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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.

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Mental health crisis response centre

Mental Health Crisis Response Centre

Electronic Health Record

Presentation for Manitoba Nursing Informatics Association

September 16, 2013

Heather Forrest, BSWNancy Parker, MM



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

Background


Wrha crisis services system
WRHA Crisis Services System developed by a broad based stakeholder group

CRC Components

Crisis

Stabilization

Unit

Mobile

Outreach

Services

Scheduled

Services

Walk In Services


Scope of services
Scope of Services developed by a broad based stakeholder group

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
CRC IT Project developed by a broad based stakeholder groupGivens

  • 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
CRC IT Solution Benefits developed by a broad based stakeholder group

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
Risks inherent in developed by a broad based stakeholder groupCRC 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
Canada: developed by a broad based stakeholder groupHow 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
Mental Health & developed by a broad based stakeholder groupSubstance 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
Health Insurance Portability & Accountability Act developed by a broad based stakeholder group(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
What were the Risk developed by a broad based stakeholder groupMitigation 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
CRC EHR ‘must haves’ developed by a broad based stakeholder groupFunctionality

Screening

Status Board

Client Overview

Suicidal Behaviour

Addictions

Diagnosis

Medications

Admissions

Service Plans

Alerts

Episode Summary

Reports


Opportunities concurrent or collaborative documentation
Opportunities: developed by a broad based stakeholder groupConcurrent 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 documentation1
Opportunities: developed by a broad based stakeholder groupConcurrent 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
WRHA Research developed by a broad based stakeholder group

  • Re-AIM:

    • Reach

    • Effectiveness

    • Adoption

    • Implementation

    • Maintenance


Re aim
RE-AIM developed by a broad based stakeholder group

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 aim1
RE-AIM developed by a broad based stakeholder group

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 aim2
RE-AIM developed by a broad based stakeholder group

ADOPTION

  • Referral Sources

  • CRC referrals to programs and resources


Re aim3
RE-AIM developed by a broad based stakeholder group

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 aim4
RE-AIM developed by a broad based stakeholder group

MAINTENANCE

  • Information sources is more program documents and surveys


Decision support

Wait times by priority types developed by a broad based stakeholder group

Interventions used

Clinical outcomes as measured by clients & staff

Collaborative partnerships

Supports and services accessed

Info transferred to collaborative partners

Decision Support

Many research questions were formulated and several routine reports will be generated. Some of the key areas to be tracked include:


Other research projects
Other Research Projects developed by a broad based stakeholder group

  • 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 / developed by a broad based stakeholder group

Momentum

Mental Health

CoreActivities

Core Activities

MCS Go Live; then CRC Go live

Acceptance & Golive Support

e

v

i

l

o

G

Addition of new Functionality

MCS then CRC User Acceptance

Status Board, Assessments, Reports

&

Data Transfer

Change Preparations

Coding

&

Testing

Core Functions

Analysis

&

CRC Requirements

Design

Solution Approval

Requirements

Gathering

Project Startup

&

Planning

Implementation Roles

Products

CRC Services

Web App

Documents


Crc it team the people that are making it happen

Mental Health Program: developed by a broad based stakeholder groupCarolyn 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


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