Mid Alabama Information Network (MAIN)

MAIN is a secure, web-accessed, password-protected database that in 2003 merged the healthcare database, Shared Patient Information Network (SPIN) , of the Montgomery Area Community Wellness Coalition; the homeless continuum of care database, Homeless Management Information System (HMIS) of the Mid Alabama Coalition for the Homeless, and health and human resources data from the IRIS database of the Volunteer and Information Center, Inc. SPIN and HMIS specific confidentiality agreements and organization-specific privacy practices, mental health confidentiality consents, and business associate agreements all comply with State of Alabama and HIPAA (Health Insurance Portability and Accountability Act) laws and regulations.

Current MAIN Partners:

Mission

To share information that bridges gaps, avoids duplication, coordinates services and reduces barriers to area health or social services and mainstream programs or resources for individuals in the Mid Alabama area.

Objectives

  • Provide to individuals who need services a single point of entry into MAIN to help determine eligibility for services and programs once instead of several times.
  • Increase coordination of, access to, and more appropriate use of health care and other services in our community, especially the homeless or un/underinsured persons particularly those diagnosed with or at risk of diabetes, asthma, hypertension, heart disease, substance abuse or mental illness.
  • Enhance providers’ ability to care for individuals with multiple needs
  • Increase community capacity to target limited resources or services to individuals who need them so that they can make life changes to manage their chronic conditions and improve their wellness and quality of life
  • Strengthen the safety net provider healthcare system
  • Facilitate collaboration among providers to achieve common goals and reduce costs

Overview

MAIN is an web-accessed, password-protected database of healthcare and resource information customized from PWHealth; an easy-to-use, yet sophisticated, tool for health care providers, case managers, program administrators and evaluators (http://www.datafutures.com 2003).

Protection Measures

To ensure compliance with privacy/confidentiality law and regulations of Alabama and HIPAA (Health Insurance Portability and Accountability Act of 1996, PL 104-191), wellness coalition partners are required to sign data sharing and/or business associate agreements. In addition, participating user staff are required to sign confidentiality agreements, while clients are asked to sign a consent form and acknowledgement of receipt of Notice of Privacy Practices for the use and disclosure of protected personal information (PPI) for HMIS and personal health information (PHI) for treatment, billing or health care operations. Alabama law requires additional protection of clients/patients with a mental illness diagnosis, and MAIN includes the Mental Health Desktop that has password-controlled and user defined field access.

Security is maintained with role and user defined field access restrictions and passwords. Policies and procedures have been established that describe parameters for sharing information within and among agencies. All users have been trained in HIPAA and Alabama law and regulations regarding the protection and security of personal and health information. All workstations require user authentication and are secured with username and password. Additional usernames and passwords are required for both Windows Terminal Server access and MAIN access. Password requirements follow industry and HMIS complexity and recommended standards using both alpha and numeric letters that do not form words found in a common dictionary. Written information about user access is not stored in a publicly accessible location. Further, firewalls and virus protection are required prior to establishing a secure connection to the network. Servers are protected by secure firewalls and there are no public access computers on which MAIN data is accessed.

Shared Client Record

A client record is created that includes many aspects of health care. The MAIN database resides on a central file server in Birmingham, Alabama, is secured by Integrated Healthcare Solution, Inc., and is accessible directly through a Wide Area Network (WAN) connection via the Internet. Creating a central location for all client/patient information improves provider staff access to a more complete client/patient activity and risk assessment record, including medical diagnosis, treatment and test results, as well as support services provided or resource referrals made.  In addition to improving the health and quality of life, service/resource coordination and nonduplication helps reduce system and provider costs as well.

Client data is entered and stored after required consent forms are completed and verified. Data is stored and retrieved utilizing Structured Query Language (SQL) that offers quick response time as well as data encryption to protect records from unauthorized access.

Client Desktop

The Client Desktop is the heart of the system – serving a wide range of user needs for storing and retrieving information. Several tabs group client data in a logical fashion. Data entry is made easier by pull-down windows where appropriate – this approach not only speeds entry, but provides for “built in” edits and standardization of entry, as well. Accessing existing data is done by a simple click of the mouse. Data that must be entered is highlighted in red. A solution is in development at DFI to provide a set of common data shared by all users to enhance the single point of entry service model for intake, assessment, navigation, crisis intervention and wellness case management, at the same time providing security over selected data considered to be confidential and nonaccessable/nonviewable without client/agency approval.

Treatment Desktop

The Treatment Desktop maintains a full history of medical treatments that a client has received – regardless of who provided these services. Through remote connectivity to the file server, all treatments are entered (either manually or electronically via batch upload or HL7 automated message transfer-if available) and tracked – this allows medical staff at any participating facility (with permission of client) to immediately view other services that were provided to the client seeking treatment.

Services Desktop

The Services Desktop is very similar in structure and theory to the Treatment Desktop, but it captures environmental/home assessment data that influence client health and management of disease/condition. Service types that are provided and tracked are user-defined, allowing system flexibility for tracking client services. Some confidential or sensitive services are not entered here, but rather behind the Special Circumstances Tab.

Eligibility Desktop

MAIN allows users to easily determine whether an individual meets the eligibility criteria for TANF, Medicaid, SSI, SSDI or any other health or human service or program entered into the MAIN database. Key features are listed below:

Participating providers’ staff is given access to MAIN via a secure, firewall-protected internet connection. The MAIN database resides on a server to which access is password protected. Access within MAIN may be further restricted by screen, site and/or user roles. Passwords and security are controlled by the MAIN database administrator.

When an individual visits a participating provider and authorizes release of information, staff will verify whether or not the individual is in the MAIN database via a query in the database. If not found, the individual is then entered into MAIN with identifying information, and staff continue to ask and enter other data that allows the assessment of health risks, barriers and needs.

  • Based on the information, staff can automatically calculate whether an individual appears to meet criteria for such programs and services for area healthcare, AllKids , Alabama ’s Children’s Health Insurance Program (CHIP), Medicaid or any other mainstream program or service for which eligibility criteria has been entered into MAIN .
  • Individuals do not have to repeat the information-sharing process (but may update with changes), and have a more efficient and satisfactory access to services and programs that should promote a more appropriate use. Through data sharing agreements among participating providers and with the consent of participating individuals, eligibility data is shared to avoid duplication and improve treatment.
  • For individuals applying for selected programs, the format command in MAIN can automatically enter information onto a pre-designed format for use as patient/client questionnaire, authorization, application, or eligibility verification documentation, and can be printed and either mailed or sent with the individual to the appropriate location.
  • Wellness or homeless case managers, wellness advocates, social services case managers, information & referral personnel, and other provider staff are able to instruct individuals in collecting documentation required by providers to substantiate their financial situation (e.g., pay stubs, copies of rent checks, W-2s) if necessary.


Note: Prior to MAIN, individuals attempting to access healthcare services through safety net providers had to demonstrate their inability to pay for health services by undergoing a financial screening at each provider location. Most providers use the same information to assess an individual’s financial status; however, the guidelines for each sliding fee or public program are usually different. Without MAIN, individuals who go to more than one safety net provider have to undergo multiple financial screenings, often presenting the same financial information and documentation several times. MAIN minimizes this duplication of effort for all providers who are connected to it.

Mental Health Desktop

The Mental Health Desktop, accessible only to approved staff, allows users to view and enter mental health or substance abuse information. Documentation of CFR 45-required consent from individuals with a mental health diagnosis is found on this desktop.

Resources Desktop

The Resources Desktop allows the user to view over 299 agencies and services from which individuals may benefit and may be referred. This desktop provides the opportunity to document referrals for clients/patients and follow-up. Plans include placing a web link to online access of the VIC database of over 1,000 agencies and programs from the desktop. This website allows searches of the VIC database for either local, area or state programs/services by keyword and/or zip code.

Staff and Facility Desktops

Staff and Facility Desktops allow for user identification and service site data and serves as a valuable description of the network partnership resources. The system allows for the inclusion of facilities other than network agencies or providers, therefore, support organizations and other resources can be stored in the Facility Desktop for easy reference by all users.

Reports Desktop

The Reports Desktop allows a user (if granted accessibility) to view/print a variety of reports, virtually all of which have several selection and sort options. Reports include data for evaluation-specific outcomes or performance indicators, the HUD required APR, and other query-based special reports such as a report of the value of selected services by provider, site and/or zip code.

MAIN Network

Current network connectivity for participating Montgomery area providers includes the following users: Montgomery Area Community Wellness Coalition office, Volunteer and Information Center Inc., Catholic Social Services Pharmacy, Chemical Addiction Center, Salvation Army, Group Homes for Children, Montgomery Area Mental Health Authority, Lighthouse Counseling Center, Inc., Family Sunshine Center, Health Services, Inc., Baptist Health, Jackson Hospital, Medical Outreach Ministries Family Health Clinic, Faith Crusade, Community Care Network, and the Montgomery County Health Department.  Hosting and security, backup, HL7 messaging, and connectivity are provided by Integrated Healthcare Solutions, Inc. ( pwingard@ihsmed.com).