3071 — TIDES VistA-Based Informatics Support for Depression Care Management

Vivell S (VA Greater Los Angeles), Austin C (VA Greater Los Angeles), Miner M (VA Puget Sound), Slaughter A (VA Greater Los Angeles), Rubenstein LV (VA Greater Los Angeles)

Objectives:
The goal of TIDES informatics is to use existing VA computing capabilities to: 1) promote fidelity to the TIDES care management model, 2) provide efficient documentation of patient encounters, 3) help manage patient panels, and 4) provide automatic feedback to referring clinicians and medical centers. Developing informatics support that was imbedded in the VA computing system was a requirement of VISN leaders in the TIDES pilot sites.

Methods:
The TIDES MH QUERI project has developed a guideline-concordant primary care-based collaborative care management program for depression. The assessment protocols are comprehensive, and without streamlined data entry procedures, it takes depression care nurses significantly longer per patient to complete their documentation of encounters and manage their panels. Working closely with care managers, application coordinators, and programmers at 15 sites, our strategy was to start with existing VA computing capabilities and make improvements as new functions became available nationally. Three formal, in-person TIDES informatics meetings were invaluable in developing our tools.

Results:
The TIDES (Class I) informatics package is available nationally and reflects current VA computing functions. It includes: 1) a patient registry based on CPRS clinical reminders and consults; 2) initial and follow-up assessment protocols set up as CPRS reminder dialog templates to produce progress notes and health summaries while also capturing patient outcomes as health factors; 3) clinic and provider reports based on depression care management health factors; 4) documentation of MH supervision using CPRS Group Notes; 5) patient alerts using CPRS team lists with Care Management Query notifications for missed appointments, admissions, ER visits, etc.; and 6) panel management using MS 2007 SharePoint to schedule encounters, record basic outcomes, and facilitate cross coverage.

Implications:
Informatics tools that reside within VistA are easily disseminated throughout the system and facilitate implementation. By working collaboratively with IT staff at multiple VAs, we benefit from nationwide expertise and encourage future improvements.

Impacts:
Like the TIDES intervention protocols, TIDES Informatics was developed in PDSA cycles of continuous quality improvement. With the basic TIDES informatics package in place, sites can adapt the tools for other clinical informatics needs and also continue to make adaptations as new VA computing functions become available.