Download Overview of e-Health

Section 0.2 Overview
Overview of e-Health
This document provides an overview of e-Health both broadly and in the context of Social Services.
Read the sections below to understand more about these topics.
Time needed: 1 hour
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The Essential Role of Social Service Agencies in Improving Health
If you work in a social service agency, you know the services you provide are essential to keeping
people healthy. Unmet social needs (housing, jobs, nutrition, mental health, legal issues, etc.) can
contribute to medical problems and prevent people from obtaining or adhering to medical therapies.
An increasing number of communities are leveraging the interdependence of clinical medicine and
social services. Studies show that these efforts can drive down cost and improve outcomes. We
provide three examples below:

An Accountable Care Organization in Minnesota: In an 2013 article in that is posted on
HealthyAmericans.org, Nancy Garrett, Ph.D., Chief Analytics Officer, Hennepin County
Medical Center, describes how Hennepin Health is serving: “over 6,000 enrollees who face
some stark health realities: 45 percent have chemical dependencies, 42 percent have mental
health needs, 32 percent have unstable housing and 30 percent suffer from at least two
chronic diseases1”. The article makes the point that coordination of social services and
medical services is the essential element of success in this emerging care model.

Reducing Unnecessary Hospitalization in Camden NJ: An initiative in Camden NJ is
reducing cost and improving care by developing a: “Citywide Collaborative of primary care,
behavioral health, social service and other supportive service providers to improve care for
this patient population2.”

Involving Communities in Health: The state of Oregon is engaged in a large demonstration
project designed to lower Medicaid cost while improving care. A 2013 New York Times
article states: “Local, interventionist, hands-on attention — reducing health problems before
care is warranted or billed — means breaking deep tradition in a system that thinks mostly
about treatment and response.3”
1 http://healthyamericans.org/health-issues/prevention_story/how-a-social-accountable-care-organization-improves-health-andsaves-money-and-lives
2 : http://www.camdenhealth.org/programs/care-management-program/
3 http://www.nytimes.com/2013/04/13/us/oregon-experiments-with-localized-medicaid.html?_r=0
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As efforts to integrate clinical medicine and social services grow, e-health will play a powerful and
essential role in gathering, interpreting, and exchanging the information needed to ensure clients get
the assistance they need to live healthy, productive lives. This document provides an introduction to
key e-health concepts.
Defining e-Health
This section provides definitions for the terms used throughout the toolkit.
E-health is the adoption and effective use of electronic health record (EHR) systems and other health
information technology (HIT), including health information exchange, to improve health care
quality, increase patient safety, reduce health care costs, and enable individuals and communities to
make the best possible health decisions. Across the nation, e-health has emerged as a powerful
strategy to transform access, care delivery, patient experiences, and healthcare outcomes.
Furthermore, e-health is essential in supporting the exchange of information necessary for health
reform initiatives such as accountable care.
The subsections below define important elements of e-health.
Electronic Health Record (EHR)
An EHR is the tool that replaces the paper record that has been used to track a patient’s health.
Specifically, we are using the following definition:
EHR is a real-time patient health record with access to evidence-based decision support tools that can
be used to aid clinicians in decision-making. The EHR can automate and streamline a clinician's
workflow, ensuring that all clinical information is communicated. It can also prevent delays in
response that result in gaps in care. The EHR can also support the collection of data for uses other
than clinical care, such as billing, quality management, outcome reporting, and public health disease
surveillance and reporting. EHR is considered more comprehensive than the concept of an Electronic
Medical Record (EMR).
Reference: http://www.hhs.gov/healthit/glossary.html
EHR and Social Services
Many social services professionals have encountered EHRs, either in parts of their agencies that
provide clinical services or in the office of their own physician. So in general, you know that EHRs
take the place of outmoded paper records.
One of the key features of an EHR is that health information can be created and managed by
authorized users in a digital format capable of being shared with authorized users across more than
one health care organization. EHRs are built to share information with other health care providers
and organizations involved with a patient’s care – such as specialists, hospitals, and pharmacies but
also with home health, school nurses, local public health workers, and, where appropriate social
workers.
The general description of an EHR, however, doesn’t take into account the specific needs of social
service agencies to use support tools and exchange information. As such, there may not currently be
effective EHR vendor solutions for social services agencies. These offerings are expected to evolve
over time, and in the meantime these agencies can plan for implementation by understanding the
potential uses and opportunities for information exchange.
Health Information Technology (HIT)
HIT is the overall category we use to describe the hardware, software, devices, etc. that are used to
manage and improve health. Specifically, we are using the following definition:
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HIT is the application of information processing involving both computer hardware and software that
deals with the storage, retrieval, sharing, and use of health care information, data, and knowledge for
communication and decision making.
Reference: http://www.healthit.gov/policy-researchers-implementers/glossary
Health Information Exchange (HIE)
Health information exchange or HIE means the electronic transmission of health related information
between organizations according to nationally recognized standards [Minn. Stat. §62J.498 sub.
1(f)]. Reference: https://www.revisor.mn.gov/statutes/?id=62J.498
Social Services and HIE
Social service agencies have special concerns about exchanging information about their clients.
First, many of their clients may experience conditions that carry significant stigma (mental health,
chemical dependency, crime, etc.). Many clients want their concerns, diagnosis, treatment plans, and
medications kept private. Protecting privacy preferences is mandated under the HIPAA regulations,
as is privacy with other types of health care.
Special data privacy rules extend to substance abuse treatment. CFR 42, part 2 requires that clients
provide written permission any time any personally identifiable information is released to another
party. Here is a table that shows the differences between HIPAA protection of health information
and CFR 42, part 24.
The good news is that technology is helping to create solutions that allow EHR users to segment data
and to apply various rules or conditions to information that is covered by the mandates cited above
and the ethical guidelines of your profession. Some key ideas in these solutions involve:
1. Segmenting data so that a client has control over different elements. In this way, a client can
restrict access to chemical health information while permitting access to primary care data.
2. Developing robust permissions functions that are based on federal privacy requirements.
These systems allow behavioral health and substance abuse services providers to capture the
detailed permissions required by federal privacy rules.
4
Substance Abuse and Rehabilitation, Dec 6, 2011, Hu, Sparenborg, and Tai
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3. Using established exchange mechanisms, like Direct (Direct is a simple, scalable, secure, and
standards-based way for participants to send authenticated, encrypted health information
directly to known, trusted recipients over the Internet), to reduce faxing, scanning and
reentering important health information.
See below for links to examples:
1. Brooklyn, New York has a health information exchange that alerts behavioral health providers to
key events in their patients’ lives (like hospitalization). Read details here:
http://www.healthit.gov/buzz-blog/state-hie/hie-bright-spots-supporting-mental-health-carecoordination-part-3/
2. EHR vendors have created technology that ensures that 42 CFR Part 2 requirements are met in a
way that allows for rapid approval of information sharing (or restriction of sharing) based on
client preferences. View a video demo here: http://www.satva.org/
3. The federal government, through its BEACON Grants gathered providers together to demonstrate
how data in an electronic record can be segmented, so that a client can grant permission to share
some data and not other. View a YouTube video here:
https://www.youtube.com/watch?v=4lMG96nmWS0
Benefits of e-Health
The use of electronic systems to manage client information and deliver care has been increasing and
will continue to increase. Tremendous benefits can be realized if we can electronically and securely
exchange client health information with appropriate caregivers.
We can help ensure this transformation is positive for clients, their families and loved ones, and for
caregivers if we focus on benefits.
In general, electronic health records (EHR) and health information exchange (HIE) can:

Improve the quality and safety of care delivered to social services patients.

Enable creation of electronic patient registries that track care patterns and health care use.

Achieve greater efficiency and improve use of resources.

Communicate in transitions of care and across the health care continuum.

Promote sound decision making and evidence-based practices.

Strengthen privacy and data protection.
Glossary
As you work through the tools, there may be terms or abbreviations that are unfamiliar or for which
you want to be sure of the meaning. To help clarify terms or abbreviations, we have provided the link
below:
The Minnesota e-Health Glossary, (http://www.health.state.mn.us/e-health/glossary.html)
Conclusion
Though there are undoubtedly hurdles to jump for any organization that is transitioning to a
comprehensive e-health system with EHR and HIE, such as placating client fears about their privacy,
or a user learning curve, the benefits that social services professionals and their clients can gain from
adoption of an e-health system that is well-planned, carefully selected and properly implemented far
outweigh any potential downsides.
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E-health enables greater efficiency, accuracy and speed in every aspect of patient care and
accounting, as well as in organizational administration. These improvements ultimately translate to
more favorable patient outcomes, streamlined operations, and captured higher revenues for the social
services agency. There is sound reasoning the behind state and government-mandated push for
adoption of e-health practices: They simply perform better than the old systems do.
Copyright © 2014 Stratis Health.
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Updated 03-10-14