Optimizing Workflows to Share Data Across Sectors: Promising Approaches to Improve Care Coordination
Written by Jenna Frkovich, MPH, Data Across Sectors for Health (DASH), Illinois Public Health Institute
To provide coordinated care that meets patients’ needs, many networks and communities are developing information systems to share data across clinical and social service settings. In order for these systems to be effective in connecting patients to the right services at the right time, care teams need access to relevant individual-level data that is seamlessly incorporated into their work process.
Data Across Sectors for Health (DASH), a Robert Wood Johnson Foundation funded initiative, was launched to support multi-sector collaborations in sharing data to improve health. Of the ten collaborations that have received support from DASH, five are focusing on improving care coordination between medical and community services through enhanced information sharing that helps orient care around the whole person, not just their healthcare needs. As these collaborations moved from planning to implementation, they generated several lessons related to adapting new workflows based on integrated data and developing end user trainings.
When designing a new care coordination workflow, it is important to answer the following questions:
Depending on the environment, care teams may choose to: 1) design workflows around existing technology capabilities or 2) build new technology to fit new workflow needs. It will be important to determine early on the infrastructure and data required to modify workflows. Four of the five DASH collaborations chose to create new data collection forms for their workflows, while one chose to integrate existing data sources into their system. Some common technical tools that were used to coordinate care included shared plan of care documents, automated alerts and notifications sent across systems, and analytics that draw on multiple types of data to predict risk and identify people in need of more intensive services.
Approaches that Work
Below are five promising approaches taken by DASH collaborations—all of which have unique target populations, goals, partners, and resources, yet are collectively generating lessons with respect to multi-sector data sharing, specifically for care coordination.
1. Understand what end users value and gain their buy-in early on.
Before HealthInfoNet set out to develop a new workflow for integrating social determinant data from Community Action Agencies (CAAs) into their state health information exchange, they documented how the CAAs were already collecting and using data for other purposes as part of their existing workflow. For example, they began by focusing on Head Start data that is already collected during the regular enrollment process and explained the clinical value of this data for at-risk pediatric populations. Taking time to understand the staff’s needs and how the new workflow could add value to their existing data rather being burdensome was key to gaining their buy-in. Read more »
2. Ensure community voices are heard during the process development. For Altair Accountable Care Organization (ACO), designing a new care coordination workflow began with understanding the personal preferences of the individuals served as well as those of their care team members. To inform the development of an e-Health infrastructure to coordinate mental and behavioral health services for people with intellectual and developmental disabilities, they gathered input from their clients about who should be on the multi-sector support team, what types of behavioral health events care team members should be alerted about, and how they should be guided to act on those events. Read more »
3. Choose a workflow that minimizes extra steps or makes work processes easier. The Center for Health Care Services, a mental health authority in Bexar County, TX, developed an alert system to notify behavioral health case managers when their clients arrive at emergency departments so that they can intervene earlier and prevent inappropriate hospitalization. By doing so, they automated the manual entry or list management that is often required of their case managers, saving them time to attend to clients. Read more »
4. Communicate roles/responsibilities clearly to all stakeholders. When the White Earth Nation began implementing WECARE, a care coordination database that screens families on the reservation to a wide range of community services, it was imperative that various tribal programs work in partnership when forming a comprehensive care team around the client’s priorities. Having great educators who could effectively discuss the benefits of WECARE, explain how to implement the screening, and work through any challenges with 800 staff from different community programs has been instrumental in building the momentum needed to implement WECARE reservation-wide. Read more »
5. Test and retest your process and allow for edits by people who complete the workflow. When the Parkland Center for Clinical Innovation, a part of Parkland Health and Hospital System, began recruiting participants into a program to share patient data between hospitals and food pantries, the health system originally led the recruitment effort. However, social workers found that providers were more focused on treating patients’ clinical needs and were not responsive to food security screenings. Instead, they decided to recruit participants from food pantries where individuals were more comfortable and accustomed to discussing social needs. Read more »
DASH has learned from these grantees how to design new care coordination workflows when leveraging new data sharing technologies. You can find more in-depth descriptions of these projects in our new issue brief, Coordinated Whole-Person Care that Addresses Social Determinants of Health. Additional resources and updates about sharing data across sectors to improve health are available on our website.
Jenna Frkovich, MPH, is the Communications Associate at the Illinois Public Health Institute, where she leads the development and execution of the communications strategy for Data Across Sectors for Health (DASH), a national initiative of the Robert Wood Johnson Foundation. DASH aims to align health care, public health, and other sectors to systematically compile, share, and use data to understand factors that influence health and develop more effective interventions and policies. Ms. Frkovich works to engage and grow a nationwide network of stakeholders by disseminating lessons learned, stories, and promising practices to help advance the field of multi-sector data sharing.
Network Leadership During Times of Change: Maintaining stakeholder engagement to transform communities
Written by Becky Gourde, MPA, program coordinator, National Rural Health Resource Center/Rural Health Innovations
Think of the last time you were faced with a change and felt resistant to it. How did you feel? What do you suppose accounted for your resistance? If you’re anything like the rest of us, you probably resist change when you feel you’re losing control over a situation, when you feel your identity is threatened, or when you feel you’re at risk of failing.
As leaders of rural health networks, it’s often your responsibility to guide diverse stakeholder groups through periods of change as you work together to accomplish new goals. Maintaining the full engagement of stakeholders is crucial to the successful navigation of a transition.
People often have several common questions as they try to wrap their heads around an opportunity for change:
Creating a shared vision
People don’t change just because someone tells them to do it. The two main reasons people decide to take on new behaviors or actions are (1) they have the motivation, and (2) they have the ability. Particularly for network leaders, change management strategies will be most effective when you focus on increasing stakeholders’ motivation and ability, rather than simply telling people what to do.
Before you can understand what motivates your stakeholders, you need to have an awareness of their goals and anxieties. The vision that you establish should help them meet their needs while reinforcing that the network’s intended destination is one that’s worthwhile to them. A vision workshop, such as the format developed by RHI for rural health networks, is a helpful method for articulating priorities and gaining consensus on a network’s desired future state.
When facing a significant transition, network members and stakeholders can feel losses of control, power, influence, relationships, or even personal identity. There are a number of techniques that can help ease the losses felt by individuals as they enter a transition.
Maintaining commitment through communication
The way you communicate information with stakeholders can have a profound effect on their decisions to stay engaged through periods of change. While communicating during transitions, network leaders can ensure that all voices are heard and stimulate participative conversations.
As you engage in dialogue, remember that understanding is more important than agreement. Reaching consensus on an implementation plan will likely be challenging, but the challenge will be even greater if there isn’t a common understanding of the circumstances. Encourage stakeholders to spend time listening to and acknowledging other viewpoints without necessarily coming to an agreement on solutions right away.
Even those who are instrumental to a solution often begin the transition by complaining. It may appear tempting to allow complainers to disengage from the process. Instead, prepare yourself upfront for the likelihood that the early stages of planning and transition will involve some negative or uneasy feedback. It’s important to encourage the continued participation of critics, as these stakeholders can be key influencers when designing comprehensive action plans.
Implementing and reviewing your plan for change
Of course, it’s tough to reach the destination of your vision if you don’t have a plan for getting there. Implementation plans or action plans are an opportunity to develop collaborative processes and maintain the commitment of results-oriented stakeholders.
Colorado Telehealth Network
How one network maintains engagement while implementing change
The Colorado Telehealth Network (CTN) in Greenwood Village, CO, provides broadband connections for Colorado’s health care delivery systems. Ed Bostick, the executive director of CTN, shares with us how their network has been involved in a collaborative process to engage stakeholders while implementing change in their communities:
“Colorado’s health care providers are finding themselves at varying degrees of readiness regarding the integration of primary care and behavioral health services. Telehealth is a tool that can support this shift; however, there is no one-size-fits-all telehealth solution for Colorado.
Recognizing these concerns, the Colorado Telehealth Working Group (CTWG) convenes a monthly meeting to discuss issues that may result in barriers to the adoption of telehealth or its implementation. The members of CTWG are voluntary and represent a wide stakeholder group comprised of behavioral and physical health organizations, hospitals, health systems, the State of Colorado, payers, insurance plans and consumers.
CTWG hosted a mini-summit in October 2015 to begin identifying and addressing barriers to telehealth adoption and implementation in Colorado. Fifty-one individuals attended the mini-summit, representing 37 distinct organizations operating in Colorado. Attendees examined how telehealth impacts integration of physical and behavioral health, policy and payment reform, clinical outlook and vision, operational outlook and vision, and telehealth innovation.
A follow-up consensus conference was held in February 2016 to identify implementation strategies for the development of telehealth service lines. Eighty-six individuals representing 55 organizations in Colorado and Wyoming participated in the conference. The group identified barriers to telehealth and then recommended solutions to those barriers for patients and providers.”
-Ed Bostick, executive director, Colorado Telehealth Network
Facilitating conversations with groups of stakeholders, such as through in-person planning events and other collaboration techniques, is a valuable part of effective change management strategies.
In the case of the Colorado Telehealth Network, the mini-summit and the follow-up consensus conference provided opportunities for many distinct entities to come together and establish a shared vision, discuss how a change would impact their areas of work, identify barriers that could get in the way of reaching the shared vision, and develop an implementation plan to bring them to the desired future.
Engagement from diverse groups helps ensure that all perspectives are taken into account before implementing a change, and their involvement early in the process allows you to start influencing their motivation and ability to change right off the bat.
The topics covered in this article are based on the research and works of Peter Senge and William Bridges. We encourage you to explore their materials as you continue to implement change within your networks.
The National Rural Health Resource Center (The Center) is a nonprofit organization dedicated to sustaining and improving health care in rural communities. Rural Health Innovations, LLC is a subsidiary of the National Rural Health Resource Center.