Implementation of an electronic information system to enhance practice at an opioid treatment program

Background: The Addiction Research and Treatment Corporation, an outpatient opioid treatment program that also provides primary medical care, including HIV/AIDS care for approximately 3,000 predominantly minority adults in New York City implemented an electronic health information system integrating counseling, social services, medical services, case management, HIV services, dispensing, and administrative/fiscal data. We combined our in-house dispensing and social services program with eClinicalWorks, which became available through a grant obtained by the NYC Department of Health and Mental Hygiene. System performance was studied.

Methods: Four domains (Quality, Productivity, Satisfaction, and Financial Performance) were evaluated utilizing a pre and post-implementation research design. A fifth domain, Risk, was dropped from the analysis due to insufficient numbers for valid statistical comparison.

Results: Pre and post-implementation data have been compiled and analyzed in the domains of Quality and Satisfaction. For Quality, pre-implementation annual medical assessments and annual multidiscipline assessments were timely for 82% and 72% of cases, respectively. Post-implementation, timeliness of annual medical and annual multidiscipline assessments was 92% and 93%, respectively, a highly statistically significant improvement. Also in the Quality domain, hepatitis C viral load was appropriately performed in 85% of cases pre-implementation; post-implementation, it was 81%. For Satisfaction, 74% of patients were satisfied or very satisfied with their care pre-implementation; post-implementation, it was 73%.

Conclusions: The pre-post comparisons compiled thus far indicate a mixed result. Once all data has been compiled, intensive review will be done to make changes to areas where performance fell short, while maintaining areas where performance improved.