Addressing the Opioid Disaster

Addressing the Opioid Disaster

Health Information Technology


Efforts to share information to reinforce well being care planning, remedy, and companies usually are not new, however targets and approaches differ considerably. We summarize tendencies and classes realized and supply a case examine of a newer strategy to implementing cross-agency information sharing concentrating on complicated shoppers with opioid use dysfunction. Key accomplishments included the event of an Enterprise Memorandum of Understanding, stakeholder suggestions by way of opioid case research, information element-by-element privateness and sharing guidelines, and a safe software program answer.

Though developed particularly to handle the opioid disaster, outcomes from this design mission might be utilized to different well being and social companies, together with housing, HIV, and psychological well being, for which companies continuously share shoppers. We conclude with classes for future data-sharing efforts.

Am J Accountable Care. 2023;11(1):31-35.


Developments in Multiagency Knowledge-Sharing Efforts, Approaches, and Classes

Efforts to share information to reinforce well being care planning, remedy, and companies usually are not new, however targets and approaches differ considerably. Earlier research have described efforts to enhance service supply for current shoppers. For instance, one examine recognized “excessive utilizers” of behavioral well being companies throughout companies to focus on remedy and case administration companies to particular people.1 One other, payer-led intervention shared data with medical suppliers on care to adults with critical psychological sickness to reinforce care coordination, together with remedy prescriptions, throughout psychological well being and first care companies.2

Different efforts have mixed information throughout private and non-private well being care suppliers to reinforce surveillance of continual situations.3 Broad county-run supply methods (eg, San Francisco County, California) have created multisector widespread information options that allow complete, retrospective utilization evaluation throughout medical, behavioral well being, and social companies, together with housing and jail well being companies.4 Different communities have centered on shoppers served in jail settings by sharing information with neighborhood suppliers round arrest and launch notifications to reinforce continuity of care.5

One other kind of initiative has been restricted to 1-time linkage of multisystem information, specializing in the supply system degree.6,7 Such advert hoc information linkages usually describe cross-system consumer traits, comparable to psychological well being or HIV remedy and jail encounters. These research have recognized the substantial position that jails play in chosen kinds of remedy and have highlighted potential factors of intervention.

Different research have highlighted giant information gaps and the significance of drawing upon a number of information methods to acquire an entire image of shoppers’ care. For instance, in comparison with affected person claims information, digital well being file (EHR) information from a big multispecialty medical group captured lower than half of outpatient psychological well being remedy and fewer than 1 / 4 of acute care.8 Equally, information shared throughout hospitals captured most hospitalizations however solely a small fraction of complete care reported by sufferers.9

Affected person and supplier perceptions of information sharing and privateness are one other consideration. A small examine of suppliers discovered that numerous companies collected completely different data and had completely different data wants; nonetheless, there was a shared curiosity in data associated to danger administration, early warning indicators, and drugs administration.10 One other examine highlighted the nuanced privateness wants of sufferers, who recognized psychological well being data and psychotherapy notes to be among the many most delicate and expressed preferences as to which suppliers have been capable of view this data.11 One other examine examined the technical challenges of programming such affected person preferences into EHRs.12

We describe an instance of a data-sharing initiative: a county’s (Fairfax County, Virginia) multistage strategy to implementing cross-agency, digital information sharing that focused shoppers with opioid use dysfunction. This Opioid Coverage & Knowledge Framework (OPDF) was a 3-year county mission supported by the federal Bureau of Justice Help to design a authorized, safe technique of sharing digital information amongst companies. The targets of the OPDF mission have been to have interaction public suppliers who serve shoppers with opioid use dysfunction and to reinforce entry to key, cross-agency data on the time of consumer interplay.

This mission sought to enhance information usability to higher handle shoppers as they transfer amongst methods and to vastly scale back clinicians’ and different companies’ burden. Though developed particularly to handle the opioid disaster, the mechanism might be utilized to different well being and social companies, comparable to housing, HIV, and psychological sickness, for which companies continuously share shoppers. By way of surveys, interviews, and assembly commentary, a design-project analysis gathered data on perceptions in regards to the mission’s group, progress, shared company targets, suggestions on the opioid tales/case research, and suggestions on communication. A complete of 34 key informant interviews have been performed with employees from 8 county entities: govt, strategic, authorized, sheriff’s, data know-how (IT), emergency medical companies, well being division, and police. Interview guides have been developed for various mission roles and have been knowledgeable by the literature overview, mission plan, and mission companions. A pattern interview information is supplied within the eAppendix (accessible at Key analysis highlights of the design analysis are offered within the following textual content. As extra company information are captured electronically, new alternatives and approaches come up to mix and make strategic use of this data.

The OPDF Mission

The OPDF enterprise was a multistage design mission somewhat than an implementation mission. From the outset, the mission advisory group prioritized information sharing to reinforce remedy and repair referral, facilitated by the info matrix, in actual time on the level of consumer contact, with a concentrate on opioid use dysfunction. With entry to further, well timed consumer data, case managers and remedy suppliers would have a fuller understanding of companies acquired by their shoppers throughout county entities and, due to this fact, a higher understanding of potential wants. In consequence, the info integration mannequin was not designed to combination information, both for functions of making lists, comparable to of excessive utilizers, or for surveillance or useful resource planning throughout methods. The preliminary effort additionally didn’t embody non-public, noncounty suppliers. One other level of distinction from a number of earlier efforts is that it didn’t contain pooling information right into a single warehouse however somewhat sought to maintain all information of their current methods. New software program would offer a gateway for county customers in a single company to view chosen information components from one other company, with acceptable controls. The design improvement had a number of key elements.

Memorandum of Understanding. The primary part was an Enterprise Memorandum of Understanding (E-MOU), a doc that permitted the alternate of data.13 The E-MOU was vetted by authorized specialists, permitting 2 or extra county companies to share information. The doc describes what sorts of information particularly could also be shared and below what circumstances, in addition to provisions to make sure the safety of shared data, in line with federal, state, and native legal guidelines and rules. As soon as an company indicators on, it agrees to make accessible all its company information—somewhat than selectively, program by program—topic to prevailing authorized protections. The E-MOU was designed to be versatile to maintain present with modifications in related legal guidelines and rules. This doc considerably reduces companies’ burden in consumer administration because it permits planning at a world degree. Having authorized illustration within the OPDF mission was a major issue, serving to to reassure suppliers that it’s attainable to share delicate data throughout companies, with protections as wanted.

Opioid consumer case research. One other necessary function of the OPDF design course of was the event of hypothetical opioid use–related case research formulated to construction conferences and information discussions amongst a number of companies. By focusing consideration on 8 particular case research, employees from psychological well being, jail, social companies, police, and fireplace and rescue departments might talk about their particular client-related roles and their information wants. Exploring a number of case research additionally helped to make sure that people of various backgrounds and demographics would obtain equitable companies. Enter from the county’s public well being division was additionally sought, however its participation was hampered by ongoing COVID-19 pandemic priorities. Individuals have been requested to droop any subjective beliefs about whether or not information sharing was authorized below prevailing privateness legal guidelines and to concentrate on what data could be most useful to their client-based work. Notably, some company employees had no use for data from different companies (eg, emergency medical employees) relative to different company employees (eg, remedy consumption employees).

Knowledge matrix. A 3rd part was an preliminary matrix of information components and sharing guidelines. This detailed, transaction-level spreadsheet mapped the “opioid story” dialogue to particular information components contained in every county information system. It contained every client-level information ingredient, the knowledge system that housed every information ingredient, and the accountable company. Importantly, authorized employees supplied indicators for every information ingredient as as to whether the info ingredient might be shared and, in that case, with clinicians or others and with or with out prior consumer consent. Having ranges of entry outlined clearly would then open up the method to share information when attainable and thus might improve acceptable service supply. Examples of information components that continuously don’t require consent are police information. In distinction, information components associated to substance use remedy usually require higher restrictions and prior consumer consent.

Consent type. A fourth key part was the consumer consent type, allowing alternate of data amongst companies the place wanted. The shape was designed to be offered together with otherHealth Insurance coverage Portability and Accountability Act and agency-specific varieties.

Software program. Lastly, the mission design included a preliminary software program answer, or safe information setting. This software program was designed to perform as a gatekeeper, controlling entry in line with employees member and information ingredient per the info matrix, recording employees log-ins to shared information, and allowing the sharing of client-specific digital information saved in a number of, current case administration/EHR methods, every in a safe information setting.

Abstract, Classes Realized, and Subsequent Steps

Though the outcomes have but to be evaluated, the OPDF mission gives an alternate of data that contributors believed would considerably improve their response to shoppers with opioid use dysfunction. The whole variety of potential shoppers was in a roundabout way estimated, however the county’s complete inhabitants was 1,170,033 as of 2021,14 with 6304 people receiving companies within the specialty psychological well being system in 2021,15 and a jail inhabitants of 14,791 people booked in 2020.16 Though developed particularly to handle the opioid disaster (eg, by way of dialogue of opioid-specific medical situations), the E-MOU and the fundamental IT framework for safe information sharing might be readily utilized to different well being and social issues, comparable to housing instability, HIV, and psychological sickness.

The next are classes that could be useful to different jurisdictions aiming to create and profit from an identical data-sharing course of.

  • The information-sharing software program described right here was designed to foster client-level data sharing throughout county companies. Future iterations would profit from the potential to generate case administration listings throughout sectors to combination reporting of cross-sector shoppers or companies volumes and so as to add sure historic remedy data. As well as, it might be useful so as to add non-public neighborhood companies, together with hospital emergency departments.
  • There’s a pervasive perception amongst suppliers and responders that many, if not most, types of information can’t be legally shared. This was demonstrated repeatedly in discussions across the opioid consumer case research. Will probably be necessary to develop a construction to teach concerned events in any respect ranges—from frontline suppliers and responders to govt decision-makers—that given acceptable consent and/or circumstances, delicate information might be legally shared.
  • Knowledge sharing in the end hinges on belief.1 Within the case of the OPDF mission, the central participation of county attorneys and the IT division fashioned the idea for creating belief within the data-sharing course of.
  • Shopper belief is one other key part.1,2 Though consent is ideally a course of facilitated by suppliers or responders with assistance from a doc,17 in actuality not all employees have the time or information to supply a context and clear function for information sharing. Efficient consent paperwork must be written in plain phrases to facilitate consumer comprehension.
  • The utility of information sharing in the end hinges on the standard of the present information. Inside a data-sharing framework, assets that improve information in a single company will profit company companions as nicely.
  • As soon as information sharing is carried out, a governing physique or our bodies ought to commonly monitor the quantity of inquiries by company and by consumer kind. Low uptake of information sharing might point out areas for course of enchancment (eg, consent course of, information components, employees workflows).
  • Knowledge sharing requires assets for implementation and sustainability. This contains updates to governance, paperwork, processes, coaching supplies, information matrices, and the software program itself.

A main curiosity was in sharing information to reinforce the well-being of particular person shoppers, however contributors additionally expressed an curiosity in having combination, cross-sector information—for instance, complete variety of shared shoppers served or complete companies delivered—to measure tendencies in companies and outcomes. Others expressed curiosity in consumer location information to develop new intervention packages. Nonetheless others hoped that information could be accessible to evaluate remedy retention and consequence, particularly after cross-agency handoffs. Though outcomes information haven’t been evaluated, a complete evaluation plan would entail measuring such results as prison justice outcomes (ie, recidivism charges), well being outcomes (ie, remedy service utilization and engagement), and financial outcomes (ie, service prices). Moreover, danger elements comparable to well being elements outdoors the affect of the OPDF mission would have to be managed for.

Total, a lot progress has been made to reinforce the response to the opioid epidemic by creating a framework for well timed information sharing amongst suppliers and responders. The county’s information efforts proceed to increase.18 We hope the strategy taken right here and these experiences might be useful to others addressing a spread of well being and social issues involving a number of companies and suppliers.

Creator Affiliations: George Mason College (AW, JPT, AEC), Fairfax, VA.

Supply of Funding: Funded by the US Division of Justice, Workplace of Justice Applications Bureau of Justice Help in partnership with the Workplace for Victims of Crimes (#4400009242) below a subagreement with Fairfax County, VA.

Creator Disclosures: Dr Tangney was a recipient of the grant that supported this mission. The remaining authors report no relationship or monetary curiosity with any entity that might pose a battle of curiosity with the subject material of this text.

Authorship Info: Idea and design (AW, JPT, AEC); acquisition of information (AW, JPT, AEC); evaluation and interpretation of information (AW, AEC); drafting of the manuscript (AW, JPT, AEC); crucial revision of the manuscript for necessary mental content material (AW, AEC); acquiring funding (AEC); and supervision (AEC).

Ship Correspondence to: Alison E. Cuellar, PhD, George Mason College, 4400 College Dr, MS IJ3, Fairfax, VA 22030. E-mail: [email protected].


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