Race, Ethnicity, and Language, Disability - REALD

Race, Ethnicity, and Language, Disability - REALD

Lessons Learned from Phase 1 Implementation of REALD for COVID-19 Encounters

Housekeeping

• While we wait to get started…• We are recording this session.• Captioning has been enabled within this meeting, and will appear at the bottom

of your screen.• For ASL interpreter access, click on the three dots next to the interpreter’s

name and select “spotlight”.• Contact Tom ([email protected]) if you are having technical

challenges.

(Enter) DEPARTMENT (ALL CAPS)(Enter) Division or Office (Mixed Case)

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Agenda

• Welcome • History and background of REALD• HB 4212 background and updates • Lessons Learned from Phase 1 Providers

– Yakima Valley Farm Workers Clinic – Virginia Garcia Memorial Health Center

• Close

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Welcome

• Goal of Lessons Learned meeting series

• General REALD Questions – E-mail [email protected]

• Questions about today’s topics – Put questions in the chat – Raise hand

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History and Background of REALD

Marjorie McGee, PhD Equity and Inclusion Division

REALD Lead

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REALD – What?

• House Bill (HB) 2134 proposed and passed 2013– Came from communities most impacted by health inequities

• Asian Pacific American Network of Oregon (APANO)• Oregon Health Equity Alliance (OHEA)

• Requires ODHS and OHA develop data collection standards in all programs that collect, record, or report demographic data.

• Standards codified 2014 in Oregon Administrative Rules 943-070-0000 through 943-070-0070 after an extensive rulemaking advisory process.– Rules were updated in 2020– Based upon local, state, and national standards and best practices

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(Race, Ethnicity, and Language Disability)

Why is REALD Important?

• Helps ensure access and equity in services, processes and outcomes

• Provides consistency in data collection

• With REALD data, together we can:• Use information to improve client/patient/member services and reduce inequities • Identify inequities; determine what groups are most impacted• Address identified inequities through policy and legislative efforts • Reallocate resources and funds needed to effectively address these inequities• Design culturally appropriate and accessible interventions

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Race & Ethnicity - 3 questions

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House Bill 4212 background and updates

Belle ShepherdGovernment Relations DivisionHB 4212 Implementation Lead

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HB 4212 REALD data collection and reporting• Requires OHA to establish rules for phased REALD data collection

and reporting by providers for COVID-19 encounters• REALD data are required when reporting COVID-19 encounters that

are reportable under Oregon Disease Reporting rules (OAR 333-018-0011)*

COVID Disease reporting includes:• COVID-19 tests (positive and negative)• COVID-19 cases• COVID-19 hospitalizations• COVID-19 deaths• MIS-C (Multisystem Inflammatory Syndrome in

Children)

COVID-19 encounters:• Interaction with provider for health

care services related to COVID-19 includes ordering COVID-19 test.

• Note: Clinical laboratories excluded until 10/1/2021

*Temporary rules in place; final rules – March 2021

Who is subject to report and when?

PHASE 1Hospitals, except for licensed psychiatric hospitalsProviders within a health systemProviders working in an FQHCExcludes clinical laboratoriesEnforcement or REALD Compliance Plan starting December 31, 2020

Oct. 1, 2020:PHASE 2Health care facilities as defined in ORS 442.015(12)(a) Health care providers working in or with individuals in a congregate settingExcludes clinical laboratories

March 1, 2021:All providersAll must report using electronic methodOHA exploring alternative methods for electronic reporting

Oct. 1, 2021:

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How often are data collected and reported?

• Annual REALD data collection is required• Providers must collect REALD data from a patient at the time of an encounter or

as soon as possible thereafter • If a provider has collected REALD data from a patient within the last year (12

months/365 days) and the patient has a subsequent encounter, providers may use the REALD data previously collected to report to OHA

• Reporting REALD is tied to COVID disease reporting• REALD data can be reported either at the time of the COVID disease reporting or

can be batched to be sent daily or at least weekly.

Updates

• 2021 legislative session introduced HB 3159 REALD/SOGI (sexual orientation and gender identity)

• New listserv available to receive updates on changes to REALD reporting materials (CSV specs, REALD template) – https://www.oregon.gov/oha/PH/DISEASESCONDITIONS/COMMUNICABLE

DISEASE/REPORTINGCOMMUNICABLEDISEASE/Pages/REAL-D-Collection-Toolkit.aspx

• General REALD Questions – E-mail [email protected]

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Lessons Learned in the field

• Phase 1 Provider Key Informant Interviews– Renee Harger [email protected]– Craig Mosbaek [email protected]

• If interested in participating in key informant interviews contact Renee or Craig

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Phase 1 Providers Experiences

– Yakima Valley Farm Worker’s Clinic • FQHC • Epic EHR

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Yakima Valley Farm Worker’s Clinic

Our REALD Implementation Story

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Goal

• Share how we made our system successful with implementing REALD

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Agenda

• Why we couldn’t use our existing build• Who we decided to make responsible for asking the questions• How do we guide our staff to make sure we ask the right

patients• How do we catch patients we missed• How do we report to Oregon• Questions?

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Why couldn’t we use the build we had

• We have values specific to programs we need to report to. For us, HRSA dictates the breakdowns of various demographic fields for UDS.

• HRSA requires very specific phrasing for their questions. REALD also requires us to use the specific phrasing of the question. Because those phrases are not the same, we could not use what we already captured.

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Who asks the Questions

• We elected to have the MAs ask the questions during rooming• We do not have a script

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How do we guide our staff to ask REALD

1. BPA (system alert) – fires if:– Patient has a COVID ordered test during the encounter.– Patient has a COVID exposure based on our travel screening questionnaires by front

office and nursing.– Patient lives in OR and is seen in an Oregon or Walla Walla clinic.– Patient does not have a REALD document scanned into their chart or SmartForm filled

out in the last 365 days.

2. This opens a box that asks the user to follow the link to the REALD questionnaire. – If the patient has had the questionnaire filled in in the last 365 days, a banner at the top

of the questionnaire will say that “You do not need to complete this form today”. If they have not, it will say “You need to complete this form today”.

3. Only needed questions show. − Question 5A says “Do you need an interpreter for us to communicate?” If the patient

responds yes, then the follow up question will ask them what kind. If they respond no, the subquestion does not show to the user.

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How do we catch patients we missed or who have missing information?

• Chase List Reports– All patients with a Covid Test who have not had a REALD form filled

out in the last year. – This is meant to be run regularly, so it is defaulted to look back for

tests in the last two weeks. This was extended as we did our original clean up.

• Medical Staff calls patients to complete the missing information.

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How do we report

• We report via csv. Our extract runs daily.• The report will not resend the patient if the date of the

questionnaire or the date the patient was submitted are less than 1 year ago. – Once a patient is sent in the report, the date of the submission is fed

back to the system. • Hard Coded crosswalks from human readable to CSV required

– ie “I do not have just one primary racial or ethnic identity” is reported as “PriNo”

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Questions?

Contact:Matt Cozon [email protected]

Anjli [email protected]

Phase 1 Providers Experiences

– Virginia Garcia Memorial Health Center • FQHC • OCHIN member (Epic EHR)

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Strategies For Implementing REALD

Early Wins

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3456 Utilizing OCHIN to develop a

system to capture REALD data within our EHR system

Building a connection behind the purpose of REALD and our

organizations mission

Leveraging our current workgroup that works on process

improvement projects that impact front office

Developing custom training that involved role playing and scenario

based practice

Embedding REALD into our current intake process forms

Collaborating with our COVID Response (CoRE) Team to

strengthen the patient-centered approach to REALD data

collection

Challenges and Next Steps

Challenges• Accelerated turn around for implementation• Commonly missed questions• Reporting challenges • Covid-19 burn-out and change fatigue

Next Steps – 3 Phase Roll Out Plan• Covid-19 screenings• New Patients• Established Patients

Questions@VGMHC

@VirginiaGarcia

Virginia Garcia Memorial Health Center and Foundation

Virginia Garcia Memorial Health Center

@VGMHCComunidad (Spanish-only page)

REALD Resources• HB 4212 and REALD:

https://www.oregon.gov/OHA/OEI/Pages/REALD-Providers.aspx• REALD Response Guide –

https://sharedsystems.dhsoha.state.or.us/DHSForms/Served/le7721b.pdf

• COVID-19 Reporting Portal - healthoregon.org/howtoreport• CSV File Specifications are available at the Electronic Case Reporting

page.