National Drug Abuse Treatment Clinical Trials Network. October 5, 2011

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1 NID A NATIONAL INSTITUTE ON DRUG ABUSE National Drug Abuse Treatment Clinical Trials Network October 5, 2011 Betty Tai, Ph.D. Director, Center for the Clinical Trials Network NIDA/NIH/DHHS

2 Measuring Performance to Improve the Quality of Substance Use Disorder Treatment State of knowledge Needed research Potential of electronic health records

3 What is an EM(H)R? aggregated electronic record of healthrelated information on an individual that is created and gathered cumulatively across more than one health care organization and is managed and consulted by licensed clinicians and staff involved in the individual s health and care National Alliance for Health Information Technology EMR vs. EHR: Same data elements, but varies on who owns it and where it is stored.

Federal Mandate of Adoption 2009 ARRA DHHS Office of National Coordinator of HIT (ONC) with $19 billion program Definitions on certified EHR & meaningful use Financial incentives to promote the

4 Federal Mandate of Adoption 2009 ARRA DHHS Office of National Coordinator of HIT (ONC) with $19 billion program Definitions on certified EHR & meaningful use Financial incentives to promote the adoption and meaningful use of certified EHRs All medical records must be digitized by 2015 for CMS reimbursement Blumenthal D. NEJM. 2009; 360(15): Blumenthal, D. & Tavenner, M. NEJM. 2010; 363(6):

5 Goal: Exchange and Use of Data Patient Clinician Researcher Healthcare Data Systems Single Source Data Uses Patient care Quality Improvement Research Reimbursement Post Marketing Safety Decision Support Administration & Mgt. Population Health Reporting Multiple Uses

6 Uses of Data Have Significant Overlap Research Reimbursement Management Clinical Care Adapted from CIC

7 The Problem - Data Exchange Data Collected or Generated During Patient Care Data Used 7 Adapted from CIC

8 What Is Interoperability? the ability of health information systems to exchange and use healthcare information within and across organizational boundaries to advance the effective delivery of healthcare for individuals and communities. Health Care Information and Management Systems Societies 2006

9 The Interface Battle System A System B 2 systems, 1 interface B 3 systems, 3 interfaces A C Adapted from: Jaffe 2007

10 The Battle Lines Are Drawn B 4 systems, 6 interfaces A C D B 5 systems, 10 interfaces A C E D Adapted from: Jaffe 2007

11 And so on! Systems 6 15 Interfaces And the math gets really ugly after that! Adapted from: Jaffe 2007

12 Syntax vs. Semantics The dog eats red meat. The dog eats blue trees. Time flies like an arrow. Fruit flies like a banana. Syntax Structure Semantics Meaning.and then there s Context He threw his hat into the ring. He s got a chip on his shoulder Adapted from: Jaffee 2006

13 Aspects of Interoperability Standards enable interoperability of healthcare information Three aspects of interoperability Technical: Moving data from system A to system B Semantic: Ensuring that system A and system B understand the data in the same way Process: Enabling business processes at organizations housing system A and system B to work together

Pathways to Interoperability Domain Analysis Model and Common Data Elements (CDEs) created in NCI cadsr emeasure specification - coding concepts in standard vocabularies: SNOMED

14 Pathways to Interoperability Domain Analysis Model and Common Data Elements (CDEs) created in NCI cadsr emeasure specification - coding concepts in standard vocabularies: SNOMED CT, LOINC, Rx Norm, etc. NQF Quality Data Model (QDM) ONC - Certified EHR Technology Certification Commission for Health Information Technology (HITSP standards) NHIN specifications

15 Electronic Health Record (EHR) ARRA 2009/Title XIII - HITECH Act* Federal Meaningful Use criteria Incentive through reimbursement Incorporate concepts and data elements to qualify for meaningful use For example Meaningful Use Stage 2 (proposed) Screen for tobacco use in 80% of clinic population Screen and brief intervention for alcohol use disorders Screening question for illicit substance use in primary care *American Recovery and Reinvestment Act Health Information Technology for Economic and Clinical Health Act

16 The Joint Commission Eight measures for tobacco, alcohol and drug use have just been released: Tobacco use screening, treatment, and treatment at or after discharge Alcohol use screening Alcohol use brief intervention Alcohol and drug use disorder treatment at or after discharge

17 Jump Start

18 NIDA s Effort 1. Develop common data elements for SUD 2. Develop a work plan for screening in primary care 3. Interface with a myriad of federal agencies

19 NIH OBSSR NLM, CDC, HIS, VA 62 CTPs + HCPs AAAP ASAM CPDD NASADAD AHRQ ONDCP CMS SUD EHR NIDA CTN SAMHSA HRSA and YOU

20 Substance Use Disorder (SUD) EHR Mind Map HITECH Act Incentives (Medicare/Medicaid Eligible) "Certified EHR Technology" SIP-AD, CIDI-SAM DSM-IV & ICD-10 coding EHR Implementation EHR Module(s) AUDIT, AUDIT-C CAGE, CAGE-AID NEXT STEPS: 4 WHO ASSIST NIDA-Modified ASSIST 3 DUDIT DAST-10 2 Single-Question 1 EHR Capabilities Adoption of EHR Technology Meaningful Use (CMS) Stage 1-3 roll-out from Regional Extension Centers Screeners (drug, alcohol) NIDA Substance Use Disorder EHR Development Stakeholders Federal HIT Standards HL7, XML, etc. Interoperability (ONC) ONC Final Rule "Certified EHR Technology" (i.e., a complete EHR) EHR Domains EHR Sub-domains Data Concepts State Community Treatment Providers (CTPs) Healthcare Providers Professional Societies and Primary Care Providers "Qualified EHR" (i.e., minimum EHR standard)s Core Questions Core Common Data Elements (CDEs) Current Effort EHR Product Vendors standardized intake questions

21 EHR Development NIDA s Proposed SUD EHR Small Core Set of Questions for Primary Care Setting Enlarged Core Set of Questions for SUD Treatment Setting

22 Primary Care Primary Care How brief? How to fit all practice/care settings? Triage Decisions: Simple screen and refer Simple screen, assessment and refer Simple screen, assessment and treat and/or refer

Expert Key Recommendations Combine screening of tobacco, alcohol and substance use Use validated screening questions Develop a standardized timeframe Standardize

23 Expert Key Recommendations Combine screening of tobacco, alcohol and substance use Use validated screening questions Develop a standardized timeframe Standardize questions or instruments Incorporate clinical decision support (CDS) and evidence-based brief interventions (BI) Consider ASAM dimensions and The Joint Commission (TJC) standards

Validated Core Questions - MU stage 2 Single question drug screen DAST-10 1. Have you used drugs other than those required for medical reasons? 2. Do you abuse more than one drug at a time?

Have you had blackouts or flashbacks as a result of drug use? Smith 5. Do PC, you Schmidt every SM, Allensworth-Davies feel bad guilty D and about Saitz R. your A. Arch drug Intern use?

24 Validated Core Questions - MU stage 2 Single question drug screen DAST Have you used drugs other than those required for medical reasons? 2. Do you abuse more than one drug at a time? How many times in the past year have you used an illegal drug or 3. Are used you a always prescription able to stop medication using drugs for when non-medical you want to? reasons? 4. Have you had blackouts or flashbacks as a result of drug use? Smith 5. Do PC, you Schmidt every SM, Allensworth-Davies feel bad guilty D and about Saitz R. your A. Arch drug Intern use? Med 2010; 170(13): Does your spouse (or parents) ever complain about your involvement with drugs? 7. Have you neglected your family because of your use of drugs? 8. Have you engaged in illegal activities in order to obtain drugs? 9. Have you ever experienced withdrawal symptoms (felt sick) when you stopped taking drugs? 10. Have you had medical problems as a result of your drug use (e.g., memory loss, hepatitis, convulsions, bleeding, etc.?

Moving Forward Obtain consensus on valid screening and assessment tools Receive recommendations for CMS Meaningful Use (ONC Quality Measures Workgroup & HIT Policy Committee) Define Clinical Quality

25 Moving Forward Obtain consensus on valid screening and assessment tools Receive recommendations for CMS Meaningful Use (ONC Quality Measures Workgroup & HIT Policy Committee) Define Clinical Quality Measures (CQMs) Develop associated clinical decision support (CDS) protocols (SBIRT) in progress Provide/develop scientific evidence to support widespread adoption emeasure specification (NQF Quality Data Model) NQF endorsement (9 steps) Inclusion of SUD screening in Health Risk Assessment for use in CMS Annual Wellness Visit

26 Proposed CDS for SUD 1. Screening 2. Brief Assessment 3. Plan of Action 1-Item Screener If score = 0 If score > 0 DAST-10 Additional Questions Adapted from G. Subramaniam, MD Sept 2011

have been developed Other activities underway for Adoption of specific CDEs into

27 Conclusions and Next Steps Consensus was reached on a core set of SUD screening and assessment questions for use in primary care Common Data Elements (CDEs) have been developed Other activities underway for Adoption of specific CDEs into Meaningful Use emeasure specification Incorporation into an SBIRT for pilot testing

Acknowledgements EMMES Corp Bob Lindblad, M.D.

D. CTN Special Interest Group on EMR CTN CTPs

D. Paul Wakim, Ph.D. Carol Cushing, R.N.

28 Acknowledgements EMMES Corp Bob Lindblad, M.D. Paul Van Veldhuisen, Ph.D. Rob Gore-Langton, Ph.D. Brian Campbell David Shide, Ph.D. NIDA CTN John Rotrosen, M.D. CTN Special Interest Group on EMR CTN CTPs NIDA CCTN Udi Ghitza, Ph.D. Steve Sparenborg, Ph.D. Paul Wakim, Ph.D. Carol Cushing, R.N. Geetha Subramaniam, M.D. NIDA DESPR Sara Duffy, Ph.D. You The audience

11/10/2015. Electronic Medical/Health Records - Common Data Elements for Substance Use Disorders

11/10/2015. Electronic Medical/Health Records - Common Data Elements for Substance Use Disorders Electronic Medical/Health Records - Common Data Elements for Substance Use Disorders Betty Tai, PhD Director, NIDA CTN Robert Gore-Langton, PhD Principal Investigator, The Emmes Corporation CTN WEB SEMINAR