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Integration & Coordination for Health Homes

The Health Home (or Patient Centered Medical Home) is a new approach to patient care. Its goal is to treat the whole patient by integrating primary and behavioral care. Complex patients may receive treatment through multiple sources of care – from physicians and hospitals, to community health centers and home care – Health Homes coordinate care amongst these providers (the Care Team).

TREAT boasts an inventory of multidisciplinary assessments, a suite of tools designed specifically for behavioral health care, a variety of primary health care treatment tools, as well as modules designed specifically to address issues of comorbidity and complex patients. TREAT can effectively be used as a stand-alone Health Home solution, or select modules can be implemented as individual components of an electronic Health Home system thanks to its modular design.

TREAT is incorporated as an application in the GSIHealth Coordinator Dashboard for Health Homes in NY State and seamlessly integrates with Health Information Exchanges (HIEs) to ensure continuity of care.

Solution Highlights

Clinical Assessment Tools

Best practice and standardized Health Home assessment tools are supported right out of the box, including tools such as the Metabolic Health Monitor, the History & Physical module, as well as a broad range of mental health and addictions assessments.

Clinical Documentation

TREAT’s Care Plan and Progress Notes modules interact to maintain a current and accurate record of client goals, progress, and outcomes across domains. Issues and interventions documented in Progress Notes, as well as assessment results automatically update a client’s Care Plan. Care Plans can carry across domains and providers, making them highly effective in a Health Home setting.

Care Coordination

TREAT’s design allows it to easily interface and integrate with external systems without impacting its advanced functionality. This feature is important in a Health Home setting as several electronic systems may need to interact in order to effectively coordinate care across providers.

Our Care Plan module is also an indispensable tool for coordinating care as it itemizes client issues by domain, and includes details, goals, and client and clinician priority. The Care Plan lends itself to use by a multidisciplinary team and can be updated and shared by multiple collaborators.

Patient Profile

TREAT’s Patient Profile module gives a comprehensive, at-a-glance view of a client’s health record. The Profile can be fully customized to display items (widgets) relevant to the individual clinician or Care Team. The Profile is a great tool for Health Home models because it can display data captured from within TREAT, or from external systems (lab results, pharmacy data).

Like the Care Plan the Patient Profile can be updated and shared by multiple collaborators.

Reporting

TREAT’s advanced reporting system enables clinicians to perform in-depth analyses of assessment results and scores, and track progress on Care Plan issues. Reports are displayed in simple, easy to read graphs and tables. Reports can be accessed and viewed by any members of a client’s Care Team, and are printer-friendly to facilitate sharing between multiple providers. Our reporting system also integrates seamlessly with Cognos and Crystal Reports.

 

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