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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 govAlexander.Harris2@va.gov

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)