Improving the Quality of Health Care for Mental and Substance-Use Conditions (2006) / Chapter Skim
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6 Ensuring the National Health Information Infrastructure Benefits with Mental and Substance-Use Conditions
6 Ensuring the National Health Information Infrastructure Benefits with Mental and Substance-Use Conditions
Pages 259-285
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data standards that will make shared information understandable to all users (IOM, 2004)
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support individual M/SU clinicians in their use of IT. A STRONG INFORMATION INFRASTRUCTURE IS VITAL TO QUALITY Crossing the Quality Chasm (IOM, 2001)
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Recently he enrolled in EQUIP, a project aimed at improving care for people with schizophrenia by applying illness management principles effective in treating other chronic illnesses. EQUIP uses the VA's electronic health record (EHR)
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a secure platform for the exchange of patient information across health care settings, and (3) data standards that will make shared information understandable to all users (IOM, 2004)
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First, federal funds should support the development of critical components of the NHII that are unlikely to receive support from private-sector stakeholders. These include the establishment of a secure platform for the exchange of data across all providers and maintenance of a process for ongoing promulgation of national data standards.
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. Electronic Health Records3 An EHR system encompasses (1)
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. Three leading associations in health care information management and technology-the American Health Information Management Association, the Healthcare Information and Management Systems Society, and the National Alliance for Health Information Technology -- have jointly launched the Certification Commission for Healthcare Information Technology to create a mechanism for the certification of health care information technology products, in particular EHRs (CCHIT, 2004)
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From page 266... ...
In October 2001, the federal government established the Consolidated Health Informatics interagency initiative to adopt interoperability data standards for federally operated and funded health care providers. Given that the federal government represents more than 40 percent of health care expenditures in the United States, this action is viewed as a powerful means of establishing such standards nationally across the public and private health care sectors (IOM, 2004)
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From page 267... ...
· The National Library of Medicine should be designated as the responsible entity for distributing all national clinical terminolo gies that relate to patient safety and for ensuring the quality of terminology mappings. The IOM also recommended that, after allowing a reasonable time for health care organizations to comply with national standards identified by the Consolidated Health Informatics initiative, the major government health care programs, including those operated by DHHS, the Veterans Administration, and the Department of Defense, should immediately incorporate these data standards into their contractual and regulatory requirements (e.g., Medicare conditions of participation)
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. Finally, Connecting for Health, a publicprivate collaborative of more than 100 diverse organizations, has launched a prototype electronic national health information exchange based on common, open standards that will allow authorized users of three very different health information networks located in California, Massachusetts, and Indiana to share health information both within and among their local regions and communities.
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Of the nearly 600 applications for funding, only "a handful" had any substantial behavioral health content, and of the 103 grants awarded, only 1 specifically targeted M/SU health care.4 Finally, leaders of SAMHSA's predominantly public-sector Mental Health Statistics Improvement Project (MHSIP) initiative (discussed below)
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Information Infrastructure Initiatives for Health Care for M/SU Conditions SAMHSA Initiatives Mental health Decision Support 2000+ and statistics improvement program SAMHSA's Decision Support 2000+ (DS 2000+) initiative is developing an integrated set of mental health data standards and information infrastructure to collect data on community health and population characteristics, enrollment in insurance programs, clients' utilization of services and encounters, providers' use of evidence-based practices, patient outcomes, and other performance measures.
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Over the past 25 years, MHSIP has produced data standards and standardized tools such as report cards and consumer surveys that are in wide use across all states' public mental health systems. MHSIP's FN-10 data standards serve as the foundation for many state mental health data systems.
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The work group shares its topical expertise on data standards in behavioral health care, apprises relevant groups in the behavioral health care field of activities and trends in national data standards, facilitates and coordinates efforts to influence national data standards, and supports the implementation of data standards in the behavioral health care field. Uniform Reporting System (URS)
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Nationwide summit on behavioral health information management and the NHII SAMHSA and SATVA held a working summit in September 2005 to define a strategy for behavioral health information management and its role within the NHII. This summit provided an initial opportunity 7 Personal communication, Mady Chalk, PhD, Director, Division of Services Improvement, CSAT, SAMHSA, on July 28, 2005.
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Private-Sector Initiatives Mental Health Corporations of America This industry trade association for more than 100 leading community behavioral health organizations nationwide is working with SATVA in a joint effort to develop best-practice guidelines for selecting software, contracting with software vendors, and implementing information systems and EHRs. The Davies Award This award is given annually by the Health Information Management Systems Society to a small number of organizations in recognition of their outstanding efforts to implement EHRs.
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that will provide electronic networks containing data elements essential to care coordination and accessible by diverse participating health care organizations in a defined geographic region. · PHRs that are consumer controlled, incorporate selected data elements from existing health records, and include data a consumer may choose to add for service providers' attention.
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. With respect to substance-use treatment providers, telephone interviews conducted in 2003 with a random sample of 175 directors of inpatient/residential, outpatient, and methadone maintenance programs across the nation revealed that approximately 20 percent of programs had no information services of any type, e-mail, or even voice mail for their phone systems.
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In examining IT adoption for five clinical functions -- obtaining treatment guidelines, exchanging clinical data with other physicians, accessing patient notes, generating treatment reminders for physicians, and writing prescriptions -- the survey found that the vast majority of patients were treated in physician practices lacking significant IT support for patient care. One-quarter of all physicians were in practices with no computer or other form of IT support for any of the five functions, and another quarter had IT support for just one function.
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For example, the managed behavioral health organizations and HMO reported that they could not require electronic transmission of claims and other forms because too few providers had the necessary skills and equipment to comply (Trabin and Maloney, 2003)
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. INTEGRATING HEALTH CARE FOR MENTAL AND SUBSTANCE-USE CONDITIONS INTO THE NHII The committee concludes that strong actions are needed to involve M/SU health care organizations, systems of care, and treatment providers quickly and directly in efforts to create the NHII, including initiatives to (1)
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for consumers of M/SU health care services, the secretaries of DHHS and the Department of Veterans Affairs should charge the Office of the National Coordinator of Health Information Technology and the Substance Abuse and Men tal Health Services Administration to jointly develop and implement a plan for ensuring that the various components of the emerging NHII- including data and privacy standards, electronic health records, and community and regional health networks -- address M/SU health care as fully as general health care. As part of this strategy: · DHHS should create and support a continuing mechanism to en gage M/SU health care stakeholders in the public and private sec tors in developing consensus-based recommendations for the data elements, standards, and processes needed to address unique as pects of information management related to M/SU health care.
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National associations of purchasers -- such as the National Association of State Mental Health Program Directors, the National Association of State Alcohol and Drug Abuse Directors, the National Association of State Medicaid Directors, the National Association of County Behavioral Health Directors, the American Managed Behavioral Healthcare Association, and the national Blue Cross and Blue Shield Association -- should decrease the burden of vari able reporting and billing requirements by standardizing requirements at the national, state, and local levels. Recommendation 6-4.
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To facilitate the delivery of coordinated care by primary care, mental health, and substance-use treatment providers, government agencies, purchasers, health plans, and accreditation orga nizations should implement policies and incentives to continually in crease collaboration among these providers to achieve evidence-based screening and care of their patients with general, mental, and/or substance-use health conditions. The following specific measures should be undertaken to carry out this recommendation: .
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Presentation to IOM Committee on Data Standards for Patient Safety on January 23, 2003. [Online]
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In: Feldman S, ed. Managed Behavioral Health Services: Perspectives and Practice.
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In: Feldman S, ed. Managed Behavioral Health Services: Perspectives and Practices.
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