Utilization of an electronic information system to evaluate and enhance practice at a medication-assisted opioid treatment program

START Treatment & Recovery Centers (formerly Addiction Research and Treatment Corporation) is an outpatient medication-assisted opioid treatment program that also provides primary medical care, including HIV/AIDS care for approximately 3,000 predominantly minority adults in New York City.  Several years ago, we received NIDA funding to evaluate the implementation of an electronic health information system.  We now utilize the capabilities of the electronic system for performance measurement in order to improve patient care.

We measured and evaluated Outcomes; Regulatory and Contractual Compliance; and Productivity monthly. This was particularly timely, given that the NYS Office of Alcoholism and Substance Abuse Services instituted fee-for-service payment methodology to replace capitation; and the Affordable Care Act mandated meaningful use of electronic systems.

The ability to provide monthly reports of Outcomes (opiate and cocaine-free status; HIV viral load suppression; HgbA1c < 7 for diabetes mellitus; and BP < 140/90 for hypertension); Regulatory and Contractual Compliance (timely completion of behavioral and medical assessments); and Productivity (all clinical/administrative disciplines) resulted in improved performance over time.  Specifically, we found that Outcomes targets for opiates/cocaine were met (negative toxicology for >80% of patients); and targets for HIV viral load suppression; HgbA1c < 7 for diabetes mellitus; and BP <140/90 (> 75% of patients) were approached. For Regulatory and Contractual Compliance, 100% target was attained or approached; and Productivity improved over time.

Electronic systems are critical to measure outcomes with precision; meet challenges presented by changes in reimbursement and documentation; and navigate changes resulting from the Affordable Care Act.