Recording case in CMI/ODS - March 2008 (Program management circular)

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Key message

The CMI/ODS is the information system for Victoria’s public mental health system. When the clinical decision is made to commence a period of integrated and coordinated care for a consumer, it is recorded through the opening of a case on the CMI/ODS. As well as being an essential clinical accountability tool, the concept of a case is used for a range of core reporting requirements, including caseload analysis and consumer outcome measurement.

Purpose

To clarify the purpose and role of cases in the Client Management Interface and Operational Data Store (CMI/ODS) and thereby improve the understanding of when to commence and close a period of integrated coordinated care (a ‘case’).

Background

The CMI/ODS was introduced in October 2000. The CMI/ODS is the Victorian public mental health clinical information system.

Central to the development of the CMI/ODS was the concept of coordinated and integrated consumer care. All consumers of public mental health services whose care is provided in the context of a formally established ‘case’ are required to have outcome measurements routinely collected in accordance with the Victorian Outcome Measurement protocol.

In 2007, CMI/ODS application changes were introduced in the information system to improve and simplify the navigation and management of cases.

Case definition

A case is ‘a clinically determined period of care for a consumer that involves individual service planning and clinical review generally within a framework of multidisciplinary care’.

For consumers receiving bed-based services a case is automatically opened on the CMI/ODS, if one is not already in existence.

CMI/ODS organisation structures

The hierarchy of a mental health organisational structure in CMI/ODS is:

• organisation
• establishment
• campus
• subcentre
• program.

A campus is the central organising component of the CMI/ODS information system (operationally referred to as an area mental health service (AMHS)). A case tracks and monitors coordinated integrated consumer care across the whole campus (AMHS) and incorporates all the episodes of care at inpatient, community residential and ambulatory services.

Care pathways

The clinical pathway for consumers commences with access to the public mental health system through to discharge.

The clinical pathway involves decision points along the way:

• triage
• intake (registration)
• case opening
• discharge.

Triage

Triage is a screening assessment to decide whether to proceed with more comprehensive (intake) assessment and service provision or referral to other services.

Intake (including registration)

If the decision is made to provide clinical services then the consumer is registered onto the CMI/ODS information system and issued with a Mental Health Statewide Unit Record number.

Case opening

A case is automatically opened on the CMI for clients admitted to a bed-based service, whereas for non-admitted clients it is a clinical decision to commence a case, it is not an automatic part of consumer registration.

The clinical decision to commence a case is based on whether the consumer requires a period of integrated multidisciplinary care incorporating service planning, monitoring and review, discharge planning and closure.

This would include clients of mobile and support teams (MST), continuing care teams (CCT), Intensive Mobile Youth Outreach Support (IMYOS) and aged persons assessment teams (APAT). A case may also need to be opened for some clients of a crisis assessment and treatment team (CATT) where they are not already in an open case.

A case is not typically required:

• where contact with clinical services may be brief or once off, such as assessment only
• for discrete specialist clinical services such as consultation and liaison (CL) or emergency department crisis teams (ECATT)
• for shared care arrangements where the primary responsibility for the care is with a designated provider outside the AMHS, for example consumers accessing a clozapine-only program or secondary consults provided by primary mental health, who are principally under the care of private psychiatrists or general practitioner.

Refer to the ‘Registration of mental health clients in CMI/ODS’ program management circular to determine if this is applicable.

Case closure

When the clinical decision is taken to discharge the client the case is closed. If required at a later date a new case for the consumer can be commenced. Case closure on the CMI/ODS is not automatic and needs to be instigated as part of local protocols, for example as a result of clinical review meetings.

Further information

Further information about mental health services in emergency departments can be obtained from www.health.vic.gov.au/mentalhealth/triage/index

About program management circulars

The information provided in this circular is intended as general information and not as legal advice. Mental health service management should ensure that policies and procedures are developed and implemented to enable staff to collect and use health information in accordance with relevant legislation.