Legislature(2015 - 2016)CAPITOL 106

01/21/2016 03:00 PM HEALTH & SOCIAL SERVICES

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03:03:12 PM Start
03:03:30 PM Presentation: Statewide Suicide Prevention Council
04:15:39 PM Presentation: State Health Information Technology
04:54:44 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
"2015 Report & 2017-2022 Suicide Prevention Plan"
by Kate Burkhart, Suicide Prevention Council
+ Presentation by Beth Davidson, Health TELECONFERENCED
Information Exchange
                    ALASKA STATE LEGISLATURE                                                                                  
      HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                     
                        January 21, 2016                                                                                        
                           3:03 p.m.                                                                                            
MEMBERS PRESENT                                                                                                               
Representative Paul Seaton, Chair                                                                                               
Representative Liz Vazquez, Vice Chair                                                                                          
Representative Neal Foster                                                                                                      
Representative Louise Stutes                                                                                                    
Representative David Talerico                                                                                                   
Representative Geran Tarr                                                                                                       
Representative Adam Wool                                                                                                        
MEMBERS ABSENT                                                                                                                
All members present                                                                                                             
OTHER LEGISLATORS PRESENT                                                                                                     
Senator Berta Gardner                                                                                                           
COMMITTEE CALENDAR                                                                                                            
PRESENTATION: STATEWIDE SUICIDE PREVENTION COUNCIL                                                                              
     - HEARD                                                                                                                    
PRESENTATION: STATE HEALTH INFORMATION TECHNOLOGY                                                                               
     - HEARD                                                                                                                    
PREVIOUS COMMITTEE ACTION                                                                                                     
No previous action to record                                                                                                    
WITNESS REGISTER                                                                                                              
WILLIAM MARTIN, Chair                                                                                                           
Statewide Suicide Prevention Council                                                                                            
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Spoke during a PowerPoint presentation from                                                              
the Statewide Suicide Prevention Council.                                                                                       
KATE BURKHART, Executive Director                                                                                               
Statewide Suicide Prevention Council                                                                                            
Department of Health and Social Services                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Spoke during  a PowerPoint presentation from                                                             
the Statewide Suicide Prevention Council.                                                                                       
BETH DAVIDSON, Acting Coordinator                                                                                               
State Health Information Technology                                                                                             
Office of the Commissioner                                                                                                      
Department of Health and Social Services                                                                                        
Anchorage, Alaska                                                                                                               
POSITION  STATEMENT:   Presented  a  PowerPoint  on State  Health                                                             
Information Technology.                                                                                                         
ACTION NARRATIVE                                                                                                              
3:03:12 PM                                                                                                                    
CHAIR PAUL  SEATON called  the House  Health and  Social Services                                                             
Standing   Committee    meeting   to    order   at    3:03   p.m.                                                               
Representatives Seaton,  Wool, Vazquez, and Tarr  were present at                                                               
the call to order.   Representatives Talerico, Stutes, and Foster                                                               
arrived as the  meeting was in progress.  Also  in attendance was                                                               
Senator Gardner.                                                                                                                
^PRESENTATION: Statewide Suicide Prevention Council                                                                           
       PRESENTATION: Statewide Suicide Prevention Council                                                                   
3:03:30 PM                                                                                                                    
CHAIR SEATON announced that the  first order of business would be                                                               
a  PowerPoint presentation  by the  Statewide Suicide  Prevention                                                               
3:04:55 PM                                                                                                                    
WILLIAM  MARTIN,  Chair,  Statewide Suicide  Prevention  Council,                                                               
reported that he represented the  Alaska Federation of Natives on                                                               
the  council  and,  after  noting   that  the  council  had  been                                                               
established by the Alaska State  Legislature fifteen years prior,                                                               
he  directed attention  to slide  2, which  listed the  13 voting                                                               
volunteer  members, and  the 4  legislative members  appointed by                                                               
the house and senate leadership.                                                                                                
KATE BURKHART,  Executive Director, Statewide  Suicide Prevention                                                               
Council,  Department  of  Health  and  Social  Services,  offered                                                               
further support  to the benefits  of institutional memory  by the                                                               
leadership of the council's senior volunteer members.                                                                           
MR.  MARTIN  moved  on  to  discuss slide  3,  which  listed  the                                                               
responsibilities of the  Council for its advice  and guidance for                                                               
suicide  prevention  to  the Governor,  legislature,  and  Alaska                                                               
communities.    He stated  that  the  council worked  to  improve                                                               
health  and wellness  throughout the  state, by  reducing suicide                                                               
and its  effects on individuals,  families, and communities.   He                                                               
declared  a desire  to broaden  Alaskan's  awareness of  suicide,                                                               
with  emphasis on  recognition  for  the signs  of  suicide.   He                                                               
reported that  classes were available  to enhance  instruction on                                                               
suicide   prevention  services   and   programs,  especially   to                                                               
corporations and  agencies.  He  stated that the  council desired                                                               
to   develop   healthy   communities  through   a   comprehensive                                                               
collaboration of community and faith  based approaches to health,                                                               
implemented  at the  community level  with  support by  regional,                                                               
state,  and federal  resources.   He  shared  that the  statewide                                                               
suicide prevention plan  was being updated, and  that the council                                                               
was working  to strengthen  existing partnerships  while building                                                               
new  partnerships between  public  and private  entities for  the                                                               
enhancement of suicide prevention.                                                                                              
3:08:53 PM                                                                                                                    
MS. BURKHART pointed out that,  as these were very broad mandates                                                               
for  a small  council  with limited  resources,  the council  had                                                               
decided to  coordinate its efforts  through a  collaboration with                                                               
partners  both  within  and outside  state  government,  insuring                                                               
effective communication.                                                                                                        
3:09:35 PM                                                                                                                    
MR. MARTIN  addressed slide 4,  "coordinate," which  depicted the                                                               
report, "Casting the Net Upstream:  Promoting Wellness to Prevent                                                               
Suicide," which  was available  on-line.  Moving  on to  slide 5,                                                               
"collaborate,"  he  pointed  to   a  variety  of  agencies  which                                                               
collaborated  with the  council,  including  the Alaska  Training                                                               
Cooperative and teams from the Iron Dog race.                                                                                   
MS.  BURKHART  elaborated   on  the  collaborative  opportunities                                                               
created  for communities  to apply  for small  project grants  to                                                               
fund  smaller events.    She  noted that  the  council helped  to                                                               
coordinate these  resources and  ensure that the  funded projects                                                               
were  aligned  with  the  state plan,  per  the  agreements  with                                                               
Department  of  Health  and Social  Services  and  Department  of                                                               
Education and Early Development.                                                                                                
3:12:26 PM                                                                                                                    
MR.  MARTIN moved  on to  slide 6,  "communicate," declaring  the                                                               
council's support  for the CARELINE,  which handled  many suicide                                                               
prevention  phone  calls.   He  referenced  the  statewide  youth                                                               
program for discussions about suicide, "You Are Not Alone."                                                                     
3:13:44 PM                                                                                                                    
MS.  BURKHART  noted  that  the Anchorage  Rotary  had  funded  a                                                               
campaign, "You  Can Save a  Life," as  an example of  the Alaskan                                                               
response  to a  call for  action  from campaigns  working in  the                                                               
3:14:57 PM                                                                                                                    
MR.  MARTIN  discussed slide  7,  "warning  signs," which  listed                                                               
warning signs  for people at risk  of suicide:  threats  for ways                                                               
to hurt or kill oneself, out  of the ordinary writing about death                                                               
and  dying, acting  recklessly and  engaging in  risky activities                                                               
without thinking or paying  attention, experiencing dramatic mood                                                               
changes,  expressing  feelings  of purposeless,  or  giving  away                                                               
their personal  goods accompanied  by statements that  these were                                                               
no longer  necessary.  He stated  that these were the  times when                                                               
it  was  so   important  to  listen,  as  often   this  was  what                                                               
individuals were seeking.                                                                                                       
MS.  BURKHART shared  that these  situations whereby  the warning                                                               
signs  were recognized  and additional  guidance and  support was                                                               
necessary, were the times for a call to CARELINE.                                                                               
MR.  MARTIN  directed attention  to  slide  8, "casting  the  net                                                               
upstream,"  and he  described  this  plan of  action.   He  read:                                                               
"every life matters.  Your life  matters.  And you are not alone.                                                               
Together, we can prevent suicide and save lives."                                                                               
MS. BURKHART explained further that  this Alaska suicide plan was                                                               
unique  among  the   other  plans  of  states,   as  it  provided                                                               
strategies and resources at three  levels:  the individual level;                                                               
the community  level; and, the  state level.   It was not  a plan                                                               
which  placed all  the  direction and  obligation  on the  state,                                                               
which, she opined, had led to its successful implementation.                                                                    
3:19:04 PM                                                                                                                    
MR. MARTIN referred to slide  9, "web of causality," stating that                                                               
suicide  was a  result  of many  causal  factors, which  included                                                               
mental  health  disorders,  depression,  alcohol  and  drug  use,                                                               
trauma, sudden loss, grief, economics,  and lack of connection to                                                               
culture, heritage, and spiritual tradition.                                                                                     
MS. BURKHART added that nutrition  and social isolation were also                                                               
issues, noting that the council  attempted to educate and operate                                                               
in a multi-dimensional way.                                                                                                     
3:20:29 PM                                                                                                                    
MR.  MARTIN read  each of  the six  goals on  slide 10,  "goals,"                                                               
which   included   that   Alaskans  accept   responsibility   for                                                               
preventing  suicide,   Alaskans  effectively   and  appropriately                                                               
respond  to  people at  risk  of  suicide, and  Alaskans  support                                                               
survivors in  healing.  He  added that quality data  and research                                                               
was  available   and  used  for  planning,   implementation,  and                                                               
evaluation of suicide prevention.                                                                                               
MS. BURKHART  expanded on  the specific aspects  for each  of the                                                               
goals, which included a multitude of more than 40 strategies.                                                                   
3:21:28 PM                                                                                                                    
MR.  MARTIN directed  attention  to slide  11, "regional  teams,"                                                               
stating  that  the  different  regional   groups  had  their  own                                                               
priorities  for the  goals.    Moving on  to  slide 12,  "suicide                                                               
data," he  shared the consistency  of the overall  statistics for                                                               
the annual rate and number of  suicides in Alaska since 2003.  He                                                               
pointed  out  that  both  the statewide  and  national  rates  of                                                               
suicide were increasing.                                                                                                        
3:23:34 PM                                                                                                                    
MS. BURKHART  moved on to  slide 13, "crisis intervention."   She                                                               
explained that CARELINE was a  nationally accredited crisis line,                                                               
based in Fairbanks and staffed  by trained Alaskans.  She pointed                                                               
to its  increased role as a  resource for both people  in crisis,                                                               
and those struggling  but not yet experiencing  a suicide crisis.                                                               
She shared that  CARELINE was funded by the State  of Alaska and,                                                               
as it was a critical  component to the suicide prevention system,                                                               
it  was widely  advertised  and included  in  most Department  of                                                               
Health and Social  Services materials.  She added  that there was                                                               
also a text option for CARELINE  to enhance its appeal to younger                                                               
3:26:21 PM                                                                                                                    
MR.  MARTIN  said that  the  State  of  Alaska made  training  in                                                               
evidence  based   suicide  prevention  and   intervention  models                                                               
accessible  to all  interested  Alaskans,  slide 14,  "training."                                                               
Directing attention  to the  QPR/Gatekeeper training  program, he                                                               
applauded the Juneau  Suicide Coalition for its  goal of training                                                               
at least  25 percent of  the people over 18  years of age  in the                                                               
Juneau area within the next two years.                                                                                          
MS. BURKHART  reported that  the numbers  for the  training would                                                               
fluctuate  due to  the funding  or subsidizing  of the  training.                                                               
She declared  that a  stable and consistent  source of  access to                                                               
training   was  through   the  e-Learning   program  offered   by                                                               
Department  of Education  and Early  Development, although  other                                                               
organizations were more dependent on grants.                                                                                    
CHAIR  SEATON asked  if e-Learning  was  individualized or  group                                                               
MS. BURKHART replied that this  was a distance delivered training                                                               
most often used  by educators and staff, although  the public did                                                               
also  have access  to training  on  a host  of topics,  including                                                               
suicide prevention, most often on an individual basis.                                                                          
3:29:11 PM                                                                                                                    
MR. MARTIN  directed attention to  slide 15,  "childhood trauma,"                                                               
and  explained  Adverse  Childhood   Experiences  (ACEs)  as  the                                                               
traumatic events  which occur  during childhood  and adolescence,                                                               
which included  abuse, neglect, domestic violence,  and household                                                               
mental illness or substance abuse.   He shared that a lowering of                                                               
the Behavioral  Risk Factor Surveillance  Survey (BRFSS)  data, a                                                               
reflection of  ACEs score,  resulted in a  lower rate  of suicide                                                               
and better  physical and mental health.   Moving on to  slide 16,                                                               
he   stated  that   "getting  rid   of   the  Adverse   Childhood                                                               
Experiences,  then  our  suicide   problem  will  be  drastically                                                               
reduced."   He pointed  out that  an ACEs score  of 7  or greater                                                               
increased  the risk  of  suicide by  51-fold  among children  and                                                               
adolescents,  and 30-fold  among adults.   Nearly  64 percent  of                                                               
suicide attempts  among adults and  80 percent of  these attempts                                                               
among  children  and  adolescents were  attributed  to  increased                                                               
ACEs.  He declared that it  was necessary to stop these childhood                                                               
adverse experiences.                                                                                                            
3:32:25 PM                                                                                                                    
MR.  MARTIN shared  slide 17,  "what's  working," reporting  that                                                               
Department  of Education  and Early  Development and  the Council                                                               
partnered to  offer suicide prevention and  awareness programs in                                                               
10 school districts,  as a part of a broader  health and wellness                                                               
program.   He  reported  that the  Sources  of Strength  program,                                                               
slide 18, "what's  working," was offered as a  peer level program                                                               
by the Juneau School District.                                                                                                  
3:33:57 PM                                                                                                                    
MS. BURKHART  expanded on these  school based  suicide prevention                                                               
programs, pointing  out that the Lower  Kuskokwim School District                                                               
was  the  only school  district  in  Alaska  with a  social  work                                                               
department  offering  licensed  clinical social  workers  in  the                                                               
schools as permanent  employees.  She reported  that this allowed                                                               
for mental  health services  to be available  in the  schools for                                                               
students.   She stated that three  things working so well  in the                                                               
schools  were  trained adult  nurses  and  counselors, access  to                                                               
mental  health services,  and peer  to peer  student models  when                                                               
talking about school based suicide prevention.                                                                                  
3:35:23 PM                                                                                                                    
MR. MARTIN read from slides  19 and 20, "what's working," stating                                                               
that  "access   to  effective  services  for   behavioral  health                                                               
disorders  is  a key  protective  factor  against suicide."    He                                                               
lauded  culturally  relevant  prevention and  wellness  promotion                                                               
programs,  including   the  Qungasvik  Project  and   the  Elluam                                                               
Tungiinum Projects in Southwest Alaska.   He offered, as examples                                                               
of  Project  AWARE,  that  mental  health  counselors  and  youth                                                               
trained in  mental health first  aid had increased the  number of                                                               
students  accessing community  behavioral health  services by  25                                                               
percent.   He moved on to  slide 21, "what's next,"  which listed                                                               
continued  implementation   of  the  Casting  the   Net  Upstream                                                               
program, with a review and update  of this program.  This program                                                               
would   include  increased   access  to   evidence-based  suicide                                                               
prevention training for all Alaskans,  would support services and                                                               
resources for parents and families,  and would publish an updated                                                               
state plan in January, 2017.                                                                                                    
3:39:34 PM                                                                                                                    
REPRESENTATIVE  TARR offered  strategies for  getting information                                                               
to  individual   Alaskans,  including  that   CARELINE,  training                                                               
opportunities,   and  other   resources   could   be  shared   by                                                               
legislative members  through their newsletters.   She pointed out                                                               
that,  as the  number of  CARELINE calls  was increasing,  it was                                                               
important to maintain the in-state regional cultural support.                                                                   
3:41:46 PM                                                                                                                    
REPRESENTATIVE  STUTES asked  if the  Alaska Mental  Health Trust                                                               
Authority was able to fund support.                                                                                             
MS.  BURKHART  replied  that  the   Alaska  Mental  Health  Trust                                                               
Authority was  already funding outreach  by the council  and some                                                               
innovative screening projects to  integrate behavioral health and                                                               
primary care, as  research data had shown that  many suicides had                                                               
occurred within a few months  after office visits to primary care                                                               
providers.  She  shared that the funding of  small project grants                                                               
issued  by   the  trust  were   often  community   based  suicide                                                               
prevention projects.                                                                                                            
3:43:17 PM                                                                                                                    
REPRESENTATIVE FOSTER  noted that he  was a big supporter  of the                                                               
aforementioned   Qungasvik  Project,   as  it   focused  on   the                                                               
culturally relevant aspects  of suicide prevention.   He asked if                                                               
the  council collaborated  with this  project, in  order to  take                                                               
what was working and use it in other rural parts of the state.                                                                  
MS. BURKHART  replied that this  model had been developed  with a                                                               
National  Institute  of  Health  grant as  a  specifically  Yupik                                                               
model,  and included  a participatory  process  that allowed  the                                                               
community to utilize and build  on traditional ways of knowing to                                                               
solve  each  problem.   She  acknowledged  that the  council  had                                                               
learned  from  this model,  and  now  used  the Casting  the  Net                                                               
Upstream  program as  a means  for Alaskans  to tell  the council                                                               
what they  wanted to do to  solve the problem.   She pointed out,                                                               
however, that the Qungasvik Project  model did not translate well                                                               
outside this region and culture.                                                                                                
REPRESENTATIVE FOSTER expressed his  agreement that although this                                                               
Qungasvik Project  model may  not work  well outside  the region,                                                               
the overall  concept for integrating culturally  relevant aspects                                                               
of  suicide  prevention  could  be  used  successfully  in  other                                                               
regions of Alaska.                                                                                                              
3:46:42 PM                                                                                                                    
REPRESENTATIVE VAZQUEZ asked to  know the amount of contributions                                                               
over  the past  five  years  by the  Alaska  Mental Health  Trust                                                               
Authority to the council and  the percentage of this contribution                                                               
to the overall council budget.                                                                                                  
MS.  BURKHART explained  that  the council  did  not receive  any                                                               
direct funding  from Alaska Mental  Health Trust Authority.   She                                                               
acknowledged  that the  communication  strategy  which the  trust                                                               
funded  was  $25,000,  held  by   the  trust  while  the  council                                                               
suggested ways  to spend  this.  She  reported that  although the                                                               
annual council budget appeared to  be more than $600,000, on July                                                               
1  of each  year, $475,000  of this  was given  to Department  of                                                               
Education  and Early  Development  for its  school based  suicide                                                               
prevention program.                                                                                                             
REPRESENTATIVE VAZQUEZ  directed attention  to the data  from the                                                               
Bureau  of   Vital  Statistics,   slide  12  of   the  PowerPoint                                                               
presentation, and  asked if there  were best  practices currently                                                               
used by  other states that could  improve this rate.   She lauded                                                               
CARELINE as  being effective.   She offered  her belief  that the                                                               
rate was not moving very much, and asked what could be done.                                                                    
3:50:34 PM                                                                                                                    
MR. MARTIN offered his belief  that the council and other suicide                                                               
enterprises had contributed a great  effort toward a reduction in                                                               
the  rate   of  suicide.     He  declared  that  the   issue  was                                                               
complicated,  and  any known  solution  would  have already  been                                                               
implemented.   He  mentioned that  the reporting  methodology had                                                               
only recently improved, as in  earlier years not all these deaths                                                               
were  reported as  suicides, noting  that, in  his youth,  "there                                                               
were  no youth  suicides."   Consequently,  with  this change  of                                                               
culture and the change in  the growing-up process, the elders had                                                               
no suggestions for resolution.                                                                                                  
REPRESENTATIVE VAZQUEZ  noted that  with some cultures  there may                                                               
have been  under reporting  in past  years, due  to a  feeling of                                                               
shame for suicide.                                                                                                              
REPRESENTATIVE  TARR offered  her belief  that only  recently, as                                                               
more  information  had   come  to  light,  there   was  a  better                                                               
understanding of the inter-connectedness  of childhood trauma and                                                               
3:53:45 PM                                                                                                                    
MS.  BURKHART  shared  that  the  council  and  its  partners  in                                                               
Department  of  Health  and Social  Services  and  Department  of                                                               
Education and  Early Development had committed  to evidence-based                                                               
practices,  and  she directed  attention  to  goal 6,  slide  10,                                                               
declaring  it was  necessary to  evaluate the  suicide prevention                                                               
system in order to make thoughtful decisions for moving forward.                                                                
CHAIR SEATON  mused that,  as it was  projected that  the suicide                                                               
rate could  move even  higher although  the data  reflected "some                                                               
very extensive efforts,"  the success of these efforts  had to be                                                               
questioned.  He  asked if the suicide rate had  been lowered with                                                               
the specific program in the Lower Kuskokwim School District.                                                                    
MS. BURKHART  pointed out that  there was a reduced  incidence of                                                               
suicide  among  enrolled  students,  but  noted  that  these  low                                                               
numbers did  not always reflect  the entire  region.  As  many of                                                               
these  regions were  very small,  a small  change in  the numbers                                                               
often showed  a greater impact;  therefore, it was  necessary for                                                               
evaluation to determine the success of each program.                                                                            
CHAIR  SEATON  expressed  agreement  that  it  was  necessary  to                                                               
evaluate  the  efficiency,  especially when  suicide  rates  were                                                               
3:57:48 PM                                                                                                                    
REPRESENTATIVE  WOOL acknowledged  that it  was easier  said than                                                               
done to  reduce the ACEs  scores.  He  asked if that  message was                                                               
also getting  out to the  communities, so that families  would be                                                               
more  sensitive to  the social  situation.   He  opined that  the                                                               
results may not be recognized for a decade or longer.                                                                           
3:58:58 PM                                                                                                                    
MS. BURKHART  noted that,  in addition to  her role  as Executive                                                               
Director for  the Statewide Suicide  Prevention Council,  she was                                                               
also Executive  Director of  the Alaska  Mental Health  Board and                                                               
the  Advisory Board  on Alcoholism  and Drug  Abuse.   She stated                                                               
that  the Alaska  Mental Health  Board had  worked diligently  to                                                               
make Alaska  specific ACEs data  available to help  guide policy.                                                               
She declared  that "the desire  all over the state  to understand                                                               
how this  affects Alaskans  in particular is  huge."   She stated                                                               
that there  were multiple groups  working on this,  including the                                                               
Alaska  Pediatric Partnership  and the  Alaska Children's  Trust.                                                               
She offered to present an overview of all the combined work.                                                                    
CHAIR  SEATON  offered  his belief  that  the  Statewide  Suicide                                                               
Prevention Council could not be  held accountable to solve abuse,                                                               
neglect, domestic  violence, household mental  illness, household                                                               
substance  abuse,  divorce  of   parents,  and  incarceration  of                                                               
parents, all of which were aspects of ACEs.                                                                                     
CHAIR  SEATON   referenced  the  research  article   titled  "The                                                               
association  of vitamin  D deficiency  with psychiatric  distress                                                               
and violence  behaviors in  Iranian adolescents:  the CASPIAN-III                                                               
study."   [Included  in  members' packets]    In describing  this                                                               
youth behavioral  study, he reported  that Vitamin D  levels were                                                               
tested and then compared in 1100  students.  He stated that there                                                               
was  50 to  80 percent  more self-reported  anger, anxiety,  poor                                                               
quality sleep,  sadness, depression, and worry  in those students                                                               
with low  levels of Vitamin  D.   He expressed his  concern that,                                                               
although  these  evidence  based   clinical  studies  and  random                                                               
control studies  showed that  depression, worry,  anxiety, anger,                                                               
and poor sleep quality issues  in adolescents was associated with                                                               
low Vitamin  D levels, the  Statewide Suicide  Prevention Council                                                               
has no  mention of  low Vitamin  D or  nutrition in  its wellness                                                               
plan to  address suicide  prevention.  He  pointed out  that this                                                               
information,  as  well  as other  studies,  had  previously  been                                                               
shared  with both  the committee  and the  council.   He reported                                                               
that  there  were many  studies  that  showed the  benefits  from                                                               
adequate levels  of Vitamin D.   He expressed  his disappointment                                                               
in  this lack  of  utilization for  evidence  based medicine  and                                                               
research, suggesting  that this  research for the  association of                                                               
low  Vitamin   D  levels  with   the  aforementioned   anger  and                                                               
depression issues  needed to be  distributed to  the communities,                                                               
while noting  that Vitamin D  could be distributed for  less than                                                               
$10 per year.                                                                                                                   
4:06:12 PM                                                                                                                    
REPRESENTATIVE TARR shared  that nutrition had been  "a big topic                                                               
of our last  [council] meeting."  She noted  that research showed                                                               
that Omega fatty  acids were also a health  indicator for suicide                                                               
prevention.  Directing attention  to chronic health conditions on                                                               
the web  of causality,  she declared that  this spoke  broadly to                                                               
the issue  of nutrition.   She noted,  as the statewide  plan was                                                               
being re-written,  there could be more  specific discussion about                                                               
the role of nutritional opportunities in suicide prevention.                                                                    
4:07:42 PM                                                                                                                    
CHAIR  SEATON pointed  out that  the research  on the  balance of                                                               
Omega  3  and Omega  6  fatty  acid  had  been presented  to  the                                                               
Department of  Defense for use as  nutritional armor specifically                                                               
for depression.  He opined that  there were much simpler ways for                                                               
change  than  to  change  the   life  style  or  interactions  of                                                               
families.  He noted that the  state was moving that way for state                                                               
employees, as it  had lauded Vitamin D in the  recent Alaska Care                                                               
wellness brochure.   He questioned  why this had not  been shared                                                               
with  other state  residents, as  it  was reflected  in the  cost                                                               
benefit basis.   He declared  that continuous  research reflected                                                               
these advances.                                                                                                                 
4:09:56 PM                                                                                                                    
REPRESENTATIVE  WOOL pointed  out that  the rate  of suicide  per                                                               
100,000 was  "fairly constant"  and asked  if this  reflected the                                                               
changes  in population  distribution  throughout the  state.   He                                                               
then  asked   how  this  compared  to   other  rural  communities                                                               
throughout the world.                                                                                                           
4:11:06 PM                                                                                                                    
MS. BURKHART explained that both  statewide numbers and statewide                                                               
per  capita  rates were  reported  by  the  council in  order  to                                                               
clarify that  this was  not a  rural problem.   She  offered that                                                               
this information could also be  provided by region.  She reported                                                               
that  rural regions  typically  had  a higher  rate  and a  lower                                                               
number than urban  areas.  Although Alaska  had consistently been                                                               
the state with  the highest suicide rate in the  nation, over the                                                               
past few years this had not been  the case.  She noted that other                                                               
rural western states had now  gotten worse, and that the national                                                               
rate had  also increased.   She offered to research  the question                                                               
of the  increased incidence of  suicide among  indigenous people,                                                               
noting that reporting  had only gotten more rigorous  in the past                                                               
10 years.                                                                                                                       
^PRESENTATION: State Health Information Technology                                                                            
       PRESENTATION: State Health Information Technology                                                                    
4:15:39 PM                                                                                                                    
CHAIR SEATON announced  that the next order of  business would be                                                               
a presentation on the State Health Information Technology.                                                                      
4:16:47 PM                                                                                                                    
BETH  DAVIDSON,  Acting  Coordinator,  State  Health  Information                                                               
Technology, Office of the Commissioner,  Department of Health and                                                               
Social Services, referenced slide  2, "Overview," and stated that                                                               
this project  utilized an electronic connection  to the statewide                                                               
Health  Information Exchange  allowing health  care providers  to                                                               
submit  required public  health data  to the  state in  a simple,                                                               
cost effective, and secure method.   This addressed a requirement                                                               
under the  Centers for Medicare and  Medicaid Services meaningful                                                               
use program,  and provided  a benefit to  both the  providers and                                                               
public health.   She  moved on  to slide 3,  "What is  the Health                                                               
Information  Exchange?"    She   stated  that  in  recent  years,                                                               
nationally,  the  health  information exchange  had  been  headed                                                               
toward  an electronic  exchange utilizing  electronic technology.                                                               
She  relayed that  Senate  Bill  133, passed  in  May, 2009,  had                                                               
created  a   statewide  health  information  exchange   that  was                                                               
interoperable    and   compliant    with   state    and   federal                                                               
specifications and  protocols for  exchanging health  records and                                                               
data.   In  March,  2010,  the Department  of  Health and  Social                                                               
Services awarded a  contract to Alaska eHealth Network  to be the                                                               
non-profit  board  and organization  to  procure  and manage  the                                                               
statewide health  information exchange.  She  clarified that this                                                               
was a  web based software solution.   In February, 2011,  a pilot                                                               
program in  Fairbanks began  to use the  exchange.   In February,                                                               
2012,  the  federal  rules  under  the  Office  of  the  National                                                               
Coordinator  Health  Information Exchange  Cooperative  Agreement                                                               
grant  changed, and  the Alaska  health information  exchange was                                                               
now required to implement and  demonstrate push-based exchange, a                                                               
secure encrypted  e-mail for more  than 300  participants, before                                                               
being allowed  to move on  to a  more robust, query  based health                                                               
information exchange.   She explained this query  based system to                                                               
be  when  provider's  electronic health  records  solutions  were                                                               
interfaced  and connected  to  the  statewide health  information                                                               
exchange.  This  was system to system versus  utilizing a person.                                                               
She offered an  example that allowed the health  care provider to                                                               
send a referral for a patient to  a specialist.  It could also be                                                               
used  for  provider  consults  and  discussions  about  a  mutual                                                               
patient,  for sharing  transition of  care documentation,  and to                                                               
transmit electronic protected health  information to the State of                                                               
Alaska  from health  care organizations  outside the  state.   In                                                               
February,  2013,   Department  of  Health  and   Social  Services                                                               
received permission  to move the  exchange into  "full production                                                               
mode."   The Alaska health  information exchange  utilizes secure                                                               
encrypted data  exchange, using standards  developed specifically                                                               
for health care.   The patient's health care  provider can access                                                               
the  records  without  the  patient  leaving  their  home.    The                                                               
exchange  allows   for  faster   and  more   effective  emergency                                                               
treatment, support  from tele-health activities,  improved public                                                               
health disease reporting, and avoidance  of duplicate testing and                                                               
negative drug  and allergy  reactions.   She offered  an anecdote                                                               
for the utility of the exchange.                                                                                                
4:24:51 PM                                                                                                                    
MS.  DAVIDSON  moved  on  to  slide  4,  "Project  Details,"  and                                                               
explained  that  this allowed  a  healthcare  provider to  submit                                                               
public  health  data  for  immunizations,  electronic  laboratory                                                               
results,   and   syndromic   surveillance  through   the   health                                                               
information  exchange  to the  Department  of  Health and  Social                                                               
Services (DHSS)  through its Enterprise  Service Bus, a  piece of                                                               
information  technology that  securely  and discretely  connected                                                               
different  information  systems  within the  department  using  a                                                               
combination  of open  technology  standards to  access, move,  or                                                               
transform data.   This  data was  accessible by  related systems.                                                               
She pointed that  it was more cost effective to  move data, as it                                                               
reduced   the  cost   to  create,   maintain,  and   monitor  the                                                               
connections and avoided the duplication  of effort.  Moving on to                                                               
slide  5,  "Project Tasks,"  she  shared  that funding  from  the                                                               
Centers for Medicare  and Medicaid Services had  allowed that the                                                               
two  systems, Immunization  and Electronic  Laboratory Reporting,                                                               
be upgraded to allow for  effective communication with the Alaska                                                               
health information exchange.  At  the same time, there was design                                                               
and  implementation  for   the  necessary  electronic  connection                                                               
between  the  health  information  exchange  and  the  Enterprise                                                               
Service Bus.   They also worked with Centers  for Disease Control                                                               
and  Prevention  (CDC)  to  design  and  implement  a  connection                                                               
between  the health  information exchange  and CDCs  BioSense for                                                               
syndromic surveillance.   The testing  of the system was  done in                                                               
parallel with  the previous data  transmission systems  to ensure                                                               
that the  data was  flowing correctly  and being  received timely                                                               
and in  the correct structure.   After  the test period,  the new                                                               
system connections were finalized.                                                                                              
4:29:10 PM                                                                                                                    
MS. DAVIDSON spoke  about slide 6, "Benefits to  Providers."  She                                                               
declared that it  was more cost effective for  providers when the                                                               
health information exchange was  connected to the DHSS Enterprise                                                               
Service  Bus,  a  single connection  between  disparate  systems.                                                               
Electronic connections allowed for  real time data, fewer errors,                                                               
and secure  data transmission.   Moving on to slide  7, "Benefits                                                               
to DHSS,"  she explained  that the  project allowed  for improved                                                               
data and  was timely  and cost effective.   She  offered examples                                                               
for the incorporation of BioSense  data into weekly flu snapshots                                                               
to allow  a sense of  statewide activity.   She pointed  out that                                                               
the transfer  of electronic lab  results allowed savings  of time                                                               
for data  entry and  allowed for  detection of  cluster outbreaks                                                               
with more immediate response to the communities.                                                                                
4:33:52 PM                                                                                                                    
MS. DAVIDSON directed  attention to slide 8,  "Future Plans," and                                                               
listed  some  of the  future  plans  for the  health  information                                                               
exchange   which  included:     transmitting   sensitive  disease                                                               
reporting  to the  Division of  Public Health,  behavioral health                                                               
data  reporting to  both the  state and  primary care  providers,                                                               
availability to  patients for their personal  health records, and                                                               
utilizing  the health  information exchange  as all  payer claims                                                               
data base.   They  were also  reviewing clinical  quality measure                                                               
reporting  by health  care providers  to meet  state and  federal                                                               
program requirements.                                                                                                           
4:37:55 PM                                                                                                                    
REPRESENTATIVE STUTES  asked for clarification that  this was "an                                                               
avenue to report to the  public health the required information."                                                               
She opined that this would be  a program for physicians to report                                                               
"everything that goes on with every  patient they see, so you can                                                               
keep  track  of 'em."    She  declared that  this  interpretation                                                               
alarmed her.                                                                                                                    
MS. DAVIDSON  declared that this  was not the intention  of DHSS.                                                               
She stated that  the health information exchange  was designed to                                                               
support  community  health care  providers  to  work together  to                                                               
share  patient  data,  as  necessary,  to  support  referrals  to                                                               
specialists, for  transition of  care, and for  cooperation among                                                               
health  care providers,  especially primary  care and  behavioral                                                               
health  care providers.   She  noted  that the  intention was  to                                                               
allow  the  emergency  room  to  no  longer  be  a  primary  care                                                               
provider.   She  further  explained  that syndromic  surveillance                                                               
data was  the identified  aggregate data  that produced  data for                                                               
the  state  and   the  Division  of  Public   Health  to  support                                                               
communities in the identification  of trends and outbreaks across                                                               
the  state, which  included flu,  salmonella poisoning  and other                                                               
infectious  diseases.    She  declared that  there  was  not  any                                                               
intention for  health care  providers to  submit "every  ounce of                                                               
data  that they  ever  possibly capture  within their  electronic                                                               
health records."                                                                                                                
REPRESENTATIVE STUTES  reiterated that  this was still  a concern                                                               
for her.                                                                                                                        
CHAIR  SEATON asked  if this  data was  for the  already required                                                               
reportable diseases, or would it  include a full panoply of other                                                               
non-reportable diseases.   He  questioned whether  this e-network                                                               
would be an expansion beyond the required incidence reporting.                                                                  
MS. DAVIDSON replied  that it was only what  was already required                                                               
under state and federal law for reportable diseases.                                                                            
4:41:46 PM                                                                                                                    
REPRESENTATIVE STUTES  asked for clarification that  this did not                                                               
include prescriptions  which were not reportable  to the Division                                                               
of Public  Health.  In  response to Ms. Davidson,  she questioned                                                               
whether the program  would be expanded to include  such things as                                                               
asthma,  as  this  alarmed  her  for  its  invasiveness  and  the                                                               
subsequent  Health Insurance  Portability and  Accountability Act                                                               
(HIPAA) consequences.                                                                                                           
MS. DAVIDSON replied that this was not the intention.                                                                           
CHAIR SEATON reviewed the aspects  of the program, which included                                                               
that these required reports and data  were the same as would have                                                               
been  submitted   as  paperwork,  although  now   they  would  be                                                               
submitted more quickly and would be electronic.                                                                                 
MS.  DAVIDSON noted  that DHSS  was now  being provided  reports,                                                               
which were required,  that had not been  submitted previously, as                                                               
a secure electronic method was now available.                                                                                   
REPRESENTATIVE  VAZQUEZ asked  which immunizations  were required                                                               
to be reported.                                                                                                                 
MS.  DAVIDSON  said  that  the   requirement  was  only  that  an                                                               
immunization   had   been   given,   and  there   was   not   any                                                               
administrative aspect.                                                                                                          
REPRESENTATIVE  VAZQUEZ asked  if this  covered all  the Medicaid                                                               
patients receiving a flu shot.                                                                                                  
MS. DAVIDSON explained  that this only included  patients who had                                                               
opted   into   the   health  information   exchange   through   a                                                               
participating  health care  provider.   She  pointed  out that  a                                                               
patient had  the option to opt  out of the exchange.   She stated                                                               
that there  was not a  requirement under either state  or federal                                                               
law  for  a  Medicaid  patient   to  participate  in  the  health                                                               
information exchange.                                                                                                           
REPRESENTATIVE VAZQUEZ  asked if there  was a written  form which                                                               
explained the patient rights, and required a patient signature.                                                                 
MS.  DAVIDSON explained  that the  Alaska eHealth  Network was  a                                                               
non-profit  organization  which  managed the  health  information                                                               
exchange  and   worked  directly   with  each  of   the  provider                                                               
organizations.    She  stated  that  although  the  provider  was                                                               
responsible  for these  forms, the  network would  work with  the                                                               
provider organization to develop the form, if necessary.                                                                        
REPRESENTATIVE  TALERICO  asked  if  the in-depth  notes  to  her                                                               
presentation were available to be shared.                                                                                       
MS. DAVIDSON agreed to share the notes.                                                                                         
4:47:28 PM                                                                                                                    
CHAIR  SEATON, referencing  the controlled  substances data  base                                                               
and its  required use, asked about  an estimate for the  time and                                                               
cost to  convert this  controlled substances  data base  into the                                                               
health  information  exchange  to   better  help  prevent  opioid                                                               
MS. DAVIDSON offered  to research and provide an  estimate of the                                                               
time and cost,  noting that this was already  being researched as                                                               
an option.                                                                                                                      
4:50:36 PM                                                                                                                    
REPRESENTATIVE TARR asked about  the security backup measures for                                                               
the  electronic information  in the  exchange in  the event  of a                                                               
crisis situation with the need for critical health information.                                                                 
MS. DAVIDSON noted that, as  this health information exchange was                                                               
web based, in an emergency, access  to the internet and this data                                                               
would be one  of the highest priorities.  In  further response to                                                               
Representative  Tarr, she  stated  that there  had  not been  any                                                               
security breaches.                                                                                                              
CHAIR  SEATON asked  if all  providers  of controlled  substances                                                               
would have  to join the exchange,  or could they be  members only                                                               
for the  reporting of controlled  substance, and not the  rest of                                                               
the required reporting.                                                                                                         
4:54:44 PM                                                                                                                    
There being no  further business before the  committee, the House                                                               
Health  and  Social  Services   Standing  Committee  meeting  was                                                               
adjourned at 4:54 p.m.                                                                                                          

Document Name Date/Time Subjects
Presention_HSS & Health Information Exchange_01.21.2016.pdf HHSS 1/21/2016 3:00:00 PM
Presentations by DHSS
Statewide Suicide Prevention Council_Presenation HHSS_01.21.16.pdf HHSS 1/21/2016 3:00:00 PM
Presentations by DHSS