Brain Storm: The EHR and Measurable Outcomes Data
Perhaps the greatest service information technology can deliver to the mental health and addictions field goes substantially untapped.
I talked with a half-dozen of the largest social service/mental health/addiction treatment organizations in New York City recently, and felt unsurprised and somewhat saddened that a couple highly placed folks shared that their organization was just now getting around to setting up Electronic Health Records(EHRs) with integrated tools to measure outcomes of consumer treatment. One of the most important tools we have to measure treatment effectiveness is data, a resource that's largely untapped.
Treatment data feeds into that fabulous tool, the EHR, and the outcomes of different approaches can be measured. Effective treatment documentation is not just therapy session notes and how certain best-practices (motivational interviewing, REBT and other types of therapy) contribute to improvement of a consumer's condition, but also blood, urine and saliva toxicology and breathalyzer results. Assessments have been administered for many years, and the outcomes of a large number of these tools have been ignored, simply because gathering and analyzing the data takes people with time to pour over paper-based records. These days, even EHR data is being ignored...but less and less as more viable data is gathered...it's used to justify grant funding for a number of projects.
When a consumer comes to a care provider, he can be desperate for help. Healthcare solutions, even for mental health and addictions treatment, gain attention and value by proving they work. Treatments can be proven effective and are more likely accepted by professionals into common usage when based on a lot of consumer results for treatment. Results gathered in an EHR tend to be more reliable because the samples can be bigger, from a number of locations, and data can be shared, contributing to outcomes studies on a grander scale. Plus, analyzing the results becomes a quicker process with computers doing the math. When a consumer is given a bi-weekly assessment, asked a bundle of questions about, say, how he feels as certain treatments progress, those check boxes the professional clicks on equate to changing the field for the better. One day, when the National Health Record is a reality, participants in treatment studies can include millions of de-identified consumer results nationwide. This will result in bringing more effective treatment to the field more quickly.
Sure, a few single agencies and perhaps a couple collaborations have been paying attention to this type of data; that's how we know some treatment helps consumers with different diagnosis' have better lives, and how the EHR can contribute to the effort. In a large part, however, as supported by the conversations I mentioned above, EHRs are either not on line at all or the companies are still implementing something that suits their need...or more interestingly, planning to build their own. Also interestingly, most software vendors include functionality like assessments, progress notes, treatment plans, scheduling modules and other commonly needed features, but the two items that get the most attention are the design tools and the reports used to develop this key functionality all over again so it's different for each agency using the system.
What if there are better tools than what professionals are using now? How will they know without analyzing outcomes?
To the rescue comes NIATx consultants like MindHealthBiz, and a host of other organizations providing education, advice and services to make sure one of the outcomes of the EHR is measurable outcomes data.
It's all evolving now, and that makes for a continuation of the most exciting time ever in American healthcare.