Community-Based Recovery Program Goes Virtual

The real promise of personal health records is in their integration with electronic health record systems, rather than as a set of files sitting idle on an individual’s PC. But getting to that type of integration may be one of the trickiest challenges the health IT community faces.

Yet some organizations are making progress on getting patients to use health IT tools and share their data. On May 15 officials from Centerstone, the nation’s largest not-for-profit provider of community-based behavioral healthcare, gave a presentation about efforts in Indiana to use portal and PHR technology to expand an already successful addiction treatment model called Recovery Oriented System of Care (ROSC) with an electronic version (e-ROSC).

It may be surprising that an addiction treatment organization would be a PHR pioneer. Treatment facilities face tremendous funding challenges, and they are not eligible for Medicare and Medicaid incentives for meaningful use of EHRs. But as the saying goes, necessity is the mother of invention. The national need for addiction treatment far exceeds the capacity of service providers to keep up. Only one in 10 individuals who needs substance use treatment gets it, notes Linda Grove-Paul, director of addiction and forensic services at Centerstone.

Could portal and PHR technology be one of the answers as addiction treatment organizations are asked to do more with less? That is what Centerstone is seeking to find out.

Funded by a three-year, $840,000 grant from the federal Substance Abuse & Mental Health Services Administration, the health IT aspect of the program combines features of social media, EHRs and PHRs to extend Centerstone’s community-based recovery programs and to offer new ways of engaging people in their communities.  

Grove-Paul started by describing some daunting challenges. Both state and federal governments are cutting budgets, and that’s not likely to change. “People with addictions are largely poor and uninsured,” she said. In Indiana, close to 90 percent are indigent and have no way to pay for services. The resources for them are mostly provided on the back end, when they show up in emergency room and jails, she added, with fewer dollars going into intervention. In addition, she said, people with addictions have many complex needs, and the organizations they have to deal with operate in silos and are complex.

To operate more effectively with fewer resources, Grove-Paul said, they decided to try to change to a healthcare navigator model and bring the services to the consumers. In Bloomington, Ind., in August 2010, Centerstone began the Recovery-Oriented System of Care (ROSC), using recovery coaches, recovery engagement centers, volunteers, and community resources to better meet the needs of each individual and to try to flatten out the silos of all the community programs they interact with.

The next logical step was to use technology to extend the program’s reach both geographically and in the communities they already serve. According to Centerstone, the e-ROSC web portal integrates the ROSC treatment approach online in five Indiana counties. It will allow people from rural areas who typically do not have access to recovery services the opportunity to receive treatment and support virtually and manage their health and recovery through online support groups, blogs and text message alerts from counselors and recovery coaches.

Cornerstone was awarded the SAMHSA grant last September and is now entering the first patients into the system. The goals for e-ROSC include measuring and tracking a client’s progress, lowering the barriers to seeking treatment and leveraging other community resources.

The system features both Centerstone clinical records as well as data controlled by the individual and stored in Microsoft HealthVault. The consumer has fine controls over what they share, and that data can be viewed in the clinical system.

“We look at this not as a traditional patient portal or PHR, but an overlay with elements of public health IT to help the community overcome barriers to care,” said Doug Dormer, founder and CEO of White Pine Systems LLC, the technology vendor on this project. Besides calendars, discussion boards, live chat, and social media, the site allows individuals to use recovery support tools to set goals and share them with coaches. Individuals and coaches can easily track progress over time.

Mike Lardiere, vice president for health information technology and strategic development at the National Council for Community Behavioral Healthcare, said these tools could easily transcend behavioral health. “The screens would have to be modified, but this approach could work with many chronic conditions,” he said. Consumer engagement tools are going to be extremely helpful going forward, he added. Having consumers identify who has access to which pieces of the record is important. “It’s all about engaging people,” Lardiere said, “and having them have control over what they are using.”