Survey Analyses for Implementing an Electronic Information System to Enhance Practice at an Opioid Treatment Program (1R01DA022030-03)
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This document summarizes a study evaluating the implementation of an electronic health information system at an opioid treatment program (ARTC) in Brooklyn, NY. The study aims to assess how an integrated electronic system impacts quality, productivity, satisfaction, risks, and financial performance. A staff survey found gaps in orientation and computer skills. Preliminary results show over half of staff need training. Next steps include completing pre-implementation data collection, staff training, selecting and implementing a system, and disseminating preliminary findings. The goal is to understand how electronic systems can enhance outcomes for substance abuse patients, especially underserved minority populations.
Survey Analyses for Implementing an Electronic Information System to Enhance Practice at an Opioid Treatment Program (1R01DA022030-03)
- 1. Survey Analyses for Implementing an Electronic Information System to Enhance Practice at an Opioid Treatment Program (1R01DA022030-03) Melissa Chu, MS; Steven Kritz, MD; Charles Madray, RPA-C, MBA; Carlota John-Hull, MD; Ben Louie, BA; Lawrence S. Brown, Jr., MD, MPH, FASAM; Division of Medical Services, Research and Information Technology,Addiction Research and Treatment Corp, Brooklyn, NY 11201NIDA RFA-DA-06-001 (R01): Enhancing Practice Improvement in Community-Based Care for Prevention and Treatment of Drug Abuse
- 2. STUDY TEAMPrincipal Investigator: Lawrence S. Brown, Jr., MD, MPH, FASAM, Senior Executive Vice President Sub-investigators: Carlota John-Hull, MD, Director of Medical Services Melissa Chu, MS, Director of Evaluation and Research Steven Kritz, MD, Research Project Manager Ben Louie, BA, Implementation Project ManagerResearch Assistant: Adashima Muhammad, MPHConsultants:Crystal Fuller, PhD, Mailman School of Public Health, Columbia University John Kimberly, PhD, Wharton School of Business, University of Pennsylvania
- 3. ACKNOWLEDGEMENTS PATIENTS AND STAFF OF THE ADDICTION RESEARCH AND TREATMENT CORPORATION, A COMMUNITY-BASED SUBSTANCE ABUSE SERVICE AGENCY
- 4. ACKNOWLEDGEMENTSThere are no financial interests or disclosures to report for any of the authors involved in this project
- 5. ABSTRACT ARTC, 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, is in the process of selecting and implementing an electronic health information system that integrates counseling and social services, medical services, case management, HIV counseling and testing, dispensing information, and administrative and fiscal data. Through a NIDA grant, an assessment of system performance will be studied. 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 for study 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. A detailed survey of 105 clinician stakeholders was done to determine (1) ability to use the current paper-electronic system; (2) challenges encountered with the current system; and, (3) training needs. 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.
- 6. BACKGROUNDElectronic information systems rarely utilized or evaluated in substance abuse treatment settings
- 7. ARTC serves a racially, ethnically and economically disenfranchised population
- 8. ARTC serves a population that experiences significant disparities in access and quality of healthcareSTUDY PURPOSETo Evaluate the Integration of an Electronic Information System at ARTC in the following areas:Quality
- 9. Productivity
- 10. Satisfaction
- 11. Risks
- 12. Financial PerformanceSTUDY DESIGNProspective, comparative study
- 14. 3-year timelineSTUDY DESIGN & DATA COLLECTION
- 15. STUDY DESIGN & DATA COLLECTION
- 16. AIMS & HYPOTHESESSpecific AIM 1: QualityHypothesis - Improved capture or timeliness of:HCV Viral Load
- 18. Multi-discipline AssessmentsSpecific AIM 2: ProductivityHypothesis - Appointments will increase for:Counseling Visits
- 20. HIV Case Management VisitsSpecific AIM 3: SatisfactionHypothesis - Overall satisfaction will increase for:Managers
- 22. PatientsAIMS & HYPOTHESESSpecific AIM 4: RisksHypothesis - Rates will decrease for:Patient Complaints
- 24. Medication ErrorsSpecific AIM 5: Financial PerformanceHypotheses:Revenue per capita staff will increase
- 25. Cost per visit will decreaseSAMPLE SIZE PROJECTIONS & PROGRESS-TO-DATESample Size Projections:900 – Patient Admissions (Quality)65,189 – Counseling, Primary Medical and Case Management Visits (Productivity)150 – Clinician & Manager Surveys (Satisfaction)1,000 – Patient Surveys (Satisfaction)100 – Incidents, Complaints, Medication Errors (Risks)Progress-to-Date:SOP Manual & CRFs Finalized
- 26. Pre-Implementation Data Collection Commenced
- 27. Staff Pilot Surveys Completed (Evaluation of paper-based/electronic record sys.)
- 28. Computer Skills Assessment Completed for All Clinician StakeholdersPRELIMINARY RESULTSStaff Pilot Survey findings:
- 29. Only 27% of respondents rated their orientation as making them ‘well prepared’ or ‘fully prepared’ to perform job functions
- 30. Of 7 questions related to HIPAA, 4 were answered correctly by more than 90% of respondents, 2 others were answered correctly by more than 80% of respondents, and 1 was answered correctly by 51% of respondents
- 31. >70% of respondents stated that lack of access to information from another discipline had moderate to high impact on ability to deliver care PRELIMINARY RESULTSComputer Skills Assessment findings:
- 32. Total # of employees assessed: 157
- 33. 80 (51%) of 157 require training
- 34. 36 of 80 have attended trainingBARRIERS & SOLUTIONSImplementation and integration of electronic system
- 35. Participation in NYSDOH/NYCDOHMH Primary Care Information Project (PCIP)
- 36. Redundant and inconsistent care processes
- 38. Mismatch between training & usage of current system
- 39. Needs assessment meetings fostered clinician input
- 40. Computer skills assessments doneWHAT WORKED?More frequent inter-divisional interaction
- 41. Support from Executive Director, which translated into greater support from senior management
- 42. Involvement with NYSDOH/NYCDOHMH Primary Care Information Project (PCIP) LESSONS LEARNEDSenior management support and direct involvement are critical
- 43. Clearly stated objectives are key
- 44. Communication between divisions highlighted the need for process mastering
- 45. There is insufficient electronic cross-talk between federal, state and local agenciesPLANS FOR NEXT 12 MONTHSComplete pre-implementation data collection and data analysis
- 46. Complete training assessment needs, begin and complete staff training
- 47. Choose and implement electronic information system (“go live”)
- 48. Disseminate preliminary findings at National Conferences