How to Plan Information Systems for
Integrated Service Systems Targeting
Dual Mental Health and Substance Abuse Disorders
In the first of a two-part Managed Behavioral Healthcare Perspectives1, we'll examine the planning elements involved in developing information technologies specific to an integrated service system targeting individuals with co-occurring mental health and substance abuse disorders.
Why Build Integrated Information Systems?
Individuals with co-occurring mental health and substance abuse disorders face some unique challenges, not the least of which is a parallel rather than integrated service system. In many states, mental health and substance abuse treatment funding, government oversight and providers are distinct delivery models.
That means regulations, access, eligibility, provider structure, treatment modalities, case management and continuity of care are separate. Frequently, each state department will develop a unique information system independent of the other. That is often necessitated by their different funding streams, management information system departments, system architectures and information requirements.
In some cases, a single provider may have as many as 10 different reporting systems to satisfy the requirements of their state funding sources. Those may include a combination of manual and automated data collection instruments. In most cases, the automated systems are simply stand-alone or online systems for collecting and reporting data to the state and require duplicate data entry by the providers.
Cost-saving efforts in some states have resulted in co-locating mental health and substance abuse treatment within a single department with the added hope of better integrating services for both consumer populations. Other state mental health and substance abuse departments have remained separate but have combined their agencies' data into a single information system. Consolidating offices does not, however, automatically result in service level integration. The parallel systems, for the most part, remain intact.
To bridge those parallel systems at the provider level, public and private authorities are now developing integrated service models that cross the barriers that previously prevented individuals with co-occurring mental health and substance abuse diagnoses from receiving services enhanced for their dual needs.
Critical Factor is Too Often Last Piece:
Common features of integrated service system models include a single point of entry, admission criteria specific to co-morbid mental health and substance abuse disorders, centralized utilization review and authorization, interagency planning and coordination, criminal justice system involvement, assertive community treatment for persistent mentally ill chemical abusers and addicted persons and homeless services.
Reliable, efficient, and real-time information management is crucial to any integrated service system initiative. Too often, however, that critical success factor is the last piece of the puzzle considered. Most integrated service systems involve a conglomeration of public agencies, nonprofit providers, managed care entities and some kind of administrative service structure or organization. Many of those agencies will also have some form and degree of automation. Linking all of the organizations together into a multi-vendor network for the purpose of exchanging information can be a daunting task.
That challenge is further complicated by the additional requirements of the dually diagnosed consumer. Consumers present with emergent, urgent, normal and long-term care issues. They may start anywhere: street, police station, court room, emergency room, shelter, school, community mental health center or simply a desperate phone call. Quickly and efficiently handling the information necessary to serve their needs requires careful assessment and planning.
Access centers and providers in a network need to be able to quickly search a master client index to determine whether the individual is or has been in treatment and, if so, with what agency and program. In addition to automating the standard provider functions, members in a network will need to be able to electronically transfer components of the clinical record to one another.
Some of the information that is useful to exchange includes consents and releases, eligibility information, case abstracts or treatment summaries, medication information, assessments and discharge plans. Communications exchanged between the providers and a managed care organization may involve requests for eligibility verification and the authorization or reauthorization of those services, submission of claims or event reports and the resultant remittance advice and funds transfer, etc.
Needs Analysis Lays Automation Groundwork:
Integrated service systems should conduct a needs analysis to determine infrastructure, operational and software requirements. That assessment should include an inventory of all present hardware, communications equipment, local telecommunications services and the applications software already in place. A gap analysis should be conducted to identify missing components and significant information management obstacles. The members should also be surveyed regarding their future plans, goals and objectives. That information can then be used to prepare a strategic automation plan for the integrated service system and its members.
The automation plan should include a summary of the present systems along with their information management obstacles, goals and objectives. An information strategy should then be designed to achieve those goals through the application of information technology. Special attention should be given to how the information will flow throughout the network, including eligibility determination, service authorization, referrals, intake, scheduling, billing, claims administration, discharge plans, etc. Since multiple providers are involved, client confidentiality will be another significant consideration. In general, the federal statutes governing confidentiality of drug and alcohol patient records are excellent and can be applied to many mental health services.
Tentative equipment configurations should then be prepared along with a phased-in implementation plan for the various applications to be automated. Finally, a tentative budget can be prepared based on sample proposals from several vendors. The selection process itself should involve the preparation of a formal request for proposal or request for information coupled with an extensive evaluation process that includes interviews, demonstrations, site visits and reference checks.
Perform a Pre-Automation Tune-Up:
Advance planning for automating an integrated service system should also include a pre-automation "manual system" tune-up. The objective is streamlining and setting up operations that will facilitate efficient transfer of both manual and electronic information. Converting a chaotic manual system, even those with islands of automation, can be very time-consuming and actually result in a loss of productivity.
For an integrated service system automation project, the key concept is one of consolidation and standardization. In recent workflow studies conducted by the authors, we found that 23% of clinical staff time was spent fighting paperwork. Therefore, we recommend addressing any workflow issues first before beginning the task of implementing your new system.
The first step in that process is to create an information management committee, both at the provider and network levels. Key individuals should be assigned to those committees who will work to develop your information management standards. The individuals on that committee will be the ones to create the standard forms, data elements, codes, reports and procedures that will be used by the partners.
That "core data set" will be the currency by which you exchange client information among the members of your network. In addition to a core data set, the specialized programs will need to develop a superset of the data that includes their common data elements. Those will be determined in part by funding sources and accreditation bodies.
Although it is time-consuming, we suggest that a baseline analysis be prepared describing your operations. That baseline narrative of existing operations will provide the information management committee with a vehicle to review and discuss the existing operations and documents. Additionally, it will provide staff with the opportunity to identify potential or existing problems areas such as inefficient workflow, redundant data and other unnecessary paper. That analysis can then become the basis for redesigning workflow.
IS Requirements Follow Functions:
The process of developing and agreeing on common forms is itself excellent preparation for the kind of decisions necessary for efficient automation. The greater the degree of standardization, the easier it will be to exchange information among providers. That data-sharing is essential as a client moves throughout an integrated delivery system. Some of the documents that may be shared include consents and releases, case summaries, treatment plans, medication forms, consultation and referral forms, quality assurance reporting and discharge plans.
Using the same forms requires, to some extent, common policies and procedures regarding their use (who, when, what), approval, content and modification. While necessary to the successful operation of an integrated service system, common policies and procedures are also helpful in establishing the flow of information among providers and managers within the integrated service system.
The information system requirements of the integrated service system will depend on its structure and functions. If the system is a loose network of independent providers, a central information system may not be required. Automation of the individual providers and the exchange of information through e-mail and/or an intranet may be adequate.
If, on the other hand, the integrated service system is administered by a managed care organization, an entirely separate set of programs will need to be purchased. Some of the applications that would be useful for a managed care organization include enrollee management, premium billing and accounts receivable, provider management, contract and benefits management, credentialing and privileging, authorizations, capitation management, claims administration, referral management, utilization review, case management and quality management.
About The Authors:
Bruce Johnson, M.S., is President of Johnson Consulting Services, Inc., an information management consulting firm that specializes in working with social service, healthcare and government organizations. He can be reached at (800) 988-0934, www.jcsconsultants.com or by e-mail at firstname.lastname@example.org.
Steven Schafer, M.Div., is President of Schafer Consulting, Inc., a managed behavioral healthcare consulting firm. He can be reached at (800) 661-2435, http://www.schaferconsulting.com or by e-mail at email@example.com.
1Reproduced by Permission form Atlantic Information Services, Inc., Managed Behavioral Health News, July 29, 1999.