I’m no professional, but I’d say prioritizing can make or break us in mental health and addictions treatment.
OK, so my work as an Electronic Health Record (EHR) Consultant has a very professional aspect, but I’m not a mental health and addictions treatment professional. We all have priorities, but it seems to me that the mental health and addictions treatment professionals’ priorities are likely to be based on criticality and probably carry more weight in the grand scheme of things than an EHR Consultant’s.
Let’s look at a day in the life of a sample mental health clinic. Our sample professional can be faced with priority list of tough choices about a whole caseload of consumers, and in the moment talking with a consumer who is experiencing suicidal ideation; this case creates its own ever-changing list of priorities. Simultaneously, the Chief Financial Officer (CFO) of the organization has a stake in our sample professional’s priorities for the day. The CFO’s priority is in making sure the professional’s work gets paid for with the highest rate of return. Yet another item in this day would be passing muster with audits in order to keep the money once treatment has been delivered and the bill paid to that professional, a situation that deserves its own spot high on the priority list. Our sample professional is still concerned with her consumer, whose welfare remains the top priority, however, after that she will likely cooperate to assure the other two priorities are met. The CFO and auditor both maintain their number one priorities, too, which can seem like a conflict.
So, all the priorities are on each other’s lists, it’s a matter of perspective as to which item floats to the top. In the end, the entire team involved in this day-in-the-life description needs to agree on one set of priorities…what comes first and how much energy should be devoted to getting each item on each list of priorities done.
When it comes to the EHR implementation, these daily scenarios need to be weighed for organization-wide importance and ordered realistically on the organization-wide list. Without team cooperation, what’s best for the entire organization may fall to the wayside and priorities may change enough to run out of budget before the EHR is fully implemented. A team needs to be forged; flexible and intent on doing the most for the organization with the available budget. Some items will be left off the list because money tends to run short before work.
The mission of the EHR is to document consumer treatment, bill for it and account for where the money goes; the mission of an EHR implementation project manager is to configure, train, comment, cajole and lead all these people to a happy consolidation of priorities that will satisfy them all in the end – at least mostly. It’s a tough job, satisfying many masters in an ever-changing environment, and if we don’t get agreement on consolidation of priorities at the outset, our project may be doomed. Sometimes priorities are mismanaged and the job is left unfinished with users struggling with a partially implemented EHR.
How can that happen?
When software configuration is out of kilter or the software’s procedures don’t dovetail with the organization’s, there are a number of factors that can be affected. Discoveries of inappropriate design and configuration come up during implementation and if the project manager and team aren’t responsive and willing to negotiate priorities, it leads to unexpected development costs. Sometimes the perfect solution is sacrificed for the good-enough solution.
Because difficulties like these are ignored, too many EHR implementation projects have been left incomplete, and that hurts the EHR manufacturers’ reputations, as well as hurting the professionals and support people who rely on the software to inject some efficiency into the flow of their work. A solid consolidation-of and agreement-upon priorities is the first step, and to avoid leaving a project unfinished, a balancing act comes into play. The team needs to stick to their guns and implement according to the original consolidation of priorities as closely as possible. When that goes off-track, the project usually requires more time, work and resources to live up to changing priorities OR some items on that priority list are dropped off with a plan to address them later (complete with a scheduled date)
I recently encountered the effects of an extensive issue where consolidation of priorities was not well done and consequently ineffective. In the Mental health and addictions treatment world, the number one reason not to use the EHR is a lack of “user friendliness”, which can mean about anything you want it to mean. Some of the project was completed, but not all. Managing schedules for consumers and professionals was left incomplete. Billing and posting payments was left about half done.
Consolidation of priorities to even make the implementation work for a team like the one described above was ineffective…gotta keep on top of that.
We want our highly skilled professional team described above to stick around, so configuring and implementing the software with “user friendliness” in mind becomes imperative. Since our EHR wasn’t implemented and managed to meet a set of negotiable, consolidated priorities, the list may have been unrealistic for the budget. The team may not have had a realistic appraisal of the number of man hours required for the job, or explosive growth may have gobbled up a bundle of the team’s time that was supposed to be devoted to the implementation. Priorities were not met, plans to meet them didn’t get made immediately upon realization that was happening.
Consolidating priorities has to be a joint agreement among all the players and needs to be revisited and re-negotiated on the inside of the organization. There has to be some give and take and a clear view of what’s best for the entire organization. If reality changes the priorities, a new plan with an adjusted budget needs to be agreed upon and approved.
…Easy-peasy, right?Read more →
The word is getting through to people who need it.
In his February 5, 2013 blog entry, Thomas Insel, Director of the National Institute of Mental Health reflected on how creating a network of integrated care for consumers resembles the IBM approach that transformed them from a hardware and software selling company into one that recognizes problems outside that box and creates solutions that may be innovative and different, or simply a network of people served by a digital network. Not necessarily a new thought, but one that has merit. In my early days of working with the Electronic Health Record (EHR), I worked with a large New York City network of over 20 methadone clinics. That organization had a special “Intake Clinic” at the time, charged with diagnosing the consumer with opioid addiction and any other psychological disorders or physical conditions, assuring the treatment was appropriate, and referring to a clinic that would best serve the consumer’s need. Our job at the time was to enable the EHR with a sort of funneling of consumer health information to the clinics so a record would be substantially completed by the time they arrived for treatment. Treatment, incidentally, needed to be provided within 72 hours due to the nature of opioid withdrawal. That 72 hour window for treatment certainly beats the tales of consumers waiting a month for treatment we hear of all too often.
It was not a bad system. The professionals in the clinics that would be treating the patient already knew the details they needed to know to treat the consumer when they arrived. If the consumer had co-occurring disorders like schizophrenia, they knew about it and could treat it because they go the word from the professionals who made the diagnosis in the Intake Clinic.
Essentially, it was a miniature health network of integrated healthcare that included a physician, nurses, medication, counseling for mental health and addictions issues, and even primary care in some cases.
All of that was driven by the EHR.
Insel talks about a recent study that encourages quick treatment at the onset of an initial episode of schizophrenia. As it turns out, early treatment helps consumers recover, decreasing the intensity of the disorder. Professionals throughout the healthcare world can’t help if they don’t know about the episode. A lot of treatments are available, and professionals in the consumer’s treatment network need to know about the episode and successful treatment, so they can be on the lookout for the recurrence of schizophrenia and do something about it quickly. That’s where the EHR and the Regional Health Information Organization (RHIO) come in. The RHIO shares information among professionals while maintaining confidentiality.
When a consumer is treated in an emergency room, a clinic, or by a solo professional for schizophrenia, the RHIO delivers a way to create an instant network of professionals; doctors, nurses, social workers, licensed clinical therapists and others aware of the problem and its treatment because they can access health information from other professionals participating in the RHIO. One key of success is the Release of Information.
Without it, the EHR and RHIO are rendered impotent for a patient. It’s a problem simply addressed by having the consumer sign a Release of Information that allows the health information to be shared with other professionals the consumer will see.
Another place these two tools for improving treatment are hampered is simply by not being used or consulted. When professionals fail to document treatment and decide not to participate in RHIOs, it’s usually driven by the cabbage, the dough, the shillings, the bucks. After all, an EHR is an expensive undertaking, and a RHIO provides a valuable service in sharing patient information securely and it adds an ongoing bill to the ever-growing pile in the office. Grants are available to resolve this issue.
The fact is, grants are being granted, and professionals and clinical organizations are increasingly using technology. The EHR and RHIO are gaining in success because they are being used, so the problem is disappearing.
The world is changing, and I choose to believe that the direction that change is taking in adopting these digital tools will ultimately help consumers recover and help professionals prosper.Read more →
“We’re a little short on resources and have to delay your EHR implementation a couple months.”
One issue a professional comes in contact with while implementing the Electronic Health Record (EHR) is lack of “resources”. When a software vendor says this, the conversation isn’t usually about memory in a PC, or a train that goes directly to the gym. They mean people. Not just any people; technical people. People who keep an implementation on track, who can write programs and train professionals to use the EHR and manage to count beans so another dreaded occurrence doesn’t occur – “overbudget!”
Sometimes the technical people who were counted on to do a job are busy with another job by the time it’s time to bring the EHR on-line. As a result, the professionals who have been preparing for the change to the EHR and could feel a little stressed over delays. Consumers can’t help but notice and possibly react to increased stress in a mental health organization.
There is a solution.
The salesperson probably indicated you’d be up and running lickety-split. During that conversation, they probably mumbled something about starting out with the “core system” or “out-of-the-box”. The difficulty with this sort of understanding is that even starting up with that software configuration, problems can be twofold; people (mental health professionals and other organization staff) need to become acclimated to the biggest change they can be put through. An EHR implementation doesn’t change much…just everything; and that “out-of-the-box” system probably doesn’t exist to fit every organization. People can get a little nervous, and that affects their job. Software configuration and programming changes are a fact of life when software is implemented.
There is a solution…really.
The people guiding this process (usually software vendors) repeatedly run low on staff. Just like any other business software vendors can be slaves to the next sale and cash flow problems, so they lay people off to run lean operations and POOF! They’re “a little short on resources”.
You’ve waited for it, here’s a solution.
For many years hospital systems have relied on consultants to configure and design systems to fit their staff workflows, as well as train the end users and offer support (technical support often requires emotional support). Likewise, mental health and addictions treatment professionals are increasingly relying on consultants. The key is to hire a “hands-on” consultant who can guide the project conceptually, knows how EHR software works, and understands that an organization is made up of people, not just “resources”, who need personal attention to understand and move forward with the technology they’ve spent a ton of money on. The consultant is generally less expensive than hiring technical staff because they’re only around and aside from retainer agreements, getting paid when they are needed.
If the product purchased has a database or programming environment other than SQL (like Cache’), it’s might be tough to have somebody available who’s familiar with the software and the software/development environment. It’s good to have somebody in your organization’s court who has worked with that environment or better yet, the software you’re purchasing. It’s good to have an implementation consultant who participated in the purchasing organization’s EHR selection process and knows the workflows of the professionals who’ll be using the software…it helps in setting up the software with efficiency in mind.
There’s good news.
The solution I promised? There are a number of people in the consulting business now who have the skills in question. Remember at the top of the page where I wrote that software companies like to lay people off when sales are slow or cash flow is tight? The folks who are out of work still have technical skills and fit very special needs required for implementing and supporting software. Whereas they may not have fit a software organization well, a project is much different than a job. It’s gratifying to some folks when their efforts have a beginning, middle and an end, so they tend to be pretty good associates.Read more →
“What happened?” asked the person on the left.
The person on the right replied, “I forgot my appointment!”
Whether you’re a consumer or a professional, you’ve likely been on one side or the other of this short conversation. Clearly, the reminder (if one’s being used) didn’t work. That signals a breakdown of marketing that can likely be improved by the Electronic Health Record (EHR).
The two most common methods of decreasing the occurrence of this conversation are (1) the telephone reminder and (2) a reminder note strategically mailed to the consumer to arrive a day or two before the appointment. The reminder needs to come close enough to the appointment that the significance doesn’t fade from memory…I read years ago that point is around 72 hours…people forget, even though they’ve been reminded. When this sort of marketing is successful, two things improve: (1) No-Shows are decreased, and (2) if a person needs to cancel or reschedule their appointment, time is available to fill the appointment with a consumer calling in at the last minute for an appointment.
So, these reminders are marketing tools because they show the professional cares enough to reach out to the consumer to assure they get the care they’ve asked for. You may ask how the EHR fits into this equation…I’m sure you have at least an inkling of how this works, and it doesn’t hurt to keep this sort of thing in mind as business processes evolve.
Appointment scheduling in the EHR is a collaborative effort among professionals (or their front desk person) and consumers, and that’s easy with the computer sharing what dates and times are available for the professional. Once an appointment is agreed upon, most EHRs are set up with the capability to both schedule an alert for a telephone call to be made and to print various reports, including a print run for appointment reminder letters to be sent to consumers that day.
If your EHR isn’t doing these things, consider the business angle: For the cost of a recouping a few no-shows, connecting with a professional (like yours truly) to set up this sort of marketing capability has a significant long-term payoff. Efficiencies gained for larger organizations should be significant.
Now, let’s talk about electronic communication between a referrer and referee. Referrals from primary physicians to Mental Health professionals assure the consumer gets integrated care. Integrated care is a buzz-phrase right now, and it makes sense, as we are all connected, body, mind and spirit.
The EHR can have a referrer portal as well as a consumer portal. The referrer portal is important because it helps the referrer track treatment in the external organization. After all, referrals are made with a specific purpose in mind, and if a consumer is being treated for anxiety or depression the referrer will need to know what’s happened since the last time the consumer was seen.
Consumer portals are a really handy method for a consumer to track their medications, appointments, bill, and other interactions with the professional. This is an attractive feature for the consumer and in some cases that can be good marketing (or perhaps some folks will agree that I’m reaching into the ozone with this concept).
These aspects of marketing are important ways the EHR can help the professional and the consumer. They’re not the only options available with this powerful tool. Newsletters can be generated and managed for a professional’s consumer base, reminders and holiday greetings can be managed by the software, and a ton of other possibilities can come into play offering better service to consumers, which equates to good marketing.
A always, more to come…Read more →
It’s continuously newer, better, and always adding more bling! It’s the Electronic Health Record!
One of the great things about the Electronic Health Record (EHR) is its constant advancement. Lately that’s been guided by Meaningful Use incentives, money from the American Recovery and Reinvestment Act (ARRA); The original idea for these legislations was at least twofold: (1) extend the EHR’s use, and (2) get some money pumping through the economy. It’s worked out pretty good for everybody involved, generally speaking. And now it feels like everything is constantly changing. The consumer wins with the EHR. I figure I’m like many Americans, and I have a tendency not to keep prescription details in my mind, reading assignments fall through the cracks unless I have them set as alerts in my SmartPhone, and Appointments? Fugghedaboudit, I must have both telephone reminders from the professional I’m working with and a calendar item set in my SmartPhone in order to focus on my healthcare issues before winding up in a place I don’t want to be, like an emergency room.
The EHR helps the consumer by recording the next appointment scheduled and creating a tickler list for calling the consumer with a reminder to make the appointment. The EHR also records what happened in the previous appointment and what direction treatment is supposed to take in the next appointment. That sort of information can be securely accessed in a “Consumer Portal”. The concept of a consumer accessing by actually using their consumer portal is a key to true participation in treatment, and just coming into use in many EHRs.
If the professional isn’t using their EHR to help the consumer focus on joint development of the treatment plan, one appointment at a time, then the software may not be living up to its potential. The professional’s records can actually help increase treatment effectiveness by keeping the treatment plan current with emergent issues and such, and assure it’s being constantly referenced. There are tons of regulations in play to enforce this practice, so it’s a good idea to optimize the treatment plan and let it do its job in this respect.
The organizations the professionals work for, behavioral health clinics, hospitals, emergency rooms and the like benefit from the improvement of treatment records on many levels. Primarily, there’s billing. What a nightmare insurance billing can be. The codes required and the rules of using them baffle PhDs across the country, and without the EHR to track what services are provided, when, and document that they meet insurance billing rules, payment may not be forthcoming. That said, the real culprit is not linking the billing portion of the software to the consumer’s medical record. When something’s done, it needs to be billed. Professionals in treatment may not be acquainted with billable services, and the software can be smart enough to automatically bill for services once a progress note is written or when a consumer successfully completes an appointment with the professional.
The software manufacturers sell software, and by reviewing the last year or so of my blog entries at www.mindhealthbiz.com, you’ll see most of the top-tier EHR programs in this industry have incredible features to help in that selling focus. They meet Meaningful Use incentive requirements, and they can do about anything a professional may need to improve both the clinical and business end of their work. Where all these benefits hang up is implementation. A professional can spend a tremendous amount of time and energy selecting just the right software, working with the perfect vendor, and in the end, if it doesn’t get used, it won’t work.
Implementation is a large project, lots of moving parts that touch every area of an organization trying to get the most out of the EHR. A lot of research goes into process workflows, insurance billing requirements, state licensing agency requirements and auditing requirements, and the result of this research needs to be part of the implementation. Too often, the implementation drags on and momentum is lost and the EHR ends up not performing as advertised because it’s not fully implemented.
And that’s not all.
Once the EHR is up and running, it’s constantly improved by the manufacturer, requiring work on the professional’s end of the equation. Constant optimization of the software adds to the complexity of the EHR implementation…it seems never ending. It’s a constantly changing world, and to respond to changing needs, software needs to be reconfigured from time to time to keep the EHR relevant and helping the consumer, the professional and mental health treatment organizations.
And that’s a never-ending story in itself.Read more →
These guys are gizmo hip.
That’s what struck me as a real high point for Credible Wireless when I recently saw their product. That and cloud-based technology. The product looks good. Whereas almost all of the other products I’ve seen this year have user interfaces that lean a bit toward the “1990’s look”, Credible looks current. It’s not surprising. Since they’re an internet based company, their focus for the past decade or so has been to look and act like they’re on the cutting edge of technology. A number of years ago, I was into computer games. Graphics development had just made some leaps and bounds, so the games were beginning to have a more real sense about the people and houses and roads and weather and other elements of life. Hardware technology had just made a couple huge leaps forward, and it seemed computers were improving overnight. From that foundation, I came to expect a lot out of software and hardware. These days, all that technology is deployed on the web for a bundle of industries, and products like Wii are setting the stage for the new world of the EHR. All the companies I’ve reviewed this year seem to be moving in the right direction, and I think Credible is somewhere near the head of the pack.
They’re proud of their ability to work on the SmartPhone, the iPad, and probably any other gizmo out there that’s internet-happy, and a lot of professionals like that. Consumers will appreciate another interesting factor that emerges from this sort of software manufacturing foundation. Electronic Health Records (EHRs) I’ve seen deployed on these sorts of technology just haven’t delivered enough real estate to do the job…the screens are too small. A well thought out screen goes a long way toward making them usable, and for consumers that means their professional can take notes or fill out assessments very quickly and efficiently. Nobody likes to wait on somebody who’s texting their girlfriend, and I think it’s the same thing when a professional’s filling out a form on the SmartPhone.
On the surface, the billing system looks good. Since I’ve been around billing systems for a long time, I walked away with questions that a facility might not ask. I plan to see the system in person soon and get some hands-on time with the software; I’ll have a better handle on whether the billing system has a reasonably sensible setup time and process and whether some key problems that occasionally come up with software have been addressed. I can’t imagine my concerns will cause them problems, but I gotta ask the questions. What I do know is that they can bill insurance electronically and have a “scrubber” that helps get a clean claim to the insurance company. This avoids denials to pay a consumer’s insurance claim…insurance companies are picky and it’s better to be ahead of the game in this regard.
I’m a big fan of screen design tools…I want to be able to make a form like an assessment or special type of progress note do exactly what I want it to do without paying a software company to write code. Credible EHR comes with just such a tool, and that will be another thing I will be looking into soon. I assume it works like a number of similar tools on the market, so it should be pretty straightforward. I have a couple of concerns I need cleared up about the technical capabilities, so it should be a fun time. I’m optimistic.
Reporting is always a concern for professionals…How many consumers are we helping? Are we helping folks with the right services? Are we getting paid for what we do? Are we able to pay our bills? These and hundreds of other questions can be answered by reports in an EHR. From what I saw, the reporting system in Credible’s EHR is good. It’s based on some standard technology and for a techie with medium skills writing reports with some value should not be a problem.
Credible’s a small company (around 140 customers and “choosing to grow slow” is what they say), so I wonder why more people aren’t buying the system. If you’re a professional working at a facility that’s purchasing an EHR, that’s a concern to address with Credible early in your selection process.
Still, after all is said and done, Credible’s probably worth a look in most parts of the country.Read more →
If the Electronic Health Record (EHR) selection process was a beauty contest, Netsmart’s myAvatar product would likely take the prize. The look and feel of the software as it was set up for a recent presentation I attended was excellent. One of the problems that can arise with EHR software is a lack of attention to making the software work within the special workflows in a mental health clinic. myAvatar’s workflows were well designed, suiting process flows for different user roles like billing, executive and clinical users. The idea is still along the lines of displaying sub-windows and rows of documents, activities and appointments; It’s easy on the eyes. As I’ve shared before, when an EHR takes this sort of detail into account, it makes for a more complete record of treatment, and the professional is better able to address the specific needs of each individual consumer. When information is at a professional’s fingertips, it’s more likely to be used; if not, and the records of previous sessions aren’t reviewed, is the consumer getting the best care?
Additionally, the inclusion of pulling data from Outlook is a plus for the Case Managers in the field. There is likely a way to launch Outlook from a hyperlink embedded in the program. I say this because it’s simple technology and a feature that was included in a previous version of the product. Data can also be pulled and pushed internally. The example was pushing problem data from an assessment to the treatment plan, and pulling goal and objective data from the treatment plan into a progress note. Professionals are human, and can be under pressure to see a high number of consumers in a given week. Those two factors conspire to make time-saving features like these vital to make the most of a professional’s time while giving her the information she needs to treat the consumer’s problems.
The reporting engine for Avatar is Crystal Reports, and although many vendors are moving toward internal reporting engines, Avatar provides a great map to the fields where certain data resides called “option documentation”; it’s quite simple to use, organizing the electronic record so it’s simple to pull data out of the system. As long as you have a person around to write the Crystal Reports, you’re set. From my experience, folks like yours truly can write Crystal Reports much less expensively than Netsmart (NTST) staff, so your organization may wish to consider outside consultants.
The EHR‘s RADplus toolkit is essentially a design tool that enables the customer to build their own system. In fact, this is what a number of customers have done. Because the RADplus is so robust, it also requires a level of skill somewhere between the design tools I’ve seen in other products and those of a programmer. If I had to guess, I’d say a slightly better-than-average Crystal Reports writer would have no problem using the tool. I’ve designed a number of screens and associated reports to them, and the outcomes have been good for the professionals using the system.
It’s tempting to use the RADplus tools and Crystal Reports to design a system from the bottom up because it would seem perfect. It would not be. The tried and true method to use for implementation is the same as for any major product on the market. Start with the existing forms and reports, modifying slightly during the implementation and approach improvements to make the system truly “my Avatar” only after the initial implementation has progressed to a level of Meaningful Use, billing and regulatory compliance.
The use of RADplus to design dashboards was flashy and impressive. Widgets can be included on dashboard screens to track whatever metrics exist in the system, from census to treatment plans due to authorizations due.
Predictive Modeling is a recent addition to NTST initiatives, encouraging research by sharing de-identified patient treatment information among the user group, a program reminiscent of the MindLinc business model. I’m not sure how far along in the process of bringing this offering to life, but if research is your bag, this is the sort of work that broadens data samples required to measure new methods of treatment and can help consumers recover on a grand scale.
Like most of the systems we’ve seen, Utilization Review and Quality Assurance problems are avoided by the customer adding compliance rules to specific activities like treatment plan reviews coming due and insurance prior authorization renewals. This removes most of the labor intensive data management from these two functions, and transfers tasks to a sort of “informed policing” of data and activities.
Netsmart has acquired a number of EHRs over the years, as well as ePrescribing, on-line education and other options. This has made them the largest EHR provider in mental health and addictions treatment and worth a look if you’re a professional whose organization is in the market for an EHR.Read more →
It’s all in one place. Not.
Not long ago I received an Email from professional who read my post on the demise of GoogleHealth, and he brought up the topic of a “universal health record”. The current and past couple presidents have helped this country move toward electronic sharing of patients’ Protected Health Information (PHI), simply because it’s good for us. These days consumers have options. Primary Care Providers send them to specialists in every discipline from cardiology to mental health. When a consumer arrives to a new facility, the amount of paperwork can be daunting. Filling out name, address, and other duplicate information has become an unnecessary nuisance thanks to the Electronic Health Record (EHR).
My friend was a little critical of vendors of (EHR)s that computerize patient health records for professionals and the organizations they work for, believing that none have really made the jump into a practical method of sharing data that makes up the Universal Health Record that’s practical on a nationwide data-sharing basis. Whereas it’s taking far too long to have a terrific system to accomplish this in our country, I believe we’re taking baby steps in the right direction. He also suggested using a personal database to store personal health information that could be shared among the consumer and the professionals that serve him. In my mind, that might be a piece of the puzzle, but not a key to sharing PHI.
The solution to the sharing of PHI lies in organizations like a Regional Health Information Organization (RHIO). Without boring too many folks with the details, RHIOs and organizations like them act as data middlemen, assuring a consumer’s confidential information remains confidential (and “Protected”). They route data that’s been approved by the consumer to move among the specialists I mentioned above, hospitals and other healthcare organizations who might be helping the same consumer. Right now, the work is actually a long way down the line in creating electronic “Continuing Care Documents” (CCD)s that carry PHI like prescriptions and who’s treating whom for what. It’s far from finished, and not perfect…baby steps.
Vendors of EHRs have a particular interest in this because their products hold all the data at each of the healthcare specialists and organizations I’ve been talking about.
You can read my reviews and see some good things about the mental health and addictions treatment records on the market today. There are around 84 vendors out there serving this business sector, and the products vary in how they approach the EHR. My friend is more critical than I am, although I agree with some of the things he had to say.
The vendors who are selling software products in this sector have chosen an interesting way to make a living. You can’t please everyone…in fact, it’s difficult to please anyone. Technology being what it its (imperfect), and vendor organizations being made up of people (imperfect) who work with models for their software that really describe the need of a minority of organizations (imperfect, imperfect, imperfect). In my business I have been to many treatment facilities, and while there are many similarities, each one is original and different from its peers.
To resolve this difficulty and serve more organizations, vendors have included “simple” software screen design tools and report writers that will help manage a consumer’s record and run the business. The idea is for the customer to modify the system to suit their needs. It’s turned out to be a complicated addition to the EHR that can be a godsend or big trouble, depending on how it’s used and how fate decides to move in changing the ever-changing environment of mental health and addictions treatment. The EHR can lose consistency, and data commonly needed for treatment among many professionals for a consumer can get lost in all that “special” screen design, never being shared with other professionals who might need it to better treat a consumer.
The RHIOs and the CCD have added a level of consistency to the EHR that helps us move toward the Universal Health Record. Vendors are cooperating with one another in the effort by joining the Software Association (SATVA). The government has helped in the effort as a result of the American Recovery and Reinvestment Act (ARRA) and HITECH funneling funds to the states for the sake of supporting and improving the huge healthcare industry and healthcare IT that serves that industry.
We ain’t there yet, but we’re taking baby steps and will get to the Universal Health Record.Read more →
They deserve a look.
If a professional group is looking for an Electronic Health Record (EHR), Defran deserves a look. Defran is an experienced company, having advanced through several versions of their software, and judging by a conversation I had with one of their folks recently, the software continues to evolve…good thing, as Evolv-CS is the name of their product. One of the most important aspects of an EHR is the ability to maintain consumer confidentiality of records. It’s nobody else’s business that a person is receiving treatment, and the “user role” approach to security and defining home screens is similar to other products I’ve seen (I call that “standard technology”), and on the surface it seems well developed.
A question comes up frequently when people in the business of helping folks with mental health and addictions difficulties interview consumers, and that’s “How did you hear about us”. Most often, the answer is a referral from another professional, organization or consumer. Defran focuses heavily on referrals in their presentation, because that’s the marketing and intake process. I like this, simply because you learn some consumer history in that stage of business. I believe the more history you can have on a person and the sooner you can get it, the better you can understand a consumer’s need, and if you have the financial information captured, the sooner you can secure authorizations if they are needed in order to bill for pre- and post-admission services. The software’s work flow appears well thought out and flexible.
In fact, all workflows are flexible. The product comes with a field-level design tool that enables the design of screens according to the need of the staff doing the work. Another plus that involves the consumer. The consumer should probably be concerned that their professional is “getting it right” and good documentation helps with that concern.
The home page approach is flexible, with the same “drag and drop” functionality to move sub windows around on the screen. The home page can be designable by the user, so that particular user will have one-click access to any forms, documentation, messaging or activity scheduling they need. As the user flows from one screen to another, there are handy task bars at the bottom and top of the windows to access data that is too voluminous and varied to present on the front page of the user screen…this tabbed approach seems to be common among software products in our field. I like it.
From the home page, the professional manages the internal communications, tasks, and a few compliance items that show up; a professional can access his caseload, which displays a face sheet showing all documents pertaining to that consumer.
One thing I’d like to know more about is how Defran’s software assures that documentation meets requirements of accreditation agencies, state and federal government and various programs that may audit a professional agency. Software usually has some nifty tricks to assure certain information is gathered and later prove that it was gathered. I likely neglected to ask about that in the interview.
Defran has recently redesigned the front desk screen. That’s generally the way a person at the front desk will know where to direct the consumer and assure she gets the care she expects and needs. Since this is new, take a careful look at it if you’re interested in the software. I’d want to talk with other professionals who’ve used this functionality before I bought it.
Defran also stresses assessments a lot. Most of the facilities I’ve worked with used an intake assessment which includes a bio-psycho-social and a psychiatric assessment with few other assessments completed during the course of treatment. To a consumer this is a lot of paperwork.
It seemed to be of interest to the salesperson that we saw the assessment’s ability to use a radio-button selection capability to score an assessment. That is nothing new, however they did have a nice way of displaying the results of such outcomes measurements at the bottom of the assessment. Assessments also push data to the treatment plan, which is also common. These sorts of assessments deliver immediate direction to the professional and consumer for the course of treatment and points toward the next steps they may want to tackle.
The treatment plan is a high point, and would deserve more attention if I were purchasing an EHR. The layout is familiar to those who are familiar to the Wiley documentation, which is included at a fee.
Notes for group therapy are fabulous. The functionality does everything other software does, only with an original approach to the group not screen. I liked it, and I’m not going to even try to describe it, leaving it up to professionals to review.
With all this good stuff and a long time track record manufacturing software, you may ask if there are shortcomings. Well, the best answer to that question will be available by looking at the software and calling some folks using the EHR. Personally, I’d suggest talking with an independent consultant…but then I would.Read more →
It’s more than “Just the facts, Ma’am” .
Qualifacts Electronic Health Record (EHR) slices, dices, and combines consumer health information in an impressive manner. This EHR is geared toward mental health clinics, and is another product that appears to have all the pieces. I was privy to a recent presentation of the software, and for the professional using assessments and other professional instruments to measure how a consumer is doing with ongoing treatment, the tools in the EHR look pretty good. The ability to include a few questions in a progress note with answers that can be plotted on a graph can help the professional and consumer zero in on what’s working in treatment; and that seems like signposts on the path to recovery.
Another tool that helps save some time for professionals is the ability to push data gathered in assessments directly to the treatment plan. If you’ve read my other reviews, you know this is nothing original, and that I feel it’s functionality necessary for success in today’s software world.
Billing seems to have all the pieces, and should a mental health or addictions treatment company move forward in the process, the billing functionality should be thoroughly researched. Due to the time allotted the presentation, I was unable to review this, and like any professionals, I’d want to be very careful with billing, since it holds the key to success with an enterprise-wide EHR.
In this age of data leaks, losses and thefts, a software company needs to do what they can to plug up the possibilities of data escaping. One of the things suggested by HIPAA is data encryption, and Qualifacts is in a minority of companies readily identifying their product and delivered environment as encrypted.
The report writer is an interesting approach. On the surface, it looks quite good, however it’s an integrated third party report writer, Panteho. Unlike Crystal Reports, which requires reports be written independent of some EHRs, this report writer is embedded into the program. The functionality seems fine, and the data dictionary looks superb at first glance. On the other hand, if I were checking out Qualifacts, I’d talk with Panteho, too. The idea is to feel good about Qualifacts receiving the maintenance and product improvements that are needed to keep up with technology as we move forward through the years. It’s likely not an issue, but it never hurts to ask questions like this.
The user interface (UI) could take some getting used to. I saw traditional design elements of systems like a persistent modular approach and needing to use several clicks to access a document from the user’s home page. From the home page, I really want one click access to tasks that need to be performed regularly like treatment plan updates and progress notes needing completion. In all fairness, I just because I didn’t see this as a consistent design element in Qualifacts doesn’t mean it doesn’t exist. Any system needs to be configured to meet workflow expectations of specific locations; it seemed like some items could be easily accessed, however, when a new item needed to be added, like an assessment, you had to go hunting through a lot of menus for it. This UI re-defines how a browser is used. The common look and feel of the menu bar that runs across the top is different than what internet-surfers are used to, even though it looks like the product is launched in the MS Internet Explorer. This is a pretty minor criticism considering every system takes some training and getting used to.
The look of the home page presents lists of tasks, scheduled appointments, documentation, and such. It makes it simple to pull up a consumer’s treatment documentation, and when documentation is easy to access, it’s more likely to actually be read.
Another design difference from some of the other EHRs lies in the way assessments are built. The facility builds assessments by selecting from components. Look at it like a suicide assessment is one component, and a mental status exam could be another component, and other sections are components of a bio-psych-social assessment that’s normally given at intake. They all add up to a lot of questions for the consumer, and that’s what an intake is like. Qualifacts uses the components to build the assessment, and then enables editing from there. The idea appears to be an attempt to cut down on the amount of work it takes to configure a system, and hopefully decrease the amount of time it takes to implement the software.
The treatment plan is a standard Wiley documentation approach. Problems-goals-objectives-interventions. As you proceed through each of these, context sensitive choices are presented. For example, a problem’s objectives list will present suggestions related to the selected problem. One thing to bear in mind is that the Wiley Libraries are available at a cost, and many mental health facilities forego the recurring fee and develop their own drop-down dictionaries, which can be a considerable task.
All-in-all, Qualifacts seems chock full of all the right stuff, and if you’re a professional whose employer is considering implementing an EHR, the software is worth a look, and if you like the User Interface and can get a half dozen or so positive references from appropriate customers, it’s worth more than a look.Read more →