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Data

Steps to Promote Shared Data Capacity

Shared data promotes integrated treatment for individuals with co-occurring mental and substance abuse disorders. It allows practitioners in different systems to communicate and collaborate with each other. It supports practitioners in providing a full range of care by sharing a comprehensive rather than piecemeal understanding of individuals' needs. It also enables policy makers to make decisions on how to allocate resources based on an the prevalence of co-occurring disorders, service utilization, and program performance.

Consider incremental change

Developing capacity for data sharing does not have to require investment in expensive and complicated new information systems. Instead, restructuring existing mental health and substance abuse data systems may offer a more practical, affordable, and manageable approach in the short term.

As with any system change effort, support from top-level leadership enhances progress. Leadership can help to share the vision of systems integration and provide incentives for change. Planning groups incorporating all stakeholders can help to develop consensus on the changes needed and establish joint benchmarks to guide efforts. Identification of financial resources to help implement changes helps to sustain progress towards goals.

Transformation often begins with smalls steps toward change, each of which builds on and reinforces each other. States have undertaken the following activities to promote their capacity for shared data, thus building infrastructure to support integrated care.

Linking Data from Different Systems

Some states are linking data from different systems through the creation of unique individual identifiers or by developing data warehouses that combine siloed data in one place. This includes linking data between the mental health and substance abuse systems as well as with the general health system. It can also include aligning data with other systems, such as the criminal justice or social services systems.

Adoption of Data Standards

Efforts to link data across systems are more effective when standards for data content are in place, including common service definitions and coding and development of data elements that specifically identify co-occurring disorder services. Such standards should align data collected among different systems within a state and with national standards. To this end, some states are focusing on adopting data coding that is compliant with the Health Insurance Portability and Accountability Act (HIPAA). The movement toward electronic health records and electronic payment transactions is also providing a strong impetus for the adoption of national data standards.

Enhancing Data Captured by Management Information Systems (MIS)

Some states have incorporated data on integrated screening into their state MIS. Others are focusing on collecting encounter level data which can then be used to monitor access to, costs of, and quality of treatments provided.

Other activities to enhance capacity for data sharing include:

  • Improving access to shared data by both practitioners and state agencies through development of Web-based reports and other strategies
  • Resolving technical issues in existing management information systems
  • Using non-proprietary software and open-source codes to foster communication between systems and adaptability in the face of changing needs over time

Examples

Washington State linked individual health data across community mental health centers and state Medicaid claims. Integrated data allowed administrators to analyze and understand that providing outpatient mental health treatment to individuals with the greatest needs was likely to reduce medical care costs in the state.

Connecticut linked data between the Department of Mental Health and Addiction Services and the Department of Corrections and showed that treating substance abuse among prison inmates leads to much lower reincarceration rates among those treated, with cost savings to society of 1.8 to 5.7 times the costs of the treatment programs.

South Carolina has an integrated data system, which is operated by the Office of Research and Statistics, a standalone state agency with expertise in gathering, integrating, and disseminating data. All state agencies submit data to this system, which creates a unique identifier that is not related to any other number. A memorandum of understanding (MOU) among state agencies allows sharing of information under HIPAA. State officials plan to use data collected and reported on co-occurring disorders through a shared Web site to conduct a series of special studies on such topics as the effectiveness and costs of co-occurring disorders services.

Possible Challenges

The planning and implementation effort needed to successfully integrate data systems is significant and likely takes more than a few years to accomplish. Some challenges may include:

  • Incompatibility of data systems and technical problems, including computer system issues
  • Disparate billing practices
  • Data quality issues at the agency level
  • Lack of sufficient resources (including staffing) to make changes to the data system
  • Reluctance to make new changes because of prior investment in the existing system
  • Reaching agreement on common concepts, data elements, and definitions for data elements

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