NIDA Conference on Narrowing the Research-Practice Divide in Evidence-Based Medicine with Adoption of Electronic Health Record Systems: Present and Future Directions

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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

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Prerequisites

• Linkage
• Access

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Prerequisites

• Linkage
• Infrastructureyours, theirs
• The problem with standards is that everyone has
  one
• Lost in translationthe problems of talking
  different languages

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Integrated Client Information System
(ICIS)Client Data Core (CDC) in Oklahoma
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Behavioral Health EHR Standards Sources

• NDIIC
• SATVA
• BH-MITA
• TEDS
• VistA
• RPMS

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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

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Prerequisites

• Access
• Legal
• Person-to-person
• Technical

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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
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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

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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

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Re-Arrest Rate by Release Type
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Cost Savings Inpatient 1,858,512 Jail
140,250
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Oklahoma Mortality Outcomes
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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.
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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 outcomesdecision support analytics
• More templates and models for sharing and
  matching EHR/HIE data with administrative
  datasets
• Personal Health Records and commodification of
  data

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Resources and References

• Defining key information technology terms.
  National Alliance for Health Information
  Technology 2008 April 28. http//www.nahit.org/im
  ages/pdfs/HITTermsFinalReport_051508.pdf.
• RWJF Measuring What Matterselectronically,
  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.pdfpage22
• 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.

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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.gov80
  80/ehrsRegistry/faces/view/detailFunctionalProfile
  .jsp?idurnuuid8c6bc951-ef42-488c-93fc-c95fd9e59
  10e
• 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?open514objID5554mode2holderDisplayURLht
  tp//prodportallb.ahrq.gov7087/publishedcontent/p
  ublish/communities/k_o/knowledge_library/key_topic
  s/health_briefing_01232006114616/electronic_medica
  l_record_systems.html