With the demand by payers, regulatory authorities and accreditation bodies to demonstrate efficacy of treatment, providers are increasingly employing standardized assessment tools to quantify outcome and satisfaction data. Most of these tools are now either automated or the results are being collected in a database for research, evaluation and planning. There are three basic approaches to automating clinical assessments including:
1. Commercial assessments that run as stand-alone packages on PCs
2. Assessment modules that are part of a behavioral health MIS
3. The use of various office systems products to create your own (spread sheets, databases and word processors)
Commercial Tests:
Numerous commercial automated tests and questionnaires are available which can be used to supplement an automated clinical record for a client. These programs may be integrated with the basic clinical record or they may be stand-alone packages running of a PC.
Currently, there are programs available for a number of social, psychological, psycho-neurological and medical conditions. Some of the potential problem areas that are evaluated include religion, family, education, marriage, personality traits, sex, military experiences, employment, crime history, alcohol and drug abuse and medical illnesses. Some of the systems produce an index of the type and severity of the problem, while others produce narrative reports that just repeat the clinician's observations.
Systems can be set up for the client to respond directly by answering questions on the computer, while others use a hard copy questionnaire that is then entered by the support staff. In the self-reporting versions, the therapist can also annotate the responses provided by the patient. Some of the programs are designed to automate a specific psychological test, while others are more generic and user definable.
"A useful feature of some of the more flexible and sophisticated assessment systems is the ability to include your own questions, perform simple calculations and/or design your own questionnaires. These systems also provide the capability to design custom reports and export files for importing into other systems. In the simplest versions, the software might just print out the field name or question and the patient's response. In more sophisticated programs, the user is provided with the tools to do additional analysis and statistics on multiple cases. If statistical analysis is required, and content analysis is not, there are some excellent survey programs developed for marketing that could be applied to mental health. ." (Johnson 1996 in Miller).
Integrated Assessment Modules:
Several of the behavioral health management information systems on the market today offer dedicated assessment modules that are fully integrated with the other clinical and client registration applications. These programs allow the user to create their own assessment on-line.
A useful feature of these integrated assessment systems is the ability to design your own questionnaires. These systems also provide the capability to design custom reports. Some of the systems offer the option of creating different types of response formats like yes/no, multiple choice, numeric, etc. Another attractive feature is the ability to build conditional logic into the questionnaire so the system will automatically branch to a particular question based on the response to a previous question. Other versions will perform mathematical operations on the responses to calculate scores and subscales for a test.
Reporting capabilities are also built into the applications. In the simplest versions, the software might just print out the field name (question) and the clients' response. In more sophisticated programs, the user is provided with the tools to do additional analysis and statistics on multiple cases.
If statistical analysis is required and content analysis is not, there are some excellent survey and statistical analysis programs that could be employed to create assessments. When designing your own database of assessment information, it is important to link the test results with other coded demographic and clinical variables.
When these data are standardized and coded, they can be used to build a database of clinical information for clinical studies and statistical reports. Despite the capabilities of the integrated assessment modules, it is probably advisable to use them for simple, limited assessments, while third-party products can be purchased for the more sophisticated applications. Our recommendation is to keep the summary data that you want to correlate with the other client variables online. All of the raw data are probably not required.
Office Systems Products:
The third option is to use spreadsheets, word processors and/or database management software to create your own assessment tools. A database could be used, for example, to create a data entry screen and store the results. These data can then be summarized and exported into a spreadsheet, which can then be incorporated into a word processing document. This process is greatly simplified now that Microsoft has developed standards for object linking and embedding (OLE) and dynamic data exchange (DDE).
The advantage to this method is that you can use programs that you are already familiar with and you have a great deal of flexibility. The disadvantage is that these projects are never as easy as they seem on paper and the data are not immediately available to the central information system.
Some Sample Assessment Capabilities:
- Determine necessity for a specific level/type/duration/security of care/services
- Determine level of functioning severity
- Compare service necessity with service criteria
- Include/reference payer protocols for assessment and admission to a particular program
- Determine need for outside referrals and consultations
- Track and monitor worker conformance to assessment and intake protocols, policies and procedures
- Track and flag need for re-assessments per payer or licensing requirements
- Correlate assessment data with financial information to estimate cost of achieving a particular outcome or level of functioning
- Allow local program variation for assessment elements, for example, extensive medical screening, substance abuse screens, behavioral assessments, mental status exam, etc.
- Aggregate assessment data longitudinally over time
- Aggregate assessment data across clients
- Aggregate assessment data with service data to determine efficacy of service pathways
- Accommodate/incorporate external payer assessment instruments
- Accommodate/incorporate commercial assessment instruments
- Compare assessment scores with benchmarks from other organizations
- Incorporate assessment data into performance improvement and outcome modules
About The Authors:
Bruce Johnson, M.S., is President of Johnson Consulting Services, Inc., an information management consulting firm that specializes in working with healthcare, social service and managed care organizations. He can be reached at (800) 988-0934, www.jcsconsultants.com or by e-mail at jcs@eos.net. Mr. Schafer is a clinical records and operations management consultant. He specializes in working with managed care, behvavioral healthcare and child welfare organizations. He can be reached at (800) 661-2435, www.schaferconsulting.com or by e-mail at steve@schaferconsulting.com.
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