This yr, a Chicago-area group data alternate (CIE) is ready to launch with the objective of coordinating look after homeless people. The initiative will combine medical and social knowledge, enhancing care coordination between federally certified well being facilities (FQHCs) and shelters. Waldo Mikels-Carrasco, director of the Middle for Well being Data Sharing and Innovation on the Illinois Public Well being Institute (IPHI), which focuses on multi-sector knowledge sharing to handle social determinants of well being, spoke with Healthcare Innovation concerning the nascent CIE.
Led by IPHI, the Chicago Regionwide CIE effort, developed in partnership with the Chicago Division of Public Well being and the Cook dinner County Bureau of Financial Growth, will search to create a community that connects healthcare suppliers, social providers, and community-based organizations to higher tackle the wants of underserved populations in Chicago.
The corporate offering the CIE’s technical infrastructure, 4medica, says that its interoperable structure embody superior knowledge integration instruments, exact id matching algorithms, and a user-friendly interface for managing medical and social service knowledge.
Healthcare Innovation: What was the impetus behind the Chicago Regionwide CIE and the way did the undertaking come collectively?
Mikels-Carrasco: Dialogue round CIE has been lively for a number of years within the Chicago area. The CIE in San Diego grew out of the need to handle the big variety of folks experiencing homelessness in San Diego County in very related methods. That is usually been the place CIEs start, as a result of it is complicated and multifactorial, with completely different teams needing to handle the issue. Individuals do not simply have a housing downside; they’ve a number of issues. Housing is rather like the chief identifier.
In Chicago, there have been many discussions, each on the county and town stage. In lots of locations within the nation, town and county authorities usually have their very own agendas and don’t play properly within the sandbox. There had been a historical past of that in Chicago. However each town and county independently had group fairness boards and completely different actions that recognized the necessity for a lot extra coordination of care supply, particularly for folks experiencing homelessness and different susceptible populations. They recognized {that a} CIE can be acceptable to deploy in a metropolitan metropolis like Chicago and Cook dinner County, which is the second-largest county within the nation.
HCI: What concerning the well being programs or FQHCs? Are they on board and concerned on this?Mikels-Carrasco: In Illinois, they’ve had one and a half makes an attempt and failures at establishing a well being data alternate. So the concept of unbiased data alternate amongst healthcare suppliers is a bit of controversial at this level. However in speaking about establishing a CIE or HIE, we discuss a use case, proper? Is it power illness? Is it maternal well being? Homelessness? And inside that, specifying who’re probably the most susceptible or important populations and or functions.
Inside the area of addressing folks experiencing homelessness, the preliminary use instances that had been recognized by means of final yr’s planning work, with enter from from completely different members of the group and businesses, was that we must always focus on medical respite and shelter-based care.
Medical respite is a subcategory of shelter-based care, however very well-defined, and it really is among the use instances supported by Illinois’ 1115 Medicaid waiver. It has a really particular care supply mannequin that it follows. For each of these, it might be essential to have each a medical associate FQHC and a shelter associate. We now have 14 organizations that will likely be concerned in these two use instances and that may set up the preliminary community of organizations for the CIE over the subsequent yr. One of many FQHCs is definitely extra of a “look-alike” that’s run by one of many main hospital programs in Chicago. So healthcare is coming into into this, however not with a want to ascertain one other HIE, however slightly to focus the work on extra utilized alternate round use instances with populations that they’re already working with.
HCI: I perceive you’re partnering with an organization known as 4medica on the know-how infrastructure. What did you want about their resolution? Mikels-Carrasco: As a result of there are solely a handful of CIEs within the nation, there hasn’t been loads of business improvement or innovation in that space. There was by no means a “Significant Use” for social data, and due to that, there was no standardization. So after we began the method of building the technical necessities and knowledge requirements for what we would want this to do, particularly with these use instances that had each medical and social data, there have been sure guardrails that we needed to have. The homeless administration data system knowledge units and knowledge assortment are decided by HUD. So it has wildly completely different requirements. We actually wanted to seek out somebody who understood the medical facet and will do this medical alternate with quite a lot of companions.
It’s also all about sustainability. When you create a system like this with any type of funding, if you cannot proceed to supply the extent of service that addresses the group and that’s sustainable — the highway to hell is paved by two-year grant funding tasks that had been amazingly nice after which died. So it was essential to have one thing that may have the ability to proceed taking a look at Medicaid, Medicare, twin eligibility, and what can be of worth to the payers.
Once we launched the RFQ [request for quotes], we obtained over 30 letters of curiosity from completely different organizations and eight viable submissions that we needed to evaluate, and any one in every of them would have been an amazing selection. One of many issues that made 4medica stand aside was how consent can be dealt with. The 4medica resolution nearly learn our minds when it comes to what our want listing can be for a consent resolution. It really has a exceptional consent engine that not solely lets you dial up a library of various consents based mostly on the organizations that you simply’re working with, but additionally has a wonderful affected person portal and following what SAMHSA laid out a number of years in the past for the consent-to-share mannequin for Half 2 knowledge, it provides the person the flexibility to refuse consent.
The opposite factor that was tremendous essential to us was that we’re bringing collectively domains of apply that have not traditionally had methods of interacting. This occurs day-after-day in Chicago: an ambulance pulls up from a well being system that’s discharging somebody that ought to actually be going to a talented nursing facility or transitioning their care to a nursing facility, however that is not attainable for this particular person, in order that they’re bringing them to a shelter. And due to their HIPAA constraints and the truth that there is not any secure solution to share data or data-sharing agreements between these organizations, they principally ask the shelter suppliers, can you’re taking this particular person and we will not inform you about their situation. The affected person has to self-report what their situation is and what medicines they might have or what limitations they might have. The shelter supplier has to take this particular person right into a congregate website, and the particular person could not inform them whether or not they’re on anti-psychotics or who will likely be chargeable for ensuring they take their medicine.
HCI: So does the CIE overcome that limitation about being allowed to convey medical data to the shelter website?
Mikels-Carrasco: For the continuity of care, even social care and social care inclusion, HIPAA does have provisions for what data could be shared, and it’s the minimal mandatory. However in 4medica, the medical and social care are so properly built-in that the shelter supplier would not have to see the medical report. They needn’t get into the EHR to see a affected person’s labs. The social care supplier goes to get a abstract of the medical data with what is critical for this social care supplier to grasp about this affected person. It would say this particular person suffers from Kind 2 diabetes. They want insulin on a sure schedule, and the insulin should be stored in a refrigerated atmosphere. The system interprets for them what is critical for them to know, to evaluate whether or not they can look after that particular person with out exposing your entire medical report.
HCI: Within the CIE pilot, have these FQHCs and shelters already been working collectively or are these new relationships? Mikels-Carrasco: The FQHCs have been caring for the folks in that respite program already. That is simply offering them a data-sharing initiative to enhance the communication between the shelter and the FQHC. Till now, the FQHCs have documented of their EHR however not had a great way to share data with the social suppliers.
HCI: What is the timeline for the undertaking and the place are you within the course of now?
Mikels-Carrasco: We’re within the means of finalizing the contract with 4medica. We’ll start implementation by means of the primary quarter, and we have already got the pilot websites that we’re strolling by means of standardized assessments of what their technical assets are. Have they got some type of shopper care platform? What are they documenting on at this time? A few of them are simply utilizing Excel. This can enable them a portal the place they’re going to have role-based entry for suppliers to go in and set up the connection with that affected person or shopper, after which have the ability to administratively use the 4medica platform if they do not have one thing else. So in some methods, this introduces an entire new stage of technical infrastructure to them at no cost that they did not have for his or her workflows earlier than, after which instantly that data is accessible to the remainder of the care staff.
HCI: You talked about earlier the challenges round grant funding cycles. Is that this a grant-funded undertaking? Do you have to get Medicaid and/or Medicare fee concerned to make it sustainable?Mikels-Carrasco: This faces the identical factor that HIEs have confronted ceaselessly — sustainability. The reply to your first query is that town initially used a small a part of their COVID-19 CDC funding to take part within the design of this undertaking. Cook dinner County has leveraged a number of million {dollars} in ARPA funds to face up the CIE and set up the preliminary community. However ARPA funds expire on the finish of 2026, and we’ve got had a enterprise planning and sustainability staff working because the starting of final yr to assist construct out a mannequin. That is constructing scaffolding off loads of work that is been carried out in philanthropy, by authorities, by social service businesses for many years within the area, and it is to facilitate what they’re doing and combine and align with that, so there are a number of worth propositions to completely different audiences — healthcare being a giant one.
We’ll even be receiving admit/discharge/switch occasion notifications from the state. Generally there are empty beds at shelters and different services ready for the one that’s subsequent up on the listing, however no one is aware of the place they’re. So that is going to extend the affected person visibility for the social sector if that particular person’s in healthcare someplace. But it surely’s additionally going to create the other for healthcare and payers and Medicaid, which have beneficiaries or sufferers who’re misplaced to care they usually cannot shut the inhabitants well being metrics on this particular person, as a result of they’re discharged however the healthcare suppliers don’t know if they’re in a shelter or not. Now they’ll. We will get them related again to providers, or we will get them into that subsequent unit, as a result of we all know the place they’re. So it is about an entire set of worth propositions.
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