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Crossing state lines to build better software

July 1, 2008
by Dave Wanser, PhD
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Public agencies can reduce costs by working together to develop IT systems

Across the country decisions are being made about how to respond to both immediate and future data-collection needs of the purchasers of services (in this case, states or counties), often without the benefit of sharing experiences with others who recently have gone through the same exercise. Superimposed on this are increasing accountability expectations, notably the implementation of National Outcome Measures (NOMs) and SAMHSA's support of state IT enhancements. The national movement toward electronic health records (EHRs) has spawned various working groups dedicated to reaching consensus on data definitions, privacy, and other issues, which have added another level of complexity to making IT decisions. These changes create an opportunity for behavioral healthcare systems, if proactive, to have a place at the table to ensure their unique needs are addressed.

To that end, about three years ago the Board of Directors of the National Association of State Alcohol and Drug Abuse Directors (NASADAD) authorized the creation of the National Data Infrastructure Improvement Consortium (NDIIC), a not-for-profit corporation. This collaborative organization intends to improve state and substate behavioral healthcare information technology infrastructure, capacity, and awareness.

NDIIC's Core Assumptions

Discussions have occurred in a number of forums about the needs of state substance abuse and mental health authorities and their provider systems to modernize existing systems while anticipating the need to meet new and changing accountability expectations. Several states' experience in developing and deploying EHRs increasingly is informing these discussions. Of particular and growing interest is how systems built on open source and nonproprietary platforms could be shared and reused across jurisdictions.

The opportunity to take much of the risk out of the decision making about new IT investments, as well as speed up implementations and reduce costs of these technologies, is quite compelling. Consequently, NDIIC was created based on these core assumptions:

  • States and counties are updating data systems to improve compliance with reporting requirements and anticipating mandates for using EHRs.

  • States and counties increasingly will require timely access to linked performance and financial information for management and accountability purposes.

  • These expectations will extend to providers, and the continued investments in provider-centric systems are difficult to justify in resource-constrained systems when state-sponsored applications can create huge economies of scale.

  • The clinical processes of behavioral healthcare service delivery are very similar in structure and content, and uniform data definitions will continue to reduce variability across jurisdictions.

NDIIC's strategic goals

NDIIC has established a number of strategic goals that include, but are not limited to, the following:

  1. Reducing the cost for designing, developing, and implementing computer data-collection systems, EHRs, and outcome-reporting systems

  2. Increasing the availability of resources through collaboration and increasing efficiency by sharing enhanced systems

  3. Improving security and streamlining the building of complex systems requiring HIPAA, 42 CFR Part 2, and other security-based transactions and processes

  4. Expediting the processing and increasing the timeliness of data collection and reporting

  5. Improving the accuracy, validity, and overall quality of data used for reporting, clinical decision making, evaluation, and policy development

  6. Meeting federal reporting requirements with a level of fidelity that enhances the competitiveness of grant applications and completeness of required grant reports

  7. Increasing the presence of substance abuse and mental health in federal discussions about EHR technology

Benefits of Working Together

Real policy benefits accrue from pooling resources and sharing the workload in developing electronic systems, whether they are full EHRs or simply automated reporting systems for agencies not ready to use all the functionality of an EHR. First and foremost, these systems actually can improve the quality of client care. Second, they can help improve administrative practices and procedures. Third, they can standardize reporting functions across a state or county, or even nationally, making it easier to fulfill mandatory reporting requirements and ensure data quality is maintained. They also can help position public behavioral healthcare service systems for inclusion in future standards development related to paperless, Web-based transaction systems. Integration and interoperability across large numbers of providers, and potentially different funding streams, are a real benefit for states and counties that sponsor these systems.