Implementation of an Electronic Information System to Enhance Practice at an Opioid Treatment Program
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The document discusses implementing an electronic health information system at an opioid treatment program to enhance practices. It will be a prospective, comparative study over 3 years. Preliminary activities included getting stakeholder buy-in and needs assessments. Five aims were identified: quality, productivity, satisfaction, financial performance, and risk management. Hypotheses were developed for each aim. Data sources and measures were identified for evaluating the hypotheses. The study received NIH funding.
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Implementation of an Electronic Information System to Enhance Practice at an Opioid Treatment Program
- 1. Implementation of an Electronic Information System to Enhance Practice at an Opioid Treatment Program L.S. Brown, S. Kritz, M. Chu, C. Madray, C. John-Hull Addiction Research and Treatment Corp, Brooklyn, NY 11201 Submitted in Response to NIDA RFA-DA-06-001 (R01): Enhancing Practice Improvement in Community-Based Care for Prevention and Treatment of Drug Abuse or Co-occurring Drug Abuse and Mental Disorders
- 2. ABSTRACT 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 these discussions, though generally not in substance abuse treatment settings. Addiction Research and Treatment Corporation (ARTC) is an outpatient opioid treatment program 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 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 general population. ARTC assessed the selection process for implementation of an electronic health information system integrating counseling and social services, medical services, case 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 this process. Five specific aims (quality, productivity, satisfaction, financial performance and risk management) with nine related hypotheses were chosen based on needs assessment 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 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 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 detailed program description have the potential to inform continuing discussions about the selection and impact of integrated electronic systems in enhancing healthcare outcomes and agency cost-effectiveness in substance abuse treatment settings for this unique patient population.
- 3. BACKGROUND Electronic information systems rarely utilized or evaluated in substance abuse treatment settings ARTC serves a racially, ethnically and economically disenfranchised population ARTC serves a population that experiences significant disparities in access and quality of healthcare
- 4. STUDY DESIGN Prospective, comparative study Pre-post implementation evaluation 3-year timeline
- 5. PRELIMINARY ACTIVITIES Buy-in by all stakeholders Needs assessment sessions with stakeholders Senior Management Clinicians (medical, counseling, social service and case management staff) Patients Evaluation of electronic information systems In-house, vendor or hybrid system
- 6. HYPOTHESES Quality: Hepatitis C viral load testing will be offered to all hepatitis C positive patients Annual assessments will be completed within 30 days of due date All five annual multi-discipline assessments will be completed within 30 days of due date
- 7. HYPOTHESES Productivity: The number of visits will increase for: counseling, primary medical care, and HIV case management
- 8. HYPOTHESES Satisfaction: Will increase for: Managers Clinicians Patients
- 9. HYPOTHESES Risks: Rates will decrease for: patient complaints, incidents, and medication errors
- 10. HYPOTHESES Financial Performance: Revenue per capita staff will increase Cost per visit will decrease
- 11. DOMAINS, MEASURES, DATA SOURCES & MECHANISMS Alerts; easier access Patient chart HCV viral load Time efficiency Clinician logs Counseling visits Alerts; easier access Patient chart Medical assessments Quality Time efficiency Clinician logs HIV case management visits Time efficiency Clinician logs Primary care visits Productivity Alerts; easier access Patent chart Multi-discipline assessments Mechanism Data Source Measure Domain
- 12. DOMAINS, MEASURES, DATA SOURCES & MECHANISMS Improved accounts receivable; billing Finance/HR Depts Revenue per capita Financial Performance Quality, productivity and satisfaction Reports to CQI Manager Complaints, incidents, medication errors Risks Reduced waiting Survey Patients Satisfaction Cost savings Finance Dept Cost per visit Easier reports Survey Clinicians/managers Mechanism Data Source Measure Domain
- 13. DATA ANALYSIS Quantitative analysis of each Study Domain chosen Means/medians: t-tests or rank tests Categorical variables: chi-square
- 14. CURRENT STATUS NIH Priority Score: 149 (85+ percentile rank) Funding approval received September 2006 with no NIH request for revision and resubmission
- 15. ACKNOWLEDGEMENTS PATIENTS AND STAFF OF THE ADDICTION RESEARCH AND TREATMENT CORPORATION, A COMMUNITY-BASED SUBSTANCE ABUSE SERVICE AGENCY
- 16. … Now the Real Work Begins
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