How to Track the Data?
How to Track it?
Some clinics will have all data integrated into the same system (i.e., a clinic that uses all components of the eClinicalWorks software). Others will be paper-based or have multiple electronic systems that may not communicate. It is important to understand where data is collected and who needs to see it. For example, whoever does registration needs to know what forms to give a patient, when that patient is eligible for SBIRT, etc… someone needs to record that data set, and it needs to be useable by whoever completes that process. The same thing is true for whoever completes the prescreening and/or screening, and whoever provides services to the patient. What is the optimal place to locate this data on a case-by-case basis? If it’s not in a shared EHR system, then how will the physician or other care provider be notified of important details?
Incorporate EHR to support implementation (if possible)
One does not need a robust, fully operation electronic health record (EHR) to introduce SBIRT. A paper screening instrument, if kept with a paper chart for patients without complex medical problems (possibly in a pre- and pot-natal obstetrics practice or family practice with a large number of young relatively well patients) may work perfectly well. As more practices turn to electronic records, you will doubtless encounter issues related to the specific system you are using. Some issues we encountered include:
How to catch up with continually changing systems. The ”moving target” of different electronic records systems (including those which are used for work flow as distinct from the archiving of clinical information). We had several delays because a new version of the EHR was being installed. Often the original targets were missed, leading to longer delays. Hard to see any way around this.- How to enter data is always a concern. We considered scanning paper forms into the record, using a general health screen administered on tablet computers or kiosks, and with the introduction of screening in the community health centers, we landed (for now) on recording screening result on paper forms with later direct entry of the data into the medical record. In the future, the screens will likely be administered by a medical assistant using a laptop.
- How to display the data for subsequent review, and ways to use it as a flag for at risk drinking or substance use (while avoiding “alert fatigue”) is a subject of research in our group. What is the best way to combine screening data in a flow sheet (and incorporate the data with all the other trends we would like to follow?
None of these are, of course, insurmountable, and we raise them simply so you are aware of them ahead of time in order to watch out for and take steps to mitigate delays caused by these data related issues.
If you don’t know what you did and how well you did it, how can you possibly know whether things are working and how to improve them!? Data. That’s the ticket. NOW you are ready to go live!