Slide 1 - NIATx Summit and SAAS National Conference

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					Transforming Addiction Services:
  Health Information Technology
                   H. Westley Clark, M.D., J.D., M.P.H., CAS, FASAM
                             Center for Substance Abuse Treatment
            Substance Abuse Mental Health Services Administration
                      U.S. Department of Health & Human Services

  NIATx Summit & SAAS National
    Boston, MA  July 11, 2011
                         “We'll computerize our
                         health care system, at
                         last, to save billions of
                          dollars and countless
                           lives as we reduce
                            medical errors.”
                               February 13, 2009
                                Washington, DC

President Barack Obama

                                             “The increased use of health
                                              information technology is a
                                                key focus of our reform
                                             efforts because it will help to
                                                improve the safety and
                                                 quality of health care
                                              generally while also cutting
                                               waste out of the system.”
            Kathleen Sebelius                        September 29, 2009
U.S. Department of Health & Human Services


                           “In 2011, and beyond, SAMHSA
                                 will work to improve
                          understanding about mental and
                          substance use disorders, promote
                              emotional health and the
                           prevention of substance abuse
                             and mental illness, increase
                            access to effective treatment,
                                and support recovery.”
                              Excerpt from Leading Change: A Plan for
 Pamela S. Hyde, J.D.
                              SAMHSA’s Roles and Actions 2011-2014
Administrator, SAMHSA

       SAMHSA’s Strategic Initiatives

Prevention of Substance Abuse and Mental
Trauma and Justice
Military Families
Recovery Support
Health Reform
Health Information Technology
Data, Outcomes, and Quality
Public Awareness and Support               6
          Health Information Technology
                    (Health IT)

 New Health Reform law requires
  implementation of uniform standards for
  electronic exchange of health information by
 Health Information Technology (Health IT) is
  the use of computer applications to record,
  store, protect, retrieve, and transfer clinical,
  administrative, and financial information
  electronically within health care settings.
      Health Information Technology
                (Health IT)

The ultimate goal of Health IT is
 to improve the quality and
 efficiency of patient care.

``Health Information Technology for Economic and
        Clinical Health Act'' (``HITECH Act'‘)

Health Reform incorporates and builds upon
 the provisions of the Health Information
 Technology for Economic and Clinical Health
 Act (HITECH Act) included in the American
 Recovery and Reinvestment Act of 2009
The HITECH Act promotes the adoption of
 interoperable health information technology
 to improve the quality and value of American
 health care.                                      9
``Health Information Technology for Economic and
        Clinical Health Act'' (``HITECH Act'‘)

The Act prioritizes access to
 health IT for uninsured,
 underinsured, historically
 underserved and other special
 needs populations, and use of that
 technology to achieve reduction in
 health disparities.
     President’s Vision for Health IT

Medical information will follow
 consumers so that they are at the center
 of their own care.

Consumers will be able to choose
 physicians and hospitals based on
 clinical performance results made
 available to them.
    President’s Vision for Health IT

Clinicians will have a patient's
 complete medical history,
 computerized ordering
 systems, and electronic

     President’s Vision for Health IT

Quality initiatives will measure
 performance and drive quality-based
 competition in the industry.

Public health and bioterrorism
 surveillance will be seamlessly
 integrated into care.
    President’s Vision for Health IT

Clinical research will be
 accelerated and post-marketing
 surveillance will be expanded.

                                Barriers or Opportunities

     “Health information exchanges
      (HIEs) and regional health
      information organizations (RHIOs)
      are forming the National Health
      Information Network’s backbone.”

Source: Connors, B. MSW, Leipold, J. DBA, MBA (2009 July/August) The 42 CFR Part 2 and NHIN conundrum Behavioral
Healthcare 29(7):52-53                                                                                             15
                                Barriers or Opportunities

  “Interoperability standards for
   electronic information exchange are
   under development. Yet the addiction
   treatment and behavioral healthcare
   fields are just beginning to review,
   discuss, and debate the effect of
   interoperable systems for electronic
   health record (EHR) exchange.”
Source: Connors, B. MSW, Leipold, J. DBA, MBA (2009 July/August) The 42 CFR Part 2 and NHIN conundrum Behavioral
Healthcare 29(7):52-53                                                                                             16
 SAMHSA Strategic Initiative - Health Information

Purpose: Ensure the behavioral
 health provider network, including
 prevention specialists and
 consumer providers, fully
 participates with the general health
 care delivery system in the adoption
 of health information technology.
SAMHSA Strategic Initiative - Health Information

Primary role of SAMHSA’s HIT
 effort is to support the behavioral
 health aspects of the electronic
 health record based on the
 standards and systems promoted
 by the Office of the National
 Coordinator for Health IT.
      A Connected Infrastructure with a
        Behavioral Health Component

                       Labs                          Pharmacies


                            Patient Centric Health
                            Information Exchange
Behavioral Health
   Provider &                                                 Physicians &
    Patient                                                      Staff

 SAMHSA Health IT Strategic Initiative Goals

Develop the infrastructure for
 interoperable Electronic Health
 Records, including privacy,
 confidentiality, and data standards.
Provide incentives and create tools to
 facilitate the adoption of Health IT and
 EHRs with behavioral health
 functionality in general and specialty
 healthcare settings.                          20
 SAMHSA Health IT Strategic Initiative Goals

Deliver technical assistance to State
 Health IT leaders, behavioral health
 and health providers,
 patients/consumers, and others to
 increase adoption of EHRs and Health
 IT with behavioral health functionality.
Enhance capacity for the exchange and
 analysis of EHR data to assess quality
 of care and improve patient outcomes.         21
Using HIT to Better Engage Patients in Care

Health IT increases patient
 involvement by creating an
 opportunity to better engage
 individuals in their care through
 use of technology which will, in
 turn, improve health outcomes.
(Smith, Meyers, & Miller, 2001; Humphreys & Moos, 2001)

     Using HIT to Better Engage Patients in Care

The functionality of interoperable
 electronic health record (EHR) systems can
 connect patients to community resources
 and supports, provide information that
 permits them to participate in shared
 decision-making with their clinicians, and
 support home monitoring of reported
 symptoms related to chronic conditions
 with the goal of preventing unnecessary
(Smith, Meyers, & Miller, 2001; Humphreys & Moos, 2001)   23
Using HIT to Reduce Redundancy & Improve

One of the goals of Health IT is to
 improve quality of care. For
 instance, among the 8.9 million
 adults aged 18 or older who had
 any mental illness in the past year
 and a past year substance use
 disorder, only 7.4% received
 treatment for both conditions.    (2009 NSDUH)
 Using HIT to Reduce Redundancy & Improve

Interoperable electronic health records
 provide information that can be shared
 among multiple participants in an
 episode of care, including providers,
 patients, and family caregivers.
Result: improved communication,
 clearer understanding, and a more
 integrated and patient-centered
 treatment.                                 25
        Electronic Prescriptions

E-prescribing – when integrated
 with electronic health records
 (EHRs) – has the potential to give
 providers access to a
 comprehensive view of the
 patient’s health history.

        Electronic Prescriptions

Greater efficiencies will be
 possible because data from
 across offices and disciplines will
 be instantly available – no need
 to send for previous records that
 may give an incomplete or
 inaccurate patient history.
Clinical Decision Support (CDS) Systems & EHR

 CDS systems are seen as critical
  components in creating EHR-based
  “learning systems” that continually
  incorporate clinical advances, apply them
  to ever-growing and more detailed patient
  databases, and increase clinicians’ abilities
  to predict (based on patient data and
  demographics) which of a range of
  interventions will offer the best outcome.
Sources: Grantham, D. (November/December 2010) CDS systems seek “real life” data. Behavioral Healthcare. pp. 35-39;
Moore, J. (January/February 2011) CDS: more signal, less noise. Government Health IT, pp. 25-27                       28
Clinical Decision Support (CDS) Systems & EHR

     The challenge is to turn evidence-
      based guidelines into machine-
      readable code an EHR system can
      readily “crunch.”

Sources: Grantham, D. (November/December 2010) CDS systems seek “real life” data. Behavioral Healthcare. pp. 35-39;
Moore, J. (January/February 2011) CDS: more signal, less noise. Government Health IT, pp. 25-27                       29
Using Health IT Performance Measures: Critical
   –Do we have a clear understanding of our
   –Are our goals measurable and evidence-
   –Are we reaching the right populations?
   –Are client and treatment properly
   –How do we demonstrate success?
      Electronic Health Records & Confidentiality

   “Evolving health information technology
    (HIT) is dragging healthcare providers into a
    world in which confidentiality rules,
    designed when patient records were
    maintained almost universally in paper
    charts, either do not apply or are in serious
    practical conflict with electronic
    information exchange.”
Source: Connors, B. MSW, Leipold, J. DBA, MBA (2009 July/August) The 42 CFR Part 2 and NHIN conundrum Behavioral
Healthcare 29(7):52-53                                                                                             31
       Ensuring Confidentiality and Trust

Increased accessibility to health records
 raises the question of how to ensure
 patient confidentiality and trust.
In order to achieve any level of systemic
 durability and success, electronic
 exchange efforts must establish trusting
 relationships with all participants,
 including patients. (Melissa M. Goldstein, JD et al, 2010)
 Principles of Fair Information Practices

Individual Access Collection, Use,
Correction         and Disclosure
Openness and       Limitation
 Transparency      Data Quality and
Individual Choice  Integrity
                                 EHR for Whose Benefit?

   “Thus, the free movement of electronic health
    information collides with privacy and security
    rules when interoperable electronic information
    exchange systems are required to comply with
    patient confidentiality standards.”
   “This collision profoundly impacts addiction
    treatment providers, who function under the
    most restrictive confidentiality constraints.”
Source: Connors, B. MSW, Leipold, J. DBA, MBA (2009 July/August) The 42 CFR Part 2 and NHIN conundrum Behavioral
                                            34                                                                     34
Healthcare 29(7):52-53
                  42 USC § 290dd-2 & 42 CFR Part 2

  The purpose of the statute and regulations
   prohibiting disclosure of records relating to
   substance abuse treatment, except with
   the patient's consent or a court order after
   good cause is shown, is to encourage
   patients to seek substance abuse
   treatment without fear that by doing so
   their privacy will be compromised.
Source: STATE of Florida v CENTER FOR DRUG-FREE LIVING, INC, 842 So.2d 177 (2003) at 181.   35
            Clarifying 42 CFR Part 2

Some believe that under the current statutory
 and regulatory framework physicians and case
 managers cannot access any information about
 an individual’s substance use.
Others believe that substance use disorder
 information regarding treatment covered by 42
 USC 290dd and 42 CFR Part 2 is unnecessarily
 withheld from physicians, payers, health
 information exchanges, and health plans.
      Clarifying 42 CFR Part 2 (cont’d.)

Still others believe that the extra
 protections of 42 CFR Part 2 are critical
 to protecting the rights of persons
 with a history of substance abuse or
 substance use disorders who might
 otherwise face discrimination in the
 workplace or community due to that
 history or current treatment.
      Critical Health IT Questions

42 CFR Part 2 and other regulations
 provide the ground rules, but how
 those rules are applied to ensure
 effective treatment of substance use
 and mental health disorders needs
 to be determined through careful
     Critical Health IT Questions

– Who needs what information
– Who determines who needs what
  Information when?
– How should psychotherapy notes be
  treated – as part of the patient
           42 CFR Part 2 FAQs

To help providers in the behavioral
 health field better understand privacy
 issues related to Health IT, SAMHSA, in
 collaboration with ONC has created a set
 of Frequently Asked Questions (FAQs).
These FAQs can be accessed at:
          42 CFR Part 2 FAQs II

SAMHSA is currently creating a
 second set of 42 CFR Part 2 FAQs as a
 result of input received from
 stakeholders that expands the existing
 FAQs to include additional
 confidentiality areas and situations.
While not legal opinions, both
 documents capture Federal guidance       41
Health Information Technology Goes Beyond

Beyond the increased emphasis on
 interoperable EHR systems, the behavioral
 health field needs to be ready for the
 sweeping changes that technology brings:
 –The ability to identify new substances
   and exploit existing ones to trigger a
   euphoric or psychedelic effect (salvia,
   K2, bath salts)

Health Information Technology Goes Beyond

  –The effect of social networking to
   get the message out, exchange
   information, build a community of
  –The ability to connect with suppliers
   throughout the world, who promise
   anonymous or discreet packaging
   and accept cash transfers.
     The Effect of Social Networks

Information exchange via social
 networking spreads the news quickly.
Advice and information – pro and con
 – connect the individual to others,
 creating an accepting community that
 provides a false sense of safety and
      The Effect of Social Networks

Armed with this interchange,
 users tell themselves: “I believe I
 can tell when the marginal cost
 of taking the new drug exceeds
 the marginal benefit.”

        Using Technology Effectively

Behavioral health providers need to:
Recognize the opportunity presented by
 Smartphones, I-pads, GPS systems, and
 other emerging technologies.
Take advantage of Facebook, YouTube,
 Twitter, Texting – and even e-mail.
Encourage the development of outreach
 tools that exploit technology.           46
    Behavioral Health E-Applications

There are over 100 consumer
 behavioral health e-applications
 developed to be used on a variety
 of different platforms, including via
 the Web, messaging systems, PDAs,
 and cell phones

      Behavioral Health E-Applications

These applications assist with:
 –self-management through reminders and
  educational prompts,
 –delivering real-time data on a patient's
  health condition to both patients and
 –facilitating Web-based support groups,
 –compiling and storing personal health
  information in an easily accessible format.
             Technology & Recovery

SAMHSA is testing a smartphone-based recovery
 tool -- called Addiction Comprehensive Health
 Enhancement support System (A-Chess) -- that
  – Online peer support group & clinical counselors,
  – A GPS feature that sends an alert when the user is near an
    area of previous drug or alcohol activity,
  – Real-time video counseling, and
  – A “panic button” that allows the user to place an
    immediate call for help with cravings or triggers.

          What Does It All Mean?

The influence of the Internet, smartphones,
 social networks and other technologies
 must not be underestimated – they are
 already being effectively exploited by drug
 dealers, distributors and users.
Behavioral health care providers need to
 understand the impact that modern
 technologies are having on those they treat
    NIATx is providing HIT solutions by…

Empowering patients through use of
 smart-phones for treatment and recovery
Protecting the behavioral health safety net
 by using IT for business operations
Providing tools and techniques to facilitate
 IT implementation
SAAS is Supporting Providers through…

Providing training and technical assistance:
 – HIT business operations
 – EHR selection and implementation
 – Networking to utilize HIT systems

Advocacy for funding to support HIT
    Business Operations Collaborative
          for Behavioral Health

SAAS, NIATx, the National Council and
 The National Association of Community
 Health Centers are working together to
 provide cross-cutting high quality
 training and resources to implement
 efficient & effective business solutions,
 including HIT training
   Business Operations Collaborative
         for Behavioral Health

HIT Offerings include a HIT 101
 Webinar Series and a NIATx/SAAS
 Pre-Conference Training Workshop
For more information on
 Collaborative offerings, log on to home page
        SAMHSA HIT Collaborations

Collaboration with Centers for Medicare
 and Medicaid Services re. preparation for
 the conversion to ICD-10
  –SAMHSA is working with CMS to identify
   and track SAMHSA and its grantees re.
   preparation for the transition to ICD-10
   diagnostic and procedures billing codes.
  –ICD-10 transition date: 10/1/2013
        SAMHSA HIT Collaborations

Collaboration with Department of Army
  –Purpose: to extend the content and
   functionality of an existing Dept. of Army
   project to incorporate SAMHSA
   substance abuse and mental health
   facility electronic records and related
   crisis centers into the existing Geographic
   Information System (GIS).
  SAMHSA HIT Collaborations (cont’d.)

Collaboration with NIH on a quality
 measure definition process
Participation in HL7 Reference Information
 Model Based Application Architecture
 working group to present information
 related to the SAMHSA Open Behavioral
 Health Information Technology
 Architecture (OBHITA) project
DHHS Interdepartmental Task Force on Privacy and

SAMHSA is participating in a HHS
  interdepartmental task force to address
  privacy and security regarding Health IT and
Meetings include the following topics:
  Scope of Privacy Protections
  Choice to Share Information
  Restrictions on Access and Transparency
  Security Safeguards                              58
 HHS/ONC Introduce Program to Encourage
        Innovation in Health IT

On June 8, 2011, ONC announced the Investing in Innovations (i2)
 Initiative, which conducts competitions and awards prizes to
 accelerate the development of solutions and communities around
 key challenges in Health IT.
Examples of competition topics include tools that allow
 individuals to customize the privacy of their personal health
 records and applications that allow individuals to securely share
 health information within their social networks.
The goal is to encourage the development of tools and
 applications that increase the effective use of health IT.
More information is available on the ONC website:
   ONC's Health IT Workforce Development

The teaching materials used to train health IT
 professionals in community colleges have been made
 publicly available. The aim of the release is to help
 reduce the expected shortfall of 50,000 health IT
 professionals nationwide.
Under a $10 million ONC program, five universities
 developed the training materials. They included
 Columbia University, Duke University, Johns Hopkins
 University, Oregon Health and Science University and
 the University of Alabama-Birmingham.
   Examples of Components of the ONC
    Sponsored HIT Training Curriculum
Introduction to Information and Computer Science
History of HIT
Health Management Information Systems
Working with Health IT Systems
Installation and Maintenance of HIT Systems
Networking and Health Information Exchange
Fundamentals of Health Workflow Process Analysis
 and Redesign
Configuring Electronic Health Records
 Quality Improvement

Health IT is essential to the transformation
 of the health care delivery system & the
 promotion of preventive care and patient
 self-care – it is the glue that connects the
 various benefits of health reform.
Its impact will be felt by behavioral health
 providers, regardless of how fully they fit
 into the new system.

Health IT has the potential to benefit
 treatment providers and their clients
 through increased efficiency and
 measurable success.
The support that NIATx and SAAS
 continue to give to providers are
 helping them make the transition to
 an interoperable health care system.     63
        THANK YOU

…and continue your good work.

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