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Speed: The key to EHR implementations

March 1, 2010
by Chris Bair
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Thousands of addiction and mental health treatment providers across the country soon will be required to adopt an electronic health record (EHR) to satisfy business, clinical, and regulatory requirements. Faced with budget cuts, overextended staff, and limited IT expertise, these organizations might see successful implementation of an EHR as a daunting challenge, but it doesn't have to be.

One of the most important (yet most often underappreciated) aspects of running a successful EHR project is speed. For a traditionally resource-constrained organization such as an addiction treatment provider, the ability to dedicate one's best resources to a project that can be quickly completed increases the likelihood of a successful implementation, and in turn better long-term results post-implementation.

The reality for providers

Every behavioral health provider executive planning to implement an EHR has heard the disheartening odds: An estimated 70 percent of the agencies that made the commitment to move to enterprise EHR and billing systems, whether commercial or “home-grown,” over the past 20 years have failed to fully operationalize their chosen system.

Why has the success rate been so low? The primary reason is that behavioral health and human service providers have been historically underfunded and understaffed, particularly for IT projects. These statistics from the 2009 Behavioral Health/Human Services Information Systems Survey, conducted under the direction of several behavioral health provider associations and the Software and Technology Vendors' Association (SATVA), tell the story. Behavioral health providers:

  • Spend only half as much as primary care providers on health information technology (HIT);

  • Employ only about one-third as many IT professionals as primary care providers do;

  • Expect to spend even less on HIT in 2010 because of budget cuts, reduced reimbursements, and higher patient volume; and

  • Would increase overall HIT spending if resources were made available.

Also, the traditional software model has the wrong goal-alignment from the start. Traditional software implementations (whereby the provider purchases licenses, hardware, and services from the vendor up front) create little incentive for the vendor to conserve an agency's time or money. Prepayment front-loads the provider's expense, to the vendor's benefit.

Furthermore, on-premise software vendors stand to gain when projects run over budget despite the fact that these same overruns put the project at risk for the provider. On-premise vendors lack the motivation to quickly deliver a system that users can skillfully utilize. And what happens to providers when EHR implementations go over budget and behind schedule? Agency resources-already stretched thin-are taxed to the breaking point, and another addiction/mental health agency joins the 70 percent of providers that fail to operationalize their EHR system.

Given today's economic environment and forthcoming EHR requirements, providers do not have the appetite or the budget for multi-year projects and hundreds of thousands of dollars in custom software. Agencies need to see value from their system investments as quickly as possible.

Case example

InterCommunity, Inc., an East Hartford, Connecticut-based behavioral health provider, struggled for three years with an on-premise (client/server) EHR implementation. It changed course in favor of Qualifacts Systems, Inc.'s EHR system, and 90 days after kicking off the new project went live on its new integrated EHR and billing platform.

InterCommunity's previous negative experiences lent its officials a new perspective-that a fast implementation was essential. The InterCommunity team set a three-month implementation timeframe. InterCommunity's senior director of quality improvement and human resources, Tyler Philips, was the lead project manager for the implementation. Early on in the process Philips decided to avoid traditional implementation models that included large committees and complicated communication structures. Because the short implementation timeline offered more flexibility on staffing the project, there was a focus on selecting an elite team from across the agency.

Chris bair
Chris Bair

InterCommunity's four-person implementation team was charged with creating, developing, improving, and implementing all aspects of the organization's service delivery through the new EHR system. The positions and roles were as follows:

  • Project Manager-Acted as the main liaison with the EHR vendor; documented and configured the EHR system to reflect the agency's operational structure, workflow, and state reporting configuration; worked with IT to ensure that only clean client data were brought into the new system; and developed standard operating procedures (SOPs) to reflect the new system's capabilities.

  • Senior Director Clinical Operations-Completed review and modification of service documents/client documentation based on medical necessity and fluidity of service information; managed feedback from a clinical/medical perspective and provided this feedback to the individuals performing EHR system development; and developed SOPs for clinical operations.