Mental health information system (MHIS)
MHISs are similar to other health/medical settings or general business settings. Their distinguishing factor is that they assist mental health program administration. James L. Hedland, Ph.D., defines MHIS as a special-purpose information system or stand-alone computer applications which play a more specific, limited role in mental health patient evaluation and care.
Volumes of clinical information are collected but never used even though the costs in time and money are high to taxpayers footing the bill, providers wanting more effective and efficient healthcare services, and state and federal policymakers who want the tax dollar to go farther and strive to improve the quality of care but instead are stymied by poor information resources.2
Despite the huge expenditure of time and effort, problems of poor recording of information, failed communications, and daily barriers, cause frustration for clinicians and managers and possible negative recourse to clinical events. For example, the clinical record of a long-term psychiatric patient may circulate in many different medical areas (in-patient and out-patient, psychiatric and acute hospital, primary and secondary care and social services). Less than optimal care derives from data that is incomplete, lacking standardization in information recording, and /or missing altogether.
So why has relatively little attention been given to follow-up reports that deal with long-term utilization and maintenance issues? That such issues are indeed important is suggested by the fact that many (perhaps most) of the MHISs initially described are no longer even in existence, and that many of the rest (probably most) have been materially changed in scope or substance.3
In the 1960’s, clinical researchers wanted information in a systematic, comprehensive and accessible format, hence mental health information systems. New to the field, there were few formal standards and, content and format were yet to be defined. In regards to clinical assessment and precise content, medical records lacked standardization. Early automation functioned on large mainframe computers in the traditional hospital setting. Attempting to support traditional mental health practices, the types of information gathered centered around patient admissions, movements within the mental health system, and dispositions; patient demographics; the physical and mental status examinations; social, developmental, medical and/or psychiatric histories; nursing staff observations about the patient during the course of hospitalization; psychological; special alcohol or drug abuse information; and certain, often-limited information about type of treatment/services being provided.4
More currently, clinical applications are specifically designed in providing actuarial interpretations and predictions concerning patients. However, there is little direct evidence in comparing individual patient data collected and processed in regards to favorably influencing mental health care decisions for those patients. 3 There is extensive evidence that a computer and carefully derived actuarial prediction models can ordinarily do at least as well as the clinician whenever explicit criteria are available. “Many (most?) clinicians seem unable to accept this and find it difficult to appropriately utilize actuarial statements about their patients.” 4
Now is the time to accept and utilize the MHIS. Interoperability is in the works and paper is a thing of the past. The quality of U.S. healthcare was assessed by research conducted by McGlynn and colleagues, examining how often consumers receive the most effective treatments available – evidence-based medicine. They concluded that Americans receive quality healthcare about half of the time (55 percent), but mental and substance-use disorders, as findings indicate that individuals with alcohol dependence receive evidence-based treatment only 10 percent of the time – the lowest proportion for all of the conditions studied.2
IOM recommended changes in the mental-substance-use disorders healthcare system to improve quality of care for those who need services. Most of the changes would require major advances in health information in this sector. These recommendations include:
- Make the patient the locus of control for decisions about treatment – yes, even in treating serious mental illness and substance dependence where legal coercion is involved.
- Disseminate the evidence basis for what comprises effective M/SU treatment.
- Devise better coding systems for M/SU interventions so that more complete data about what treatments patients receive is collected nationwide under HIPAA-standardized payment transactions.
- Develop instruments for screening, diagnosis, and monitoring to validly assess response to M/SU treatment that are practical for routine use.
- Develop a consensus process for developing measures of quality for treatment and outcomes to improve M/SU care.
- Share patient information among healthcare providers and with social services, even if new privacy laws must be written to permit information exchange among providers of M/SU services.
- Integrate M/SU needs into the National Health Information Infrastructure (NHII) so that advances in standards development and information exchange fully encompass M/SU providers and services.
- Encourage the adoption of new information technology, such as electronic health records, computer-based clinical decision support systems, computerized order entry, etc.
- Improve the M/SU workforce through better planning, oversight, licensure, and training.
- Reduce risk-selection against M/SU in health plans to improve access to services.
- Replace grant-based financing with quality-of-care-based financing so that providers have the right incentives to improve patient care.
- Fund research on treatment effectiveness and quality improvement in local settings, the frontlines of treatment.2
Restating an earlier comment, these system issues are indeed important is suggested by the fact that many (perhaps most) of the MHISs initially described are no longer even in existence, and that many of the rest (probably most) have been materially changed in scope or substance.3
The few articles that I found on MHISs were lacking in change management discussion, supporting the notion that changing from paper records to electronic records is a people issue, not a technical issue. Dr. Hedlund and Dr. Vieweg comment that one of the greatest lessons learned is that successful MHIS implementation requires user participation. To some, this seems obvious. MHISs may need customizing before it enhances performance. “This means that extending its use beyond clinical operations has human capital, management, technical support, and governance implications.” 5 Improving understanding, education, involvement and support of clinicians while optimizing the choice and implementation having the best chance to be initially accepted and used long-term in an organization. 6 And, now is the time to create successful MHISs.
- Hedlund JL, (1978). Computers In Mental Health: An Historical Overview And Summary of Current Status. 
- Centers for Medicare and Medicaid Services (2007): Increasing Interoperability in Health Information Systems: for Medicaid, Mental Health, and Substance Abuse Treatment. (Found at: http://csat.samhsa.gov/IDBSE/idb/modules/FINAL-CMS_SAMHSA_InteroperabilityConfPapers.pdf)
- Hedlund JL, Vieweg BW, Department of Psychiatry and Missouri Institute of Psychiatry University of Missouri-Columbia, School of Medicine: Some Utilization And Maintenance Issues With Mental Health Information Systems, Found at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2580335/pdf/procascamc00008-0154.pdf
- Hedlund JL, Vieweg BW, Wood JB, Cho DW, Evenson RC, Hickman CV, Holland RA: Computers in mental health: A review and annotated bibliography (NIMH Series FN No 7,DHHS Pub. Nn. (ADM) 81-1090). Washington, D.C.: Superintendent of Documents, U.S. Government Printing Office, 1981.
- Carter, JH (2008). Electronic Health Records, Second Edition. American College Physicians (ACP), March 2008, p.236.
- Carter, ibid. p.272.
Submitted by Ronda Adkins