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Perspectives

Bringing Mental Health into Focus

One organization is deriving value from its foundation of data.

Dr. Damian Jankowicz, Ph.D., Vice President, Information Management, Chief Information Officer and Chief Privacy Officer, Centre for Addiction and Mental Health

9/19/2018

Thanks to investments in digital infrastructure, health care technology has moved beyond automation and into the era of insights based on the data that exists in the system. As value has become a top priority in health care, many health care organizations, such as the Centre for Addiction and Mental Health (CAMH), are using these insights to deliver value back to their organization and to their patients.

As Canada's largest mental health teaching hospital and one of the world's leading research centers in this field, CAMH provides comprehensive clinical care for illnesses that are not always seen but deeply felt, such as addiction, depression, schizophrenia and stress disorders. Thanks to our extensive research department and affiliation with the University of Toronto, we also have unique access to clinical research data that provides insights into the physical and genetic causes of mental illness. For us, defining value means leveraging the different types of data we have access to and using that to improve outcomes for our patients.

When we wanted to improve our Closed Loop Medication Administration (CLMA) rates, we used a data-driven strategy to encourage behavior change among our clinicians. At the start, our rates were close to 60 percent, and we knew we needed to improve that to advance patient outcomes. We decided to make all unit and individual CLMA rates transparent so each individual clinician could see how their rates compared to their peers. The idea was to use the data to create friendly competition that would encourage clinicians to change their behavior, and it worked. Within nine months, our rates were up to 99 percent. Our nurses pushed further, wanting to get to 100 percent, which led to barcoding the medications that patients themselves brought in. The key was using the data in a way that would motivate and activate people to change their behavior and have a positive effect on patient outcomes. We've also used a data-driven approach to improve the way we respond to opioid addiction. Like so many health care providers, the opioid epidemic has affected our treatment plans and protocols as we are seeing an enormous increase in the number of patients with an opioid addiction. Our emergency department (ED) specifically has seen large increases in the number of these patients. Looking at the ED data, we saw that very few patients were started on a treatment plan after initial diagnosis. People were coming into the ED and then getting referred to addiction services for treatment. This referral lag time was causing people to fall through the cracks. We refined our process so treatment would start right there in the ED and referral was streamlined. We saw the percentage of patients starting on a treatment plan jump by 20 percent, and the number continued to rise. When you consider the number of lives positively affected by that change in protocol, having the data available to us was hugely impactful.

We're also looking at the long-term potential of data to improve care and outcomes for patients. We use our electronic health record system to recruit patients for clinical research studies and we merge that clinical research data with other types of data, like imaging or genetics. This creates a rich longitudinal record for the patient and allows us to develop predictive algorithms to predict suicidality, aggression and readmission rates. We're also developing protocols based on our clinical data. For example, with a large-scale pharmacogenetic study, we're able to determine that if a patient has a particular gene, they should be on a certain type of drug. This kind of analysis wouldn't be possible without the ability to integrate data the way we can now.

As health care continues to advance, there will be an increasing number of data sources available, from a patient's personal mobile device-collected data to genetic data and beyond. One of the things that has helped CAMH make the most of our data is focusing on the data that is actionable. We have found that our clinicians are open to integrating data into their care, but it can quickly become overwhelming when we provide data for data's sake. Providing numbers and information that are tied to quality improvement initiatives is the key. Furthermore, the numbers have to lend themselves to be acted upon in clinical practice. Typically, this involves simple data around the treatment patients receive as well as tools to help identify performance problem areas.

In short, emphasize improvement, not data. At CAMH, we have invested in a data infrastructure that will allow us to continue utilizing it to improve patient outcomes. We feel that, even though we have reached HIMSS Analytics Electronic Medical Record Adoption Model (EMRAM) Stage 7, we have only just begun by creating the foundational building blocks for continued improvement and growth.

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