march 29, 2012 improving health outcomes for children in foster care: the role of electronic...
TRANSCRIPT
March 29, 2012
Improving Health Outcomes for Children in Foster Care:
the Role of Electronic Information Exchange
Overview
Need for improved information sharing in the provision of health care services to children in foster care
How electronic information exchange (EIE) can be used to improve health outcomes
Strategies for developing EIE for children in foster care
Ventura County Foster Health Link: an EIE demonstration project
About The Children’s Partnership (TCP) TCP is a national nonprofit, nonpartisan child
advocacy organization with offices in California and Washington, DC
Mission is to ensure that all children grow up to lead healthy and lead productive lives
Expertise in research, analysis and policy development to benefit all children, especially the underserved
Expertise includes
About TCP (cont’d)
Primary focus has been on securing health coverage for uninsured children and expanding access to technology to underserved children
TCP’s e-health work includes development of Express Lane eligibility and enrollment system, telehealth, electronic record systems, and now, foster care coordination
Health Care Challenges Facing Children in Foster Care
Large number of children in care
Poor health status and significant unmet health care needs
Greater utilization of services and disproportionately high health care expenditures
Fragmented care and poor health outcomes
Factors Contributing to Inadequate Health Care and Poor Outcomes
Placement instability and variability
Resource and staff limitations in child welfare services
Lack of coordination and information sharing between service providers
Electronic Information Exchange (EIE): The Means to a Solution
EIE can support information sharing and address coordination gaps
EIE can support provider practice changes, especially through the use of electronic health records
EIE can help assess the changing health status and needs of a population
Why Development of EIE for Children in Foster Care Should be a Priority
Gives providers access to more comprehensive information about a child
Facilitates communication between providers for purposes of coordinating care and delivery of services
Provides youth with a record of health conditions and services received as they prepare for permanency or emancipation
Basic Elements of EIE for Children in Foster Care
Data Included Basic health information including allergies,
immunizations, diagnoses, and provider contact information
Medical service claims, pharmacy claims, lab data
Access Medical providers, child welfare workers, foster
parents and foster youth
Basic Elements of EIE for Children in Foster Care (cont’d)
Additional FunctionsReminders about a child’s needs, warnings of
gaps in care or medication interactions
Potential for ExpansionEIE can be expanded to include other
responsible entities such as schools and courts, with appropriate safeguards
Early Evidence Supports Use of EIE for Children in Foster Care
Improved Health Outcomes Better preventive care Decreased hospital stays Improved clinical conditions
Cost Savings Decrease in expensive avoidable illness and
hospital stays Reduction in pharmacy costs
Strategies for Developing EIE for Children in Foster Care
Identify public and private funding Medicaid, including Early and Periodic
Screening, Diagnosis, and Treatment (EPSDT), Medicaid Management Information Systems, and standard Medicaid administrative match
HITECH, including Innovation Grants State and county sources Private funding, primarily foundation grants
Strategies for Developing EIE for Children in Foster Care (cont’d)
Identify and develop stakeholders and strong leadershipDevelopment process may be long and require
complex negotiations Involve stakeholders, including foster parents
and youth, early in the processProgrammatic champions from state and local
government help drive the process
Strategies for Developing EIE for Children in Foster Care (cont’d) Address privacy and confidentiality
concerns early and oftenLaws are complex and there are unique and
varied privacy concerns for children in foster care
Key considerations: Who controls information into and out from EIE? Who has access to information contained in the EIE? What role do foster parents and youth play in contributing to
and controlling information in the EIE?
Strategies for Developing EIE for Children in Foster Care (cont’d)
Scope EIE Project Appropriately Important to balance need for including
enough information to improve outcomes with need to avoid including so much information the system becomes unwieldy
Select an EIE architecture that allows a narrow approach at first and broadening of scope over time
Strategies for Developing EIE for Children in Foster Care (cont’d)
Discuss evaluation and sustainability early in EIE development Important to build key evidence base to
demonstrate improved outcomes and cost savings as soon as possible
Long-term sustainability depends on: Secure funding Engaged leadership and stakeholders Clear privacy and confidentiality protections Demonstrated improved outcomes and cost savings
Ventura County Foster Health Link (VCFHL): an EIE Demonstration Project Why Ventura County?
Manageable size—population of about 825,000 (2010) with about 800 children in foster care
County-operated system of hospitals and clinics—ease of implementation
Strong leadership in both county human services and health care agencies
VCFHL Project (cont’d)
Primary Goals:Connect health and child welfare information
for all children in foster care
Leverage existing technology
Provide appropriate access to real-time information
VCFHL Project (cont’d)
Key Components
Master Person Index
Record Locator Service
“Youth-facing” Portal
Interface with state CWS and health databases
VCFHL Project (cont’d)
Current Status and Next Steps:
Partnering with State for $1 million federal Medicaid HIE funding; submission of IAPD-U
Nonfederal $100,000 match in place—county funds and foundation grants
Governance structure for EIE developed; developing MOUs and contracts
Once federal funding received, 22-month project timeline
For more information
TCP Website:www.childrenspartnership.org
Contact me:Ginny Puddefoot, Director
HIT Initiatives for Vulnerable ChildrenThe Children’s [email protected]