Patient stories are powerful, but there is no easy way to capture them in a standard EHR. The Centre for Addiction and Mental Health (CAMH) overcame this challenge by customizing their Cerner system to accommodate a special “This is Me” section where patients and clinicians could jointly document stories. Both patients and staff have benefitted from this enhancement.
I recently had the opportunity to sit down with a team from CAMH to learn more about their remarkable work to incorporate patient stories into their EHR. In the video below you will hear from:
- Aileen Sprott, CAMH Risk Specialist;
- Lydia Sequeira, a doctoral student at the CAMH Digital Mental Health Research Lab;
- Denise Johnson, a CAMH social worker with the Forensic General Unit;
- Colin Chu, a CAMH senior project manager; and
- Sarah Kimball, a member of the CAMH Patient Advisory Council.
Seeing patients as people
CAMH, is Canada’s largest mental health and addiction teaching hospital and a world leading research centre in this field. CAMH combines clinical care, research, education, policy development and health promotion to help transform the lives of people affected by mental illness and addiction. They deliver clinical care to more than 34,000 patients each year.
The seed for the idea of incorporating patient stories in their EHR was planted way back in 2008. At that time, Chu had a conversation with the deputy chief of nursing. During that conversation the chief made a “wish list” request – wanting somewhere to document “get to know you” patient information so that clinicians could see their patients as people.
Chu loved the idea, but knew it wasn’t feasible at the time. It took until 2014 before the opportunity came to bring the idea to life. Chu pitched the idea at CAMH’s Innovation Expo. Even though he didn’t win, the Expo provided exposure and the idea landed on the right ears, gained traction, and eventually secured internal resources to move forward.
Co-designing with patients and clinicians
While Chu was developing the technology, Sprott was involved in an organizational strategic initiative to enhance safety through piloting “Safewards”. Safewards is an evidence-based, open source, model of care developed by Len Bower involving ten interventions shown to reduce conflict and containment in mental health inpatient settings. One of the interventions is “Know Each Other” which focuses on fostering mutual familiarity through sharing innocuous information to help build therapeutic relationships with patients. The idea was to bring attention to the importance of understanding patients as a whole – especially their life outside of the facility.
The idea just made sense to Sprott. CAMH’s Patient and Family Advisory Council agreed.
“When I’m inpatient, I want the nurses I’m working with to view me as more than just depressed with PTSD,” explained Kimball. “I want to be seen as more than my diagnosis. I want to be viewed as a whole person.”
Kimball also noted that having her story in her record helps her clinicians get a deeper understanding from a clinical perspective. For example, her story may talk about how she regularly sees friends and family during the week. But if a clinician finds out that she has been more reclusive over the past few weeks, that may be a clue that something is going on. That type of insight is not possible without a deeper understanding of a patient’s full story.
During the design phase, many stakeholders were asked for their input:
- Social workers
- Union leadership
- CAMH executives
- Patients
- Clinicians
- Nurses
Getting so many involved, helped with sustaining buy-in for the initiative. This was critical to the success of the project because the technology changes were not simple and multiple stakeholder support was needed to make it happen.
Capturing patient stories
The team at CAMH customized their Cerner system to include a set of forms and pages where their patient stories could be captured and viewed. Right when you log in, a clinician can access the patient story via the “Know Me” option on the home page.
The patient’s story is initially entered by a social worker in consultation with the patient. The social worker asks a series of questions based on the standardized form that is in Cerner and enters the responses into the system.
The result is a rich narrative that paints a more complete picture for clinicians about the patients they are helping.
*Note the patient information above is fictitious and does not correspond to an actual CAMH patient.
Well received
“This is Me” was rolled out in October 2018 and by August 2020 over 1,400 stories had been entered into the system. The feature has been well received by staff. “Having these stories available really helped them feel closer to the people they are serving,” said Johnson.
In a paper about “This is Me” written by Sequeira, Chu, Sprott, Rani Srivastava, John Strauss and Gillian Strudwick, published in Healthcare Quarterly in early 2021, the team shared the following reasons why clinicians at CAMH used the feature:
Anyone with system access, can view and add to the patient story at any time.
Johnson noted that patients have the final say about their story: “They have the choice of whether or not they’d like to be involved. If they’re interested, we’ll sit down and go through the various domains and we can get to know them a little bit better. The beauty of it is it’s on the homepage so it can follow patients during different admissions so they don’t have to start from ground zero each time, reintroducing themselves over and over again.” Patients can opt out of having their stories entered into the EHR.
An impressive accomplishment
While speaking with the CAMH team, their passion for the project was palpable. It is impressive how they kept the flame burning for almost 10 years and how many stakeholders they involved in the design of the solution. In the end, their “This is Me” addition to Cerner humanizes their patients – an important aspect for the important work that they do with mental health and addiction.
It was a joy to speak to so many people so passionate about the same common goal. I’m sure you’ll agree as you watch the video.
Watch the video to hear more about:
- How the various areas within CAMH and their Patient Advisory Council coordinated efforts to make innovation happen
- The workflow the team follows to capture the new patient information
- How a task force helped this project go from “green-light” to implemented in less than a year
- The importance of having organizational buy-in and how you might be able to get it
- Sustainability and why it’s such an important consideration for new technology initiatives
The CAMH team will be presenting their work at the upcoming e-health Conference.
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