The Internet's explosive growth and the rapid development of interoperable information technology (IT) have significantly expanded healthcare's capabilities. It is imperative to harness the benefits of state-of-the-art IT in all areas of healthcare, including behavioral health (BH).1
BH professionals generally recognize that both the system and patients would benefit enormously from greater IT use, yet we have many technical and administrative hurdles to overcome. “Stovepipe” (proprietary) systems developed in an earlier stage of the technologic revolution of the past 50 years still exist in many states. Many BH service providers lack even basic case management systems.
To become a part of the national effort to move toward 21st-century healthcare technology, BH providers must begin by examining the status of current IT use. New York State conducted a survey of all alcoholism and substance abuse service providers in the summer and fall of 2005. This article summarizes the survey, and we hope other states will benefit from this work and use the material and methodology to advance their own BH IT efforts. (The full survey report is at http://www.asapnys.org under “Statewide Information Technology Survey.”)
Survey Concept and Methodology
To be successful, a BH information system should demonstrate at least two qualities: the ability to be fully integrated and the flexibility to change.2 In New York the Practice Improvement Collaborative (PIC) is stressing the importance of chemical dependency (CD) treatment providers having comprehensive, reliable, and standards-based computerized information systems. PIC is a consortium of state policy makers including those in the New York State Office of Alcoholism and Substance Abuse Services (OASAS), the Alcoholism and Substance Abuse Providers of New York State (ASAP), and the federal Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment.
OASAS and ASAP jointly sponsored the IT survey to gather detailed information on automated systems being used in CD services. The research's primary objectives were to determine:
infrastructure and operational data, including services provided;
the types of hardware and software being used, as well as the level of satisfaction with both components and vendor implementation;
the networking and communications infrastructure;
security features used to protect personal data and abide by HIPAA standards; and
areas of IT that CD service providers need assistance with.
The survey was first tested with six service providers to determine whether the questions were understandable and if the responses were appropriate and comprehensive (see the table for sample survey questions). After the test survey was completed successfully, the survey was sent to all 693 CD service provider organizations in New York State, including 450 treatment and 243 prevention service providers; 115 (16.59%) were returned.
Providers focused on financial applications. The survey revealed that CD providers who administer treatment programs tend to use IT systems far more than those who manage prevention programs, and much of the technology is primarily used for financial applications. Thus, the multiple benefits of case management systems, such as improving provider efficiency and effectiveness and substantially improving services, are being overlooked. Unfortunately, the emphasis is on financial applications because of their quick return on investment (ROI). ROI from case management systems is not easily predicted or calculable, especially within a short time frame.figure 1
Areas in which provider organizations are interested in receiving state assistance
IT systems were paid through operating revenue. Providers overwhelmingly indicated that hardware and software purchases were paid through operating revenue, although about 25% indicated that grants (mostly state grants) paid for IT.
Providers had a wide and varied level of IT infrastructure. PCs (Pentium 4s) were the most common (71%). A variety of application software programs were being used, with e-mail and PC/workstation software the most prevalent. A majority of the providers (55%) were using case management systems from 20 different vendors.
A majority of providers were satisfied with their IT systems and their vendor's implementation plan. Vendors were recognized for their support before and during implementation. However, 29% reported dissatisfaction with vendor plans, with complaints about vendors' lack of responsiveness to providers' needs and problems.
Larger provider organizations are further along in IT implementation. Larger provider organizations, which tend to be part of a larger medical or mental health system, have the necessary resources including financial and IT expertise, while smaller ones are making frustrating attempts to adopt IT. Not surprisingly, about 83% of providers do not have multiyear budgets and 53% have an annual budget of less than $1 million. About 63% of providers have spent only up to $10,000 on IT expenditures.