EHR Improves Treatment Teamwork
Everybody likes to see results.
How many consumers really have a handle on their progress in treatment? A couple innovations involving the Electronic Health Record (EHR) have received a lot of attention lately, because they work...and that's backed up by data from the EHR. Concurrent or collaborative documentation with the consumer and effective scheduling are perhaps the two most important tools that professionals and consumers can add to their tool box to deliver a clear vision of treatment effectiveness.
If a counselor cancels an appointment with a consumer, what message does that send? As a consumer, I might get the impression that it's OK to miss appointments, with or without notice. Either way, missing appointments leads to less concentration on treatment goals and hampered recovery. Gathering data from the electronic central-scheduling module can help analyze who's canceling appointments, and who's simply not showing up for appointments. Once we know where the disconnect is, we can discover the reasons and overcome them.
I recently attended a web presentation by Bill Schmeltzer of MTM consulting discussing collaborative documentation (The slides are at http://www.omh.state.ny.us/omhweb/clinic_restructuring/resources.html), and I liked the approach because it had a focus of improving treatment results. The idea is to jointly recap the session (something most people receiving mental health services are used to) at the end of session, recording what the professional and consumer did together in the session, and how that discussion focused on one of the goals in the treatment plan, as well as any plans for the patient to employ tools like active listening or breathing techniques to improve daily life. Once again, this information will be available in the EHR. When the patient returns, the notes are handy reminders of where the professional and consumer left off; this might be a good place to resume discussions.
In many treatment centers, scheduling has been a topic of heated discussions over professionals' control of their time. Recently The National Council (the mental health community's most popular support organization) published a study that compiled data from ten Community Behavioral Health Organizations (CBHOs) that sheds some light on how important scheduling is.
One organization had a counselor with 30 "no-shows" by consumers. That seems like a lot. It certainly affects the bottom line, so agencies want to know more about this, because this consumers weren't the only ones perpetrating the trend. As it turned out, the counselor didn't show up for 24 of his appointments…legitimizing the idea of missing appointments. That's a solid example of a work culture that needs to be changed.
The answer to decreasing no-shows and increasing effectiveness appears to be involving the consumer more in the nuts and bolts of treatment. Collaborative documentation keeps consumers and professionals focused on the goals of treatment, what the consumer actually wants to improve, as opposed to the mini-crisis of the moment. I like that, I learned that most of my crisis' are bogus anyhow…a result of behaviors I have long-since changed.
One agency I heard about on Long Island hired a scheduling person with a master's level education. This person was savvy enough to read a chart and consider treatment goals and objectives, as well as no-shows by both the counselor and consumer when scheduling appointments and determining what sorts of effort needed to go into getting the parties together to collaborate on effective treatment. Although the scheduling person was very expensive, filling the position with this type person paid off in the bottom line in reducing no-shows, and therefore paid sessions.
Yes, she used the scheduling module in the EHR to access the information needed to make these decisions, and she couldn't be effective in the job without the treatment plan, progress notes and scheduling history information in the computer.
So, the foundation of success for both consumers and counselors, and even the treatment facility winds up being all wrapped up in the EHR. I love that.