APTS takes a close look at the OCCI computerized tool

APTS takes a close look at the OCCI computerized tool

Use of the OCCI computerized clinical treatment pathway is becoming generalized in most sectors. A panacea for some and a source of concern for others, what position should we take on it?

When the OCCI computerize tool was first introduced, it was mainly used to track home support services enabling people to continue to live independently in their homes, and it replaced the OEMC multi-clientele assessment tool. Its use has been progressively extended and the tendency is to impose psychosocial and rehabilitation services on all professionals and technicians. To assess the impact of this tool on our members’ work, the APTS launched a survey at the end of June and called together a consultation group on September 13.

The aspects examined were: the frequency with which the OCCI computerized tool is used, the difficulties encountered, the time devoted to it in the presence of patients and at the office, the workload it represents, the effectiveness of the tool in determining the needs of service users and encouraging their participation, its compatibility with personnel’s clinical judgement, and its relevance. The objective: to orient our support for members and decide on possible recommendations to make to the health and social services ministry (MSSS).

Developed by the research team of Professor Nicole Dubuc at the Université de Sherbrooke, this tool is defined as “a process that ensues in a personalized response to the needs of the person and her or his family, based on clinical processes and evidence.” It is supposed to guide personnel and help identify a response to needs, without excluding the latter’s clinical judgement. However, the exclusion of clinical judgement is precisely one of the concerns raised.

In addition, the OCCI tool makes it necessary to bring a laptop on home visits, as questions have to be completed in the presence of the person receiving services. This is an irritant for some employees, who see it as an obstacle to developing the kind of trust that’s needed to build a helping relationship.

Its proponents claim that the OCCI computerized tool reconciles clinical and administrative pathways, but this assertion still has to be verified.

On paper, a number of features seem promising, such as:

  • the comprehensive nature and multidisciplinary approach of the assessment
  • the fact that service users are encouraged to take their problems in hand, set objectives with personnel, and participate in the treatment
  • the promotion of interdisciplinary collaboration and complementarity
  • access to data in real time, and support for personnel in making decisions.

What’s it like in “real life?” For more than a year, the MSSS has been conducting pilot projects in three integrated centres in Chaudière-Appalaches, the Montérégie-Ouest and Montréal West Island, before recommending broader implementation that should naturally be preceded by about 10 hours of training. We have received comments from a few people who took part in these pilot projects. Their reservations include:

  • the time it takes to fill out the long questionnaire, which adds to the work of already overburdened personnel
  • the incongruity of questions that are unrelated to the requested service or the employee’s expertise
  • the inconsistent indicators generated by the algorithms in terms of their appropriateness and relevancy, and the need to always examine them in light of clinical judgement.

The 1,000 responses we received through our online survey this summer will help us pinpoint the new realities ensuing from the use of this tool in our members’ workplaces.

What should we think of this new initiative to standardize the work practice of APTS members? While there are still a number of vacant positions and long waiting lists for access to services, what proportion of employees’ work should be devoted to this time-consuming tool for gathering increasingly detailed statistics? If the employer requires members to use the OCCI tool, what measures should be set up to preserve good conditions of practice? These are the kinds of questions that the APTS consultation process will help us determine.