The Mental Health Centre in Penetanguishene, Ont. (MHCP) is piloting a software tool designed to help it meet an Ontario government mandate by October.
By that time, all 75 or so facilities with psychiatric beds in the province
will be required to use a standardized assessment tool for patients requiring mental health services. The Canadian Institute for Health Information is in charge of the project.
The driver for implementing the resident assessment instrument-mental health (RAI-MH) is the need to better understand which patients and facilities require a greater portion of the funding dollars: facilities that service patients with more serious, long-term mental illnesses require more resources than others. The goal is to ensure more equitable funding that is driven by patient need rather than just facility or provider characteristics.
The assessment tool has already been used in long-term care facilities.
Although the tool doesn’t have to be electronic, the MHCP has chosen to use software developed by Toronto-based B Sharp Technologies Inc.
If B Sharp receives licensing approval from CIHI in September, the MHCP will be able to do a full implementation of the software.
According to Kelly-May Moreau, the centre’s RAI lead, the software enables health-care staff at the facility in a variety of disciplines, such as psychiatrists, psychologists, nurses, social workers and occupational therapists, to ask patients at the point of admission questions to best determine the kind of care the patient will need.
“We’ve chosen a multi-disciplinary model … and we’ve chosen an electronic method to complete that,” said Moreau. “Some facilities are doing it paper-based and some have different vendors.”
Moreau said the software has protocols built in so that certain answers can trigger further questions in 28 different areas, called maps. So, for example, if an assessment triggers any indication of violence, clinical staff will be alerted to the fact they need to complete other assessments.
The tool also provides embedded risk scales so clinicians can run reports on patients over a period from their last admission.
Tony Iantorno, a partner a B Sharp, said the facilities that have chosen to stick with a more traditional paper-based tool are not going to reap the benefit of using a database.
“When the mandate came out last year, a number of facilities that were familiar with the tool – I call it a tool because it wasn’t a computer application — had done the pilots on paper, and there were about 350 questions,” said Iantorno. “Anybody who uses the tool realizes if you’re not doing it in a point of care fashion on the computer using a database to get immediate feedback, you’re not doing justice to the tool.”
B Sharp’s software allows the facility to decide who can ask certain questions, as well as who can look at those questions and who can view the patient’s answers.
“Every user has to be provisioned,” he explained.
The software can also run on tablet PCs, although few mental health facilities are using them, he said.
“Tablet PCs are used mostly on experimental basis,” said Iantorno. “A lot of facilities have implemented a wireless environment, but you’re still dealing with a population where a lot of people haven’t even touched a computer, so you have to make it easy to use, and if they’re deriving clinical benefits in real time, it encourages use.”
So far about 100 of the 700 MHCP staff are using the assessment tool.
“We’re trying to streamline the process the best we can so it’s not cumbersome,” said Moreau. “There’s not a lot of typing so people that are not comfortable with the tool can, after a few assessments, feel comfortable maneuvering in the tool.”
The RAI software, which is based on an internationally developed list of questions, also allows the user to add his or her own questions, but MHCP hasn’t used that capability much yet, said Moreau.
“We’ve only added in a couple of questions so far because we’re just learning about the system,” she said. “You don’t know what you don’t know, but we’re hoping we can build in some of the questions that would be indicators for us, such as indicator data for accreditation purposes or for decision support to improve client care.”
Although the MHCP would eventually like to be able to integrate the RAI with an electronic health record, it’s not anywhere close to making that happen, said Moreau.