According to Sanaz Riahi, the need for automation and digitization for behavioral health organizations is no different than for hospitals and group practices. But the mountain to climb is much higher.
“We realized very quickly that we were going to have enormous challenges getting an EHR in place, because when we decided to automate, there weren’t any EHRs out there designed for behavioral health settings,” says Riahi, the clinical practice leader in professional practice at Ontario Shores Centre for Mental Health Services, a public teaching hospital in Whitby, Ontario, Canada with 326 inpatient beds that specializes in mental health and addictions services.
“On top of that, we weren’t trying to increase automation; we were trying to begin it,” Riahi said. “We had a completely paper-based environment, and our clinical staff had no experience at all using computerized systems. It was a truly enormous project.”
Seven years after making a big bet on information technology, Ontario Shores is using an enterprise EHR that pulls together the numerous departments and caregivers responsible for treating extremely complex, persistent mental illnesses. For those efforts, the organization was named one of four recipients of the 2015 HIMSS Enterprise Nicolas E. Davies Award of Excellence, which recognizes outstanding achievement of organizations that have utilized health information technology to substantially improve patient outcomes while achieving return on investment.
The overriding goal of the effort was to reduce treatment variances by providing caregivers with an automated game plan for evidence-based practice. Mental health patients require frequent and detailed psycho-social assessments and therapies, as well as complex medication regimens. The challenge had been coordinating those treatments using paper documents that often were long narratives of one-on-one encounters with patients, Riahi says.
“One of the most difficult tasks transitioning to an EHR was looking at our paper-based assessments are devising ways to break down those components and descriptors into discrete data, while still enabling clinicians to include some of the narrative information they were used to providing,” Riahi says. “Right from the start, we focused on capturing that discrete data along with any necessary narrative information, and using that data to trigger automated decision support.”
One of the organizations biggest automation wins has been around treating schizophrenia. When the patient is admitted, the physician is asked whether they will continue or discontinue anti-psychotic medications for that patient. Their response triggers protocols for metabolic monitoring, lab investigations and necessary assessments by physicians and nurses, as well as the frequencies they need to occur.
“There are so many domains that need to be involved in the care of mental health patients, and we’ve focused on providing triggers for all of them in our guidelines,” Riahi says. “You can’t expect clinicians to memorize 120-page clinical guidelines around these conditions, but you can provide a series of prompts and triggers during their time with patients so they can adhere to them.”
The automation around treatment for schizophrenia patients has helped connect clinicians across the care spectrum: since Ontario Shores has fully implemented its protocols, its adherence to polypharmacy regimens has increased by 5.8 percent; metabolic monitoring has jumped 52 percent; and referrals to cognitive behavioral therapy rose by 74.8 percent.
The EHR has also built bridges to mental health patients discharged from the facility by enabling Ontario Shores to create a patient portal that provides access to lab results, enables patients to review and refill prescriptions, and message caregivers.
“Mental health patients have been stigmatized by most acute care facilities and as a result haven’t had the same level of access to their health information as other patients,” Riahi says. “The patient portal lets them review their treatment information, which is their right, and helps breaks down that stigma so they can be a participant in their healthcare. It’s made a huge difference for our patients.”
Ontario Shores has also leveraged its EHR to address hospital-acquired infections, which are a serious challenge for mental health facilities. “We’re different than other inpatient facilities in that our patients are encouraged to move around the facility and interact with other patients, individually or in groups,” Riahi notes.
However, many patients are suffering from respiratory problems and other infectious conditions, and HAI outbreaks had been common at Ontario Shores. The organization addressed that issue by increasing electronic surveillance of patients who might be susceptible to HAIs and deploying status boards that are monitored by its infection control team to enable them to check units where patients are trending toward outbreaks.
Since rolling out the monitoring system, Ontario Shores went from 20 HAI outbreaks in 2013-2014 to no reported outbreaks in 2014-2015.
Greg Gillespie, former editor-in-chief at Health Data Management, is a Chicago-based healthcare content consultant.
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