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Sharing information on our shared clients: Is the juice worth the
squeeze?
SF Department of Public Health Coordinated Care Management System
Maria X Martinez
SituationOverwhelming need in Managed Care to identify, understand, and find high-risk individuals
Silo systems are linear. People come in, get served one at a time, get diagnosed, data stored
Need to coordinate and track high-risk individuals, measure their system usage and system’s effectiveness, have markers
Providers unaware of others working with patients and duplicate, miss, confuse care
Money spent on homeless system of care is reported, but unduplicated homeless individuals unknown
2Maria X Martinez, SF DPH, 415-554-2877,
MIS Challenges
Data segregated by specialty silos, funding silos, vendor silos
IT priorities are to implement large systems to maximize revenue, serve as clinical chart, & meet meaningful use criteria
Getting systems to talk to each other is expensive
Manual integration of datasets for analyses is very time-consuming and one-shot…not sustainable
Jumping on and off of multiple systems requires too much time, too complicated in the provider setting
3Maria X Martinez, SF DPH, 415-554-2877,
Approach to Solution
Integrate datasets and create composite picture of each unique patient.
Identify transactional datasets that collect bio-psycho-social information about high-risk patients
Develop design team (Clinical, Epidemiology, IT, and Management) to determine what data are relevant.
Set-up transfer of data to warehouse server; once there, program system to match and merges
4Maria X Martinez, SF DPH, 415-554-2877,
Purpose of Data Integration
Aim is not to replace source databases, to bill, or serve as an EMR
Goal is to tell the patient’s story, identify the Care Coordinating Team, facilitate timely communication, and offer “actionable” information
5Maria X Martinez, SF DPH, 415-554-2877,
Begun in 2005, CCMS has grown to include
bio-psycho-social histories of over 600,000 adult
high-risk / high-cost patients.
6
Coordinated Case Management System
Maria X Martinez, SF DPH, 415-554-2877, [email protected]
Physical Health
Mental Health
Substance Use
Living Situation
Finances
Legal Safety Skills Support Meaning-ful Role
CCMS by Domains
9Maria X Martinez, SF DPH, 415-554-2877,
Stratifying Risk
• Identify risk factors and acuity based upon multiple health and human service systems
• Profile utilization of urgent/emergent services
• Determine span of time with homeless history
• Compare programs, clinics, panels, populations
• Determine overlapping/shared populations
[email protected], 415-554-2877
EMS High Users
EMS High Users are defined as anyone transported four or more times in any one month. Two-thirds
appear acutely, one-third are chronic.
Misuse of crisis services results in fragmented care for high-risk patients and cost overruns for an already
over-taxed system; as well as delayed response times for others in need of ambulance and emergency
department services.
16Maria X Martinez, SF DPH, 415-554-2877,
High Users of Multiple Systems (HUMS)
A small percentage of clients, despite assertive case management and repeated efforts at stabilization in the community, are failing to recover.
Present with transitory cognitive impairments and lengthy histories of self-neglect and assaults, necessitating higher levels of care in multiple systems. In lieu of routine community care, they repeatedly use urgent / emergent services.
Their confluence of co-morbid disorders results in extremely high rates of premature mortality & high costs to the system.
21Maria X Martinez, SF DPH, 415-554-2877,
Urgent/Emergent Care in SFDPH
Maria X Martinez, SF DPH, 415-554-2877, [email protected]
22
System Urgent/Emergent Service Count
Medical EMS Transport Transport
Hospital Inpatient Day
ED Visit
Medical Respite (Hosp Offset) Day
Urgent Care Clinic Visit
Mental Health Day Crisis (PES & Dore Urgent Care) Visit
Hospital Inpatient Day
Outpatient Crisis (Drop-in/Mobile Crisis) Visit
Acute Diversion (Hosp Offset) Day
Substance Abuse Medical Detox Day
Sobering Center Visit
Social Detox Day
FY1314 Total U/E Users 43,357
FY1314 Total U/E Cost 193,088,875$
Stratifying Risk
Maria X Martinez, SF DPH, 415-554-2877, [email protected]
23
Stratification Description 1 system 2 systems 3 systems
Top 1% Users Category "3" "2" "1"
433 Individuals 131 187 115
96.0 Avg Svcs Each 91.6 97.3 99.0
33,156,711$ Dollars 12,281,343$ 13,248,155$ 7,627,213$
17% % of Total Cost 6% 7% 4%
Top 2-5% Users Category "6" "5" "4"
1,729 Individuals 805 635 289
36.1 Avg Svcs Each 34.9 36.1 39.7
54,414,451$ Dollars 30,992,953$ 16,836,839$ 6,584,659$
28% % of Total Cost 16% 9% 3%
HUMS
Acuity
Maria X Martinez, SF DPH, 415-554-2877, [email protected]
24
The Elixhauser Co-morbidity Index is a
research tool to predict early mortality
among inpatients. It is being tested here
for ambulatory care patients.
The ability to identify tri-morbid and co-
morbid chronic, or urgent conditions is
expected to add risk assessment value.
The Elixhauser Comorbidity Index (Quan
et al, Med Care, 2005) is a list of 31 co-
occurring conditions that contribute to
early mortality.
AIDS/HIV
Blood Loss Anemia
Cardiac Arrhythmias
Chronic Pulmonary Disease
Coagulopathy
Congestive Heart Failure
Deficiency Anemia
Diabetes, Complicated
Diabetes, Uncomplicated
Fluid and Electrolyte Disorders
Hypertension, Complicated
Hypertension, Uncomplicated
Hypothyroidism
Liver Disease
Lymphoma
Metastatic Cancer
Obesity
Other Neurological Disorders
Paralysis
Peptic Ulcer Disease, Exc. Bleeding
Peripheral Vascular Disease
Pulmonary Circulation Disorder
Renal Failure
Rheumatic Arthritis / Col. Vasc. Dis.
Solid Tumor W/O Metastasis
Valvular Disease
Weight Loss
Alcohol Abuse
Drug Abuse
Depression
Psychoses
25Maria X Martinez, SF DPH, 415-554-2877,
FY1314 USERS OF URGENT/EMERGENT
SERVICES (Excludes OOMG) Top 1% U/E Users
Primary Care w
25+ SFGH Med
Inpt Days
Total Individuals (Unduplicated) 433 236
Total U/E Costs 33,156,711$ 17,787,443$
Average Cost per User 76,574$ 75,371$
% of All FY1314 U/E Users 1.0% 0.5%
% of All FY1314 U/E Costs 17.2% 9.2%
Homeless Within Last Year 69.5% 32.2%
Deceased (as of report date) 7.4% 3.0%
Jail Health History During FY 21.7% 6.8%
MEDICAL U/E System Users (during FY) 91.9% 100.0%
MENTAL HEALTH U/E System Users (during FY) 53.6% 10.6%
SUBSTANCE ABUSE U/E System Users (during FY) 50.8% 16.5%
Medical Elixhauser Conditions 90.8% 96.6%
Psych Elixhauser Conditions 85.0% 66.9%
Substance Abuse Elixhauser Conditions 87.8% 67.8%
Tri-Morbid Elishauser Conditions 71.8% 49.2%
1. Generate shared vision and leadership
…this is going to take time.
2. Iron-out privacy and security issues for
sharing data.
3. Assure you have IT bandwidth.
4. Engage the provider community…what
do they need at the moment of truth to
improve the patient experience? What
do they need to manage their panels or
caseloads better?
5. Engage the epidemiology
community…what data do they need to
evaluate outcomes?
6. Develop protocols for how providers are
expected to use integrated data.
26
Keys
Maria X Martinez, SF DPH, 415-554-2877, [email protected]
San Francisco Department of Public Health
Maria X MartinezOffice of the Director of Health
28Maria X Martinez, SF DPH, 415-554-2877,
Revised Dec 1, 2014
City and County of San Francisco
Edwin M. Lee, Mayor
Coordinated Care Management System The Coordinated Care Management System (CCMS) is a composite database of integrated medical, psychological, and social information about high risk, complex, and vulnerable populations served by the San Francisco Department of Public Health (SFDPH). Source databases are located throughout the county in a variety of medical, mental health, substance abuse, housing, human service, and criminal justice sites. Behind the scenes, the repository is structured to meet the highest standards of data security and integrity including HL7 and PHIN meaningful use criteria. CCMS began on a small scale in 2005 designed by intensive case managers and epidemiologists to facilitate communication regarding shared vulnerable clients. The initial clients were high users of ambulance services, homeless or frail elderly residents. The common patient trait was having multiple serious needs and using multiple care systems to address those needs, often without the knowledge of the various providers involved. The ability to share information was crucial to protecting patient safety and preventing duplication of scarce fragmented resources. As “whole person care” becomes more and more essential in the managed care environment, CCMS enables practitioners and the managed care office to view all health care and safety net services utilized by a patient, or a patient population, in an unduplicated fashion. Today, CCMS has grown to include bio-psycho-social integrated histories of over 600,000 patients who meet one or more aspects of high risk populations. CCMS helps SFDPH deliver whole person care in two ways: The CCMS Patient Summary (example attached) is viewable via through a link provided in the patient’s multiple EMRs. The purpose of this report is to identify members of the treatment team, alert providers of the patient’s high risk factors in all domains (bio-psycho-social) and display the individual’s integrated and time-lined utilization of services and diagnostic histories. Care Coordinators view individual records for their assigned patients with new documentation streaming in overnight or in real time. When maximally functional, they will see early warning flags of chronic conditions that, in combination, signal urgency and action. Also planned is the ability to provide panel and caseload reports listing patient-specific activity that the provider wishes to track. Finally, they will see a risk and strength index uniquely designed for CCMS to measure acuity, outcomes, and progress based upon case manager input as well as computer algorithms. CCMS Population Profile Reports (example attached) provide SFDPH with “whole person” perspectives for various high-cost/high-risk populations including their healthcare utilization, diagnostic histories, demographics, socio-economic status, and housing status, among others. These profiles help leadership identify vulnerable populations and measure acuity of populations between one clinic and another, one population and another, and one population over time. Epidemiologists and researchers of aggregate data download data to better understand patient trajectories and indicators of system needs/successes. Planners, policy makers, and administrators have an ever increasing choice among regularly scheduled reports to help prioritize limited resources. The enthusiastic support of the Mayor and city leaders in the Departments of Public Health, Fire, Human Services, and the Controller’s Office has helped CCMS grow. Please contact Maria X Martinez at 415-554-2877 or [email protected] for more information.
Revised Dec 1, 2014
Revised Dec 1, 2014
FY1314 USERS OF URGENT/EMERGENT
SERVICES (Excludes OOMG) All U/E Users
% of
Cohort Top 1% U/E Users
% of
Cohort
Primary Care w
25+ SFGH Med
Inpt Days
% of
Cohort
Total Individuals (Unduplicated) 43,357 100.0% 433 100.0% 236 100.0%
Total U/E Costs 193,088,875$ 100.0% 33,156,711$ 100.0% 17,787,443$ 100.0%
Average Cost per User 4,453$ 76,574$ 75,371$
% of All FY1314 U/E Users 100.0% 1.0% 0.5%
% of All FY1314 U/E Costs 100.0% 17.2% 9.2%
Average # of U/E Services per User 5.7 96.0 61.8
Demographics
Homeless Within Last Year 7,709 17.8% 301 69.5% 76 32.2%
Average Age 44.2 ~ 48.3 ~ 52.3 ~
Deceased (as of report date) 1,006 2.3% 32 7.4% 7 3.0%
Jail Health History During FY 3,632 8.4% 94 21.7% 16 6.8%
Utilization of U/E Systems
MEDICAL U/E System Users (during FY) 39,803 91.8% 398 91.9% 236 100.0%
MENTAL HEALTH U/E System Users (during FY) 5,541 12.8% 232 53.6% 25 10.6%
SUBSTANCE ABUSE U/E System Users (during FY) 2,869 6.6% 220 50.8% 39 16.5%
Diagnoses (Any History)
Medical Elixhauser Conditions 23,458 54.1% 393 90.8% 228 96.6%
Psych Elixhauser Conditions 17,558 40.5% 368 85.0% 158 66.9%
Substance Abuse Elixhauser Conditions 15,195 35.0% 380 87.8% 160 67.8%
Tri-Morbid Elishauser Conditions 7,750 17.9% 311 71.8% 116 49.2%
AIDS/HIV 2,246 5.2% 61 14.1% 40 16.9%
Blood Loss Anemia 565 1.3% 15 3.5% 14 5.9%
Cardiac Arrhythmias 3,838 8.9% 143 33.0% 87 36.9%
Chronic Pulmonary Disease 7,334 16.9% 160 37.0% 107 45.3%
Coagulopathy 1,067 2.5% 47 10.9% 43 18.2%
Congestive Heart Failure 2,221 5.1% 73 16.9% 64 27.1%
Deficiency Anemia 2,526 5.8% 86 19.9% 71 30.1%
Diabetes, Complicated 1,844 4.3% 40 9.2% 47 19.9%
Diabetes, Uncomplicated 6,279 14.5% 108 24.9% 101 42.8%
Fluid and Electrolyte Disorders 4,176 9.6% 168 38.8% 128 54.2%
Hypertension, Complicated 2,592 6.0% 45 10.4% 53 22.5%
Hypertension, Uncomplicated 12,771 29.5% 249 57.5% 164 69.5%
Hypothyroidism 2,209 5.1% 52 12.0% 26 11.0%
Liver Disease 6,365 14.7% 183 42.3% 116 49.2%
Lymphoma 328 0.8% 12 2.8% 13 5.5%
Metastatic Cancer 420 1.0% 13 3.0% 10 4.2%
Obesity 5,815 13.4% 75 17.3% 58 24.6%
Other Neurological Disorders 2,630 6.1% 104 24.0% 56 23.7%
Paralysis 398 0.9% 11 2.5% 15 6.4%
Peptic Ulcer Disease, Exc. Bleeding 632 1.5% 11 2.5% 7 3.0%
Peripheral Vascular Disease 1,991 4.6% 66 15.2% 52 22.0%
Pulmonary Circulation Disorder 629 1.5% 33 7.6% 32 13.6%
Renal Failure 2,124 4.9% 53 12.2% 60 25.4%
Rheumatic Arthritis / Col. Vasc. Dis. 1,979 4.6% 50 11.5% 37 15.7%
Solid Tumor W/O Metastasis 1,967 4.5% 45 10.4% 47 19.9%
Valvular Disease 1,677 3.9% 38 8.8% 43 18.2%
Weight Loss 2,086 4.8% 66 15.2% 61 25.8%
Alcohol Abuse 9,874 22.8% 316 73.0% 123 52.1%
Drug Abuse 11,441 26.4% 319 73.7% 138 58.5%
Depression 15,466 35.7% 328 75.8% 145 61.4%
Psychoses 6,845 15.8% 254 58.7% 74 31.4%
CCMS source report date 12/1/14 - MXM SFDPH 415-554-2877 rev 12/1/14
**The Elixhauser Co-morbidity Index is a research tool to predict early mortality among inpatients. It is being tested here for ambulatory care patients. Ability to
identify tri-morbid and co-morbid chronic, or urgent conditions is expected to add risk assessment value. The Elixhauser Comorbidity Index (Quan et al, Med
Care, 2005) is a list of 31 co-occurring conditions that contribute to early mortality.
1 | P a g e December 1, 2014 - 415-554-2877
San Francisco Department of Public Health
High Users of Multiple Systems
Who are HUMS patients? Data systems have enabled plan administrators to identify “outliers,” those people whose healthcare costs and health risk put them far outside the vast majority of other patients. In most systems nationwide, steps are being taken to try to maximize outcomes and minimize avoidable costs by identifying their outliers, also referred to as “hot spotters,” those who overly rely on acute care services due to poorly managed chronic conditions. However in 2007, the San Francisco Department of Public Health (SFDPH) took a different approach to understand how individuals use services within their $1.5 billion network, a safety net that includes medical, mental health, and substance abuse treatment systems of care. Instead of looking for outliers within one system, SFDPH tracks those people who bounce across systems using urgent/emergent care at very high rates. High users of multiple systems (HUMS) not only denotes individuals struggling with multiple disorders, it also describes individuals who are less visible because they are often not the highest user of a single system. Once identified, they are more difficult to engage in health services, as they tend to rely only on urgent/emergent care instead of coordinated care that stabilizes them in the community. HUMS patients have a higher burden of chronic disease due to multiple factors such as chronic intoxication, significant cognitive impairment, mental illness, and behavioral issues. To identify these people, the safety net was divided into three categories of health systems: medical, mental health, and substance abuse. Table 1 notes the urgent/emergent services that are included in each system.
Table 1: SFDPH Systems of Care and Urgent/Emergent Services (Unit of Service)
Medical System Mental Health System Substance Abuse System
Inpatient (Days)
Emergency Department (Visits)
Urgent Care Clinic (Visits)
Medical Respite (Days)
Ambulance (Transports)
Inpatient (Days)
Psych Emergency (Visits)
Psych Urgent Care Clinic (Days)
Dore Urgent Care Clinic (Days)
Acute Diversion Unit (Days)
Outpatient Crisis (Visits)
Sobering Center (Encounters)
Residential Medical Detox (Days)
Residential Social Detox (Days)
SFDPH users of urgent/emergent services are identified by merging records via the integration of multiple stand-alone datasets into the SFDPH Coordinated Case Management System (CCMS). Individuals are ranked by the number of their total count of services utilized during the fiscal year, not by their total cost. This is because some systems are significantly less expensive than others (substance abuse versus medical for example) and the frequency of use is a more useful indicator of high risk than is cost alone. Once the top 1% users of urgent/emergent services are identified, those utilizing two or three systems are categorized as HUMS patients. Keep in mind that these patients are not already identified as “outliers” and that many of the services they receive are relatively inexpensive. Please refer to Table 2, appendix and as follows: Over 50,000 unique individuals receive at least one urgent/emergent service annually, totaling nearly
$200 million of estimated costs per year The Top 1% (511 people) account for 25% of the costs ($49,793,566 per year) Those engaged in two or three systems (312) are identified as HUMS patients and they average nearly
$100,000 each, or over $300 million per year in total. Despite receiving an average of 91 separate urgent/emergent services a year at very high costs, HUMS
patients are not known as outliers to a single system, are not sticking to any stabilizing services, have no care coordination, and have very poor health outcomes including high mortality rates.
2 | P a g e December 1, 2014 - 415-554-2877
Why are HUMS patients so hard to help? HUMS patients are individuals who are unable to navigate our traditional systems of care. Data analysis shows that these patients are more likely to be white and middle aged and to have a combination of severe medical, mental health, and substance use (predominantly alcohol) problems. As noted in Table 3, nearly two-thirds of the top 1% users (312) crossover two or three systems of care (primarily Mental Health and Medical systems) and nearly half of those (137) utilize all three systems (Substance Abuse, Medical and Mental Health). However, when you look at the diagnoses associated with these urgent/emergent services, as noted in Table 4, an additional 45 patients, for a total of 232, are struggling with all three disorders. HUMS individuals are almost universally chronically homeless and often suffer persistently from severe alcohol disorders, brutal living conditions, chronic medical problems, and serious mental illnesses. They have extremely high rates of premature mortality, create adverse effects on certain geographic areas of the city, and result in high costs to the health system. As such, the San Francisco Department of Public Health has taken an innovative, multi-pronged approach to addressing this pressing issue. What is being done about HUMS patients? A Care Coordination Team (Transitions) has been created to provide the necessary system navigation to facilitate the various entry and service points throughout the network that contribute to recovery, wellness and stability. Transitions’ Care Coordination differs from other care coordination models in the country because it focuses on the Top 1% of High Users of Multiple Systems, in addition to those who are the more traditionally single medically complex populations. Transitions Care Coordination works in close collaboration and develops care plans with the other Care Coordinators within the network and with the Medi-Cal Managed Care Plans. Community Care Plans include whom to contact when the patient presents to an ED. Hospitals are encouraged to call Transition’s Engagement Specialist Team (EST) to inquiry about patients who present at their EDs and fit the profile of HUMS. EST will remain engaged with the patient until he or she agrees to case management services. Careful tracking, coordination, and follow-through with their care, no matter where they appear for services, will enable us to proactively intervene and help them to improve the quality of their lives. SFDPH is applying for approval to begin a comprehensive pilot program to treat ten HUMS volunteer patients with Naltrexone, which has been shown to help individuals reduce their craving for alcohol. Along with this treatment, the SF FIRST Intensive Case Management team will provide outreach, temporary beds, benefits advocacy, assistance with permanent housing applications, and wrap-around services. If the pilot is successful, the department will consider applying for grants to widen the scope of availability of this potentially life-saving intervention. The HUMS project is crucial in finding these patients, and remains essential for identifying areas for proactive measures. The HUMS project is also crucial in assessing which types of interventions are successful, and to what degree. SFDPH remains committed to creating and finding innovative ways to address the costs, suffering and premature deaths of a group of patients who represent some of the most intractable problems of our times.
Harry HUMS* A person walking along Market Street sees someone lying on the sidewalk and calls 911. Paramedics arrive and find Harry Hums unconscious, with bruises on his head, and an infected scalp laceration. Harry is taken to San Francisco General Hospital emergency. He has a head scan which shows impressive amounts of old head trauma, and he gets a full evaluation for drug overdoses. His blood alcohol level is shockingly high. His medical records show he has HIV and diabetes. When Harry gradually comes around, he becomes combative and tells his doctor that he drank a fifth of vodka to help with the pain in his head, pain from hitting his head jumping off a balcony. Harry refuses to say if he was trying to kill himself, or if he was pushed, or fell. Harry is transferred to psych emergency. Harry, although clearly suffering from both long-standing cognitive deficits and poor impulse control, states that he’s not going to do that again, he was simply drunk and jumped on a dare. Records show that after intensive efforts to find Harry and get him to hearings, Harry was legally conserved last year, but his conservation did not stop his use of urgent/emergent services, nor did it get him to his primary provider, whom he has never met. After his psych evaluation, Harry is beginning to withdraw from alcohol but refuses admission. He is given appointments and prescriptions for his HIV and diabetes, but leaves before picking up his meds. He has no phone, no address and no emergency contacts. Three hours later paramedics pick him up again, drunk, and this time take him to the sobering center. The EST team meets him at the sobering center and transports him to a shelter bed. EST returns to escort Harry to his first primary care visit in
three years and finds Harry bathed and neatly dressed. (*for confidentiality reasons, Harry is a composite of many patients)
3 | P a g e December 1, 2014 - 415-554-2877
San Francisco Department of Public Health
High User of Urgent Emergent Services - Stratifying Risk
System Urgent/Emergent Service Count
Medical EMS Transport Transport
Hospital Inpatient Day
ED Visit
Medical Respite (Hosp Offset) Day
Urgent Care Clinic Visit
Mental Health Day Crisis (PES & Dore Urgent Care) Visit
Hospital Inpatient Day
Outpatient Crisis (Drop-in/Mobile Crisis) Visit
Acute Diversion (Hosp Offset) Day
Substance Abuse Medical Detox Day
Sobering Center Visit
Social Detox Day
FY1314 Total U/E Users 43,357
FY1314 Total U/E Cost 193,088,875$
Stratification Description 1 system 2 systems 3 systems
Top 1% Users Category "3" "2" "1"
433 Individuals 131 187 115
96.0 Avg Svcs Each 91.6 97.3 99.0
33,156,711$ Dollars 12,281,343$ 13,248,155$ 7,627,213$
17% % of Total Cost 6% 7% 4%
Top 2-5% Users Category "6" "5" "4"
1,729 Individuals 805 635 289
36.1 Avg Svcs Each 34.9 36.1 39.7
54,414,451$ Dollars 30,992,953$ 16,836,839$ 6,584,659$
28% % of Total Cost 16% 9% 3%
Top 6-50% Users Category "9" "8" "7"
19,933 Individuals 17124 2548 261
5.8 Avg Svcs Each 5.3 8.4 13.6
93,911,836$ Dollars 77,767,697$ 14,337,901$ 1,806,237$
49% % of Total Cost 40% 7% 1%
Below Median Users Category "12" "11" "10"
21,262 Individuals 21,106 156 -
1.2 Avg Svcs Each 1.2 2.0 -
11,605,878$ Dollars 11,456,425$ 149,453$ -
6% % of Total Cost 6% 0% 0%
Maria X Martinez - SFDPH - 415-554-2877, [email protected]
HUMS
City and County of San Francisco Department of Public Health
DPH Privacy Policy Matrix – Sharing Protected Health Information for
TREATMENT PURPOSES
When allowed by law (see below), Protected Health Information (PHI) may be shared for treatment purposes across disciplines and programs on a “need-to-know” basis and for the purposes of improving health outcomes. PHI includes case management/coordination communication, medication prescription and monitoring, counseling session start and stop times, the modalities and frequencies of treatment, results of clinical tests, and any summary of the following items: diagnosis, functional status, treatment plan, symptoms, prognosis, and progress to date.
Description of PHI Who may disclose it? Who may receive it?
General Health
(includes knowledge of Mental Health, Substance Use/Abuse, HIV/AIDS, STD conditions)
General Health Provider
Patient's providers and providers’ staff for the purpose of treatment, diagnosis, or referral
[Reference: Civil Code 56.10(a); HIPAA Treatment Exception]
Mental Health
(includes knowledge of General Health, Substance Use/Abuse, HIV/AIDS, STD conditions)
Mental Health Provider Any healthcare provider (any discipline) "who has medical or psychological responsibility for the patient"
[Reference: W&I Code 5328(a); HIPAA Treatment Exception]
Drug/Alcohol Treatment Program (includes knowledge of General Health, Mental Health, HIV/AIDS, STD Conditions)
Drug/Alcohol Treatment Program Provider
Only another member of the client's treatment team WITHIN the specific drug/alcohol treatment program
Exception: a medical emergency
[Reference: 42 CFR Part 2, section 2.12 (c)(3)]
HIV/AIDS CCSF Health Service Provider Network (includes knowledge of General Health, Mental Health, Substance Use/Abuse, STD conditions)
HIV/AIDS CCSF Health Service Provider
Only another HIV Health Service provider who registers client in ARIES database.
[Reference: CCSF Local Share Mandate established with the
California Office of AIDS]
STD Condition CCSF City Clinic Patient's provider of health care only if necessary to complete treatment of the STD
[Reference: SFDPH Policy]
Revised 01-05-10
See next page for further explanations.
Treatment Providers Individual practitioners and program staff in agencies that furnish health services in the normal course of their business are considered treatment or healthcare providers. HIPAA defines treatment as "the provision, coordination, or management of health care and related services by one or more health care providers, including the coordination or management of health care by a health care provider with a third party; consultation between health care providers relating to a patient; or the referral of a patient for health care from one health care provider to another." References: Civil Code 56.10(c)(1), H&S Code 123010, and HIPAA (45 CFR sec.164.506, 45 CFR 164.501 45, CFR 164.506). For purposes of care coordination and treatment, healthcare providers may be inside or outside the DPH Safety Net, but they and/or their agencies must be bound by state and federal confidentiality laws and/or DPH MOUs to be considered a “treatment provider” as noted in the above matrix. The DPH Safety Net includes civil service, contract, and affiliate programs (such as those of UCSF and the SF Community Clinic Consortium). The following are some examples of other treatment providers whose clients’ PHI may be shared for treatment and coordination purposes without an authorization: 1. Individual practitioners and treatment providers of private sector hospitals and clinics who are
bound by state and federal confidentiality laws. 2. Providers who sell or dispense drugs, devices, equipment, or other items in accordance with a
prescription. 3. (via MOU) Paramedics of the San Francisco Fire Department EMS 4. (via MOU) Case managers in the Human Services Agency Homeless Programs:
a. HSA Behavioral Health Roving Team b. Housing Access Team
5. (via MOU) Case managers in the Department of Aging and Adult Services Case Management Programs:
a. Bernal Heights Neighborhood Center’s b. Neighborhood Elders Support Team (NEST) Case Management Program c. Active Senior Case Management Program d. Episcopal Community Services’ Canon Kip Senior Center Case Management Program e. Curry Senior Center Case Management Program f. DAAS Adult Protect Services (APS) Case Management Program g. Family Service Agency Seniors Case Management Program h. IHSS (In Home Supportive Services) Consortium Case Management Program i. Institute on Aging j. MSSP (Multipurpose Senior Services) Case Management Program k. Linkages Case Management Program l. District Wide Social Services/District 5 Case Management Programs serving Mission, Noe
Valley, Bernal Heights, Buena Vista, and Eureka Valley m. Neighborhood Resource Centers Case Management Programs serving Richmond District,
Western Addition and the Mission n. Meals on Wheels Case Management Program o. San Francisco Senior Centers Case Management Programs p. Self-Help for the Elderly Case Management Program q. On Lok 30th Street Senior Services Case Management Program
6. (via MOU) Care Coordinators of the San Francisco Health Plan Questions about who is and who is not a health service provider should be directed to your Privacy Officer. [revised mxm 031313)
5795021 (Rev. 01/11) Health Insurance Portability and Accountability Act (HIPAA) Notice of Privacy Practices Summary Form – SFDPH
NAME
SUMMARY DPH NOTICE OF HIPAA PRIVACY PRACTICES
The attached Notice describes how health information about you may DOB be used and disclosed in the San Francisco Department of Public Health and your rights regarding the use of that information. MRN Please review this summary and the full Notice carefully.
DPH Pledge: Employees of the San Francisco Department of Public Health (DPH), its affiliates and contract
providers understand that information about you and your health is personal. They are committed to protecting your health information.
Who will follow the rules in this notice: All DPH and contract provider employees, DPH affiliates, as well as staff assigned to DPH by the University of California at San Francisco, must follow these rules.
You have the right to: (please see possible restrictions starting on page 2 in the full Notice) Ask to see, read and/or obtain a copy of your health record (charges may be necessary). Ask to correct information that you believe is wrong in your health record. Ask that your health information not be shared with certain individuals. Ask that your health information not be used for certain purposes; for example, research. Ask DPH to send copies of your health record to whomever you wish (charges may be necessary). Be informed about who has read your record (for reasons other than treatment, payment, and program improvement purposes). Specify where and how DPH employees may contact you. Receive a paper copy of the full DPH Notice of Privacy Practices.
DPH may use and disclose your health information to improve your treatment. To improve the quality of care you receive, your health information may be shared between treatment
providers – including health information regarding mental health, substance abuse, HIV/AIDS, sexually transmitted diseases (STD), and developmental disabilities.
There are circumstances when health information about you will not be shared unless you first give your permission for it to be shared; such as when you receive services in a substance abuse treatment agency.
See Page 4 in the “Notice of Privacy Practices” for more information. If you have concerns about how your health information might be (or has been) shared, please speak with your provider or call the DPH Privacy Officer directly at (415) 206-2354.
If you believe your privacy rights have NOT been maintained while receiving DPH services, you may file a complaint with the DPH Privacy Officer at (415) 206-2354. You may also file a complaint with the Secretary of the U.S. Department of Health and Human Services’ Office of Civil Rights, Attn: Regional Manager, 50 United Nations Plaza, Rm. 322, SF, CA 94103. You will not be penalized in any way for filing a complaint.
I acknowledge receipt of the San Francisco Department of Public Health “Notice of Privacy Practices.”
Signature: _________________________________________________________ Date: _____________________ Relation (if other Printed Name: _____________________________________________ than patient): ______________________ Patient/Client declined to sign receipt (staff signature): ______________________________________________ Patient/Client unable to sign (witness signature): ___________________________________________________
Reason unable: _________________________________ Interpreter: ____________________________________
