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Developing and Implementing Electronic Health Records for Behavioral Health Services

Strategic Planning for Providers to Improve Business PracticesOctober 21-23, 2009

Dave Wanser, Ph.D.

Executive DirectorNational Data Infrastructure Improvement Consortium

dwanser@ndiic.orghttp://www.ndiic.com/

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Assumptions

States and Counties are updating data systems to improve compliance with reporting requirements and mandates for electronic health records

States and Counties will increasingly need timely access to linked performance and financial information for management and accountability purposes

These expectations will extend to providers Governmental entities will become the leaders in

making universal deployment of EHRs a reality

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How do Shareable EHR Systems Assist States and Counties?

Quality/standardized record keeping; High levels of data quality due to business rules and edits Mechanisms to facilitate service networks; Ability to monitor compliance and performance; A way to combine, clinical, research, and financial data; and State and Federal reporting.

Quality data on a timely basis

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How do Shareable EHRs Help Providers?

Standardizes clinical records Improves proper evaluation and placement of clients Tracks services provided Determines client progress during treatment Submits claims to the State or County Immediate access client records Fulfills State and Federal reporting requirements

with high quality data

Quality client care

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Reality Check

There will be universal adoption of EHRS in all aspects of healthcare

Substance abuse prevention and treatment is healthcare

Patient clinical information will need to be transferable, and data systems will need to be interoperable across providers and settings

Health Information Exchanges will be important gateways for sharing clinical information

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What is an EBHR?

It’s a complete, or nearly complete clinical record.

It is relational – the various parts of the record are integrated and interactive with the rest of the record

It is real time It allows immediate access to quality

measurement and performance accountability

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States Approaches to EBHRS

States that have implemented statewide EBHRS

States that are planning to within the next year

States with a high level plan without a firm date

States taking a hands-off approach States not ready to think about it.

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Success Factors for States that Have Implemented EBHRS

Executive engagement throughout the entire process

Dedicated IT resources Clear vision and guiding principles Cross-functional workgroup with facilitation Oversight team meets weekly Holding to agreed upon timelines Modest beginning with build out Multifaceted training and support functions

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Myths About EBHR Implementations: There is an off the shelf solution This is a technology project Our needs are unique EBHRS are just like paper records – only on a

computer It’s best to plan the entire system out and implement

all at once It solves all our problems (it only solves some

problems) It can be done in a few months It will take years (although it could happen if success

factors are ignored)

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Principles for Successful Selection, Procurement and Implementation Perfect is the enemy of good One of the most significant challenges of EBHR deployment is

clinical process transformation Leadership must be engaged and support needed

organizational and process change Workgroups require multidisciplinary engagement There are significant tradeoffs for variation Workflow changes are enormous and no consultant or vendor

can help in this area Oversight or “management team” is essential to manage

change control Not a technology project… Yet the solution must still fit within

the State’s technical infrastructure.

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Currently Available Administrative Features in Many State Implemented EBHRS

HIPAA Compliant Billing Based on Services Provided Financial and Clinical Eligibility Capacity Management Provider Level Security Administration Outcome Measures Federal Reporting Mechanism Desk Audits without Travel Extensive Data Analysis for Outcomes, Trends, etc. Decision Support – in it’s infancy

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Features of Current State & County Hosted EBHR Systems

Adult and Children’s Screening and Assessment “Smart” Treatment Plan and Review Admission, Discharge, and Follow-up Progress Notes and Client Progress Billing Case Management and Automated Messaging Wait List and Capacity Management Drug Court interface Web-based user training Co-Occurring State Incentive Grant, ATR Voucher System, and SBIRT

documentation Prevention Services Automated Referral and Release of Confidential Information Mental Health and psychiatric emergency services Reports and Downloads, including automatically generated provider specific

reports

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How is ARRA Meaningful Use Relevant to Behavioral Health?

A major focus of meaningful use is the use of quality data to improve care

Improving the quality of care will be dependent on the availability of structured data

Developing, sharing and continually improving a common EBHR reference model will provide substantial opportunities to move behavioral health treatment from personal opinion and tradition to data based decision support

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Take Aways

Does your organization have a data strategic plan?

Does your organization have a means to use timely data to improve clinical practice?

Is your state leadership at the table in discussions about HIT and HIE?

Have you sought assistance in planning? This is a pass-fail quiz. Passing score is

answering yes to all 4 questions.