SBIRT Program Updates
February 12- March 13 2015
Implementation Highlights -Two of our medical settings ( The Health Center & Community Health Center of Burlington) are now beginning to implement SBIRT in their Dental clinics. The Good Neighbor Free Clinic in White River Junction will be implementing SBIRT with Dartmouth medical students in several of their satellite locations throughout the upper valley. This is a great step in creating longterm behavioral integration change through early workforce development. Rutland Regional Medical Center ED has now offered positions to two SBIRT job applicants and should be starting their pilot later this month. Northwest Medical Center ED is finalizing their grant with VDH. CVMC & CHCB continue to provide SBIRT and are working on increasing the rates of BIs, BTs and RTs. Due to the Tobacco risk level (23%) of Vermonters report using tobacco products – we are collaborating with the VDH prevention team to disseminate the Tobacco resources to all of our programs with increased tenacity.
HIT –We all had a great visit with UVM SHS staff and a demonstration of their EHR capacity which includes patient “check in kiosks” that present the patient with the AUDIT C and Drug questions and then sends an immediate screening risk score to the MD for that visit. Additionally, UVM SHS uses patient tablets in the room if the secondary screening is warranted – so that all of the SBIRT screening measures are inputed into the EHR in real time. The success of this model was dependent on having Medical, Nurse and IT champions on board – as well as dedicated IT staff time to develop and ensure efficient HIT integration for alcohol, drug and depression screening. Another reason why UVM SHS was able to create the patient automated screener was that their EHR had a already built in “patient check in “ infrastructure so adding the screening questions to this infrastructure was not complicated but took time. Other vendors do not have the same capacities and thus to develop the patient check in screeners it will likely go through “web based” application – like a check in portal. This type of screener can possibly occur at the Good Neighbor Free clinic which has piloted the use of a free EHR called “Practice Fusion” . GNC has plans to fully adopt and implement this EHR by end of July. We are in discussion with them about the patient check in SBIRT suite and how to include that capacity in their adoption. Two of our sites (CHCB & UVM) will be offering their patients the CARING TxT program to see if patients have interest in receiving motivational drinking messages and tracking their use through secure messaging via cell phones.
Sustainability – We are examining all aspects of this major priority for SBIRT and more generally integrated care: community based regional trainings, CHT & blueprint collaboration, EMR integration, payment reform and medicaid code changes. We have created a document which summarizes several SBIRT grantee funded states across the country and their Sustainability plans. At our policy steering committee meeting we were asked to follow-up with any states that have implemented SBIR in hospitals and are able to billing for the delivery of SBIRT as a unique patient service. We are also in regular contact with Oregon and Washington’s SBIRT management as they are two of the most evolved SBIRT states.
Training – We are developing two very exciting upcoming SBIRT conference events for late May and June – One is a day long conference for MDs. which will showcase programs successful in SBIRT implementation and also EHR successes. The other conference is a SBIRT grantee 2 day meeting to allow us to network and work in person with our SBIRT grant colleagues from other states to discuss and develop best strategies for sustainability, HIT, training and evaluation. Our trainer delivered part one of the brief treatment training to a group of 12 providers – from many communities with the goal that we are increasing the overall skill level of the workforce and the possible referral network in many Vermont communities. She will also be joining VDH’s program specialist on Aging to deliver the third training for the community providers involved in caring for the aged. Given the special needs of this population and workforce – we see this as a critical step in helping Vermonters.
Evaluation – In February the feds made large scale changes to the data collection system – SAIS is no longer and there is anew system called CDP or common data platform. We all are in communication with our project officer about CDP and the impact this has had on our evaluation teams work and specifically our ability to provide CQI to our sites. There are many obstacles to jump through and most of the problems are not worked out at the federal level. We are all on hold for awhile until the problems are fixed. However, out VTSBIRT project is still collecting data and could if needed analyze some data on a separate database which we have always been using and created for many reasons including just this type of problem.