Project: SYNAPSE

Canada Health Infostructure Partnerships Program

Synopsis

SYNAPSE is a software application that collects and presents clinical and administrative information about Mental Health clients in the form of an Electronic Health Record (EHR). This EHR for mental health is intended to track care episodes across the full continuum of mental health services for the seriously and chronically mentally ill, including inpatient psychiatry and emergency, outpatient, community, and residential programs, but excluding physicians' offices. The design, creation and implementation of SYNAPSE were the collaborative efforts of health authorities, federal and provincial governments, research and data institutes, and individuals representing an array of content and technical expertise.

Outcomes

An objective of the SYNAPSE project is to promote the adoption and implementation of standards, particularly concerning data, technology and policy. Indeed, the popularity of SYNAPSE has grown dramatically over the phase funded through CHIPP, and the original expectation for implementation on a pan-Canadian level has doubled since the funding was first secured.

SYNAPSE has successfully raised awareness across Canada of the importance of the electronic health record in the diagnosis and treatment of mental illness. In fact, as the healthcare industry continues to evolve, it is now apparent that SYNAPSE has equal benefit in its support of Addictions programs as well. All new implementations are moving forward based on this expanded scope.

SYNAPSE technology has also led the way towards the utilization of best practices in the creation of the EHR. The SYNAPSE service-event based data model is well-accepted in the field, as is the use of HL7 standards to support loosely-connected integration across EHR domains, ensuring consistent semantic meaning. These successes are an integral part of the project's go-forward strategy, especially as new funding will be tied to the industry's maturity around EHR standards.

The introduction of the EHR into Mental Health and Addictions services has had a significant impact on patient/client care. There are many anecdotal examples of persons entering the system that are assessed and treated with the benefit of appropriate information available at the point service, where many of these cases would have previously led to long-stay admissions into inpatient Psychiatric facilities.

Policy Implications

None were noted.

Research Implications

None were noted.

Lessons Learned

The Synapse project reported multiple lessons learned, including many suggestions and comments related to data quality, such as "Complete integration of the client record via SYNAPSE can only be achieved by improving the accessibility and integrity of the data it contains and by appropriately addressing the varying security and operational needs for use of the data."

A selection of other lessons learned include:

• Establishing a small pilot study to look at how some programs/clinicians have almost eliminated the need for paper records - then widely publicizing/training others of the results - can be beneficial;
• Existing charts should be reviewed and strategies and protocols should be established for handling fragmentation of the clinical record; and
• Early mechanisms for garnering participant involvement and for managing change requests play a significant role in acceptance.

The Future

SYNAPSE is now a developed, sophisticated and stable system and is delivering benefits to users and clients, but not necessarily consistently or always in proportion to their time and effort. Therefore, there needs to be a concerted effort to ensure that the system maximizes its potential to improve the daily life and work of all its users, in order to facilitate better care outcomes for mental health patients/clients.

SYNAPSE has undergone extensive sustainability planning. Most significantly, ongoing funding requirements were divided between "sustainability funding" and "aggressive development funding". This allowed the ongoing commitment of major stakeholders to support ongoing management and maintenance while simultaneously allowing for the attraction of grant funding required to support major initiatives.

Priorities for the future development are as follows:

• The exploration of the infrastructure to support governance in a pan-Canadian environment;
• The maintenance of financial stability through sustainable funding;
• Pan-Canadian interoperability and the associated expansion and adoption of HL7 tools;
• Data interchange amongst Health Authorities to support the requirement for a 'system view';
• Discussion with Electronic Medical Records vendors about the development of a full interchange of 'appropriate' clinical information versus the current primary care integration;
• Identifying alternative methods of supporting users across large geographies during implementation and training of public domain software; and
• Ongoing collaboration with other EHR initiatives.

Appendix A: Documents or Products Generated

Document /Product Name

User Guide and/or Training Manual:

• Available on SYNAPSE website

Policy and Procedure Manual

• Available from implementation partners - VCHA and NHA

Job Descriptions

Software Applications:

• EHR application
  • Full source and object code for the SYNAPSE application.

Standards:

• Data
  • Data model fully available.
• Messaging
  • Data messaging specifications and implementations fully available.

Clinical Training Protocol

• Available on SYNAPSE website.

Clinical Program Protocols

• Available from project partners.

Confidentiality and Privacy documents

• Available on SYNAPSE website.

Consent Forms

• Available on SYNAPSE website.

Sustainability Plan

• Available on SYNAPSE website

For more information please contact:

Michael Nusbaum, Project Director, at michael@mhnusbaum.com
or  www.synapse-ehr.com