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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. - PowerPoint PPT Presentation
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Mental Health Crisis Response Centre
Electronic Health Record
Presentation for Manitoba Nursing Informatics Association
September 16, 2013
Heather Forrest, BSWNancy Parker, MM
CRISIS RESPONSE CENTRE
• 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
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-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.
RE-AIM
MAINTENANCE• Information sources is more program
documents and surveys
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