of all that when it was going on and what some of the issues were and why perhaps the new state-designated HIE Connie has a better chance of doing well and getting more uptake?
Dauphinais: Well, it's been a huge relief because I was involved in one or two of those earlier attempts. The biggest challenge was there was money assigned, but there was no mandate for having to participate. And I think there was a lot of feeling of ownership of data and not necessarily wanting to share or agree with whose idea was the best idea. I think the reason Connie worked was because it was state-led. They are saying everybody has to play nice together and everybody has to participate. Plus using a nice platform [from CRISP] that already works in another state, and not building it from scratch was a really good idea.
HCI: I understand that your organization has begun receiving real-time ADT [admission/discharge/transfer] notifications through the HIE. Could you talk about why that's so important and what was happening previously for those clinicians and patients?
Dauphinais: In the two years prior to the Connie ADTs, Connecticut did have a system called Project Notify that did ADT notifications but only on Medicaid clients and it was only from a select few hospitals, which did not include our local hospital. We were getting some, and we could see the benefit, but we weren't getting our full population and we weren't getting our local hospital. Getting that has been a huge game-changer. A lot of our clients aren't necessarily great self-reporters. Sometimes they just won't think to tell us that they went to the emergency department, or sometimes they don't necessarily want us to know that they went to the emergency department but they are in fact in crisis or having issues that we can assist with.
In a lot of patients’ minds, there is a separation between medical health and behavioral health and they don’t think about telling their behavioral health providers about the medical issues, a lot of which impact their behavioral health. Now we're able to follow up with them within 24 hours. We have a policy where anybody who hits the emergency department or is discharged from an inpatient setting, we reach out within 24 hours. A case manager contacts them and sets any follow-up services that they need, any coordinating of the care. We've been able to catch a lot of things. The other piece is that communications with the hospitals themselves can be tricky and can be delayed. Sometimes we won't find out that one of our clients was discharged until a couple of days later. Those two days make a big difference in either tracking down the client or bridging the care from the hospital setting to the outpatient setting.
HCI: What kind of information is in the ADT notification?
Dauphinais: It gives us the admission. It gives us name, date of birth, all of their demographics, the facility and the triage notes. We can see why they're there. And then the discharge will give us the disposition and the discharging diagnosis. We know whether they were discharged home or sent to another facility. And we can pull up the client in the HIE to get the full discharge summary.
HCI: Are there still any issues to work through around consent and sharing sensitive data or substance use disorder data?
Dauphinais: I actually have a call with Connie later today to talk about that. That is not currently being shared. I know they are working on it. I'm scheduled to get an update on the 42 CFR Part Two data, the substance use data. I know that is currently being worked on. I just don't know the status of it.
HCI: Do you have a sense of whether primary care providers in your area are starting to use the HIE?
Dauphinais: The federally qualified health center in our area is starting to use it. They're in the process of building out their workflows and how they want to use it. But they they're definitely excited by the idea. Connie is changing every day in terms of what people are sending in, and there's still more that we are going to participate in over time. In terms of sending in information right now, we just send labs.
HCI: Do you have an anecdotal example involving a patient that could illustrate the value of the ADTs?
Dauphinais: Something that happened in the first three weeks that we were doing this, back in February, really sold the concept to our direct care providers. We had a client who had disengaged from services. We weren't able to get her on the phone. We weren't able to get her by mail and she wasn't answering the door in her apartment. We were getting ready to close her case. Then we received a notification that she was in the emergency department and then immediately transferred to inpatient at that hospital. When we received the discharge notice a couple of days later, we immediately called and followed up. She answered and said she had been stabilized, that she was so glad we had called and that she was not okay, that her physical health had declined to a point where her behavioral health was also declining and she just was not physically able to get in touch with us. We were able to immediately set her up with her case manager, get her a new appointment, arrange transportation, and get her re-engaged with services that week. And she's continued to be engaged in services since then. It was one of those moments where you go ‘Ah, this is why we do this.’