eBehavioral Health Solutions (eBHS) CBHDA CSOC Meeting 8/20/15 Rikke Addis

Small County Data Center Project: Phase 1 Health reform is transforming health and behavioral health service systems and practices, and increasing need for IT capacity Small counties have unique needs and challenges collecting, analyzing, and meeting data reporting requirements Lack the resources to invest in complex information technology systems and personnel dedicated specifically to evaluation and quality improvement performance measurement. Pilot Goal: Develop and implement a web-based data solution to address the technical assistance and data system needs of the small counties.

Building eBHSolutions (eBHS) CIBHS contracted eCenter Research Inc. -- Canadian corporation specializing exclusively in Software as a Service for mental health and addictions treatment providers, regional authorities, and research organizations in over 50 countries. Annual licensing model avoids the high cost of application development, secure server hosting, on-going expenses for technological infrastructure, and costly desktop software programs that do not evolve as user needs change.

Building eBHS CiBHS engaged the small counties in collaboration with CBHDA to identify and prioritize the system functionality desired by the counties: Flexible, real-time reporting and querying to support individual client, population, and system improvement and outcome tracking Data collection Data storage Uploading from existing EHRs and local databases Analysis Querying and reporting HIPAA and 42CFR compliance The eBHS platform was designed to address Small County priorities:  Routine collection, analysis, tracking, and reporting of standardized measures (e.g., PHQ-9 and GAD-7) Data tracking capacity/registry function for counties participating in the Advancing Recovery Collaborative and the Care Coordination Collaborative Analytic functions currently employed in CIBHS evidence-based practice (EBP) program performance and outcome evaluation protocols (specifically the Youth Outcome Questionnaire (YOQ) that are currently being used for treatment planning, monitoring, and outcome evaluation across multiple programs in several counties.

Participating Counties by Function/Capacity Testing Participating County SCDC Standardized Measures Collection and Reporting Data Tracking/Registry Function to Support Care Coordination and Advance Recovery Practices Data Collection and Analytic Functions for Evidence-Based Practice Program Imperial X X  Modoc   Mono Tuolumne Amador Colusa Lake Trinity

Value of eBHS Functions: County Feedback “Reporting is more straightforward than using crystal reports with EHR, which take time and resources to develop and use” “Parameters of data reports change according to different reporting requirements; and a report writer must be available to make the changes, which is now possible in eBHS” “The volume of data is multiplying exponentially and eBHS shows promise helping us manage it” “Systems resources are needed to run reports off our EHR, but eBHS is more flexible and easier to use” “Reminders to administer the tools on an ongoing basis are not embedded in the EHR system, but can be developed in eBHS”

Data Entry: County Feedback   Measuring, tracking and supporting care coordination and client recovery Measurement that informs work improvement Data gathering and reporting of key measures on a monthly basis Moves data collection from manual to electronic format Helps systematize collection of data Structures data collection for clinicians when face to face with clients Allows for information sharing with clients to improve their understanding of their health, behavioral health, and recovery status and progress "1-click analytics"

Data Upload: Imperial County Feedback Imperial County reported the following experience piloting the upload function of their PHQ-9 data from Avatar to eBHS: Successfully conducted reconciliation of systems - different names for same data points – with no issues Data anomalies are handled expeditiously (consumer transfer to another program) 24 hour Help Desk for system issues was responsive and helpful The upload process appears to be seamless Secure data exchange site was straightforward and easy to use

Reporting Small counties requested the following analytic and reporting capabilities: Calculation of scores associated with each clinical measure Number and percent of clients above and below clinical cutpoints Aggregate report functionality that allows the user to "hover" over the clinical cut points and provide a list of clients that fall into an "at-risk" category. Aggregate pre- and post- comparisons Reliable change formulas to accurately classify observed pre/post change into three groups (reliable negative change, no change, reliable positive change) Individual reports on clients to show change over time Graphical reporting appropriate to share with clients and other stakeholders, as appropriate

Report: GAD-7 Individual

Report: PHQ-9 Individual

Report: PHQ-9 Aggregate

Phase 2: Ideas for eBHS Improvements and Expansion Improve and expand clinical functionality to support clinical functions, such as: 1) Shared care planning across providers 2) Clinical prompts and reminder flags to promote proactive care and prevention 3) Treatment Reconciliation across providers 4) Treatment progress and measurement 5) Communication and information exchange   Expand clinical measures, e.g.: substance use screens and treatment assessments, evidence-based practices, and recovery measures Develop client portal function Expand reporting function to include tailored data dashboards to enable tracking of clinical outcomes for quality improvement and clinical monitoring, and overall population management