SPIKE: Mental Health Numbers

[kmariepat-cityfriends]

As an editor of mental health numbers, I need to specify the primary mental health phone number for a facility

I expect this is structured as single source of truth, don't want another field that uses the same phone number under the service. just putting a phone number on the facility could create duplication no divergence between facility health service number

We have a mental health service where editors put in phone numbers AND we want a field to designate the primary health number AND we don't want editors to maintain numbers in two different places

Right now we know not every facility has a mental health number, it is not a required service. Working with office of mental health need to determine if it's a required field.

FE Notes:

• already a spot on the front end for mental health (may need updated queries to pull the correct number)
• need CM that number is no longer coming from lighthouse (they are now responsible)

Acceptance Criteria

• [x] I expect that at least 2 approaches are proposed for implementing the following user story As an editor of mental health numbers, I need to specify the primary mental health phone number for a facility note that we do not divergence between facility health service number
• [x] consider that FE changes may be needed based on approach
• [x] Note that this data will have to be pushed to Lighthouse, keep this in mind while working through solutions
• [x] I expect Blake on CMS team is consulted (and ask thoughts on expectation for reviewing and partnering on this work, use collab cycle?)
• [x] I expect that the approaches are reviewed with the team and PO (meeting scheduled to get complete AC)

[kmariepat-cityfriends]

This will not be deployed ahead of change management plan, that will be in place before the code is merged

KB: how do I maintain basic facility data

[kmariepat-cityfriends]

maybe starting with a spike, using editorial flipper

interested in training video

[kmariepat-cityfriends]

How and when and what do we need to worry about in terms of collisions, how do we pair this with other comms

[mmiddaugh]

Mental health numbers in CMS

• Facility mental health number via migration (not editable) - appears on system home page (if it is the main location) facility main page, locations list page, and in Facility Locator search results
• Facility health service accordion
  • Scheduling (appointments)
    • if no number is entered, the main facility phone number will be displayed
  • Contact info for each service location
    • checkbox option to use the general facility phone number
    • can enter 5 additional numbers with labels
• System level Mental health care coordinator page, i.e. VA Wilmington health care > Health services > Mental health care - main content blocks - all editable

[kmariepat-cityfriends]

The approaches determined in this card will be reviewed and validated with editors (talk further about approach and resources needed for this)

[kmariepat-cityfriends]

@kmariepat-cityfriends to make a new card to audit KB articles where this is mentioned

it is known to be mentioned in the basic facility info article

ask VHA DM what they are concerned

[mmiddaugh]

Most recent information informed by a conversation with the Office of Mental Health

• We have support for moving toward CMS as a single source of truth
• There may be a need to default to a Clinical contact center phone number if no mental health number is available (Clinical contact center numbers are assigned at a VISN level and are partially present in CMS. They would need a label to differentiate them from a local facility number for Veteran understanding)

[swirtSJW]

(in progress - this is my notepad)

Option 1 - Make existing facility field editable

Solution

• Make the existing field field_mental_health_phone on VAMC facilities editable.
• Remove it from the migration (and either keep the existing values or blank them out)
• Push that field to lighthouse with the status push.
• Does this field need to be required?

Pros

• Lowest lift
• No FE change needed
• No CMS content model change needed
• Single point of failure, editor not entering a value.

Cons

• No comprehensive fallback if there is no number specified at the facility level.
• Data is not riding where it makes the most sense. Mental Health number is a number for a service, so making it a property of a facility seems misplaced.

Possible enhancements

• Add a Clinical contact center field to each VAMC System that could be used as a fallback.
• Make Mental Health facility service pull from this field on the facility rather than the main phone number.

[swirtSJW]

(in progress - this is my notepad)

Option 2 - Phone on Mental health service, fallback to existing field in Facility, fallback to new Clinical contact center number on system

Solution

• Leverage "VA Health Connect phone" field to VAMC System content type since this number is a VISN level thing and that is as high up the existing chain as we can get it (or maybe this gets added to System Service?) .
• Add "primary phone" field to VAMC Facility Service content type
• When sending to lighthouse we send the Mental Health phone number based on this priority order
  • Primary phone from from Facility Mental Health Service.
  • Mental health number from the Facility
  • Clinical number from System (or system service)
• This would definitely need changes to GraphQL queries and FE templates

Pros

• Flexible for all variations of system and local overrides
• Connects the number with the related service rather than off on its own at the Facility or System node.
• Immediately extensible for any existing services (ie. Oncology hotline, Patient Advocates hotline ...) It would be there in case we needed it.
• Redundant fall backs

Cons

• Largest level of effort
• Fallbacks are not transparent to editors (it resembles magic)
• More points of failure due to complexity.
• More difficult set of steps for editors to carry out this change.

[swirtSJW]

Every facility gets the field-mental-health-phone from the migration from the FacilityAPI from the entry phone[mental_health_clinic] Out of the 1,324 vha facilities, 871 (66%) have mental_health_clinic numbers, so 66% of the facilities in the CMS have this value. Here is what it looks like in the FAPI result.

And here is where we put it in the CMS

@mmiddaugh I have a few questions:

1. Should we stop grabbing that value from the FAPI and just let the facility edit that value from this point forward? Or do we have low confidence in the values coming from the Facility API and we want to start with a blank slate?
2. Would this value be required for every facility (editor can't save without it?) There was mention higher up about the possible need for a fallback number
3. You mentioned higher up about there being a number that was at the VISN level (Clinical contact center) that might need to be a fallback. Is this something you envision living at the system level?

[swirtSJW]

@kmariepat-cityfriends In hindsight I think this AC is a bit misplaced (I know I am the one that misplaced it).

I expect Blake on CMS team is consulted (and ask thoughts on expectation for reviewing and partnering on this work, use collab cycle?)

I think it is too early to bring CMS team or Blake into this until after we pick one of the two paths and refine the chosen path more. They need more refining because there is still some uncertainty on the business logic behind all this.

[swirtSJW]

I expect that the approaches are reviewed with the team and PO

@kmariepat-cityfriends & @jilladams I think we are far enough along on this that I can explain the possible approaches to our product owner(s) and the team. So we are good to go for a meeting.

[jilladams]

@kmariepat-cityfriends 2 things here, from scrum discussion:

1. We need to review the proposals here (options 1 & 2) to get final clarifications from VHA DM on which way to go. Maybe also Lighthouse.
2. For VHA DM sync, is it possible to move the standing agenda / notes doc into the Team folder so we can all access / add to it?

[mmiddaugh]

@swirtSJW and I discussed the above questions live - posting answers here for our future selves

• Q: Should we stop grabbing that value from the FAPI and just let the facility edit that value from this point forward? Or do we have low confidence in the values coming from the Facility API and we want to start with a blank slate?
  • A: For the most part, Jay's earlier analysis revealed a few discrepancies between the mental health number at the facility level and those at the mental health service level so we should be able to use existing numbers as a starting point
• Q: Would this value be required for every facility (editor can't save without it?) There was mention higher up about the possible need for a fallback number
  • A: We should confirm this with VHA DM, particularly because Lighthouse mentioned it may be a required field for the API
• Q: You mentioned higher up about there being a number that was at the VISN level (Clinical contact center) that might need to be a fallback. Is this something you envision living at the system level?
  • A: The Clinical contact center number previously mentioned is also known as VA health connect (which is already a concept in Drupal for the VISNs in which it is available). Given it is not widely available, it probably isn't a viable option as a default for most VISNs and could be theoretically be entered by editors if desired. Otherwise, we're not expecting other system level numbers of this sort to be needed.

One additional note: we're expecting Mental health service availability and phone numbers to be confirmed during the planned health service validation process. We need to learn more from VHA DM about the timing of this initiative.

[jilladams]

@swirtSJW can you confirm re: the AC on talking to Blake about this ticket? Is that done and the VHA DM check is all that's left? Addressed here: https://github.com/department-of-veterans-affairs/va.gov-cms/issues/13785#issuecomment-1595366111

[kmariepat-cityfriends]

I spoke with @swirtSJW

and confirmed we have met the criteria to close this ticket, Meeting has been scheduled on 6/27

[mmiddaugh]

@swirtSJW @kmariepat-cityfriends I'm wondering about the need to make it clear to editors in the interface that the phone number entered into the mental health facility field will be the one pushed to Lighthouse and therefore available in Facility Locator search results and possibly elsewhere in the ecosystem

[davidmpickett]

My very official wireframe of a possible interface for adding to VAMC Facility

Very official explanation of interaction

1 - would check for instance of Mental Healthcare service at this facility. If found, display all associated phone numbers and let editor pick one (simpler version, pick the first phone number from the first service location)

2 - populate this field with data from a new field on VAMC system that indicates 1 fallback mental health number per VAMC system

3 - lets editor put in a different phone number that is specific to facility and different from previous two options. Could we prepopulate this field with existing data from Lighthouse to give editors a starting point?

[davidmpickett]

This is very much in line with option 2 proposed by @swirtSJW, but more transparent to the editors about choosing between possible sources.

[mmiddaugh]

Collecting the latest thoughts:

We have the opportunity to leverage two fields

• the facility-level mental health number (from the OMHSP/current source of truth)
• the mental health service-level number(s) entered by editors

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• We need a way to connect this main facility mental health number with the service details displayed in the mental health service.
• All facilities are not expected to have the mental health service associated with the location but are expected to display a mental health number. These locations will likely direct Veterans to call the system Medical Center's mental health number.
• The facility-level mental health number can be assumed to be correct and can be used by default, but should be made editable.
• We will want to consider what label to use when the system number appears so that Veterans understand they are calling a different medical center