Stephanie Hepburn is a writer in New Orleans. She is the editor in chief of #CrisisTalk. You can reach her at .
Mental health experts worldwide share a common frustration—the dearth of real-time data, they say, is a vital hindrance to developing and improving psychiatric crisis care. It results in long wait times and no centralized way to identify system bottlenecks or service delays. It also, says Prof. Martin Connor, CEO and co-founder at Healthcare Logic in Queensland, Australia, prohibits defining benchmarks and quality standards. “If you can’t measure it, you can’t improve it.”
That’s precisely what Connor and Dr. Christopher Ogg, Healthcare Logic’s co-founder and director of product, have set out to change. Connor says this moment of global technologies—the intersection of web, service, data processing technologies, and visualization—“means we can see what we’ve never been able to before because we can move high volumes of data quickly.”
In 2017, Healthcare Logic launched SystemView, a performance improvement platform designed to give situational awareness to clinical teams across the system, which is in the process of being extended to crisis care. SystemView has installations progressing across five different jurisdictions, including the Gold Coast Health hospitals that use the rapid analytics software to track three cadences: five-minute, hourly, and daily data feeds. Connor says the platform will soon give crisis teams the ability to see the people in front of them and those who might come soon or who can’t get in at the moment.
“Historically, crisis teams haven’t been able to see upstream or downstream,” he says, “diminishing their ability to respond to system challenges and develop tactics most appropriate to improve care.”
The end-game, says Connor, “is to see the entire system.” And he doesn’t mean just retrospectively. After years of working with local clinical teams and health services managers, Connor and Ogg have developed new techniques to manage data, enabling them to do high-frequency analysis without a time lag. In the crisis space, that means five-minute data flows while also gathering hourly and daily information in other scheduling areas.
“This enables us to look at the present situation, but also trend data over time, helping us understand demands on the system and make it easier for people to navigate it,” he says.
Connor and Ogg are quick to point out they are data scientists, not mental health experts, which is why they work closely with psychiatrist Dr. Kathryn Turner, clinical director at Gold Coast Mental Health and Specialist Services (GCMHSS). She’s a visionary clinical leader, says Connor, and the person responsible, along with the team at GCMHSS, for pulling together Gold Coast innovations for crisis response. “We work within Kathy’s rubric, and with her teams, to help them maximize their aim of improving crisis response.”
Together, they’re developing a care traffic control center, featuring large screens that track the three main hospital access points in Queensland for a person in crisis: a crisis call, ambulance to emergency department, or a community clinic referral. The screens also give the controllers, says Connor, an overview of all patients in the ED and inpatient hospitalization.
“They can quickly see bed openings and patient characteristics, including physical conditions and demands on the emergency department.”
SystemView tracks patients along a linear path from preliminary diagnosis, review—identifying if a patient is waiting for a bed or package of care (also known as services)—through to discharge, showing the team where there are system bottlenecks or delays. “It’s an enrichment of the conversation,” says Connor. “We can visualize the system as a whole and key characteristics of individual patients, giving crisis teams better awareness of the decisions they’re making and the implications.”
At present, Connor, Ogg, and Dr. Turner’s focus is on extracting maximum value from SystemView’s hospital data and further improving the system. Long-term, they aim to gain a more comprehensive cohort analysis, allowing for a broader, deeper dive into the overall crisis system. This includes, says Connor, building an interface to identify and track people they haven’t yet reached “like people who are ambulatory or for whom a community clinic has said hospitalization should happen within 24-hours.”
The Healthcare Logic team is working on several modules to build out and improve upon the current SystemView platform. They’re developing a care traffic control component that will track people after discharge from the ED or an inpatient stay as they move on to a provider or package of care. Connor and Ogg hope to launch the module in March or April 2021.
Simultaneously, Gold Coast Health is opening a dedicated crisis stabilization facility as an alternative to the emergency department. The first of its kind in Australia. Meaghan Scanlon, the labor member for Gaven in the Queensland Legislative Assembly, said in a July 2019 press release that the aim is twofold: the facility will help “support people experiencing an acute mental health crisis” and “take the pressure off Gold Coast hospital emergency departments,” which she notes are among the busiest in Australia. This might be even truer today during the pandemic, though Queensland has had far fewer identified coronaviruses cases than harder hit Victoria, 1,294 compared to 20,428. As of August, wait times for emergency and elective care in Queensland hospitals improved despite the pandemic.
As Healthcare Logic works with psychiatric crisis teams to look at individualization, tracking patients across each various pathways, Ogg says they’re also using that information to set standards to ensure that “each part of the system provides optimal care.” It’s more complicated than that, though, he points out. For data to be maximized, it must be at the right frequency.
“Rapid intervals allow us to track far more than once-a-day updates,” he says. “We need five-minute feeds to track who is on a call now and how many calls have happened so far in the day.”
With that information, Ogg says he, Connor, and the Gold Coast Health mental health team can put standards around each part of the pathways to ensure that patients receive quality care. They can also measure, says Ogg, the demand on each part of the system like the emergency department, crisis stabilization center, crisis call center, and ambulances. “Measuring variations in demand allows us to predict and meet capacity,” he says.
Each day, the team also reviews what happened the day before. They look at what worked and didn’t on that particular day, which Ogg says provides improvement opportunities. “It’s part of our learning environment,” he says.
Over time, they hope to gain an increasingly detailed and bird’s-eye view with data, allowing them to see the complete system while analyzing particular spots or pathways. Connor and Ogg are also systematically getting closer to prevention and recovery to identify people at risk.
There are three commonly used geometric metaphors for mental health crisis care, notes Connor. There’s an arrow for a particular episode of care, a circle for the continuous relationship between services, patients, and families, and a triangle for the relative cohorts of risk that we see recurring in populations on any given day. He says in the latter metaphor, there’s a relatively large base that’s fine. In the middle are people at risk, and at the pointed top are those in an acute phase or recently recovering from a crisis.
Connor and Ogg aim to stretch the SystemView model outward, not just addressing people at the top of the triangle but also those in the middle. “We want to use high-frequency data to identify people at risk,” says Connor, “so they can be matched with appropriate services, reducing the likelihood of crisis.” For those in crisis, they aim to help in the most humane and time-effective way possible.
“The job is not only to do the job but to improve the system as we go,” he says.
