Health and Social Integration Platform: Resource Connection Network

Join the Resource Connection Network Action Team

This team works to build a sustainable medical and social system integration tool using technology to connect existing platforms across sectors. This technology infrastructure is meant to create a more cohesive and operationally manageable ecosystem to support service care delivery and ultimately our community. The platform will support comprehensive high-quality resources that support communication, referrals, data sharing, and shared case management between organizations.

RESOURCE CONNECTION NETWORK: THE HEALTH AND SOCIAL INTEGRATION TOOL

Sonoma Connect | Sonoma Unidos is partnering with Community Action Partnership of Sonoma, United Way of the Wine Country 211, Aliados Health, and partnering organizations, leveraging the technology NinePatch to build a platform that supports community-wide health, wellness and equity by piercing through silos and enabling cross-sector collaboration, data sharing, and care coordination. Inspired by the Community Information Exchange model, this system will focus on integrating Social Service sector data systems with Healthcare sector Health Information data systems.

  • Sonoma County residents and service providers are not always aware of available resources and often there is no easy way to access these resources.

  • Sonoma County social service and health providers use many different data systems resulting in duplication of data entry, inefficiency in our system of care, and an uncoordinated approach to reducing disparities and inequity in access to services.

  • Given increasing need and demand, improved tools to support cross-sector referrals and workflows are needed now.

WHY IT IS NEEDED

HOW DO CLOSED-LOOP REFERRALS WORK?

Closed-loop referrals provide a means for healthcare professionals to send patient information to a community-based organization (CBO) to help address a patient’s needs that are typically better served outside of clinical workflows. A CBO can provide an array of different support programs within the community, including services that address a patient's social needs or address underlying causes of poor health outcomes with the goal of positively impacting the patient’s overall health outcome(s). The CBO can then provide feedback on the outcome of that referral back to the referring individual/entity (CRISP).

Please note that close-loop referrals are not limited to communication between CBOs and Health Centers. Closed-loop referrals can occur between any referring partners, such as tribal partners, schools, government, etc.

KEY FUNCTIONALITIES

  • Award-winning “Whole Person” client profile

  • Closed-loop referrals, intelligent resource directory

  • Screening and case management tools

  • Capacity for interoperability between referral platforms

  • Plus powerful, customizable dashboards, and reporting

EARLY ADOPTERS

  • Sonoma County Comprehensive Perinatal Services Program (CPSP)

  • Sonoma County Home Visiting Programs, Sonoma County Office of Education (SCOE)

  • Petaluma Health Center, Petaluma People Services

  • Community Support Network

  • Food for Thought

  • Hanna Center

  • Community Action Partnership

  • La Familia Sana. Partners

Implementation Timeline

  • STEP 1

    Community engagement to drive platform goals, priorities, technical criteria

  • STEP 2

    Platform chosen and acquired

  • STEP 3

    Build system and workflows with community input

  • STEP 4

    Initial implementation and bug fixes with pilot cohort

  • STEP 5

    Outreach and Training

  • STEP 6

    Expanded implementation with additional partners

    WE ARE HERE

  • STEP 7

    Build out and implementation of additional functionality

HOW WAS NINEPATCH SELECTED FOR THE RESOURCE CONNECTION NETWORK?

Technology Criteria

This document lists desired criteria and specific components for the medical and social system integration technology platform.


Technology Demonstrations

See the technology demonstration from different vendors to learn more about the features they offered and how they aligned with our needs.