How a Statewide HIE Streamlines Care Coordination for Children in Foster Care

As children move through the foster care system, ensuring that their health data moves with them from provider to provider is key for care coordination. However, data siloes across healthcare and social care present health information exchange (HIE) challenges.

The Arkansas State Health Alliance for Records Exchange (SHARE) helps fill that void.

While every state has HIE organizations, SHARE is unique because it falls under the state's Department of Health. Created in 2011 as part of the Arkansas Medicaid strategy, the designated statewide HIE is open to anyone with a treatment, a payment, or an operational need.

Since SHARE is nestled in as part of the state’s government, it’s had opportunities to create unique partnerships with other state programs that also impact health.

For instance, a partnership between SHARE and the Division of Children and Family Services (DCFS) is helping ensure foster children's health information is available when and where it's needed for proper care coordination.

Once a child enters foster care in Arkansas, they must see a pediatrician two counties over from their home county within 72 hours.

Having the HIE operate under a state agency makes things easier because foster care caseworkers can help move information around, while healthcare providers can find information about who is managing that child's foster placement.

Previously, DCFS caseworkers would contact a child's care team to request health documents to share with the new pediatrician. However, the 72-hour time frame was not always long enough to gather the child's complete medical history, leaving the child's new provider without access to health information to guide treatment decisions.

Moreover, the lack of data transfer often posed a care access barrier. In the past, it could take weeks for the child's original care team to learn that their patient was in foster care, leading children to miss high-value specialty appointments.

"The child could have had an appointment with a specialist, but through that custody change, the DCFS caseworker wasn't made aware, so the appointment was missed," said Justin Villines, MBA, BSM, health IT policy director at Office of Health Information Technology (OHIT), which oversees SHARE.

However, through the DCFS and SHARE collaboration, both caseworkers and pediatricians can now access information about the child.

Caseworkers can securely access the child's complete medical history through the SHARE portal and send it to the new pediatrician before the child's appointment.

The HIE also alerts the children's previous care team of the change in custody to ensure care coordination, which is key in a population that the American Academy of Pediatrics (AAP) classifies as having special healthcare needs. According to AAP, one-third of children enter state custody with a chronic medical condition.

SHARE gives the child's providers the DCSF caseworker's contact information to help ensure any therapies they have are not interrupted. DCFS also provides a daily roster of foster care children to SHARE. The HIE then runs the list of children through its master patient index, identifies their providers, and sends a notice out to them about the change in custody.

"We're able to notify providers in real-time so they can note that within their EMR and work with the DCFS partners to communicate upcoming appointments," said Villines.

"It's key to have that information at the fingertips of individuals taking care of those kiddos, whether it be the caseworker at DCFS, the care coordinator at the clinic, the provider themself, or that gastroenterologist at the Arkansas Children's Level I hospital," he added.

SHARE also notifies providers when children leave foster care and are either adopted, placed with a relative, returned to their family or previous guardian, or emancipated.

"Having that information allows providers to close the record and only provide access for those that truly need to view that child's medical record," said Anne Santifer, director of OHIT. "That's important on closing the loop."

In addition to elevating healthcare delivery for children in foster care, the DCSF and SHARE collaboration aims to alleviate provider burden across sectors.

"One of our big initiatives is reducing burden," Santifer noted. "Giving folks at the Department of Human Services that have a need for medical records access to SHARE reduces the amount of time they are asking providers for records if they're trying to make determinations."

The partnership also allows healthcare providers to spend less time gathering and sending patient health records, which Santifer noted is key as the industry faces unprecedented levels of clinician burnout.

According to a study published in Mayo Clinic Proceedings, over 62 percent of clinicians reported burnout in 2021.

"We know we have an issue right now with workforce in the healthcare setting, so whatever we can do to reduce that is our charge," Santifer said. "The goal is to streamline processes happening within state government to ease the load on providers."

Villines emphasized the role partnerships played in ensuring the HIE's DCFS custody report would benefit stakeholders.

SHARE launched a pilot and gathered feedback from DCFS, the Arkansas Children's Hospital, the Arkansas Pediatric Association, and independent practitioners.

"The pilot started small so we could get that feedback," he said. "We needed to make sure that we were putting enough information on the report to empower our provider community, so they have that information to contact the DCFS worker and work with that kiddo."

Santifer also pointed out that SHARE conducted a marketing campaign for the report, which included a webinar with the Arkansas Academy of Pediatrics.

"We notified the pediatric community in a couple of different ways because if you are going to build something, you want to make sure that people are using it," Santifer emphasized.