Association for Public Policy Analysis & Management

Background and Purpose: Health information technology (HIT) holds the potential to improve service delivery and patient outcomes, while reducing healthcare costs. Despite the growing emphasis on provider adoption of HIT, incentivized by federal funding, uptake has continued to be slow and uneven. To understand the enduring resistance to HIT adoption, as part of the National Drug Abuse Treatment System Survey (NDATSS) project, this paper focuses specifically on substance abuse treatment system stakeholder interviews regarding enacted or proposed changes in data reporting and data systems as a result of healthcare reform.

Methods: Case studies of eight states -- California, Colorado, Florida, Georgia, Kentucky, New Hampshire, New York, and Ohio – were conducted. Using a maximum variation sampling approach, states were selected to meet the following criteria: (1) Medicaid expansion versus non-expansion; (2) state-based versus federally-facilitated insurance exchange; and (3) high salience of substance use disorder (SUD) issues, as measured by media attention. A total of 83 audio-recorded telephone interviews were conducted with approximately 10 stakeholders per state involved in implementation of state-level reforms including administrators from Single State Agencies, Medicaid, and Health Insurance Exchanges; regional and county behavioral health authorities; SUD service providers; treatment and recovery advocacy groups; and insurance plan representatives. Verbatim transcripts were first coded using an a priori-based scheme. Transcripts were then co-coded to establish consensus. Finally, emergent themes were identified and analyzed with respect to state policies and delivery model factors.

Results: Preliminary analysis revealed four emergent themes highlighting the impediments to HIT utilization for quality improvement: 1) Lack of system interoperability; 2) antiquated systems; 3) mismatch between data collected and data needs; and 4) inadequate knowledge or support in analyzing and interpreting the data. Non-integrated data systems were reported as a persistent obstacle to data sharing and collaboration efforts between state agencies. States that have Medicaid demonstration waivers reported greater progress toward data integration and systems modernization, though. Even with technological advances, many states continue to operate with antiquated data systems or those that cannot be fully reconfigured to support updates in service delivery models or billing codes. Another problem that various stakeholders reported was that the data available are not fine-grained enough or more broadly, do not accurately capture what is needed. Finally, across the different levels of stakeholders, the insufficient number of staff trained to offer technological as well as data support was repeatedly cited as a problem to harnessing the full potential of HIT. Collaborations with university researchers/research centers, however, were indicated to be an effective means of overcoming limited data understanding and support.

Conclusion and Recommendations: With the increase push for HIT use, there needs to be a greater understanding of the value of data and the resources to utilize it. Connecting stakeholder agencies to, and providing support for collaboration with, researchers can fill data support gaps and speed up data assessment and application of results. Furthermore, demonstration waivers can be a good mechanism for improving HIT infrastructure and advancing systems integration that should be tapped into by more states.