1. The BHL Software: An IT tool supporting PC-MHI care management and collocated collaborative care Erin Ingram, BA Senior Research Associate VISN 4 MIRECC

2. 2 BHL Software: What is it?  Software package developed to support measurement based care, including care management and Collocated Collaborative  Aids in tracking patient contacts and treatment progress  Assists with quality assurance and quality improvement

3. Does it interface with CPRS?  Stand alone software  Software generates progress notes  Coming Soon (in VA timeline): next version (V5) will interface with CPRS 3

4. 4 VISN 4 MIRECC BHL Software Features  Flexible and User-friendly  Adaptable decision support  Patient Tracking Tools  Supports measurement based-care  Progress notes creation  Workload and clinical outcome data easily available

5. 5 VISN 4 MIRECC Potential PCMHI Components – supported by BHL software  Watchful waiting For Veterans who are subsyndromal  Care management/ Brief treatment Depression, anxiety, alcohol, pain, PTSD Medication adherence and side effects, symptoms  Referral management Tracking and facilitating treatment engagement

6. 6 VISN 4 MIRECC Structured Interviews  Core – triage/initial assessment  Watchful Waiting prompted for weekly contacts to track PHQ-9 scores Built in algorithm for referral to care management  Care Management (Brief Treatment) Interview Intended for tracking and supporting measurement based care

7. 7 VISN 4 MIRECC Initial Triage Assessment: Core Interview  Phone or in person  20-25 minutes  Array of mental health symptoms and substance use  Helps determine next step in treatment  Output: patient letter, provider report, baseline data

8. 8 VISN 4 MIRECC Core Interview: Assessments  Demographics  Current MH care  Financial status  Social support  Blessed Orientation-Memory-Concentration (>55 yrs or head injury)  Mini International Neuropsychiatric Interview (psychosis, mania, GAD, panic)  Depression assessment: PHQ-9  PTSD Checklist (PCL-c)  Anxiety assessment: GAD-7 (optional)  Brief Pain Inventory Interference scale  Current Psychotropic/Pain medications  5-item Paykel scale for suicidal ideation  Alcohol use (7 day follow-back)  Illicit substance use  Depression history  Work Limitations questionnaire (optional)  SF-12 (optional)

9. Easy to Navigate 9

10. 10 VISN 4 MIRECC Core Summary Page: Interview Results

11. 11 VISN 4 MIRECC

12. 12 VISN 4 MIRECC Clinical Report Generates report for clinical chart into a Word document Available for each completed interview

13. 13 VISN 4 MIRECC Care Management Interview  For tracking follow-up contacts  6 optional domains: Depression: PHQ-9 Anxiety: GAD-7 PTSD: PCL-c Pain: BPI for pain interference Alcohol: 7-day time line follow-back Referral Management: to track engagement in specialty care

14. Enrollment into CM interview 14

15. 15 VISN 4 MIRECC Changing the Symptom Domains

16. 16 VISN 4 MIRECC Tracking Symptoms Overtime

17. Care Management Summary 17

18. 18 VISN 4 MIRECC Patient Level Reports  Progress Note Creation for all interviews: Treatment plan Results of all assessments  Patient letters and Progress reports Patient education Visual of treatment progress

19. 19 VISN 4 MIRECC Patient Tracking: Panel Management

20. 20 VISN 4 MIRECC Tracking Contact Dates – Date Categories  (a) = Appointment trumps all dates Time indicates appt versus “target date”  (c) = Last Contact made  (o) = Episode Open date Indicates to you that you have not attempted to contact this patient yet or set an appt/target

21. 21 VISN 4 MIRECC Reports available to help track active patients  Active Patient listings - excel spreadsheet of active patients  Aggregate data on active patients enrolled in the Core interview, Watchful Waiting and Care Management  Upcoming appointment reports  Supervision Reports – excel spreadsheet of flagged patients

22. 22 VISN 4 MIRECC OUTCOME DATA : Available at the program, clinic, Primary Care Provider and staff level Outcome Data : How is our program doing?

23. Who should have access to the software?  Anyone on the PC-MHI team PC-MHI nurse care managers PC-MHI social workers PC-MHI psychologist PC-MHI psychiatrists and CRNPs Psychology/health technicians Other possibilities: health behavior coordinator  Helps to track patient contacts and symptoms for both CM and CC services 23

24. 24 VISN 4 MIRECC User Classifications: General versus Administrative  General users of the software have access to: All patient tracking features All clinical reports Administrative reports on their own workload  Administrative users – additional access: Program users, clinics and clinicians into software Program decision support preferences for triage interview All options for administrative reports

25. How do I describe the software to my IT department?  Commercial product (not Class software)  Does not interface with CPRS  NET thick client desktop application  Interacts with a SQL Server backend database  Application is executed from end user desktops via a windows network share over the local area network 25

26. 26 VISN 4 MIRECC Resources  BHL SharePoint Site: https://vaww.visn4.portal.va.gov/networks/BHL/default.aspx BHL Software Manuals Example Cheat Sheets for services  BHL Software Support -wkly conference call Tuesdays, 2pm EST 1-800-767-1750, Access code: 31307#  To request the software, contact me at: erin.ingram@va.gov 215-823-5800 x12895#