EMR Spiritual Assessment Review
Conference Call - Notes
July 31, 2014
Call Participants: Bev Beltramo; Richard Brochu; Carolanne Hauck; Matt Kronberg; Tim Serban; Mark Skaja; Mary Toole; David Lichter
Excused: Marie Parker
1. Opening Reflection: Catch Your Breath; David Lichter
2. Common elements in Spiritual Care Assessments in EMRs – from an exercise worked on by Tim, Mark, and Marie of Pastoral Care Advisory Committee; small group work, then reported out to the overall group
· Using the input from various health systems, identified the elements most common to the Spiritual Care Assessments in the various systems’ EMRs
· Then asked what are the essential elements needed for EMRs?
· Discussed the four basic assessment models: SOAP, SOAPIER, APIE, AIE
· Identified the essential elements involved in a quality chaplain encounter
o Patient-focused
o Referral to others
o Clear communication
o Future care
o Accessible to all; transparency
o Interdisciplinary team focus: assessment tool for spiritual care available in all settings; assure quality information/charting about the spiritual care
· Also discussed direct vs. indirect contact/tele-chaplaincy; ways in which spiritual care/chaplaincy can be engaged in formats that are asynchronous; webpages for comfort accessible to the community; patients create the space for patient healing, beyond the limits of the hospital; prayer line with recorded prayers
3. Responses/Reactions /Questions
· Bev: In regard to quality measures and chart reviews: our department is trying to develop benchmarks for judging how well we doing, including measures for quality, meaningful charting; it’s the link to the rest of the team
· Carolanne: for charting, have a template in EPIC as a consistent way of being more objective; helping to convey and define what we’re doing; more consistent and objective than doing individual chart reviews
o Comments: Need concrete framework on which to base chart reviews; it would be good to have a common definition of an assessment
o Response: our charting template has short definitions of terms like “assessment”,” goals”, “outcomes”
· Bev: have already used common terminology identified by the EMR Spiritual Assessment Quality Committee to clarify the terminology on the templates in our EPIC system; it’s been very helpful
· Richard: has also been trying to look at the presentation/description of outcomes: what happened as a result of chaplain’s intervention in the short-term, and what is the goal for future outcome with further intervention; more access to assessments by the team would help chaplains involved with long-term patients – be part of the continuum
· Carolanne: in our system, when chaplain opens a patient’s page, can immediately see other chaplains’ assessments of the patient; the hope is that a chaplain could follow up with the goals already noted for the patient by earlier chaplain interventions and assess progress
· Carolanne: we don’t use dropdowns, in hopes that chaplains will think for themselves and not just use others’ language; will be focusing on language and documentation of outcomes in this next year
· Matt: Dignity is focusing on future care, rather outcomes language, due to short duration of hospital stays – may or not have an immediate outcome that can be assessed; addresses anticipated future needs
· Matt: Also want their assessments to be measurable as well as quantifiable; have become aware of emphasis on spiritual distress language rather than spiritual assets language – need to become more aware of identifying assets; may be able to document patient’s progress on a continuum from negative to positive within a stay or within multiple stays to greater levels of spiritual coping
· Bev: this approach was also helpful to her group
· Matt and others: one helpful tool for quantifying a patient’s spiritual state is an questionnaire given by caregivers which rates aspects of a patient’s spiritual state on a scale of 1 to 10; a low number triggers a referral
· Matt: are we able to assess if chaplains are present when it really matters; Dignity is looking at ER processes – finding whether communication is timely when bad news is anticipated, is the chaplain being called first in order to be present when the bad news is communicated; finding that’s not being done consistently; bad news may have to come from someone other than the chaplain
· Carolanne: has heard that Johns Hopkins is doing a pilot study in their ER involving providing chaplain presence more often because their doctors’ score are so low
· Matt: what was response to NACC Now inquiry about chaplains doing referrals for spiritual practices (something like a prescription for spiritual care following a hospital stay)
o per DL: no response has been received to the inquiry, which has been published three times; will be published again on Monday; not sure of the reason for not receiving responses
o Matt: have been thinking about this particularly in view of the trend to shorter hospital stays and more outpatient care
4. DL: The Quality Committee initially started thinking about how to talk about quality using three approaches to quality:
1) Performance against standards or measures/benchmarks
2) Quality from a vantage point of process
3) Quality from a vantage point of outcome
Today’s discussion has touched on those three areas as relates to EMR. Does this still provide a workable approach to quality?
· Carolanne: asks Bev if they could work together to come up with a template both could use to assess quality?
o Bev: Sure, it would be an interesting challenge. There’s a tendency to measure quantitative things because we can measure them but there’s a tendency to measure around the edges without really looking at the things that are really important, a real temptation in chaplaincy. How do we get below the surface to see if the patient interaction is affective or is missing the mark?
· Matt: Identifying what we really value and are trying to accomplish is vital, before we can determine what we really need to measure
o Bev: and then we figure out how to measure it; rather than figuring out what we can measure and then using that to define who we are
o How do we define excellence?
5. DL: what direction might we want to take this?
· Four Spiritual Care Champion sessions on quality are coming up later this year and early next year; what at this point do we have to share and reflect upon
o Suggests that it would be valuable to report out in an initial session where we are in this discussion, re: the EMR framework; what are we learning?; here are some questions we’re asking
· How best can we benefit from sharing with each other in this process and also share our ideas with our fellow chaplains?
o Can we benefit from having this group convene again in the upcoming months to address the questions raised today? What issues do we need to pursue next? How can we come up with criteria for processes?
o Bev: we could also use this for self-assessment in the CPE process
· What is your passion when it comes to these quality issues:
o Carolanne: passion is documentation; quality and documentation are key
o Mark: need to define common understanding of the terminology needed: assessment, goals, etc.
o Richard: the conversation should include those who will use the spiritual assessment; we need to educate clinicians as well as chaplains about what to look for in spiritual assessments – what’s important for them in providing quality care
§ Bev: have involved their critical care and palliative care staff in the development in of spiritual assessment to get their input on what is helpful to them
o Bev: look for common themes
o Matt/Mark: we just need to pick an issue and go forward
o Matt: might try asking what would bring value to a spiritual assessment, considering the impact of EMR on accessibility of information to all staff and to the patient; might be a benchmark for quality documentation – that we are adding value
§ Carolanne: excellent point; that’s the direction where we have to go eventually
§ How can we add value to benchmark, processes and outcome documentation
o Bev: might ultimately be able to post the components of quality documentation on the NACC website for reference by any chaplain to pick and choose examples and best practices suited to their own situation and institution
· DL: wrap up and next steps
o Schedule for next call? Late August? What topics to focus on for next call? Will send Doodle
o October 15, 2014, 12 noon Central time: CHA webinar - could someone present an overview to today’s discussion? Another webinar on second Wednesday in December – perhaps one or two could share what they’re doing in the area of quality documentation
o Could Carolanne share the definitions she’s been working on?
o How could we utilize participation in this group to apply in our respective work?
o How can we spread and help others share in the benefits of the work of this group on these issues?
o Matt(?): would love to see something more done with spiritual practices in the transition from inpatient to outpatient. May be beyond the scope of this work on assessment.
o Tim: in addition, quality staffing is also a concern; is coming up on CHA webinar; on-call support, small clinics, some in rural areas are challenges in finding quality/adequate staffing in spiritual care
§ Those concerns apply not only to small facilities in rural areas