Transcript Mental Health Crisis Response Centre Electronic Health Record

Mental Health Crisis
Response Centre
Electronic Health Record
Presentation for Manitoba Nursing Informatics Association
September 16, 2013
Heather Forrest, BSW
Nancy Parker, MM
CRISIS RESPONSE CENTRE
Background
• 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
WRHA Crisis Services System
CRC Components
Crisis
Stabilization
Unit
Scheduled
Services
Walk In
Services
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
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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)
Kaiser Permanete Healthcare e.g.
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
What were the Risk
Mitigation Strategies
Customization was planned for the following areas:
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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
• Medications
• Status Board
• Admissions
• Client Overview
• Service Plans
• Suicidal Behaviour
• Addictions
• Diagnosis
• 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
Documentation
Benefits 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
WRHA Research
• Re-AIM:
– Reach
– Effectiveness
– Adoption
– Implementation
– Maintenance
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-AIM
ADOPTION
• Referral Sources
• CRC referrals to programs and
resources
RE-AIM
IMPLEMENTATION
• 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.
RE-AIM
MAINTENANCE
• Information sources is more program
documents and surveys
Decision Support
Many research questions were formulated and
several routine reports will be generated.
Some of the key areas to be tracked include:
• Wait times by priority
types
• Interventions used
• Collaborative partnerships
• Supports and services
accessed
• Clinical outcomes as
• Info transferred to
measured by clients & staff
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
Implementation Roles
eHealth / Momentum
Core Activities
Mental Health
Core Activities
Products
Addition of new Functionality
Status Board, Assessments, Reports
Data Transfer
Golive
MCS Go Live; then CRC Go live
Acceptance & Golive Support
MCS then CRC User Acceptance
&
Change Preparations
CRC Services
Coding & Testing
Core Functions
Web App
Analysis &
Design
CRC Requirements
Solution Approval
Requirements
Gathering
Project Startup
Planning
Documents
&
CRC IT Team:
The People that are making it Happen
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