Psychiatric Medical Care prides itself on delivering evidence-based care services. It wanted the ability to drive patient treatment through their responses to evidence-based testing.
THE PROBLEM
The healthcare provider organization is accredited by The Joint Commission, which requires patients’ treatment plans be developed based on an evidence-based testing process. Psychiatric Medical Care sets goals based on patients’ test scores and routinely tests them to measure improvement.
The organization also is required to review its aggregate data.
“We needed a way to look at our data from a bigger-picture perspective and make sure we were driving outcomes throughout our whole program,” said Stephanie Weatherly, DNP, RN-BC, chief clinical officer at Psychiatric Medical Care. “We also wanted to use that data to create performance improvement projects that help move the needle for our patients and our clinicians.
“Another reason we were on the hunt to find a software platform that could assist us was because we previously had to do all that work manually,” she continued. “You can imagine when you’re taking care of dozens of patients, trying to gather that information through each patient record, put it into a spreadsheet, and do the legwork to make that data meaningful requires a significant amount of time.”
PROPOSAL
Psychiatric Medical Care leadership was looking to help their clinicians drill down into a more appropriate diagnosis for patients.
“In the mental health world, something we struggle with a lot is uncovering a patient’s true diagnosis,” Weatherly explained. “Some of the platforms we looked at only offered the common, evidence-based tests that are available, and these are doing essentially the same thing as my spreadsheet.
“One of the things I was most excited about when we were on this search and finally landed on a vendor was that they had additional evidence-based tools we weren’t familiar with,” she continued. “These expanded our ability to provide more specific testing to our patients, allowing us to drill down into their diagnoses.”
In addition, Psychiatric Medical Care had a very long intake process. Patients needed to come in and complete all of their tests on paper, or staff would ask them the questions and enter their responses into the EHR.
“We wanted to shorten the length of our intake considerably,” Weatherly noted. “When you look at the adolescent population we serve, they’re very apprehensive about coming in to begin with. By the time they were done with our intake process, which would take two and a half hours, they were often burned out for the day.”
Psychiatric Medical Care decided on vendor Proem, which markets a clinical workflow software engine designed to help healthcare providers and research organizations screen, assess, diagnose, treat and measure outcomes for those suffering from mental illness.
The workflow engine captures data at every step of the behavioral healthcare process and offers clinical follow-up suggestions to help determine the next steps to take in a patient’s care.
MEETING THE CHALLENGE
“Using the clinical workflow technology from the very first encounter with a patient, we’re getting an accurate diagnosis, which helps drive the treatment we provide,” Weatherly reported. “Then we use the vendor’s evidence-based tests, diagnostically specific for the patient.
“It’s not a cookie-cutter approach,” she noted. “Every patient is getting the specific test that matters to them and their needs. We received a lot of exciting features with this vendor and their technology that other vendors didn’t provide.”
With the technology, the organization was able to shorten the length of its intake considerably. The software automatically sends out all intake questionnaires and forms to patients, including consents and other forms patients must sign before arriving.
“Now patients can come in and immediately start the intake process,” she said. “This change took something that was about two and half hours long down to something that was about an hour long. This is a huge patient satisfier.
“It really helps our staff as well, because now we can admit more patients in a day since we’re not being so bogged down in paperwork,” she added. “Patients can do the paperwork before they come to our treatment center.”
The process looks like this: When a new patient appointment is scheduled, the intake packet is automatically sent to the patient, who completes their forms before their initial appointment. That information comes into the EHR, so it’s now available for any of the clinical staff who will be working with the patient. In addition, throughout treatment, outcome monitors are sent to the patient to track their progress.
“We also have an API built between the clinical workflow technology and the EHR, Lightning Step, which created huge work efficiencies for our team,” Weatherly explained. “We don’t have to upload anything into our EHR anymore. This integration also allows our physicians and psychiatric nurse practitioners to see the test results as soon as they’re completed. We get real-time results without needing to go back and forth between systems, which has been wonderful.
“Additionally, every team member in our program uses the clinical workflow technology,” she continued. “One of the things that’s kind of unique about how we at PMC provide care is that everyone in our program is a clinician. Our office and patient coordinator, who is the person who ushers the patient into our program and does the intake, is a clinician.”
Staff use Proem throughout the treatment process. They use it at every touchpoint with the patient in their individual sessions. They’re reviewing that information in the family sessions as well, so they’re diving into that information with the families. Then they use the information one final time at the patient’s discharge.
“Another thing we like about our clinical workflow technology is it enables us to allow parents to give their perspective on their child’s symptoms,” Weatherly observed. “At intake and any time following intake, we’re able to send assessments to the patient’s parents.
“It’s one thing for a child to say whether they missed school or lost productivity, but we want to hear from the parents about how they perceive their child’s lost productivity,” she continued. “Our technology platform has the functionality to get multiple people’s input into a patient’s progress.”
Staff also use the vendor’s monitors throughout a patient’s treatment. This data comes into the platform’s dashboard that staff can then share with the patient so they and their parents can see they’re getting better.
“We use the technology this way a lot,” Weatherly said. “When you’re a kid, it can be really hard to see how well you are doing or how much you’ve healed. We’ve often had kids say they’re not getting any better. We pull their information up and show them how they were doing and the answers they gave in the past versus the answers they’re giving now. Then they can see they are getting better.”
RESULTS
“On an individual results level, this has been a wonderful tool for the parents,” Weatherly reported. “Everybody loves a graph, and when you see a graph and it’s headed in the right direction, that’s been great during family sessions for parents to see how their children have changed for the better.
“On a non-clinical side, the technology has helped us get really good reviews from parents, and improve other engagement metrics we need as an organization to succeed and continue to get our name out there and build awareness of the quality care we provide,” she added.
For anybody who takes care of people, they know sometimes they can have one negative development or setback and it can make people feel like they haven’t made progress, Weatherly noted.
“This technology provides us with something quantifiable to show the families and patients,” she said. “This just makes all the difference in the world for them to wrap their arms around the difference in their child. The children get this same encouragement and reward.
“From the perspective of board reporting, something that had taken a long time for me to gather together is now as simple as taking a few screenshots,” she continued. “The technology also provides me with everything I need to be able to report aggregate data not only to our board but to The Joint Commission during our survey process. We’ve learned a lot from the data we’re capturing in the technology.”
Weatherly also highlights the value of the therapeutic alliance scale that is included on the platform.
“It’s such an important tool,” she contended. “Using this scale, we’re able to see whether our patients are connecting with their therapist, which can guide feedback to the therapist. In addition, we do performance evaluations all the time. I use that scale to help me perceive how well somebody is working with patients.
“To have the patients, who are our customers, tell us how they perceive us and our people provides a great immediate feedback loop that helps our therapists change and improve,” she added.
ADVICE FOR OTHERS
The first step is to speak with the people closest to the patient and find out about their struggles, Weatherly advised.
“How are they currently measuring progress in patients? How are they showing patients whether they’ve progressed and how they’ve gotten better? What is it your clinicians want and need? They’re going to be the users of whatever technology you decide on, so you want to make sure you understand the problems they are experiencing in your organization,” she said.
“Look at a lot of technology options,” she continued. “Find out what’s out there. Get proposals. Find customers currently with the vendors you’re considering and speak to those customers to find out how the product works for them. This should help you better understand how it would work for you.”
It’s also important to be open to having a product that’s better than what one set out to find and perhaps expected, she added.
“When I go into researching something, I often predetermine exactly what it is that I need,” Weatherly said. “When I do that, I can be pigeonholed into something because I know what my problem is and what I want to solve. But sometimes the solutions can be a lot bigger, broader and better than you thought was available. It could be more useful, but because you’ve pigeonholed yourself into something, you don’t necessarily look at or fully appreciate all your options and what they can do for you.
“Lastly, really think about the timing of implementation and make sure you can implement the technology around the schedule you need,” she concluded. “In other words, what’s the appropriate timeframe to implement it? If you’re up against a Joint Commission survey, for example, can you accomplish implementation in that timeframe? If not, do you need to explore other options?”
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