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ASAM Criteria evolves into electronic tool

December 1, 2014
by Julie Miller, Editor in Chief
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David Gastfriend

Providers that have long relied on the book text for the American Society of Addiction Medicine (ASAM) Criteria will be able to make a digital leap starting next year. In January, ASAM will premier its new decision-tool software for treatment centers and county programs.

And it’s not just a electronic version of the book text, but rather, it’s an interactive program that intelligently leads counselors and their patients through data inputs to arrive at level of care recommendations.

David R. Gastfriend, MD, chief architect of the software and CEO of the Treatment Research Institute in Philadelphia, says the digital leap is transformative because the criteria itself impacts so many stakeholders. It’s used worldwide and is a best-practice protocol in 30 states.

“The software takes the book, which is now 500 pages, and every decision rule in the adult admission criteria and implements those rules using research-quality question items and a precise algebraic equation to calculate the recommended level of care,” Gastfriend says.

Behavioral health EHR vendors will offer the tool exclusively, and ASAM has received agreements from 18 companies to host the software so far. Programs can purchase the tool at cost: $65 per intake clinician per month, for unlimited read-write use. Discounts will be available, based on volume, and Gastfriend says, vendors are also planning spinoffs for new derivative products, such as custom reporting tools.

“The beauty of that is that ASAM is stimulating the whole behavioral healthcare IT industry to better serve the addiction treatment field,” he says.

Quantified decisions

Rather than inferring decisions from the criteria text alone, counselors and other clinicians will answer prompts from the software, such as “How many times has the patient been in treatment previously?” Each response will lead to the next logical prompt.

After the provider completes the structured process, the answers are distilled. At that point, the provider uses his or her own experience and expertise to choose the recommended level of care from the software’s results.

Les Washburn, director of recovery programs for Janus of Santa Cruz (Calif.), a multilevel countywide addiction program, says his organization participated in the demonstration project for the ASAM Criteria software.

“It’s a good assessment tool for counselors and intake people to get a feel of where the possibilities are for placement of clients, especially in this day and age where there are so many limitations on placement,” Washburn says. “This gives us a direction beyond what might be just our gut instinct.”

Provider-level benefits

But most treatment centers will want to know whether the tool provides a direct benefit or if it’s just another layer of administration.

“When we piloted this in beta testing and in a national demonstration project with hundreds of patients, what the programs told us is they got faster managed care approvals,” Gastfriend says.

For example, a typical managed care prior authorization reviewer might balk at approving coverage for a patient for his sixth round of treatment, assuming that because of the recidivism, the service isn’t helping. He says the ASAM tool is programmed to get details so it will ask not just how many times a patient has received treatment, for example, but what the level of treatment was—such as detox versus rehab. Knowing that a patient left detox five times without following through to the next level of care can help the provider make the case for treatment.

“Now the counselor gets to inform the utilization review nurse that this patient keeps going through the revolving door of detox, because nobody has ever gotten the patient to follow through,” he says.

Some programs in the demonstration billed for the interaction as an Extended Evaluation, which provided a higher reimbursement.

Ramping up

Many early adopters were able to interact with their first patient using the software after completing a 45-minute online training video. Staffwide use of the software, however, will call for additional effort with up to 20 hours of in-service training, primarily on the ASAM Criteria itself, rather than on the use of the software, according to ASAM.

In Santa Cruz, Washburn says he doesn’t consider himself to be particularly computer-savvy but the tool has been easy to use.

“Intake is a bit longer on the front end, maybe another 30 to 45 minutes,” Washburn says. “But it saves time because we have printed information that we refer to to watch for changes more easily during assessment and continued assessment.”

Over $8 million of research funding and another $1 million of web application development has been put into the software, according to ASAM. The future outlook includes EHR vendors using their capital and resources to expand to complementary products based on the ASAM tool.

Currently participating behavioral EHR commercial vendors include (as of November 2014):

  • BestNotes
  • Brain Resource.com
  • Compulink
  • Computalogic's MethodOne
  • DocuTrak
  • eHana
  • Foothold Technology
  • Lauris / Integrated Imaging
  • ManageAttendance
  • Orion Systems
  • Qualifacts
  • Ramsell
  • Sigmund Software
  • Smart
  • Stratus EMR
  • The ECHO Group
  • TenEleven Group
  • Welligent
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Comments

I would appreciate receiving a copy of the validation studies done by parties - independent from the author(s). The tone of the article would indicate this is a diagnostic tool that determines what conditions should be developed in the personalized treatment plan for each client.

In 2004, I built a web-site that provides clinicians with multi-scaled, independently validated - diagnostic tools. Note: All authors have a bias. A compiled instrument provides a summary of these biases. These tools also include numerical ASAM criteria.

During the last 30 years in the field, I have found a few clinicians that were more concerned with saving lives than filling classrooms or beds. State agencies and their contractors are using diagnostic tools that don't comply with DSM-IV or ASAM criteria. Seems that the DSM-V and ASAM have different diagnostic elements. A disease vs behavioral elements. Is this important?

These tools were built by a team that work in the treatment field and are aware of the shortcomings of current solutions and wished to save lives. The client needs to "accept" the diagnostic results and treatment plan developments.