HomeMy WebLinkAboutchr-user-newsletter-11-2020-archiveCommunity Health Record (CHR) User Newsletter
November 2020
Welcome to our November CHR User newsletter! Here you’ll find updates on
improvements and enhancements to increase the Community Health Record’s (CHR’s)
usefulness to your work and benefits to consumer care, and links to useful resources. Topics
include:
· Organizations with the most CHR users trained
· The value the CHR brings to whole person care
· New features and enhancements and other updates
· Answers to frequently asked questions
· Upcoming enhancements
· Opportunities to develop your skills; and
· CHR usage stats
If you are new to our mailing list and didn’t receive prior issues, you can find them here. We
hope you find these updates helpful to your work and we appreciate your readership.
Top Three Organizations
As of November 13, the organizations with the most CHR users trained were:
Bay Area Community Services: 129 users, a 19% increase over last month!
Alameda County Behavioral Health: 110 users
LifeLong Medical Care: 69 users
Impact Story: How the CHR is being used to support whole person care
Your stories about the Community Health Record (CHR) as a tool for coordinating care and
improving health outcomes are inspiring. This month’s story was shared by Amory Knut,
Peer Support Specialist with Bonita House.
Amory’s client was in the emergency department (ED) at Alameda Hospital due to a serious
medical condition. The client was a very vulnerable elderly woman who was unhoused, had
complex medical needs and frequent ED visits, and had previously not been receptive to
receiving services. At the time, Bonita House’s In-Home Outreach Team (IHOT) was under
pressure to close similar client cases due to their over-extended case load. Amory had
collected the Information Sharing Authorization (ISA) for this consumer and added himself
to the Care Team in the CHR. As a result, the hospital social worker contacted Amory when
the client was admitted to Alameda Hospital, which is a member of Alameda Health System
(AHS). Because the client was willing to receive services, Amory was able to advocate with
AHS to keep the patient long enough for him to set up care coordination with Bay Area
Community Services (BACS) and Roots Community Health Center. A BACS provider met the
client at the hospital and she consented to receive services.
“This was a major break-through,” said Amory. “This
client had been very difficult to engage before this
visit. Now she is receiving needed services. Being
able to view hospital and emergency department
admissions in the CHR, as in this case, has been very
helpful. I'm very pleased with the outcome of this
case, and the CHR played a pivotal role in achieving
this end result.”
We welcome your CHR success stories! Please contact our Helpdesk
at CareConnectHelp@acgov.org or (510) 618-1997 to share your story.
What's New?
Important update: Improvements to the Special Permissions section of the Information
Sharing Authorization (ISA). This month AC Care Connect introduced a new, updated ISA
form (ISA 2.0). The changes are to the section where consumers indicate that they read the
special permissions section for sharing mental health treatment information and HIV test
results. In the prior version (1.0) consumers needed to put their initials next to both types of
information to confirm that they read the section. If they wanted the information shared,
they also had to check a box next to the type of information they wanted shared. The new
ISA form does not require initials. The consumer can simply check a “yes” or “no” box to
indicate whether they give permission to share each type of information. The new form
along with detailed instructions on how to complete it can be found on Elemeno.
Important Note: After January 31, 2021, the old ISA form will no longer be accepted.
Client Story: How the ISA supports care coordination and delivery of whole person care.
Kelley Halvorson, MSW, Service Coordinator with Abode Services Housing Tenancy
Sustaining Services, shared a story of a client that highlights the value having a signed ISA.
The client has diabetes and possible Traumatic Brain Injury (TBI) which can complicate
management of diabetes. He was having a hard time maintaining relationships with medical
providers because of his often-aggressive behavior. After working with him over several
months, Kelley gained his trust and he signed an ISA. Now Kelley is able to view all of his
clinical information in the CHR, which she says “has been helpful in coordinating his care
because I can see which other providers he’s seen and we share basic information with each
other and provide appropriate services to the client.” Kelley discussed how the client “often
has medical issues and shows up at the emergency department [ED]. In these instances, he
may be confused and act out. I’ve set alerts in the CHR so I know when he is in the ED and
can help him calm down and try to get him home safely after he’s discharged.”
Update on actions to address the CHR user survey findings. We continue to work on
enhancements to the CHR in response to your feedback in your responses to our August
survey. (See the September CHR User newsletter for a summary of the survey findings.) In
November we continued our work to:
Restructure the Super User Workgroup starting in January 2021 to support an
expanded role for Super Users: This will include providing more advanced training
topics and supporting Super Users in expanding their knowledge and skills to provide
basic technical support for CHR users at their organizations. Starting in January,
attendance at Super User work group meetings will be strongly encouraged. Email
Carla Justice at cjustice@pcgus.com to receive an invite to join the CHR Super User
Workgroup.
Reengage with leadership at partner organizations to share progress and challenges
related to CHR implementation: In early 2021, we will launch a communication to
provide regular updates to partner organization leadership on how the CHR is being
used by their staff and providers and to offer suggestions on ways to increase the
value of the CHR for consumers and clients.
Expand technical capacity of the Helpdesk to provide increased direct support to
end-users.
Expand current CHR user support to include quick reference guides that explain how
to use various features of the CHR: See Tips & Tricks section below for links to these
guides.
Develop case studies and capture impact stories that illustrate ways the CHR is being
used to support whole person care: We are featuring these stories in our newsletters
and other communications so CHR users can learn about the many features and
functions of the tool from each other.
The CHR is being used to connect Project Roomkey guests with medical homes for
primary care: Members of AC Care Connect’s CHR User Onboarding team conducted CHR
user training for more than 70 UCSF nurse practitioner students who are working with
guests at Project Roomkey hotels. Drawing on information in the CHR, clinical staff at are
connecting clients to assigned medical homes, coordinating care with primary care
providers, and supporting with Medi-Cal and benefits enrollment.
AC Care Connect team members—left to right
standing: Lillawa Willie, Sheilani Alix, and Gregg
Martin, and lower left: Shannon Eng—led the
training effort at Project Roomkey hotels.
Lynn Noyce, Laura Sanchez, Rebecca Small, and
Elizabeth Choa were among the 70+ UCSF NP
students who participated in the CHR user
training.
California’s Project Roomkey initiative has successfully sheltered individuals around the
state. Their stories are impactful as shared in this video produced by the California
Department of Social Services.
Feature: Spotlight on the Social Health Information Exchange (SHIE)
As a member of our user community, you are most likely very familiar with the CHR. You
may not know much about the engine that powers the CHR: AC Care Connect’s Social
Health Information Exchange (SHIE). In contrast to Health Information Exchange (HIE)
databases, which hold medical-related information, the SHIE holds data from both medical
and non-medical providers. It is enabled by a network of partner organizations across key
sectors—medical, mental health, substance abuse, housing, social care, legal, and crisis
response—that securely and appropriately share information over the internet using a
standardized approach and in compliance with the Federal and State legal standards. The
SHIE integrates with other core systems (electronic health record, case management,
claims, etc.).
In contrast, the CHR is a tool to support care coordination for specific consumers by closing
gaps in the safety net to accelerate connections. It summarizes curated information from
the SHIE and enables the organizations that provide care to access information for a shared
consumer, and supports care team members in communicating with each other. While the
CHR is used by providers working directly with consumers and clients, the SHIE provides a
“big picture” view of health status and social determinants of health in the community and
can be used to identify solutions to improve care delivery.
Case Study: Use of the SHIE to enroll guests at Project Roomkey hotels in Medi-Cal
The SHIE’s report function proved valuable in helping enroll guests of the Project Roomkey
hotels in Medi-Cal. When Project Roomkey co-medical directors Alexis Chettiar and Katie
Hayes learned that a large portion of guests were not enrolled in Medi-Cal they reached
out to AC Care Connect’s Data Exchange Unit (DEU) team. The team used the SHIE to
generate a list of hotel guests that included their Medi-Cal status and basic identifying
information (e.g., date of birth). The co-medical directors then coordinated with the Social
Services Agency (SSA) to identify individuals whose Medi-Cal field in the SHIE was blank or
inactive, and who were eligible to enroll. Hotel staff and RNs connected the SSA team with
these guests to help them complete the Medi-Cal application. In just five weeks, half of the
more than 100 guests who didn’t have Medi-Cal have been enrolled.
Tips & Tricks
As many of you know, Elemeno has a host of useful information to help CHR users
understand how to navigate the CHR and learn about available resources in the community.
New tip sheets and other resources are posted in Elemeno on an ongoing basis. (See also
Upcoming Trainings and Resources below.) Resources posted in the past month include the
following Quick Reference guides:
How to Renew Your Client’s Medi-Cal
Connecting Your Client to a Primary Care Provider
How to Find Your Client’s Birth Certificate for Housing
Connecting Your Client to Substance Use Treatment
Connecting Your Client to Specialty Mental Health Services
Referral from Santa Rita Jail to Residential Treatment
Clean Slate
Roots Community Health Center: Safe Landing Project
Elemeno also has guides to help you navigate various programs and services. A popular recently-
published Navigator guide is: Housing Problem Solving - Housing Navigation Services
Learn how Elemeno, an Oakland-based software company, and AC Care Connect are partnering to
support community health workers from various agencies access information to address health
and housing needs of their homeless clients and connect them with organizations that provide
help.
What's Next?
Let’s continue the dialog! Be on the lookout for our December CHR user survey: We’ve
decided to conduct brief surveys of CHR users on a quarterly basis thanks to your responses
to the August CHR user survey. Your feedback will help us identify ongoing enhancements
and support needed to maximize the tool’s usefulness to you and the consumers we serve.
Resources and Upcoming Trainings
We offer many ways to learn about the CHR and get your questions answered. These are
tailored to your needs.
Missed a training? Attend a CHR make-up training. This is for CHR users who have never
been trained and are staff of a program previously onboarded. After completing the
training, attendees receive their CHR username and password and are able to access the
CHR. The next training will be Monday, December 14, 9 am - noon. Register here.
Need quick support? Stop by our Elbow Support Office Hour. Office hours are the third
Wednesday of each month from 11 am - 12 pm. This is for trained CHR users. No
registration is required and you may drop in at any time during the zoom session. Stop by
on Wednesday, December 16, 11 am - noon; click here to join.
Already attended a training, but need a refresher? This training is for you! This two-hour
participatory session for current CHR users covers primary components of the data privacy
framework and includes a demo of key "impact moves" in the CHR. Register here for the
session on Monday, December 21, 1 - 3 pm.
Need additional support? Elbow Support sessions are opportunities for one person or small
groups/teams of current CHR users to access additional support and training. Click here to
schedule a session.
New to the CHR? Click here to sign-up to onboard new programs to the CHR.
Missed a webinar? Recordings of past webinars are available here.
Have ideas for webinars? Do you have a topic you would like us to review at an upcoming
webinar? Send your ideas to careconnecthelp@acgov.org
New to Elemeno? Elemeno is an online platform containing tip-sheets, guides, videos, and
other resources for the CHR and for services related to Care Management, Health Plans,
Housing, Mental Health, Primary Care, and Substance Use Disorder Treatment. Use the self-
registration feature by clicking “First time? Create an Account” and entering your
organization email here.
Data Corner
Recent highlights include:
As of mid-November, 787 persons have been trained as CHR users and have
CHR user accounts.
In the first two weeks of November, a total of 23 new CHR users were trained.
To date, trainings have been conducted for CHR users in a total of 27
organizations/county departments.
Expansion of the population viewable in the CHR to support coordination of care
during the COVID-19 pandemic: To facilitate care for vulnerable residents of
Alameda County, AC Care Connect was authorized to expand the population
viewable in the CHR during the COVID-19 public health emergency to include all
Medi-Cal eligible and uninsured persons. This increased the population in the CHR
from 55,199 consumers who were “ever-eligible” for AC Care Connect to more than
650,000 Alameda County residents. Given the fact that consumers’ eligibility for
health care coverage fluctuates over time, the expansion supports care coordination
for those at greatest risk for infection and illness. The graph below shows the
change in the population viewable in the CHR. Data prior to May 2020 represents
the AC Care Connect “ever eligible” population growth, which increased steadily
over the period from the baseline population in June 2019 (40,510) to April 2020
(61,208). In May 2020, the expanded population was added increasing the viewable
population by a total of close to 551,801 persons to just over 613,009 persons. Since
then, the viewable population has grown to 650,515. (See article above on how
reports generated from the SHIE on this expanded population are helping to identify
critical population health needs and interventions to improve health status of our
most vulnerable residents).
Questions?
Contact the AC Care Connect Help Desk at:
CareConnectHelp@acgov.org or (510) 618-1997
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Visit our website
AC Care Connect Steering Committee Members
Aaron Chapman, Alameda County Behavioral Health Care Services | Kathleen Clanon, M.D., Alameda County Care Connect | Scott Coffin,
Alameda Alliance for Health | Lori Cox, Alameda County Social Services Agency | Elaine de Coligny, Everyone Home | Delvecchio Finley,
Alameda Health System | Colleen Chawla, Health Care Services Agency | Beau Hennemann, Anthem | John Jones III, East Oakland Black
Cultural Zone and Just Cities | Karl Sporer, M.D., Alameda County Emergency Medical Services | Wendy Peterson, Senior Services
Coalition | Ralph Silber, Alameda Health Consortium | Wendy Still, Alameda County Probation | Suzanne Warner, Housing and
Community Development
www.accareconnect.org