Week 6
Collaborative Documentation (CD)
Completing All or most of the documentation with the individual during the time of the service
Benefits of CD
Efficient
Allows our clients to know what is in their charts
Clarify information
Include client perspectives
Clients will become more engaged and involved in their treatment
Specific treatment outcomes can be discussed
Change in treatment plan can be addressed more quickly (emphasis on collaboration)
CD and Clinical Practice
Collaborative Documentation integrates documentation into clinical practice
Documentation becomes useful to the interests and values of practitioners
Documentation becomes timely (real time)
Client participation will improve
Focus on treatment goals/objectives
Intake Process with CD
Non clinical staff collect the non-clinical information (demographics)
Completing all Information- gathering collectively
Allowing clients to view the computer screen
Pointing to the computer screen and alternating between listening and summarizing
Depending on client presentation, some parts of the assessment may be completed post session (e.g., mental status exam).
Tips for Psychiatric Providers
Start by asking ‘What do we want to result from our work over the next few months? How will we know we if we’re successful?’
Measurable or observable outcomes
What can we do together to move towards your goal (e.g., how medication monitoring services will assist in the overall treatment goal)
Changes in functioning, behaviors, symptoms, skills
Additional Tips
‘I may be typing while you are answering some of my questions so that I am not missing any information shared with me.’
Alternating between listening, summarizing, and eye gaze will assist in building a therapeutic alliance.
Completing the note during intervals (whatever works for the individual-some clients may need a brief break or a change in focus)
More Tips!
Allow the individual and family to see the note!
Agree to Disagree
Think of CD as written ‘wrap up’ versus paperwork
Control documentation to enhance the clinical process
Invite clients to share their values/perspectives
Use formatted notes (thank you, HMS!)
Attitude is KEY-present CD as an invitation
Office Setup
Where is your desk in relation to where clients sit?
How is your computer positioned?
Are you facing clients ?
Are you able to turn your screen so clients can see what you’re typing?
Is your office conducive to CD?
Office Setup
Clinical Benefits
Highly positive responses from individuals/families
Improved recall and plan adherence
Improved Engagement-reductions in NO SHOWS/CANCELLATIONS
More time to see clients and meet the needs of the community
Data from 10 CMHCs
10 community mental health centers were randomly assigned to receive training in person-centered planning and collaborative documentation or provide treatment, as usual (N=17,000)
Medication Adherence and Service Engagement were measured over 11 months
RESULTS-Medication Adherence increased significantly in the experimental group (B=.022, p<.01) but showed no significant change in the control condition (B=.004, p=.25). Appointment no shows were also reduced in the experimental group.
National Council Survey
1. On a Scale of 1 to 5, how helpful was it to have your provider review your note with you at the end of session?
81% stated it was either ‘Very helpful’ (51%) or ‘Helpful’ (30%)
9% stated it was ‘Neither Helpful’ or ‘Nor Not Helpful’
1% stated it was ‘Not Helpful’
5% stated it was ‘Very Unhelpful’
4% had No Opinion/NA
Involvement in Care
2. On a scale from 1 to 5, how involved did you feel in your care, compared to past experiences? (either with us or another agency)
51% stated they felt ‘Very Involved’
28% felt ‘Involved’
14% felt ‘About the Same’
1% felt ‘Not Involved’
3% felt ‘Uninvolved’
3% N/A or No Opinion
Provider Approach
3. On a Scale of 1 to 5, how well do you think your provider did in introducing and using this new system?
68% reported ‘Very Good’
25% reported ‘Good’
4% stated ‘Average’
0% reported ‘Poorly’
1% reported ‘Very Poorly’
2% had No Opinion/No Answer
Continue with CD?
4. On a Scale of 1 to 3, in the future, would you want your provider to continue to review your note with you?
77% said YES!
11% were unsure
6% said NO
6% had No Answer/NA
Medication Adherence
Outpatient Pilot
Selected interested clinicians from 4 outpatient sites to go through a collaborative documentation training (webinar) and management provided ongoing support/guidance (N=242). Used the same 4 question survey from National Council
77% of clients reported it either ‘Very Helpful’ or ‘Helpful’ to have their provider review notes with them at the end of session (similar to national average)
80% of clients reported they felt either Very Involved or Involved (Likert Scale) in their care (similar to national data)
Outpatient Data
88% of clients reported their provider did a ‘Very Good’ or ‘Good’ job with introducing the system
72% of clients reported they would want their provider to continue the CD method
Overall, data from this pilot was similar to national average in terms of client responses/reactions to CD
Staff Reactions to CD
100% of the staff who were surveyed had implemented CD for one or more months
83% reported it was either ‘Very Easy’ or ‘Easy’ to learn collaborative documentation vs. 16% of staff who reported it was ‘Not Easy.’
58% reported CD is helpful to the treatment process vs. 33% who reported it was ‘Neither Helpful nor Not Helpful.’
50% reported clients were either ‘Very Involved’ or ‘Involved’ in the treatment process as a result of CD (77% of clients reported feeling involved in their care)
75% reported CD has been helpful with paperwork efficiency
50% reported better workplace satisfaction with the use of CD
Research on Nonverbal Communication
A study out of Northwestern evaluated eye gaze patterns between PCPs and patients while electronic health records are used
100 patient visits were observed and video-taped in 10 PCP offices
Researchers wanted to assess eye contact as it relates to using electronic health record systems vs. paper charts
Investigators interested in how EHR affects the quality of the patient/physician interaction
Possible design guidelines indicated
Findings
Given that nonverbal communication is being explored as an important aspect to treatment, eye contact, body language, posturing, and facial expressions are vital when using an EHR system
This study found patients eyes go where the physicians eyes go (patients gazed at their doctor 50% of the visit vs. doctors gaze patterns towards patients, which was 47% of the visit)
Physician initiated eye gaze was found to be an important driver of interactions between the patient/physician.
Implementation
Skepticism
Concerns
Healthy work/life balance?
4-6 weeks to transition fully into CD mode
Addressing concerns as they arise
Seeking guidance/support from management during the initial phase
Questions?
References
Asan, O., Montague, E. (2014). Dynamic modeling of patient and physician eye gaze to understand the effects of electronic health records on doctor-patient communication and attention. International Journal Of Medical Informatics. Vol 83, 225-234.
Schmelter, B. (2013). Collaborative documentation gets you off the compliance treadmill. Retrieved from TheNationalCouncil.org.
Stanhope, V., Ingolia, C., Schmelter, B., Marcus, S.C. (2013). Impact of person- centered planning and collaborative documentation on treatment adherence. Psychiatric Services, Vol 64, 1, 76-80.