concurrent documentation - the national council

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www.TheNationalCouncil.org

Poll Question

> Why did you decide to join today’s webinar?• My agency has successfully implemented CD and I’m

curious how it is working at another agency• My agency has implemented CD but faces continued

challenges • My agency is considering CD• My agency has not CD yet, but we’re curious to learn

more

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Poll Question

> What is your position within your agency?• Psychiatrist• Therapist• Administrator (CEO, ED, COO, etc.)• Billing and/or Compliance staff

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In Search of the Holy Grail of Documentation:

> Quick and easy to perform.> Rapidly accessible.> Containing needed clinical data.> Guiding clinical activity in rational

direction.> Linked to labs, tests, prescribing.> And so easy even a psychiatrist can

use it!

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No Holy Grail out there…

> Linkages to databases [meds prescribed, lab results, consents, etc] not happening in our software [CMHC.]

> Prescribing programs not working.> Psychiatrists balky but not irrational –

they don’t love us enough to waste time being alpha testers.

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Cut-and-Paste Technique

> Quick and dirty [until technology catches up with us.]

> One page, no click-through.> Who cares if it is repetitive?> Collects all data: history, meds, labs,

etc.

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Implementation

> Began October 2004> Implemented for all staff by March 2006> 7 psychiatrists [and dozens of non-MD

therapists]> Follow by CMHC Enterprise view –

moment-by-moment follow up of progress of note and billing entry.

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Acceptance by MD’s

> Carrot: Go home early. Be caught up all day.

> Adoption varies.> All MD’s concurrently document to some

degree – those that do less, stay later.> Obstacles:

• Lack of fluency with computer• “Too many things at once” for recent hires.• [Not for us] – a dysfunctional IS system.

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Effects on practice style

> Briefer sessions. > Possible for me to provide services to a

larger number of clients in the same period of time.

> Less time spent searching for data, labs, old session notes, etc.

> Obvious implications for center – waiting list now down from hundreds to close to zero.

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Effects on documentation completeness

> March 2005: 143 missing progress notes

> March 2006: 4 missing progress notes.

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Keeping up with staff documentation

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Client acceptance

> “It must be important if it is being written down.”> “Make sure you also say so-and-so.” > Not a single complaint after thousands of

sessions.

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Treatment Record as Joint Endeavor

> Necessity for tactful language keeps clinicians in therapeutic stance, forces them to think / speak / write clearly:

• “Client is upset about changes in meds,” vs. “Client continues to be impossible to please.”

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Commitment to the practice

> Typing now a prerequisite for work here, even though this has meant turning away some promising older candidates.

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Limitations

> I still would like a note that would do the cut-and-paste for me.

> Still no complete list of prescribed meds, labs.

> Newer software will be the end of cut-and-paste, but not as soon as I would have thought.

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Summary – impacts of concurrent documentation

> Improved timeliness of billing and supporting clinical documentation.> Improved quality and usefulness of clinical documentation, especially

for psychiatrists, in terms of monitoring drug interactions, consents, laboratory tests, medications prescribed.

> Reduction in time spent in documentation, especially using the cut-and-paste technique.

> Increased involvement of clients in the treatment planning and documentation process.

> Improvements in therapeutic interactions necessitated by clinicians being forced to clarify thoughts in front of the patient.

> Improvements in the quality of work life of clinicians • Less time spent documenting. • Feeling caught-up all day.• Being finished with work at the end of the client day.

www.TheNationalCouncil.org

Poll Question

> What is your primary reason for wanting to implement concurrent documentation?• Greater provider satisfaction: less time spent on

reporting, not staying late to finish paperwork• Improve reporting compliance across agency:

timeliness, improved quality and usefulness of clinical info

• Greater client involvement: client participation in documentation and treatment planning

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How we do it

www.TheNationalCouncil.org 19Presented by: John Kern MD

www.TheNationalCouncil.org 20Presented by: John

www.TheNationalCouncil.org 21Presented by: John Kern MD

www.TheNationalCouncil.org 22Presented by: John Kern MD

www.TheNationalCouncil.org 23Presented by: John Kern MD

www.TheNationalCouncil.org 24Presented by: John

www.TheNationalCouncil.org 25Presented by: John Kern MD

www.TheNationalCouncil.org 26Presented by: John Kern MD

www.TheNationalCouncil.org 27Presented by: John Kern, MD

www.TheNationalCouncil.org 28Presented by: John Kern MD

www.TheNationalCouncil.org 29Presented by: John Kern, MD

Regional Mental

www.TheNationalCouncil.org 30Presented by: John Kern MD

www.TheNationalCouncil.org

Questions?

JOHN S. KERN, MDChief Medical Officer

The Regional Mental Health CenterMerrillville, IN

john.kern@regionalmentalhealth.org