mental health crisis response centre electronic health record presentation for manitoba nursing...
TRANSCRIPT
Mental Health Crisis Response Centre
Electronic Health Record
Presentation for Manitoba Nursing Informatics Association
September 16, 2013
Heather Forrest, BSWNancy Parker, MM
• 2003/04 - Initial conceptualization of a community based CRC developed by a broad based stakeholder group
• 2005 - CRC concept included in ER Task Force Report as part of solutions to key issues in ERs related to mental health
• 2005 – Consumer focus groups re: crisis system redevelopment
• 2006 – Functional CRC Plan developed by a multi-program planning group and submitted in Regional Health Plan
• 2007 – NDP Election promise
• 2008 – Final functional program developed
• 2009 – Government announcement of the CRC
• 2011 – CRC groundbreaking ceremony
Background
WRHA Crisis Services System
Crisis Stabilization
Unit
Mobile OutreachServices
ScheduledServices
Walk In Services
CRC Components
Scope of Services The linked service components include:
• Screening for psychiatric and medical concerns
• Integrated mental health assessment
• Crisis response interventions and brief treatment
• Mobile outreach
• Onsite psychiatric consultation/referral
• Referral to the crisis stabilization unit
• Linkage to short term transitional service
• Linkage to longer term service and supports
CRC IT Project Givens
• Build toward electronic linkage between community health services
• Facilitate collaborative communication across the social service delivery systems
• Improve services for clients, providers & administrators through
• More efficient access to information• Improved information sharing & collaboration• More clinical time & less time managing paper• Improved quality of care• Improved reporting for trend analysis & research
CRC IT Solution Benefits
Momentum Convergence offered a web based solution with a proven track record showing enhanced collaborative practices and outcomes management within the pilot project at PACT – Leila.
Risks inherent in CRC IT solution
Customization
• Too little customization for optimal use in Crisis Services• Too much customization for optimal use by others
across the system
Integration
• Too much information flowing into the integrated solution
• Too little information available to health services
Canada: How Privacy Considerations Drive Patient Decisions and Impact
Patient Care Outcomes • 43.2 percent of Canadian patients stated they would
withhold information from their care provider based on privacy concerns
• 31.3 percent stated they have or would postpone seeking care for a sensitive medical condition due to privacy concerns
• More than 2 out of 5 Canadian patients indicated they would seek care outside of their community due to privacy concerns
Mental Health & Substance Abuse:
STIGMA• 1 in 5 Canadians experience a mental disorder or
substance use problem in their lifetime
• Most people living with a mental disorder say the stigma they feel is worse than the symptoms they feel
Health Insurance Portability & Accountability Act (HIPAA)
If the information to be used/disclosed contains any of the types of records or information listed below, additional laws relating to the use and disclosure of the information may apply. I understand and agree that this information will be used or disclosed if I place my initials in the applicable space next to the type of information:
__________ Drug/Alcohol diagnosis, treatment or referral information
__________ Mental Health information – including provider notes
__________ HIV/AIDS information
__________ Genetic testing information
Kaiser Permanete Healthcare e.g.
What were the Risk Mitigation Strategies
Customization was planned for the following areas:
• Client Status Tracking • Staff Dispatch Tracking• Management of linked episodes of care over time • Client Plans at the system level, service level and visit level • History sections for Suicidal Behaviours & Addictions• Visit Summaries and Clinical Reporting, • Documentation of delegated duties related to physician assistants
Compromise was reached regarding stepping away from new development that could be better managed by other larger projects
• Enterprise number • Waitlist functions • Integration to Accuro
CRC EHR ‘must haves’ Functionality
• Screening
• Status Board
• Client Overview
• Suicidal Behaviour
• Addictions
• Diagnosis
• Medications
• Admissions
• Service Plans
• Alerts
• Episode Summary
• Reports
Opportunities: Concurrent or Collaborative Documentation
Benefits for individuals coming to the CRC:
• Involves client/family in the therapeutic process
• Empowers the client/family
• Increases engagement in process
Opportunities: Concurrent or Collaborative
DocumentationBenefits for Program and Staff:
• Ensures greater content accuracy because of reduced time between the actual service and writing the clinical note
• Sets a standard for clinical formulation among all staff to assure documentation completeness, consistency, and compliance
• Increased staff morale and enhance quality of life would reduce staff burn-out and turnover rates
RE-AIM
REACH• Number and characteristics of clients
using the Crisis Response Centre– Age, city location, previous attempts to
access other services (ED), socio-economic demographics…
RE-AIM
EFFECTIVENESS• Outcome measures
– Session Rating Scale (SRS-Miller)– Clinical Global Impression– Change of triage status
• Request for permission to follow up with research staff
RE-AIMIMPLEMENTATION• The data gathered from the
health record does not specifically speak to this aspect of the research plan.
• Materials used include PMO plans such as communication, risks, lessons learnt, etc.
Decision Support
• Wait times by priority types
• Interventions used
• Clinical outcomes as measured by clients & staff
Many research questions were formulated and several routine reports will be generated.
Some of the key areas to be tracked include:
• Collaborative partnerships
• Supports and services accessed
• Info transferred to collaborative partners
Other Research Projects• Round Room Evaluation:
Purpose and use of this space• Screening: Both medically and
non-medically trained clinicians are performing the initial screening – are both groups able to perform this task with equal effectiveness
Gol
ive
Project Startup &Planning
RequirementsGathering
Analysis &Design
Coding & TestingCore Functions
MCS then CRC User Acceptance &
Change Preparations
MCS Go Live; then CRC Go live
Addition of new FunctionalityStatus Board, Assessments, Reports
Data Transfer
CRC Requirements Solution Approval
Acceptance & Golive Support
eHealth / MomentumCore Activities
Mental HealthCore Activities
Web App
Documents
CRC Services
Products
Implementation Roles
Mental Health Program: Carolyn Strutt, Susan Chipperfield, Nancy Parker, Heather Forrest, Elliott Drewniak, Laura Calhoun
eHealth: Jennifer Glen, Norm Smith, Kelly Francey, Kevin Soroka, Kieran Savage, Larry Cherlet
Community Services Information Systems (CSIS): Holly Madden, Sandra Mann, Lisa Rempel, Barb Cieszynski, Janis Wisher
WRHA Health Information: Bonnie Schellenberg, Leona Lane
WRHA Research & Evaluation: Catherine Charette, Olga Norrie
Momentum: Michael Gifford, Kelly Hinds, Giles Thompson, Bruce Penner
CRC IT Team: The People that are making it Happen