Complex psychiatric requirements ‒ resolved through i.s.h.med
Klinikum Lippe GmbH (KLG) – with its three sites in Lippe, Detmold and Bad Salzuflen – is one of the major hospital groups in Germany, with 2,800 employees and 1,400 beds. i.s.h.med® was rolled out in 2008, and now the Child and Adolescent Psychiatry fully forgo the last pieces of paper documentation in favor of the digital documentation.
The Child and Adolescent Psychiatry in Lippe includes 48 inpatient beds and 35 day-patient offerings, as well as approximately 150 employees and three day clinics. The entire spectrum of developmental disorders and psychiatric illnesses of children and adolescents from three to 18 years of age is treated. Eva-Maria Scheiwe leads the i.s.h.med core project team at the Child and Adolescent Psychiatry. She presented the establishment of the hospital’s digital documentation at i.s.h.med User Conference 2021.
Special requirements of psychiatric institutions
In clinical psychiatry, many different professional groups work together to meet a common goal: the recovery of their patients. Cases are reviewed interdisciplinary. That means digital documentation needs to consider the different roles and interactions of the clinician and nursing teams, as well as all the ancillary therapists and social services involved. Additionally, lots of different forms and types of therapy like one-on-one or group therapy in planning and documentation, patient tests and interprofessional team meetings need to be showcased.
In Lippe, the goal was to forgo paper-based documentation entirely. Moreover, it was important to build a connection across departments (in this instance, the Children's Hospital) and implement a documentation that is both time- and resources-efficient. This enables employees to warrant their young patients more therapy time. It was equally important to be able to access the current action planning and actions, avoid double documentation at all costs and enable a quick and clear availability of important information. To handle all of that and more, a high overview and a simple documentation mechanism was needed.
Planning reasonable time and capacity for the conception phase
Other specialist departments of KLG – like neurology, surgery or geriatrics – have been very successful in mapping with i.s.h.med, which was beneficial for the project team. They were able to engage with already existing application scenarios while auditing their own needs. It took only a short time to establish that the design phase is one of the central moments of project deployment and the key aspect for the performance of the practical application in the future ‒ for example, are there possibilities to include free text in the order functions and if so, which ones. Part of the interdisciplinary i.s.h.med core project team by Eva-Maria Scheiwe was Christos Tarassidis, lead physician of the Child and Adolescent Psychiatry, key user from nursing and therapy as well as Cerner consultants and project developers responsible for customizing.
Everyone involved met regularly to actively carry the concept forward in joined planning sessions. The goal: digital implementation. “Looking back, we did everything right. Especially taking a lot of time for the design phase. Users have been able to clearly communicate and explain their requirements and thus definitely challenged the programmers in the project team. This is now clearly paying off in practical operation,” says a pleased Eva-Maria Scheiwe.
Sufficient scope through i.s.h.med standard functionalities
In Lippe, everyone is excited that in i.s.h.med it is possible to showcase the different professional groups with their different requirements, that need to work very closely with each other and confirm that they are up to date for every single patient. It is also possible to switch to other documents, orders, medication, nursing plans or progress documentation while you work on the documentation, to document there as well or view information that is up to date. The EHR’s clear visibility of the occupancy provides a quick overview about coming actions and tasks for varying editors. The tab scheme known from the paper chart was recreated, to be able to recognize new orders or changes to medication, for example. There is also scope for implementing specific content and tasks, which is especially needed in psychiatry. Thus, KLG developed a central base document that maintains all essential and relevant patient data from the time of admission. For example, you can also find specific content, shown in columns in the occupancy views, like instructions for an ordered physical activity, for weekend exertion, existing hazards, etc. Case-related documentation of all professional groups can be linked to the discharge summary later.
Furthermore, the Child and Adolescent Psychiatry decided to opt for the team meeting function as a supplementary enhancement in i.s.h.med. In this case, the good experience with this enhancement from the geriatrics department of the Klinikum were adopted. All persons involved in a case insert their notes in occupational group-related history documents; this information about deficits/progress and goals/actions are the basic for the next group-related team meeting and are put in a joint team meeting document.
The added value is immense: documentation and billing are linked
In order entry, all benefits of digital documentation in Lippe come into effect ‒ i.s.h.med is a great help in reducing the workload. This is because in order entry, the clinical documentation is related through the automatic distribution of service figures from the catalog of services. This happens after an order is approved. That time, duration, team, and content can be documented in one interface is experienced as very practical. All this information will be uploaded automatically to the history menu, where it will be accessible for view. Single therapy units (for groups and/or single patients) can be accounted as relevant for billing purposes as well.
Digital standards economize clinical processes
Today, all the information is readily available in the Child and Adolescent Psychiatry in Lippe and you don’t need a lot of handwritten input, reducing the risk of error and transmission as well as unnecessary duplicate entries. “The possibility of using different entry points to access the documentation in i.s.h.med proves very flexible at the same time,” says Eva-Maria Scheiwe. It doesn’t matter how the entry happens – through an order, medication or the patient profile. Users can quickly find their way to the overview or patient-specific task lists. The clean overview of i.s.h.med is essential for the fast orientation of editors and their ability to directly move on with their work. During the design phase, the team in Lippe worked towards checking the processes that had been mainly analog until then and replaced them with the implementation of digital workflows with improved efficiency for all persons involved. “You are able to access every case’s textual documentation at all times and in every location where a computer is available. You no longer have to search for a patient’s paper chart.” Eva-Maria Scheiwe is certain: “Readability, overview and a high level of availability are tangible benefits.”