A highly placed woman in a major New York City social services agency impressed me with her wisdom recently. She said that she didn’t want to have a committee build an Electronic Health Record (EHR) from scratch, even though that’s possible with the software the agency selected. The facilities would use whatever came from the software manufacturer wherever possible. During the purchase process, she had seen that the vendor had fine-tuned solid functionality over the course of many years and the result was a pretty good product even though some of her staff might want it to operate a little differently.
EHR software is generally manufactured with a number of workflows in mind, and some software can be modified to work virtually any way the staff wants to use it. These days the difficulty can be in where to draw the line and accept what the vendor suggests.
In this age of screen and functionality design tools and report writers that moderately tech-savvy professionals can use, this was the voice of experience speaking: too much design slows the EHR implementation process and can detract from consumer service. If treatment professionals on a software implementation team are obsessing about adding data elements, logic and reports to the system, they spend less time focusing on the mission of the facility they work for: serving the consumer.
Here’s how report writers and customization tools pay off: A lot of consumers depend on government and charitable funding to get the help they need. Sometimes these funding sources are not used by many professionals or treatment facilities, so software vendors will charge extra to meet reporting needs that facilitate getting paid…everybody needs to buy shoes, and the vendor’s development option may be quite expensive. A design tool or report writer in the right hands may be able to produce what’s needed at a fraction of the vendor cost in order to assure a consumer’s services are paid for.
So, this is the dilemma. Many software products include tools delivered to make at least minor modifications to EHR software’s “out of the box functionality”. Most treatment organizations keep their professional staff busy helping consumers, so they’re not the ones to be using those tools. The simple solution to getting needed functionality on line is to hire an EHR professional, who does this sort of work for a living, cheaper than the vendor. These folks are certainly available, and as long as they have guidance from both the executive and professional levels, they can usually help minimize disruption of services to consumers during and beyond software implementation. It’s also in the interest of minimizing disruption and getting the EHR functioning in a reasonable amount of time that an agency should consider using as much “out of the box” software functionality as possible. For the minor changes (adding a data field, modifying a screen or writing a report), the design tools and report writers come in mighty handy and avoid future development fees.
When an agency purchases an EHR, it makes sense to assure it comes with a flexible, powerful design tool. Sometimes work flows change, and management seems to forever be asking for more information displayed in a different manner to meet some requirement or another. Two years down the line, new fields or even an entire form may be needed to meet the need for only a few people to do the input, and fewer people to see the reports. The financial reward of the new features or functionality may not justify what a vendor charges; a person on-staff or consultant who knows the built-in design tools can limit the new fields and reports to just the right people if the design tool is good and the EHR security rights comply with current technology standards.
Since mental health and substance abuse treatment professionals should be busy helping consumers, a reliable EHR professional to help with additional functionality needs to be accounted for…both present in the workplace and with a line in the annual budget. Another great thing about purchasing an (EHR) right now is taking advantage of groovy technologies like SmartPhone connections, functionality that forces users to meet the rules of HIPAA, HITECH, and other acts or agencies, and patient access to their own medical records over a secure internet connection. Professionals seeking an EHR need to be cognizant that the bulk of the features and functionality they want comes with the system. Development is expensive and generally takes a long time. So, make sure what you want and need is in the contract, and whatever’s not in the contract can be built with the design tools that come with the system.
Getting the EHR to fit a specific organization’s needs can be an expensive undertaking, and tying together standard elements involved in purchasing and implementation of the software is important down to a very granular level…it’s good to know what you’re getting yourself into.Read more →
The practical implications for professionals and consumers of meeting Meaningful Use measures with the Electronic Health Record (EHR) can be quite positive. I commented on the first ten of the fifteen measures in the last couple posts, and we’ll explore the balance today.
The measures are intended as a way for the Center for Medicare and Medicaid Services (CMS) to confirm that the EHR is being well-used. Computerizing mental health and substance abuse treatment organizations with software that works also needs to fit into the plan for a national health record with the goal of improving health for all Americans. From a national perspective, communication among healthcare professionals, improving efficiency, effectiveness and increasing outcomes data for research are good results of the effort for a national health record that started so long ago. It’s also important to protect consumers’ privacy; today’s plan for that is pretty effective.
Incentives from Medicaid are over $63,000 per prescriber, reason enough for some professionals’ organizations to seek them.
Here are a few tidbits about practical value of meeting the Meaningful Use measures in your EHR.
11. Clinical Decision Support Rule: This sounds tougher than it is, and the value is simple. For example, if, during an intake, a prospective consumer shares he is suicidal, then it’s a requirement to administer a suicide assessment. If the assessment scores in the danger zone, the treatment organization may set a policy (automated in the EHR) to pay some additional attention to that in the form of increased services. Periodic scores from the same assessment could be output to a report that gauges improvement of the condition. This tracks effectiveness of the rule, which pays off greatly for professionals and consumers alike. If the clinical decisions are not leading to better outcomes, that’s brought to the forefront of attention, and whatever’s not working can be improved.
12. Electronic Copy of Health Information: A few hospitals and mental health treatment agencies have integrated a Consumer Portal into their EHR. This delivers a consumer the information via a secure Internet connection. The major concern is complying with HIPAA security requirements and keeping a consumer’s health information from leaking to others. The portals are designed to securely deliver information like blood or urine test results, problem and medication lists, even medication allergies to the consumer…it’s the consumer’s treatment record, and she’s entitled to it. Naturally, not all treatment organizations will want to maintain a Consumer Portal, and those organizations can elect to provide electronic media to the consumer within three days of the request.
13. Clinical Summaries: Did you ever leave a professional’s office wondering what just happened, and if the money for the treatment was well spent? Clinical Summaries are a written description of what happened in that session’s treatment, whether medications were prescribed, a counseling session occurred, or other service offered by the healthcare professional. The information can be available on the Consumer Portal, however other electronic formats or even a printed copy are acceptable under this measure. Whether or not the money is well spent, you’ll at least know what just went on, and since the information is yours, it’s supposed to be part of the service and not charged.
14. Electronic Exchange of Clinical Information: This is one of my favorite parts of the electronic approach. I abhor filling out duplicate information. It always bugs me when I have to repeat the same information within an organization that’s supposed to be serving me…This measure assures that certain information can be shared not only within an organization, but also among healthcare providers. The consumer controls this sharing of data, and if she doesn’t want certain information shared, it’s supposed to be excluded. A good outcome of this is reduced mistakes, eliminating human keystrokes on the computer and electronic updating of information automatically when a consumer visits a new professional.
15. Protect Electronic Health Information: Consumers deserve privacy, and that’s the outcome of this measure. It’s the consumer’s decision to share information…or not. HIPAA security has been pretty effective and around a while, so this sort of protection is not a reach.
Meaningful Use measures assure EHRs meet standards. From what I’ve seen, the standards are reasonable and carry true benefits for both the consumer and the professional.
Beyond these measures, the next subtopic in this line of thought for me to cover is the Menu Set Measures…but that’s another day.Read more →
In my last message, the first five measures that provide critical proof of using an Electronic Health Record (EHR) were explored from a different angle, the practical implications for professionals and consumers. There are fifteen of these measures, and we’ll tackle a few more today.
Incentives from Medicaid are over $63,000 per prescriber, and that contributes greatly to offsetting purchase price and ongoing expense of the EHR. Mental Health clinics and Substance Abuse Treatment organizations were left out of the original definition of who could qualify for Meaningful Use incentives, and the solution to that oversight is to use prescribers to qualify, at least for now. Checking the progress of the bill that’s intended to add these healthcare providers to the equation, it’s rocketing through House of Representative committees at the speed of government…a tedious process that requires a lot of lobbying to keep it on the radar.
Here are a few tidbits about measures six through ten:
6. Medication Allergy List: The functionality for this relates back measure 2, Drug Interactions and Allergy Checks. In order for an alert to pop up on the CPOE (Computerized Physician Order Entry), it has to come from somewhere in the software, usually another list (doctors seem to like lists). As with other related measures, professionals and consumers really like avoiding an interaction or allergic symptoms invading a consumer’s day because of an interaction with the medication. Additionally, I remember somewhere in the dim past that medication / allergy interactions can occasionally be fatal. It’s lifesaving technology, and the professionals’ inputting a consumer’s allergies is a fairly simple matter. In most software. Some products I have seen have been more work than it’s worth to use. If you’re shopping for an EHR, check the CPOE out thoroughly to assure it’s easy for the prescribers to use.
7. Record Demographics: Who is this consumer? Where does he live? When was he born? Addressing these questions is a no-brainer; professionals need to know who they’re working with. It’s a pretty inoffensive process to gather the required demographics, and they’re needed in order to bill, and consumers are used to this delay. It goes with the territory, so the software needs to work within the professionals’ process to be effective.
8. Record Vital Signs: Blood pressure, and Body Mass Index (BMI) help the professional recognize and monitor conditions like a weight problem. In Mental Health, it’s probably a casual notation to most professionals, however to the consumer, something like that BMI can be an indication of a body-image problem, and a professional may want to discuss this sort of thing.
9. Record Smoking Status: If the consumer is twelve years old, don’t worry about recording this. For those of us over age 13, however this is a terribly important notation. I have heart disease…how much of that condition was aggravated by my smoking, even though I quit over 17 years ago? I have a pal battling bladder cancer every day; his doctors say that’s a direct result of smoking. OK. That’s enough of me on my soap box. The fact is that smoking is an addiction, and that’s of concern to professionals in this business.
10. Clinical Quality Measures: Is treatment working? In my mind, this is one of the most important things we can do in this field because peoples’ lives improve when treatment is successful. There are a ton of assessments intended to measure treatment outcomes. They’re pretty painless, using radio buttons and check boxes to speed the process and enable improvement tracking on a report. Many of these assessments are intended to be administered multiple times, providing a graph of progress toward a treatment goal. In our field, suicide and other assessments deliver measurements of outcomes. In other areas of healthcare, there are different measurements. (http://www.cms.gov/QualityMeasures/03_ElectronicSpecifications.asp#TopOfPage)
If you’re a professional who wants to take advantage of Meaningful Use incentives, remember that your EHR needs to be certified. A couple of companies have been identified as approved in this effort by the government. (http://www.ihealthbeat.org/features/2010/onc-names-temporary-certification-bodies-for-meaningful-use-program.aspx) Not all EHR vendors have sought and received certification, and usually professionals and the organizations they work for are relying on these vendors to secure certification of their software…so ask them if you don’t know and want to collect Meaningful Use incentives.
I’ll share my take on the final five measures in the very near future.Read more →
In the Electronic Health Record (EHR) business, we have been pointing professionals and the organizations they work for in the direction of collecting incentives from Medicaid for proving they are effectively using the her. Mental health and substance abuse treatment agencies stand to collect good money for meeting Meaningful Use requirements (over $63,000 per prescriber meeting the requirements).
So what? What’s that mean, how can it be good for the consumer and the professional helping them?
There are fifteen “core measures” to be proven in meeting the requirements and collect the incentive payments. Tackling the first few of them, here’s how they affect both the consumer and the professional. Since the biggest payoff for agencies seeking these incentives appears to be in Medicaid, we’re assuming 30% of a prescriber’s work serves Medicaid patients, and they write over 100 prescriptions in the reporting period.
1. CPOE for Medication Orders: That would be Computerized Physician Order Entry. A prescriber just having the capability to maintain records on the computer keeps a ton of treatment information easily accessible. If a medication’s not working, the record helps prescribers determine whether a dose increase, perhaps another drug, or some other measure will be more helpful. From the consumer’s side, CPOE not only shortens their visit and helps zero in on good medications for their conditions, it also sets the stage to send the prescription to their neighborhood pharmacy, a later requirement that eliminates the need to call in or drop off a prescription and delay picking up the medication they need.
2. Drug Interaction and Allergy Checks: One of the greatest features this functionality delivers is a safety net for prescribing. Alerts are built into most CPOE systems to avoid prescribing multiple medications that interact poorly with one another or might aggravate an allergy, which carries the possibility of undesirable side effects like sickness or death. Both professional and consumer like this idea. After all, prescribers are only human, and oversights or mistakes can be made. These alerts help avoid such problems.
3. Maintain a Problem List: If a professional doesn’t have immediate, up to date information regarding all of a patient’s diagnoses, she doesn’t know what to treat. This hampers development of a treatment plan. If a consumer has a diagnosis of alcoholism and a diagnosis of depression, different treatments apply for the multiple problems, goals and objectives in the treatment plan; conditions can aggravate one another. Past diagnosis’ can recur, so noting a previously resolved issue on the problem list can help a professional make good treatment decisions. Consumers deserve well informed treatment for their problems. If a problem list is intrusive, in the professional’s face, there’s a much higher likelihood of staying focused on treatment goals that are agreed upon between the professional and the consumer.
4. Electronic Prescribing: This is the actual delivery of a prescription to the neighborhood pharmacy mentioned above. This feature lowers liability for professionals because the handwriting problem is eliminated…the right dose of the right medication is assured to be legible with electronic prescribing. This is vital to the continued health of the consumer, and pharmacies like the idea because it decreases time they spend on the phone verifying illegible prescriptions.
5. Active Medication List: Similar to the problem list (professionals seem to have a lot of lists), this list provides an immediate update for a professional of not only the consumer’s current status, but the history…if a medication has been effective or ineffective in the past, it may help, hurt or be a waste of time in the future. A consumer may not remember medications that he’s used in the past, or get the name of a medication wrong that he thought worked well for him (take a look at a list of medication names and you can see it could be easy to make a mistake. The medication list provides an accurate record.
If you’re a professional who wants to take advantage of Meaningful Use incentives, the link cited above delivers the hoops you’ll have to jump through immediately. As far as the EHR goes, check out a few of my previous posts for some valuable tips.
I’ll explain a few more of these elements of a good Electronic Health Record (EHR) in the very near future.Read more →