Improving Health Outcomes for
Children in Foster Care:
the Role of Electronic Information
Exchange
March 29, 2012
Overview

Need for improved information sharing in the
provision of health care services to children in
foster care

How electronic information exchange (EIE)
can be used to improve health outcomes

Strategies for developing EIE for children in
foster care

Ventura County Foster Health Link: an EIE
demonstration project
About The Children’s
Partnership (TCP)

TCP is a national nonprofit, nonpartisan child
advocacy organization with offices in
California and Washington, DC

Mission is to ensure that all children grow up
to lead healthy and lead productive lives

Expertise in research, analysis and policy
development to benefit all children, especially
the underserved
Expertise includes

About TCP (cont’d)

Primary focus has been on securing health
coverage for uninsured children and
expanding access to technology to
underserved children

TCP’s e-health work includes development of
Express Lane eligibility and enrollment
system, telehealth, electronic record systems,
and now, foster care coordination
Health Care Challenges Facing
Children in Foster Care

Large number of children in care

Poor health status and significant unmet
health care needs

Greater utilization of services and
disproportionately high health care
expenditures

Fragmented care and poor health outcomes
Factors Contributing to
Inadequate Health Care and
Poor Outcomes

Placement instability and variability

Resource and staff limitations in child welfare
services

Lack of coordination and information sharing
between service providers
Electronic Information Exchange
(EIE): The Means to a Solution

EIE can support information sharing and
address coordination gaps

EIE can support provider practice changes,
especially through the use of electronic
health records

EIE can help assess the changing health
status and needs of a population
Why Development of EIE for Children
in Foster Care Should be a Priority

Gives providers access to more
comprehensive information about a child

Facilitates communication between providers
for purposes of coordinating care and
delivery of services

Provides youth with a record of health
conditions and services received as they
prepare for permanency or emancipation
Basic Elements of EIE for
Children in Foster Care

Data Included



Basic health information including allergies,
immunizations, diagnoses, and provider
contact information
Medical service claims, pharmacy claims, lab
data
Access

Medical providers, child welfare workers,
foster parents and foster youth
Basic Elements of EIE for
Children in Foster Care (cont’d)

Additional Functions


Reminders about a child’s needs, warnings of
gaps in care or medication interactions
Potential for Expansion

EIE can be expanded to include other
responsible entities such as schools and
courts, with appropriate safeguards
Early Evidence Supports Use of
EIE for Children in Foster Care

Improved Health Outcomes




Better preventive care
Decreased hospital stays
Improved clinical conditions
Cost Savings


Decrease in expensive avoidable illness and
hospital stays
Reduction in pharmacy costs
Strategies for Developing EIE for
Children in Foster Care

Identify public and private funding




Medicaid, including Early and Periodic
Screening, Diagnosis, and Treatment
(EPSDT), Medicaid Management Information
Systems, and standard Medicaid
administrative match
HITECH, including Innovation Grants
State and county sources
Private funding, primarily foundation grants
Strategies for Developing EIE for
Children in Foster Care (cont’d)

Identify and develop stakeholders and strong
leadership
Development process may be long and require
complex negotiations
 Involve stakeholders, including foster parents
and youth, early in the process
 Programmatic champions from state and local
government help drive the process

Strategies for Developing EIE for
Children in Foster Care (cont’d)

Address privacy and confidentiality
concerns early and often
Laws are complex and there are unique and
varied privacy concerns for children in foster
care
 Key considerations:




Who controls information into and out from EIE?
Who has access to information contained in the EIE?
What role do foster parents and youth play in contributing to
and controlling information in the EIE?
Strategies for Developing EIE for
Children in Foster Care (cont’d)

Scope EIE Project Appropriately
Important to balance need for including
enough information to improve outcomes with
need to avoid including so much information
the system becomes unwieldy
 Select an EIE architecture that allows a
narrow approach at first and broadening of
scope over time

Strategies for Developing EIE for
Children in Foster Care (cont’d)

Discuss evaluation and sustainability early
in EIE development
Important to build key evidence base to
demonstrate improved outcomes and cost
savings as soon as possible
 Long-term sustainability depends on:





Secure funding
Engaged leadership and stakeholders
Clear privacy and confidentiality protections
Demonstrated improved outcomes and cost savings
Ventura County Foster Health
Link (VCFHL): an EIE
Demonstration Project

Why Ventura County?
Manageable size—population of about
825,000 (2010) with about 800 children in
foster care
 County-operated system of hospitals and
clinics—ease of implementation
 Strong leadership in both county human
services and health care agencies

VCFHL Project (cont’d)

Primary Goals:

Connect health and child welfare information
for all children in foster care

Leverage existing technology

Provide appropriate access to real-time
information
VCFHL Project (cont’d)

Key Components

Master Person Index

Record Locator Service

“Youth-facing” Portal

Interface with state CWS and health
databases
VCFHL Project (cont’d)

Current Status and Next Steps:

Partnering with State for $1 million federal
Medicaid HIE funding; submission of IAPD-U

Nonfederal $100,000 match in place—county
funds and foundation grants

Governance structure for EIE developed;
developing MOUs and contracts

Once federal funding received, 22-month
project timeline
For more information

TCP Website:


www.childrenspartnership.org
Contact me:

Ginny Puddefoot, Director
HIT Initiatives for Vulnerable Children
The Children’s Partnership
916-572-7340
gpuddefoot@childrenspartnership.org