CleanSlate

Challenge

Patient Information Management 

CleanSlate, founded in 2009 and headquartered in Northampton, is a physician-supervised office practice that operates 11 addiction treatment centers in Massachusetts. To date, CleanSlate has treated more than 20,000 patients statewide suffering from substance abuse disorders. Its comprehensive, compassionate outpatient programs combine evidence-based medical management and behavioral therapy to support long-term recovery and success.

CleanSlate received support from MeHI’s eHealth Services team during their Health IT implementation process. MeHI provided clarification on Meaningful Use measures and the attestation process as well as shared recommendations to capture and report on core, menu, and clinical quality measures.  

On the day CleanSlate opened its first treatment center in Western Massachusetts, its leaders recognized the need to adopt more advanced and effective technologies and processes. It was immediately clear that delivering on its mission—to provide superior-quality care to underserved populations—would be impossible without a documentation tool and an integrated Electronic Health Record (EHR) solution to manage patient information and clinic operations.

Managing patient records is difficult for any medical practice, but the challenge is even greater for CleanSlate, given the frequency of office visits among the population it serves. During the early stages of care, CleanSlate’s patients typically visit a center as often as twice a week, as they progress through the various phases of recovery. These visits resulted in an overwhelming number of paper records, for which the treatment centers lacked storage space. Another part of the challenge involved maintaining simplified visit reports that include enough meaningful detail to stand up to an audit. 

“We have embraced Health IT and made it an integral part of how we operate our business and provide high-quality care. Electronically managing this patient population provides us with the critical data we need to identify the best treatment combinations for achieving outcomes that matter.”

—Amanda Wilson President and CEO CleanSlate

CleanSlate adopted an EHR solution to resolve these record management issues electronically. One obstacle the treatment centers faced during the transition from paper to electronic patient records was the need to maintain both hard copy and electronic versions until the technical conversion was complete. Some duplicated effort was necessary to manage both formats during the early days of EHR adoption. Paper records scanned into the electronic system are not searchable, so a provider may need to access the paper chart to retrieve a particular test result, for example. This duplication is necessary only for patients who started seeing a provider prior to the implementation of the EHR system, since all new patients are immediately entered into the electronic system at the time of their first visit. 

The greatest challenge faced by CleanSlate involved information sharing with other healthcare providers who work with the same patients. CleanSlate believes addiction is more than a bad choice or habit; it is a chronic disease. Based on that treatment philosophy, the organization partners with behavioral health organizations to coordinate counseling and other support services patients need to succeed in their recovery and regain control of their lives.

Unfortunately, most behavioral health providers, cautious about complying with strict confidentiality requirements, still use paper to exchange information on patients suffering from substance abuse disorders. Additionally, because of the stigma associated with addiction, many patients are reluctant to consent to sharing their information. Developing sound security standards, effective methods to obtain patient consent, and best practices to protect patient privacy remain the primary challenges for effective collaboration among behavioral health providers.

Solution

Create Cost-Effective Synergies and Efficiencies

CleanSlateWithin nine months of opening its first treatment center, CleanSlate transitioned from paper to electronic records, launching a fully integrated and certified system from Stratus EHR in Easthampton, Massachusetts. Treatment center clinicians now have online access to secure, encrypted, HIPAA-compliant and password-protected patient records that they can review anywhere, at any time—a vast improvement over transporting paper files in a briefcase with the potential for data loss and poor tracking. In order to comply with the additional confidentiality requirements that apply to substance abuse providers, CleanSlate intentionally maintains silos of information within its EHR to ensure that patient records are shared only with designated practitioners who are granted access to files through legally required release forms signed by patients.

The EHR drives all operations, encompassing everything from interoffice communications to patient management. CleanSlate’s call center in Northampton is the hub for offices located across the state. When a patient calls the New Bedford practice, for example, the call is routed to the call center, where a staff member pulls up the record in the EHR and alerts the most recent provider, via a pop-up message, regarding actions required to address the caller’s issue in real time.

Early last year, CleanSlate added an innovative interface to its EHR system that significantly enhances the core capabilities of the documentation tool. CleanSlate physicians now rely on assistance from a criteria-based model embedded in the EHR to categorize patients by color code according to severity of illness and progress in recovery. The selected category then drives automated output of treatment protocols that precisely align with the patient’s current status. This year, CleanSlate’s CIO and Director of IT are working with clinicians to further enhance this groundbreaking algorithm. Another new interactive capability, now in pilot phase and scheduled for an early summer launch, walks clinicians through a structured interview following a patient visit. Using the clinician’s responses, the system creates detailed documentation and a streamlined decision-making tree to facilitate more efficient coordination of care.

Impact

Digitized Health Information Saves Lives

The Drug Addiction Treatment Act (DATA) of 2000 is a national law that limits physicians to managing no more than 100 simultaneously active prescriptions for Suboxone (or generic buprenorphine), the leading drug used to treat opioid addiction, an epidemic that impacts more than 100,000 people in Massachusetts. 

Real-time tracking of a particular doctor’s active prescriptions at any given moment requires an advanced electronic solution. CleanSlate leverages its sophisticated EHR system to help the small number of physicians licensed to prescribe Suboxone adhere to legal restrictions while maximizing access to this critical medication, without which many patients would die of opioid overdose.

In June 2015, CleanSlate will expand beyond Massachusetts and open six new treatment centers in Pennsylvania, continuing on its path to national leadership in providing high-quality addiction services in underserved communities. CleanSlate’s optimized EHR system built by Stratus, which can be customized to address state regulatory requirements, is the platform that will help ease the organization’s expansion into these new areas. The system is expected to rapidly expedite the process of remotely onboarding and training new providers, who will be carefully guided by the evidence-based clinical care guidelines embedded in the tool.

For more information about CleanSlate’s program or to learn about the services it offers to fight opioid addition, visit cleanslatecenters.com