Project: Integrated Community Mental Health Information System

2004
Canada Health Infostructure Partnerships Program

Synopsis

The Integrated Community Mental Health Information System (ICMHIS) is a web-enabled health care information system that allows the collection and sharing of clinical and non-clinical information across a continuum of hospital and community-based services. The initial deployment was at five sites in the Victoria, BC area. The partners for this project included the Vancouver Island Health Authority (VIHA), the Victoria Cool Aid Society, and LogicLynx Technologies.

The project focused specifically on community-based service provision within the array of downtown core providers that collectively care for a difficult-to-treat group of disenfranchised individuals affected by a combination of problems, including major psychiatric illness, addictions, major health problems, various communicable diseases, and manifold consequences of poverty.

Outcomes

The ICMHIS project adopted an aggressive development cycle to get a production version of the system up and running by the conclusion of the CHIPP-funded part of the initiative. The following list demonstrates clearly identified impacts on the practices of individual providers within the ICMHIS project evaluation:

• More systematic observation, evaluation and documentation of acuity/risk characteristics of clients - the ICMHIS clinical minimum datasets provide a structure and focus for clinical documentation, regardless of whether information is being registered in an ad hoc or structured fashion.
• More appropriate registration of information - the system enforces a relatively low level of inference by requiring the user to specify an information source for data that calls for some form of validation.
• Better discrimination - by separating out information concerned specifically with risk from information concerned with mental status, the system helps to clarify the distinction between behaviours which are benign, albeit unusual, from behaviour that carries significant risk. This is important from a privacy standpoint, as behaviour related to risk has a clear need-to-know basis for registration into an information system.
• Decision support - by separating out unusual behaviour from high-risk behaviour, the system enabled providers to be appropriately thoughtful and cautious about initiating intrusive interventions (e.g., calling police).
  
  
  • More effective communication - the clinical tools built into the ICMHIS system are intended to facilitate communication with VIHA core service providers by supplying community based providers with the same clinical vocabularies that are slated for deployment among YIHA service providers working at various points in the Mental Health & Addictions continuum of care.
  • More appropriate data management practices - there is considerable variation in the manner in which information is maintained and safeguarded in community sites. In its current implementation, the ICMHIS system stores data in a single protected site. The system also ensures that data is backed up and preserved for an appropriate length of time.
• The categories of information contained within the ICMHIS clinical assessment methodology provide adequate coverage for the environments in which the system was deployed.

Policy Implications

The ICMHIS system was successfully deployed within a portion of the service continuum that is not typically covered by enterprise solutions for core services within Health Authorities. Development and deployment within this sector brought to light several issues related to structures governing the collection and organization of clinical data. These issues are critically important to the extension of outcome assessment/population health status assessment methodologies into the sector of care lying outside the boundaries of services supplied directly by many health authorities. Further efforts to extend the ICMHIS deployment in the community may carry important policy implications, and the weight attached to the data within an accountability framework should be based on additional research.

Policy Implications - Accountability/Performance Monitoring Framework

There are policy implications associated with the use of ICMHIS data to construct an accountability/performance monitoring framework. These policy issues centre around data standards, selection of an underlying conceptual health data model for purposes of system design, and construction and utilization of new indicators and client descriptors that capitalize on the data supplied by the ICMHIS for purposes of accountability.

Research Implications

Applied Research Implications - Ad hoc vs. Structured methods for the Collection of Health Information

Structured methods for collecting information (e.g., use of tools such as the RAI assessments) may be effectively deployed in settings where structured collection of health information is a central part of the business process (e.g., delivery of care within an inpatient unit). However, in many important service delivery sites within downtown core areas (e.g., emergency shelters), providers of an array of services do not engage in routine collection of health information, and the business process will not support routine collection of information using relatively time-consuming methods.

The use of ad hoc methods to register information poses two major research tasks:

• Development of clinical vocabularies to support ad hoc registration of information; and,
• Development of reporting methodologies to derive structured indicators from information registered in an ad hoc manner.

A clinical methodology that is appropriate for the shelter environment must be tailored to this type of work flow, i.e., it must support the ad hoc registration of information that is not collected according to any particular assessment protocol.

Lessons Learned

The ICHMIS project reported numerous lessons learned which are included in their evaluation report. Many of them revolved around the need of the project and the system being built to support an evolutionary development process and to address change management and a steep learning curve by:

• "Up-front loading" of user support and identification of high priority areas for efficiency in screen design and system functionality;
• Education on the clinical methodologies built into the system (in addition to basic training); and
• Use of familiar web interfaces.

In addition, the project noted that projects undertaken with the assistance of external funding need to be in-line with the strategic direction and priorities of all the participating organizations.

The Future

The ICMHIS solution, although in operation at user sites for a short time, was used with success by the staff of the Streetlink Emergency shelter. The technology architecture and state of the art technology used in the development of the system appears to have been validated, and potential for use in other settings is high.

The sustainability costs for the ICMHIS operation have yet to be determined. The functionality of the current system is minimal to meet current needs based on available time and project resources. This functionality will need to be expanded to meet future needs. In addition, there need to be opportunities to demonstrate the cost effectiveness of the software product in other settings. There are no technological limitations preventing broader-based deployment, and Phase 2 planning within the VIHA Mental Health & Addictions Service will support expanded use of the system within the community sector.

Once the solution is tried/used in other settings will it be possible to determine if the generic software approach can result in benefits to the health or social services sectors. One or more future champions will be required in order to truly measure the potential of the system.

Appendix A: Documents or Products Generated

Document /Product Name

User Guide(s) and/or Training Manual(s):

• Training Plan and Materials
• Software User Manual

Software Application(s):

• Scope Document
• Concept of Operations
• System & Business Requirements
• Case Tool Selection
• System Physical Implementation
• Messaging Protocols & Standards
• Software Evaluation Plan
• ICMHIS Software (including EDSA)

ICMHIS Final Evaluation Report

Standards, includes:

• Minimum Data Set: Mental Health Triage(MDS:MHT)
  • 16 Item Acuity/Severity Scale
  • Structured Observations

Clinical Training Protocols:

• Implementation Plan
• Use Case Scenario - Vanessa

Confidentiality and Privacy documents:
ICMHIS Privacy Impact Assessment

Sustainability Plan

• Needs-Based Service Delivery Initiative
• Business Plans; Charter

For more information, please contact:

Brian Shorter at brian.shorter@caphealth.org or at 250-370-8428.