Features of the eRecord include:

Integration of Clinical Documentation, Patient Accounting and Claims
Every time a clinician writes a Progress note or completes an Intake, a charge is posted to the patient’s account and, if the patient has insurance, a claim is generated in X12 format for immediate submission to the insurance company.  Thus, duplicate data entry, filling out billing tickets and the like are eliminated, saving time and money. Built in rules validate data to ensure clean claims.

Clinical Documentation
The eRecord has an extensive library of clinical templates for Intakes, Progress Notes, Treatment Plans, Case management assessments, Outcomes assessments, etc. Also, the forms maker enables users to either edit our templates or create their own.

Intake Assessments
Intake assessments for children and adolescents, adults, geriatrics, substance abuser and other special populations are available in our library. Diagnoses entered at intake are pulled forward to subsequent clinical documents (progress notes) and can be modified as needed. A completed Intake automatically creates a patient charge and insurance claim if there is a coverage.

Progress Notes
Progress notes cover individuals and groups for the various mental health disciplines: social work, psychology, nursing, and psychiatry. Diagnoses are always pulled forward from note to note; in addition there is the option to allow notes to pre-populate forward so that an entire note from a previous session is displayed for easy editing. Group notes can be written rapidly. For example, a general comment can be applied to all the participants in the group and individual content applied for specific clients. This saves clinicians a great deal of time while insuring comprehensive documentation. As with Intakes, billing is integrated into progress notes so that each time a progress note is written a charge is posted in the patient’s account and a claim is automatically generated.

Treatment Planning
The e-Record enables clinicians to write treatment plans rapidly using templates that embody clinical pathways and best practices. Organizations and clinicians can use the e-Record’s standard pathways or they can create custom pathways tailored to the unique needs of their client populations. The treatment planning templates enables the creation of pathways that connect problems with symptoms, goals, objectives, and interventions. All templates allow clinicians to further customize elements in the pathway so that treatment plans never have a “canned” quality. CarePaths Treatment Planner has been approved by both CARF and JCAHO.

Scheduling
The scheduler has views for individual clinicians and the group or clinic. Features include, drag and drop appointments, check-out receipts, and automated email appointment reminders.

Outcomes Assessments
Built into the e-Record is a library of widely used client self-report, clinician-rated, and parent-significant other rated instruments. Real time reports are provided to clinicians and clients. Aggregate reporting at the clinician, program, clinic, and PRN level enable organizations to use outcomes measurement for quality improvement and benchmarking. The Patient portal and the Parent/Collateral portal expedites data collection. The automatic email reminder system allows for outcomes protocols to be automated.

Unlimited Electronic Claims Submission
Claims are submitted electronically to payers insuring rapid claims payment.  Users of the eRecord do not need to fill out billing tickets as claims are automatically generated from completed Intakes and Progress Notes. Electronic remittance advice posts automatically to the patient account.  Users who choose not to use the eRecord can use the separate claims submission module and can generate paper HCFA 1500′s if necessary.

Authorization Tracking
Authorization tracking gives the user a place to record authorizations. The system compares services provided with those authorized and alerts the user if there are additional units of service that haven’t been used. e-Claims allows a user to enter a scheduled service and determine if it is covered by an existing authorization.

Manage Receivables
Once claims are submitted, users can record receipts, write-offs and denials through the client ledger. Accounts receivable reports are available for receivables by payer or client.

Reporting
Reports analyze client demographics, claims history, accounts receivable, revenue statements, receipts history, utilization, outcomes and more.  There are hundreds of online reports available as well as an export utility which enables easy export of clinical data to standard formats such as Exel, Access, etc .

Patient Portal
The Patient portal enables clients to login online and fill out all required forms: consent for treatment, disclosure of information, HIPAA privacy notices, insurance and demographic information forms, clinical questionnaires, etc.  Information entered by the patient online populates the eRecord, saving staff time and enabling paperless practice.  Also, the upload function assures paperless practice by enabling paper documents to be scanned into the system.

E-Prescribing
The eRecord has a built in E-Prescriber that enables physicians and nurse practitioners to quickly write and electronically submit prescriptions. Features such as drug look-ups, drug interaction alerts, etc are available as well.

Secure Messaging
Clinicians can communicate with each other securely, i.e. protected patient health information, can be sent between clinicians asynchronously.

Forms Maker
Users can create their own forms from scratch or edit CarePaths’ templates from it’s template library.  The eRecord works very much like a shell that allows end users the freedom to capture the information that fits their needs. Custom dictionaries, screens, and drop-down menus are easily created and modeling automatically maps to the database.

Alerts
For each staff, a To-Do list provide reminders of needed progress notes, treatment plan reviews, and other required documentation. Case managers and supervisors have access to staff To-Do lists.

System Access
The e-Record gives administrators granular control over access privileges enabling full compliance with the HIPAA “need to know” rule. Each staff member or group of staff–clerical, clinician, administrator, supervisor, or case manager–can be assigned the permission level privileges that are appropriate to their responsibilities insuring full control over who has access to the information.

Scalability
The e-Record is scalable and can be–and is–used by solo practitioners as well as by large multi-site psychiatric facilities. Features such as a call center (triage) module, user-definable access security, privileging, intra-organizational communications, multidisciplinary assessments, 24/7 access to records, etc. enable large-scale implementations. The core of the system–the intuitive clinical modules–serve the needs of any clinician, be he or she a solo practitioner, member of a small group practice, or staff member of a large treatment facility

The HAM-D is the standard depression outcome measure used in clinical trials presented to the Food and Drug Administration by pharmaceutical companies for approval of New Drug Applications. It is also the primary outcome measure in the National Institute of Mental Health collaborative studies comparing pharmacotherapy with psychotherapy for the treatment of depression. The HAMD is the usual standard against which other depression rating scales are validated. The scale has been translated into many European and Asian languages.

Benefits of HAM-D:

• Widely-used – The HAM-D is the most widely used instrument for clinical assessment of depressive symptoms.
• Well-validated – The tool was developed in 1960 and has since that time has been widely evaluated and established as a highly reliable and valid assessment tool for the assessment of depressive severity.
• ‘Gold’-standard of depression rating scales.
• Frequently used in studies as an anchor with which to compare newer instruments.

Guidelines For Clinical Interpretation

The higher the score the more severe the depression.  A score of 11 is generally regarded as indicative of a diagnosis of depression.  A score of 10-13 = mild depression; a score of 14-17 = moderate depression; a score >17 = moderate to severe depression.

The YOQ^®-30 is available in a parent rating version (staff members can complete the parent version in 24-hour care), which is appropriate for ages 4 through 17, and a self-report version, which is appropriate for ages 12 through 17. The question of whether a parent-report or a self-report measure is most appropriate for child and adolescent populations is not settled. Developmental considerations, such as verbal skills and reading ability, factors such as motivation for treatment, social desirability, and perception of the problem behavior or feelings (i.e. whether the child sees a particular symptom as problematic or his parents or teacher sees it as problematic), all influence the decision to use parent or self-report data with children. With children under 11 or 12, parent-report is the norm with the assumption being that parents will be the most reliable source for obtaining data about a young child’s functioning and behavior. In adolescents, research (Achenbach and Edelbroch, 1991) have shown that the major differences between parent and self-report are: 1) the tendency of adolescents to under-report their symptomatology as compared to parents and 2) the finding that parents are better sources of data regarding objective behaviors (e.g. oppositional attitude, school failures, etc) while adolescents themselves are considered more accurate informants regarding their subjective states (moods, feelings, etc).

The YOQ^®-30 is designed to be used repeatedly and is sensitive to change in children and adolescents receiving mental health treatment. The YOQ^®-30 provides easy to use interpretive indices that enable a clinician to quickly assess his/her client’s level of disturbance and adequacy of treatment response. A cutoff score discriminates between normal functioning and clinical disturbance. Also, a reliable change index (RCI) has been established so changes in patient scores can be evaluated to determine if they are clinically significant. Additionally, there are flags for clinical follow-up of critical items such as suicidality and drug/alcohol abuse.

The thirty items for the YOQ^®-30 were chosen from the YOQ^® 2.0 based on their individual sensitivity to change as estimated from a large-scale study of patients undergoing treatment in a variety of settings. The items that comprise the YOQ^® 30 address commonly occurring problems and symptoms across a wide variety of disorders.

Outstanding features of the measure include:

• Standardized data: The Y-OQ^® 30.1 is a standardized instrument with empirical support.
• User-friendly. The Y-OQ^® 30.1 is brief to complete (less than 5 minutes), provides real time feedback, and is designed to be incorporated into an office visit in an unobtrusive manner.
• Can be used by either the parent (guardian) or youth patient capable of self reporting.

The OQ^®-30 is a short form of the OQ^®-45.2. It is a brief self-report measure of severity of disturbance in mental health patients that can be used repeatedly and is sensitive to change in adults receiving mental health treatment. It was developed from the largest active mental health outcomes database in the country and has been and is being used extensively in research and clinical applications, including public sector clients. 

The OQ^®-30 provides easy to use interpretive indices that enable a clinician to quickly assess his/her client’s level of disturbance and adequacy of treatment response. A cutoff score discriminates between normal functioning and clinical disturbance. Also, a reliable change index (RCI) has been established so changes in patient scores can be evaluated to determine if they are clinically significant. Additionally, there are flags for clinical follow-up of suicidality and drug/alcohol abuse.

The thirty items for the OQ^®-30 were chosen from the OQ^®-45.2 based on their individual sensitivity to change as estimated from a large scale study of patients undergoing treatment in a variety of settings (Vermeersch, Lambert, and Burlingame, 2000). The items that comprise the OQ 30 address commonly occurring problems and symptoms across a wide variety of disorders. Domains tapped include: symptomatic distress, social relationships, work functioning and quality of life.

 Outstanding features of the measure include:

• Standardized data: The OQ^® 30.1 is a standardized instrument with empirical support.
• User-friendly. The OQ^® 30.1 is brief to complete (less than 5 minutes), provides real time feedback and is designed to be incorporated into an office visit in an unobtrusive manner.

Noteworthy features of the Y-OQ^®-2.0 include:

• Standardized data: Y-OQ^®-2.0 has been found to be both reliable and valid, yielding high internal consistency across the 3 samples and correlating favorably with other widely used instruments such as the Child Behavior Checklist. Statistically significant differences are present between the means for the clinical and normative samples.
• Sensitivity to change and robust norms: The Y-OQ^®-2.0 is highly sensitive to change in patient’s functioning; interpretive indices tell the clinician if that change is clinically significant.
• Content areas that assess clinically relevant functional domains. The Y-OQ^®-2.0 is comprised of six separate subscales of behavioral problems as well as elements of healthy behavior. The subscales include Interpersonal Distress, Somatic, Interpersonal Relations, Critical Items, Social Problems, and Behavioral Dysfunction.
• Applicable to all patient populations. The Y-OQ^®-2.0 cuts across treatment models, diagnoses, and disciplines, allowing for use and comparison in a wide variety of settings.
• Ease of administration and scoring. The Y-OQ^® -2.0 items are rated by the parent/guardian on a 5 point scale and takes only a few minutes to complete.
• Risk assessment. High scores on the critical items scales indicate those who may need immediate intervention beyond standard outpatient treatment.
  

  

Psychometric Properties

The reliability of the YOQ was tested using Chronbach’s alpha with a small student sample drawn from an elementary school (N=41), a community normative sample of 651 subjects and the clinical sample of 490. The total score on the YOQ has an internal consistency estimate of .97 across the three samples. The critical items and somatic subscales had the lowest internal consistency estimates of the six subscales, suggesting greater item heterogeneity. The high reliability estimate of the total YOQ score suggests a strong single factor underlying the 6 subscales.

Preliminary criterion validity was also assessed. The relationshp between the YOQ total and subscales score were examined by comparing parallel subscales from the Child Behavior Checklist (Achenbach, 1991) and the Connors Rating Scale (Connors, 1990). The parents of a sample of 41 elementary children aged 6 to 12 were used. In each case, the highest correlation found between subscales were those expected to converge, indicating adequate convergent validity. Adequate divergent validity was also established as small and nonsignificant coefficients were noted between dissimilar scales. A moderately high correlation was found between the YOQ and CBCL total scores.

A second validity sample of 80 inpatients was used to examine the relationship between the CHCB and relevant YOQ subscales. A strong relationship of .84 was found between the total YOQ score and its counterpart on the CBCL. Overall, the findings from these two samples suggest that the relationships between the YOQ and established criteria are strong.

Support for the construct validity of the YOQ was assessed by comparing the inpatient and outpatient scores on the YOQ and those of the community samples. It was assumed that statistically significant differences would be found between the means of the clinical and normative samples and would be ordered from most pathological to least pathological. The data suggest that the YOQ reflects pathology in line with expectations: inpatients had the highest means (most disturbed), outpatients the next highest, and the community sample the lowest (most healthy).

The sensitivity of the YOQ is 0.81. This means that approximate 81% of true positives of the Normal group were correctly identified as “normal” and 19% were misclassified (put in the abnormal group) using the cutoff score of 46 (see clinical interpretation. The specificity of the YOQ is .79 which means that 79% of true members of the Abnormal group were placed in the abnormal group using the cutoff of 46. Sensitivity and specificity provide an index of the accuracy of the YOQ as a screening tool. It is important to note that the obtained sensitivity/specificity scores may be even higher because the studies considered the children of the community sample to be normal and the children from the patient samples to be abnormal.

Guidelines for Clinical Interpretation

The YOQ^®-2.0 total score quantifies overall level of disturbance. A score of 46 or higher is in the clinical or dysfunctional range. A score under 46 is considered to be in the normal or non-clinical range.

The reliable change index for the YOQ^®-2.0 is 13 points. This means that a patient must change by at least 13 points for that change to be considered clinically significant.

Spanish Versions of OQ^®-45.2 and Y-OQ ^®2.0:

Spanish versions of the OQ^®-45.2 and Y-OQ^®- 2.0 are available for Spanish speakers not fluent in English.

Self-report methods of psychological assessment are the most frequent means of operationally defining psychological distress and well being for cognitively intact adults. Uhlenhuth (1970) writes: “…it is the patient’s opinion with all its biases that is most relevant for the initiation and maintenance of treatment.”

The BPRS is an 18-item observer-scale designed to assess patients with major psychiatric disorders, particularly schizophrenia. The BPRS measures positive symptoms, general psychopathology and affective symptoms. Some items (e.g. mannerisms and posturing) can be rated simply on observation of the patient; other items (e.g. anxiety) involve an element of self-report by the patient. The BPRS is administered by a trained clinician via a semi-structured interview.

When rating BPRS, it is important to allow unstructured sections in the clinical interview so that disorganization in the patient’s thought and speech and unusual thought content can be observed.

Each BPRS item is rated on a seven-point scale (1=not present to 7=extremely severe).

Benefits of the BPRS:

• Well established – among the most researched instruments used in psychiatry
• Well known – clinicians tend to be familiar with symptom scores and changes
• Sensitive to change – may be used to rate treatment response
• Broad evaluation – allows rating of severity of a number of different symptoms
• Used in many classic studies of new antipsychotics
• Psychometric properties and underlying factor structure is well-established
• Grouping on item scores allow scoring on distinct factors (tension; emotional withdrawal; mannerisms and posturing; motor retardation; uncooperativeness)

Benefits of the AIMS:

• Benchmark scale for assessment and recording of tardive dyskinesia.
• Global use – AIMS is probably the most widely-used assessment tool to establish the presence and severity of involuntary movements.
• Standard procedure – Because of its design and simple/short assessment time, AIMS can easily be integrated into a routine clinical evaluation by clinician or other trained rater (psychiatric nurse).
• Quick – Easily accommodated within outpatient clinic appointment.
• Inter-rater reliability – AIMS has been established as a reliable assessment tool.
• The consistent and timely application of the AIMS provides an objective record of the presence/absence of dyskinetic movements over time, which may prove important in the light of the trend towards litigation in this area.

CarePaths eRecord sponsors Practice Research Networks (PRNs) through its collaboration with research and clinical training organizations. Currently, CarePaths is sponsoring a number of PRNs, e.g. the Association of Directors of Psychology Training Clinics (http://adptc.clinicprn.org), Family Service of Canada (http://www.fsc.clinicprn.org), the Outdoor Behavioral Health Industry Council (http://obhic.clinicprn.org), and the National Association of Therapeutic Training Schools (http://natsap.clinicprn.org). Practice research networks offer a group of organizations the opportunity to pool data for a variety of purposes, including quality improvement and benchmarking, advocacy, and clinical research. Borkovec, for instance, writes that PRNs are needed now in clinical psychology because of the “increasing pressure to produce evidence that therapies we provide are in fact beneficial” and to answer “society’s questions about the effectiveness of psychotherapy.” In primary care settings, PRNs can help to identify barriers to effective mental health practice and promote best practices. PRNs can also advance basic science by carrying out rigorous experimental investigations in naturalistic settings that allow for unambiguous conclusions about effectiveness.

CarePaths also participates in a number of other research initiatives and NIMH sponsored research.  CarePaths users can participate in research should they be interested.

CarePaths enables any user, solo practitioner or clinic, to benchmark their clinical outcomes results against comparative norms. Using nationally recognized instruments such as the OQ 45, OQ 30, YOQ, Mental Health Advisor-30 and others, participants can find out how effective they are in comparison to their peers. Practice evaluation is a powerful quality improvement tool. Clinicians can use the data to demonstrate to referral sources, payers and others, the effectiveness of their services.