The top technology goal of any healthcare organization is to achieve integration so all data from all sources can be shared. For behavioral health facilities, however, this can be problematic.
A recent study conducted by researchers at the University of Colorado concluded that limitations inherent in most electronic health records (EHRs) prevent behavioral health data from being fully integrated. This is largely due to the differences in language, classifications, codes and reporting requirements. But the task is not impossible.
Ontario Shores Centre for Mental Health Sciences in Ontario, Canada, has been recognized for its strategic efforts to not only roll out an EHR, but also to tailor allied systems so that all data from all sources can be effectively integrated.
Breaking with the past
With 326 inpatient beds and service to more than 60,000 outpatients, Ontario Shores was almost solely paper-based until it began working on its integrated infrastructure in 2007.
“We modified the entire solution, tailoring the system to what our needs were,” says Sanaz Riahi, director of professional practice and clinical informatics. “This was not to be an IT project but a clinically-driven project with close cooperation with the IT department.”
Acknowledging that there are differences in the way behavioral health professionals compile data, Riahi says a software solution was added that turns hard-to-document narrative information into a flow sheet containing clinical data. That same information is translated into panels, or a table-type of format, to show trends, she says.
The EHR with the integrated system went live for outpatient services in 2012 and was rolled out for the entire organization in 2013, Riahi says.
Quality of care, patient safety and workflow have improved since Ontario Shores began using its EHR, she says.
For example, physicians are now required to enter medication orders through computerized physician order entry (often known as CPOE), and nurses scan bar codes on their own staff identification badges, the medication unit doses and the patient wristbands to record and verify in real time that the right medication is delivered to the right patient, she says.
Ontario Shores also adopted clinical practice guidelines that cover a wide range of behavioral health diagnoses. Since the guidelines are incorporated into the EHR, built-in rules help to drive the clinical staff toward evidence-based decisions.
The technology strategy executed by Ontario Shores has not gone unnoticed. In 2014, it became the first hospital in Canada to adopt a paperless medical record system, receiving the Health Information and Management Systems Society (HIMSS) Electronic Medical Records Adoption Model Stage 7 award. Last month, it also received the HIMSS Nicholas E. Davies Enterprise Award for Excellence — becoming one of only 77 organizations in the world to be recognized for using health information technology to substantially improve patient outcomes while achieving return on investment.
Officials at HIMSS say Ontario Shores clinicians have reduced medication errors and infections and are using real time data directly in care delivery.
Riahi believes that reaching what is known as “HIMSS Stage 7” has markedly improved patient care. HIMSS has established a series of stages with the goal of reaching Stage 7, which represents a truly paperless electronic health record environment.
But she also says early engagement with clinicians; having a physician to champion the IT strategy; and providing opportunities for feedback made the transition a lot easier. She recommends working collaboratively across the organization.
However, Riahi says the work is not over. The next project she is looking forward to is leveraging predictive analytics, which could, for example, use data to identify ways to predict—and thus prevent—violent behavior, she says. It’s a growing area of health IT.
And with the growing popularity of mobile devices in healthcare, Riahi says the organization is already working to develop a mobile app that would allow information provided by patients to be incorporated directly into their EHRs.
Richard R. Rogoski is a freelance writer based in North Carolina.