A Network-Based System to Improve Care for Schizophrenia: The Medical Informatics Network Tool (MINT)

Department of Veterans Affairs Desert Pacific Mental Illness Research, Education and Clinical Center, Los Angeles, CA, USA.
Journal of the American Medical Informatics Association (Impact Factor: 3.5). 09/2004; 11(5):358-67. DOI: 10.1197/jamia.M1492
Source: PubMed


The Medical Informatics Network Tool (MINT) is a software system that supports the management of care for chronic illness. It is designed to improve clinical information, facilitate teamwork, and allow management of health care quality. MINT includes a browser interface for entry and organization of data and preparation of real-time reports. It includes personal computer-based applications that interact with clinicians. MINT is being used in a project to improve the treatment of schizophrenia. At each patient visit, a nurse briefly assesses symptoms, side effects, and other key problems and enters this information into MINT. When the physician subsequently opens the patient's electronic medical record, a window appears with the assessment information, a messaging interface, and access to treatment guidelines. Clinicians and managers receive reports regarding the quality of patients' treatment. To date, MINT has been used with more than 165 patients and 29 psychiatrists and has supported practices that are consistent with improvements in the quality of care.

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    • "1998 ✓ ✗ ✗ ✗ Gadd et al. [40] 1998 ✓ ✗ ✗ ✗ Panzarasa et al. [41] 2002 ✓ ✗ ✗ ✓ Young et al. [42] 2004 ✓ ✗ ✗ ✗ Shiffman et al. [43] 2004 ✓ HL7 ✓ ✗ Rosenbloom et al. [44] 2004 ✓ ✗ ✗ ✗ Galanter et al. [45] 2005 ✓ ✗ ✗ ✗ Haller et al. [46] 2007 ✓ ✗ ✗ ✗ Stutman et al. [47] 2007 ✓ ✗ ✗ ✗ Wilson et al. [24] 2007 ✓ ✗ ✗ ✗ Lobach et al. [48] 2007 - HL7 ✗ ✗ Graham et al. [49] 2008 - HL7 ✗ ✗ Marcy et al. [50] 2008 ✓ ✗ ✗ ✗ Wright et al. [51] 2008 ✓ HL7 ✗ SNOMED CT,ICD Gerard et al. [52] 2008 ✓ ✗ ✗ ✗ Field et al. [53] 2008 ✓ ✗ ✗ ✗ Schnipper et al. [54] 2008 ✓ ✗ ✗ ✗ Peleg et al. [55] 2009 ✓ ✗ GLIF ✗ Saleem et al. [56] 2009 ✓ ✗ ✗ ✗ Field et al. [57] 2009 ✓ ✗ ✗ ✗ Chen et al. [58] 2010 ✓ ✗ ✓ ✗ Galanter et al. [59] 2010 ✓ ✗ ✗ SNOMED CT,ICD Noormohammad et al. [60] 2010 ✓ HL7 ✗ ✓ Trafton et al. [61] 2010 ✓ ✗ ✗ ✗ Were et al. [62] "
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    ABSTRACT: It is observed that clinical decision support (CDS) and electronic health records (EHR) should be integrated so that their contribution to improving the quality of health care is enhanced. In this paper, we present results from a review on the related literature. The aim of this review was to find out to what extent CDS developers have actually considered EHR integration in developing CDS. We have also investigated how various clinical standards are taken into account by CDS developers. We observed that there are few CDS development projects where EHR integration is taken into account. Also, the number of studies where various clinical standards are taken into consideration in developing CDS is surprisingly low especially for openEHR, the EHR standard we aimed for. The reasons for low adoption of openEHR are issues such as complex and huge specifications, shortcomings in educational aspects, low empirical focus and low support for developers. It is concluded that there is a need for further investigation to discover the reasons why the rate of integration of EHRs and CDS is not at an optimum level and mostly to discover why CDS developers are not keen to adopt clinical standards.
    Federated Conference on Computer Science and Information Systems - FedCSIS 2011, Szczecin, Poland, 18-21 September 2011, Proceedings; 01/2011
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    • "Throughout the 15 months of intervention, patients met with the nurse care coordinator for a brief clinical assessment immediately prior to each meeting with his psychiatrist. Assessment data were provided via a computer “pop-up” window to the patient’s care team at the time of the clinical encounter.22 Situations typically leading to poor outcomes23 were highlighted on the screen (high persisting symptoms, reports of family stress, and/or medication non-compliance). "
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    ABSTRACT: Families are rarely included in clinical care despite research showing that family involvement has a positive effect on individuals with schizophrenia by reducing relapse, improving work functioning, and social adjustment. The VA QUERI study, EQUIP (Enhancing QUality of care In Psychosis), implemented family services for this population. At two VA medical centers, veterans with schizophrenia and their clinicians were interviewed separately at baseline and 15 months. A family intervention was implemented, and a process evaluation of the implementation was conducted. Veterans with schizophrenia (n = 173) and their clinicians (n = 29). Consent to contact family was obtained, mailers to engage families were sent, families were prioritized as high need for family services, and staff volunteers were trained in a brief three-session family intervention. Of those enrolled, 100 provided consent for family involvement. Seventy-three of the 100 were sent a mailer to engage them in care; none became involved. Clinicians were provided assessment data on their patients and notified of 50 patients needing family services. Of those 50, 6 families were already involved, 34 were never contacted, and 10 were contacted; 7 new families became involved in care. No families were referred to the family psychoeducational program. Uptake of the family intervention failed due to barriers from all stakeholders. Families did not respond to the mailer, patients were concerned about privacy and burdening family, clinicians had misperceptions of family-patient contact, and organizations did not free up time or offer incentives to provide the service. If a full partnership with patients and families is to be achieved, these barriers will need to be addressed, and a family-friendly environment will need to be supported by clinicians and their organizations. Applicability to family involvement in other disorders is discussed.
    Journal of General Internal Medicine 01/2010; 25 Suppl 1(Suppl 1):32-7. DOI:10.1007/s11606-009-1136-0 · 3.42 Impact Factor
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    • "Although QUERI should still be considered a work in progress, much like the overall field of implementation science, the results of QUERI efforts to study and improve VA healthcare delivery practices are documented in a growing body of journal articles and reports [27-32]. In particular, QUERI-related publications and presentations reflect the steps of the QUERI process, as follows (see Table 1): pre-implementation intervention studies establishing best practices or measurement tools, per Steps M and C [33-40]; research and related activities relevant to QUERI Steps 1 to 3, e.g., regarding best and current practices [41-47]; activity relevant to QUERI Step 4/5/6 projects, including implementation trials and studies employing non-experimental designs [8,22,48-55]; and specific outcomes of overall QUERI efforts [19]. "
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    ABSTRACT: Continuing challenges to timely adoption of evidence-based clinical practices in healthcare have generated intense interest in the development and application of new implementation methods and frameworks. These challenges led the United States (U.S.) Department of Veterans Affairs (VA) to create the Quality Enhancement Research Initiative (QUERI) in the late 1990s. QUERI's purpose was to harness VA's health services research expertise and resources in an ongoing system-wide effort to improve the performance of the VA healthcare system and, thus, quality of care for veterans. QUERI in turn created a systematic means of involving VA researchers both in enhancing VA healthcare quality, by implementing evidence-based practices, and in contributing to the continuing development of implementation science. The efforts of VA researchers to improve healthcare delivery practices through QUERI and related initiatives are documented in a growing body of literature. The scientific frameworks and methodological approaches developed and employed by QUERI are less well described. A QUERI Series of articles in Implementation Science will illustrate many of these QUERI tools. This Overview article introduces both QUERI and the Series. The Overview briefly explains the purpose and context of the QUERI Program. It then describes the following: the key operational structure of QUERI Centers, guiding frameworks designed to enhance implementation and related research, QUERI's progress and promise to date, and the Series' general content. QUERI's frameworks include a core set of steps for diagnosing and closing quality gaps and, simultaneously, advancing implementation science. Throughout the paper, the envisioned involvement and activities of VA researchers within QUERI Centers also are highlighted. The Series is then described, illustrating the use of QUERI frameworks and other tools designed to respond to implementation challenges. QUERI's simultaneous pursuit of improvement and research goals within a large healthcare system may be unique. However, descriptions of this still-evolving effort, including its conceptual frameworks, methodological approaches, and enabling processes, should have applicability to implementation researchers in a range of health care settings. Thus, the Series is offered as a resource for other implementation research programs and researchers pursuing common goals in improving care and developing the field of implementation science.
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