Challenges and Solutions
When we began to plan the implementation of PsychConsult Provider at Advocate, we knew it would require a complex set of negotiations and considerations. The Behavioral Health Services' full time staff of 60 physicians, clinicians and administrative support and 20 part time master's level psychology, social work and psychiatric trainees provide approximately 7,500 services per month for children, adolescents and adults. Service provided include alcohol and substance abuse, intensive outpatient, aftercare and DUI counseling and emergency assessment, crisis intervention and referral, social rehabilitation services, individual outpatient, group, couples and family counseling.
Our previous information system was chosen and administered by our parent hospital system, Advocate Health Care. It was primarily used for billing purposes and did not accommodate many of the features necessary to run a behavioral health division. As a result, many of our processes were still paper-based and some staff members had no computer experience.
As we prepared to implement the Clinical Documents module, we felt that the way to ensure a successful integration was to adopt an iterative approach:
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Identify a small group for a pilot implementation
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Assess successes and problems experienced
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Refine system configuration, workflow, and training to address lessons learned during pilot
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Conduct second pilot with another small group
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Refine system according to lessons learned
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Deploy to full department
By testing the waters with smaller groups, we felt we would be better able to resolve the unavoidable surprises and glitches that accompany any software implementation before they impacted the entire department. The program staff for Cleanstart, our alcohol and drug abuse program, participated in the first pilot. The tight-knit group of nine staff members possessed a range of computer literacy, so it was very beneficial that we were able to quickly replicate a number of their specialized forms to gather and report information in Provider. We were also pleasantly surprised at the overall ease of system set up. The intuitive table structure made the database creation and management much less complex than other systems we've used. The pilot group went live with considerable success.
One of the major lessons learned from the initial pilot concerned clinician buy-in. It was critical for clinicians to feel that Provider would not be an impediment to the care they delivered to patients. To reassure them, we took two measures
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We identified implementation team resources that could be called upon to help them work through real-time difficulties as they got used to the system.
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Staff meetings dedicated time to discussing their experiences of using the system. The implementation team factored these experiences into revisions to workflow and system set up.
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Training structure provided another important lesson. It was critical that staff felt that their time learning to use the system was productive. To improve the effectiveness of the training experience:
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We adopted a role-based training approach, sculpting targeted trainings for specific job roles. This means that staff do not spend time learning tasks that they will never use.
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A multimedia self-training module was developed and provided to staff members on CDs so that they could get acquainted with some of the basics before they attended the live training sessions.
For the second pilot group (our staff psychiatrists), forms were tweaked and added, specialized training material was created, and implementation point people established supportive relationships with the group. We asked that staff review the material and animations on the self-training CD so that they were generally familiar with the major features they would utilize, and a large percentage of people complied with the request. The multimedia presentation was more palatable for many people, especially the less computer savvy staff. The group also realized that great care was being taken to ensure a positive experience for them. The second pilot group's go-live was even smoother than the first, and the staff were more thoroughly trained to conduct their work.
From the second pilot, a number of implications emerged concerning the distribution of staff resources. Because Provider collects and maintains a vast amount of information about a patient in one place, fewer resources are necessary to "chase down" information. Schedules of multiple staff members can be reviewed at once when searching for an appointment; charts are never misplaced; clinicians can see the notes from a therapy session conducted with another staff member; billing staff know whether a patient cancelled an appointment before they generate a bill. It also automates many important tasks, such as sending reminders when documentation updates are due.
By eliminating wasted effort, staff had more time to devote to other tasks. With this new flexibility, we reorganized our staff structure to optimize productivity. We organized the clinicians and physicians into groups of 8-12, assigning each a dedicated support staff responsible for assisting them with a number of tasks. These Unit Secretaries were given additional training support so they could serve as the Provider super-user for their group. In addition, each group was made responsible for managing a number of revenue related tasks, such as securing procedure authorizations and addressing delinquent account balances with their patients.
Successes
The introduction of PsychConsult Provider has yielded a number of positives outcomes throughout our organization.
ROI of Integrated Information
Provider's integration of clinical and billing functionality has created a streamlined flow of information between departments. When one group can draw upon the accurate information entered by another group, there is a ripple effect of precise efficiency throughout the organization. Intake information critical for grant funding is gathered with greater thoroughness. Documentation is completed sooner and is more accurate, which means that it is available for review by other clinicians treating the patient. We saw an astonishing 64% drop in AR over a 12-month period! Billing staff can confirm which services should be billed and which need corrections to avoid denials. In fact, we found that we did not need as many administrative support staff on weekends, because Provider made everything so accessible.
Patient Care
There has been a striking increase in our staff's confidence in the continuity of care that their patients receive. By having such rich information immediately accessible, everyone is aware of the patient's interactions with other parts of the organization: from scheduling to therapy to billing.
Staff Productivity
The reorganization of our clinical and support staff has resulted in a number of improvements in overall staff productivity. The clinician and physician groups, with the help of their Unit Secretaries, have successfully adapted to the routines of using the software to manage appointments, documents, and authorizations, and have achieved a significant decrease in AR for their patients.
Efficient Training for New Hires
The self-training module remains a valuable resource to efficiently train new hires as needed. Instead of relying on a limited one-time training, new staff can guide themselves through a comprehensive overview of how they use Provider to conduct their work.
About Advocate
Innovative services and programming provided in English, Spanish and American Sign Language by a caring and competent staff have made Advocate Illinois Masonic Community Mental Health Center one of the most successful programs of its kind in the metropolitan Chicago area. It is a comprehensive mental health program that helps seniors, adults and adolescents achieve their optimum health by offering a full range of behavioral health services, including alcohol and substance abuse, crisis intervention and outpatient psychiatric services.
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