1. Integrating SBIRT in to the E lectronic H ealth R ecord Presented by: Ryan Hensler EHR Program Manager Lifelong Medical Care rhensler@lifelongmedical.org rhensler@lifelongmedical.org

2. LifeLong Medical Care LifeLong Medical Care, a dynamic nonprofit community organization with over 25 service locations, delivering quality health services for all ages. LifeLong is a safety net provider of medical, dental, and social services in Alameda and Contra Costa Counties. LifeLong also offers Adult Day Health Center services in Marin County. LifeLong provides services to over 45,000 underserved individuals, many with complex health conditions every year.

3. Who, what, and why? What is SBIRT? SBIRT stands for Screening, Brief Intervention, and Referral to Treatment. SBIRT is an evidence-based public health strategy to identify, reduce, and prevent unhealthy alcohol use. SBIRT Consists Of: – Screening: universal screening (ages 18+) using a validated screening tool – Brief Intervention: a 5-15 minute conversation with “moderate risk” patients about cutting down – Referral to Treatment: referral to specialty care and/or medication for interested “high risk” patients Why are we doing this? About 30% of U.S. adults drink at levels that increase their risk for physical, mental health, and social problems (NIAAA). Unhealthy alcohol use (which includes the full spectrum from risky drinking to abuse to dependence) is the third leading cause of preventable death in the United States, and is associated with numerous health and social problems. Numerous studies have found that for adults receiving behavioral interventions, SBIRT reduces alcohol consumption and reduces heavy drinking episodes. The U.S. Preventive Services Task Force gives alcohol screening and brief intervention a grade B recommendation. Medi-Cal now requires SBIRT.

4. Integrating SBIRT in to your EHR workflow Modeled after the PQ2 to PHQ-9 workflow. Integrated in to the existing Screening Tools data grid. Can be completed as a standalone screening tool or within the medical visit by support staff and provider. Positive AUDIT alerts provider in SOAP Document Macro for Screening and Brief Intervention. Configured in to Care Guidelines. English and Spanish versions of the Tool were developed. Dependent on patient language set in demographics. Reporting Capabilities can be configured within Nextgen or i2i.

5. Alcohol Consumption Screening “AUDIT-C” Alcohol Use Disorders Identification Test Button Added to Intake Template

6. Scoring calculation is different for male and female – For men, a score of 4 or more should prompt the full AUDIT – For women, a score of 3 or more should prompt the full AUDIT – If a pt gets all their points from question #1 (and scores 0 on questions 2 or 3), they are likely drinking within low-risk limits (i.e. have a negative screen).

7. Positive AUDIT-C  AUDIT

8. Positive AUDIT Creates Alert in SOAP. Prompts link to Brief Intervention Template

9. Brief Intervention

10. Brief Intervention (Cont’d) Adds Screening Dx to today’s encounter. Submits a 99408 for UDS Reporting Screenings Show in Data Grid

11. Master Document (sub document)

12. Spanish Version of Screeners

13. Spanish Version of Screeners (cont’d)

14. Care Guidelines Alert/Update

15. Reporting Reports currently setup in i2i – # of AUDIT-C’s performed – # of AUDIT-C’s performed which were positive – # of AUDIT’s performed – # of AUDITS’s which were positive – # of Brief Intervention’s Completed (99408) – # of Brief Interventions Refused

16. Challenges / Lesson’s Learned One challenge is a slow turnaround from pilot to fully implementing The lesson has been to have a plan to pilot for ~ 2 weeks and then be ready to train the rest of the providers/MAs and get started. Another challenge is competing priorities at the clinics (i.e. it is hard to get time with the providers, and/or clinics are - understandably - reluctant to start due to staffing changes). Limited time to train staff, especially medical providers.

17. Additional Resources http://pubs.niaaa.nih.gov/publications/Rethinki ngDrinking/OrderPage.htm

18. Questions? Ryan Hensler EHR Program Manager Lifelong Medical Care rhensler@lifelongmedical.org rhensler@lifelongmedical.org