Michael R. Lardiere , LCSW Vice President Health Information Technology and Strategic Development

1. SAMHSA - CSATTargeted Capacity Expansion - Health Information Technology1st Annual Grantees’ MeetingSept. 6 -7, 2012 Michael R. Lardiere, LCSW Vice President Health Information Technology and Strategic Development MikeL@thenationalcouncil.org

2. Mobile and Interactive Communications Technologies

3. Definition • mHealth is a component of eHealth. • No standardized definition of mHealth has been established. • WHO Definition • mHealth or mobile health as medical and public health practice supported by mobile devices, such as • mobile phones, • patient monitoring devices, • personal digital assistants (PDAs), and • other wireless devices.

4. mHealth involves the use and capitalization on a mobile phone’s • core utility of voice and short messaging service (SMS) • as well as more complex functionalities and applications including general packet radio service (GPRS), • third and fourth generation mobile telecommunications (3G and 4G systems), • global positioning system (GPS), and • Bluetooth technology.

5. Overview of WHO 2009 mhealth Survey • the emergence of mHealth is occurring through experimentation with technologies in many health settings • Development of Health call centers was (number 1) • Decision support systems was (number 14);

6. Top Barriers to mHealth implementation • Need for further knowledge and information, • such as assessing effectiveness and cost-effectiveness of mHealth applications • Other key barriers included • Conflicting health system priorities • Lack of supporting policy, and legal issues • Evaluation of programs is low (only 12%)

7. Data security and citizen privacy are areas that require legal and policy attention to ensure that mHealth users’ data are properly protected • Sharing global ICT standards and architecture is needed • Cooperation in the development of best practices enterprise architecture will ensure that data can move more effectively between systems and applications

8. mHealth categories used in the 2009 survey • „Communication between individuals and health services • Health call centres/Health care telephone help line • Emergency toll-free telephone services • Communication between health services and individuals • Treatment compliance • Appointment reminders • Community mobilization • Awareness raising over health issues • Included downloading health information onto the mobile device

9. Consultation between health care professionals • Mobile telemedicine • Intersectoral communication in emergencies • Emergencies • Health monitoring and surveillance • Mobile surveys (surveys by mobile phone) • Surveillance • Patient monitoring • Access to information for health care professionals at point of care • Information and decision support systems • Patient records

10. The most frequently reported types of mHealth initiatives globally were • Health call centers/health care telephone help lines (59%) • Emergency toll-free telephone services (55%), • Emergencies (54%), and • Mobile telemedicine (49%) • „The least frequently reported initiatives were • Health surveys (26%), • Surveillance (26%), • Awareness raising (23%), and • Decision support systems (19%).

11. mHealth Technologies Available Today!! Consumer eHealth BodyTrack: Open Source Tools for Health Empowerment through Self-Tracking:  “self tracking” • open source tool, Fluxtream , allows an individual to aggregate and visualize self-tracking data from a variety of sources. (Think wireless weight scale, dietary tracker, exercise monitor, and sleep habits mashup.)

12. Hacking Yourself: Hard Core Behavior Change RunOrElse.com • Commit to a running goal • If you do not make your goal • Your PayPal account is charged!!!

13. Weighing Scale • Pulse Oximeter • Blood Pressure Monitor • Thermometer • Cardiovascular • Strength • Activity Hub • Adherence Monitor • Peak Flow Monitor • Glucose Meter

15. Home Monitoring Behavioral Health Conditions

16. M3 Checklist – The Solution A patient rated mental health assessment screen that simultaneously assesses the risk of several existing mood and anxiety disorders, including depression, anxiety, bipolar disorder and post traumatic stress disorder The only patient-rated, validated, multi-dimensional Mental Health screen in the market. Key Features • Patient-rated 27 question screen/3 minutes to complete • Evidence-based tool to diagnose/detect mood and anxiety disorders • Highly predictive & sensitive to early detection • Cloud-based data capture facilitates easy link to EMRs & PHRs • Longitudinal tracking for continual monitoring

18. BH-Works: Behavioral Health Screen for Children & Adolescents

19. Behavioral Health Screen (BHS) Behavioral Health Screen (BHS) • Web-based, self report application to assess risk behavior and psychiatric symptoms in children, adolescents, and adults • Validated screen developed in collaboration with Guy Diamond, the University of Pennsylvania, and The Children’s Hospital of Philadelphia (CHoP) • Screen across 13 domains in under 10 minutes • Covers areas recommended by the American Academy of Pediatrics and the American Psychiatric Association. • Used in Primary Care, Schools, Mental Health Intake and Outcomes • Available in English and Spanish Staff Prints Report & Adds to Med. Record Doctor Reviews Report & Makes Referral Patient Enters Clinic Patient Completes Screen

20. BHS Key Domains • Medical • School • Family • Safety • Substance Abuse • Sexuality • Nutrition and Eating • Anxiety • Depression • Suicide and Self-Harm • Psychosis • Trauma • Independence

21. BHS Screen Results • Summary Results Immediately Identify: • Critical Items (i.e. Suicide) • Scores and Clinical Significance • Risk Behaviors (i.e. Substance Abuse) • Patient Strengths (i.e. School/Work) • Streamlines Diagnosis and Treatment • Aggregate Measures for QI/Outcomes Reporting

22. Computerized CBT The broad nature of our programs provides unique value. Our suite covers the vast majority of outpatient behavioral health problems that affect more than 25% of the population annually, including anxiety (18%), insomnia (10%), depression (7%), alcohol and drug use (9%), and obsessive compulsive disorder (1%). In addition to the broad treatment coverage the portfolio provides, there is additional value provided in a number of ways: • Saves Direct Costs: Our products demonstrate 63% cost savings compared to current treatment modalities while maintaining comparable efficacy. • Leverages Mental Health Clinicians: Our products allow clinicians to see many more patients (3-4X improved eciency) and can be administered either by MDs, PhDs or non-CBT trained clinical workers.

23. Decreases “Step ups” in Care: Patient often avoid long term medication treatment and/or face-to-face therapy altogether. Research has shown an up to 66% reduction in patients stepping up to more intensive forms of care. • Increases Access: No geographic limitations--available on the Internet and can work with telemedicine or call center guides. • Provides Revenue Opportunities: Where appropriate, revenue can be generated through Medicaid, Medicare and insurers. • Reduces Side Effects: Our programs are often an alternative to psychoactive medications that have severe side effects including risk of falls in the elderly and diabetes.

24. VIGNET Together with SAMHSA and the National Institutes of Health, Vignet has leveraged its flexible platform to conceptualize flexible and powerful solutions in the contexts of behavioral health and substance abuse treatment and prevention. Vignet leverages the several different tools to collect patient-reported data and enable personalized clinical interventions Patient Monitoring, Reporting and Surveillance with Smartphones, Tablets and Web-Browsers MOBILE, REAL-TIME, ECOLOGICAL MOMENTARY ASSESSMENT: customizable behavioral time-use and event logging mobile dairy solution for patients, clinicians and researchers, which allows for a cross-sectional view of a patient’s behaviors, activities, moods, medication, food intake and more. MOBILE EDIARY: collect detailed self-reported data for a specific condition such as anxiety DATA AGGREGATION FROM BIOMETRIC SENSORS: collect data from weight scales, blood pressure cuffs, etc. and view on a phone, PHR, provider portal or EMR

25. SELF-REPORTED BIOMETRIC DATA: wireless or patient entered readings for weight, blood pressure, etc. using a mobile or web-based interface GPS AND POINTS OF INTEREST: geo-fencing, alerts and messages based on where the patient is and what is nearby (liquor store, etc.) REGIMEN AND COMPLIANCE TRACKING: behavior change, medication adherence, etc. TECHNOLOGY Behavioral health EMR integration 42 CFR Part 2 compliance / advanced consent management model Secure cloud computing Cross-platform mobile development

26. Vignet Solutions Address the Continuum of Care – For Physicians and Patients Screening, Prevention, Education Diagnose Journaling Log, Questionnaire, Medication Adherence Remote Monitoring / Manage Clinical Follow-up Surveillance / Predict Solutions Across the Continuum of Care

28. Client/Consumer Engagement

29. Interactive Web Portals Recovery Oriented System of Care(ROSC) • A cost-effective, community-based, whole-health approach to addictions treatment • Focus on increasing “Recovery Capital” in addition to meeting “treatment need” • Focus on “Targeted Treatment” • Uses Recovery Coaches, Recovery Engagement Centers, volunteers, and community resources to meet the need of each individual

30. Next: eROSC • SAMHSA’s 2011 CSAT Health IT RFP was a perfect fit. • Our goals for the e-ROSC: • Educate and raise awareness • Engage clients through new media • Measure and track a client’s progress • Promote increased communication • Leverage community resources • Create a community • Improve operational efficiency • Lower the barriers to seeking treatment.

31. Three logical domains v-recover.com (Public Site) Moderated Discussion Live Chat (with a Recovery Coach or volunteer) Request an appointment Addicted / Need Help? Terms of Service and Privacy Policy Code of Conduct • Public Calendar • Announcements • Community Resources • Our View / What we Provide • Real Recovery • Gallery • The Rec Family • About

32. Three logical domains (Cont.) Recovery Center (Private Site) My Personal Health Record (Participant controlled) Recovery Tools (Provider controlled) • Recovery Plan • Weekly Update • Secure Message Center • Personal Calendar • Recovery Capital Scale

33. v-Recover.com

34. Recovery Tools are those materials that are used by the Client and the Recovery Coach to plan, organize and direct Recovery Support. Recovery Tools are a part of the Clinical Record.

35. Tele Behavioral Health

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37. Center for Integrated Health Solutions (CIHS) • The SAMHSA-HRSA CIHS is funded under a training and technical assistance cooperative agreement with SAMHSA • Update on CIHS HIT Supplement • Individual Grantees • 5 state HIE Initiative

38. CIHS PBHCI HIT Supplement Grant Technical Assistance and Training • Challenge – Support the implementation of Behavioral Health electronic health records systems (EHRS) and BH provider participation in “Meaningful Use” through the exchange of patient data, under the umbrella of the PBHCI initiative

39. Requirements • Three Grant Requirements • Implement a certified Electronic Health Record System • Attain Meaningful Use • Engage in patient information exchange to improve patient care

40. HIE Supplement

41. HIE Supplement Goals • To develop infrastructure supporting the exchange of health information among behavioral health and physical health providers • Development or adaptation of electronic health information exchange (HIE) systems to support the exchange • Work through the challenges of exchanging 42 CFR data and implement a process to do so • Identify the behavioral health data elements that should be part of the CCD

42. What the National Council is Doing

44. National Network of Vetted Consultants • Knowledgeable in HIT • Knowledgeable in Safety Net Provider Organizations • Knowledgeable in behavioral health • Provide services to Regional Extension Centers • Full Range of expertise • Discounted Fees for Members

45. VIT Products and Services • M-3 Clinician – Screening tool for PHQ9 + BiPolar + PTSD + SA • Meets Medicare as a reimbursable screening m3clinician.com/default.aspx • Cobalt Therapeutics – Computerized CBT • Depression, Anxiety, Sleep Disorders www.cobalttx.com • VignetCorp. - Enterprise solutions for individual health, public health and population health www.vignetcorp.com • Access Psychiatry – provides national tele behavioral network and consulting http://www.accesspsych.com/main/index.html • Mdlogix– Behavioral Health screening tool for children and adolescents www.mdlogix.com • ClearDATA– provides mass storage and secure hosting specifically for healthcare cleardata.net • DIRECT– easy onboarding to use DIRECT secure messaging through Healthricity. The MU Stage 2 requirement

47. Michael R. Lardiere, LCSW Vice President Health Information Technology & Strategic Development MikeL@thenationalcouncil.org 202-684-7457 xt 273