Health agency looks to data governance to streamline

Washington, D.C.’s Department of Behavioral Health (DBH) has almost 70 disparate databases and little to no data governance, which complicates its ability to provide prevention, treatment, recovery services and support for about 30,000 district residents with mental health and/or substance use disorders.

In May, IdeaCrew announced that DBH had tapped the company to create a proof of concept for redesigning the agency’s use of technology. It will map the various data sources into an integrated technology engine that will allow data to be easily shared and analyzed.

“DBH doesn’t have a governance structure for how we manage data,” said Michael Neff, chief of administrative operations at the agency. “We don’t have a standard process for somebody adding a field to one of our electronic health records. We found through the discovery process of this project that we have 68 disparate little databases running throughout our agency, which is just crazy.”

Exactly what technology will eventually be deployed is yet to be determined, said Patrick Canavan, vice president of consulting services at IdeaCrew, but part of the first of the project’s two phases is determining how to manage data access and management, redundancy and servers — whether they be on premise, in the cloud or a mix.

IdeaCrew is working with DBH to look at costs, management, redundancies and assigning value to help make those decisions, Canavan said. “One of the deliverables in this proof of concept is looking at governance of how that will work out overall.”

The first phase runs through Sept. 30. Phase 2 begins Oct. 1 and runs for the 2023 fiscal year. It will involve building out the server configuration, setting up a credentialing database and creating a grants management system. Currently, the department manages the $70 million in grants it gets each year on paper, Neff said.

Another area under the microscope is electronic health records. The department currently uses three systems and would like to consolidate so that the 70 providers DBH works with can submit their own EHRs from which DBH can extract data.

“The governance structure is critical to this,” Neff said. There should be processes in place so that a request to add something to a system is vetted,  and there should be standardized fields in the EHRs, which would require a robust data dictionary, he said. “Those things don’t exist. There really isn’t integrity to our data, and data isn’t validated before it’s given out.”

DBH also has an opportunity to make better use of other data. For instance, it has access to all of the district’s Medicaid’s data, “which we haven’t done a good job of managing,” Neff said.

Also during Phase 2, the department will serve as the beta site for CRISP DC’s social determinants of health, a pilot focusing on behavioral health populations. CRISP DC is the designated health information

exchange serving the District of Columbia.

That pilot supports DBH’s shift to whole-person care because behavioral health problems often coexist with other factors, including employment, physical health and access to nutritious food. “It’s going to be information that combines behavioral health and somatic care, so we’re looking at the populations we serve as a whole,” Neff said. We’re not “going to treat somebody for a mental health service but not pay attention to other things that might be driving the need for that care. We need to be more predictive,” he added.

That predictability is one benefit he expects to come from this effort. Others include getting a better understanding of which services are effective and being able to identify gaps in needs for new services. “I think the benefit will be structure to data – something that foundational. That sounds crazy,” Neff said. But “we don’t have it, and that’s critical. We need to have confidence in data.”

Change management will factor heavily into the project because it will fundamentally alter the way many DBH workers and contractors do their work. Buy-in from executives like Neff is in place. To get support throughout the department, the IdeaCrew team has had “interviews with pretty much every senior executive and middle manager,” Canavan said. “We hope they’ll continue to play with us as we break those [solutions we come up with] and put them back together.”

Stephanie Kanowitz is a freelance writer based in northern Virginia.