Some Thoughts on Mental Health Treatment Plan Software:

1) Some of my personal thoughts and a general discussion about choosing mental health treatment plan software.

2) The best program I've seen to date is TxPlan by Earley Corp. A demo is available. This is described as a program best known for producing and maintaining treatment plans in behavioral healthcare systems. However, it also allows you to track patients from intake through admissions, conduct assessments, write progress notes, complete discharge summaries, and produce CQI, UR and other customized reports. It is fully modifiable by the user.

Additional software to consider:

3) Harry Brown of PC Services has developed aWindows/Lotus network database program to simplify client documentation. He describes this as a "fully integrated program that automates: intake, information/history taking, treatment planning/review, referral/form letters, charting, discharge summary, and more."

4) InfoNation systems offer the Clinical Manager. This is described as a complete management information system offering intake, assessment & treatment planning, plans of care, discharge plan, family and treatment team information, critical events, funding info, 3rd party billing info, test score tracking, medication management, placement tracking, contact management, staff credentialing, staff time/cost tracking, staff/client schedule assistance/ and Email.

5) Frontline Systems offer the Integrated Care & Outcomes Management System. This is described as a powerful, easy to use database system that enables MH/MR service providers to manage both the clinical and financial aspects of client or patient care. ICOMS supports both the operational activities of resource coordinators (i.e., Caseworkers) as well as the monitoring and analysis requirements of administratistrators. ICOMS is a tool designed to support agencies that provide wraparound, residential and partial day services in: A) Capturing and maintaining information about clients, external providers, support staff and other members of the client "team" B) Implementing service plans according to Medical Assistance "Best Practice" format C) Preparing client reports and electronic transmissions required by funding sources D)Tracking activities related to client treatment for billing and performance purposes E)Monitoring the cost-effectiveness of services Tracking the progress of treatment in relation to client goals and objectives.

6) The Treatment Planning System (TPS) is described as a program to assist mental health agencies in meeting Medicare and Joint Commission standards and to support continuous quality improvement through the measurement of outcomes. It eases the burden of producing paper documentation of treatment plans, assessments and progress notes. It provides a Problem Plan Library to make sure all needed interventions are done for most common problems. It keeps treatment history available so that correct decisions can be made on readmission. A demo is available.

7) The Mental Health Case Manager (MHCM)  is the Windows 95 or Windows NT 4.0 based solution for case management documentation and on-line document management for mental healthcare professionals. The software suite consists of four modules:  Treatment Planning, Progress Notes, On-line Signatures, and Managerial Report.

8)  Clinician's Desktop/Echo Management Group:  Written for a 32-bit Windows environment, Clinician’s Desktop is a user-friendly electronic medical record-keeping system that makes it quick and easy for clinicians and direct service staff to manage their client care and client reporting responsibilities. This sophisticated software tool provides instant access to everything from scheduling to treatment planning and patient record information. It addresses critical Managed Care issues, such as Outcome Measures; Utilization Review; Information & Referral; and Assessments.

9) Chartman is an electronic patient record and data management program for psychiatric treatment facilities. The program validates, stores, retrieves and prints client data, using a virtually unlimited number of forms. CHARTMAN permits complex analysis of client data, including outcomes, demographics, medication records, treatment plans, and per-client costs.

This is a copy of some comments I posted in September 1996, on Martin Briscoe's
COMPUTERS IN MENTAL HEALTH mailing list. Several readers felt
this info was useful, so it is repeated here.

My apologies in advance for the length (and mild circumstantiality) of what follows, but hopefully it will be helpful to some who are looking into automated treatment planning. I agree with [a previous comment on this mailing list] that there are pros and cons to computerized treatment plans. I've been (somewhat reluctantly) involved in this issue for a couple of years now. I first spent several weeks making phone calls, finding vendors (no easy task!), and reviewing demos.

At that time I selected TxPlan by the Dovetail Group [now known as Earley Corporation]. It seemed the most customizable and user-friendly of what was available at the time. We used it on our adolescent unit for several months, before our staff revolted and resumed using written plans.

The result has been that I have written them a replacement program using WordPerfect for Dos macros. The code is too cumbersome to market, but I'm optimistic my efforts will help us generate a facility-specific "library", and that I'll eventually find a suitable software package to plug our library into. Here are some of my observations from this experience which may be informative to others:

1) Despite all the administrative (read JCAHO related) noise about treatment plans, most clinicians seem to view them as unnecessary paperwork and a major pain in the butt. It is very difficult to convince them that there is potential benefit to automation for their patients and themselves. The only real motivation comes from the hope that automation will let them spend less time on this paper-work exercise so they can focus their attention on "more important" issues. In fact, the plans generally seem to be ignored once they have been created... except for a lip-service review at the required intervals.

2) Most potential users of treatment planning software (including myself) are initially very naive about what they are purchasing. The assumption is that you're going to buy a 'turnkey' package... install it and immediately generate great plans by clicking on a few menus. This is not realistic. Even if you could find a program with a comprehensive "library" of interventions, there is so much variability in staff expertise, staff availability, theoretical orientation, professional dominance, intervention resources, etc. that any interventions would either have to be so vague and general as to be useless, or else they would have to be extensively modified to fit each setting.

3) Assuming you convince your staff of the value of automation, it is EXTREMELY difficult to motivate their effort in creating the necessary library of interventions. Everyone thinks its a great idea, but they seem to be too busy to participate in the project. Personally, I think this has more to do with insecurity about criticism of their efforts than about passive resistence. So be prepared to spend considerable time coaxing, encouraging, reassuring, and reinforcing staff for their participation.

4) Most treatment plan programs are built around a database platform. This gives you the (necessary) ability to add/modify components. Unfortunately, this also requires the user to create each new plan in a segmented fashion. In other words, they must be able to visualize the final product, while looking at successive screens of problem names, problem descriptions, goals, interventions, and objectives. Experienced computer users (especially those with programming experience) have no problem with this... we are accustomed to creating documents "out of order." However, this is THE MAJOR obstacle for naive users. They need to see the document as it is being put together, otherwise they get frustrated easily. My WordPerfect macros enable this, but take away the end-user customizabilty.

5) I've heard a number of objections to automated plans, including the ones about lack of variability across plans, lack of specificity to the patient's unique problem, and the "lack of heart and soul" mentioned [earlier in the discussion group]. These are good points, but there is a counter-point to each. The variability/specificity argument doesn't really hold up because when you look at several plans created by a single person (or small group of staff), they tend to be very repetitive. (One of the facilities most critical of our own automation efforts was actually using photocopied, multiple choice forms to create their plans!) A computer program (potentially) gives staff access to a much wider variety of prompts and is more likely to result in variability. As to the "heart and soul" argument, this is a concern only if users see automated plans as a comprehensive program that produces the complete plan. A more realistic view is for the automated program to produce a shell, with basic strategies in place... the end user must still go back and customize each plan to fit the client's unique needs.

6) Despite institutional emphasis on "team" approaches to treatment plan development, my experience is that the actual plan is usually generated by a single person... sometimes this follows a multidisciplinary "team" discussion, sometimes not. The writer may not have a thorough understanding of what contributions other disciplines may offer. An automated plan gives him access to prompts which are more likely to result in truly multidisciplinary contributions.

7) There seems to be great emphasis on treatment plans among JCAHO advocates. In spite of this, reading JCAHO guidelines gives you very little confidence. The guidelines that exist are very vague and contradictory. This leads to considerable differences of opinion about what constitutes "compliance." Staff debates over this are hard to moderate because there are no concrete examples of what the darn things 'should' look like. The very staff who are most critical of existing efforts for non-JCAHO compliance often refuse to produce examples because they are just as uncertain as everyone else. One of the main benefits of our current automation efforts was that it forced staff to start generating specific examples. For the first time we had something concrete to discuss.

8) Some staff members (particularly the more experienced ones) react with fear/resentment of automation efforts. Their concern is that naive-but-grandiose administrative staff are trying to tie their hands with respect to treatment efforts. This is certainly a danger, since admin staff will invariably feel that they are the only ones with authority to give final approval to the intervention "library." I don't really have a good counter-point for this one, except that you probably have the same problem even with hand-written plans.

9) In an ideal situation, you would have a multidisciplinary team of equally proficient and equally motivated staff. Each would be very familiar with all the treatment options for any given problem and fully comprehend the individual dynamics of each case. If anyone knows of such a place, please let me know... perhaps in a galaxy far far away. In real life you have some highly competent staff... mixed in with the usual compliment of problem staff who get rotated around (or promoted!) because no one has the (shall we call it initiative) to fire them; long term staffers who have learned how to do as little as possible and still keep their jobs; turf-defenders who obstruct the planning process to prevent encroachment on their professional autonomy; narcissistic clinicians who insist that they alone should have any input over treatment decisions; etc. Automated treatment plans have the potential benefit of compensating for some of these interpersonal and competence problems by providing a less threatening source of ideas for specific interventions.

Since I mentioned TxPlan, here is a copy
of a messsage I sent to another user around July 1996...
in case anyone is interested.

I've used TxPlan at a large psychiatric hospital in Mississippi. I picked it about 2 years ago after doing an extensive search of their competitors. TxPlan was the best I could find at the time. Pros include end user customizability and considerable flexibility of format. Cons include the need for at least minimal understanding of programming techniques if you want anything other than the canned format.

The program comes with standard libraries of interventions. However, its probably not realistic to expect that libraries created by others will be very helpful. There's just too much variation in how individual facilities/providers provide treatment, what staff are available, what skill levels are available, etc. At our facility we decided to throw out the included library and start building our own.

We also completely re-designed the format to be consistent with our existing plan. [That's another hurdle, BTW, getting past those who worship the current form... and helping them to see the benefit of a standardized "format" rather than a standard "form".]

Overall, I thought it worked quite well. (My role was to be the clinician/computer nerd who set it all up.... and, frankly, I was motivated largely by my desire to avoid the need to write my own program from scratch.) The unfortunate upshot was that our staff tried Txplan for about 1 year, then rejected it. Complaints were that the user interface was non-intuitive, they had too many plans lost to unexplained crashes (which they were never able to replicate when they called me to complain <grin>), and, most importantly, they could not get used to the "segmented" development you have to follow to use TxPlan. By "segmented" I mean that you have to work on separate sections of the plan (e.g., problem statement, goal, intervention/objective, and discharge criteria) in isolation... it was hard for them to visualize how the whole plan would look when they got through.

In short, I liked it, they didn't, it's gone, and I'm now writing a Treatment Plan program using Wordperfect-Dos Macro language which fits our staff requests for a plan which is visible on-screen in the background while the macros run in the foreground to generate the text.

TxPlan is a fine product, but plan to have a dedicated clinician/computer nerd who can spend several months adapting it to your facility. Keep in mind, this is no criticism of TxPlan, this will be true of any treatment plan generating software you buy. If you have visions (as I did) of taking such software out of the box and immediately using it to produce acceptable treatment plans, you'll find that this is very unrealistic.

[By the way, TxPlan now (1999) has a windows version (TxPlan II) which reported addresses many of the concerns we had with the dos version of the product, and builds in some outcome assessment capability. Check with the Earley Corp. web site for info.]

Holler if you want any other feedback on it. Cheers, Greg.

gregnail @ msresource.com

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This page last updated on December 19, 2009.