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