Using HIT to Support Integrated Care
by Michael R. Lardiere, LCSW
Vice President, Health Information Technology & Strategic Development
SAMHSA - HRSA Center for Integrated Health Solutions
Sharing Information is the Standard
- Health Information Exchanges RULE!
- Integration and improved outcomes will only be successful if we can share information
- Common Barrier
- If not addressed, promotes stigma
- Information can be shared securely in RI
- RI leads the nation through its work with the SAMHSA/HRSA Center for Integrated Health Solutions
Using Data for Population Based Interventions
||No of members
||Average Charges per Member
||Community Support Services/15 min
||Community Support Services /day
||Personal care per diem
||Habilitation, prevocational/15 min
||Supported employment/15 min
||Inpatient room and board
||Targeted case management/15 min
||Case management/ 15 min
||Psych medication management
||Office visits - primary care
Table of top cost by diagnosis, January-March,2006
||No of Members
||Average Charges Per Member
||Schizophrenia and Affective Psychosis
||Moderate Mental Retardation
||Severe Mental Retardation
||Profound Mental Retardation
||Mild Mental Retardation
||Alcohol and Drug Abuse
||Congestive heart Failure
||All Fractures and Dislocations
Cost Data by Primary Diagnosis
Total Charges By Primary Diagnosis, January-March, 2006 (ppt)
Cost By Service Type
Top Cost By Treatment Type, January-March,2006 (ppt)
Using Data for Individual Interventions
High Utilizer Report
- 3 consumers with an average cost of $272,652 each
Drill down: Consumer with brittle diabetes and personality disorder - frequent ER and inpatient
- 4 consumers with average cost of $236,434 each
Drill down: Consumer with SUD without motivation & personality disorder; multiple complex medical conditions
- 4 Consumers with average cost of $85,867 each
Drill down: Consumer with SUD- frequent detox ;lack of community services
- Case #1 - Service Primary Diagnoses, Diagnoses Description, and Charge (ppt)
MU Stage 2 Behavioral Health Outcome Measures
Center for Disease Control and Prevention, Sortable Statistics (ppt)
At Risk Criteria
- Blood pressure combined
Systolic greater than 130 OR Diastolic greater than 85
Greater than or equal to 25
- Waist circumference
Male, greater than 102 cm
Female, greater than 88 cm
- Breath CO
Greater than or equal to 10
- Fasting Plasma Glucose
Greater than 100
Greater than or equal to 5.7
HDL, less than 40
LDL, greater than or equal to 130
Triglycerides, greater than or equal to 150
- Others that the organizations determine
Indicator Percentages Measuring Disparities (ppt)
Issues to Consider
- Who will collect the data?
- Sharing Lab data is a significant workflow issue to resolve
- How will it be shared with the partner organization?
- Via the HIE
- Via Direct
- Other secure method
- Use a standard CCD
- What if the partner does not have a certified EHR?
- Use Meaningful Use Measures
MU Stage 2 Measures
National Quality Forum
Measure number and name
|Clinical Quality Measure Description
Antidepressant medication management:
(a) Effective Acute Phase Treatment
(b) Effective Continuation Phase Treatment
The percentage of patients 18 years of age and older who were diagnosed with a new episode of major depression, treated with antidepressant medication, and who remained on an antidepressant medication treatment. Two rates are reported.
(a) Percentage of patients who remained on an antidepressant medication for at least 84 days (12 weeks)
(b) Percentage of patients who remained on an antidepressant medication for at least 180 days (6 months)
Initiation and Engagement of Alcohol and Other Drug Dependence Treatment:
The percentage of patients 13 years of age or older with a new episode of alcohol and other drug (AOD) dependence who received the following. Two rates are reported.
(a) Percentage of patients who initiated treatment within 14 days of the diagnosis
(b) Percentage of patients who initiated treatment and who had two or more additional services with an AOD diagnosis within 30 days of the initiation visit
Preventive Care and Screening: Tobacco Use-Screening and Cessation Intervention
|Percentage of patients aged 18 years and older who were screened for tobacco use one or more times within 24 months AND received cessation counseling intervention if identified as a tobacco user.
Use of High-Risk Medications in the Elderly
Percentage of patients ages 65 years and older who received at least one high-risk medication. Percentage of patients 65 years of age and older who received at least two different high-risk medications.
(a) Percentage of patients who were ordered at least one high-risk medication
(b) Percentage of patients who were ordered least two high-risk medications during the measurement year
Falls: Screening for Fall Risk
|Percentage of patients aged 65 years and older who were screened for future fall risk during the measurement period.
Major Depressive Disorder (MDD): Suicide Risk Assessment
|Percentage of patients aged 18 years and older with a new diagnosis or recurrent episode of MDD who had a suicide risk assessment completed at each visit during the measurement period.
ADHD: Follow-Up Care for Children Prescribed Attention Deficit Hyperactivity Disorder Medication
Percentage of children 6-12 years of age as of age and newly dispensed a medication for attention deficit/hyperactivity disorder (ADHD) who had appropriate follow up care. Two rates are reported.
(a) Initiation Phase: Percentage of children who had one follow up visit with a practitioner with prescribing authority during the 30-day initiation phase
(b) Percentage of children who remained on ADHD medication for at least 210 days and who, in addition to the visit in the initiation phase, had at least two additional follow-up visits with a practitioner within 270 days (9 months) after the initiation phase ended
Bipolar Disorder and Major Depression: Appraisal for Alcohol or Chemical Substance Use
|Percentage of patients with depression or bipolar disorder with evidence of an initial assessment that includes an appraisal for alcohol or chemical substance use.
Preventive Care and Screening: Screening for Clinical Depression and Follow-Up Plan
|Percentage of patients aged 12 years and older screened for clinical depression on the date of the encounter using an age-appropriate standardized depression screening tool AND, if positive, a follow up plan is documented on the date of the positive screen.
Documentation of Current Medications in the Medical Record
|Percentage of specified visits for patients 18 years and older for which the eligible professional attests to documenting a list of current medications to the best of his/her knowledge and ability. This list must include ALL prescriptions, over the counter, herbals and vitamin/mineral/dietary (nutritional) supplements AND must contain the medications' name, dosage, frequency, and route of administration.
Adult Weight Screening and Follow-Up
Percentage of patients aged 18 years and older with a calculated body mass index (BMI) in the past 6 months or during the current reporting period documented in the medical record AND if the most recent BMI is outside of normal parameters, a follow-up plan is documented within the past 6 months or during the current reporting period.
Normal Parameters: Age 65 years and older BMI = 23 and < 30.
Age 18-64 years BMI = 18.5 and < 25.
Depression Remission at 12 Months
|Adult patients age 18 and older with major depression or dysthymia and an initial PHQ-9 score > 9 who demonstrate remission at 12 months defined as PHQ-9 score less than 5. This measure applies to both patients with newly diagnosed and existing depression whose current PHQ-9 score indicates a need for treatment.
Depression Utilization of the PHQ-9 Tool
|Adult patients age 18 and older with the diagnosis of major depression or dysthymia who have a PHQ-9 tool administered at least once during a 4-month period in which there was a qualifying visit.
Child and Adolescent Major Depressive Disorder: Suicide Risk Assessment
|Percentage of patient visits for those patients aged 6-17 years with a diagnosis of major depressive disorder with an assessment for suicide risk.
Not Yet Endorsed
Dementia: Cognitive Assessment
|Percentage of patients, regardless of age, with a diagnosis of dementia for whom an assessment of cognition is performed and the results reviewed at least once within a 12-month period.
Where will the Data Come From?
Data Integrity - Follow the Continuity of Care Document / C-CDA (ppt)
MU CCD Sample
Data Elements Recommended by the 5 States & Their Workgroups
What is Needed to Provide Better Quality Care?
- Emergency contact
- Crisis plan
- Housing status
- Risk status for suicide/homicide
- History of Risk of Violence
- History of Risk of Suicide
- Specialty of prescriber
- History of psychiatric medications
- Medication history
- Behavioral Health Advance
Plan of Care
--DSM Diagnosis (all 5 Axis)
HIPAA & 42 CFR Part 2
Michael R. Lardiere
VP HIR & Strategic Development