CCS - Secure EMR Access in Our Communities

Organization Information:

Organization Name:
Community Counseling Services of South Dakota
City & State:
South Dakota
Organization Website:
Organization's Mission Statement

Mental Health For All

Submission Information

Impact Essay

The Rural Behavioral Health Challenge - Client Driven Goals and Locations The old Hollywood image of a psychologist inviting the client into an office, to recline on the couch and tell their life story seldom applies to the Behavioral Healthcare providers of today. Community Counseling Services staff must see their clients and securely access their electronic medical records in any secure location available - including homes, businesses, schools or unorthodox places that clients may exist within our seven counties. CCS leadership recognized in 2003 that reaching outside of the clinic to meet clients in their settings is an effective way to provide behavioral healthcare. Because CCS clinicians must go to the client, the process of transporting our data securely is challenging. CCS has designed a process that allows our data to remain in centralized, secure locations. Often the clinician, client and their family must meet to create and electronically sign treatment plans and other documents. CCS employs an array of Microsoft products in this process. While we describe these systems in some detail below, suffice to say that, CCS could only succeed with the help of Microsoft – our business is counseling, not technology. Our staff presents the data we formulate with the client using Windows laptops and secure network connections. Because the data is never stored on the laptops, once the connection is ended, the laptop has no proprietary data stored. While this centralized data concept works well, a challenge to this system is finding network connections that can reach all remote clients in east-central South Dakota. CCS has begun accessing a number of technologies, including cell-phone based connectivity, tablet computers and electronic signature pads. CCS has committed to eventually providing every traveling staff member with a laptop and connectivity. The clinicians at CCS are faced with a significant challenge. We must go to the clients in their homes and other daily environments to better visualize, evaluate, offer resources and “see” their daily struggles. Our data must be available for the client and clinician to map out plans for treatment and recovery. The need for this delivery method encompasses clients of all ages, from pre-school children experiencing difficult home life to a growing population in nursing homes. Wherever CCS staff goes, we need to take our data and systems with us. From the inception of the electronic medical record rollout plan at CCS in 2003, to the continuing search for the best connectivity available today in 2009, CCS has maintained a regimented approach to adding functionality. The storyline with some of our major accomplishments and Microsoft products we have used throughout, is as follows: 2003 – CCS evaluates Behavioral Health-related Electronic Medical Records systems with visits to peers with systems in place to consider. (Microsoft SQL2000 is selected as the preferred server platform. All servers and workstations have long been standardized on Windows and MS Office. Wondows 2000 Terminal Services is the backbone for remote access to systems on our Citrix servers.) 2004 – CCS hires their first full-time IT Director to manage the technology portion of the rollout. A team of four CCS staff (Business Manager, IT Director, Mental Health Director, and Chemical Dependency Director) is formed to plan and guide the process. The Windows XP-based laptop replaces the Windows 2000 desktop computer and the primary workstation platform at CCS – preparing our staff to become mobile users. 2005 – CCS completes final selection, installation and training of the selected systems, with rollover of old billing system into new integrated packages. Scheduling, billing, clinical documentation and paper record elimination are major considerations in the plan. The SQL server updates can be performed internally and workstation users can perform their own client updates with a few clicks of the mouse. This is important because early versions of the software are updated monthly or more often as CCS’s unique needs are met by our Microsoft certified software vendors. 2006 - Scanning of paper client files is developed with collaboration between clinical software vendor, scanning hardware technical support and CCS IT Director. SQL2005 is added to a server for hot-site backup and table replication needed during the document scanning at remote locations. Video conferencing between the two largest offices at CCS (75 miles apart) also allows new training to take place without the lead clinicians leaving their home offices of Huron (Chemical Dependency Director) and Madison (Mental Health Director). Windows XP Professional and video vendor software provides the first video conference platform. CCS finds that there are still few options for mobile high speed internet connectivity in rural South Dakota, so we collaborate with businesses and healthcare partners to build wireless “hotspots” in critical areas we serve. 2007 - A major cell phone carrier in South Dakota upgrades to 3G, allowing CCS staff to add high-speed connections to our Windows XP laptops. Electronic signing of clinical notes by CCS Staff and clients begins. Of course not everything can go as planned, when a major player in the entire process, the Business Manager, leaves the organization. She was the backbone of the entire scheduling and billing process and was fortunately able to return as a trainer and consultant briefly for her replacement. A Windows 2003 Active Directory domain and Exchange 2003 mail server replace older Microsoft servers. The first Windows XP Tablet-based laptops are added to our systems. 2008 - Exploration into electronic medication systems (eMARS) begins. We currently scan the paper MARS, but seek more database-driven alternatives for reporting purposes. The Doctors and Nurses take a major role in the eMARS research. CCS performs a proactive HIPAA risk assessment with a local university and determines that our HIPAA compliance levels are well met overall – due in part to a well-maintained Microsoft-based software environment. 2009 – CCS invites vendor presentations for eMARS. Scanning and elimination of the paper client records reaches the 40 to 50% range. Our video conferencing sites and Windows XP Tablet-based computer numbers grow as well. Windows 2003 terminal services are added as we upgrade our Citrix servers. As you can see, there are many challenging aspects to this ongoing process. Through the many hills and valleys, the 65 employees of CCS have embraced the process. The leadership of CCS has played an active roll in refining the State Human Services Department of South Dakota’s requirements for documentation content. Nearly everything about the delivery of our services has changed in the last ten years at CCS, the constant in all of this change has been Microsoft products we use to deliver those services.

Submission Category
Transformations to Maximize Impact