The Implementation of an Integrated Information System for Substance Use Screening in General Medical Settings

Abstract

SummaryThe Massachusetts Screening, Brief Intervention and Referral to Treatment (MASBIRT) Program, a substance use screening program in general medical settings, created a web-based, point-of-care (POC), application -the MASBIRT Portal ( the "Portal") to meet program goals. Objectives: We report on development and implementation of the Portal. Methods: Five year program process outcomes recorded by an independent evaluator and an anonymous survey of Health Educator's (HEs) adoption, perceptions and Portal use with a modified version of the Technology Readiness Index are described.[8] Specific management team members, selected based on their roles in program leadership, development and implementation of the Portal and supervision of HEs, participated in semi-structured, qualitative interviews. Results: At the conclusion of the program 73% (24/33) of the HEs completed a survey on their experience using the Portal. HEs reported that the Portal made recording screening information easy (96%); improved planning their workday (83%); facilitated POC data collection (84%); decreased time dedicated to data entry (100%); and improved job satisfaction (59%). The top two barriers to use were "no or limited wireless connectivity" (46%) and "the tablet was too heavy/bulky to carry" (29%). Qualitative management team interviews identified strategies for successful HIT implementation: importance of engaging HEs in outlining specifications and workflow needs, collaborative testing prior to implementation and clear agreement on data collection purpose, quality requirements and staff roles. Discussion: Overall, HEs perceived the Portal favorably with regard to time saving ability and improved workflow. Lessons learned included identifying core requirements early during system development and need for managers to institute and enforce consistent behavioral work norms. Conclusion: Barriers and HEs' views of technology impacted the utilization of the MASBIRT Portal. Further research is needed to determine best approaches for HIT system implementation in general medical settings. Research Article C. Shanahan et al.: Evaluation of Integrated Information System for Substance Use Screening in General Medical SettingsFor personal or educational use only. No other uses without permission. All rights reserved. The spectrum of unhealthy substance use, from risky use to substance use disorders (SUD), is a major cause of preventable morbidity and death [12, 13]. In the US, from 2012, the prevalence of unhealthy substance use in the adult population is 29.2% for alcohol and 7.0% (adults aged 26 years or older) and 21.3% (young adults aged 18 to 25) for illicit drugs. For SUD, prevalence rates are 8.5% for alcohol and 2% for illicit drugs [14][15][16].To address this public health problem, the Substance Abuse and Mental Health Services Administration (SAMHSA) funded through a cooperative agreement for Screening, Brief Intervention and Referral to Treatment (SBIRT) programs to implement universal SBIRT to address unhealthy substance use in gener...

Prevalence and Correlates of Positive Follow-up Screens in Primary Care for Unhealthy Alcohol and Other Drug Use After a Negative Screen

“…24 MASBIRT had its own record of screening results stored in a web-based, screening application. 26 This screening application also systematically identified patients due for annual screening in “real time” as s/he registered for their visit. Screening was conducted using established clinical protocols that included health educators trained and monitored to ask screening questions verbatim - an important feature of reliable, in-person screening.…”

“…The follow-up screening process was identical to the initial screening process outlined above. Health educators used an integrated information system 26 to alert them of a patient that had registered for a primary care appointment who was eligible to be screened again.…”