Methadone Maintenance Treatment Service Evaluation and Critical Appraisal of the Electronic Database at Addiction Prevention and Treatment Services, Nova Scotia Hospital
This report summarizes the internship work of Patryk Simon, a Master in Health Informatics candidate. The internship was completed from April 26 to August 19, 2011 at the Addiction Prevention and Treatment Services (APTS), Capital Health. APTS is responsible for providing addiction treatment to adults within Capital District Health Authority. The two main objectives of the internship were to re-evaluate Methadone Maintenance Treatment Service (MMT) using health data from the Addiction Services’ electronic database, called ASsist, through discussions with APTS staff, examine how information and clients flow between APTS services, and how ASsist helps or impedes these processes. Finally, the report provides a critical evaluation of ASsist with respect to health information standards and what steps are necessary to transition to the electronic health record. One major problem with ASsist, which was highlighted by the MMT service study, is that very few parameters highlighted in the research literature can be obtained from ASsist. For instance, drug use history, medical and psychiatric history, or treatment protocols provided cannot be extracted. Furthermore, employment status, education, income, recorded at the time of admission to service cannot be obtained as only last modified information is saved. This poses a significant challenge in future studies of clients seeking services of APTS. Tracking clients through a continuum of APTS services is difficult; at present referral recommendations are not used. Discussions with clinical staff of five areas of APTS as well as the work and information flows highlighted the redundancy in the existing processes and how the information obtained is used. As clients progress through the continuum of services of APTS, they are required to complete multiple intakes for each service, essentially providing the same information. This may be a barrier to some clients. Discussion participants identified there are gaps in information they have available at hand about a client and they defined their future information technology needs to include case noting, scheduling, seamless flow of collected client data between services, managing waitlists and a greater accessibility to information available within CDHA. Although ASsist is an electronic database, it does not meet any health information standards. It also is not interoperable; it does not allow for exchange of information with other information technology solutions. Recommendations provided outline both the short-term and the long-term goals, which will help APTS in alleviate the duplication inherent in the existing processes and in adopting a more comprehensive solution, an electronic health record. The internship was a valuable learning experience for the author. Conducting a health service evaluation using health data, discussions with APTS staff, and documentation of existing flows were time-consuming but useful processes. They allow the organization to discover areas of inefficiencies and provide concrete steps that the front-line staff see as essential in making service improvements.