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Friday, 12 April 2019

Exerting Control Over Compliance, Workflows, Tracking, and Reporting

Exerting Control Over Compliance, Workflows, Tracking, and Reporting

NOTE: This article is adapted from a Facebook Live presentation by Dr. Michael Gordon. The co-founder of ClinicTracker, Gordon is a Ph.D. clinical psychologist, veteran clinic administrator and clinical researcher, and a longtime advocate for effective, data-driven clinic management.

Years ago I saw some opportunities to work with our local department of social services to provide psychiatric services to children who had been placed in care. It was your basic win-win. DSS got high-end psychiatric services for children who most needed it (and who traditionally were served piecemeal by community providers), and we had opportunities for training, research, and to earn money we could use to expand our services.

The rub was that the commissioner in charge and the one that followed her were sharp administrators who insisted on regular and detailed reporting about our clinical activities. We also billed them based on the quantity and nature of the services we offered as well as the time we spent in collateral activities like phone calls to pediatricians and schools. Some of the data we had to provide was obvious – like how many children we saw in the last 90 days or how many appointments we provided during that time. Other obligations were more refined, like how many appointments were for play therapy, how many with the whole family, how many for pharmacotherapy. They wanted to know how many of the kids were in foster placement versus some of the DSS in-house programs, and so on.

We had only the most rudimentary systems at that time (mainly hash marks kept on legal pads and the beginnings of a clinic database). I also had one secretary for all our services and not enough income to pay for much more.

The software packages at the time could give me an electronic medical record and some canned templates for paperwork, but that was it. I needed a system that went far beyond an electronic health record and some reporting. I needed a way to make sure I could comply with the terms of contracts I was negotiating and with the increasing burden of regulations from the state and insurance companies.

Watch the recorded Facebook Live session with Dr. Michael Gordon.

Listen to Dr. Michael Gordon here or on your favorite podcast player.

My requests stumped the vendors. I asked, “What if I need to prepare a report that lists these 15 stats broken down by these 5 different groups over a reporting period of my choosing, like the last 90 days?” Or “How do I get the system to notify me if we’re providing more than the agreed upon number of appointments during the last 30 days?” And this got the blankest stare: “We agreed that we’d see children for an intake within 5 working days. Can your system tell me the average number of days it took us to see children for the intake and, by the way, can you have it alert me when a referral comes in and the youngster still hasn’t been seen within the 5-day span?”

The way I looked at it, if I was going to commit to this contract, I’d better be able to make sure I was honoring our obligations. The only way I knew to do that was to have a system that allowed me to nimbly track and report our activities. I also needed it to serve as an early warning system if we were veering from meeting our responsibilities. And I sure wasn’t patient enough to wait for programmers to generate reports and data. These commissioners expected reports on time and accurate. So it became obvious that the only way I’d get a system to work for me the way I needed it to work was to design it myself.

The other contributing factor was that the state office of mental health was tightening its requirements for clinic certification. To me, the scariest part was that they were shifting from scheduled site visits to unannounced ones. That concerned me big time because, in the past, we knew when they were coming and we’d bring in a crew of secretaries over the weekends to go through all our files and make sure we were at least within spitting distance of compliance. The game had changed and we had to be compliant at all times. We either had to come up with a system that let me know the status of our paperwork, or I was in trouble.

Pure necessity was the mother of this particular invention. I either came up with a system that could help me manage the growth of our programs or I’d have to back off from seeking contracts that would help us grow.

There were numerous aspects of our services that I wanted to coordinate and track using the system we were developing. We started subspecialty clinics, like for ADHD and anxiety, and we needed to account for them separately from our general clinic. They also had specialized forms we wanted the system to make available. And then we realized that we’d better keep a close eye on release of information forms, so we developed a system that let us know when those papers had to be re-signed. And then the department of social services got interested in how many of their children took one psychotropic medication, how many took two, etc. And then there was a black box warning on some of the meds, so they wanted assurance that we could get a quick report on which of their children might be affected. And so on.

Through the years and with the input of our staff, we kept looking for ways that I or any of the supervisors could know our status on any number of factors with just a click. Most important to our long-term survival is that I never had to wonder whether all our progress notes were signed or whether we were in compliance with any other performance indicator that the office of mental health might decide was important to our accreditation.

That’s how ClinicTracker ended up being much more than just a way to keep an electronic health record or bill patients. It evolved into a system that you always knew you could modify and expand as you needed it to or as you had some other bright idea.

As best I can tell, ClinicTracker still is the only system or at least one of very few systems that gives managers such total control over what they can track and how they can track it, how they can report on things, and how they can set up workflows. I know of no other system that lets you design reports that show exactly what you want them to show. I don’t know why our system is one of few that provides managers with an instant infrastructure that they can continuously customize as the need arises. It might be that managers don’t think through the extent to which the software should help them manage their operations. Maybe administrators have enough staff who can do things manually. Maybe their state regulators don’t suddenly decide to institute idiosyncratic reporting requirements. Maybe they’re all a lot smarter and more disciplined than I am.

Now, more than ever, we’re under pressure to be as efficient and alert as possible. By thinking through how we can use software to automate and track and report on everything, we can keep our operations on the straight and narrow.

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