Implementation of an Electronic Implementation of an Electronic Information System to Enhance Information System to Enhance Practice at an Opioid Treatment Practice at an Opioid Treatment

ProgramProgram

L.S. Brown, S. Kritz, M. Chu, C. Madray, C. John-L.S. Brown, S. Kritz, M. Chu, C. Madray, C. John-HullHullAddiction Research and Treatment Corp, Brooklyn, NY Addiction Research and Treatment Corp, Brooklyn, NY 1120111201

Submitted in Response to NIDA RFA-DA-06-001 (R01): Submitted in Response to NIDA RFA-DA-06-001 (R01): Enhancing Practice Improvement in Community-Based Enhancing Practice Improvement in Community-Based Care for Care for Prevention and Treatment of Drug Abuse or Co-Prevention and Treatment of Drug Abuse or Co-occurring Drug occurring Drug Abuse and Mental Disorders Abuse and Mental Disorders

ABSTRACTABSTRACTConsiderable discussion continues about ways to achieve desirable healthcare outcomes Considerable discussion continues about ways to achieve desirable healthcare outcomes cost-effectively. Use of an electronic health information system has been the focus of many of cost-effectively. Use of an electronic health information system has been the focus of many of these discussions, though generally not in substance abuse treatment settings. Addiction these discussions, though generally not in substance abuse treatment settings. Addiction Research and Treatment Corporation (ARTC) is an outpatient opioid treatment program Research and Treatment Corporation (ARTC) is an outpatient opioid treatment program providing onsite primary medical care and HIV-related care for approximately 3,000 providing onsite primary medical care and HIV-related care for approximately 3,000 predominantly minority adults in Brooklyn and Manhattan in New York City. A large percentage predominantly minority adults in Brooklyn and Manhattan in New York City. A large percentage of this economically disenfranchised population is also infected with hepatitis C virus. These of this economically disenfranchised population is also infected with hepatitis C virus. These patients are subject to significant disparities in healthcare access and quality compared to the patients are subject to significant disparities in healthcare access and quality compared to the general population. ARTC assessed the selection process for implementation of an electronic general population. ARTC assessed the selection process for implementation of an electronic health information system integrating counseling and social services, medical services, case health information system integrating counseling and social services, medical services, case management, HIV counseling and testing, dispensing information, and administrative and management, HIV counseling and testing, dispensing information, and administrative and fiscal data. Buy-in by stakeholders (patients, clinicians and managers) was the initial focus of fiscal data. Buy-in by stakeholders (patients, clinicians and managers) was the initial focus of this process. Five specific aims (quality, productivity, satisfaction, financial performance and this process. Five specific aims (quality, productivity, satisfaction, financial performance and risk management) with nine related hypotheses were chosen based on needs assessment risk management) with nine related hypotheses were chosen based on needs assessment meetings with stakeholders and literature review of prior published investigations. The final meetings with stakeholders and literature review of prior published investigations. The final selection of specific health information hardware and software is informed by a number of selection of specific health information hardware and software is informed by a number of specific criteria, including the ability to provide relevant data regarding the aims mentioned specific criteria, including the ability to provide relevant data regarding the aims mentioned above, information obtained from stakeholders and literature review, and determination as to above, information obtained from stakeholders and literature review, and determination as to whether the system will be developed totally in-house, by an outside vendor or as a hybrid. whether the system will be developed totally in-house, by an outside vendor or as a hybrid. Presentations by various vendors were evaluated using specific criteria. The results of this Presentations by various vendors were evaluated using specific criteria. The results of this detailed program description have the potential to inform continuing discussions about the detailed program description have the potential to inform continuing discussions about the selection and impact of integrated electronic systems in enhancing healthcare outcomes and selection and impact of integrated electronic systems in enhancing healthcare outcomes and agency cost-effectiveness in substance abuse treatment settings for this unique patient agency cost-effectiveness in substance abuse treatment settings for this unique patient population.population.

BACKGROUNDBACKGROUND

Electronic information systems rarely Electronic information systems rarely utilized or evaluated in substance utilized or evaluated in substance abuse treatment settingsabuse treatment settings

ARTC serves a racially, ethnically and ARTC serves a racially, ethnically and economically disenfranchised economically disenfranchised populationpopulation

ARTC serves a population that ARTC serves a population that experiences significant disparities in experiences significant disparities in access and quality of healthcareaccess and quality of healthcare

STUDY DESIGNSTUDY DESIGN

Prospective, comparative studyProspective, comparative study

Pre-post implementation Pre-post implementation evaluation evaluation

3-year timeline3-year timeline

PRELIMINARY ACTIVITIESPRELIMINARY ACTIVITIESBuy-in by all stakeholdersBuy-in by all stakeholders

Needs assessment sessions with Needs assessment sessions with stakeholdersstakeholders

Senior ManagementSenior Management

Clinicians (medical, counseling, social service Clinicians (medical, counseling, social service and case management staff) and case management staff)

PatientsPatients

Evaluation of electronic information systemsEvaluation of electronic information systems

In-house, vendor or hybrid systemIn-house, vendor or hybrid system

HYPOTHESESHYPOTHESES

Quality:Quality:Hepatitis C viral load testing will be Hepatitis C viral load testing will be

offered to all hepatitis C positive offered to all hepatitis C positive patientspatients

Annual assessments will be completed Annual assessments will be completed within 30 days of due datewithin 30 days of due date

All five annual multi-discipline All five annual multi-discipline assessments will be completed within assessments will be completed within 30 days of due date30 days of due date

HYPOTHESESHYPOTHESES

Productivity:Productivity:

The number of visits will increase for:The number of visits will increase for: counseling, counseling,

primary medical care, and primary medical care, and

HIV case managementHIV case management

HYPOTHESESHYPOTHESES

Satisfaction:Satisfaction:

Will increase for:Will increase for: ManagersManagers

CliniciansClinicians

PatientsPatients

HYPOTHESESHYPOTHESES

Risks:Risks:

Rates will decrease for:Rates will decrease for: patient complaints, patient complaints,

incidents, and incidents, and

medication errorsmedication errors

HYPOTHESESHYPOTHESES

Financial Performance:Financial Performance:

Revenue per capita staff will increaseRevenue per capita staff will increase

Cost per visit will decreaseCost per visit will decrease

DomainDomain MeasureMeasure Data Data SourceSource

MechanismMechanism

QualityQuality

HCV viral loadHCV viral load Patient chartPatient chart Alerts; easier Alerts; easier accessaccess

Medical Medical assessmentsassessments

Patient chartPatient chart Alerts; easier Alerts; easier accessaccess

Multi-discipline Multi-discipline assessmentsassessments

Patent chartPatent chart Alerts; easier Alerts; easier accessaccess

Counseling visitsCounseling visits Clinician logsClinician logs Time efficiencyTime efficiency

ProductivityProductivityPrimary care visitsPrimary care visits Clinician logsClinician logs Time efficiencyTime efficiency

HIV case HIV case management visitsmanagement visits

Clinician logsClinician logs Time efficiencyTime efficiency

DOMAINS, MEASURES, DATA DOMAINS, MEASURES, DATA SOURCES & MECHANISMSSOURCES & MECHANISMS

DomainDomain MeasureMeasure Data Data SourceSource

MechanismMechanism

SatisfactioSatisfactionn

PatientsPatients SurveySurvey Reduced waitingReduced waiting

Clinicians/managersClinicians/managers SurveySurvey Easier reportsEasier reportsRisksRisks Complaints, incidents, Complaints, incidents,

medication errorsmedication errorsReports to Reports to

CQI CQI ManagerManager

Quality, Quality, productivity and productivity and

satisfactionsatisfactionFinancial Financial PerformancPerformancee

Revenue per capitaRevenue per capita Finance/Finance/HR DeptsHR Depts

Improved Improved accounts accounts

receivable; receivable; billingbilling

Cost per visitCost per visit Finance Finance DeptDept

Cost savingsCost savings

DOMAINS, MEASURES, DOMAINS, MEASURES, DATA SOURCES & DATA SOURCES &

MECHANISMSMECHANISMS

DATA ANALYSISDATA ANALYSIS

Quantitative analysis of each Quantitative analysis of each Study Domain chosenStudy Domain chosen

Means/medians: t-tests or rank Means/medians: t-tests or rank teststests

Categorical variables: chi-Categorical variables: chi-squaresquare

CURRENT STATUSCURRENT STATUS

NIH Priority Score: 149 (85+ NIH Priority Score: 149 (85+ percentile rank)percentile rank)

Funding approval received Funding approval received September 2006 with no NIH September 2006 with no NIH request for revision and request for revision and resubmissionresubmission

ACKNOWLEDGEMENACKNOWLEDGEMENTSTSPATIENTS AND STAFF PATIENTS AND STAFF

OF THE ADDICTION OF THE ADDICTION RESEARCH AND RESEARCH AND TREATMENT TREATMENT CORPORATION, A CORPORATION, A COMMUNITY-BASED COMMUNITY-BASED SUBSTANCE ABUSE SUBSTANCE ABUSE SERVICE AGENCYSERVICE AGENCY

…Now the Real Work Begins