Provider-Driven Development of a Measurement Feedback System to Enhance Measurement-Based Care in VA Mental Health

Given the importance of implementing measurement-based care (MBC) to enhance the quality of care provided to veterans with mental health disorders, the Department of Veterans Affairs (VA) has developed guidelines and a mandate for MBC and use of specific measures. Nonetheless, current use of MBC for mental health in VA is low and easily extractable outcomes are not available within the electronic medical record (EMR). This paper reviews obstacles to MBC for mental health in VA and the potential for a measurement feedback system (MFS) to overcome these obstacles. This paper reports the results of a local VA provider survey of barriers to MBC and describes a multidisciplinary, provider-driven local process to develop a software-based MFS to address some of these barriers. This MFS, named COMMEND (Collaborative Mental health Management ENhanced Dashboard), was developed in an iterative fashion with ongoing feedback from providers. It was created to interface with VA's EMR and provide a way to easily input patient intervention and outcome information, create a progress note, and visualize interventions and outcomes over time on a single graph. This paper describes a pilot implementation of this tool, including a qualitative description of how it was incorporated into a particular provider's workflow, how features were adapted based on provider feedback, and initial implementation data. Lastly, plans are described to study factors affecting successful implementation and explain how local experiences may be applicable for providers in a variety of settings.