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 L.S. Brown, S. Kritz, M. Chu, C. Madray, C. John-Hull Addiction Research and Treatment Corp, Brooklyn, NY Submitted in Response to NIDA RFA-DA (R01): Submitted in Response to NIDA RFA-DA (R01): Enhancing Practice Improvement in Community-Based Care for Enhancing Practice Improvement in Community-Based Care for Prevention and Treatment of Drug Abuse or Co-occurring Drug Prevention and Treatment of Drug Abuse or Co-occurring Drug Abuse and Mental Disorders Abuse and Mental Disorders

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.

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

STUDY DESIGN  Prospective, comparative study  Pre-post implementation evaluation  3-year timeline

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

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

HYPOTHESES Productivity:  The number of visits will increase for:  counseling,  primary medical care, and  HIV case management

HYPOTHESES Satisfaction:  Will increase for:  Managers  Clinicians  Patients

HYPOTHESES Risks:  Rates will decrease for:  patient complaints,  incidents, and  medication errors

HYPOTHESES Financial Performance:  Revenue per capita staff will increase  Cost per visit will decrease

DomainMeasure Data Source Mechanism Quality HCV viral load Patient chart Alerts; easier access Medical assessments Patient chart Alerts; easier access Multi-discipline assessments Patent chart Alerts; easier access Counseling visits Clinician logs Time efficiency Productivity Primary care visits Clinician logs Time efficiency HIV case management visits Clinician logs Time efficiency DOMAINS, MEASURES, DATA SOURCES & MECHANISMS

DomainMeasure Data Source Mechanism SatisfactionPatientsSurvey Reduced waiting Clinicians/managersSurvey Easier reports Risks Complaints, incidents, medication errors Reports to CQI Manager Quality, productivity and satisfaction Financial Performance Revenue per capita Finance/HR Depts Improved accounts receivable; billing Cost per visit Finance Dept Cost savings DOMAINS, MEASURES, DATA SOURCES & MECHANISMS

DATA ANALYSIS  Quantitative analysis of each Study Domain chosen  Means/medians: t-tests or rank tests  Categorical variables: chi-square

CURRENT STATUS  NIH Priority Score: 149 (85+ percentile rank)  Funding approval received September 2006 with no NIH request for revision and resubmission

ACKNOWLEDGEMENTS PATIENTS AND STAFF OF THE ADDICTION RESEARCH AND TREATMENT CORPORATION, A COMMUNITY-BASED SUBSTANCE ABUSE SERVICE AGENCY

…Now the Real Work Begins