Inova Kellar Center (IKC) is a nonprofit behavioral healthcare provider based in Virginia that provides programs and services for children, adolescents and their families.

IKC Inova Health System has relied on evidence-based solutions and standardized approaches to treat patients, earning recognition for excellence in healthcare from the Centers for Medicare and Medicaid Services (CMS), U.S. News & World Report Best Hospitals, and Leapfrog Hospital Safety Grades.

THE PROBLEM

While IKC always had used standardized approaches to measuring progress with clear, established treatment goals, it still was somewhat of a subjective approach. Ultimately, IKC wanted to better answer the questions: "Is what we're doing working? Can we prove we are making a difference and improving patient outcomes?"

Though IKC was aware of its clinical outcomes based on its clinical understanding, recidivism rates and regular feedback from patients, it needed a way to confirm it, and to demonstrate that the treatment programs it put in place were working.

"Current methods of proving that out included extensive resources to do longitudinal follow-up, which was difficult and costly and, quite honestly, wrought with issues in trying to get the data," said Dr. Rick Leichtweis, executive director of Inova Kellar Center. "Specifically, IKC needed an automated, outcomes-focused, measurement-based care solution with tangible evidence to confirm patient progress.

"As the behavioral health industry continues to evolve, patients, parents, regulatory bodies and third-party payers are increasing their demand for evidence-based treatment interventions that have demonstrated success in the treatment of mental health disorders," he continued. "Further, providers are being asked – and in some cases, such as with The Joint Commission, required – to demonstrate the use of evidence-based outcome measurement systems to evaluate efficacy."

This is of particular note as consumers seeking services become more sophisticated in researching provider outcomes and patient satisfaction. It has become more common to have patients and/or parents ask about patient outcomes and program evaluation.

"IKC now can do multiple screeners for patients with Owl. Instead of previously doing one or two by paper and pen when they are in the waiting room, IKC can provide a full battery of 9-10 assessments that would best inform the clinician for a treatment plan."

Dr. Rick Leichtweis, Inova Kellar Center

For the organization, measurement-based care is the opportunity to assess the effectiveness of programming and interventions as a key component of ongoing performance improvement initiatives, he said.

"It also was important to IKC that the solution be both patient-friendly, to ensure high patient engagement, and clinician-friendly, so that IKC providers would use it and see the benefits it brought them in their day-to-day work with patients," Leichtweis said. "Paper-and-pen-based standardized assessments were being used, but that often took valuable time for IKC providers to assess and score the measures. Time that could be more productively spent in session with the patients."

PROPOSAL

Given IKC was already a high-functioning organization, it wanted to "up its game" with measurement-based care to further demonstrate that the improved patient outcomes were real. It turned to measurement-based care IT vendor Owl.

There are several features of the Owl solution that made it stand out to Leichtweis and his team:

• An organic solution. It was developed by clinicians for clinicians with a purpose to assess a community-based mental health intervention model, he said. The platform is tailored to the needs of providers and it's clear to users that it was created by clinicians rather than by a large for-profit organization that doesn't understand clinician needs and workflows, he added.
• It informs IKC treatment planning. Owl provides the clinician sound data that is used to inform treatment planning and treatment strategies, he said.
• Easily accessible for patients. Patients simply need access to an iPad to complete the questionnaires in a straightforward manner; the Owl is easy to use and is designed to deliver the same user-friendly experience that people today have come to expect from all their routine online or app experiences, he said.
• Real-time visibility for clinicians. The ability to assess patient progress using real-time charts and graphs to provide a visual synopsis of a patient's clinical presentation is appealing to clinicians, Leichtweis explained. The technology, in near-real time, automatically scores and interprets data, which previously was a time-intensive, pen-and-paper task for clinicians. As a result, clinicians save precious time by quickly narrowing their patient discussions on the most important issues.
• Comprehensive assessment library. The number of evidence-based screening measures available for mental health is robust, he observed. Owl has more than 200 standardized, validated measures in its library, which introduced a wealth of assessment opportunities that may not have previously been available to the clinician, he said.

MEETING THE CHALLENGE

All of the clinicians at IKC use Owl, as well as the front office staff who provide the questionnaires through the iPads for patients in the waiting rooms.

"Given children and adolescents sometimes are unable to answer certain questions and the importance of getting parental input as part of these assessments, IKC provides questionnaires to parents as well," Leichtweis explained. "The parental perspective helps the clinician better understand the patient in different settings, ultimately helping improve the quality of patient care.

"The integration with our Epic EHR was key for IKC," he continued. "Furthermore, the single sign on was incredibly helpful to providers so they could access both Epic and Owl with just a single point of sign-on. That was significant for our clinicians."

RESULTS

IKC has reported statistically significant reductions across partial hospitalization programs (PHPs) and intensive outpatient programs (IOPs) for adolescent clients in severity of: suicidal ideation, non-suicidal self-injury, depressive and anxiety symptoms, sleep disturbances, disordered eating symptoms, PTSD symptoms, and alcohol abuse/dependent symptoms.

"IKC now can do multiple screeners for patients with Owl," Leichtweis noted. "Instead of previously doing one or two by paper and pen when they are in the waiting room, IKC can provide a full battery of 9-10 assessments that would best inform the clinician for a treatment plan. This provides a broader view and perspective of what is happening for the patient."

The time saved for the clinician to score and interpret the assessments is significant: anywhere from 5-20 minutes per patient is saved and now focused on quality time with the patient.

ADVICE FOR OTHERS

"When it comes to the implementation of a measurement-based care solution, different approaches will work better at different organizations," Leichtweis advised. "Oftentimes, mandating the use of the new tool from the get-go is the most effective strategy – doing so achieves 100% adoption right away, and therefore the business benefits will be realized more quickly, too.

"But at IKC, a careful, phased approach that slowly achieved buy-in worked better than demanding 100% adoption from the get-go," he continued. "While IKC ultimately informed staff they would be moving to a new platform and that people could not opt out, they slowly and methodically delivered the mandate within smaller groups, so that those clinicians without initial access to the tool saw the benefits from afar and were motivated to use it themselves."

This strategy led to a "when can we get it, too" attitude across the organization, which helped tremendously, he added.

Twitter: @SiwickiHealthIT
Email the writer: bsiwicki@himss.org
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