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Overview of Issues: Barriers to Developing EHR in This Field

Overview of Issues: Barriers to Developing EHR in This Field. Constance Weisner, DrPH, MSW Jennifer Mertens, PhD Stacy Sterling, MSW, MPH Narrowing the Research-Practice Divide in Evidence-Based Medicine with Adoption of Electronic Health Record Systems: Present and Future Directions

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Overview of Issues: Barriers to Developing EHR in This Field

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  1. Overview of Issues:Barriers to Developing EHR in This Field Constance Weisner, DrPH, MSW Jennifer Mertens, PhD Stacy Sterling, MSW, MPH Narrowing the Research-Practice Divide in Evidence-Based Medicine with Adoption of Electronic Health Record Systems: Present and Future Directions National Institute of Drug AbuseRockville, MDJuly 13-14, 2009

  2. Overview • History • Barriers • Infrastructure • Workforce • Multiple system interaction • Most programs are free-standing-not part of a health plan/using the same EMR • Privacy • Potential

  3. National Policy Approach to Behavioral Health Care Crossing the Quality Chasm’s aims, rules, and strategies for redesign should be applied throughout Mental Health/Substance Use health care on a day-to-day operational basis tailored to reflect the characteristics that distinguish Mental Health /Substance Use health care from general health care. Institute of Medicine. Improving the Quality of Health Care for Mental and Substance-Use Conditions: Quality Chasm Series. Washington, DC: National Academies Press; 2006.

  4. Six Critical Pathways for Achieving Aims • Effective use of information technology (IT) • News ways of delivering care • Managing the clinical knowledge, skills, and deployment of the workforce • Effective teams and coordination of care across patient conditions, services and settings • Improvements in how quality is measured • Payment methods conducive to good quality

  5. Increased stigma, discrimination, & coercion Patient decision-making ability not as anticipated / supported Diagnosis more subjective A less developed quality measurement & improvement infrastructure More separate care delivery arrangements Less involvement in the NHII and use of IT More diverse workforce and more solo practice Differently structured marketplace M/SU Health Care Compared to General Health Care

  6. Health Plans / Purchasers Recommendations (cont): • Require all contracting organizations to appropriately share patient information; • Provide incentives for the use of electronic health records and other IT; • Use tools to reduce adverse risk selection of M/SU treatment consumers; and • Use measures of quality and coordination of care in purchasing / and oversight. • Associations of purchasers work to reduce variation in reporting / billing requirements.

  7. Characteristics of the Addiction Treatment System

  8. Addiction Specialty Care 11,600 13,200specialtyprograms in US • 31% treat less than 200 patients per year • 65% private, not for profit • 77%primarily governmentfundedPrivate insurance <12% Sources – NSSATS, 2002; D’Aunno, 2004

  9. Referral Sources Source 19902008 Criminal Justice 38% 61% Employers/EAP 10% 6% Welfare/CPS 8% 14% Hosp/Phys 4% 3%

  10. Adolescent Treatment Referral Sources • Parents - 83% • Health care provider - 18% • Legal system - 33% (20% Court Mandated) • Friends - 19% • Mental health providers - 35% • Schools - 13%

  11. Program Infrastructure Phone Interviews With National Sample of 175 Programs regarding personnel, management, information McL, Carise & Kleber JSAT, 2003

  12. Program Changes In 16 Months: • 12% had closed • 13% had changed service operation • 31% of the rest had been taken over, usually by MH agencies

  13. Counselor turnover 50% per year 50% of directors have been there Less Than 1 year STAFF TURNOVER!

  14. Other Staff • 54%Had no physician 34% Had P/T physician 39% Had a Nurse • < 25% Had a SW or a Psychologist • Major professional group - Counselors

  15. Information Systems: • Modest Computer Availability • Mostly For Administrative Work • 80% Had a Computer • 50% had Web Access • Still very little computer/software availabilityfor CLINICAL STAFF

  16. Multiple System Interaction • Unique to behavioral health care: Most programs are free-standing • collaborative care with: • Health systems • Criminal Justice • Welfare • Important issues for internal EMRs and cross-system communication • Should privacy regulations be the same for each system? • Where the program is embedded?

  17. Privacy • “Prevent disclosure of addiction treatment and diagnoses; also create barriers to accessing data and complicate coordination of care, especially with regard to EHRs and electronic networks.”(Institute of Medicine, 2006)

  18. Privacy (cont’d) • Continuing Care • Stigma • Variation in clinical and patient concerns

  19. Opportunities • Coordination with other systems • Communication with patients • Epidemiologic surveillance • Outcomes monitoring

  20. Using Standardized Instruments at Intake and Follow-up

  21. Conclusion • Barriers are large and involve characteristics of the treatment system, regulatory issues, workforce issues, and long-term work styles. • Opportunities are increasing and field is ready to grapple with these issues.

  22. Thank you!

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