Mental Health Outpatient Information System (MHOIS) Data Quality Improvement Project
Shah, Abrar Ali
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Mental Health Outpatient Information System (MHOIS) is used to store demographic, socio-economic, administrative and clinical data of mental health patients seen at various facilities offering Mental Health Services throughout the province of Nova Scotia (NS). The MHOIS data is used by the Department of Health (DoH) to increase its ability to audit, evaluate, monitor and fund services.  It is important for DoH, NS to collect consistent, accurate, comparable information timely from all the nine District Health Authorities in the province for above-mentioned purpose. DoH drew attention of some of the hospitals to data quality problems and Izaak Walton Killam (IWK) was one of them. The Department of Psychiatry of the IWK hired author as an intern to research on how to improve the MHOIS data quality working very closely with Decision Support Services (DSS) team. This internship goal was set up to review the manual and ensure all the IWK MHOIS administrative and clinical staff were aware of the guidelines and time lines for submission, ensure proper program codes were assigned to each event. Review current practices and forms to ensure they met the guidelines and were being used appropriately. Quality check processes should be developed to ensure all the MHOIS data submitted by the central clinics of the IWK to the DoH was accurate, consistent and comparable. Reports were to be reviewed and analyzed utilizing the Cognos Cubes for distribution of the provincial MHOIS data. The completed project would be presented to the Mental Health Operations Committee. The intern divided the MHOIS data quality improvement project in three phases. The first phase of the project was to analyze the problem in detail. The second phase was to develop the solutions and strategies to fix the data quality problems. The third phase was to test and implement the recommended solutions. In the first phase of the internship, the intern realized that it is a research-oriented project. The intern and a team member from DSS department visited all the physical locations that offer Mental Health Services at the IWK to perform root-cause analysis. The routine process of collecting, storing and transferring of the MHOIS data was observed and investigated. All the people were involved in this process including administrative and clinical staff who were interviewed. After completing the first phase of the internship, the findings and the recommendations were presented by the intern to the Mental Health Operations Committee at the IWK on May25, 2006. The key findings were duplicate entries, data entry errors, inaccurate capture of the MHOIS data, lack of audit procedures, no deadlines for submission of the MHOIS data, loss of some MHOIS events, inconsistent and irregular backup of the MHOIS data, lack of the processes and no ownership of the MHOIS overall. The intern and DSS team suggested these recommendations: A Standard MHOIS form should be used, develop quality checks, establishing firm deadlines for clinicians and administrative Staff, training / refresher session for administrative and clinical staff, creating Centralized Backup System, an appointment of a MHOIS Co-ordinator and transfer of data though E-mail within IWK. The Mental Health Operations Committee at the IWK approved all the recommendations. The intern faced some challenges in the second phase of the internship to develop informatics solutions because of limited resources and unavailability of some of the key staff due to vacation season. Another major hurdle was to find the solution within the MHOIS system and existing workflow at all the clinics. The intern categorized all the problems into three major categories: People, Processes and Technology. The MHOIS system is 14 years old and is based on outdated technology. After thorough study of the MHOIS manual, investigation of the MHOIS information system, getting some assistance from MHOIS consultant and Programmer/Analyst at DoH, and having a technical background the intern was able to find workarounds to generate solutions to resolve data quality problems. The intern created solutions by using information technology, establishing processes and providing training to staff The third phase of the internship was to implement solutions. The intern believed that MHOIS users required refresher training to fix most of the data quality problems. Hence the comprehensive training material was prepared and distributed to the administrative and clinical staff. The intern along with the team member of the Decision Support Services (DSS) department delivered the training to all the administrative and clinical staff at all the satellite and central clinics. Some of the improvements were achieved immediately, and other improvements will be achieved after following the administrative and clinician training documents. The improvements following the solutions implemented are faster data transmission using E-mail within the IWK, reduction of the manual and Paper work for the administrative staff, consistent collection of the MHOIS Data, development of the quality checks of the data, merger of the clinic-specific unique client numbers to IWK unique client number (K number), processes for the administrative staff, principal diagnosis coding consistency, creation of the centralized backup systems, firm Deadlines for timely data Submission, reduction of the MHOIS data entry errors and duplicate entries. In order to maintain the sustainability of the data quality, MHOIS coordinator to be appointed should ensure maintenance of all the established processes, quality checks and the standards for collecting and submitting accurate, consistent, comparable IWK MHOIS data. In addition to that, the MHOIS coordinator should send a reminder to clinicians and the administrative staff before deadline and detect the discrepancy between data submission and the data available on Cognos cubes at the secured web site of DoH. The Provincial MHOIS Committee has requested the IWK authorities and the intern to share the work done at IWK to improve MHOIS data quality with all its members at the quarterly Provincial MHOIS Committee meeting. The Mental Health Operations Committee at the IWK has approved the request made by the Provincial MHOIS Committee. During the project, it was observed that some of the administrative staff logged on locally to their workstations (computers) but not on the IWK network and hence were unable to see the network drives. All their important work was saved on the C: drive of their computer. In case of computer or hard disk failure, the useful and the important data files can easily be lost. This was bought to the attention of higher authorities of Mental Health.