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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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slide1

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
Prerequisites
  • Linkage
  • Access
prerequisites3
Prerequisites
  • Linkage
    • Infrastructure—yours, theirs
    • The problem with standards is that everyone has one
    • Lost in translation—the problems of talking different languages
behavioral health ehr standards sources
Behavioral Health EHR Standards Sources
  • NDIIC
  • SATVA
  • BH-MITA
  • TEDS
  • VistA
  • RPMS
bh ehr standard
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

prerequisites9
Prerequisites
  • Access
    • Legal
    • Person-to-person
    • Technical
slide10

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
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
‘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
slide14

Cost Savings:

Inpatient = $1,858,512

Jail = $140,250

icd 9 principle diagnosis top categories
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
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
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
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