Reduce drug seeking by Drug Court
clients: Collaboration with hospital
Emergency Departments
Presentation to WSADCP Friday October 18, 2013
Sandra J. Altshuler, Ph.D., L.I.C.S.W.,
Coordinator
Tony McBride, B.A., C.D.P.,
Clinical Director
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 Holy Family
INHS
Deaconess (CHS)
Providence Sacred Heart
Valley Hospital (CHS)
ED Visit Process
Registration Reveals
Patient on Consistent Care
Physician reviews
ED care guidelines
Patient’s ED chart
flagged for doctor
Usual Triage
No controlled
substances
medical screening
exam by ED physician
EDIE
Auto-Notification
ED case manager talks to
patient prior to discharge
Auto-Notification
ED case manager called.
Medical Director sent text message
PCP emailed *planned*
Insurance Company emailed *planned*
ED Care Guidelines Faxed to ED and ED Called *planned*
Patient Discharged
The Process
EMR on INHS
network
ED Care Guidelines
Consistent Care
Staff
PCP Office
ED Care Guidelines
Patient Notification Letter
Insurance
Mailed to patient’s home
Emergency Department
Information Exchange
www.ediecareplan.com
Consistent Care
Staff
ED Visits
1 yr before and 1 yr after
2500
-50%
2037
-16%
1959
2000
1638
p < 0.001
1500
1022
1000
0
Consistent Care
Control (waiting list)
After
Before
After
Before
500
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 provided
 Provides 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?
15
The Consistent Care Program
Darin Neven MS, MD, Medical Director
Linda Marsh RN, BSN, CCM, Program Manager
Genevieve Green, Staff Support
For further information contact Linda Marsh
Linda.marsh@providence.org
www.consistentcare.com
Providence Sacred Heart Medical Center & Holy Family Hospital Spokane, Washington
What is EDIE?
The Emergency Department Information Exchange (EDIE) is a webbased 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:
System Workflow
Notification Methods:
Patient Event
Notification
•
•
•
Patient Data
Regional Hospital
1. 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:
EDIE
•
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:
•
•
•
•
Other Provider Facilities
Care Managers
or Coordinators
PCP, Mental Health
Provider, Specialists
•
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
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
EDIE
Report
on
TDC
Client
(pg. 1)
EDIE
Report
on
TDC
Client
(pg. 2)
EDIE
Report
on
TDC
Client
(pg. 4)
Visit Date
Location
Type
10/02/2013
Holy Family Hospital
Emergency
09/22/2013
Sacred Heart Medical Center
Emergency
Diagnoses
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 KEENE
CLIENT RELATIONS MANAGER
509.590.2353
KRISTINA.KEENE@COLLECTIVEMEDICALTECH.COM
Superior Court Behavioral Health
Adult Felony Therapeutic Drug Court
For further information:
Sandra Altshuler, saltshuler@spokanecounty.org 509-477-6355
Tony McBride, tmcbride@newta.org 509-326-7740