Evaluating IDENTITY, an Automated Data Sharing Platform to Improve Health Outcomes for Youth in Protective Custody

Purpose Integrated Data Environment to eNhance outcomes in cusTody Youth (IDENTITY) is a web-based portal designed to share linked electronic health record (EHR) and child welfare information in near-real time for children in protective custody. The purpose of this study was to evaluate the feasibility and utilization of IDENTITY by child protective services workers and clinicians. Methods IDENTITY links records between the State Automated Child Welfare Information System (SACWIS) and the EHR using deterministic matching and non-deterministic matching algorithms (Dexheimer et al., 2018), updated twice daily and displayed in a web-based, read-only application. The pilot system launched April 9, 2018. Uptake and utilization of IDENTITY has been collected and recorded to assess user experience. Semi-structured interviews were completed with child protective services staff (N = 34) to understand the impact of IDENTITY on their work. Results IDENTITY was launched with 66 child protection caseworker and 5 clinician users. By January 2019, IDENTITY had spread to 637 users (346 caseworkers, 291 clinicians). Of those users, 70% have accessed the application. An average of 68 users (66% caseworkers) access an average of 207 children’s records in IDENTITY per week (53% by caseworkers, 47% by clinicians). “Health Information” is most commonly accessed (73%), which displays diagnoses, allergies, medications, and surgical history. “Primary Contacts” is second most common (14%), and lists caseworker, supervisor, section chief, GAL/CASA, and primary care doctor contact information. “Referrals and Appointments” is third most common (7%), and displays future appointments, missed appointments, and open referrals. Caseworkers and clinicians are accessing different information in IDENTITY; more than 85% of views for health information, completed visits, and upcoming appointments and referrals are the result of caseworker access, while clinician views account for the majority (69%) of child welfare history views. Interviews with 34 child protection staff revealed that the majority of weekly users (92%) accessed IDENTITY several times per day, most commonly to prepare for Semi-Annual Reviews (58%). Case workers reported referencing health information (42%), validating existing diagnoses (17%), and checking on currently documented lead levels (17%). One supervisor noted, “[IDENTITY] has made our roles more productive.” A frontline worker explained, “It is way easier to use [IDENTITY] compared to SACWIS. You do not have to jump from screen to screen just to find simple information.” Reports from the low-end users reflected two themes: half of low-end users did not understand the purpose of IDENTITY, and half reported trouble managing their login credentials. Conclusion IDENTITY has demonstrated good user uptake and utilization and resulted in positive feedback from users. This demonstrates that it is possible to use integrative technology to improve information sharing between two different systems by linking, merging, and displaying existing information from healthcare and child welfare systems.