The Value of Electronic Medical Record Implementation in Mental Health Care: A Case Study

Abstract

BackgroundElectronic medical records (EMR) have been implemented in many organizations to improve the quality of care. Evidence supporting the value added to a recovery-oriented mental health facility is lacking.ObjectiveThe goal of this project was to implement and customize a fully integrated EMR system in a specialized, recovery-oriented mental health care facility. This evaluation examined the outcomes of quality improvement initiatives driven by the EMR to determine the value that the EMR brought to the organization.MethodsThe setting was a tertiary-level mental health facility in Ontario, Canada. Clinical informatics and decision support worked closely with point-of-care staff to develop workflows and documentation tools in the EMR. The primary initiatives were implementation of modules for closed loop medication administration, collaborative plan of care, clinical practice guidelines for schizophrenia, restraint minimization, the infection prevention and control surveillance status board, drug of abuse screening, and business intelligence.ResultsMedication and patient scan rates have been greater than 95% since April 2014, mitigating the adverse effects of medication errors. Specifically, between April 2014 and March 2015, only 1 moderately severe and 0 severe adverse drug events occurred. The number of restraint incidents decreased 19.7%, which resulted in cost savings of more than Can $1.4 million (US $1.0 million) over 2 years. Implementation of clinical practice guidelines for schizophrenia increased adherence to evidence-based practices, standardizing care across the facility. Improved infection prevention and control surveillance reduced the number of outbreak days from 47 in the year preceding implementation of the status board to 7 days in the year following. Decision support to encourage preferential use of the cost-effective drug of abuse screen when clinically indicated resulted in organizational cost savings.ConclusionsEMR implementation allowed Ontario Shores Centre for Mental Health Sciences to use data analytics to identify and select appropriate quality improvement initiatives, supporting patient-centered, recovery-oriented practices and providing value at the clinical, organizational, and societal levels.

What to expect from electronic patient record system implementation: lessons learned from published evidence

“…In another, overall productivity increased by around 5% per year post-full EPR implementation98; whilst productivity may initially fall, billing income may increase due to improved coding 99. Furthermore, cost-savings include reduced medication errors, improved implementation of clinical practice guidelines, enhanced infection prevention and cost-effective diagnostic testing100; order-set creation and care pathway redesign have significant benefits 101. Such guideline integration may require calculated and complex variables, hence workflows may require modification to collect such data 102.…”

Measuring and improving the quality of mental health care: a global perspective

“…In some countries with common claims datasets or electronic medical records, mental health care measures have been variably adopted 66,67 . For example, the UK National Health Service has a long tradition of using electronic medical records in primary care for routine quality measurement, most notably through the Quality Outcomes Framework, the largest payment-by-results program in the world.…”

“…One of these areas is the abovementioned IAPT initiative, which embedded routine outcome measurementusing validated tools such as the PHQ-9 and the Clinical Outcomes in Routine Evaluation (CORE) -and could demonstrate good outcomes that have led to further funding into the initiative 71 . In Canada, there has been the adoption of mental health care quality measures in electronic medical records 67 . Still, due to long-standing stigmatization and functional challenges, consumers of mental health services may feel burdened by the data gathering.…”

A mixed‐methods survey to explore views of staff and patients from mental health wards prior to introduction of a digital early warning system for physical deterioration

“…Examples of major change involving adoption of technology are already underway within the UK National Health Service (NHS), including an organization‐wide change from paper to electronic patient records by 2020 (National Information Board, ), in line with evidence linking electronic notes with improved clinical outcomes in both general hospitals (Amarasingham, Plantinga, Diener‐West, Gaskin, & Powe, ) and mental health services (Riahi, Fischler, Stuckey, Klassen, & Chen, ). In addition, the Nursing Technology Fund, launched in 2013, has provided financial support to enable nurses to incorporate innovative technology in their daily practice, in order to improve efficiency and patient care (NHS England, ).…”

“…After reviewing abstracts and confirming by reading full papers, six papers were initially identified as meeting the criteria, with three related to aspects of the same intervention (see Table ). Two further papers (Ben‐Zeev et al, ; Riahi et al, ) were identified through checking citations and references and subsequent citations of the initial list of six (see Table ).…”