Data Is Gooooood!
The number of folks able to validate "best practices" with significant research data is startling...meaning it ain't many.
There are a ton of "best practices", or different "brands" of therapy in use across the nation with no single method of proving on a grand scale how well they work. Maybe if they were tracked in an interoperable Electronic Health Record (EHR), and shared among professionals, a handful of these methods of treatment would have the data needed to prove their worth. The fact is, we're behind the curve in this.
Recently H Wesley Clarke, director of SAMHSA's Center for Substance Abuse Treatment shared his feelings on the condition of Health Information Technology in the field at the 2011 National Conference on Addiction Disorders, and he's convinced that the EHR is under-deployed, to say the least.
It's all about data. Clarke understands that without analyzing the data that could be gathered using the EHR, professionals in addictions treatment are slow - as snails - to get the job done. In my experience, there are some professionals who believe documenting their treatment in the EHR slows them down and detracts from therapy. The question becomes, how do they know their brand of treatment, what they believe to be their "best practice" is the best way to help the consumer? Without documentation and a means to measure outcomes we're relying on gut feeling, and when gut feelings are stood alongside outcomes measurement data, who knows whether they'll be borne up unless we compare?
When a consumer paying for her own treatment (no insurance or Medicaid), she may want to know where her money's going. She may respond better to the professional if there's a study that can be quoted showing the effectiveness of the best practice she's participating in. One thing I've learned after a number of years serving professionals with EHRs is that the more data you have, the more impressive the study. When I run across studies with absolutely huge data samples used to draw the conclusions, I'm inclined to believe the study's true without even reading the study or book…call me trusting, but it's trust based on data.
Assessments are the EHR's greatest tool to provide measurable outcomes...ask enough folks with substance abuse problems questions about suicide, and compare the results with people who lack the addiction disorder, and you start to see patterns. How do we know the measurement tool (the assessment) is worth its salt? Are we asking the consumer the right questions? Once we determine there is a danger of someone hurting themselves and we decide to treat it, how do we know that best practice used to treat that danger is the most effective treatment we can use?
Without data, we don't know.
Without the EHR, our data can be insufficient. Without computer assistance, analyzing data just takes too long and is prone to mistakes in data compiling and analysis.
OK, so the EHR solves the local data problem in a professional practice, clinic or multi-location facility...When does it happen? There are a number of professionals who have used electronic documentation for a number of years, however the bulk of our field is in the dark…Email and Facebook on the work computer, and maybe Word documents about patients, which is a no-no when it comes to confidentially.
The EHR is the best tool going to help improve treatment. So, let's get started, it will make H Wesley Clarke happy and is likely to save lives and help a bundle of consumers be happier, too.
That still leaves the question of how to get huge data samples an open issue. That requires interoperability and data sharing among professionals across the nation, and next time I'll share some expert opinions (other than my own) on how to get that job done.