The Medical Director's Desk
QIPS Supports Profession's And Patients' Needs
Psychiatric News
Volume 41 Number 12 page 4-4

The Department of Quality Improvement and Psychiatric Services (QIPS) helps psychiatrists acquire tools and information necessary to provide quality treatment and concentrates on issues involving quality of care, substance use disorders, and children's mental health.

Some APA members may have participated in the excellent track at the annual meeting last month, "Rethinking Alcohol Use Disorders: Science, Diagnosis, Treatment, and Policy." The series was sponsored by the National Institute on Alcohol Abuse and Alcoholism and APA and was facilitated by QIPS staff. We were proud to offer this focused educational experience to our members and other meeting attendees.

Three related priority issues that are being addressed by QIPS are practice guidelines, clinical-performance measurements, and electronic health records.

In response to demands from the public and policymakers for increased attention to scientifically proven medical treatments, APA's Steering Committee on Practice Guidelines, supported by QIPS staff, has produced 14 guidelines. The following three revisions will be provided to APA members this summer as supplements to their copies of the American Journal of Psychiatry: Practice Guideline for Psychiatric Evaluation, 2nd edition (June issue); Practice Guideline for the Treatment of Patients With Eating Disorders, 3rd edition (July issue); and Practice Guideline for Treatment of Patients With Substance Use Disorders, 2nd edition (August issue). All of the guidelines, as well as Guideline Watches and Quick Reference Guides are available at<www.psych.org> at no cost to members.

A 2006 Compendium of Practice Guidelines and a 2006 Compendium of Quick Reference Guides can be purchased from American Psychiatric Publishing Inc. at its Web site at<www.appi.org>.

QIPS staff, working with APA's Council on Quality Care, have supported performance measurements developed with the goal of improving quality of care rather than reducing cost of or access to care. The QIPS staff have positioned APA at national venues where development, identification, and endorsement of national performance measures are occurring. Examples include the AMA's Physician Consortium for Performance Improvement (PCPI), which produces measures developed by physicians for use by physicians. APA members and staff served in a leadership role in the PCPI development of performance measures for the treatment of depression in adults and in children and adolescents.

This past spring, APA gained a seat on the PCPI Executive Committee. This fall we will begin work with the PCPI on performance measures for the treatment of substance use disorders.

APA members and QIPS staff also have worked with the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), National Association of Psychiatric Health Systems, and National Association of State Mental Health Program Directors to identify five "core measures" for hospital-based inpatient psychiatric programs. Reporting on the five core measures will replace reporting on nine other measures currently required by the JCAHO.

QIPS staff monitor the growing number of coalitions, such as the National Quality Forum and the Ambulatory Quality Alliance, that have assumed roles in measurement development and approval processes. Performance measures in many cases are not well constructed, well understood, or well executed. However, further development of this concept has gained momentum and public support. It is APA's view that physicians with clinical knowledge and experience will be able to develop more meaningful, useful measures than individuals whose interests are primarily financial or political and should be active in these arenas.

APA committees and QIPS staff have operated on the principle that measurement programs must minimize the data-collection burden placed on the reporting physician or practice.

Concerns about data collection and reporting often lead to discussion of implementation of electronic health records (EHRs) and related health information technology (HIT). While computer programs are likely to simplify data collection and reporting, current estimates are that only 14 percent of physicians are using electronic health records. Many physicians are waiting for the standards for design and use of EHRs to be clarified. The challenges to federal agencies, hardware and software vendors, and clinicians to collaboratively achieve clarity are enormous.

QIPS staff continually monitor national activity leading to the development of standards, interoperable software and hardware, certification processes for these products, "architecture" for national and regional health information networks, security mechanisms, and disparate federal, state, and local laws or policies governing privacy.

APA's Committee on Confidentiality is crafting recommendations to protect the privacy of electronic health records, and the Committee on EHRs is preparing recommendations about electronic options needed by psychiatrists to carry out their clinical roles when patients request their EHRs.

With guidance from the Committee on EHRs, QIPS staff have created a new electronic health record Web page in the Members Corner of the APA Web site at<www.psych.org/members/ehr/index.cfm> to provide more EHR information to psychiatrists. The site include links to educational resources and tools, updates on HIT developments, a resource for APA members to post and read HIT software reviews, and a forum for members to communicate about EHR software and issues. We invite you to complete the EHR survey posted on the site. ▪

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