Reduce drug seeking by Drug Court clients: Collaboration with hospital

Emergency Departments

Sandra J. Altshuler, Ph.D., L.I.C.S.W.,Coordinator

Tony McBride, B.A., C.D.P.,Clinical Director

Presentation to WSADCP Friday October 18, 2013

The Problem

Drug Court clients use multiple Emergency Departments (EDs) to obtain pain medications by reporting chronic pain.

Our policy is not to interfere with medical prescriptions, but clients do lose clean date.

Clients are not forthcoming regarding their addiction and/or current participation in TDC program to EDs.

Core Principles of Consistent Care

Always what is best for the patient.Coordinate care.Keep the primary care provider in control.Support Drug Court efforts.Enable patient to make good medical

decisions.Protect from prescription overmedication and

abuse.Provide information for ED provider to make

a good medical decision.

What is Consistent Care

Program to reduce inappropriate drug seeking and high utilization of ED visits (5+ visits in 12 month period).

Develops individualized Patient Restriction Coordination (PRC) Guidelines for all program enrollees.

Decreases controlled substance prescribing and administration in the ED.

Provides individuals with quality care.Provides real-time treatment plans and PRC to the ED.

Individualized PRCs accessible by all ED physicians city- and county-wide.

Immediate alert to ED physicians of client’s participation in TDC program and addiction history.

All Four Spokane Hospitals

Providence Sacred Heart

Valley Hospital (CHS)Deaconess (CHS)INHS

Providence Holy Family

Registration Reveals Patient on Consistent Care

Patient’s ED chart flagged for doctor

EDIEAuto-Notification

Auto-NotificationED case manager called.Medical Director sent text messagePCP emailed *planned*Insurance Company emailed *planned*ED Care Guidelines Faxed to ED and ED Called *planned*

Physician reviews ED care guidelines

Patient Discharged

medical screening exam by ED physician

No controlled substances

ED case manager talks to patient prior to discharge

ED Visit Process

Usual Triage

The Process

ED Care Guidelines

EMR on INHS network

ED Care Guidelines

Emergency Department Information Exchangewww.ediecareplan.com

Patient Notification Letter

Mailed to patient’s home

PCP Office

Insurance

Consistent Care Staff

Consistent Care Staff

Consistent Care Control (waiting list)0

500

1000

1500

2000

2500

20371959

1022

1638

ED Visits1 yr before and 1 yr after

-50% -16%

Be

fore

Afte

r

Afte

r

Be

fore

p < 0.001

TDC Collaboration with Consistent Care

ED Care Guidelines as displayed in shared EMR (Meditech PCI)

TDC Collaboration with Consistent Care

Provides immediate information about client visits to the ED and/or the hospital. Verification of visit information (e.g., date/time,

reason, outcome) Medications sought and medications ultimately

providedProvides in-depth medical information, as

needed.Verifies accuracy of information and/or

written documentation client provides. Altering prescriptions Falsified documents

Falsified Documents

Which One is False?

The Consistent Care ProgramDarin Neven MS, MD, Medical Director

Linda Marsh RN, BSN, CCM, Program ManagerGenevieve Green, Staff Support

For further information contact Linda MarshLinda.marsh@providence.org

www.consistentcare.com

Providence Sacred Heart Medical Center & Holy Family Hospital Spokane, Washington

15

What is EDIE?

The Emergency Department Information Exchange (EDIE) is a web-based application that enables care providers to better identify and treat high-utilization and special needs patients, as well as track those patients across the EDs and other care settings they present to.

EDIE provides: A flexible framework for case management programs. Notifications to all stakeholders when high-utilization or

special needs patients visit an ED. Secure access to participating facility visit information

regarding clients/patients. A communication platform between all interested

parties.

How EDIE Works:

Patient Event

Regional Hospital

EDIE

Notification

Notification Methods:

Other Provider Facilities

Care Managers or Coordinators

PCP, Mental Health Provider, Specialists

System Workflow1. The Patient registers at a Hospital.2. The Hospital auto-transmits the patient’s

information to EDIE (HL7 feed).3. EDIE evaluates the patient data against

customizable trigger criteria.4. If any of the hospital’s criteria are met,

EDIE then sends the Hospital a Notification—by any of the available Notification Methods—within 3 to 5 minutes of Patient Registration, with actionable information compiled from other EDIE facilities visited by the patient, including:

• ED Care Guidelines• Known Care Providers• 3-Month Visit History, with Location and

Diagnoses• 12-Month Aggregate Visit History by

Location

5. Any other EDIE-participating involved stakeholders will also be sent a Notification and can log-in to the EDIE Web Application to view any of the patient’s most recent visits, as well as view and contribute to the patient’s EDIE record, including:

• Created Care Guidelines for any facility• Other Care Providers• Notes on the patient from other Providers• Insurance, Medication and Diagnoses

information from all providers• Historical Visit Data, including frequency

and mobility

Patient Data

HIPAA Compliance

Collective Medical Technologies (CMT) has made every effort to ensure EDIE’s HIPAA compliancy, and goes to great lengths to ensure that security standards are maintained and EPHI is properly protected.

On a front-end level, a facility in EDIE is only able to view those patients that they have an established treatment relationship with.

On a back-end level, CMT sets up a secure interface with a hospital to receive its ED data in real-time. This data is encrypted for transfer and is then stored in our secure, SOC 2, HIPAA, HITECH, FISMA compliant data centers.

TDC Collaboration with EDIE

Provides immediate, real-time information about client visits to the ED. Verification of visit information (e.g., date/time, reason,

outcome). Medications sought and medications ultimately provided. Non-disclosed overdoses and narcotics prescriptions

obtained.Allows for 24/7 alerts and access regarding client

ED visits.Provides in-depth medical information, as needed.Verifies accuracy of information and/or written

documentation client provides.Summary of history of all ED visits for every client

(diagnosis, treatment and discharge).

TDC Collaboration with EDIE

TDC Collaboration with EDIE

EDIE Web Application Portal

EDIEReportonTDCClient (pg. 1)

EDIEReportonTDCClient (pg. 2)

EDIEReportonTDCClient (pg. 4)

Visit Date Location Type Diagnoses

10/02/2013 Holy Family Hospital Emergency

09/22/2013 Sacred Heart Medical

Center

Emergency 1. Painful respiration

2. Nausea alone

3. Jaundice, unspecified, not of newborn

4. Other, mixed, or unspecified drug abuse, unspecified

5. Tobacco use disorder

09/08/2013 Holy Family Hospital Emergency 1. Scabies

2. Amphetamine or related acting sympathomimetic abuse,

unspecified

3. Tobacco use disorder

09/06/2013 Valley Hospital and Medical

Center

Emergency 2. Amphetamine or related acting sympathomimetic abuse,

unspecified

3. Tobacco use disorder

E.D. Visit Count (1 Yr.) Visits Low Acuity

Deaconess Medical Center 2 0

Sacred Heart Medical Center 2 0

Holy Family Hospital 2 0

Valley Hospital and Medical

Center 10 0

Total 16 0

FOR INFORMATION ABOUT IMPLEMENTING EDIE AT YOUR FACILITY, CONTACT COLLECTIVE MEDICAL

TECHNOLOGIES:

KRISTINA KEENECLIENT RELATIONS MANAGER

509.590 .2353KRISTINA.KEENE@COLLECTIVEMEDICALTECH.COM

Superior Court Behavioral Health Adult Felony

Therapeutic Drug CourtFor further information:

Sandra Altshuler, saltshuler@spokanecounty.org 509-477-6355Tony McBride, tmcbride@newta.org 509-326-7740