ELECTRONIC HEALTH RECORD A JOURNEY LIKE NO OTHER…. "THE ART OF PROGRESS IS TO PRESERVE ORDER AMID...

ELECTRONIC HEALTH RECORDA JOURNEY LIKE NO OTHER…."THE ART OF PROGRESS IS TO PRESERVE ORDER AMID CHANGE

AND TO PRESERVE CHANGE AMID ORDER" - ALFRED NORTH WHITEHEAD

WHAT DO YOU GET WHEN YOU COMBINE….

• Five Fiscal Years

• 2 EHRs

• 300 Users

• A Team of Superusers

• 4,402 hours of work over 22 months (Houston)

• 400+ Forms

• Over 20 Contracts

• Multiple Funding Sources

• A Merger

• A Fire

• And……Daily Life

ANSWER: An exhausted, yet proud team that feels it was well worth the effort!

WHAT DO YOU NEED WHEN CHOOSING AND IMPLEMENTING AN EHR?

A SENSE OF HUMOR

• Experience is simply the name we give our mistakes – Oscar Wilde

• If we could sell our experiences for what they cost us, we'd all be millionaires – Pauline Phillips

• A man who carries a cat by the tail learns something he can learn in no other way – Mark Twain


LEARNED OPTIMISM & HEALTHY SKEPTICISM

QUALITY CONSCIOUS, CHANGE-ORIENTED, FUTURE-FOCUSED CULTURE

COMMON & REALISTIC GOALS & OBJECTIVES

AN EVALUATION OF CURRENT AND DESIRED WORKFLOWS

A COMMITMENT – AT ALL LEVELS OF THE ORGANIZATION


AN AGREEMENT ABOUT “DEAL BREAKERS”

OUTSIDE SUPPORT – THROUGH CONSULTATION, MENTORSHIP ETC.

FINANCING

A TEAM THAT REPRESENTS EVERY DEPARTMENT IN YOUR AGENCY – PROGRAM, BUSINESS & IT; FRONTLINE STAFF, LEADERS ETC.

TIME…..LOTS AND LOTS OF TIME!!!

A DETAILED PROCESS AND TIMELINE FOR IDENTIFYING, INTERVIEWING, TESTING AND IMPLEMENTING


WHY AN EHR?

• You are Required to (Meaningful Use)?

• To get the Incentive?

• To be Proactive?

• To Be Able to Communicate with Healthcare and Insurance Providers?

• To Save Money?

• To Make Money?

• To Save Time?

• Quality Assurance?


THINGS TO CONSIDER

• How many funding sources do you have?

• What other systems are your required to use?

• How many different reports do you need and what do they include?

• Will you include all your programs in an EHR?

COMMON & REALISTIC GOALS & OBJECTIVESTHE COUNCIL AS AN EXAMPLE

• To Improve Business Operations and Increase Revenue/Collection (e.g. Eliminate spreadsheets for tracking financial transactions, maintain accurate account balances, apply insurance payments)

• Improve Productivity

• To Improve Quality Assurance – maintain control of forms/documents, send alerts, maintain charts properly and on time, HIPAA etc.


THE COUNCIL AS AN EXAMPLE

• Improve Diagnostic Procedures and Recommendations

• To Improve Documentation and Access to Client Data – no longer need to decipher handwriting, do not need to “find” charts, they are no longer left in drawers or on desks

• To Improve Reporting (for contracts, to apply for grants, for quality management) – to date this has not been realized, but we are still optimistic!

WHAT AN EHR CANNOT DO!!

• Improve the Ability of Staff to Provide Medical or Behavioral Health Services

• Develop Relationships with Clients for you

• Make Clients Pay

• Change Contractual Requirements

• Operate Independently of Staff

• Census Building – build relationships, marketing, client success stories

• Completely Prevent Human Error

IN SHORT: Staff are still the foundation for the quality of work

AN EVALUATION OF CURRENT AND DESIRED WORKFLOWS

TRACKING

• Track clients from scheduling to intake to their appointment

• Track financial transactions from intake to billing/collections to accounting

• Track documentation

• Track quality assurance procedures

• Track data collection, entry, analysis and reporting

POTENTIAL IMPACT OF EHR ON WORKFLOWS

• Scheduling

• Check-In and Check-Out

• Provision of Services – Medical and Behavioral Health

• Documentation

• Communication and Decision-Making

• Medication Ordering and Management

• Billing and Collections

AN AGREEMENT ABOUT “DEAL BREAKERS”IDENTIFICATION OF NEEDS (prior to even looking at systems)

• What do you absolutely need the system to do that cannot/should not be done another way? And why? (e.g. bill electronically, produce statements that clients can use to bill their insurance)

• What do you really want it to do, but if it can’t you will still be successful? And Why? (e.g. produce output reports by program and services, as well as an unduplicated count of clients served within a date range)

• What would be a bonus, but isn’t necessary? And why? (e.g. being able to rearrange items on a screen or between screens to match workflows and the tasks people are supposed to complete

A TEAM THAT REPRESENTS EVERY DEPARTMENT IN YOUR AGENCY

THE TEAM

• Front-Line Staff

• Doctors, Therapists

• Managers/Directors

• Accountants

• Admissions and Business Office

• IT (Programmer)

• Officer(s)

SUPPORT

• Want and Need Support and Buy-in from ED/CEO and your Board

• ALL departments (accounting, human resources, IT, program, administrative), even if they won’t work in the system. Some of these staff’s workflows will be effected by the EHR even though, so you want buy-in


PROJECT CHARTER

• States What the Project is For and Why - identifies needs and history that led to the initiative

• Identifies How You Plan to Reach Your Goals

• Defines the Purpose – goals, objectives, deliverables

• Identifies Project Resources

• Identify the Team

• Provides a Timeline

• Gives Indicators of Success


CONSULTATION/MENTORSHIP

• How involved do you want them?

• Do you want someone that facilitates or directs?

• How well do they need to understand your business?

• What is your budget? Can you partner with another organization?

• Who else in your field or in your community can you learn from?

A DETAILED PROCESS AND TIMELINE FOR IDENTIFYING, INTERVIEWING, TESTING AND IMPLEMENTINGREQUEST FOR INFORMATION

• As detailed and specific as you can make it

• Ask the same question multiple ways

• Tier in order of “Deal Breakers” and “Types of Needs”

• Request information about their company (e.g. profit/loss, size, # of current implementations, # of organizations they have worked with like your’s etc.

• How are charges calculated (per user, per active user etc.?)

• How does customization work and what is the cost?


DEMONSTRATIONS – for those of interest

• Ask for more than a dog and pony show – insist they show you the features you care most about

• Insist they walk a fictitious client through the system as much as possible

• Request time to “play in the sandbox”

• How does it match your workflow? what would need to change?

A DETAILED PROCESS AND TIMELINE FOR IDENTIFYING, INTERVIEWING, TESTING AND IMPLEMENTINGSELECTION

• This decision should involve everyone’s input/opinion, especially those that will use it most

• Negotiate for what you want and need

CONFIGURATION – this takes more time than anything else

• Practice Management

• Electronic Health Record

TRAINING – before, during and/or after configuration

• When does this happen? Who conducts? Where? Are there training materials

CHALLENGES

• Merging of two locations in one system

• Role definition

• Responses from vendor

• System capabilities not matching expectations

• Not understanding the domino effect within the system

• Workflow changes

• Minimal time to test the system

• Limited staff time

• Training

• Forms & Reporting – statements, outputs

• Change in state contracts

• Marketing

• Alignment with accounting procedures

HOW TO ADDRESS THESE CHALLENGES

• Adjust expectations to having 2-3 things work extremely well in the EHR and then know you will need workarounds for others

• Involve more staff and give defined roles, tasks

• Have realistic expectations

WAS IT WORTH IT??

YES!!!• Decrease staff time on phone, at check-in and with communication

• Quality assurance

• Increase in collections

• Can bill electronically, claims scrubber,

• More prepared for the future

CONTACT INFORMATION

Mary H. Beck, LMSW, CAI

Chief Operations Officer

The Council on Alcohol and Drugs Houston

PO Box 2768

Houston, Texas 77252

281-200-9331

ELECTRONIC HEALTH RECORD A JOURNEY LIKE NO OTHER…. "THE ART OF PROGRESS IS TO PRESERVE ORDER AMID...

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