From NRI's conference on State Mental Health Agency Services Research, Program Evaluation and Policy in DC, Improving Data Interoperability: Opportunities for States, Jeffrey Buck, & Rick Friedman.
J. Buck (SAMHSA/CMHS) - Data interoperability is the degree to which databases can be combined to provide information on aggregate data questions. These are affective by coding standards, payment method, and reporting elements. The difficulty comes from the siloed systems and from the constant revisions of those systems. (Hard to find the same person or provider in multiple systems.) Interoperability is a goal in the larger policy issues (e.g., New Freedom Commission on Mental Health and the IOM quality report). The focus is to encourage the development and use of client-centric data systems using a common data platform. Confidentiality (HIPAA and 42 CFR Part 2) is important but these do permit data sharing under certain circumstances (e.g., research, audits, healthcare operations) and SAMHSA is developing a guide to confidentiality.
Current status. Good-Most states use unique client identifies with client-level data, encounter/claims data and the majority link with one or more agencies. Bad-Multiple IT platforms, much legacy systems, many use state-owned or proprietary software, unique service coding and DSM IV, few have have detailed prescription drug data.
How to evaluate interoperability. some criteria include:
- Client ID
- Provider ID
- Access common and unique data elements
- Assess EHR "readiness" (how much can information can be easily shared, currently working on a set of measures for this)
To move toward interoperability you need to invest effort and FTE to move toward this goal. Consideration needs to be given to the process because this is an expensive and difficult task. But early results are important to help develop and maintain momentum. Don' wait until you can get it all start small and expand. Start using of-the-shelf data systems. Implement HIPAA compliant coding and pay attention to the provider identifiers.
[It is interesting that there was a strong call for an open architecture. In Missouri there was an attempt to follow this approach but it has devolved into an expensive and over due customized system.]
R. Friedman (Center for Medicaid and Medicare, CMS) - Medicaid Information Technology Architecture (MITA) and Mental Health. MITA will give us some information of where SAMHSA is headed. Focus more on outcomes and as a collaborative process. Promoting sharing of data among partners, access to multiple databases. Does not dictate structural changes in individual states. MITA is a web based modular development system that states can use to develop their own system but based on shared standards. Provides the basis for EHR, eRx, PHR, ...
Components:
- Business architecture (operations concept, maturity model, business process model, self-assessment, business services)
- Information/Data architecture (
- Technical architectures
Asking states to complete a State Self Assessment (SS-A) to identify where the state is in terms of their maturity (interoperability) and where they want to go. This helps the feds identify where a state is so that they can share that information telling the state to whom to go talk with who already knows how to do where you are trying to go. This is not yet available for behavioral health but will soon be doing pilot work on this assessment in the real world. There was a point raised during the discussion that compared the SS-A to a readiness to change model where there is a clear road map from where you start to where you could end.
CMS is willing to invest in systems that support enterprise-wide IT initiatives and pays 50-90% based on how much the medicaid providers drive the process.