5. Presentation on the e-Health Advisory Committee (e-HAC). Presenters: e-HAC Vice-Chairs Ms. Nora Cox, ExecutiveDirector of the Texas e-Health Alliance and Brett Moran, MD, Sr. Vice President and Chief Health Officer of theParkland Health and Hospital System.

[5. Presentation on the e-Health Advisory Committee (e-HAC). Presenters: e-HAC Vice-Chairs Ms. Nora Cox, ExecutiveDirector of the Texas e-Health Alliance and Brett Moran, MD, Sr. Vice President and Chief Health Officer of theParkland Health and Hospital System.]

WORK. WELCOME AND THANK YOU ALL FOR JOINING US.

THANK YOU SO MUCH. CAN YOU HEAR ME? I ALWAYS WORRY WHEN I'M NOT PART OF ROLL CALL.

WE CAN HEAR YOU. GREAT. THANK YOU. FANTASTIC.

WELL, I NEED TO ASK SOMEBODY TO ADVANCE THE SLIDES AFTER EACH ONE.

IF YOU DON'T MIND, THAT'LL BE FINE. AND WE HAVE SOMEONE TO DO THAT.

FANTASTIC. THANK YOU SO MUCH. I WANT TO START.

I'M LAURA COX. I AM THE CEO OF THE TEXAS E-HEALTH ALLIANCE AND THE RECENTLY ELECTED CHAIR OF THE E-HEALTH ADVISORY COMMITTEE.

WITH ME TODAY IS MY VICE CHAIR, DOCTOR BRETT MORAN, THE CHIEF HEALTH OFFICER FOR PARKLAND HEALTH.

DOCTOR MORAN AND I HAVE BOTH BEEN ON THE COMMITTEE FOR SOME TIME AND HAVE RECENTLY ASSUMED THESE LEADERSHIP ROLES.

I WANT TO THANK KEN HOLLAND FOR INITIATING SOME OF THE CONVERSATION THAT LED TO THE PRESENTATION TODAY.

THIS COMMITTEE'S WORK IS REALLY IMPORTANT, AND I THOUGHT I WOULD START BEFORE I GOT INTO THE RECOMMENDATIONS.

WITH A LITTLE BIT OF HISTORY AND SCOPE OF THE COMMITTEE FOR THE STATEWIDE HEALTH COORDINATING COUNCIL MEMBERS, BECAUSE I THINK THAT CONTEXT IS IMPORTANT. I WANT TO START BY MENTIONING THAT I USED TO SERVE ON THE STATEWIDE HEALTH COORDINATING COUNCIL FROM 2001 TO 2003.

I WAS ACTUALLY THE TEXAS MEDICAID REPRESENTATIVE TO THE SCHICK, AND I WORKED ON TELEMEDICINE BECAUSE WE HAD TELEMEDICINE BILLS 20 PLUS YEARS AGO, AND THE SCHICK WAS LOOKING AT THAT AS AN ISSUE.

SO IT IS A FULL CIRCLE MOMENT FOR ME PERSONALLY TO BE BACK IN FRONT OF THIS GROUP THAT I USED TO SERVE ON TALKING ABOUT TELEMEDICINE AND TELEHEALTH.

OBVIOUSLY, I'LL BE TALKING ABOUT OTHER ISSUES, BUT IT JUST GOES TO SHOW THAT WHEN YOU START YOUR CAREER, YOU NEVER KNOW WHAT ISSUES MIGHT ATTACH THEMSELVES TO YOU AND NEVER LEAVE.

AND IN MY CASE, THAT WAS ONE OF THEM. SO WHAT I WANT TO DO FOR JUST THE NEXT COUPLE OF MINUTES IS WALK THE MEMBERS OF THIS COMMITTEE THROUGH THE RECOMMENDATIONS THAT WERE IN OUR MOST RECENT REPORT, AND I WANT TO BUILD SOME CONTEXT AROUND THOSE RECOMMENDATIONS IN TERMS OF THE WAY THAT WE SEE THE WORK THAT WE'RE DOING AND THEN CLOSE.

AND THEN DOCTOR MORAN, I BELIEVE, IS ALSO HERE, AND WE'RE HAPPY TO TAKE ANY QUESTIONS OR DIALOG.

MR. HOLLAND, AS WELL AS A, AS A PERSON WHO'S WEARING A FOOT IN BOTH OF THESE UNIVERSES TODAY.

AND YOUR INPUT IS ALSO VERY WELCOME. SO LET'S MOVE TO THE NEXT SLIDE.

SO THE HEALTH ADVISORY COMMITTEE WAS CHARGED WITH THREE TASKS.

AND A LITTLE OVER A DECADE AGO, Y'ALL MIGHT REMEMBER HEALTH AND HUMAN SERVICES SYSTEM WENT THROUGH SUNSET.

THE ADVISORY COMMITTEE STRUCTURE WAS REDONE. AND ONE OF THE THINGS THAT WAS RECOMMENDED WAS TO COMBINE TWO OLD COMMITTEES.

WE HAD A HEALTH INFORMATION EXCHANGE ADVISORY COMMITTEE.

WE HAD A TELEMEDICINE, TELEHEALTH AND REMOTE PATIENT MONITORING ADVISORY COMMITTEE.

THEY GOT PUT TOGETHER AND THEY BECAME THE E-HEALTH COMMITTEE.

AND IN DOING SO, THE COMMISSION ALSO COMBINED THE CHARGES OF THOSE PREVIOUS COMMITTEES INTO THE THREE TASKS THAT WE HAVE TODAY.

NEXT SLIDE PLEASE.

I'VE ALSO GOT THIS ON MY DESKTOP. IF THE SLIDES HAVE GONE OFFLINE, I CAN JUST READ IT AND WALK EVERYBODY THROUGH IT.

Y'ALL LET ME KNOW WHAT YOU'D LIKE ME TO DO. YES, MISS COX, THAT WOULD BE FINE.

[00:10:05]

I'M HAPPY TO DO THAT. OKAY, SO TASK ONE IS TO ADVISE HHS AGENCIES ON THE DEVELOPMENT, IMPLEMENTATION AND LONG RANGE PLANS FOR HEALTH INFORMATION TECHNOLOGY. THAT INCLUDES ELECTRONIC HEALTH RECORDS, COMPUTERIZED CLINICAL DECISION SUPPORT, HEALTH INFORMATION EXCHANGE, AND THEN OTHER WAYS TO INCORPORATE HEALTH IT TO DRIVE BOTH COST EFFECTIVENESS AND BETTER PATIENT OUTCOMES.

SO THAT IS OUR TASK ONE. THERE IT IS RIGHT THERE ON THE SCREEN.

WHEN WE STARTED AS A COMMITTEE, WE WERE STILL IN THE EARLY DAYS OF THE HIGH TECH ACT, WHICH WAS THE HEALTH INFORMATION TECHNOLOGY ADOPTION ACT.

THAT WAS PART OF THE STIMULUS IN 2009. AND SO WE HAVE CONTINUED TO REVISE RECOMMENDATIONS AROUND THIS POLICY SPACE EVERY CYCLE BECAUSE WE REPORT EVERY TWO YEARS. SO LET'S GO TO THE NEXT SLIDE. THERE WE GO.

SO FIRST OF ALL, THE SUBCOMMITTEE THAT WORKS ON THESE ISSUES HAS RECOMMENDED TO ADOPT ALIGNMENT ALIGNED CLINICAL QUALITY MEASURES AND ELECTRONIC CLINICAL QUALITY MEASURES ACROSS HHS PROGRAMS, BOTH THROUGH INTAKE AND IN THE BIENNIAL REPORTS.

WE WANT TO SEE EVERYBODY THAT'S TALKING ABOUT QUALITY, TALKING ABOUT QUALITY IN RELATIVELY SIMILAR, MAYBE NOT ALWAYS IDENTICAL, BUT RELATIVELY SIMILAR TERMS, BECAUSE WE'VE GOT A LOT OF STANDARDIZATION AROUND QUALITY.

NEXT SLIDE PLEASE. AND WE ALSO WERE RECOMMENDING THIS CYCLE THE ADOPTION OF THE AMERICAN HEALTH INFORMATION MANAGEMENT ASSOCIATION PATIENT NAMING FRAMEWORK. WE ARE FINDING REAL PROBLEMS WITH THE LACK OF CONSISTENCY IN PATIENT NAMING AND THE EXAMPLE THAT'S BEEN USED THE MOST OFTEN IS BABY NAMES.

BELIEVE IT OR NOT, NOT EVERY HOSPITAL USES THE SAME NOMENCLATURE FOR BABY NAMES.

SOMETIMES IT'S BABY SMITH, SOMETIMES IT'S BABY GIRL SMITH, SOMETIMES IT'S BABY GIRL SMITH JOHNSON, SO ON AND SO FORTH. IF THAT BABY THEN ENDS UP BEING TREATED IN MULTIPLE FACILITIES, YOU CAN'T ALWAYS FIND THAT PATIENT'S FILE.

WE'VE ALSO DONE SOME FAIRLY EXTENSIVE WORK AND I'VE GOT A GREAT PRESENTATION ON THIS, IF ANYBODY WANTS IT, AROUND HOW LATINO POPULATIONS USE SURNAMES AND LATIN AMERICAN LATINOS MIGHT NOT HYPHENATE, BUT AMERICAN LATINOS MIGHT HYPHENATE THE MOTHER'S MAIDEN NAME WITH THE FATHER'S LAST NAME.

AND HOW DO WE NEED TO BE TRACKING THAT IN A STANDARDIZED WAY INSIDE OUR ELECTRONIC MEDICAL RECORDS? SO THAT'S A REALLY IMPORTANT SPACE TO WORK ON STANDARDIZED NAMING, BECAUSE IF YOU DON'T STANDARDIZE THE NAMES, IT'S HARDER TO MATCH THE PATIENTS. IT'S HARDER TO TRACE THE RECORDS.

NEXT SLIDE PLEASE. SO RECOMMENDATION THREE UNDER TASK ONE IS TO CONTINUE TO CREATE STANDARD DATA EXCHANGE PROTOCOLS USING CERTIFIED NATIONAL STANDARDS, SO MOST ELECTRONIC MEDICAL RECORDS HAVE TO FEED TO MEET A FEDERAL CERTIFICATION PROCESS.

AND IN ORDER FOR BOTH CLIENTS, PATIENTS, PROVIDERS, EVERYONE TO GET MAXIMUM BENEFIT FROM THAT INVESTMENT.

THE RECEIVING SYSTEMS ON THE STATE SIDE ALSO NEED TO BE USING THE SAME STANDARDS TO MAKE THAT DATA EXCHANGE AS SMOOTH AS HUMANLY POSSIBLE.

WE'VE DONE SOME GREAT WORK, FOR EXAMPLE, ON THAT FRONT, WITH AMTRAK DOING BIDIRECTIONAL EXCHANGE USING NATIONAL STANDARDS FOR AMTRAK FOR THOSE DATA ELEMENTS. NEXT RECOMMENDATION PLEASE. THIS IS A BIG ONE.

SO I MENTIONED THE HITECH ACT EARLIER. THE MONEY IN THE STIMULUS FOR ELECTRONIC MEDICAL RECORDS.

BEHAVIORAL HEALTH WAS NOT FUNDED THE SAME WAY THAT AMBULATORY AND ACUTE CARE WERE FUNDED THROUGH THE INCENTIVE PROGRAM TO ADOPT EHRS.

NEITHER WAS LONG TERM CARE, FOR THAT MATTER. SO ONE OF THE RECOMMENDATIONS THAT THE COMMITTEE HAS PUT FORWARD IS TO HAVE A STRATEGIC PLAN TO MOVE FROM OUR LEGACY BEHAVIORAL HEALTH SYSTEMS AND MOVE TOWARDS A STANDARD OPERATING SYSTEM THAT USES STANDARDS FOR INTEROPERABILITY.

THIS IS A FAIRLY EXTENSIVE RECOMMENDATION. LET'S GO TO THE NEXT SLIDE.

BUT I DO WANT TO MAKE SURE THAT I TALK ABOUT EACH OF THESE RECOMMENDATIONS OF WHAT WE THINK SHOULD BE IN SUCH A PLAN.

THE FIRST ONE WOULD BE APPROPRIATE SHARING PROTOCOLS WITH OUR STATE HEALTH INFORMATION EXCHANGE, LOCAL HEALTH INFORMATION EXCHANGE, MANAGED CARE PLANS AND PROVIDERS, AND REALLY DEFINING THE STATE'S ROLE IN DEVELOPING DIGITAL REQUIREMENTS AND WHETHER OR NOT THE STATE SHOULD BE PROVIDING THE EMR TO SOME OF ITS PROVIDERS, OR WHETHER THOSE RESOURCES NEED TO BE DIRECTED IN A DIFFERENT WAY.

I KNOW THAT DEPARTMENT OF STATE HEALTH SERVICES HAS BEEN ASKING FOR MONEY AND HAVING CONVERSATIONS, FOR EXAMPLE, ABOUT EHRS FOR LOCAL PUBLIC HEALTH DEPARTMENTS, PARTICULARLY THE ONES THAT ARE SERVED DIRECTLY BY THE STATE.

SO WE REALLY HAVE SOME WORK TO DO HERE AROUND STANDARDIZATION AND GETTING EVERYBODY TO SORT OF A LEVEL PLAYING FIELD AROUND THESE DIGITAL PLATFORMS. NEXT SLIDE PLEASE. I AM SO GLAD I'M NOT THE ONLY ONE THAT DOES THAT SORT OF THING WHEN FORWARDING SLIDES. THIS HAPPENS TO ME AND IT'S HAPPENING TO ME AND I'M NOT EVEN TOUCHING IT. SO THIS IS THE SORT OF THING SLIDES DO WHEN I'M AROUND. IT'S LIKE THEY KNOW WHAT I DO FOR A LIVING.

[00:15:01]

A COUPLE MORE UNDER RECOMMENDATION FOUR, WE REALLY STILL NEED TO DO INTEGRATION AROUND PHYSICAL HEALTH AND NON-MEDICAL DRIVERS OF HEALTH, SOCIAL DETERMINANT ITEMS, WHATEVER LANGUAGE YOU USE FOR THAT, NATIONAL STANDARDS ARE BEING DEVELOPED FOR THAT.

AND WE NEED TO BE USING THOSE IN OUR SYSTEM AS WELL, AND THEN HAVING STANDARD INTEGRATION PLANS WITH OTHER STATE SYSTEMS. THIS IS AN ONGOING CONVERSATION IN CHILD WELFARE.

IT'S AN ONGOING CONVERSATION IN CRIMINAL AND JUVENILE JUSTICE.

SO THERE'S A LOT OF WORK TO BE DONE TO BRING IN SORT OF THESE OUTER RINGS OF CARE AND MAKE SURE THAT WE'RE USING STANDARDS AND SHARING DATA ACROSS ALL THOSE ECOSYSTEMS. NEXT SLIDE PLEASE. AND THEN FINALLY, I THINK YOU CAN TELL OUR STAKEHOLDERS WE'RE VERY ADAMANT ABOUT THIS.

NOT ONLY DO THEY WANT A PLAN, THEY WANT MOVEMENT ON THE PLAN.

IT IS TIME TO GO. WE HAVE BEEN TALKING ABOUT THIS STUFF FOR A REALLY, REALLY LONG TIME.

FOR BEHAVIORAL HEALTH IN PARTICULAR, WE'VE GOT TO MOVE TO A MORE AGILE SYSTEM AND A BETTER WAY OF SHARING DATA THAN WHAT WE CURRENTLY HAVE IN PLACE.

SO THAT SORT OF CLOSES OUT THE COMPONENTS OF THAT PLAN THAT'S BEING RECOMMENDED UNDER TASK ONE.

NEXT SLIDE PLEASE. AND THEN FINALLY SET UP SOME GUIDELINES TO DECIDE WHAT SYSTEMS THE STATE MIGHT PURCHASE VERSUS WHAT SYSTEMS THE PROVIDERS NEED TO HAVE. AND THEN ALSO MAKE SURE THAT WE ARE KEEPING IN MIND WHAT IT COSTS TO MAINTAIN ANY OF THE SYSTEMS WE HAVE THAT ARE NOT STANDARD, THAT FORCE PROVIDERS TO HAVE TO DROP TO A FAX, PERHAPS, OR SENDING A PDF OR DOING SOME SORT OF BATCH FTP TO SEND DATA RATHER THAN DOING PURE WHAT WE CALL BIDIRECTIONAL EXCHANGE, WHERE THEIR ELECTRONIC MEDICAL RECORD IS SENDING DATA DIRECTLY TO THE STATE.

THE END GOAL NEEDS TO BE TO GET THERE FOR ALL THE PROVIDERS ACROSS THE CARE CONTINUUM.

NEXT SLIDE PLEASE. TASK TWO HAS TO DO WITH INCENTIVES TO INCREASE HEALTH CARE PROVIDER ADOPTION AND USAGE OF EHRS.

AND HIS NEXT SLIDE PLEASE. THE FIRST RECOMMENDATION UNDER TASK TWO IS THE SAME RECOMMENDATION AS UNDER TASK ONE, WHICH IS ALIGNMENT OF THE CLINICAL QUALITY MEASURES.

SO I'VE ALREADY GONE OVER THAT. NEXT SLIDE PLEASE.

RECOMMENDATION TWO YOU'VE SEEN THIS BEFORE BUT IT SUPPORTS BOTH TASKS.

SO WE HAVE IT LISTED UNDER BOTH WHICH IS ADOPTION OF THESE STANDARDIZED NAMING FRAMEWORKS TO IMPROVE PATIENT MATCHING.

RECOMMENDATION THREE PLEASE. THERE WE GO. THIS IS SIMILAR FROM AN INCENTIVES PERSPECTIVE THOUGH A LITTLE BIT DIFFERENT, WHICH IS HOW DO WE INCENTIVIZE AND MAKE SURE THAT OUR STATE HOSPITALS AND LOCAL HEALTH AUTHORITIES GET THEIR SYSTEMS INTEROPERABLE, GET CONNECTED TO HEALTH INFORMATION EXCHANGE, AND SHARE WITH COMMUNITY BASED PROVIDERS.

SO THIS IS AN ONGOING DIALOG THAT WE'RE HAVING WITH THE AGENCY ABOUT HOW THAT MIGHT WORK.

NEXT SLIDE PLEASE. AND THEN FINALLY, AND THIS WAS PROPOSED LAST SESSION THE PSYCHIATRIC HOSPITALS THAT DIDN'T GET TO PARTICIPATE IN THE INCENTIVE PROGRAM, THERE IS DISCUSSION ABOUT WHETHER THE STATE SHOULD CREATE A GRANT OPPORTUNITY TO TO HELP THOSE HOSPITALS ACQUIRE THE SYSTEMS THAT THEY NEED TO BE FULL PARTICIPANTS IN THAT INTEROPERABLE DATA SHARING ECOSYSTEM.

AND THERE HAS BEEN, I THINK, AT LEAST ONE BILL.

THERE MIGHT BE TWO FILED THIS SESSION TO ADDRESS THAT ISSUE.

SO IF YOU THINK ABOUT DATA SHARING AND EVEN CONCEPTS LIKE VALUE BASED PURCHASING, YOU REALLY GOT TO GET EVERYBODY TO A BASELINE LEVEL OF INTEROPERABILITY AND DATA SHARING FOR THOSE CONCEPTS TO WORK AND FOR PROVIDERS TO ALL BE ABLE TO COLLABORATE AROUND ON PATIENT CARE.

NEXT SLIDE PLEASE. LET ME PIVOT TO TASK THREE.

I'M NOT SUPPOSED TO BE BIASED, BUT I'M OFFICIALLY THE REMOTE PATIENT MONITORING REPRESENTATIVE ON THE COMMITTEE.

AND SO THIS IS THE TOPIC. LIKE I SAID, AT THE TOP, IT'S NEAR AND DEAR TO MY HEART, WHICH IS ADVISE THE AGENCIES ON THE DEVELOPMENT, USE AND LONG RANGE PLANS FOR TELEMEDICINE, TELEHEALTH, HOME TELEMONITORING AND THE NEW BENEFITS, POTENTIALLY FOR INCLUSION IN MEDICAID AROUND THESE TOPICS.

SO LET ME GO OVER THESE RECOMMENDATIONS, AND THEN I'LL BE ABLE TO CLOSE AND SEE IF THERE'S QUESTIONS.

FIRST OF ALL, AS WE ALL KNOW, POST COVID, WE ARE STILL LEARNING WHAT WE LEARNED THROUGH THE MASSIVE EXTENSION OF TELEMEDICINE AND TELEHEALTH DURING COVID. SO WE STILL NEED TO BE MONITORING FEDERAL CHANGES, STATE CHANGES THAT MIGHT IMPACT UTILIZATION, AND THE USE OF TELEHEALTH IN TEXAS. AND THE BEST EXAMPLE I CAN GIVE IS THAT WE ARE STILL IN LIMBO WITH THE DRUG ENFORCEMENT AGENCY AT THE FEDERAL LEVEL OVER IMPLEMENTATION OF THE RYAN WHITE ACT, WHICH REQUIRES AN IN-PERSON VISIT FOR A PRESCRIPTION FOR CERTAIN CONTROLLED SUBSTANCES.

IT WAS WAIVED DURING THE PANDEMIC. WE ARE TECHNICALLY STILL UNDER THE WAIVER BECAUSE THE DEA HAS NOT BEEN ABLE TO DO FUNCTIONAL RULEMAKING TO TO SEE WHAT A POST-COVID REGULATORY APPROACH WOULD BE FOR PRESCRIBING CONTROLLED SUBSTANCES.

IT STARTED AS AN OPIOIDS ISSUE, BUT NOW IT'S CAPTURED DRUGS LIKE ADDERALL.

SO THERE'S A LOT OF WORK TO BE DONE THERE. AND WHATEVER THE DEA DOES DECIDE TO DO IS GOING TO HAVE DOWNSTREAM IMPACT ON TEXAS.

SO WE'RE WATCHING FOR THAT. NEXT SLIDE PLEASE.

[00:20:06]

THE ANOTHER PRIORITY THAT THE SUBCOMMITTEE FOR TELEMEDICINE, TELEHEALTH AND REMOTE PATIENT MONITORING HAS IDENTIFIED IS THE DIGITAL DIVIDE AND IMPROVING DIGITAL LITERACY AND USING TOOLS LIKE TELEMETRY TO RAISE THE LEVEL OF DIGITAL LITERACY ACROSS THE BOARD.

OBVIOUSLY, WE WANT OUR PATIENTS TO BE ABLE TO GET THE FULL BENEFIT OF THE DIGITAL TOOLS.

NEXT SLIDE. WE ALSO WANT TO MAKE SURE THAT THERE IS APPROPRIATE COMMUNICATION WHEN TELEHEALTH IS USED BACK TO A PRIMARY CARE PHYSICIAN. SO THIS IS SOMETHING THAT'S ACTUALLY MANDATED IN STATUTE, BUT I SUSPECT IS NOT HAPPENING EVENLY ACROSS ALL PRACTICES IN THE STATE.

IF YOU'VE GOT A PATIENT USING TELEHEALTH AND THEY'VE GOT A PRIMARY CARE PHYSICIAN THAT PCP SHOULD BE RECEIVING A REPORT ABOUT THE TELEHEALTH ENCOUNTER, AND THAT HAPPENS IN SOME PLACES AND DOESN'T HAPPEN IN OTHERS.

AND SO WE'VE GOT TO STEP UP ON THAT ONE A LITTLE BIT, ESPECIALLY NOW THAT WE'RE OUT OF THE PANDEMIC AND EVERYBODY CAN SORT OF CATCH THEIR BREATH AND LOOK AT HOW THEY'RE USING THESE TOOLS IN A SYSTEMIC WAY INSTEAD OF A EVERYTHING'S ON FIRE KIND OF WAY, LIKE WE DID A FEW YEARS AGO WHEN THE PANDEMIC STARTED.

NEXT SLIDE. AND THEN THIS ONE IS, AGAIN, THE BIASED NEAR AND DEAR TO MY HEART.

WE'VE GOT REALLY COMPLEX PROCESSES AROUND REMOTE PATIENT MONITORING BILLING AND SOME OF THAT'S REQUIRED BY STATUTE AND SOME OF THAT'S ADMINISTRATIVE.

SO THE SUBCOMMITTEE THAT'S WORKING ON THIS HAS IDENTIFIED SIMPLIFYING REMOTE PATIENT MONITORING BILLING TO ENCOURAGE MORE PROVIDERS TO BE PROVIDING THESE SERVICES AS A KEY PRIORITY. AND THAT'S GOING TO BE ANOTHER ONGOING CONVERSATION.

NEXT SLIDE PLEASE. WE ALSO WANT TO CONTINUE TO TALK TO HHC ABOUT STREAMLINING ADMINISTRATIVE PROCEDURES.

AND THEN WE DID CHANGE THE STATUTE IN 2023 TO ALLOW HHC TO ADD ADDITIONAL CONDITIONS TO THE REMOTE PATIENT MONITORING BENEFIT WITHOUT HAVING TO GO BACK TO THE LEGISLATURE. SO WE WOULD LIKE TO SEE BROADER ADOPTION OF THIS TECHNOLOGY.

SO THIS IS TECHNOLOGY THAT MONITORS A PATIENT AT HOME.

MIGHT BE A BLUETOOTH SCALE, MIGHT BE A BLOOD PRESSURE CUFF, ALL SORTS OF DIFFERENT DEVICES.

THIS CAN ALSO BE DONE FOR HIGH RISK PREGNANCIES AND KEEPING PATIENTS AT HOME.

BUT KEEPING AN EYE ON THEM IS A TOOL THAT WE NEED TO BE USING MORE OF AT MEDICAID.

SO I THINK I'M GOING TO THE SUBCOMMITTEE IS GOING TO CONTINUE TO WORK WITH THE AGENCY AND FIGURE OUT HOW WE CAN EXPAND THOSE OPPORTUNITIES.

NEXT SLIDE PLEASE. THAT'S ALL THE RECOMMENDATIONS.

DOCTOR MORAN, I CERTAINLY, IF YOU'RE HERE, WOULD WELCOME ANY ADDITIONAL COMMENTS THAT YOU WANT TO MAKE.

I'M DONE WITH MY PREPARED REMARKS, AND I WOULD OPEN THIS TO YOU AND TO MR. HOLLAND, IF YOU GUYS WANT TO ADD ON ANYTHING, AND THEN, OF COURSE, HAPPY TO TAKE ANY QUESTIONS THAT THE STATEWIDE HEALTH COORDINATING COUNCIL HAS ABOUT WHAT I JUST PRESENTED OR THE WORK OF THE COMMITTEE.

I THINK I THANK YOU, MISS COX. I WOULD JUST ADD THAT, YOU KNOW, THANK YOU FOR LETTING US COME AND PRESENT AND GIVE A LITTLE BIT OF WHO WE ARE AND WHAT WE DO. I KNOW MR. HOLLAND AND I HAD TALKED ABOUT THIS WOULD BE A GREAT OPPORTUNITY BOTH TO SHOW WHAT THIS ADVISORY COMMITTEE IS.

AND AS MISS COX HAS SAID, WE HAVE WITH THE NEW LEADERSHIP, WE HAVE A LOT OF DESIRE TO ASK AROUND AND TRY TO FIND OUT WHAT CAN WE DO TO BETTER HELP INFORM HEALTH AND HUMAN SERVICES COMMITTEE AND GROW THE FOOTPRINT OF EHEALTH FOR THE RESIDENTS OF THE STATE OF TEXAS.

HOW CAN WE MAKE THINGS BETTER? HOW CAN WE HELP WITH EDUCATION? HOW CAN WE HIGHLIGHT BEST PRACTICES AND GOOD THINGS THAT ARE HAPPENING SO THAT THERE CAN BE BETTER DEVELOPMENT AND GROWTH OF THOSE THINGS? AND SO I WANTED TO MAKE THIS GROUP AWARE OF IT AND GET AN INPUT FROM THEM THAT THEY WOULD LIKE TO PROVIDE TO US.

CAN I THANK YOU? YOU'RE ON MUTE. YEAH. DOCTOR MORAN AND MISS COX AS THE PUBLIC MEMBER OF THE OBVIOUSLY, I'M A MEDICAL PROFESSIONAL, SO HAVING YOU ALL BE HERE AND CONVEY THE MESSAGE OF THE IHCC WORLD IS SO MUCH BETTER THAN I COULD DO. SO I APPRECIATE YOU COMING TODAY AND SHARING WITH THE REST OF THE COMMITTEE OR THE COUNCIL, AND I LOOK FORWARD TO ANY QUESTIONS AND DIALOG THAT CAN BE HAD BECAUSE OF IT.

WELL, THANK YOU ALL VERY MUCH, MISS COX. A GREAT PRESENTATION.

AND DOCTOR MORAN, THANK YOU FOR BEING HERE. AND, KEN, YOU'RE VERY HUMBLE BECAUSE YOU'VE DONE A GREAT JOB SO FAR AS OUR REPRESENTATIVE TO THE HAC AND RELAYING TO US WHAT THEY'VE BEEN DOING, AND FOR THAT WE'RE VERY GRATEFUL.

I'M GOING TO START THE QUESTIONING. I HAVE JUST TWO QUESTIONS FOR YOU ALL IF YOU CAN HELP ME OUT WITH.

AND THEN I'M GOING TO OPEN UP FOR THE REST OF THE MEMBERS.

SO THE FIRST THING I HAVE FOR YOU IS THE. YEAH, WE KIND OF LOST THE I LOST YOU ALL, BUT I THINK HOPEFULLY YOU STILL CAN SEE US.

SO THE FIRST ONE IS, WHAT KIND OF INFRASTRUCTURE DO YOU THINK THAT THE STATE NEEDS TO BE ABLE TO INVEST IN, TO BE ABLE TO BRING ALL THESE YOU KNOW, INITIATIVE THAT'S VERY MUCH NEEDED, ESPECIALLY IN THE AREAS THAT DOESN'T HAVE THE INFRASTRUCTURE TO BE ABLE TO UTILIZE IT.

[00:25:05]

AND THE OTHER QUESTION I HAVE FOR YOU, OF COURSE, IS WHAT KIND OF ENFORCEMENT DO YOU THINK YOUR YOUR RECOMMENDATIONS WILL BE ABLE TO HAVE TO ACTUALLY BE ABLE TO BE CARRIED OUT.

I'M GOING TO ASK YOU TO ASK THAT SECOND ONE AGAIN. I WANT TO MAKE SURE I'M UNDER ENFORCEMENT IN TERMS OF GETTING THE AGENCY TO DO THINGS, GETTING THE LEGISLATURE TO GET THE AGENCY TO DO THINGS, OR JUST THE COLLABORATION COMPONENT.

I UNDERSTAND YOU HAVE A LOT OF INFLUENCE. I'M NOT SURE EXACTLY HOW MUCH POWER DO YOU HAVE? SO YOU COME UP WITH GREAT. I LOVE THAT QUESTION.

OKAY. LET ME START WITH THE EASIER ONE, WHICH IS THE INFRASTRUCTURE COMPONENT.

WE ARE AT 100% ADOPTION OF ELECTRONIC MEDICAL RECORDS BY HOSPITALS IN TEXAS, OUTSIDE OF THE ONES THAT ARE THE PSYCHIATRIC HOSPITALS THAT DIDN'T RECEIVE HI TECH FUNDING. THEY DO HAVE EHRS, BUT NOT AT THE SAME LEVEL AS THE ACUTE CARE HOSPITALS.

MOST OF THE NUMBERS THAT WE SEE FOR PHYSICIAN HOSPITAL FOR PHYSICIAN PRACTICES PEG ADOPTION, IT'S SOMEWHERE BETWEEN 78 AND 90% OF PHYSICIAN PRACTICES AND OF COURSE, PHYSICIANS AND MEDICAID, FOR THE MOST PART, DID HAVE SOME OPPORTUNITY TO RECEIVE INCENTIVE FUNDS FOR ADOPTION AS WELL.

I THINK THERE'S TWO INFRASTRUCTURE QUESTIONS THAT ARE STILL UNANSWERED THAT ARE BEING FAIRLY HOTLY DEBATED.

AND ONE IS, SHOULD THE STATE BE INVESTING GENERAL REVENUE IN LEVELING UP THE USE OF VIDEO GAME TERM? BECAUSE I'M A GAMER AND LEVELING UP THE PROVIDERS THAT DIDN'T GET MONEY FROM THE FEDERAL GOVERNMENT TO THE SAME LEVEL AS THE OTHER PROVIDERS.

IT IS MY PERSONAL OPINION, NOT SPEAKING FOR THE EEOC IN THIS MOMENT, BUT I THINK THE REPORT REFLECTS THE SAME ANALYSIS THAT WE ARE MISSING AN OPPORTUNITY IF WE DON'T INVEST IN BRINGING THE OTHER PROVIDERS UP TO THE SAME LEVEL OF BEING ABLE TO DO DATA SHARING.

WE KNOW, FOR EXAMPLE, THAT MOST PATIENTS WITH CHRONIC CONDITIONS, AND I'M NOT A CLINICIAN EITHER.

SO, DOCTOR MORAN, I WANT YOU TO LIKE JUMP RIGHT IN HERE AFTER ME ON THIS ONE.

MOST PEOPLE WITH CHRONIC CONDITIONS ALSO HAVE A MENTAL HEALTH CONDITION FOR EXAMPLE.

SO CONTINUING TO NOT FUND INTEROPERABLE INFRASTRUCTURE ON THE BEHAVIORAL HEALTH SIDE MEANS THAT YOU'VE GOT PROVIDERS TREATING CONDITIONS WITHOUT A FULL PICTURE OF THE PATIENT'S CONDITION AND MEDICAL NEED. AND, DOCTOR, YOU WANT TO CHIME IN ON THAT.

THAT'S SORT OF MY AS A POLICY EXPERT, KIND OF MY TAKE ON IT.

YEAH. NO, I AGREE I THINK, YOU KNOW, KIND OF THE ANECDOTE THAT I HAVE IS, IS IN, IN OUR ORGANIZATION, WE HAVE BEEN TRYING TO GROW TELEHEALTH LIKE EVERYBODY HAS, AND WE HAVE FAIRLY GOOD ADOPTION.

AND ON AVERAGE, ABOUT 4% OF OUR VISITS ARE ARE VIRTUAL CARE.

BUT WHEN WE LOOK AT THE DATA, THERE ARE SOME WHO ARE CARRYING THE LOAD FOR MOST.

AND THEN THERE ARE MANY WHO ARE DOING MINIMAL.

AND SO GROWING TELEHEALTH, IT TAKES A LOT OF WORK TO INCENTIVIZE IT.

AND SO IN OUR HEALTH SYSTEM, WE'VE STOPPED TRYING TO JUST SET GOALS GLOBALLY.

AND WE'VE TRIED TO INCENTIVIZE INDIVIDUAL PRACTITIONERS. AND SO NOW WE'RE SAYING 90% OF PCP'S HAVE TO HAVE A TELEHEALTH VISIT EACH MONTH, AND THAT'S SOMETHING THAT THEY WEREN'T DOING BEFORE.

IT WAS JUST 1 OR 2 DOING THE BULK FOR EVERYBODY.

AND SO WE'RE TRYING TO GET GLOBAL ADOPTION. AND I THINK TO MISS COX'S POINT, WHEN IT COMES TO TRYING TO GET UPTAKE OF SOME OF THE E-HEALTH TECHNOLOGIES, THERE ARE SOME ORGANIZATIONS THAT ARE LEADING AND GOING FAR ABOVE AND BEYOND, AND THE ADOPTION AT THE STATE LEVEL LOOKS GOOD, BUT IT'S NOT CONSISTENT. IT'S NOT HOMOGENEITY.

THERE'S NOT A GLOBAL ADOPTION. AND I THINK THERE'S OPPORTUNITIES FOR THAT.

SO CERTAINLY THAT'S SOMETHING THAT THAT I WOULD LOVE FOR THERE TO BE MORE INCENTIVES TO TRY TO GET THOSE THAT ARE LAGGARDS IN SOME OF THE E-HEALTH TECHNOLOGIES.

BUT I ALSO THINK TO THE POINT OF THE QUESTION THERE, THERE IS OPPORTUNITY FOR BETTER INTERFACES AND INTEROPERABILITY AT THE STATE LEVEL, AND THEY DO HAVE TO BE MORE PREPARED TO BE ABLE TO HAVE THOSE CONNECTIONS WITH THE HEALTH SYSTEMS AND THE HEALTH PRACTITIONERS.

AND, YOU KNOW, TO DATE, SOME OF THE INITIAL USE CASES SUCH AS AMTRAK HAVE NOT BEEN WIDELY SUCCESSFUL AND HAVE BEEN FRAUGHT WITH SOME ISSUES.

AND SO THOSE ARE OPPORTUNITIES WHERE THINGS COULD BE BETTER.

AND I THINK THAT'S WHERE I WOULD WANT THE STATE TO BE GOING.

SO I THINK YEAH. OH, NO. I JUST WANTED TO ADDRESS THE SECOND HALF OF YOUR QUESTION, WHICH IS ABOUT INFLUENCE.

OBVIOUSLY WE ARE ADVISORY, RIGHT. AND I KNOW THIS IS A PUBLIC MEETING LIKE THE AGENCY THIS IS ABOUT.

I'M SORRY. BEFORE WE MOVE THE QUESTION, LET'S JUST FINISH THE FIRST QUESTION FIRST. I GOT. OKAY. SO YOU GUYS ANSWERED VERY WELL FROM THE PROVIDER POINT OF VIEW AND INTEREST AND INTERCONNECTIVITY WITH THE STATE. BUT I'M ALSO WORRIED ABOUT ABOUT THE PATIENTS BECAUSE, YOU KNOW, YOU HAVE TO HAVE ACCESS TO BE ABLE TO UTILIZE THESE SERVICES.

SO THANK YOU FOR THAT. THIS IS NORAH AGAIN. FOR THOSE OF YOU THAT MIGHT JUST BE LISTENING,

[00:30:02]

THERE ARE ENORMOUS. THERE'S AN ENORMOUS NUMBER OF PROJECTS TRYING TO INCREASE PATIENT ACCESS RIGHT NOW TO THESE TECHNOLOGIES.

AND I'VE SEEN EVERYTHING FROM KIOSKS TO A PROJECT AT TEXAS A&M THAT'S GIVING MENTAL HEALTH PATIENTS IPADS TO TAKE HOME.

THAT'S ACTUALLY BEEN VERY SUCCESSFUL. THE IPADS DID NOT VANISH OR GET DESTROYED LIKE PEOPLE THOUGHT THAT THEY MIGHT.

YOU KNOW, WE'VE INVESTED MILLIONS OF DOLLARS IN TEXAS, FUNDS IN BROADBAND.

AND BECAUSE THAT'S ALSO REALLY IMPORTANT. IF YOU CAN'T EVEN GET TO THE INTERNET, YOU CERTAINLY CAN'T USE IT FOR SERVICES.

AND SO THAT OVER THE LAST FEW YEARS, THAT'S BEEN A BIG INVESTMENT.

I DO THINK, THOUGH, THAT DIGITAL LITERACY CONTINUES TO BE AN ISSUE THAT EVERYBODY NEEDS TO PAY ATTENTION TO.

AND WE WORK WITH PARTNERS LIKE UNITED WAY AND OTHERS THAT ARE TRYING TO GET THAT MESSAGE OUT.

WE ALSO HAVE TO PROTECT THE CAPACITY OF OUR SAFETY NET PROVIDERS TO SORT OF BE A HOME FOR TELEMEDICINE AND TELEHEALTH SERVICES.

SO ONE OF THE MOST FREQUENT USE CASES IS YOU MIGHT HAVE A FEDERALLY QUALIFIED HEALTH CENTER OR RURAL HEALTH CLINIC THAT HOSTS A PATIENT, AND THEY'RE DOING A TELEHEALTH VISIT WITH SOMEBODY AT A SPECIALTY HOSPITAL OR MAYBE A SPECIALIST.

MAYBE YOU NEED A PEDIATRIC GASTROENTEROLOGIST AND YOU'RE IN BIG SPRING.

AND THERE ARE NO PEDIATRIC GASTROENTEROLOGISTS IN BIG SPRING, I'M PRETTY SURE.

BUT YOU COULD GO TO YOUR LOCAL CLINIC AND THEN HAVE A TELEMEDICINE VISIT THAT WAY.

WE ALSO HAVE TO REMEMBER THAT TELEMEDICINE IS NOT JUST SOMETHING THAT YOU DO FROM HOME.

IT'S ACTUALLY SOMETHING THAT CAN QUITE SUCCESSFULLY BE DONE PROVIDER TO PROVIDER.

AND WE PAY A FACILITY FEE TO THE HOSTING PROVIDER TO SORT OF HELP PAY FOR THAT INFRASTRUCTURE.

SO I THINK WE'VE MADE GOOD PROGRESS, ESPECIALLY SINCE COVID.

THERE ARE DEFINITELY COMMUNITIES THAT ARE GOING TO NEED ADDITIONAL INVESTMENT.

AND THEN THE RURAL HOSPITALS, I'VE SEEN SOME ACTIVITY THERE LATELY WHERE THEY'RE SORT OF BANDING TOGETHER AND TALKING ABOUT DOING STUFF THAT'S COLLABORATIVE ACROSS THOSE RURAL HOSPITALS. AND I THINK THAT COMPONENT OF IT IS ALSO REALLY IMPORTANT.

AND I'LL JUST TAG TEAM. ON WHAT MISS COX SAID IS THAT, NUMBER ONE, IN MY MIND, THE DIGITAL DIVIDE.

AND I THINK THERE'S A LOT OF OF WORK BEING DONE.

BUT THERE'S STILL OPPORTUNITY. AND AND FROM MY STANDPOINT, BEING STATIONED IN DALLAS, IT'S ALSO IT'S NOT JUST A RURAL THING.

THERE ARE MAJOR DIGITAL DIVIDES WITHIN THE MAJOR METROPLEX AREAS, DESPITE WHAT THE MAPS SHOW.

SO I THINK THAT'S SOMETHING. AND AND THERE IS DATA TO SHOW VALUE AND EFFICACY OF AUDIO ONLY PHONE CALL, VIRTUAL VISITS FOR PEOPLE WHO DO NOT HAVE CAPABILITY OF HAVING A VIDEO VISIT.

AND SO I WOULD ENCOURAGE THAT. WE DON'T DISINCENTIVIZE THAT.

AND I KNOW THERE'S BEEN SOME TALK, I THINK BOTH AT THE MEDICARE AND MEDICAID LEVEL OF OF KIND OF REIMBURSING PEOPLE WHO HAVE THE CAPABILITY, BUT THE PATIENT DOESN'T. I THINK DIGITAL LITERACY IS HUGE.

AS WE'RE USING MORE AND MORE TECHNOLOGY WITH REMOTE MONITORING AND VIRTUAL CARE.

THERE HAS TO BE SOME SIGNIFICANT MOVEMENT TO MAKE SURE THAT WE LOOK AT A MEASURING SOMEONE'S DIGITAL LITERACY, WHAT'S THEIR DIGITAL ENGAGEMENT? AND THEN B, WHAT DO WE DO ABOUT IT.

SO WE DON'T WANT TO JUST IF THEY'RE NOT DIGITALLY ENGAGED, MAKE THEM COME IN IN PERSON.

BUT WE WANT TO PROVIDE EXTRA HAND-HOLDING AND RESOURCES FOR THOSE INDIVIDUALS.

AND THEN TO ME, THE LAST ONE THAT'S MAYBE MOST IMPORTANT IS LANGUAGE CONCORDANT CARE.

YOU KNOW, MORE THAN A THIRD OF THE RESIDENTS OF THE STATE OF TEXAS SPEAK A LANGUAGE, PRIMARY LANGUAGE OTHER THAN ENGLISH.

AND IT IS SO IMPORTANT FOR US TO PROVIDE CARE TO THEM IN A LANGUAGE THAT THEY CAN SPEAK, AND GIVING THEM INSTRUCTIONS IN THAT LANGUAGE.

AND THERE JUST AREN'T ENOUGH TRANSLATORS TO DO THAT.

AND SO USE OF TECHNOLOGY SUCH AS AI AND THINGS LIKE THAT TO HELP MIGHT BE OPPORTUNITIES.

THANK YOU. SO, MISS RODRIGUEZ, IS THE QUESTION YOU HAVE RELATED TO THIS TOPIC OR SHOULD WE MOVE TO THE SECOND QUESTION? MR. MORAN IN KIND OF MENTIONED AI. SO THAT'S MY QUESTION.

MAY I PRESENT MY QUESTION NOW, IF YOU DON'T MIND, IF YOU DON'T MIND, CAN YOU LET ME GO AHEAD AND ANSWER THE SECOND QUESTION, BECAUSE I KIND OF CUT HER OFF? OKAY. GO AHEAD. ONCE SHE'S DONE, WE'LL ADDRESS THE ISSUE.

THANK YOU. THANK YOU. SO THIS IS NORA COX AGAIN, AND I APOLOGIZE FOR JUMPING AHEAD OF OUR MEETING CHAIR.

I JUST DIDN'T WANT TO FORGET WHAT YOU HAD ASKED ABOUT THAT COMPONENT OF IT.

OBVIOUSLY, WE ARE AN ADVISORY COMMITTEE, BUT I THINK WHAT IS HAPPENING IN THE COMMITTEE AND WHAT I'VE REALLY BEEN HAPPY TO SEE OVER THE LAST COUPLE OF MEETINGS, IS THAT SOME OF THESE TOPICS I'M GOING TO TAKE NAMING PROTOCOLS AS AN EXAMPLE.

IF YOU ARE, IF THIS IS NOT YOUR FULL TIME JOB.

RIGHT. WORKING ON INTEROPERABLE STANDARDS FOR THE EXCHANGE OF HEALTH INFORMATION, IT IS REALLY HARD TO KEEP UP WITH AN ECOSYSTEM THAT IS CONSTANTLY IN MOTION AND CONSTANTLY EVOLVING. AND SO I THINK ONE OF THE THINGS THAT THE IHCC HAS BECOME A VENUE FOR IS WE'RE BRINGING IN NATIONAL EXPERTS TO TALK ABOUT THINGS LIKE, LET'S MAKE SURE THAT WE HAVE AN APPROPRIATE APPROACH TO HANDLING LATINO LAST NAMES IN OUR EHRS AND IN OUR STATE SYSTEMS. I MEAN, I'VE CERTAINLY SEEN TRUNCATED NAMES. I'VE SEEN THEM SMASHED TOGETHER.

I'VE SEEN SYSTEMS THAT WOULDN'T HOLD THE HYPHEN.

[00:35:01]

THAT FIRST, THAT MIDDLE NAME. WHAT LOOKS LIKE A MIDDLE NAME TO TO SOME PEOPLE IS NOT A MIDDLE NAME.

IT'S ACTUALLY THE MOTHER'S FACE. SO THAT'S A CULTURAL SENSITIVITY ISSUE.

IT'S A LANGUAGE ISSUE, BUT IT'S ACTUALLY ALSO A STANDARDS ISSUE.

SO BRINGING IT INTO THE IHRC AND HAVING THAT CONVERSATION, I WAS GETTING DIALOG FROM PEOPLE SAYING, I HAD NO IDEA THIS WAS EVEN A PROBLEM. LET'S TAKE A LOOK AT IT AND SEE HOW WE CAN FIGURE OUT HOW TO SOLVE IT.

SO I THINK OPENING THAT DIALOG WITH THE AGENCY AND WHAT I WOULD ENCOURAGE, YOU KNOW, THIS GROUP TO DO IF YOU'VE GOT ISSUES, WE TAKE PUBLIC COMMENT LIKE YOU DO IN EVERY PUBLIC MEETING, AND WE SHOULD PROBABLY CROSS-POLLINATE AND HAVE A PRESENTATION ON THE STATEWIDE HEALTH COORDINATING COUNCIL COME INTO THE IHRC SO WE CAN DO THAT CROSS COORDINATION AS WELL.

AND THE LAST THING I'LL SAY IS THAT OBVIOUSLY SOME OF THESE RECOMMENDATIONS REQUIRE LEGISLATIVE ACTION.

AND SO THERE ARE STAKEHOLDERS WORKING OUTSIDE OF THE PROCESS, BECAUSE THE HACK DOES NOT LOBBY AND DOES NOT REPRESENT THE AGENCY.

BUT THERE ARE STAKEHOLDERS LEADING ON SOME OF THIS.

SO IF PEOPLE ON THIS CALL HAVE QUESTIONS RELATED TO SOME OF THE LEGISLATIVE ACTIVITIES, LIKE ASKING FOR STATE FUNDING FOR PSYCHIATRIC HOSPITALS, FOR EHRS, IF THEY CAN GET CONNECTED TO ME, I CAN CONNECT THEM TO EXTERNAL STAKEHOLDERS OUTSIDE OF THE AGENCY PROCESS THAT ARE WORKING ON THOSE ISSUES IN THE LEGISLATIVE FORUM. IS THAT THE SORT OF INFORMATION YOU WERE LOOKING FOR? I WANT TO MAKE SURE THAT I'M RESPONSIVE. THAT HELPS ME OUT A LITTLE BIT.

I MEAN, THE WHOLE IDEA IS YOU GUYS DO A GREAT WORK, BUT THERE IS NOBODY THAT WOULD ACTUALLY IS TASKED BY MAKING SURE IT DOES HAPPEN.

SO IT HAS TO BE SOME SORT OF COORDINATION OUTSIDE TO, YOU KNOW, TO HELP THAT FOR OUR PATIENTS, YOU KNOW, FOR THE, FOR THE CITIZENS OF THE STATE SAKE. SO AT THIS TIME, I'M GOING TO ASK MISS RODRIGUEZ FOR ONE MORE QUESTION, AND THEN WE'LL MOVE TO THE NEXT ITEM AFTER THAT. THANK YOU FOR YOUR PRESENTATION AND WORK IN THIS COMMITTEE.

SO MY QUESTION IS QUESTION IS ON. I AS YOU ALL SAID, TECHNOLOGY IS JUST MOVING FAST.

DO YOUR RECOMMENDATIONS INCLUDE AND INCORPORATE THE ROLE OF AI WITHIN THE TELEHEALTH DOMAIN? THANK YOU SO MUCH FOR YOUR QUESTION. THIS IS NORA COX AGAIN.

AT THIS POINT IN TIME, WHAT WE HAVE BEEN TOLD BY AGENCY STAFF IS THAT AI IS OUTSIDE OF THE SCOPE OF OUR THREE TASKS AS THEY ARE CURRENTLY WRITTEN.

HOWEVER, THE TASKS ARE TEN YEARS OLD, AND SO WE ARE HAVING A PRELIMINARY CONVERSATION WITH THE AGENCY RIGHT NOW, AND I DON'T WANT TO GET AHEAD OF IT.

BUT I WILL SAY YOU ARE NOT THE FIRST PERSON TO FLAG THAT ISSUE TO OUR ATTENTION.

WE HAVE HAD DIALOG WITH THE AGENCY ABOUT IT. AND IT IS THEIR CHARGE TO US.

IT IS NOT OUR CHARGE TO THEM. SO WE DO HAVE TO WORK WITH THE AGENCY TO TO BRING THAT TO THE TABLE.

AND I HOPE YOU CAN TELL I'M TRYING TO BE VERY DIPLOMATIC WITH MY RESPONSE HERE, BECAUSE I DON'T SPEAK FOR THE AGENCY AND I DON'T WANT TO GET AHEAD OF THE CONVERSATION.

BUT THE COMMITTEE STAKEHOLDERS HAVE RAISED THIS EXACT SAME ISSUE.

AND THE CONVERSATION EVEN GOING INTO THIS REPORT WAS WE'RE GOING TO ISSUE A REPORT.

WE'RE NOT GOING TO TALK ABOUT AI, WHICH IS ALL ANYBODY IS TALKING ABOUT IN HEALTHCARE RIGHT NOW.

IT'S REVOLUTIONIZING SERVICE DELIVERY. IT'S REVOLUTIONIZING ALL THESE THINGS.

BUT AS A ADVISORY COMMITTEE TO THE AGENCY, THERE ARE BOUNDARIES THAT WE HAVE TO LIVE WITHIN AS WE WORK ON OUR TASKS.

SO WE HAVE OPENED UP THAT DIALOG. I AM CAUTIOUSLY OPTIMISTIC ABOUT IT BECAUSE I THINK IT'S INCREDIBLY IMPORTANT, AND I CERTAINLY THINK OTHER STAKEHOLDERS FLAGGING THAT AS AN IMPORTANT ISSUE CAN ONLY HELP US EVOLVE THE COMMITTEE, SO THAT WE'RE TAKING ON SOME OF THESE REALLY CURRENT TOPICS THAT ARE CURRENTLY OUTSIDE OF OUR TASK.

I THINK TO TO MISS COX'S POINT, YOU KNOW, WE WE HAVE STAYED OUT OF IT.

TO SOME EXTENT, WE DO FEEL LIKE AI IS ALREADY PERMEATING EVERYTHING THAT PEOPLE ARE DOING WITHIN EHEALTH, AND THERE ARE OPPORTUNITIES, AND SO IT'S HARD FOR US TO NOT TALK ABOUT IT.

AND SO THOSE ARE ONGOING CONVERSATIONS, AS SHE MENTIONED.

CERTAINLY THIS ADVISORY GROUP WOULD NEVER SUPPOSE TO GIVE POLICY ABOUT GOVERNANCE, OVERSIGHT AND REGULATION.

WE KNOW THAT THERE ARE WORKSTREAMS AND TEAMS AND LEADERSHIP GROUPS WORKING ON THAT, BUT THERE MAY BE OPPORTUNITY TO TALK ABOUT AI TECHNOLOGIES THAT WOULD THEN FALL UNDER THE AUSPICES OF THOSE POTENTIAL LAWS COMING DOWN THE PIKE, AND THAT WOULD BE SOMETHING THAT WE WOULD HOPE WOULD BE FAIR GAME FOR THIS ADVISORY GROUP.

THANK YOU. THANK YOU FOR YOUR RESPONSE. THANK YOU ALL SO MUCH FOR FOR A GREAT PRESENTATION.

AND AGAIN, I WANT TO THANK KEN FOR DOING A WONDERFUL JOB.

REPRESENTING US AT THE IHRC AND REPRESENTING IHRC HERE IN THE SHEIKH.

SO, MOVING TO THE NEXT ITEM, ITEM NUMBER SIX.

[6. Presentation on Texas (Alliance for Innovation on Maternal Health) AIM program. Presenter: Dr. Manda Hall, DeputyCommissioner, Community Health Improvement Division, Texas Department of State Health Services.]

DOCTOR HALL WILL GIVE AN UPDATE ON THE TEXAS AIM PROGRAM.

[00:40:01]

THANK YOU VERY MUCH FOR JOINING US, MISS HALL.

ARE YOU ON? GOOD MORNING EVERYONE. CAN YOU SHARE MY SLIDES, PLEASE? YES, I'M WORKING ON IT. THANK YOU. OKAY. WHILE SHE'S GETTING MY SLIDES UP, I WILL INTRODUCE MYSELF.

I'M DOCTOR AMANDA HALL. I'M THE DEPUTY COMMISSIONER FOR THE COMMUNITY HEALTH IMPROVEMENT DIVISION HERE AT DSHS.

MY DIVISION OVERSEES THE MAJORITY OF OUR MATERNAL AND CHILD HEALTH PROGRAMS HERE AT DSHS.

AND I'M HERE TODAY TO SHARE WITH YOU ALL SOME INFORMATION ON ONE OF OUR KEY MATERNAL HEALTH AND SAFETY PROGRAMS, WHICH IS TEXAS AIM. NEXT SLIDE PLEASE. SO BEFORE WE START TALKING SPECIFICALLY ABOUT TEXAS AIM, I WANTED TO SHARE WITH EVERYBODY HERE WHAT IS OUR HEALTHY TEXAS MOTHERS AND BABIES FRAMEWORK.

THIS FRAMEWORK IS REALLY WHERE ALL OF OUR INFANT, MATERNAL AND WOMEN'S HEALTH PROGRAM LIVES WITHIN OUR DIVISION. THIS FRAMEWORK IS REALLY DRIVEN BY FIVE DIFFERENT PILLARS.

YOU CAN SEE THEM HERE ON THE SCREEN. THAT INCLUDES INDIVIDUAL AND PUBLIC AWARENESS AND KNOWLEDGE PROFESSIONAL EDUCATION, COMMUNITY EMPOWERMENT AND IMPROVEMENT. AND THEN FINALLY OUR PERINATAL QUALITY IMPROVEMENT NETWORK.

AND THIS THIS NETWORK IS WHERE I'M GOING TO FOCUS TODAY, BECAUSE THAT IS ACTUALLY WHERE OUR TEXAS AIM INITIATIVES LIVE.

IN ADDITION TO THAT, THERE ARE OTHER PROGRAMS THAT FOLKS MAY HAVE SOME FAMILIARITY WITH THAT INCLUDES THE MATERNAL MORTALITY AND MORBIDITY REVIEW COMMITTEE WHICH IS HERE AT DSHS. YOU'RE GOING TO GET A PRESENTATION AFTER THIS ON SOME OF OUR CONGENITAL SYPHILIS EFFORTS THAT ARE ALSO WITHIN THIS FRAMEWORK.

AND THEN SOME OF OUR OTHER WORK ARE WITH OUR STATE PERINATAL QUALITY COLLABORATIVE, WHICH IS THE TEXAS COLLABORATIVE FOR HEALTHY MOTHERS AND BABIES.

NEXT SLIDE PLEASE. TO SHARE A LITTLE BIT ABOUT WHAT AME IS.

AME STANDS FOR THE ALLIANCE FOR THE INNOVATION OF MATERNAL HEALTH.

THIS IS A NATIONAL PROGRAM THAT KIND OF BROUGHT TOGETHER EXPERTS TO PUT TOGETHER BEST PRACTICES AROUND CONDITION SPECIFIC THAT BUNDLES THAT IMPACT MATERNAL HEALTH OUTCOMES.

AND SO THERE ARE DIFFERENT MATERNAL HEALTH AND SAFETY BUNDLES.

YOU CAN ACTUALLY GO TO THEIR WEBSITE AT THE NATIONAL LEVEL AND READ MORE ABOUT THEM.

BUT IT'S REALLY CENTERED AROUND WHAT THEY CALL THE FIVE R'S.

SO THESE ARE READINESS WHICH IS GETTING EVERY UNIT PREPARED AND READY IN CASE THERE IS SOME SORT OF SOMETHING THAT HAPPENS, LIKE AN OBSTETRIC HEMORRHAGE OR A PREGNANT MOM THAT COMES IN AND HAS SEVERE RANGE OF BLOOD PRESSURES PREPARING AND EDUCATING AROUND THAT BEING ABLE TO RECOGNIZE AND PREVENT THE BAD OUTCOMES FROM HAPPENING.

RESPONSE, WHICH IS HAVING A TEAM APPROACH TO RESPONDING WHENEVER THESE EVENTS HAPPEN REPORTING AND SYSTEMS LEARNING SO THAT WE ARE LEARNING FROM WHAT HAPPENED AND THEN REALLY RESPECTFUL AND SUPPORTIVE CARE, WHICH IS WHERE WE'RE ACTUALLY ENGAGING PATIENTS AND FAMILIES IN THEIR CARE.

NEXT SLIDE. TEXAS AIM ITSELF HAS TWO COMPONENTS.

SO WHAT HAPPENS WITH TEXAS AIM IS THAT WE WILL WE WILL LAUNCH A BUNDLE AROUND A SPECIFIC TOPIC.

AND HOSPITALS PUT TOGETHER THEIR HOSPITAL IMPROVEMENT TEAMS. THESE TEAMS CAN THEN CHOOSE TO PARTICIPATE IN EITHER A BASIC OR A PLUS LEVEL.

IF YOU ARE A TEXAS AIM BASIC HOSPITAL, YOU GET ACCESS TO OUR QUALITY IMPROVEMENT WEBINARS NETWORKING OPPORTUNITIES WITH OTHER HOSPITALS.

WE DO PROVIDE SOME TECHNICAL ASSISTANCE AND RECOGNITION OF PARTICIPATION.

IF YOU DECIDE TO PARTICIPATE AS A PLUS HOSPITAL, WHICH THE MAJORITY OF HOSPITALS IN TEXAS PARTICIPATING IN THIS PROGRAM ARE, PLUS HOSPITALS, YOU GET ALL OF THOSE ITEMS THAT I MENTIONED WITH THE BASIC PROGRAM, BUT YOU GET A LOT MORE SUPPORT, ENHANCED SUPPORT, AND YOU ARE ALSO REALLY SIGNING ON TO BE PART OF OUR LEARNING COLLABORATIVE.

AAM. SO IN ADDITION WE HAVE TARGETED FACULTY TO SUPPORT WE HAVE COACHING AND TRAINING CALLS.

WE CAN PROVIDE SITE VISITS TO HOSPITAL TEAMS. AS I MENTIONED YOU HAVE AN OPPORTUNITY TO PARTICIPATE IN OUR COLLABORATIVE LEARNING PEER TO PEER MENTORING AND THEN A BUNCH OF DIFFERENT RESOURCES AND PARTNERSHIPS THE WAY THAT THE PROGRAM IS SET UP IS THAT WE HAVE ACTUALLY TEXAS AIM FACULTY.

THESE ARE PHYSICIANS AND NURSES. AND ALSO WE HAVE FAMILY MEMBERS, WOMEN WHO HAVE BEEN IMPACTED BY MATERNAL MORBIDITY, AS WELL AS OUR PROGRAM TEAM HERE AT DSHS WHO ARE REALLY SUPPORTING THESE HOSPITALS AND DRIVING OUR PROGRAMING.

[00:45:03]

WE HAVE DIVIDED THE STATE INTO OUR LEARNING COLLABORATIVES.

AND THESE LEARNING COLLABORATIVES ACTUALLY COME TOGETHER IN PERSON THREE TIMES DURING THE COURSE OF PARTICIPATION IN THE PROGRAM.

AND SO WE WILL HAVE A LEARNING SESSION. HOSPITALS COME TOGETHER.

THEY'RE LEARNING FROM FACULTY, LEARNING FROM OUR STAFF.

THEY'RE LEARNING FROM EACH OTHER. AND THEN THEY TAKE IT BACK TO THEIR HOSPITAL.

AND THEN WE HAVE KIND OF AN IMPLEMENTATION PERIOD BACK AT THE HOSPITAL ITSELF, WHERE WE'RE ACTUALLY IMPLEMENTING SOME OF THESE BEST PRACTICES THAT WE HAVE BEEN TALKING ABOUT. WE HAVE ONGOING CALLS, WEBINARS, ADDITIONAL SUPPORTS DURING THAT TIME PERIOD, AND THEN THEY WILL COME BACK TOGETHER FOR THAT SECOND AND THEN THAT THIRD IN-PERSON LEARNING SESSION. NEXT SLIDE. WE ACTUALLY LAUNCHED THE PROGRAM BACK IN 2018.

WE BEGAN WITH THE OBSTETRIC HEMORRHAGE BUNDLE.

WE KNOW THAT IF WE LOOK AT THE DATA AND WE LOOK AT PREVENTABLE PREGNANCY RELATED DEATHS, WE KNOW THAT OBSTETRIC HEMORRHAGE IS ONE OF THOSE TOP CAUSES OF PREVENTABLE PREGNANCY RELATED DEATHS.

WE THEN LAUNCHED SEVERE HYPERTENSION IN PREGNANCY.

OUR EFFORTS IN THAT BUNDLE WERE IMPACTED, LIKE SO MANY DIFFERENT THINGS BY THE PANDEMIC.

AND DURING THAT TIME PERIOD, WE REALLY SWITCHED OUR INFRASTRUCTURE TO HELP SUPPORT A HOSPITAL'S LABOR AND DELIVERY UNITS DURING THE COVID 19 PANDEMIC.

AND THEN WE RELAUNCHED THE SEVERE HYPERTENSION AND PREGNANCY BUNDLE IN 2022.

IN ADDITION TO THAT, WE LAUNCHED AN OPIOID AND SUBSTANCE USE DISORDER BUNDLE.

WE RELAUNCHED IT IN 2023. THIS WAS A RELAUNCH BECAUSE WE WERE ORIGINALLY HAD LAUNCHED THE BUNDLE AND THE NATIONAL BUNDLE REALLY ONLY FOCUSED ON OPIOID USE DISORDER. AT THE NATIONAL LEVEL, THEY REALLY REALIZED THAT WE NEEDED TO BE FOCUSING ON MORE THAN JUST OPIOID USE DISORDER.

WE NEEDED TO THINK ABOUT ALL SUBSTANCE USE DISORDER.

AND PREGNANT WOMEN. AND SO THEY ACTUALLY RELAUNCHED IT AT THE THE FEDERAL LEVEL.

THIS BUNDLE IS DIFFERENT THAN MANY OF THE OTHER BUNDLES THAT WE HAVE IMPLEMENTED, AND THAT THERE IS A LARGER OUTPATIENT COMPONENT.

AND WE REALLY FOCUSED ON HAVING A MUCH SMALLER GROUP OF HOSPITALS PARTICIPATE SO THAT WE COULD THEN WORK ON HOW WE WOULD THEN LAUNCH THIS KIND OF AS A STATEWIDE BUNDLE.

AND THEN WE HAVE OTHER FUTURE BUNDLES. AND I'LL TALK A LITTLE BIT ABOUT THAT IN A LATER SLIDE.

NEXT SLIDE PLEASE. AS I SAID BEFORE, WHEN WE LAUNCHED IN 2018, WE STARTED WITH THE OBSTETRIC HEMORRHAGE BUNDLE.

WE HAD 98% OF BIRTHING HOSPITALS IN TEXAS PARTICIPATE IN THIS BUNDLE.

THAT REPRESENTED ALMOST 380,000 WOMEN THAT THEY TAKE CARE OF EVERY YEAR.

AND OVER 99% OF BIRTHS IN THE STATE OF TEXAS WERE IN HOSPITALS THAT WERE IMPLEMENTING THIS BUNDLE.

SO IT HAD HAS A HUGE IMPACT STATEWIDE. BUT ALSO AS A NATION, WE ARE ACTUALLY WE'RE RESPONSIBLE FOR ABOUT 10% OF THE NATION'S BIRTH HERE IN THE STATE OF TEXAS.

SO IF WE CAN MAKE CHANGE HAPPEN HERE, WE HAVE THE OPPORTUNITY TO IMPACT IT ON A NATIONAL LEVEL.

WHEN YOU LOOK OVER TO THE RIGHT, YOU WILL SEE A MAP OF THE STATE OF TEXAS.

IT'S A LITTLE BIT HARD TO SEE, BUT YOU WILL SEE THAT WE'VE GOT THE STATE DIVIDED OUT INTO FIVE DIFFERENT LEARNING COLLABORATIVES, THOSE THAT WAS THE GEOGRAPHY OF THOSE INITIAL KIND OF LEARNING COLLABORATIVE GROUPS.

AND THEN YOU CAN SEE THE DIFFERENT HOSPITALS LABELED THERE.

YOU CAN ACTUALLY GO TO TEXAS HEALTH DATA NOW AND YOU CAN ACTUALLY LOOK UP TEXAS A&M.

YOU CAN SEE SOME OF THE METRICS FROM WHEN WE LAUNCHED THE OBSTETRIC HEMORRHAGE BUNDLE.

AND YOU CAN ACTUALLY GO TO AN INTERACTIVE MAP NOW AND SEE IF A HOSPITAL IS PARTICIPATING IN THE PROGRAM.

NEXT SLIDE. WHEN WE IMPLEMENT THIS BUNDLE, WE HAVE TO HAVE A WAY THAT WE CAN MEASURE HOW WE ARE DOING IN IMPLEMENTING THE BUNDLE. AND SO ALL OF OUR BUNDLES HAVE A FAMILY OF MEASURES, AND THEY'RE DIVIDED INTO PROCESS STRUCTURE AND OUTCOME MEASURES.

THE PROCESS AND STRUCTURE MEASURES REALLY ARE MEASURING THOSE DIFFERENT INTERVENTIONS, THOSE THINGS THAT WE'RE IMPLEMENTING.

AND THEN OUR GOAL IS THEN OF COURSE, TO SEE CHANGES IN THOSE OUTCOME MEASURES, AND YOU CAN SEE SOME OF THE PROCESS STRUCTURE AND OUTCOME MEASURES HERE ON THIS SLIDE. AND IF YOU GO TO THE NEXT SLIDE. NEXT SLIDE PLEASE.

THIS WAS SOME OF THE OUTCOMES THAT WE SAW WITH THE WITH THE IMPLEMENTATION OF THAT FIRST BUNDLE.

THESE ARE THREE OF OUR PROCESS AND STRUCTURE MEASURES THAT WE THAT WE HIGHLIGHT FROM THE OBSTETRIC HEMORRHAGE BUNDLE.

[00:50:02]

AND YOU CAN SEE HERE THAT WE SAW FOR THOSE HOSPITALS THAT WERE PARTICIPATING AND THEY WERE PROVIDING US DATA.

WE SAW IMPROVEMENT IN STAGE BASED MANAGEMENT PLANS, RISK LEVEL ASSESSMENT AND LEVEL ASSIGNED TO PATIENTS.

AND THEN FINALLY QUANTIFICATION AND CUMULATIVE MEASUREMENT OF BLOOD LOSS THROUGH RECOVERY.

SO YOU CAN SEE HERE WE SAW QUITE A BIT OF IMPROVEMENT.

AND THEN IF YOU GO TO THE NEXT SLIDE. WE ACTUALLY SAW IMPROVEMENTS IN SEVERE MATERNAL MORBIDITY FOR THOSE HOSPITALS THAT WERE PARTICIPATING IN THE BUNDLE AND PUTTING THEIR DATA IN DURING THAT TIME PERIOD.

NEXT SLIDE. WE THEN HAD LAUNCHED OUR TEXAS AIM SEVERE HYPERTENSION BUNDLE.

AS I SAID BEFORE, WE HAD OUR INITIAL KICKOFF IN DECEMBER OF 2020 THAT GOT IMPACTED BY COVID.

BUT SOME OF THE KEY THINGS THAT WE WERE DOING IN THIS BUNDLE, REALLY FOCUSING ON ADDRESSING HEALTH DISPARITIES AND CENTERING PATIENT AND FAMILY SUPPORT IN THIS BUNDLE. WE THEN RELAUNCHED IN 2022 AND BEGAN OUR LEARNING COLLABORATIVE AGAIN IN JANUARY OF 2023, HAD OUR IN-PERSON LEARNING SESSIONS. AS I SAID, THOSE ARE WHERE THE HOSPITALS ARE COMING TOGETHER AND LEARNING FROM EACH OTHER AROUND IMPLEMENTATION. WE HAVE WHAT WE CALL A HARVEST MEETING.

WE BRING HOSPITALS, HIGH PERFORMING HOSPITALS TOGETHER AT THE.

TOWARDS THE END OF BUNDLE IMPLEMENTATION SO WE CAN LEARN FROM THEM.

WHAT DID WE DO WELL WHAT DID WE DO RIGHT? WHAT DO WE NEED TO IMPROVE ON? WHAT REALLY HELPED YOU TO BE SUCCESSFUL IN BUNDLE IMPLEMENTATION? AND THEN WE ACTUALLY CAME TOGETHER IN DECEMBER OF THIS PAST YEAR, WHERE WE REALLY RECOGNIZED THOSE HOSPITALS THAT WERE PARTICIPATING IN THE SEVERE HYPERTENSION AND PREGNANCY BUNDLE.

AND THEN WE ALSO LAUNCHED THE NEXT BUNDLE IN OUR SERIES, WHICH IS THE SEPSIS BUNDLE.

NEXT SLIDE. LOOKING AT SEVERE HYPERTENSION AND PREGNANCY, THIS BUNDLE ALSO HAD OVER 90% OF BIRTHING HOSPITALS IN TEXAS PARTICIPATING IN THIS BUNDLE.

ONCE AGAIN, YOU CAN SEE THE NUMBERS AS FAR AS IMPACT GOES AROUND THE NUMBER OF WOMEN THAT THESE HOSPITALS SERVE, AS WELL AS THE IMPACT OF BURSTS NOT ONLY HERE IN THE STATE BUT ALSO IN THE NATION.

NEXT SLIDE. THESE ARE THE MEASURES THAT WE HAD FOR THIS PARTICULAR BUNDLE.

YOU CAN SEE ONCE AGAIN PROCESS STRUCTURE AND OUTCOME MEASURES.

AND THEN ON THE NEXT SLIDES I'M GOING TO SHARE WITH YOU ALL SOME OF THE DATA THAT WE HAVE SEEN FROM THIS BUNDLE IMPLEMENTATION.

SO THE FIRST MEASURE THAT I WANTED TO SHARE WITH YOU ALL WAS LOOKING AT SIMULATION AND DRILLS WITH DEBRIEFS.

SO DID THE HOSPITAL SYSTEMATICALLY AND ROUTINELY CONDUCT UNIT BASED DRILLS RELATED TO SEVERE HYPERTENSION AND PREECLAMPSIA.

AND YOU CAN SEE HERE FOR THOSE HOSPITALS THAT WERE PARTICIPATING AND INPUTTING THEIR DATA, WE SAW ABOUT A 40% IMPROVEMENT IN THOSE HOSPITALS HAVING THESE SIMULATIONS AND DRILLS WITH DEBRIEFS IN PLACE.

NEXT SLIDE. ANOTHER KEY ASPECT OF IMPLEMENTING THESE BUNDLES ARE AROUND WHAT WE CALL OUR URGENT MATERNAL WARNING SIGNS, AND REALLY HAVING EDUCATION FOR ALL PREGNANT AND POSTPARTUM PATIENTS AND THEIR SUPPORT NETWORKS.

SO THESE ARE SIGNS THAT WE SHOULD BE PAYING ATTENTION TO, TO LET US KNOW THAT THERE MAY BE SOMETHING GOING ON AND THAT A WOMAN NEEDS TO REALLY BE EVALUATED AND WE NEED TO PAY ATTENTION TO.

AND YOU CAN ALSO SEE HERE THAT WE DID SEE A 51% IMPROVEMENT IN THOSE HOSPITALS PARTICIPATING AND HAVING THAT POLICY AND PROCESS TO PROVIDE THAT TO PREGNANT AND POSTPARTUM WOMEN AND THEIR SUPPORT NETWORKS.

NEXT SLIDE. AND THIS IS A VERY BIG EFFORT THAT WE HAVE BEEN LOOKING AT, ACTUALLY, NOT ONLY THROUGH TEXAS AIM, BUT THROUGH OUR TEXAS COLLABORATIVE FOR HEALTHY MOTHERS AND BABIES IS REALLY AROUND THIS SCREENING FOR PREGNANCY STATUS. IN THE EMERGENCY DEPARTMENT.

WE KNOW THAT'S REALLY IMPORTANT BECAUSE HOW YOU TREAT A PATIENT CHANGES DEPENDING ON THEIR PREGNANCY STATUS.

AND SO YOU CAN SEE HERE WE STILL HAVE A ROOM TO GO, BUT WE HAVE SEEN QUITE A BIT OF IMPROVEMENT IN THOSE HOSPITALS AROUND HAVING THAT STANDARDIZED VERBAL SCREENING IN THE EMERGENCY DEPARTMENT.

NEXT SLIDE. AND THEN FINALLY PATIENT AND FAMILY SUPPORT AROUND OUR STRUCTURE MEASURES.

AND THIS IS REALLY WHERE WE HAVE THOSE RESOURCES AND PROTOCOLS FOR THOSE FAMILIES AFTER THEY HAVE HAD A COMPLICATION.

AND ONCE AGAIN WE HAVE ROOM HAVE PLENTY OF ROOM TO CONTINUE TO IMPROVE.

[00:55:04]

BUT WE HAVE SEEN SOME IMPROVEMENT IN THOSE HOSPITALS THAT WERE PARTICIPATING IN THE BUNDLE IMPLEMENTATION. NEXT SLIDE.

AND THEN RESPECTFUL AND SUPPORTIVE CARE. AND THAT'S REALLY AROUND FOSTERING THAT CULTURE WITHIN THE HOSPITAL ITSELF.

AND ONCE AGAIN YOU CAN SEE HERE THE IMPROVEMENT WE SAW IN THE HOSPITALS.

NEXT SLIDE. WE'RE GOING TO SWITCH TO SOME PROCESS MEASURES NOW.

THE OUR FACULTY CAME TOGETHER AND REALLY SAID THAT THERE WERE THREE PROCESS MEASURES THAT WE REALLY NEEDED TO FOCUS ON TO REALLY HELP ENSURE THAT WE WERE IMPROVING MATERNAL HEALTH OUTCOMES. AND THE FIRST ONE WAS AROUND TIMELY TREATMENT OF PERSISTENT AND SEVERE HYPERTENSION.

AND THIS WAS AROUND GETTING THAT TREATMENT WITHIN 60 MINUTES OF ONSET OF THAT FIRST EPISODE.

YOU CAN SEE HERE THAT WE DID SEE IMPROVEMENT IN THE HOSPITALS THAT WERE PARTICIPATING IN THE BUNDLE.

WE WERE STARTING AT ALREADY ABOUT 57% AND THEN DID SEE THAT 30% IMPROVEMENT.

AND THEN IF YOU GO TO THE NEXT SLIDE, THE NEXT TWO PROCESS MEASURES ARE REALLY GOING TO BE AROUND.

FOLLOW UP PATIENT FOLLOW UP. NEXT SLIDE PLEASE.

AND THIS FOLLOW UP IS REALLY DEPENDENT ON REALLY WHAT HAPPENED WITHIN THE CONTEXT OF DELIVERY FOR THAT PATIENT? IF THAT THAT DELIVERY WAS COMPLICATED BY SEVERE HYPERTENSION, SEVERE PREECLAMPSIA, OR THE SYNDROME, THEN YOU REALLY WANT TO HAVE THAT WOMAN FOLLOW UP WITHIN THREE DAYS OF DISCHARGE.

AND YOU CAN SEE HERE THAT WE DID SEE IMPROVEMENT WITH OUR HOSPITALS.

AND THEN IF WE GO TO THE NEXT SLIDE PLEASE. WHEN WE LOOK AT WOMEN WHO HAD PREECLAMPSIA NOT QUITE AS SEVERE AN OUTCOME, GESTATIONAL OR CHRONIC HYPERTENSION, YOU WANT TO HAVE THEM FOLLOWED UP WITHIN SEVEN DAYS.

AND WE ALSO SAW IMPROVEMENTS IN THIS IN THIS PROCESS MEASURE FOR THOSE HOSPITALS PARTICIPATING.

SO NEXT SLIDE. SO WE WERE REALLY HAPPY TO SEE THOSE IMPROVEMENTS AND THOSE PROCESS AND THOSE STRUCTURE MEASURES FOR OUR HOSPITALS. BECAUSE AS I SAID, WHEN WE START SEEING IMPROVEMENTS IN THOSE MEASURES, THEN THAT SHOULD LEAD TO SEEING IMPROVEMENTS IN OUR OUTCOME MEASURES, WHICH ARE REALLY FOCUSED ON SEVERE MATERNAL MORBIDITY.

AND THOSE WERE KIND OF LOOKING AT THE BUNDLES THAT HAVE BEEN IMPLEMENTED.

WE HAVE OTHER KIND OF EXCITING THINGS THAT WE'RE DOING WITHIN THE PROGRAM.

ONE OF THEM, AS YOU CAN SEE HERE ON THIS SCREEN, IS WHAT WE'RE CALLING OUR SUSTAINABILITY AND READINESS STRATEGY.

THIS IS REALLY OPPORTUNITIES TO ENHANCE THE WORK THAT IS ALREADY BEING DONE AROUND BUNDLE IMPLEMENTATION.

WE'RE FOCUSING ON WHAT WE'RE CALLING OUR PATIENT FAMILY PARTNER ENGAGEMENT LEARNING NETWORK.

AND THAT'S REALLY AROUND HOW DO WE HELP HOSPITAL TEAMS HAVE PATIENTS AND FAMILIES ENGAGED IN THEIR CARE.

WE'RE ALSO DOING A SELF BLOOD PRESSURE MONITORING BLOOD PRESSURE CUFF PROJECT.

AS I SHARED, SOME OF OUR KEY PROCESS MEASURES WERE AROUND FOLLOW UP AND GETTING WOMEN IN IN A TIMELY MANNER.

WE WOMEN CAN GO HOME. BUT IF YOU DON'T HAVE A BLOOD PRESSURE CUFF TO CHECK YOUR BLOOD PRESSURE, WE'RE NOT GOING TO BE ABLE TO MONITOR AND KNOW HOW SOMEONE MAY BE DOING.

AND WE SAW THAT THERE WERE GAPS IN THE ABILITY FOR HOSPITALS TO ALWAYS BE ABLE TO DISCHARGE WOMEN HOME WITH BLOOD PRESSURE CUFFS.

SO WE'VE BEEN ABLE TO PROVIDE BLOOD PRESSURE CUFFS IN PARTNERSHIP WITH THE PREECLAMPSIA FOUNDATION, THE HOSPITALS THAT WERE INTERESTED IN THIS KIND OF PILOT PROJECT WE HAD A LOT OF ENTHUSIASM.

WE HAD TO TURN PEOPLE AWAY. SO WE'RE HOPEFUL THAT WE'LL BE ABLE TO CONTINUE WITH THIS PROJECT AFTER THE PILOT.

WE'RE DOING ONGOING QUALITY IMPROVEMENT, MENTORING AND SIMULATION TRAINING.

A BIG PART OF THE AIM PROGRAM IS ACTUALLY SIMULATION.

SO IT'S REALLY THAT PRACTICING AND TRAINING BEFORE AN INCIDENT HAPPENS SO THAT YOU ARE READY TO RESPOND.

WE HAVE A FACULTY CHAIR WHO REALLY LEADS THESE EFFORTS.

WE'VE WORKED WITH HOSPITALS TO ENSURE THAT THEY HAVE THE EQUIPMENT THAT THEY NEED TO BE ABLE TO CONDUCT THESE SIMULATIONS.

AND WE'RE REALLY WANTING TO FOCUS ON KIND OF THIS TRAIN THE TRAINER MODEL SO THAT WE CAN TRAIN FOLKS TO THEN GO BACK INTO THEIR HOSPITALS AND RUN THE SIMULATIONS AND TRAIN OTHER FOLKS THERE. WE HAVE A LOT OF OPPORTUNITIES AROUND CONTINUING EDUCATION.

WE HAD A MATERNAL LEVELS OF CARE SURVEY OR TRAINING SERIES THAT WE CONDUCTED LAST SUMMER.

WE DO THIS THROUGH OUR TEXAS AIM SUMMIT AND WE LAUNCHED BACK IN JANUARY WHAT WE ARE CALLING OUR DSHS PERINATAL ACADEMY.

SO THIS IS WE'RE HOSTING THIS ABOUT ONCE A MONTH.

WE DO IT AT 7 A.M., SO HOPEFULLY WE CAN CATCH PEOPLE ON SHIFT CHANGES.

AND WE'RE REALLY WANTING TO FOCUS ON THOSE BUNDLES THAT WE HAVE ALREADY IMPLEMENTED.

WE KNOW THAT WE CAN'T IMPLEMENT A BUNDLE AND BE DONE WITH IT.

[01:00:02]

YOU HAVE TO CONTINUE TO REINFORCE THOSE THINGS THAT WE HAVE LEARNED AND WE HAVE DONE THROUGH BUNDLE IMPLEMENTATION, SO WE DON'T LOSE THE GAINS THAT WE HAVE MADE.

AND SO THAT'S REALLY A FOCUS OF THIS PERINATAL ACADEMY.

IT ALSO PROVIDES COURSES FOR THOSE THAT PARTICIPATE.

WE ALSO ARE PUTTING TOGETHER A LOT OF ON DEMAND CONTINUING EDUCATION FOR MATERNAL SAFETY READINESS, AND THEN ALSO ACCESS TO THIS II OPEN SCHOOL ACCESS, WHICH REALLY SUPPORTS QUALITY IMPROVEMENT.

AND THE NEXT SLIDE. OUR ROADMAP, AS I SAID, BACK IN DECEMBER, WE HELD OUR TEXAS AIM SUMMIT HERE IN AUSTIN WHERE WE WRAPPED UP OUR PREVIOUS BUNDLE WORK, BUT WE LAUNCHED OUR SEPSIS BUNDLE.

WE'RE CURRENTLY ENROLLING HOSPITALS RIGHT NOW, AND THEY HAVE TO BEGIN WHAT THEY CALL PRE-WORK.

SO THEY ARE PUTTING TOGETHER THEIR HOSPITAL TEAMS, BUT IT ALSO MEANS OUR FACULTY IS COMING TOGETHER AND DOING A LOT OF THE WORK ON THE FRONT END TO GET PREPARED FOR WHAT WILL BE OUR FIRST LEARNING SESSIONS, IN-PERSON LEARNING SESSIONS, WHICH ARE GOING TO TAKE PLACE IN JUNE. AND THAT IS ACTUALLY GOING TO BE IN CONJUNCTION WITH OUR TCMPB TEXAS COLLABORATIVE FOR HEALTHY MOTHERS AND BABIES SUMMIT, WHICH WILL ALSO BE HERE IN JUNE IN AUSTIN AND JUNE AS WELL.

WE'RE ALSO LOOKING AT LAUNCHING OUR MENTAL HEALTH AND SUBSTANCE USE DISORDER BUNDLE.

WHENEVER WE LAUNCHED OUR OPIOID AND SUBSTANCE USE DISORDER BUNDLE, WE FOUND OUT VERY QUICKLY THAT WE COULDN'T TALK ABOUT OPIOID AND SUBSTANCE USE DISORDER WITHOUT TALKING ABOUT MENTAL HEALTH. AND SO THERE ARE ACTUALLY MENTAL HEALTH BUNDLES AT THE NATIONAL PROGRAM.

AND WE BEGAN TO PULL IN COMPONENTS AROUND THE MENTAL HEALTH BUNDLE INTO OUR WORK.

OUR PLANS ARE TO ACTUALLY HAVE AN OUTPATIENT AND AN INPATIENT ARM.

OUR GOAL IS TO LAUNCH THE OUTPATIENT ARM IN SPRING OF 2026, AND OUR INPATIENT ARM IN WINTER OF 2027.

AND JUST A REALLY QUICK SHAMELESS PLUG. WE DO HAVE A TEXAS AIM SUBSTANCE USE DISORDER, DSHS GRAND ROUNDS.

IF FOLKS ARE MORE INTERESTED IN LEARNING MORE ABOUT THIS TOPIC AND THE WORK THAT IS BEING DONE IN THIS SPACE, AND IT'S GOING TO TAKE PLACE ON MARCH 26TH. YOU CAN ACTUALLY REGISTER ONLINE.

AND THEN FINALLY, WE ARE LOOKING TO DECEMBER OF 2028 TO LAUNCH OUR CARDIAC CONDITIONS AND OBSTETRIC CARE.

SO YOU CAN SEE HERE WE'VE GOT OUR PLANS OUT TO 2028 ON THE ORDER OF BUNDLES THAT WE ARE PLANNING TO LAUNCH.

AND NEXT SLIDE PLEASE. AND THAT IS IT. SO I'M HAPPY TO TAKE ANY QUESTIONS FOLKS MAY HAVE.

THANK YOU SO MUCH DOCTOR HOLT. IT'S A GREAT PRESENTATION.

SO I'M AN OBSTETRICIAN BY TRAINING AND I'VE BEEN VERY INVOLVED AS WELL WITH THE WITH THE IMPLEMENTATION AND STARTING OF THESE BUNDLES.

AND IT'S BEEN A GREAT WORK AND I APPRECIATE YOU VERY MUCH.

REALLY, REALLY IMPORTANT FOR THE SAFETY OF OUR PATIENTS.

HOWEVER, I HAVE TO SAY THAT I'M A LITTLE DISAPPOINTED AT SOME OF THE OF THE OUTCOME AS WE CELEBRATE THE IMPROVEMENT BY 36% AND SO FORTH. LIKE EVEN THE ONE HOUR MEDICATION FOR A PATIENT WITH HYPERTENSION IS UP TO 75%, WHICH IS, IN MY OPINION, STILL A MAJOR FAILURE. SAME THING AS WELL WITH THE YOU KNOW, THE THREE DAY FOLLOW UP IS ONLY DOWN TO 52 OR 57% IMPROVEMENT AFTER THE BUNDLE HAS BEEN IMPLEMENTED.

THE POSTPARTUM HEMORRHAGE TILL TODAY, I HAVE PHYSICIANS IN MY HOSPITAL THAT REFUSE TO USE QUANTITATIVE BLOOD LOSS AND USE ESTIMATED BLOOD LOSS.

AND I CAN'T TELL YOU HOW MANY PATIENTS THAT I HAVE TO REVIEW IN MY HOSPITAL WHERE POSTPARTUM HEMORRHAGE COULD HAVE BEEN EASILY PREVENTED IF THAT PHYSICIAN HAD JUST FOLLOWED THE BUNDLE AS AS INDICATED AS A SIMPLE CHECKLIST.

AND IT'S SO HARD TO GET SOME OF THE PHYSICIANS WHO ARE EXTREMELY BUSY IN THEIR PRACTICE THINK THEY KNOW WHAT THEY'RE DOING FOR A LONG TIME TO ACTUALLY SIT DOWN AND LISTEN OR COME TO A DRILL TO SEE, OH MY GOD, THIS MAKES SO MUCH MORE SENSE THAT I'VE BEEN DOING.

SO WHAT IS IT THAT THIS THAT THAT THE STATE IS DOING TO HELP EDUCATE THOSE PHYSICIANS, AT LEAST COMMUNICATE TO THEM.

AND I'M NOT SAYING THEY'RE BAD PHYSICIANS. THEY'RE EXCELLENT PHYSICIANS, EXCEPT THEY JUST NOT USING CHECKLISTS. THEY JUST FEEL LIKE THEY'VE BEEN TRAINED FOR SO LONG. THEY KNOW WHAT THEY'RE DOING, AND THEY DON'T HAVE THE TIME TO STOP AND ACTUALLY REALIZE THAT, OH MY GOD, THIS ACTUALLY CAN SAVE LIVES. SO I APPRECIATE THE QUESTION AND YOU ARE CORRECT.

AND THAT WE WE HAVE TO REINFORCE SOME OF THE THINGS THAT WE'VE ALREADY DONE IN THOSE PREVIOUS BUNDLES.

THAT'S WHY WE HAVE ACTUALLY LAUNCHED THIS SUSTAINABILITY AND READINESS STRATEGY.

I HAD A LOT OF THINGS LISTED ON THAT SLIDE, BUT A LOT OF OUR FOCUS IS IN REINFORCING EXACTLY WHAT YOU'RE TALKING ABOUT WITH OBSTETRIC HEMORRHAGE AROUND DOING THAT QUANTITATIVE BLOOD LOSS. WE ARE ALSO HAVE PUT TOGETHER REALLY THESE MENTOR TYPE ROLES THAT ARE GOING TO BE

[01:05:01]

PHYSICIAN AND NURSES. AND THEY CAN ACTUALLY WILL BE GOING DIRECTLY TO HOSPITALS WHO NEED ADDITIONAL SUPPORT TO HELP THEM AROUND THE QUALITY IMPROVEMENT.

SO THAT'S KIND OF EXPANDING OUR OUR FACULTY TO REALLY HAVE THE OPPORTUNITY TO GO IN AND PROVIDE KIND OF MORE ONE ON ONE KIND OF EDUCATION AND SUPPORT FOR THESE DIFFERENT HOSPITALS.

WHEN WE HAVE TALKED TO OTHER STATES CALIFORNIA, FOR EXAMPLE THEY, THEY REDID THE OBSTETRIC HEMORRHAGE BUNDLE.

THEY DID IT, AND THEN THEY DID IT AGAIN. WE HAD THE BILL SAPPENFIELD, WHO OVERSEES, HAD BEEN WITH THE PERINATAL QUALITY IMPROVEMENT PERINATAL QUALITY COLLABORATIVE IN FLORIDA. AND THAT IS ONE OF HIS KEY MESSAGES IS THAT YOU DON'T IT'S NOT ONE AND DONE.

YOU HAVE GOT TO CONTINUE TO REINFORCE THOSE THINGS THAT WE HAVE DONE THROUGH BUNDLE IMPLEMENTATION.

AND THAT IS REALLY ONE OF THE KEYS FOR US AS WE HAVE IMPLEMENTED THIS SUSTAINABILITY AND READINESS STRATEGY, THE ONLY OTHER THING THAT WE ARE DOING IS THAT WE ARE PARTNERING FULL IMPLEMENTATION PARTNER WITH OUR STATE PERINATAL QUALITY COLLABORATIVE, WHICH IS THE TCMPB, WHICH IS ALSO ONE OF OUR KEY INITIATIVES UNDER THE PERINATAL QUALITY IMPROVEMENT NETWORK, WHICH IS REALLY GOING TO HELP US TO BE ABLE TO FURTHER REINFORCE THE WORK THAT IS BEING DONE.

I THINK THE FINAL PIECE OF THIS, AND WE'VE ALWAYS KIND OF SHARED THIS TEXAS AIM HAS ALWAYS BEEN WHAT WE CALL A COALITION OF THE WILLING.

THE PEOPLE WHO ARE PARTICIPATING IN THIS, THEIR VOLUNTEER, THEIR VOLUNTEERING, THE HOSPITAL TEAMS ARE VOLUNTEERING.

THE PEOPLE WHO ARE PARTICIPATING VOLUNTEER ARE VOLUNTEERING.

WE DON'T HAVE A MANDATE, A STATUTORY MANDATE THAT A HOSPITAL WILL PARTICIPATE.

AND SO WE'RE DOING EVERYTHING THAT WE CAN TO SHOW THE VALUE FOR HOSPITALS AND TEAMS TO PARTICIPATE AND TO REALLY HAVE THIS AS A RESOURCE TO THEM. THANK THANK YOU, DOCTOR HALL, AND I APPRECIATE THAT.

AND OBVIOUSLY THE WILLING SHOULD BE MORE ABLE AND WILLING TO ACTUALLY DO THIS.

BUT BY THE SAME TOKEN, I KIND OF WISH THAT THERE IS SOME SORT OF AND I KNOW THAT THERE'S SOME SORT OF RELATIONSHIP BETWEEN THE MATERIAL DESIGNATION PROCESS AND THE IMPLEMENTATION OF THE BUNDLES, AND I JUST WISH IT WAS MORE ENFORCED FOR PEOPLE TO UNDERSTAND THE THE IMPORTANCE OF THIS, BECAUSE THESE, THESE EHM, BUNDLES HAVE ACTUALLY PROVEN TO, TO SAVE LIVES.

AND IT'S REALLY SAD FOR ME TO BE LIVING IN A STATE WHERE IT'S MORE LIKELY FOR WOMEN TO DIE HAVING A CHILD, HAVING A CHILD THAN IN CALIFORNIA, FOR INSTANCE.

THAT TO ME IS JUST HEARTBREAKING. AND THERE IS NO REASON FOR US NOT TO BE JUST AS GOOD.

EVEN BETTER IS JUST FOLLOW THE SCIENCE AND BE ABLE TO COMMUNICATE TO THE PHYSICIAN AND PROVIDE NURSING STAFF, AS WELL AS THE PATIENTS THEMSELVES, THAT IT IS A GROUP EFFORT.

SAFETY CULTURE DOESN'T GO JUST BY ONE, BY THE PHYSICIAN ONLY, OR THE NURSE ONLY, OR THE PATIENT ONLY.

IT TAKES EVERYBODY TO BE WILLING AND ABLE. THANK YOU AGAIN VERY MUCH FOR THE VERY IMPORTANT WORK THAT YOU DO, AND I APPRECIATE THAT. I WILL OPEN UP FOR ANYBODY TO HAVE ANY QUESTIONS FOR DOCTOR HALL.

THIS IS DAVID LEWIS OVER HERE. PUBLIC MEMBER, NOT A DOCTOR.

I REALLY DO APPRECIATE THE INROADS YOU'RE MAKING HERE.

IT'S QUITE IMPRESSIVE, ESPECIALLY GIVEN THE NUMBER OF HOSPITALS, CLINICS AND SO FORTH ACROSS THE STATE.

THE ONE PIECE THAT I DIDN'T QUITE UNDERSTAND OR WOULD LIKE TO BETTER UNDERSTAND IS, IS THE HOW WE ARE ENSURING THAT THE ESPECIALLY THE YOUNGER PATIENTS ARE MADE AWARE OF JUST HOW IMPORTANT IT IS TO MAKE SURE THEY SELECT A HOSPITAL, CLINIC OR SO FORTH THAT IS UTILIZING YOUR BUNDLES BECAUSE YOU DON'T YOU DON'T WANT TO SCARE THE NEW MOTHERS, BUT, YOU KNOW, IF THERE'S LIKE A PAMPHLET OR SOME QUICK DISCUSSION THAT THEY CAN SEE MAYBE IN HIGH SCHOOLS, IN COMMUNITY COLLEGES, UNIVERSITIES AND SO FORTH.

NOT EXACTLY SURE, BUT AT LEAST THEY SEE THE URGENCY OF MAKING SURE THAT THEY'RE GOING TO THE RIGHT DOCTORS, HOSPITALS AND SO FORTH SO THAT THIS DOESN'T HAPPEN TO THEM.

I ALSO APPRECIATE THAT. THAT'S A REALLY GREAT QUESTION.

I WILL SAY THAT ONE OF THE THINGS THAT WE HAVE DONE, I MENTIONED THIS AND I HIGHLY ENCOURAGE FOLKS WHO ARE INTERESTED IN THIS TOPIC, INTERESTED IN THE DATA TO GO TO OUR TEXAS HEALTH DATA WEBSITE.

YOU CAN ACTUALLY GO NOW AND SEE WHAT HOSPITALS ARE PARTICIPATING.

SO THAT'S ONE WAY TO DO IT. ANOTHER ARM OF OUR PROGRAM THAT I DIDN'T TALK ABOUT TODAY IS SOMETHING CALLED OUR HEAR HER TEXAS CAMPAIGN.

THIS IS OUR PUBLIC AWARENESS CAMPAIGN AROUND MATERNAL HEALTH AND SAFETY.

AND TO ME, THE NAME REALLY KIND OF SAYS IT ALL.

WE NEED TO BE LISTENING TO TO OUR TO OUR PATIENTS, TO OUR FAMILY MEMBERS.

ON. IF THEY ARE SAYING THAT SOMETHING IS WRONG, THEY NEED TO BE EVALUATED.

[01:10:01]

THEY NEED TO BE SEEN. BUT WE NEED TO ALSO EDUCATE WOMEN ON WHAT THEY NEED TO BE THINKING ABOUT AND KNOWING ABOUT, WITH, WITH THEIR OWN BODIES. AND SO IF YOU GO TO HEAR HER TEXAS, YOU WILL SEE THIS CAMPAIGN.

AND THAT'S REALLY WHAT WE'RE WORKING TOWARDS PUTTING OUT THERE. THOSE MATERNAL EARLY WARNING SIGNS THAT I TALKED ABOUT EARLIER.

BUT ALSO WE ACTUALLY HAVE STORIES FROM WOMEN AND FAMILIES WHO HAVE BEEN IMPACTED BY SEVERE MATERNAL MORBIDITY.

AND I THINK IT'S REALLY POWERFUL WHEN WE HEAR FROM THOSE PATIENTS, THOSE FAMILIES WHO HAVE BEEN IMPACTED THAT REALLY, I THINK, DRIVE HOME ABOUT LISTENING TO YOUR BODY, GETTING THE HELP YOU NEED, BUT LISTENING TO EACH OTHER.

THANK YOU. THANK YOU SO MUCH. APPRECIATE YOUR PRESENTATION.

VERY MUCH SO. AND WE HAVE I THINK ONE MORE QUESTION FOR SURE.

HI. THANK YOU. THIS IS DOCTOR CHARLOTTE WATKINS.

I'M A PHYSICIAN AS WELL. SO I'D LIKE TO KNOW, JUST TO EXPOUND ON THE PUBLIC.

THE QUESTION FROM THE THE PUBLIC COMMENT. WHAT SPECIFICALLY IS ACTUALLY BEING DONE WHEN YOU TALK ABOUT UNDERSTANDING YOUR SYMPTOMS AND BEING MORE ASSERTIVE AND AGGRESSIVE ABOUT RELAYING THAT INFORMATION TO YOUR PROVIDER? WHAT IS BEING DONE SPECIFICALLY IN THE SPACE OF UNCONSCIOUS BIAS THAT'S HAPPENING IN THE SPACE OF MINORITY WOMEN OR WOMEN OF COLOR WHERE WE'RE SEEING HIGH RATES OF MORBIDITY AND MORTALITY.

YOU KNOW, AMONG BIRTHS. SO IN TEXAS, I THINK, YOU KNOW, THE NUMBERS ARE.

SO I JUST HATE TO EVEN COMMENT ON THE NUMBERS HERE IN TEXAS.

BUT WHAT'S BEING DONE SPECIFICALLY BY AIM AS FAR AS TRAINING AND EDUCATION TO PROVIDERS TO BE MORE AWARE OF UNCONSCIOUS BIAS AND TO LISTEN TO WOMEN OF COLOR, EVEN THOUGH THEIR SYMPTOMOLOGY MAY BE DIFFERENT FROM WHAT'S BEING PRESENTED SO THAT THEY CAN THEY CAN HAVE THEIR ISSUES ADDRESSED.

AND I THINK THAT'S A BIG CONCERN. HERE IN THE STATE OF TEXAS.

SO TO YOUR POINT, WE KNOW THAT BLACK WOMEN ARE DISPROPORTIONATELY IMPACTED BY SEVERE MATERNAL MORBIDITY AND MORTALITY.

AND SO AND I THINK AT THE FEDERAL NATIONAL LEVEL, THAT WAS REALLY WHERE THAT KIND OF FIFTH R WAS ADDED, WHICH IS AROUND THAT RESPECTFUL CARE. AND SO THAT IS REALLY BEEN A HUGE FOCUS FOR US AS WE HAVE KIND OF IMPLEMENTED THE SEVERE HYPERTENSION IN PREGNANCY BUNDLE AND BRINGING THAT IN. AND SO THERE ARE WHEN, FOR EXAMPLE, WEBINARS AND WHEN WE HAVE THE OPPORTUNITY TO COME TOGETHER TO KIND OF LEARN FROM EACH OTHER, FROM THE HOSPITALS. THAT IS REALLY WHERE WE'RE ABLE TO ADDRESS THOSE.

THE OTHER THING THAT WE DO IS WE ACTUALLY WORK WITH, FOR EXAMPLE, THE PREECLAMPSIA FOUNDATION, WHICH IS REALLY FOCUSED ON KIND OF THAT PATIENT VOICE AND UNDERSTANDING PREECLAMPSIA, SEVERE HYPERTENSION AND PREGNANCY, WHERE WE HAVE BEEN ABLE TO ACTUALLY HAVE WOMEN WHO HAVE BEEN IMPACTED TO KIND OF BE A PART OF THE PROGRAM SO THAT WE'RE ABLE TO KIND OF LEARN FROM THEM.

IF YOU ACTUALLY GO TO THE HER.HER, TEXAS WEBSITE, THERE ARE GOING TO BE TANGIBLE RESOURCES ON SPECIFIC TOPICS, ON THINGS TO AROUND THINGS TO BE AWARE OF, WHAT TO TALK ABOUT WITH YOUR PHYSICIAN, THINGS OF THAT NATURE.

WE HAVE OUR DIFFERENT VIDEOS THAT HAVE DIFFERENT WOMEN WHO HAVE BEEN IMPACTED BY SEVERE MATERNAL MORBIDITY.

WE ALSO HAVE RESOURCES FOR PHYSICIANS. THEY CAN GO ONLINE, THEY CAN DOWNLOAD THEM.

THEY CAN ORDER THEM FROM US. SO IT'S REALLY FROM OUR PERSPECTIVE HAVING THE HAVING THAT WE HAVE THE AIM PROGRAM, BUT WE HAVE OTHER ARMS HERE AT DSHS THAT WE'RE ALSO LEVERAGING AS WELL WITHIN THAT MATERNAL HEALTH SPACE.

AND SO IT'S TRYING TO MAKE SURE THAT EVERYONE KIND OF HAS AWARENESS OF ALL THE WORK THAT WE DO.

A LOT OF WHAT I'M HERE TO KIND OF TALK ABOUT IT OUR MATERNAL MORTALITY REVIEW COMMITTEE WE ACTUALLY HAVE A SUBCOMMITTEE ON MATERNAL HEALTH DISPARITIES.

AND SO THE PURPOSE OF THAT COMMITTEE IS TO REALLY LOOK AT THOSE DISPARITIES THAT IMPACT THOSE OUTCOME DIFFERENCES THAT WE SEE.

AND SO WE WE'RE LOOKING AT IT FROM THAT PERSPECTIVE AS WELL.

THANK YOU. AND ONE FINAL QUESTION. SURE. I DO REPRESENT AN INSURER.

SO ARE YOU GETTING I KNOW THAT MY COMPANY IS ACTUALLY FOCUSED ON THIS ISSUE.

ARE YOU GETTING BUY IN FROM OTHER INSURERS THAT COVER MEMBERS WITHIN THE STATE, OR ARE YOU FINDING COLLABORATION WITH THOSE INSURERS? BECAUSE IT'S A PERSPECTIVE THAT, YOU KNOW, WEIGHS HEAVY FOR US BECAUSE IT'S SUCH A BIG ISSUE AND WE WANT TO BE INVOLVED IN IN

[01:15:05]

ASSISTING WITH THE SOLUTION. SO AND AND I THINK THAT THAT IS THAT'S GREAT TO HEAR.

I WILL SAY THAT WE DO HAVE I THAT WAS ADDED DURING THE LAST LEGISLATIVE SESSION.

WE HAD OUR MEMBERSHIP EXPANDED AND WE DID HAVE A MANAGED CARE ORGANIZATION HAS BEEN ADDED TO OUR MEMBERSHIP.

SO I THINK FROM THAT PERSPECTIVE, I THINK IT ALLOWS US IT'S GOING TO ALLOW US TO BE ABLE TO GET THAT PERSPECTIVE AND THAT ENGAGEMENT.

AND THEN WHERE WE HAVE AN OPPORTUNITY TO SHARE ABOUT THE PROGRAM THE OUTCOMES AND THE THINGS THAT WE ARE SEEING.

WE ALWAYS WANT TO HAVE THAT OPPORTUNITY. SO, DOCTOR WATKINS, IF YOU YOU HAVE AN OPPORTUNITY FOR US, PLEASE LET ME KNOW BECAUSE WE WILL. YES, WE WILL BE THERE WITH BELLS ON.

SO THANK YOU FOR THAT. THANK YOU, THANK YOU, THANK YOU.

AND DOCTOR HALL, OBVIOUSLY MOST DELIVERIES IN THE STATE OF TEXAS ARE FUNDED BY MEDICAID.

AND I'M HOPING THAT MEDICAID HAS A, YOU KNOW, A SEAT AT THE TABLE BECAUSE OBVIOUSLY THEY HAVE A THEY'VE DONE THEY'VE DONE A GREAT JOB TRYING TO ENFORCE QUALITY AND ATTACH IT TO PAYMENT.

AND SOMETIMES THAT'S THE ONLY THING THAT MOVES THE NEEDLE.

AGAIN, THANK YOU SO MUCH. AND IN THE INTEREST OF TIME, WE'RE PROBABLY GOING TO MOVE TO THE. MR. CHAIRMAN, I HAVE A QUESTION AS WELL.

SURE. YOU DON'T MIND. THANK YOU SO MUCH, DOCTOR HALL.

THANK YOU FOR YOUR PRESENTATION. MY NAME IS LAUREN DAY.

I'M ALSO ON THE COUNCIL. I WANTED TO ASK YOU WHAT WHAT ARE THE NUMBERS OF TEXAS BABIES THAT WERE BORN LAST YEAR OUTSIDE OF THE HOSPITAL SYSTEM? I HAVE TO GET THAT NUMBER FOR YOU. SO WE WOULD NEED TO GO BACK TO OUR TEAM.

AND THEN WE COULD WE COULD DEFINITELY GET THAT NUMBER BACK FOR YOU.

GREAT. AND I WOULD LIKE TO KNOW ALSO HOW DID THAT CHANGE IN TERMS OF STATISTICS FROM THE GREATER NUMBERS OF TOTAL CHILDREN WITH VITAL STATISTICS FROM LIKE 2019 TO 2021? DID WE SEE AN INCREASE OF BABIES BEING BORN AND BIRTHING CENTERS, HOME BIRTH, THINGS LIKE THAT.

AND LIKE WHAT PERCENTAGE AND JUST THE NUMBERS AND ESPECIALLY GOING BACK.

THAT WOULD BE HELPFUL AS WELL AS LAST YEAR. AND THEN I ALSO WANTED TO ASK TO FOLLOW UP HAVE YOU ALL STUDIED THE STATISTICS OF THE DIFFERENCES OF ALL OF THESE TASKS OF HEMORRHAGE, OF QUALITY OF CARE AND ALL THE OTHER AREAS YOU MENTIONED OF MOTHERS AND BABIES DELIVERED IN HOSPITALS VERSUS IN BIRTHING CENTERS AND HOME BIRTHS. CAN I ALSO GET SOME OF THOSE INFORMATION AS WELL? I WILL TELL I WILL TAKE ALL THAT BACK TO THE TEAM AND THEN WE'LL BE ABLE TO FOLLOW UP.

I WILL SAY THAT A LOT OF OUR WORK HAS BEEN FOCUSED, OF COURSE, WITHIN THE HOSPITAL SETTING, BUT THERE HAS BEEN PARTS OF THE PROGRAM THAT HAS LOOKED AT THE WORK, LIKE BIRTHING CENTERS AND THINGS LIKE THAT.

BUT WE'LL FOLLOW UP WITH ALL THAT FOR YOU. OKAY.

EXCELLENT. BECAUSE THAT IS A THAT IS A SEGMENT OF TEXAS MOTHERS AND BABIES THAT WE DO YOU KNOW, AS A PART OF THE SHACK THAT WE DO NEED TO KNOW ABOUT.

THANK YOU SO MUCH. SURE. THANK THANK YOU SO MUCH.

AND THAT IS CORRECT. TO TO TO ASK YOUR OPINION, YOUR YOUR SENTIMENT THERE THAT I, I DON'T KNOW THE NUMBERS EXACTLY, BUT I CAN MY FEELING IS THAT IT'S BEEN INCREASING AND IT CAN BE AS SAFE.

I'M NOT SURE IF THEY ARE ABLE OR HAVE ACCESS TO THESE BUNDLES.

THE MAIN PROBLEM ESPECIALLY HOME BIRTH AND SOME OF THE BIRTHING HOMES, IS THAT THEY DON'T HAVE PRESCRIPTIVE AUTHORITY, SO THEY'RE NOT ABLE TO PROVIDE THE MEDICATIONS THAT ARE PART OF THIS BUNDLE.

AND THAT'S KIND OF AN IMPORTANT ISSUE. SO UNFORTUNATELY, AS A PRACTICING OBSTETRICIAN, I'M NO LONGER PRACTICING OBSTETRICIAN.

BUT UNTIL RECENTLY I WAS WE HAVE BEEN SEEING A LOT OF COMPLICATIONS FROM BLEEDING THAT STARTED OUT OUTSIDE THE HOSPITAL. AND SOMETIMES BY THE TIME THEY COME TO THE HOSPITAL, IT'S BEHIND THE EIGHT BALL BY.

BY ALL MEANS. THAT'S NOT UNIVERSAL. SO THAT'S NOT VERY COMMON, BUT THAT'S SOMETHING I THINK THE AIM SHOULD BE ABLE TO LOOK AT AND GATHER THE NUMBERS AND SEE HOW CAN WE MAKE IT SAFER FOR PATIENTS TO PURSUE THEIR THEIR WISHES, WHETHER THEY WANT TO HAVE THEIR BABIES AT HOME OR IN A BIRTHING CENTER? THANK YOU. YEAH. AND JUST BE NICE TO KNOW THE DIFFERENCES.

IS IT, YOU KNOW, ARE THEY GETTING BETTER QUALITY CARE? ARE THEY HEMORRHAGING LESS OR MORE? AND THAT THAT WOULD BE HELPFUL.

THANK YOU. THANK YOU SO MUCH. IT'S BEEN A VIABLE, YOU KNOW, VERY NICE DISCUSSION I APPRECIATE THAT.

NEXT WE WILL ASK DOCTOR BOMB, WHICH WILL GIVE US AN UPDATE ON THE COMMUNITY HEALTH IMPROVEMENT DIVISION'S INITIATIVES TO ADDRESS CONGENITAL SYPHILIS.

[7. Presentation on initiative to address congenital syphilis. Presenter: Dr. Kelly Fegan-Bohm, Medical Director,Community Health Improvement Division, Texas Department of State Health Services.]

THANK YOU SO MUCH FOR JOINING US. THANK YOU. HI, I'M DOCTOR KELLY FEIGENBAUM.

I AM THE MEDICAL DIRECTOR FOR THE COMMUNITY HEALTH IMPROVEMENT DIVISION. SO I ACTUALLY WORK FOR DOCTOR HALL, WHO YOU GUYS JUST HEARD FROM.

AND THANK YOU SO MUCH FOR THIS INTRODUCTION. SO YES, I'M GOING TO TALK ABOUT CONGENITAL SYPHILIS IN TEXAS.

IF YOU CAN GO TO THE NEXT SLIDE. SO HERE'S WHAT WE'RE GOING TO COVER TODAY.

[01:20:04]

AND I WILL TRY TO BE VERY TIMELY KNOWING Y'ALL'S TIME IS VERY IMPORTANT.

SO FIRST WE'LL GO TO DATA ON CONGENITAL SYPHILIS.

IF YOU CAN GO TO THE NEXT SLIDE AND THEN THE NEXT SLIDE.

GREAT. SO IN 2023 WE SAW 930 CASES OF CONGENITAL SYPHILIS, WITH A CASE RATE OF 234 CASES PER 100,000 BIRTHS. AND THIS IS ABOUT A 1% INCREASE FROM 2022, WHEN TEXAS REPORTED 922 CONGENITAL SYPHILIS CASES AND 114 COUNTIES IN OUR STATE REPORTED A CASE, AT LEAST ONE CASE OF CONGENITAL SYPHILIS, AND THIS IS A 7% INCREASE OVER 2022, WHERE WE HAD 107 COUNTIES THAT REPORTED AT LEAST ONE CASE OF CONGENITAL SYPHILIS.

SO STILL ON THE RISE. NEXT SLIDE. THIS IS A OH.

CAN YOU GO BACK ONE. SORRY. THIS IS A BREAKDOWN OF THE CONGENITAL SYPHILIS CASES IN TEXAS BETWEEN CONFIRMED STILLBIRTH PROBABLE UNKNOWN AND TOTAL. AND WHAT YOU CAN SEE HERE IS THAT WE HAD 46 STILLBIRTHS IN TEXAS IN 2023.

IF YOU GO TO THE NEXT SLIDE, YOU CAN SEE HOW THIS COMPARES TO PREVIOUS YEARS.