A Clinical Decision Support Tool for Electronic Health Records

描述(由申请人提供)：药物滥用治疗通常会因抑郁、家庭和人际冲突以及法律问题而变得复杂。当这些问题通过有效的循证治疗(EBT)得到解决时，结果会有所改善。为了提高成瘾治疗的质量，专家们呼吁采用持续护理管理办法，将EBTS更全面地纳入治疗过程。然而，将EBTS整合到临床工作流程中往往是困难的，因此临床医生依赖于旧的护理模式。如果临床医生在服务点可以获得有关EBTS的信息，则最有可能实施EBTS。电子健康记录(EHR)使用的扩大为克服这一问题提供了一个重要机会。虽然CDS系统通常在行为健康环境中不可用，但SAMHSA鼓励将行为健康整合到EHR中，并希望增加使用EHR的行为健康提供者的数量。下一步是构建CDS功能，随着EHR不可避免地在行为健康环境中扩展，CDS功能将可用。这项提案将通过两家公司之间的合作来解决这一差距，这两家公司已经在药物滥用治疗方面建立了全国地位。Inflexion开发了一种名为ASI-MV的成瘾严重程度指数的计算机版本，目前在全国600多个治疗中心使用。菲的旗舰产品是治疗服务网络基础设施(WITS)，这是一个捕获大量客户级治疗数据的网络应用程序，在22个州被100多万客户使用。Inflexion和FEI将开发一个CDS组件，该组件将“插入WITS用户界面”。将先进的统计和数据挖掘技术应用于广泛的WITS数据集(包括ASI-MV数据)，我们将评估客户概况(关键预测变量)、服务和结果之间的关系，以提供有关将产生最佳结果的治疗服务的建议(例如，成功康复和减少抑郁症、增加就业时间、减少法律/司法问题)。他们的系统将随着案例数量的增加而获得智能，而不是依赖静态算法。这种方法的优点是：(1)它利用统计分析和数据挖掘将有效的干预措施与客户概况相匹配；(2)帮助临床医生在服务点为客户确定最佳的服务组合、EBTS、资源；以及(3)帮助组织确定EBT的实施和结果。这对公共卫生的潜力非常大，并将把范式从基于培训的异步EBT实施模式转变为数据驱动的持续护理模式。目前的提案代表着一项重大创新，它解决了实施环境技术转让的传统障碍。由于FEI和Inflexion都在药物滥用治疗领域取得了显著的集体存在，因此将有机会在大量治疗环境中实施该系统。我们设想了一种商业模式，最初在WITS应用程序中出售对拟议系统的订阅访问权限，最终出售给其他EHR系统的用户，以促进更广泛的医疗保健集成。 公共卫生相关性：当通过循证方法在药物滥用治疗中解决共病问题时，患者结果会有所改善。如果临床医生在护理时可以获得关于循证治疗的信息，则最有可能使用循证治疗(EBT)。然而，EBTS在药物滥用治疗中的使用仍然滞后。我们建议开发一个系统，以：(1)将有效的干预措施与客户档案相匹配；(2)确定最有效的服务组合；以及(3)通过将系统集成到电子健康记录中，在护理点向提供者提供数据。这将是一项重大创新，解决了实施EBT的主要障碍，并加强了电子健康记录在药物滥用治疗中的使用。

DESCRIPTION (provided by applicant): Substance abuse treatment is often complicated by problems such as depression, family and interpersonal conflicts, and legal issues. When these issues are addressed with effective, evidence-based treatments (EBTs), outcomes improve. To improve the quality of addiction treatment, experts have called for the adoption of a continuing care management approach, involving a more comprehensive integration of EBTs in the treatment process. However, it is often difficult to integrate EBTs into the clinical workflow, so clinicians rely on old patterns of care. EBTs are most likely to be implemented if information about them is available to the clinician at the point of service. The expansion of electronic health record (EHR) use offers an important opportunity to overcome this problem. Although CDS systems are generally not available within behavioral health settings, SAMHSA has encouraged the integration of behavioral health into EHRs and is wants to increase the number of behavioral health providers who use EHRs. The next step is to build CDS capabilities that will be available as EHRs inevitably expand across behavioral health settings. This proposal will address this gap through a partnership between two companies that have developed a national standing in substance abuse treatment. Inflexxion has developed a computerized version of the Addiction Severity Index called the ASI-MV, now used in over 600 treatment centers nationwide. FEI's flagship product is the Web Infrastructure for Treatment Services (WITS), a web application that captures extensive client-level treatment data, and is used in 22 states, by more than 1,000,000 clients. Inflexxion and FEI will develop a CDS component that will "plug into the WITS user interface. Applying advanced statistical and data mining techniques to the extensive WITS data set (that includes ASI-MV data), we will assess the relationships among client profiles (key predictive variables), services, and outcomes, to provide recommendations about treatment services that will yielded the best outcomes (e.g., successful recovery and decreased depression, increased duration of employment, fewer legal/judicial problems). Rather than rely on static algorithms, they system will gain intelligence as the number of cases increases. The advantages of this approach are: (1) it utilizes statistical analysis and data mining to match effective interventions with client profiles; (2) assists clinicians in identifying the best service combinations, EBTs, resources for their clients at the point of service; and (3) assists organizations in identifying EBT implementation and outcomes. The public health potential of this is very significant, and will shift the paradigm away from an asynchronous, training-based EBT implementation model to a data-driven, continuing care model. The current proposal represents a significant innovation that addresses the traditional barriers to EBT implementation. Because FEI and Inflexxion have both attained a significant collective presence in substance abuse treatment field, there will be an opportunity to implement the system in a large number of treatment settings. We envision a commercial model that initially sells subscription access to the proposed system within the WITS application and, eventually to users of other EHR systems, to facilitate broader healthcare integration. PUBLIC HEALTH RELEVANCE: When co-morbid issues are addressed in substance abuse treatment, via evidence-based approaches, patient outcomes improve. Evidence-based treatments (EBTs) are most likely to be used if information about them is available to the clinician at the point of care. However, the use of EBTs in substance abuse treatment continues to lag. We propose developing a system to: (1) match effective interventions with client profiles; (2) identify the most effective combinations of service and (3) make the data available to the provider at the point of care by integrating the system in an electronic health record. This would represent a significant innovation that addresses major barriers to EBT implementation, and enhances the use of electronic health records in substance abuse treatment.