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NIDA Conference on Narrowing the Research-Practice Divide in Evidence-Based Medicine with Adoption of Electronic Health Record Systems: Present and Future Directions. Implementing Compatible EHR Databases Across Agencies Steven Davis, PhD Chief Information Officer
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NIDA Conference on Narrowing the Research-Practice Divide in Evidence-Based Medicine with Adoption of Electronic Health Record Systems: Present and Future Directions Implementing Compatible EHR Databases Across Agencies Steven Davis, PhD Chief Information Officer Oklahoma Department of Mental Health and Substance Abuse Services Rockville, Maryland July 13-14, 2009
Prerequisites • Linkage • Access
Prerequisites • Linkage • Infrastructure—yours, theirs • The problem with standards is that everyone has one • Lost in translation—the problems of talking different languages
Integrated Client Information System (ICIS)Client Data Core (CDC) in Oklahoma
Behavioral Health EHR Standards Sources • NDIIC • SATVA • BH-MITA • TEDS • VistA • RPMS
BH EHR Standard Behavioral Health Functional Profile Developed by The Behavioral Health Profile Working Group Sponsored and Facilitated by The Center for Mental Health Services and The Center for Substance Abuse Treatment Substance Abuse and Mental Health Services Administration U.S. Department of Health and Human Services Based on the HL7 EHR-S Functional Model Release 1, February 2007 Co-facilitators: Jim Kretz, SAMHSA Sarah Minden, MD, Abt Associates Tom Trabin, Ph.D., SATVA Registration Release 1, 09/14/2007
Prerequisites • Access • Legal • Person-to-person • Technical
Turning Data into Information Data Sources DMHSAS Dept. of Health OK State Bureau of Investigations Dept. of Corrections OK Employment Security Comm. OK & Tulsa County Jails Dept. of Human Services OK Health Care Authority Other Data Sources Decision Support Services Transformation TANF Access to Recovery PACT Strengthening Treatment Access & Retention Co-Occurring Older Adults Suicide Prevention OK Prevention Initiative Seclusion & Restraint Meth Prevention Grant/Project Evaluation Information
Matched Administrative Data Sources and Data Sharing Agreements • OK Health Care Authority (State Medicaid Authority) - Enrollment, Eligibility and Claims • Dept. of Corrections – Incarcerations, Probation & Parole • OK Employment Security Commission – Wage & Unemployment Benefits • OK State Bureau of Investigation – Arrests • Dept. of Public Safety – DUI Convictions • OK State Dept. of Health - Mortality and Hospital Discharge Data • Dept. of Human Services – TANF, Food Stamps, Child Welfare • OK and Tulsa County Jails – Arrest and Booking Information
‘Other State Agency’ Study This study is focused on the other state agencies that provide mental health services and essential supports to persons with mental illnesses. • document the numbers of persons served by other state agencies • document the expenditures of these agencies for mental health services. Collaborating with: • Department of Rehabilitation Services • Department of Corrections • Health Care Authority (Medicaid Agency) • Department of Human Services - Child Welfare • Office of Juvenile Affairs • State Department of Health - Early Intervention • Department of Education
Cost Savings: Inpatient = $1,858,512 Jail = $140,250
ICD-9 Principle Diagnosis Top Categories *Only females, age 10-49, were used in the denominator to calculate the rates for Normal Pregnancy/Delivery and Pregnancy/Delivery Complications.
Coming up… • Incentives for adoption • Widespread use of the BH Functional Profile in BH-EHRs • Comparative Effectiveness Research (CER) in BH • Large-scale data mining to identify models for detecting undiagnosed cases, risk and protective factors, compiling performance measures, treatment outcomes—decision support analytics • More templates and models for sharing and matching EHR/HIE data with administrative datasets • Personal Health Records and commodification of data
Resources and References • Defining key information technology terms. National Alliance for Health Information Technology; 2008 April 28. http://www.nahit.org/images/pdfs/HITTermsFinalReport_051508.pdf. • RWJF Measuring What Matters—electronically, automatically, (somewhat) painlessly. http://www.rwjf.org/qualityequality/product.jsp?id=44907 • Hall, MA and Schulman, KA: Ownership of Medical Information. JAMA, March 25, 2009, Vol 301, No 12. • The Comparative Effectiveness Rally. http://www.govhealthit.com/docs/magazine/GHIT_v4n4_final_cover.pdf#page=22 • Data matching software: Both are free, but Link King requires a SAS license. The Link Plus takes into consideration how common names are, nicknames, if the first and last names are switched, etc. You can pick the items you want to use for matching. • For Link King, go to the software at http://www.the-link-king.com/. • For Link Plus, go to NPCR Home Page: http://www.cdc.gov/cancer/npcr, select ‘Tools’ then click on ‘Registry Plus’ under the 'Registry Plus Components,' then click on ‘Link Plus,’ then ‘Technical Information and Installation.’
Resources, continued • National Institute of Mental Health. Series FN No.10, Data Standards for Mental Health Decision Support Systems, by Leginski, W.A.; Croze, C.; Driggers, J.; Dumpman, S.; Geertsen, D.; Kamis-Gould, E.; Namerow, M.J.; Patton, R.E.; Wilson, N.Z.; and Wurster, C.R. DHHS Pub. No. (ADM)89-1589. Washington, DC: Supt. of Docs., U.S. Govt. Print. Off., 1989. DHHS Publications No. (ADM) 89-1589 Printed 1989. • Behavioral Health Functional Profile for an electronic health record. http://xreg2.nist.gov:8080/ehrsRegistry/faces/view/detailFunctionalProfile.jsp?id=urn:uuid:8c6bc951-ef42-488c-93fc-c95fd9e5910e • Garnick, DW et al. Are Washington Circle Performance Measures associated with decreased criminal activity following treatment? JSAT, Vol 33, pp 341-352, 2007. • Banks SM; Pandiani JA: Probabilistic population estimation of the size and overlap of data sets based on date of birth. Statistics in Medicine, Vol 20, pp 1421-1430, 2001. • Agency for Healthcare Research and Quality (AHRQ) National Resource Center for Health Information Technology. http://healthit.ahrq.gov/portal/server.pt?open=514&objID=5554&mode=2&holderDisplayURL=http://prodportallb.ahrq.gov:7087/publishedcontent/publish/communities/k_o/knowledge_library/key_topics/health_briefing_01232006114616/electronic_medical_record_systems.html