Before the COVID-19 pandemic, a leading provider of high-quality behavioral health services in the United States was providing onsite treatment at its numerous outpatient clinics, and delivering inpatient treatment at its hospitals. The provider specializes in mental illness, alcohol and drug dependence, anxiety and depression—some of the same conditions that have seen a steep rise in the U.S. due to the COVID-19 outbreak.

Before the outbreak: a paper-intensive, in-person model

Before the pandemic, the provider’s processes were heavily paper-based. They had no electronic medical record system or online patient portal—in other words, no electronic systems to support telehealth.

All key clinical documentation was paper based, including: consent to treatment, patient handbook, treatment plan and clinical documentation. Many documents required signature before treatment could begin, and all signed documents were scanned, post discharge, into their legal system of record, Hyland OnBase Medical Records Management solution.

Additionally, the majority of interactions were conducted face to face: outpatient therapy patients were treated onsite, and group collaboration and documentation were all handled in-person.

After the outbreak: responding and rebounding with agile business practices and enabling technology

To protect clinicians and outpatients from the spread of COVID-19, the provider had to become “digital” overnight, and without suspending critical services as demand grew. Therapists and clinicians were asked to work from home when possible. In-person outpatient therapy sessions were moved to video-based telehealth sessions, increasing videoconference usage exponentially.

Additionally, they needed a rapid way to move their documentation processes online as patients were continuing to come into waiting rooms to sign authorization forms in person. Another challenge was patients had varying access to technology (e.g. due homelessness, mental impairments, etc.). The new solution would need to be accessible from mobile devices as well as home computers.

“Leveraging what we have” was a key criteria for addressing these challenges. Since the provider had OnBase and knew of CGI’s certified expertise as an OnBase integration partner, they immediately called us to help. A team of CGI experts was assembled quickly to brainstorm a solution with the client.

Step 1: Rapid implementation of DocuSign

As a first step, CGI assisted with implementation of DocuSign’s eSignature solution to obtain the patient’s consent for treatment. In record time, more than 70 different DocuSign templates were implemented that are available to be emailed from the provider’s registrar to patients. Forms were also standardized across facilities. The implementation required long hours and close collaboration among CGI and provider teams to complete a project that typically would have taken months.

The new solution requires patients to click specific boxes, initial their acknowledgement and electronically sign the form. Once complete, the signed document is sent to both the patient and provider. The provider is now able to collect all required signatures on the essential documents, online. With CGI’s help, the provider’s team has also learned how to configure the forms themselves.

The process has been digitized as few patients are coming in to sign forms. However, users still must enter the information manually, allowing room for error, especially with email addresses. Tracking unreturned documents also is still a manual process, as is the final document upload into OnBase. With the signature hurdle behind them, CGI and the provider moved to the next step to further transform and even reinvent their former ways of working.

Step 2: DocuSign integrated with OnBase

To automate as many remaining processes as possible, CGI is now helping the provider integrate DocuSign with OnBase for outpatient documentation. OnBase Image Forms are being used to create the documents and integrate with DocuSign for the patient signatures. Image Forms replicate paper forms electronically, reducing the time it takes to fill out, submit, and process them. When documents are signed electronically, they are returned automatically to OnBase and versioned.

While OnBase had not been used in this way in healthcare before, the CGI team took a consultative approach to bring forward a creative and effective solution based on proven results with use cases in other industries.

Five use cases are being developed and tested, including an automated workflow where the document is created, sent to the patient to sign, then signed by the provider. In all cases, the workflow prompts users to sign the documents.

The provider is also working to add patient emails to the provider’s main patient information system so the data can be transmitted to OnBase, reducing errors. The integrated solution is being piloted at two facilities with plans for enterprise-wide rollout. Additional enhancements being investigated are the use of barcodes and the potential to expand to other departments such as contracts/legal and human resources.

Necessity is the mother of reinvention

This is another example of how the pandemic is compelling providers to turn to and achieve transformative digital innovation to rapidly respond to unprecedented demands while reengineering processes to provide new products and services in a post-pandemic future. This provider had been discussing a digital strategy for several years, but it was urgent circumstances that sparked this creative solution in an extremely rapid timeframe.

This type of solution also is applicable in other industries for any processes where people are passing paper for signatures today, such as in contracts management, facilities management and construction management as examples.