Case Study: Crittenton Services, Inc.
Crittenton Services, Inc. has been aiding young women in need for over 100 years, providing them with a residential facility, maternity care, enrichment programs and behavioral health services. Crittenton is licensed by the West Virginia Department of Health and Human Resources as a behavioral health center, certified family preservation provider, residential maternity facility and child care agency. Crittenton is a member of the National Crittenton Foundation family and the West Virginia Child Care Association and is accredited by the Council on Accreditation.
Serving up to 42 women in their residential program and over 500 children in their community program at any time, Crittenton was looking for a way to improve their record keeping in order to improve access to information, reduce the risk of errors and reduce the inefficiencies of dealing with paper-based records.
The Problems:
With over 500 community based charts in the Wellspring Family Services program open at any given time, Crittenton was spending endless hours organizing and maintaining client paperwork. Detailed and accurate client records were essential to the quality of care and services provided. Accurate record keeping was also critical to receiving reimbursement for services rendered. Between their residential and community programs and services, staff members were always feeling like they were a step behind with their paper processes.
Additionally, West Virginia regulations require provisional counselors to be supervised for two years prior to obtaining their license. This meant Crittenton supervisors had to review all documentation generated by these counselors. With a service area spanning 16 counties and over 4,400 square miles, this provided a significant logistical challenge for Crittenton. As a result, the review process could take upwards of a month due to the manual process of passing paper back and forth (often times via the mail) between the counselor and supervisor.
The process of moving charts for audit purposes was also extremely arduous. Crittenton performs internal chart audits as well as executive chart reviews, peer reviews, utilization reviews and the external licensing board reviews. These audits and reviews required a constant flow of charts from the remote locations to the main office. From Chain of Custody documentation to driving 80 miles to pick up charts, the gathering of charts for the review process was a huge resource drain on the organization.
Crittenton’s residential program presented its own unique challenges. The average length of stay for the residential program is six to nine months. The daily documentation on clients results in a typical client having at least four large three-ring binders full of paperwork that needed to be accessed and reviewed constantly. With the sensitive nature of client documentation, paper documentation presented a global confidentiality issue. Not all staff members needed access to an entire client’s record. Yet, by virtue of the fact that the client’s record was paper-based, it was nearly impossible to restrict access.
The Solution:
To improve their access to clinical information and the processes associated with managing this information, Crittenton required a solution that would decrease their dependency on paper, the amount of time necessary to process paperwork and replace all current paper-based client records with an electronic version of client records.
With a number of implementations at other West Virginia agencies, Crittenton sought out ScerIS to help them address their problems. Being a non-profit agency, Crittenton was challenged to find the capital funding for a project of this scope. As a result, Crittenton opted for a “phased” implementation approach.
Phase I: ScerIS Imaging & Electronic Medical Records (EMR) Repository
The implementation of ScerIS Imaging provided Crittenton with a solution that allowed for on-line access to client records. Open client records were scanned from the designated inception date and were scanned from that point forward. Ongoing daily documentation was also scanned and indexed by staff members. ScerIS seamlessly integrated with Crittenton’s host database to facilitate the indexing process. With ScerIS, multiple users across Crittenton’s network can simultaneously view a client’s record. ScerIS also provided a completely secure environment for confidential patient information with multiple security levels and HIPAA audit trails.
The ScerIS Repository allows for the presentation of client records in a “tabbed” format. This tabbed presentation provided Crittenton staff with a user interface that looked like the former paper charts, allowing staff to more easily embrace the new electronic environment. Beverly Petrelli, VP of the Wellspring Family Services stated "Rather than travel 80 miles to obtain one document, I can retrieve it with one click."
Phase II: ScerIS E-Forms
ScerIS E-Forms was implemented to eliminate as much of the paper as possible. Client documentation is completed electronically on E-Forms that were designed to have a similar look and feel to the former paper documents. The familiarity of the E-Form to the paper reduced the learning curve required for completing documentation. E-Forms were also set up with required fields and rules defined insuring uniformity of record keeping. Completed E-Forms are signed using a signature pad and routed or archived depending on required next steps.
New staff documentation requiring supervisory review is routed to a supervisor. The supervisors can provide feedback to the staff member on the E-Form content, requesting adjustments to the documentation if necessary. Upon completion of review, E-Forms are archived to the ScerIS Image Repository where they seamlessly integrate with any scanned documents.
Phase III: ScerIS Remote E-Forms
One of the challenges Crittenton had not initially anticipated was the completion of E-Forms by staff who provided services remotely at schools and client’s homes. Air cards were not an option for Crittenton due to the remoteness of the West Virginia mountains and lack of wireless signal. Crittenton turned to ScerIS in search of an additional solution for managing these remote staff.
ScerIS Remote E-Forms allow field staff to complete E-Forms on their laptops. When staff arrives back at one of the offices, they now synch their remote E-Forms to the main ScerIS E-Forms environment. This allows any database looks-ups and validations to occur. Staff then sign their completed E-Form and route/archive them in their traditional fashion.
The Results
Today, Crittenton has eliminated the physical paper records on active clients in both the residential and community programs. Clinicians have instant access to client information. Supervisors have instant access to documentation completed by new staff for review and feedback. Kathy Szafran, CEO for Crittenton Services commented “The service delivery has been absolutely outstanding. No exaggeration, this is the legitimate truth. ScerIS Solution Engineers ROCK.”
Even the external review boards such as APS Healthcare, West Virginia’s state Medicaid audit firm had instant access to client records for audit purposes, recently reducing the audit time by 33%. APS complemented Crittenton on their electronic records management solution. Internal and external audits no longer require a scramble to track down paperwork or travel all over West Virginia to obtain files. Kathy Szafran stated “ScerIS makes staff more accountable for completing their paperwork in a timely and accurate fashion." Crittenton has reduced its audit risk and reduced the risk of errors all while improving the services it provides as a result of instant access to information.
Future Endeavors
With the success of implementing ScerIS, Crittenton plans to expand using ScerIS for maintaining Human Resource records and Business Office paperwork. Additionally, Crittenton is looking into possibly leasing out space on their server for smaller agencies, enabling other behavioral health organizations to benefit from ScerIS technologies and solutions.