Stakeholder-informed development of a measurement-based mental health software tool

Steven Lindley lindleys@stanford.edu
Dan Wang Dan.Wang@va.gov

Abstract

Background:  Systematically collecting and recording treatment intervention, outcome, and side effect data and using this data to inform mental health treatment decisions – also known as measurement-based care - is essential to excellent patient care. Routine recording and tracking of mental health treatments and their outcomes into the electronic medical record (EMR) improves outcomes for individual patients, improves overall quality of care, and significantly enhances efficacy and implementation research efforts. But measure-based care is difficult to achieve without the right tools to assist providers in this task. Tools in use in many medical systems are not routinely used by providers because they are time consuming to use, impede workflow, and do not collect data that providers and patients find clinically useful.  Many tools are developed with insufficient input from provider and patient stakeholder at all stages of the software development process. For these reasons, in most health care systems, data that could inform individual mental health treatment decisions and overall program effectiveness are not available.

Development Process and Results:  Using an on-going collaborative process among providers, administrations, and software developers, we have developed software to facilitate measurement-based mental health care called COMMEND. COMMEND is integrated into the local EMR system and into the provider’s workflow. The software provides a single, integrated system for documenting, recording and analyzing a) administrative and clinical data, b) mental health clinical interventions, and c) outcome assessments in the treatment of patients with mental health disorders.  It works alongside the current EMR, accesses already available data, facilitates progress note creation, and displays data in an easy, user-friendly visual manner.

Presentation Objectives:  We will demonstrate through screen shots some of the key features of COMMEND, including 1) graphs used to track symptoms, psychotherapy interventions, and medication use by patient, 2) portals for data entry including those to create ideographic measures, treatment goals, and progress notes, 3)  provider/treatment team pages to track treatment progress for a panel of patients, and 4) administrator pages to evaluate progress by providers or teams.  We will also present summary data on treatment interventions obtained through COMMEND.   Finally, we will discuss lessons learned during our early implementation to assist others in similar efforts.

Conclusions:  Through on-going stake-holder involvement in the development, we started development of a tool and associated procedures to enhance measurement-based care.  The overall goal of the project is to inform the development of future mental health information technology tools that have maximum impact on the quality of patient care and facilitate patient-centered care. 

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