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Introduction to the Mental Health Information System (MHIS) Dashboard
Presented by Alex Sox-Harris, Ph.D.
Associate DirectorVA Program Evaluation and Resource Center (PERC),
VA Palo Alto Health Care SystemPalo Alto, California
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Presentation OutlinePresentation Outline
• MHIS Dashboard: Background, Basics, and FAQs
• Example Site Review Templatep p
• Brief Description of the Pilot Mental Health Outcomes
Monitor (MHOM) Project
• Additional Resources• Additional Resources
• Questions and Discussion
P f th MHIS D hb d
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Purpose of the MHIS Dashboard
• A product created by Office of Mental Heath Operations (OMHO)
▫ PECs (PERC, NEPEC, SMITREC) and many other collaborators (OMHS VSSC OQP and many others)(OMHS, VSSC, OQP, and many others)
• To fulfill the requirement for OMHO to develop and maintain a dashboard for monitoring and reporting on the state of mental health services and programs
• To ensure that the requirements of the Handbook on Uniform Mental Health Services and related documents are implemented
• Not a performance management system. More of a QI system/tool
Purpose of MHISPurpose of MHIS• Primarily for OMHO to use internally▫ To detect and decrease variability between facilities as▫ To detect and decrease variability between facilities as
well as VISNs Both negative and positive outliers
▫ To guide technical assistance to VISNs and facilities –“conversation starters”
▫ To provide information resources to support program▫ To provide information resources to support program evaluation and planning by staff in VACO, VISNs
• Hopefully will be used by facilities and programs to self-assess and make adjustments.
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Development of the MHIS Dashboard
• Extract all unique requirements from the Handbook• Enumerate the concepts that need to be operationalized• Enumerate the concepts that need to be operationalized
in order to construct a metric that maps onto each requirement. T h ibl hi i h db k• To the extent possible, matching metrics to handbook language and structure, we operationalized concepts with the diagnostic, clinical, pharmacy, and other datag , , p y,
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“All facilities must make medically-supervised withdrawal management available as needed, based on a systematic assessment of the symptoms and risks of systematic assessment of the symptoms and risks of serious adverse consequences related to the withdrawal process from alcohol, sedatives or hypnotics, or opioids. Although withdrawal management can often be Although withdrawal management can often be accomplished on an ambulatory basis, facilities must make inpatient withdrawal management available for those who require it. Services can be provided at the facility, by referral to another VA facility, or by sharing arrangement, contract, or non-VA fee basis arrangements g , , b gto the extent that the veteran is eligible with a community-based facility.”
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Development of the MHIS Dashboard
• After initial metric specifications were drafted, we involved a larger group of clinical experts and policyinvolved a larger group of clinical experts and policy leaders to provide feedback on the dozens of choices that were made in operationalizing each construct. Oth I• Other Issues:▫ Standardizing concepts across PECs▫ Assigning patients to facilitiesAssigning patients to facilities▫ Time frames▫ Constructing item thresholds and domain scores
Thresholds for MeasuresThresholds for Measures• Set by policy-based program goals if available. • In the absence of policy-based program goals,
thresholds are based on distributions.Distribution based thresholds require expert• Distribution-based thresholds require expert consensus
Dashboard Domains9
Dashboard Domains
H db k I l t ti S ifi S i ( t’d)Handbook Implementation Survey
T21 Measures Staffing Specific Services
Specific Services (cont’d)▫ Ambulatory services for SMI▫ PTSD▫ SUD
Specific Services▫ Population coverage▫ Access▫ Screening and follow-up
S ifi i d iti
▫ Evidence-based psychotherapy▫ MH care for homeless Veterans▫ Integrated MH with medical
services▫ Specific required positions▫ Care transitions▫ Inpatient ▫ Residential
▫ Services for older adults▫ Services for women▫ MST services▫ Suicide prevention
▫ High intensity ambulatory services
▫ Emergency services▫ General ambulatory services
Suicide prevention▫ Medical care for mentally ill
14 Measures in the SUD Domain10
14 Measures in the SUD Domain• SUD patients receiving any intensive SUD treatment• SUD patients that receive intensive residential SUD• SUD patients that receive intensive residential SUD
treatment • Inpatient medically managed withdrawal for alcohol or
opiates • Follow-up after inpatient medically managed withdrawal
for alcohol or opiatesfor alcohol or opiates • Pharmacotherapy for alcohol use disorder • Pharmacotherapy for opioid dependence
SUD patients receiving intensive SUD patients receiving intensive specialty SUD treatment
HistogramMean: 9.2%SD 7 6%
50.000
60.000Histogram SD: 7.6%
Threshold < 1.6%Facilities identified: 9
40.000
ilit
ies
20.000
30.000
# o
f Fa
ci
0.000
10.000
0.000 0.020 0.030 0.072 0.114 0.156 0.198 0.240 0.282 0.324 0.366
Metric Score
To access the MHIS:
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To access the MHIS:
Current LocationCurrent LocationCurrent LocationCurrent Location
• http://vssc.med.va.gov/uat.asp
Final Location Final Location (MHIS is (MHIS is not here yetnot here yet, but will be…eventually), but will be…eventually)
• http://vssc.med.va.gov/products.asp?PgmArea=9
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1. Go to main VSSC site (http://vssc.med.va.gov/) 2 Interim location2. Interim location
3. Final 3location
The MHIS InterfaceThe MHIS Interface14
REPORT FILTERSREPORT FILTERS
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REPORT FILTERSREPORT FILTERS1
Fiscal Year drop-down 32
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Location selection drop-down
Reporting period drop-down
Outputting ResultsOutputting Results16
p gp g
Click “View Report”
Expand/collapse (+/-) buttons
Exploring ResultsExploring Results17
p gp g
Expanded results by Metric Grouping
Exploring Results18
p g
Expanded results for SUD Metric Grouping (Domain)
Exporting Results19
p g
File export menup
Excel Output Example
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Excel Output Example Example
Expand/Collapse ButtonsExpand/Collapse Buttons
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Frequently Asked Questions Q Wh h t th MHIS?Q. Who has access to the MHIS?
All VA employees.
Q. Where does the data in the MHIS come from?
Administrative (workload) data
•National Patient Care Database (NPCD),
•Decision Support Systems (DSS),
•Pharmacy Benefits Files •Pharmacy Benefits Files.
•Handbook Survey
• EPRP reviews, and other sources and developed by OQP.
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Frequently Asked Questions Q Wh d ’t f f ilit ’ f Q. Why don’t some of my facility’s performance measure scores match the scores from the VSSC site?
The VSSC site updates some of their data more frequently than the MHIS site.
Q Why do some of my facility’s scores for some of Q. Why do some of my facility’s scores for some of the non-performance measure metrics seem off?
•Local methods of coding workload may not be recognized
•Mistakes in calculation
•Home-facility “credit”
Site Visit Pre Work Process
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Site Visit Pre-Work Process1. Focus
P bl • Problem areas
• Exemplary areas
2. Report includes:
• Flagged areasgg
• Non-flagged weak areas
• Strong areasStrong areas
• Trends
Site Visit Report
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Site Visit Report
Site Visit Report25
p
F ilit X P k R t
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Facility X Pre-work Report
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Additional Resources
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Performance Measure Resource2012 PM Report
To access up-to-date mental health performance measure data.http://reports2 vssc med va gov/ReportServer/Pages/ReportViewer aspx?%2fMgmtRephttp://reports2.vssc.med.va.gov/ReportServer/Pages/ReportViewer.aspx?%2fMgmtRep
orts%2fSHRED%2f2011MeasureReport&rs:Command=Render\
PITAOQP's site for official documentation on performance measuresOQP s site for official documentation on performance measures.
http://vaww.reporting.oqp.med.va.gov/ReportServer/Pages/ReportViewer.aspx?%2fPerformance+Reports%2fMeasure+Management%2fMeasureSummary&rs%3aCommand=Render
ARC To access mental health staffing data.https://vaww.proc.arc.med.va.gov/pas/en/src/proclarity.asp?uiConfig=&book=%7b9CEB
1B58-8D60-4C64-BF50-97F2DD7149B8%7d&page=%7bBC366F31-A916-49C3-1B58-8D60-4C64-BF50-97F2DD7149B8%7d&page=%7bBC366F31-A916-49C3-88CB-CD1D2BE7112A%7d&folder=root&LibID=%7bCC01C41F-03ED-4FDB-8A9D-1B2403146B87%7d
ARC data29
ARC data1
2
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ARC data
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ARC data
Non Core Mental Health
https://vaww.proc.arc.med.va.gov/pas/en/src/proclarity.asp?uiConfig=&book=%7b9CEB1B58-8D60-4C64-BF50-97F2DD7149B8%7d&page=%7bBC366F31-A916-49C3-88CB CD D BE A% d&f ld t&LibID % bCC C F ED FDB 8A D88CB-CD1D2BE7112A%7d&folder=root&LibID=%7bCC01C41F-03ED-4FDB-8A9D-1B2403146B87%7d
PERC R
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PERC Resources
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Other Projects in the Worksj
• Pilot testing chart review metrics for services that can’t be measured with other data sourcesthat can t be measured with other data sources▫ e.g., Involved Veteran and Family in Treatment
planning. p g
• Pilot testing the Mental Health Outcomes Monitor (MHOM)
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Mental Health Outcomes Monitor (MHOM)(MHOM)
• (MHOM) pilot project is a quality improvement project funded by the OMHO and conducted by project funded by the OMHO and conducted by PERC.
• The goal is to test the feasibility of collecting The goal is to test the feasibility of collecting high-quality patient outcome data to guide clinical operations and policy development to improve the quality and efficiency of VA mental health care.
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MHOM Project Basicsj• Identify a sample of Veterans who are new to
mental health treatment at each facility based on mental health treatment at each facility based on their diagnoses and a visit in the prior week to a specialty mental health service.
G l i h d l f i ▫ Goal is to gather data on a sample of veterans in major diagnostic groups.
• Veteran will be contacted via phone within a Veteran will be contacted via phone within a week of that visit by staff at the Canandaigua VA Call Center. Call Center staff are supervised by a li d li i l h l i tlicensed clinical psychologist.
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MHOM Project Basicsj• If the Veterans agrees to participate in the QI
project, he or she will complete a group of i d d bli h h i f i i assessments intended to establish their functioning
and mental health symptoms. Re-contacted 3 months later for a follow up assessment.
h ill i l d hi h• The assessments will include measures which are currently being used or developed for regular clinical use in the Mental Health Assistant (e.g. PHQ VR PCL) ll i f l PHQ9, VR-12, PCL), as well as questions useful to program and policy planning by OMHO, such as Veteran perceptions of benefit from, recovery-
i t ti h l f l d ti li f t l orientation, helpfulness, and timeliness of mental health care, and use of non-VA mental health care.
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MHOM Project Basicsj
• If a Veteran you saw completes an assessment interview you will receive a PKI encrypted einterview, you will receive a PKI-encrypted e-mail with the results of the assessments.
• We will template it to make it simple for you to We will template it to make it simple for you to include in the Veteran’s medical record.
• Currently piloting this process in several sites. y p g p
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MHOM Project Basicsj
• Characterize system-wide variability in clinical improvement for QI purposes improvement for QI purposes.
• To identify the processes and patterns of care • To identify the processes and patterns of care that are most tightly linked to clinical improvement and patient satisfaction. p p
For Questions Comments Suggestions:
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For Questions, Comments, Suggestions:
Alexander Harris2@va [email protected]
For Global Domain Metrics: J di T ft Al H i (PERC)Jodie Trafton or Alex Harris (PERC)
Greg Greenberg or Rani Desai (NEPEC) Fred Blow or John F. McCarthy (SMITREC)
For Handbook Domain Metrics:Greg Greenberg or Lindsey Pilver (NEPEC)g g y ( )
For Performance Measure items:Email VHA OMHS Metrics (on Outlook)Email VHA OMHS Metrics (on Outlook)