Designing Health Information Technologies for Upta

Authors: Aaron R Lyon Cara C Lewis

Publish Date: 2015/12/12

Volume: 43, Issue: 3, Pages: 344-349

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Abstract

Driven by recent policy developments that emphasize accountability and data sharing eg Patient Protection and Affordable Care Act 2010 HITECH Act 2009 health information technologies HIT are rapidly becoming ubiquitous within the contemporary healthcare landscape Specific subtypes of HIT support service quality monitoring and can be classified within the “quality management” set of implementation strategies articulated by Powell et al 2012 2015 Despite their potential to function as an implementation strategy these technologies often require their own strategic implementation supports to be successfully installed and effectively used in new service systems Cohen 2015 Ruud 2015 Although there is widespread recognition of the potential for HIT to usher in new cost savings in healthcare issues related to technology design and implementation processes have interfered with the extent to which those savings have been realized Carroll 2015 Leviss 2011 Ribitzky et al 2010Measurement feedback systems MFS Bickman 2008 are one type of HIT that support service quality monitoring and directly inform care decisions through a the ongoing collection of intervention process and outcome data and b databased feedback to providers ie routine outcome monitoring ROM Because it is a core component of numerous evidencebased psychotherapies eg Cognitive Behavioral Therapy Interpersonal Psychotherapy and in light of the burgeoning evidence for its positive impact on service recipient outcomes ROM has been identified a potential minimal intervention needed for change MINC Glasgow et al 2014 Scott and Lewis 2015 MFS represent a leading strategy to enable ROM in mental health service delivery offering two basic functions 1 They include or provide the ability to input into the system quantitative measures that are administered regularly throughout treatment to collect ongoing information about the process and progress of the intervention and 2 They provide automated presentation of that information to support timely and clinicallyuseful feedback to mental health providers about their cases Bickman 2008 Importantly these functions do not necessitate a freestanding system Although MFS technologies often exist as standalone products they may also be integrated into other HIT such as electronic health records Douglas et al 2014 Steinfeld et al 2015 MFS have seen rapid proliferation with close to 50 such systems identified Lyon et al this issueDespite the growth of MFS and their widespread endorsement in the mental health services literature eg Garland et al 2013 Halford et al 2012 SAMHSA 2012 little empirical work has examined the strategies through which these systems are developed eg contextual inquiry software design system usability testing and implemented eg training consultation use of incentives in real world mental health service delivery settings The integration and effective use of MFS is beset with the typical implementation challenges common across behavior change efforts Cohen 2015 However technology development and roll out are perhaps uniquely complicated and often unexpectedly protracted tasks in which mental health professionals eg administrators researchers practitioners and resourcepoor settings are rarely equipped to engage Unfortunately no matter how well intentioned or conceptualized problematic system design and implementation can impede use and undermine the otherwise effective practices that technologies are intended to support Littlejohns et al 2003 Karsh 2004 Maguire 2001 Presently there are few examples and scarce guidance available to inform design/implementation processes as they relate to the popular technology of MFS—including how to effectively engage key business/technology partners who may not be primarily focused on a system’s clinical utility As a result development teams tend to remain highly “siloed” which limits the extent to which innovative and effective approaches are developed and shared leading to redundant work and wasted resources Although some authors have begun advocating for the application of usercentered design principles to MFS development Bickman et al 2012 Lyon et al 2015 scant literature exists to describe the iterative process of system design testing and revision Furthermore although implementation science frameworks have identified key variables and outcomes related to the introduction of innovations into novel contexts eg Aarons et al 2011 Damschroder et al 2009 Proctor et al 2011 they have only recently begun to be applied to the domain of MFS technologies These issues have significantly hampered the identification and dissemination of “best practice” models for MFS design and implementationAs a component of the larger special issue on outcome assessment and feedback processes this special section focuses on the design development refinement and implementation of MFS technologies across mental health service delivery sectors This collection of articles reflects projects in which new technologies or capabilities were developed eg Bruns et al 2015 Steinfeld et al 2015 as well as examples of adapting existing technologies to meet local needs eg Lyon et al 2015 Nadeem et al 2015 In addition the articles present process eg Bruns et al 2015 Gleacher et al 2015 Lyon et al 2015 Nadeem et al 2015 and outcome eg Bickman et al 2015 Gleacher et al 2015 Steinfeld et al 2015 data from MFS development and implementation efforts that reflect the full range of success from the decommissioning of the Contextualized Feedback System due to ongoing technological and cost issues Bickman et al 2015 2015 to moderate uptake of the Team Management System WrapLogic Bruns et al 2015 and to 90  penetration of a the mental health progress monitoring tool embedded within the electronic health record at Group Health Cooperative Steinfeld et al 2015Specifically Bruns et al 2015 describe their usercentered design informed process of developing an electronic behavioral health information system EBHIS to support Wraparound care coordination for youth They detail the core functions of electronic health records acknowledging the critical importance of integrating measurementfeedback and care coordination functions into the existing required infrastructure and workflow Bruns et al 2015 break down their process into replicable phases eg literature review input from the field development etc and put forth a theory of impact as it pertains to Wraparoundspecific EBHISNadeem and colleagues present a schoolbased communitypartnered method for developing and piloting an MFS to support teacher use of classroom practices and feedback to improve student emotional and behavioral issues They present an iterative approach to integrating user feedback into the adaptation of a relatively lowtech dashboard MFS eg using Microsoft Excel designed to fit the implementation context per a baseline needs assessment Pilot data indicated a dose–response relationship between the amount of feedback provided and its impact on outcomesLyon et al 2015 introduce the contextualized technology adaptation process CTAP a systematic approach to HIT development that draws heavily on humancentered design principles and models of implementation science The CTAP contends that optimizing innovationorganization fit is vital to MFS implementation and that usercentered design provides methods and techniques for making necessary adaptations Phase 1 of 5 phases—contextual evaluation—is presented in the context of MFS development for use in schoolbased mental health as an illustration of this mixed methods approachSteinfeld et al 2015 highlight the importance of emphasizing the clinical utility of the measurement tool to be featured in a MFS This led to their development of the mental health progress monitoring tool MHPMT—a combination of established measures eg Patient Health Questionnaire and new items eg regarding therapeutic alliance deemed relevant to the majority of their population After ceasing work with an external vendor due to cost time and privacy issues their team prioritized integrating the MHPMT into their electronic health record system to streamline workflow and relied upon patient completion of a paper copy to be entered by clinicians Using lean process improvement tools Steinfeld et al 2014 following a pilot implementation at a single site Steinfeld present quantitative and qualitative data from providers and patients on the utility of the MFS and its impact on patient progress

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