Hatching Creativity: Conversations on Success, Innovation, and Growth
Welcome to "Hatching Creativity: Conversations on Success, Innovation, and Growth"! Join us as we dive deep into the world of creativity and explore the minds of remarkable individuals who have achieved extraordinary success in their respective fields.
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Discover the strategies, mindset, and experiences that have propelled our guests to new heights. We'll explore guests journeys, challenges, and breakthrough moments. Be inspired by their stories, learn from their failures, and gain practical insights to apply in your own creative endeavors.
Get ready to tap into the boundless potential of your own creativity, ignite your passion, and embark on a transformative journey of success, innovation, and growth. Subscribe now and join us on this exciting adventure!
Hatching Creativity: Conversations on Success, Innovation, and Growth
Standardizing EMRs, Improving Addiction Treatment Outcomes and Lessons Learned From the FORSE Report with Dr. Annie Peters
People talk about being, "Data Driven", but what does that actually mean?
How can data-driven approaches revolutionize addiction treatment? Join us as we sit down with Dr. Annie Peters, the Director of Research and Education at NAATP, to uncover the power of leveraging data for enhanced treatment efficacy and operational efficiency in addiction treatment centers. Dr. Peters brings a wealth of expertise from her time at Hazelden Betty Ford Foundation and various academic roles. She also discusses her latest initiative, the Foundation for Recovery Science and Education (FORSE), and how it's setting new standards for applying evidence-based practices in behavioral healthcare.
We also tackle the intricacies of standardizing electronic medical records (EMRs) and the critical need for precise documentation, including gender identity and discharge types. Our conversation highlights a crucial collaboration with Kipu to develop standardized forms that comply with state and accrediting body requirements. Dr. Peters explains how accurate data tracking can significantly improve patient care and inform better policy-making. Don't miss this deep dive into the transformative potential of data in addiction treatment and the leadership required to cultivate a culture of continuous improvement.
Welcome to Hatching Creativity. This isn't just another behavioral health podcast. This is the place where thought leaders converge to talk about real-life challenges, breakthroughs and pivotal aha moments. Hey everybody, I'm really excited for today's guest, dr Annie Peters with NATAP, or NAATP as some call it. Peters with NATAP, or N-double-A-T-P as some call it. Annie is a behavioral healthcare expert. She's been in this field for a long time, working with her current project now FORCE. And, annie, I'd love if you can talk a little bit just about yourself and your background and tell us about FORCE and what you're doing with FORCE.
Speaker 2:I can Great. Well, thanks, mike. Thanks for having me. This is fun always to just chat about things of interest in the field and what we're doing and collaborations. Currently I am the Director of Research and Education at NATAP, or the National Association of Addiction Treatment Providers. I've been in this role for three years now.
Speaker 2:I'm a clinical psychologist and so most of my career was in clinical work. I started in 2006, hazelden, betty Ford Foundation, worked there it was just Hazelden then and worked there for about nine years. Eight years Mostly did co-occurring disorders, support of patients in both long-term outpatient settings and, of course, in patient and residential treatment at Hazelden and Betty Ford. And then I transitioned into their graduate school and was a assistant professor in their graduate school helping people as they became addiction counselors. So that was a assistant professor in their graduate school, helping people as they became addiction counselors. So that was a really fun component of my career.
Speaker 2:Then I moved to a treatment center in Colorado Harmony Foundation and was chief clinical officer there for six years and then I joined the staff at NWATP. I was actually on the board when I was working at Harmony. For a couple years I was on the board of NWATP. Nwatp did a pilot study on treatment outcomes published in that 2019. And after that they said you know, we really need to do this bigger scale and help treatment providers to do this work. So they brought me on board and we established the nwatp foundation, which is the foundation for recovery, science and education, which is what uh force is, and so force is the. It's a part of nwatp, but it's also a standalone uh 501c3 non-profit. That's a.
Speaker 1:that was kind of a long intro, but well, I got a lot of questions about it.
Speaker 2:Talk about me and talk about force, so I tried to fit it all in one.
Speaker 1:You look at outcomes data and you speak with people about outcomes all the time. If you're asking me for my feedback, if we don't actively show what we're doing with the information that they're giving us, it becomes a waste of time for people, and that's really where compliance has sat for so long is. People are like yeah, I'll do all of this, but you're not going to be able to use the information for anything. It's just too much of a hassle.
Speaker 2:We're not looking at that stuff as a staff. And then the staff you know, the clinicians or the techs you know, can say I think I might know part of why this is happening that the team comes together and says what are we doing that we could do better to improve? That's an outcome. You know is completing treatment, who's being well served by treatment, satisfied with treatment, and who isn't? Again that reflection back in that analysis of the data. It's one thing to collect it all, but then to really get in there and make meaning of it and make change because of it, make process improvement because of our data, that's another thing.
Speaker 1:For sure. I also find from my experience with this that when you share it with the staff and you start reviewing the data with the staff, they feel very empowered, right. They're like, oh wow, this all makes sense, this lines up with this, this lines up with this, and now I see how this all impacts this. You know and we talk all the time and I think you and I had a conversation about this last time about turnover and keeping staff on right. Staffing shortage is huge right now. So being able to do something that helps your outcomes, it helps your business efficiency and it keeps people engaged, it keeps your staff excited to be there.
Speaker 1:You walk around a conference, right, and you can go to a booth of ABC Treatment Center and there's three people at the booth that work there and you ask them about their center and they say, oh, we're an evidence-based practice and we're this and we're that. And then you know they pass you a brochure and you say, oh good, what evidence are you looking at? And they'll rattle off a couple of different things and you say, well, when and how often are you collecting this and when are you reviewing it? What are you reviewing it? What are you using it to review with, or who are you reviewing with, and you'll get a set of answers, or you get the deer in the headlights look usually one or the other right and you can go back like an hour later and talk to somebody else at that same booth who will give you a whole different set of answers Right, you'll think it's a different center.
Speaker 1:Yeah, and it's really hard because what I guess the point I'm getting at with it is that it's something that and good outcomes need to be pushed by leadership, and it all has to start at the top of the organization and really be working its way down consistently. As we have more tools to collect data, I think that there will be more use of it and people are respecting it more now for sure.
Speaker 2:Yeah, we all know we need to look at outcomes. We need to come to some kind of consensus on what that means and and measure together, not, like you said, not just one treatment center measuring what they think is important and then not comparing that to other treatment centers.
Speaker 2:You know is if you're not making the same things as other treatment centers, then how do we know? How do you compare? So that's, that's kind of a big part of with force. We want to provide that opportunity for people to look at their outcomes by some type of definition compared to others and so that they can start seeing differences and get some standardization. You know, someday we will have measures that everyone will measure these five things. They may be collected by a wearable device, they may be collected by blood. They may be collected by self-report.
Speaker 1:You know, we're not sure yet, as we're talking about data and, as you've had a chance to review the data collected from force, what was the biggest surprise?
Speaker 2:So what surprised me most in the data I don't know if this was a surprise or not, because I knew it would happen but essentially the amount of missing data, the amount of particularly even demographics and the amount of difference in those basic measures like length of engagement or medications, how those are recorded. Ethnicity and race, gender this is now, I would say, about 75% of the treatment centers in force are taking private insurance and so they're not publicly funded and they're not taking Medicare, Medicaid and state funding and things like that, so they're not required to use very, very specific data points. Gender I would say by and large we're getting male, female and other, or people have 50 options, or they use a free text, which clinically is ideal to say how do you define your gender, and letting the person self-report, but then trying to compare that.
Speaker 2:People are trying to be inclusive and yet then how do we aggregate that and use that? So that's not an outcome I was surprised by, but just the amount of variability and challenges we have in the health IT world collecting measures. You know, it's nice when we get just data from a PHQ-9 because you know a depression screen, there are nine standard questions and they don't change questions and they don't change, Although we have had some sites that changed standardized measures, which is a challenge. So I guess that was one thing that was surprising, and how much missing gender and race, ethnicity data we had because of the differences in how people are recording it.
Speaker 1:So when you say missing information, are you saying like people are just not completing this in their medical records?
Speaker 2:Well. So we picked away at some of the reasons. A lot of times it's where it's completed in the medical record, so they might ask a question in an assessment that then doesn't make it onto a face sheet or something in the EMR, which is where the data point is pulled from. So in that case it's sort of an EMR issue. It's a technology issue. Other times, you know, when we talk to a treatment center, they'll say well, we know their gender or there's something assumed that somehow it gets from an assessment, or it's not specifically asked, or all the options aren't given or something and it's missing for another reason. You know we have some who were. There's two data points gender identity and birth sex or something, a sex assigned at birth. An EMR or a provider would default to birth gender if they hadn't asked the gender identity question.
Speaker 1:Right right birth gender, if they hadn't asked the gender identity question.
Speaker 2:So they'd be pushing essentially gender assigned at birth, when what we were asking for was the person's own self-identification of gender and because that wasn't asked explicitly it affects your data, of course.
Speaker 1:What I'd like to do, annie, too, is we're working on this big project with Kipu right now, where we're building out standardized documentation to meet state and accrediting body requirements, because, as you know, everybody creates their own EMR and everybody wants to customize it to their own, and we've all recognized the need for standardization. I know they're one of the software providers that has given this to you. I think it would be really valuable if we get together once we've created these forms for them, and we get an understanding of what documentation you need for this, so that that can be one of the standardized forms or questions or fields that will help you to be able to get that, because I think the information you're collecting is real valuable.
Speaker 2:Yeah, can you work on discharge type, sure?
Speaker 1:Because here's another one, because there's another one.
Speaker 2:I was just looking at this yesterday thinking you know I need to write a blog about this or something. Is, you know, discharge status usually in healthcare, you know in?
Speaker 1:a hospital or something.
Speaker 2:You're discharged to a disposition or setting like you're discharged. You're discharged to a long-term hospital, you're discharged, et cetera. They may indicate whether you completed your treatment or not or you left against medical advice or something. But in addiction treatment we use discharge type to talk about things like not just where they're going, because you know, we don't just want to say they transferred, but we want to know did they transfer to a place that had more psych services or a place that had more medical care, or a place that was a different level of care or something you know, we really want to know that. But then we also want to know why the person left. And unfortunately we still most a lot of sites use something like administrative discharge or, you know, even still use the term non compliant. That, you know, is the patient not complying with the rules of the center and there's been a lot written about that. You don't see that in an ER.
Speaker 1:You know One of the things that we do in our software is we take the AMA and we have AMAs tracked as incidents.
Speaker 1:And the AMA gets paired with the reason or reasons behind them leaving. Who was their primary therapist? Who was their case manager? Right, how many times did they attempt to leave? A lot of times. That's a staff training issue being able to interrupt an AMA and then, of course, the social determinants of health.
Speaker 1:Substance of choice, we find, is when people actively use it this way, and it doesn't have to be in our system.
Speaker 1:It could be anywhere where you're tracking this, but if they look at it right and collect the information, they can go oh, this primary therapist is an abstinence-based person and this client just wanted to stop or slow down or change their lifestyle, or and you can really break up how you can be better treating people and people don't look at this and and it's hard because they are inundated with so much that's part of the problem with fee-for-service is they're taking everybody that they can and they miss opportunities to treat better because of that too.
Speaker 1:Yeah, what? When you talk about the discharge type, too, you know? Another thing that comes to mind is admissions where's this person coming from? Are they coming from prison or are they coming from a private therapist? You, you know what's the source, and a lot of treatment centers are not tracking this. If you are a treatment center and you are listening to this, these are really important data points to be looking at if you want to be able to improve care and improve service overall. You know Annie's taking this data and making it usable, so, and even if you're not submitting data to force, this is something that could be really helpful.
Speaker 2:Wherever force goes in the future. You know, helping people measure, helping them standardize, helping them use data effectively with whatever tool they're using. Whether they're doing that for compliance reasons, they're doing it for process improvement reasons, they're doing that to improve staff and patient satisfaction. You know, whatever the immediate goal is, moving toward a place where we can really be considered, like other types of healthcare, more in the research literature. You know that there's more research on real life treatment. You know, wherever it occurs, that it's published and that you know people who make policies can look at that data and say, oh, you know, here's what we're seeing about, where people are being served and how they're doing. And I think both of us are working toward collect it, use it, understand it, and you don't have to do it alone.
Speaker 1:I remember I had a conversation with my daughter. She's saying I'm having a hard time sleeping. Sleep isn't real good. Can you give me some ideas to help me with my sleep? I totally nerd out on this stuff. I've got the ring, I've got the watch. I like I track, I know every bit about my sleep and that was probably why she asked me to go. Why don't you start tracking it? Make some changes bit by bit, and look at your data, and or I'll look at the data with you. But let's start collecting it. And unfortunately, we're still in an age where people are still collecting information on paper. Yeah, you can't do anything with. I can't tell you how many people are collecting information on paper. I'm shocked. It really is so important if you're going to modernize your business.
Speaker 2:Can't even share the information across your staff unless they go look at a piece of paper, yeah, not to mention compare your data to someone another center.
Speaker 1:Is there anything else that stood out like a hammer over the head going wow, this is real surprise.
Speaker 2:You know we're still analyzing the data, we're still validating the data. But some of the dramatic changes in symptom report over in treatment, whether it's outpatient or residential big decreases in depression, anxiety, craving, improvements in recovery capital you know all the things we'd hoped to see we're seeing. You know wanting to get the data to a point where it's publishable and it's usable to advocate for people to get help, because that's, I think, what's most exciting. And seeing some of those centers out there who somehow have, you know, really good post-discharge follow-up response rates. You know that they're. They have staff, staff who are their job is to follow up with people and find out how they're doing and you know getting that's. It's so hard to get a good response post-discharge from treatment, but you know really seeing what's happening to people, not just to get their data but to stay connected.
Speaker 2:And you know look at this as a long-term illness and a long-term engagement. You know, whether you come back to our center or you go somewhere else, you know that someone has their, their finger on the pulse. You know they're, you know, really trying to stay connected with people and and really looking at at some pretty dramatic changes as people are engaged with care. So that's really heartening because a story that needs to be told about, about the, the good that happens in treatment. You know we often hear about about the, the horror stories and there are many the transformations that that happen in treatment. Telling that story in data rather than just, you know, alumni stories, is really exciting.
Speaker 1:So, Annie, this has been really interesting. I was expecting to spend 15 minutes talking about the force and what you were doing with that. I know we're kind of winding down our time. I definitely want to bring you back on here and talk more about some of the other topics that we had planned.
Speaker 2:Yeah, we had a whole list.
Speaker 1:Taking the information that you got from this, what would you pass on to them to be able to offer better treatment?
Speaker 2:I guess the top thing that comes to mind is don't do it alone. Join with others you trust, whether it's a vendor, whether it's, you know, an ATP Enforce or it's Hatch or it's other providers, a provider group that you trust, join together and start talking. You know how are you collecting data, how are you using it, how are you analyzing it? Who are you sharing it with? How do you share it back with patients and families and the public? How do you market with it? How do you advocate, you know, for policy change with it? Don't think you have to do it alone. There's so many efforts out there. Join one. If it's the wrong one, join another one. Tell these stories together and make a big impact in addiction health care. There's a lot of work to be done, but so much more can be done when we do it in partnership.
Speaker 1:So many times people are like this is my little secret. There's no secrets. We all do. Every treatment provider, or most treatment providers, are doing the same or similar kinds of things. There definitely needs to be more data sharing and people being more willing to share information. It will make a really big difference and I love that takeaway. Annie, thank you very much. I really appreciate it. Thank you, mike. Thanks for tuning into Hatching Creativity. We appreciate your support. Please don't forget to like and subscribe and tell all your friends about the show, and remember it's never just about one thing.
