w w w . T h e N a t i o n a l C o u n c i l . o r g
Michael R. Lardiere,LCSW
VP HIT & Strategic Development
September 16, 2013
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
Role of data in the healthcare system of the future

How will information be used and data shared under health reform

Using Data for Population Management

Health Information Exchange/DIRECT Secure Messaging

Meaningful Use – opportunities now

Meaningful Use
– Opportunities in the Future

Strategies to Position your Organization
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•
Payment reform; fundamental shift away from fee-for-service
•
Delivery system reform: encourage reorganization of system to take out waste and deliver high ‐ value care
•
Different opportunities for providers based on readiness
•
Strategic partnerships with data
•
Robust quality monitoring
•
Emphasis on multi ‐ payer strategies and approaches
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Jonathan Blum, CMS

•
Shifts in revenue sources as more people become eligible and enroll in new insurance options
•
Increased competition as health providers meet new value-based purchasing standards built on health system partnerships and accountability for clinical outcomes
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

Collaborative Care

Patient Centered Healthcare
Homes

Accountable Care Organizations

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w w w . T h e N a t i o n a l C o u n c i l . o r g
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5



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6

16
24
29
36
13
14
15
8
9
10
11
12
3
4
5
6
7
Cost
Rank
1
2
Treatment Type
Community Support Services/15 min
Community Support Services /day
Personal care per diem
Habilitation, prevocational/15 min
Supported employment/15 min
Inpatient room and board
Targeted case management/15 min
Inpatient- ancillaries
Case management/ 15 min
Emergency room
Psych medication management
Inpatient-facility charges
Labs
ACT program
Medical supplies
Family therapy
Office visits – primary care
Surgery
Ambulance
Total Charges
$2,890,038
$1,916,375
$1,394,614
$758,157
$713,680
$699,602
$557,154
$494,577
$438,577
$356,478
$356,478
$288,479
$287,935
$286,773
$241,812
$221,136
$154,773
$105,085
$54,581
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81
470
247
1,086
52
218
181
123
104
154
90
689
437
115
156
181
616
98
67
No of members
$6,878
$1,052
$1,776
$328
$5,548
$659
$2,494
$1,550
$1.222
$215
$1,072
$815
Average Charges per Member
$13,257
$10,588
$11,338
$7,290
$4,634
$7,773
$1,009
7

Cost
Rank
Primary Diagnosis Total Charges
3
4
1
2
5
6
7
10
11
8
9
12
Schizophrenia and Affective Psychosis
Depression/Anxiety/Neuroses
Moderate Mental Retardation
Severe Mental Retardation
Profound Mental Retardation
Mild Mental Retardation
Alcohol and Drug Abuse
Pregnancy
Congestive heart Failure
Chest Pain
All Fractures and Dislocations
Diabetes Mellitus
$6,167,527
$1,710,759
$1,040,669
$1,032,094
$982,760
$709,344
$283,077
$183,653
$168,130
$161,260
$137,901
$134,161
39
131
177
1,102
347
112
74
39
7
65
19
42
No of Members Average Charges Per
Member
$5,597
$4,930
$9,292
$13,947
$25,199
$5,415
$1,599
$4,709
$24,019
$2,481
$7,258
$3,194
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Top Cost by Treatment Type
January-March, 2006
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Community Support
Services/15 min
Community Support Services
/day
Personal care per diem
Habilitation, prevocational/15 min
Supported employment/15 min
Inpatient room and board
Targeted case management/15 min
Inpatient- ancillaries
Case management/ 15 min
Emergency room
9

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w w w . T h e N a t i o n a l C o u n c i l . o r g
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11

•
3 consumers with an average cost of $272,652 each
•
Drill down: Consumer with brittle diabetes and personality disorder - frequent ER and inpatient
•
4 consumers with average cost of $236,434 each
•
Drill down: Consumer with SUD without motivation & personality disorder; multiple complex medical conditions
•
4 Consumers with average cost of $85,867 each
•
Drill down: Consumer with SUD- frequent detox ;lack of community services
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14

Timeframe
Charges
Jul2005 Aug2005 Sep2005 Oct2005 Nov2005 Dec2005
$49,010 $52,632 $18,050 $27,376 $42,493 $8,058
$60,000
$50,000
$40,000
$30,000
$20,000
$10,000
$0
Jul-05 Aug-05 Sep-05 Oct-05 Nov-05 Dec-05
Charges
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16

http://wwwn.cdc.gov/sortablestats
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At Risk Criteria
 Blood pressure combined
Systolic greater than 130 OR
Diastolic greater than 85
 BMI
Greater than or equal to 25
 Waist circumference
Male, greater than 102 cm
Female, greater than 88 cm
 Breath CO
Greater than or equal to 10
 Fasting Plasma Glucose
Greater than 100
 HgbA1c
Greater than or equal to 5.7
 Cholesterol
HDL, less than 40
LDL, greater than or equal to 130
Triglycerides, greater than or equal to 150
 Others that the organizations determine
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

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September 9, 2013
Office of the National Coordinator (ONC) Issued:
Certification Guidance for EHR Technology Developers
Serving Health Care Providers Ineligible for Medicare and Medicaid EHR Incentive Payments
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Purpose:
Guidance is meant to serve as a building block for federal agencies and stakeholders to use as they work with different communities to achieve interoperable electronic health information exchange.
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2014 Edition EHR
Certification Criterion
45 CFR §170.314(b)(1)
45 CFR §170.314(b)(2)
Transitions of Care
45 CFR §170.314(b)(4)
Clinical Information
Reconciliation
Short Description 3
These two certification criteria require EHR technology to be, at a minimum, capable of: A) electronically creating and receiving summary care records with a common data set in accordance with the Consolidated Clinical Document
Architecture (CCDA) standard; and B) electronically exchanging in accordance with the Direct transport specification.
Require EHR technology to allow a user to electronically reconcile the data that represent a patient’s active medication, problem, and medication allergy list.
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Exchange
Among
Providers in
One system
Somewhat Difficult but Occurring Nationally
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Exchange Among Providers in
Multiple Systems
More Difficult but
Occurring Nationally
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Secure Messaging Exchange
Uses DIRECT Protocols
Meets Meaningful Use Requirements
Easy
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





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FY/CY 2011
MU Stage 1
FY/CY 2012
MU Stage 1
EHR Reporting Period
FY/CY 2013
MU Stage 1
All EPs, EHs, and CAHs must have:
1)EHR technology that has been certified to all applicable 2011 Edition EHR certification criteria or equivalent 2014 Edition EHR certification criteria adopted by the Secretary; or
2) EHR technology that has been certified to the 2014
Edition EHR certification criteria that meets the Base
EHR definition and would support the objectives, measures, and their ability to successfully report
CQMs, for MU Stage 1.
FY/CY 2014
MU Stage 1 or MU Stage 2
All EPs, EHs, and CAHs must have
EHR technology certified to the 2014
Edition EHR certification criteria that meets the Base EHR definition and would support the objectives, measures, and their ability to successfully report the CQMs, for the
MU stage that they seek to achieve.
There is no such thing as being “Stage 1 Certified” or “Stage 2 Certified” – 2014 Edition EHR technology would be able to support the achievement of either meaningful use Stage.
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What varies is the quantity of EHR technology certified to the 2014 Edition EHR certification criteria that would be necessary to be used to meet MU
EP/EH/CAH would only need to have
EHR technology with capabilities certified for the MU menu set objectives & measures for the stage of
MU they seek to achieve.
Base
EHR
1
EP/EH/CAH would need to have EHR technology with capabilities certified for the MU core set objectives & measures for the stage of MU they seek to achieve unless the EP/EH/CAH can meet an exclusion.
EP/EH/CAH must have EHR technology with capabilities certified to meet the
Base EHR definition.
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2014 Edition EHR Certification Criteria
Mapped to the 2014 CEHRT
Definition for EHs & CAHs Seeking to Achieve MU
Stage 2 in and after CY 2014
2014 Certification Criteria associated with
MU Core Stage 2:
•
Drug-drug, drug-allergy interaction checks
(170.314(a)(2))
•
Vital signs, BMI, & growth charts
(170.314(a)(4))
•
Smoking status (170.314(a)(11))
•
Patient list creation (170.314(a)(14))
•
Patient-specific education resources
(170.314(a)(15))
• eMAR (170.314(a)(16))
•
Clinical information reconciliation
(170.314(b)(4))
•
Incorporate lab tests & values/results
(170.314(b)(5))
•
View, download, & transmit to 3rd Party
(170.314(e)(1))
•
Immunization information (170.314(f)(1))
•
Transmission to immunization registries
(170.314(f)(2))
•
Transmission to PH agencies
– syndromic surveillance (170.314(f)(3))
•
Transmission of reportable lab tests & values/results (170.314(f)(4))
* optional
2014 ed. certification criteria for which certification may be required:
> Automated numerator recording (170.314(g)(1))
> Automated measure calculation (170.314(g)(2))
> Safety-enhanced design (170.314(g)(3))
> Quality management system (170.314(g)(4))
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2014 Certification Criteria associated with a Base EHR:
> CPOE (170.314(a)(1))
> Demographics (170.314(a)(3))
> Problem list (170.314(a)(5))
> Medication list (170.314(a)(6))
> Medication allergy list (170.314(a)(7))
> Clinical decision support (170.314(a)(8))
> Transitions of care (170.314(b)(1) & (2))
> Data portability (170.314(b)(7))
> Clinical quality measures (170.314(c)(1) - (3))
> Privacy and Security CC: o Authentication, access control, authorization (170.314(d)(1)) o Auditable events & tamper resistance (170.314(d)(2)) o Audit report(s) (170.314(d)(3)) o Amendments (170.314(d)(4)) o Automatic log-off (170.314(d)(5)) o Emergency access (170.314(d)(6)) o End-user device encryption (170.314(d)(7)) o Integrity (170.314(d)(8)) o Accounting of disclosures* (170.314(d)(9))
2014 Certification Criteria associated with
MU Menu Stage 2:
> Electronic notes (170.314(a)(9))
> Drug-formulary checks (170.314(a)(10))
> Image results (170.314(a)(12))
> Family health history (170.314(a)(13))
> Advance directives (170.314(a)(17))
> eRx (170.314(b)(3))
> Transmission of e-lab tests & values/results to providers (170.314(b)(6))

Do you have EHR Technology that meets the new
Certified EHR Technology definition for Meaningful
Use Stage 1?
START HERE
Do you have a 2014
Edition Complete EHR for the
Ambulatory (EPs) or Inpatient
(EHs/CAHs) Setting?
Do you have EHR technology that has been:
 Certified to ≥ 9 CQMs
 ≥ 6 from CMS’ recommended core set
 Address ≥ 3 domains from the set selected by CMS for EPs?
Is your EHR technology certified to the following certification criteria required to meet the Base EHR definition?
§ 170.314:
 (a)(1),(3)&(5-8) – CPOE/Demogfrx/ProbList/
MedList/MedAllergyList/CDS

(b)(1),(2)&(7)
– TOC/Data Port

(c)(1)-(3)
– CQMS

(d)(1)-(8)
– P&S
Do you have EHR technology that has been:
 Certified to ≥ 16 CQMs from
CMS ’ selected set for
EH/CAHs
 Address ≥ 3 domains from the set selected by CMS for
EH/CAHs?
Is your EHR technology certified to the following certification criteria to support the MU1 EP Core Objectives you seek to achieve and for which you cannot meet a MU exclusion?
§ 170.314:

(a)(2)
– DD/DA
 (a)(4) – Vitals

(a)(11)
– Smoking

(b)(3)
– eRx
 (e)(1) – VDTx3

(e)(2)
– Clinical Sum
Is your EHR technology certified to the following certification criteria to support the MU1 EP Menu Objectives you seek to meet? § 170.314:

(a)(10)
– RxFormulary 
( b)(5)
– Incorp Lab

(a)(14)
– Pt List 
(f)(1)
– Immz Info
 (a)(15) – Pt Edu
 (b)(4)
– ClinInfoRec
 (f)(2) – Immz Tx
 (f)(3)
–
Syn Surv
Is your EHR technology certified to the following certification criteria to support the MU1 EH/CAH Core
Objectives you seek to achieve and for which you cannot meet a MU exclusion? § 170.314:
 (a)(2) – DD/DA
Smoking
 (a)(4) – Vitals
 (a)(11) –
 (e)(1) – VDTx3
Is your EHR technology certified to the following certification criteria to support the MU1 EH/CAH Menu
Objectives you seek to meet? § 170.314:

(a)(10)
– RxFormulary 
(b)(5)
– Incorp Lab

(a)(14)
– Pt List 
(f)(1)
– Immz Info

(a)(15)
– Pt Edu
 (a)(17) – AD
 (b)(4) – ClinInfoRec



(f)(2)
(f)(3)
(f)(4)
– Immz Tx
– Syn Surv
– ELR
Note: To meet the CEHRT definition, EHR technology will need to have been certified to:
 Automated numerator recording (170.314(g)(1)) or Automated measure calculation
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 Safety-enhanced design (170.314(g)(3)); and

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CMS Stage 2 Webpage:
• http://www.cms.gov/Regulations-and-
Guidance/Legislation/EHRIncentivePrograms/Stage_2.html
Links to the Federal Register
Tipsheets:
•
Stage 2 Overview
•
2014 Clinical Quality Measures
•
Payment Adjustments & Hardship Exceptions (EPs & Hospitals)
•
Stage 1 Changes
•
Stage 1 vs. Stage 2 Tables (EPs & Hospitals)
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•
Patient and Family Engagement
•
Patient Safety
•
Care Coordination
•
Population and Public Health
•
Efficient Use of Healthcare Resources
•
Clinical Processes/Effectiveness
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Core Objective
EPs
Measure
Complete 6 out of 44
• 3 core or 3 alt. core
• 3 menu
Eligible Hospitals and CAHs
Complete 15 out of 15
2014 and Beyond*
Complete 9 out of 64
Choose at least 1 measure in 3 NQS domains
Recommended core CQMs include:
• 9 CQMs for the adult population
• 9 CQMs for the pediatric population
• Prioritize NQS domains
Complete 16 out of 29
• Choose at least 1 measure in 3 NQS domains
* Regardless of the stage of meaningful use, all providers will complete this number of CQMs in
2014.
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w w w . T h e N a t i o n a l C o u n c i l . o r g
Clinical Quality Measures
Behavioral Health Specific Clinical Quality Measures
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NQF 0105 w w w . T h e N a t i o n a l C o u n c i l . o r g
Title: Anti-depressant medication management:
(a) Effective Acute Phase Treatment
(b)Effective Continuation Phase Treatment
Description: The percentage of patients 18 years of age and older who were diagnosed with a new episode of major depression, treated with antidepressant medication, and who remained on an antidepressant medication treatment. Two rates are reported.
a)Percentage of patients who remained on an antidepressant medication for at least 84 days (12 weeks) b)Percentage of patients who remained on an antidepressant medication for at least 180 days
(6 months)
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w w w . T h e N a t i o n a l C o u n c i l . o r g
NQF 0004
Title: Initiation and Engagement of Alcohol and Other Drug
Dependence Treatment: (a) Initiation, (b) Engagement
Description: The percentage of patients 13 years of age or older
With a new episode of alcohol and other drug (AOD) dependence who received the following. Two rates are reported: a) Percentage of patients who initiated treatment within
14days of the diagnosis b) Percentage of patients who initiated treatment and who had two or more additional services with an AOD diagnosis within 30 days of the initiation visit
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w w w . T h e N a t i o n a l C o u n c i l . o r g
NQF
0028
Title: Preventive Care and Screening: Tobacco Use:
Screening and Cessation Intervention
Description: Percentage of patients aged 18 years and older who were screened for tobacco use one or more times within 24 months AND received cessation counseling intervention if identified as a tobacco user
C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l . o r g |
2 0 2 .
6 8 4 .
7 4 5 7

0022 w w w . T h e N a t i o n a l C o u n c i l . o r g
Title: Use of High-Risk Medications in the Elderly
Description: Percentage of patients ages 65 years and older who received at least one high-risk medication. Percentage of patients
65 years of age and older who received at least two different high-risk medications. a: Percentage of Patients who were ordered at least one high-risk medication b: Percentage of Patients who were ordered least two high-risk medications during the measurement year
C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l . o r g |
2 0 2 .
6 8 4 .
7 4 5 7

w w w . T h e N a t i o n a l C o u n c i l . o r g
0101 Title: Falls: Screening for Fall Risk
Description: Percentage of patients aged 65 years and older who were screened for future fall risk during the measurement period
C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l . o r g |
2 0 2 .
6 8 4 .
7 4 5 7

w w w . T h e N a t i o n a l C o u n c i l . o r g
0104 Title: Major Depressive Disorder (MDD): Suicide Risk
Assessment
Description: Percentage of patients aged 18 years and older with a new diagnosis or recurrent episode of MDD who had a suicide risk assessment completed at each visit during the measurement period.
C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l . o r g |
2 0 2 .
6 8 4 .
7 4 5 7

w w w . T h e N a t i o n a l C o u n c i l . o r g
0108
Title: ADHD: Follow-Up Care for Children Prescribed
Attention Deficit Hyperactivity Disorder (ADHD) Medication
Description: Percentage of children 6-12 years of age as of age and newly dispensed a medication for attention deficit/hyperactivity disorder (ADHD) who had appropriate follow up care. Two rates are reported a. Initiation Phase: Percentage of children who had one follow up visit with a practitioner with prescribing authority during the 30-day Initiation Phase b. Percentage of children who remained on ADHD medication for at least 210 days and who, in addition to the visit in the
Initiation Phase, had at least two additional follow-up visits with a practitioner within 270 days (9 months) after the
Initiation Phase ended
C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l . o r g |
2 0 2 .
6 8 4 .
7 4 5 7

w w w . T h e N a t i o n a l C o u n c i l . o r g
0110
Title: Bipolar Disorder and Major Depression:
Appraisal for alcohol or chemical substance use
Description: Percentage of patients with depression or bipolar disorder with evidence of an initial assessment that includes an appraisal for alcohol or chemical substance use.
C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l . o r g |
2 0 2 .
6 8 4 .
7 4 5 7

w w w . T h e N a t i o n a l C o u n c i l . o r g
0418 Title: Preventive Care and Screening: Screening for
Clinical Depression and Follow-Up Plan
Description: Percentage of patients aged 12 years and older screened for clinical depression on the date of the encounter using an age appropriate standardized depression screening tool AND if positive, a follow up plan documented is documented on the date of the positive screen.
C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l . o r g |
2 0 2 .
6 8 4 .
7 4 5 7

w w w . T h e N a t i o n a l C o u n c i l . o r g
0419 Title: Documentation of Current Medications in the Medical
Record
Description: Percentage of specified visits for patients 18 years and older for which the eligible professional attests to documenting a list of current medications to the best of his/her knowledge and ability. This list must include ALL prescriptions, over the counter, herbals and vitamin/mineral/dietary (nutritional) supplements AND must contain the medications ’ name, dosage, frequency and route of administration
C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l . o r g |
2 0 2 .
6 8 4 .
7 4 5 7

0421 w w w . T h e N a t i o n a l C o u n c i l . o r g
Title: Adult Weight Screening and Follow-Up
Description: Percentage of patients aged 18 years and older with a calculated body mass index (BMI) in the past six months or during the current reporting period documented in the medical record AND if the most recent BMI is outside of normal parameters, a follow-up plan is documented within the past six months or during the current reporting period.
Normal Parameters: Age 65 years and older BMI ≥ 23 and <
30
Age 1864 years BMI ≥ 18.5 and < 25
C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l . o r g |
2 0 2 .
6 8 4 .
7 4 5 7

0710 w w w . T h e N a t i o n a l C o u n c i l . o r g
Title: Depression Remission at Twelve Months
Description: Adult patients age 18 and older with major depression or dysthymia and an initial PHQ-9 score > 9 who demonstrate remission at twelve months defined as PHQ-9 score less than 5. This measure applies to both patients with newly diagnosed and existing depression whose current PHQ-9 score indicates a need for treatment.
C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l . o r g |
2 0 2 .
6 8 4 .
7 4 5 7

0712 w w w . T h e N a t i o n a l C o u n c i l . o r g
Title: Depression Utilization of the PHQ-9 Tool
Description: Adult patients age 18 and older with the diagnosis of major depression or dysthymia who have a PHQ-9 tool administered at least once during a 4 month period in which there was a qualifying visit.
C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l . o r g |
2 0 2 .
6 8 4 .
7 4 5 7

1365 w w w . T h e N a t i o n a l C o u n c i l . o r g
Title: Child and Adolescent Major Depressive Disorder:
Suicide Risk Assessment
Description: Percentage of patient visits for those patients aged 6 through 17 years with a diagnosis of major depressive disorder with an assessment for suicide risk.
C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l . o r g |
2 0 2 .
6 8 4 .
7 4 5 7

w w w . T h e N a t i o n a l C o u n c i l . o r g
Not yet endorsed
Title: Dementia: Cognitive Assessment
Description: Percentage of patients, regardless of age, with a diagnosis of dementia for whom an assessment of cognition is performed and the results reviewed at least once within a 12-month period.
C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l . o r g |
2 0 2 .
6 8 4 .
7 4 5 7

w w w . T h e N a t i o n a l C o u n c i l . o r g https://www.cms.gov/Medicare/Quality-Initiatives-Patient-
Assessment-Instruments/QualityMeasures/Downloads/Eligible-
Providers-2014-Proposed-EHR-Incentive-Program-CQM.pdf
C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l . o r g |
2 0 2 .
6 8 4 .
7 4 5 7

C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l . o r g |
2 0 2 .
6 8 4 .
7 4 5 7
62

Data Integrity
Follow the Continuity of Care Document
/ C-CDA
C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l . o r g |
2 0 2 .
6 8 4 .
7 4 5 7

C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l . o r g |
2 0 2 .
6 8 4 .
7 4 5 7
Psychotherapy
Notes are not Sent

C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l . o r g |
2 0 2 .
6 8 4 .
7 4 5 7

C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l . o r g |
2 0 2 .
6 8 4 .
7 4 5 7

C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l . o r g |
2 0 2 .
6 8 4 .
7 4 5 7
67

Purpose
Patient
Henry Levin , the 7th
Birthdate
September 24, 1932
Guardian
Kenneth Ross
17 Daws Rd.
Blue Bell, MA, 02368 tel:(888)555-1212
Good Health Clinic Continuity of Care Document
Created On: January 6, 2012
MRN
996-756-495
Sex
Male
Next of Kin
Henrietta Levin tel:(999)555-1212
Table of Contents

Purpose

Payers

Diagnosis

Allergies, Adverse Reactions, Alerts

Medications

Immunizations

Results

Treatment Plan

Progress Note

Suicide Risk

Risk of Violence

Substance Abuse
Transfer of care
C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l . o r g |
2 0 2 .
6 8 4 .
7 4 5 7
68

Payers
Payer name Policy type / Coverage type
Healthy Insurance Extended healthcare / Self
Covered party ID
14d4a520-7aae-11db-9fe1-0800200c9a66
Authorization(s)
Diagnosis






Axis I Primary : 296.21 - Major Depressive Disorder , Single Episode
Axis I Secondary : 303.90 - Alcohol Dependence
Axis II Primary : 301.6 - Dependent Personality Disorder
Axis III : None
Axis IV : Social Environment (Recently divorced), Occupational (Recently unemployed), Housing (Recently lost home to foreclosure and is homeless), Other Problems (Recent evidence of male pattern baldness)
AxisV:58
C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l . o r g |
2 0 2 .
6 8 4 .
7 4 5 7
69

Allergies, Adverse Reactions, Alerts
Substance
Penicillin
Aspirin
Codeine
Reaction
Hives
Wheezing
Nausea
Medications
Medication
Albuterol inhalant
Clopidogrel (Plavix)
Metoprolol
Prednisone
Cephalexin (Keflex)
Instructions
2 puffs QID PRN wheezing
75mg PO daily
25mg PO BID
20mg PO daily
500mg PO QID x 7 days (for bronchitis)
Status
Active
Active
Active
Start Date Status
Active
Active
Active
Mar 28, 2000 Active
Mar 28, 2000 No longer active
C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l . o r g |
2 0 2 .
6 8 4 .
7 4 5 7
70

Immunizations
Vaccine
Influenza virus vaccine
Influenza virus vaccine
Pneumococcal polysaccharide vaccine
Tetanus and diphtheria toxoids
Results
Hematology
HGB (M 13-18 g/dl; F 12-16 g/dl)
WBC (4.3-10.8 10+3/ul)
PLT (135-145 meq/l)
Chemistry
NA (135-145meq/l)
K (3.5-5.0 meq/l)
CL (98-106 meq/l)
HCO3 (18-23 meq/l)
Date Status
Nov 1999 Completed
Dec 1998 Completed
Dec 1998 Completed
1997 Completed
Source of Information
Immunization Tracking System
Immunization Tracking System
Immunization Tracking System
Immunization Tracking System
March 23, 2011
13.2
6.7
123*
April 06, 2011
140
4.0
102
35*
C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l . o r g |
2 0 2 .
6 8 4 .
7 4 5 7
71

Treatment Plan
Problem 05-Substance Abuse
Goal Accept chemical dependence and begin to actively participate in a recovery program.
Objective Describe childhood experience of alcohol abuse by immediate and extended family members.
Goal Establish a sustained recovery, free from the use of all mood-altering substances.
Objective Develop a right aftercare plan that will support the maintenance of long-term sobriety.
Progress Note
02/04/2009 Henry Levin was assessed and completed testing. He showed signs of alcohol dependence as evidenced by marked tolerance, previous attempts at abstinence, relationship problems as well as hangovers and blackouts. He also has a previous OWI and completed Level I with this program in 2007. Referred to XYZ Counseling Center for IOP.
Baseline UA taken.
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2 0 2 .
6 8 4 .
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72

Suicide Risk
Suicide
Thoughts?
Yes
Date of Last
Suicidal Thought
04/15/2009
Risk Factors
Guns in house, potentially lethal medications
Previous attempts?
Yes - 1
Date of Last
Attempt
11/27/1989
Additional
Information
Recently lost job, feeling despondent
Risk of Violence
Threat towards others?
Existence of Plan
Yes
Moderate
Plan
Plan details
Reduce the risk of domestic violence
Level of
Intent
History of
Violence?
Minor Yes
History details
Risk
Factors
Assault on 1 individual with deadly weapon
Guns in house
Additional
Information
No vehicle to carry out plan
Substance Abuse
Substance Route Frequency
Primary Methamphetamine Injection 3-6 times in the past week
Age of First Use Date of Last Use
15 05/04/2009
Secondary Methylphenidate Oral 1-2 times in the past week 17 04/27/2009
Electronically generated by: on January 6, 2012
C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l . o r g |
2 0 2 .
6 8 4 .
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73

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2 0 2 .
6 8 4 .
7 4 5 7
74

Mental Health and Addiction Policy Agenda
The National Council promotes a mental health and addiction policy agenda that supports a strong mental health and addiction safety net. Our public policy agenda includes:
Establishing federal status for community behavioral health organizations, as outlined in the Excellence in Mental Health Act
Promoting federal initiatives that support public education on mental illness and addiction such as the Mental Health First Aid Act
Working to ensure that behavioral health providers are eligible for health information technology incentives , as in the Behavioral Health IT Act
Ensuring behavioral health’s full inclusion in health reform implementation
Protecting federal funding for Medicaid and protecting beneficiaries and providers
Preserving funding for other important behavioral health programs such as those funded by the Substance Abuse and Mental Health Services Administration
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2 0 2 .
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75

w w w . T h e N a t i o n a l C o u n c i l . o r g
C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l . o r g |
2 0 2 .
6 8 4 .
7 4 5 7
76

C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l . o r g |
2 0 2 .
6 8 4 .
7 4 5 7
77

 Focus on Interoperability
 Obtain a DIRECT Secure Messaging Address
 Speak to your vendor about compatibility with the C-CDA
 Select Clinical Quality Measures that the rest of health care is using
 Then add your own
 Begin sharing data with your health care partners
C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l . o r g |
2 0 2 .
6 8 4 .
7 4 5 7
78

w w w . T h e N a t i o n a l C o u n c i l . o r g
C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l . o r g |
2 0 2 .
6 8 4 .
7 4 5 7
79

w w w . T h e N a t i o n a l C o u n c i l . o r g
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2 0 2 .
6 8 4 .
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80

Vice President, HIT & Strategic Development
MikeL@thenationalcouncil.org
•
Website: www.thenationalcouncil.org
•
CIHS: www.integration.samhsa.gov
Blog: www.MentalHealthcareReform.org
•
Twitter: @nationalcouncil
•
Facebook: www.facebook.com/TheNationalCouncil
C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l . o r g |
2 0 2 .
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