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Maximizing Use of the Electronic Health Record

December 1, 2006
by Joseph C. Monastra and William R. Connors, MSW
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Hanley Center's implementation of technology focuses on making care more comprehensive

The national picture as it pertains to technology usage in addiction treatment facilities will change dramatically in the next five years. The concentrated effort of national initiatives that have blossomed from the Bush administration's call to automate health care will profoundly affect whether treatment providers automate and get aboard the technology train.

A major focus of the Substance Abuse and Mental Health Services Administration (SAMHSA) currently and for many years to come is the development of electronic health record (EHR) standards, standard outcomes, and interoperability (the interchanging of patient records between service providers). These points of focus mandate a technologically knowledgeable treatment provider organization—one that views technology as a major instrument for care delivery and business operations.

At present, there remains major distance between the targets of interoperability and a National Health Infor-mation Network and the practical abilities of today's treatment provider organizations. The challenges of a largely paper-oriented care delivery process along with the complexities of reimbursement/revenue, exacerbated by a lack of technology resources, have led many to ignore the topic of technology. While these obstacles are real, many premier treatment centers have invested considerably in the use of technology and have reaped some return related to care delivery as well as reduced cost. One such facility is the Hanley Center in West Palm Beach, Florida.

Hanley Center has helped people struggling with addiction find their way from hopelessness. For more than 20 years Hanley has treated patients as individuals, providing personal care in programs and services designed to address each one's particular needs. Hanley's professionals understand that substance abuse is like a fingerprint—each case is unique—and they treat each patient using a holistic approach with a focus on physical, emotional, and spiritual needs. Hanley offers a full range of services for recovering adult men and women; service offerings include The Center for Older Adult Recovery, which provides programs designed for older adults who develop addictions in response to grief, medical issues, isolation, or major life changes.

A walk around Hanley's campus provides a sense that technology is no more a part of the organization's process than it is at any other addiction facility. It is the personal interactions that are most obvious to the observer. Hanley is not a technical facility wired with computers or visible signs of technology. Perhaps that is what is special about its use of technology: It is utilized to its fullest to support care delivery and is interwoven into day-to-day procedures.

Business decision making

Hanley Center embarked on several major business initiatives two years ago that included significant technology changes. Virtually all of the organization's software systems were changed, as were many business processes. A new IT infrastructure with staff was put in place. These major changes were designed by Hanley's executive management: CEO Terry Allen and Chief Operating Officer Joseph C. Monastra. They were guided by their board to conduct due diligence in a rapid but thorough manner in order to select an electronic health record, a patient financial system, an accounting system, and all necessary support infrastructure software systems. The Hanley executive team members were all veterans of successful EHR installations. Therefore, it was a question not of whether to install an electronic record system, but of which one to select.

The information systems team evaluated several EHR and financial systems. Initial meetings were held with key clinical and operations staff to access the important focal points for each system. The crucial areas identified for the EHR were intuitive interface (i.e., easy to understand by end users), end-user customization, ability to adapt to Hanley workflow, HIPAA compliance, integrated billing, and strong customer focus, with an ability to integrate well with financial systems. On the financial systems side, the major areas of focus were integration with the financial system of Hanley's sister organization (Hanley Center Founda-tion), compatibility with EHR, strong financial reporting capabilities, and experience with implementing not-for-profit accounting systems.

Following a comprehensive search and review, Hanley selected Sequest Technologies' TIER® Workflow System to provide it with a foundation software solution for clinical services, human resources, environmental management, quality management, and patient billing/accounts receivable. Hanley selected Blackbaud and Financial Edge accounting and financial management software to complement Sequest's billing system. The TIER® Workflow System provided Hanley with a strong clinical package as well as supporting modules for human resources, facilities management, business development, and quality management. Customization tools were provided for Hanley's IT resources to individualize the software. Hanley's leadership also desired working with a company that would form a partnership as well as provide a product.

The IT team then presented these solutions to the Hanley board's building and finance committees, and was granted approval to proceed. One of the keys to rapid board approval was a comprehensive executive summary that outlined the major factors and how each alternative rated. This allowed the board to come up to speed quickly, assess the alternatives, and make a timely decision.