The Electronic Health Record (EHR) is a traffic cop.
When I consider how many different sorts of traffic there are in a mental health or addictions treatment facility, I quickly become amazed with successful organizations of professionals. Sometimes it seems like it should be a magnified Three Stooges bit, there’s so much traffic. Just off the top of my head, there are 5 types of traffic that can be managed by an EHR.
Without managing the traffic, the facility just doesn’t run smoothly. Manyt facilities have a person who guides people to where they should be, is really good at what they do, and that person becomes known as the “go-to” person by professionals and consumers alike. That’s fine except when they’re out sick, or quit, or have a fit, or whatever. Reality gets in the way of the human traffic cop, and in this field, the EHR is a great tool to manage the traffic patterns I mentioned.
Consumers are likely not be aware of it, but in a mental health facility, their movements are planned; guided and recorded in the EHR. First, there’s the scheduled or unscheduled event…either way, the EHR can match up the right professional with a consumer to fill the need for that visit, whether it’s a regular counseling session, an HIV education session, or a visit with a nurse. Once an event is scheduled in the EHR, the front desk person can guide the consumer to the right place for the meeting; an effective scheduling module keeps people from bumping into each other in rooms that should have been reserved; reservations are in the EHR, and everybody involved in an encounter knows where to go, when, who will be in the room, and when they need to exit. Furthermore, when a room is freed up, the EHR has live information for a good place to have an impromptu meeting.
Having visited a lot of clinics and multi-professional offices, I’ve seen a ton of mis-scheduled rooms, complete with usurpers who try (sometimes effectively) to abscond with these valuable resources because the room was double booked. Or not booked according to Hoyle. Sometimes even professionals will try to beat the system. The problem is that valuable professional time that could be spent treating the consumer is too often diverted to searching for a place to get together or spent trying to get somebody else out of the spot they reserve.
Professionals in treatment generally want nothing more than to help the consumer, whether it’s a group therapy, a nurse’s session, physical therapy or any of a myriad of treatment options available in our sector these days, they just want to do their job. All too often, a problem erupts when consumer and professional are mis-scheduled…the wrong counselor can get matched with the consumer, or the room to meet in isn’t available or can’t be found, or the professional is double booked and both consumers show up in the same room. There are more examples, all of which can be avoided if time, place, professional and consumer are matched up in a good EHR scheduling module.
A good scheduling module will also know when a consumer is a no-show, and the professional’s available or a drop-in visit from a different person, perhaps in the room that freed up in the earlier example above.
Notes, treatment plan updates and other treatment documents that need to be updated resultant to a consumer’s visit can all be tied to a good scheduling module. Managing the traffic of documentation is the key job of an EHR.
That good scheduling module also has the ability to assure correct charges for services can be made once an event happens…so traffic through the billing office is also managed by the EHR. It’s easier to deal with insurance companies in billing disputes if all the documents are tied together from the admission, through treatment, to discharge.
All this connectivity makes for good statistics that most administrators love. The figures on how well professionals’ time is managed, how quickly a consumer gets served, and other benchmarks all tie together into a neat little bow that help manage organizations of professionals, keeping the lights on and paychecks flowing when the baby needs shoes. In fact, when a facility needs more room, the executive director can prove it to the board of directors and expand the facility.
Not bad work for a traffic cop.Read more →
I know, I’ve belabored the “release of information” subject.
It’s good to know somebody else is thinking about this, and in a far-reaching way. SATVA, our industry’s software vendors’ association recently posted an interesting article on Behavioral Healthcare’s magazine that lays out the importance of a “consent to disclose” form (I’ve called it a Release Of Information form or ROI) in the Electronic Health Record (EHR). Without a single, signed form in common, disclosure of the consumer’s health information can’t be shared without breaking at least one of 32 federal and state laws that protect consumers’ confidentiality. The goal would be to make a common electronic form available in all EHRs and RHIOs in order to assure a consumer gets the best treatment from any healthcare facility he walks into and maintains health information confidentiality. Naturally, consumer records electronically shared among their professionals providing care can reduce duplicate tests, duplicate data input and other wasteful activities, and even prevent medication errors that could cause big trouble for consumers, simply because the professionals are acting as a team, not lone guns. None of these benefits can be realized without a solid, mutually accepted ROI or consumer consent agreement (same thing, I’ll stick with ROI for now)
SATVA even delivered a specification for the consent form, (amazing these guys agree on something given the competitive spirit in the software industry), stating a number of ways RHIOs are affected by the protective laws I mentioned above.
The ROI would deliver instant approval to share information, which means more timely treatment for the consumer and less pain, whether physical or emotional. Wouldn’t it be great if you moved from Oregon to New York and your new professional had access to your chart across the country when you came in for your appointment? That’s electronically possible now, except for the lack of an ROI.
So, why is this little stumbling block to all these benefits a problem, you ask? There must be a way to overcome the problems.
Right now, all it takes is a signed form to share the data between providers and that can be faxed. A major drawback of this system is that most providers have completely different forms to fill out, and filling out multiple forms them takes expensive professional time. Then there’s the clerical time and energy spent faxing different professionals for their specific ROI forms, getting them signed, and then faxing them back before the patient record is transferred. Then, depending on the professional’s legal limitations and technological status, the information sought (could be many pages) would need to be faxed, mailed or shipped. Now multiply all that effort and trouble by the number of physical and mental health professionals involved in the consumer’s care.
Oh, and next, multiply that by the number of consumers seeking care that day among all the professionals involved. The energy and expense both mount up.
I’ve commented quite a bit on Health Information Exchanges (HIEs) or Regional Health Information Organizations (RHIOs), and they’re key to this subject. RHIOs need to become intimately acquainted with those laws and rules I mentioned earlier…they have the same responsibilities to consumers as software vendors and professionals. This means the electronic ROI would need to be a common design among all the software vendors, professionals and their RHIOs, and also maintain the consumer’s stamp of approval and specific mention of the professionals involved, whether it’s an individual or an organization. That’s quite a job, too, but it can be done more simply and elegantly with electronic transfer of the health information data. The ROI also needs to cover why the consumer’s information is being shared; is the reason clinical, financial or something else? Since a RHIO can’t pass along information to anybody who’s a member without authorization, some sort of accountability needs to be built into the string of data sharing and availability to assure consumer confidentially.
Like I said, it’s a big job. The good news is that SATVA says they’ve already built it and have tentative approval of SAMHSA, and all the professionals and RHIOs need to do is buy it…but then again, maybe it’s free.
How likely is that?Read more →