Knowledge platform envisions better clinical, operational decisions: recent Netsmart moves aim at closing gap between behavioral health and rest of healthcare field.
Subject: Health care industry
Behavioral health care
Author: Grantham, Dennis
Pub Date: 11/01/2012
Publication: Name: Behavioral Healthcare Publisher: Vendome Group LLC Audience: Academic; Trade Format: Magazine/Journal Subject: Health; Health care industry; Psychology and mental health Copyright: COPYRIGHT 2012 Vendome Group LLC ISSN: 1931-7093
Issue: Date: Nov-Dec, 2012 Source Volume: 32 Source Issue: 6
Topic: Canadian Subject Form: Behavioural medicine Computer Subject: Health care industry
Product: SIC Code: 8000 HEALTH SERVICES
Accession Number: 313161190
Full Text: When Michael Valentine, former COO at acute-care technology giant Cerner joined Netsmart Technologies as its new CEO in May 2011, many in the field wondered exactly what changes might be in store. Now, the picture is becoming clearer, as Netsmart acquired Behavioral Pathway Systems (BPS), the industry benchmarking arm of Centerstone Research Institute (CRI), in August and announced a September deal with CRI to collaborate in developing and mining the field's largest database of deidentified patient data.


Netsmart envisions creating and promulgating cloud-based services that will 1) consolidate and continually refine clinical decision-making and treatment tools; and 2) provide a growing base of benchmark, quality, and performance-measurement tools that will help provider organizations improve the business of treatment delivery.

In an exclusive interview with Behavioral Healthcare magazine, Valentine and other Netsmart executives said that the new tools are vital to enabling behavioral health and human services providers to meet the demands of health reform while re-integrating their specialties with the rest of medicine. At present, they estimate that behavioral health is "about a decade behind" the rest of healthcare in the development and use of such tools.

It all starts with data

"Our strategy says: if we're going to advance the field of behavioral health, we have to greatly improve the clinical content of our EHRs--and those across the industry. We felt that we could do that today by aggregating the voices of our customers," says Kevin Scalia, Netsmart's EVP of corporate development. The effort began last year when Netsmart acquired industry rival Sequest Technologies--along with its customer base and core of skilled clinicians--and by hiring Denny Morrison, PhD, the former CEO of CRI. Resources like these, he said, would help Netsmart "deliver improved clinical tools in a way that doesn't disrupt the clinical workflow."

But what tools? Scalia explains that Netsmart's search for existing national standards, assessments, or measures showed that few existed among its current customers. But, a conversation with CRI CEO Tom Doub led Netsmart to an important insight: "A major national study might have results from 300 individuals, [but Netsmart and its customers] were sitting on an installed base of 20 million individuals," says Scalia. "We began to think, if we could work with CRI to mine that real-world data, they might well be able to develop all sorts of clinical decision support (CDS) algorithms that we hadn't even thought of."

With that approach in mind, Netsmart began construction of a central database that would allow its users to voluntarily contribute deidentified individual data. At the same time, the company is developing additional methods to monitor and communicate with customer EHRs so that it can "layer on" new clinical information and decision tools incrementally. This, Scalia continues, is the first step in a broader effort to expand database access to a much wider circle of would-be contributors, starting with current Netsmart and Behavioral Pathway Systems customers, but extending to others, such as academic institutions that would contribute new information, decision support algorithms, or data-mining strategies.

Under terms of its collaboration deal, "Netsmart agreed to make CRI the first ones to have access to this new data-base," Scalia states. "They are going to adapt their predictive models--models already under development through the Knowledge Network--to see if they can better inform treatment decisions being made at the point of care." Ultimately, the knowledge gained would be the basis for advanced CDS tools for the treatment community.

The acquisition of Behavioral Pathway Systems, which Scalia said is already working with another very large and very diverse base of providers, promises to make behavioral health organizations more efficient during the period when improved clinical systems are being developed.

CRI: A chance to reach out

Through its new agreement with Netsmart, CRI's CEO Tom Doub recognized a chance to do two things: get access to a huge new font of data and, potentially, to impact the field of behavioral health with CRI's predictive analytics much more quickly I than CRI could ever do on its own.

"We've been fortunate in getting our research effort off the ground, thanks to some major donors, but we recognized that if we were going to create something beneficial, we wanted the benefits to go beyond Centerstone--to the field as a whole," Doub says. "This relationship is a way to quickly integrate our efforts onto a key technology platform and get it out to people rapidly."

Doub's former boss, Netsmart's Denny Morrison, PhD, agrees. "Our industry hasn't been very forward-thinking in its use of data-driven decision making," he says, noting that "the fundamental premise of bringing better information to the clinician is that the clinician, not the computer, must make the decision."

Information to "change the trajectory of treatment"

But Morrison says that developing new clinical supports for clinicians involves several sticky problems. "Problem 1 is bringing the information to the clinician," he says. Problem 2 is more basic: "We've never really gotten away from the model of paper records." To allow for the impact of improved CDS tools, Morrison insists that "we have to accept the fact that electronic records can and must do things that paper records can't." Key to realizing this capability is to present useful knowledge in ways that "don't screw up the workflow" but can "change the trajectory of treatment in real time." Research findings, he says, must be converted into "digestible nuggets" of information. You can't," he explains, "send up a system alert that says 'read this paper' when the patient is in the room."

Getting that interaction right will be tricky. "The way we think about the workflow will be as important as the way that we present the information. We're looking at all sorts of ways to do that now."

As the problems of clinical decision support get worked out, work on another transformation in care quality will continue: the strategic transition from managing the care and outcomes of individuals to predicting and managing the health of populations. Such population-focused strategies are important to the success of accountable care organizations and health homes.

Population management "is where all of the automation comes together," Scalia says. He suggests that its value will come in the form of algorithms that look at a population and determine who is most likely to need care or who, for example, has missed recent visits and may be at risk for quitting meds, relapsing, or ending up in the emergency room.

Anticipating and resolving preventable problems across populations is vital, echoes Morrison. "If you can identify those most in need, and perhaps, send out a case manager to work with them, you'll be able to take care of them at a [small] cost, instead of waiting until [they need] an emergency room visit." Morrison believes that behavioral health organizations are ideal for the role of operating health homes because they're accustomed to reaching out to individuals in the community, something that primary care providers do not ordinarily do.

Putting it together: an "EHR agnostic" knowledge platform

Netsmart envisions that the products of all its recent efforts--new benchmarking and evolving clinical decision support products, plus other content and knowledge products--will be hosted in the cloud and available through a series of web services. The products will begin to roll out for current Netsmart EHR and BPS customers as early as next spring, with other variants becoming available for subscription use by the users of other EHRs sometime thereafter. The services would be available not only to behavioral health providers, but to physical health providers too, since these patients might well have mental health or addiction problems that exacerbate their physical problems.

"One way to look at all of this is as part of the natural evolution that happens when you digitize things," says Netsmart CEO Valentine, who compares the coming evolution of behavioral healthcare to the one that's already occurred in the rest of healthcare. "Step one is to digitize the information, from paper to a mostly digital environment. All that data then drives step two, a drive for a lot more reporting and analytics, when you can begin to leverage the systems to enlighten your environment and make better decisions."





Noting that the behavioral health field is "somewhere between steps one and two," Valentine goes on to explain that Netsmart's planned knowledge platform "targets the space between steps two and three of the process, by offering advanced clinical information to drive better decisions and by providing analytics and benchmarks that will show organizations "what you're doing differently from others who are successful."

Then, step three is quick to follow, "Step three happens when you use systems and knowledge to layer on additional evidence and proven practices that drive and sustain good behavior." He believes that if technology can be used to "introduce and compare what's working and what's not working clinically and operationally, we'll be doing what the physical health side has been doing for some time now across the entire industry."

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