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  • Implementing Electronic Health Records System in the Behavioral Health Industry



    Categories
    Archives
    July 2nd, 2014

    Key Considerations

    Behavioral health organizations face many challenges in today’s quickly changing healthcare landscape.  The movement from paper medical records to Electronic Health Records (EHR) is one of the biggest challenges, but also, an opportunity to reduce overall cost of care and improve patient outcomes. This blog post highlights key areas of consideration for behavioral health organizations as they implement new EHR systems including the impact of regulatory compliance, meaningful use, environment, systems implementation, organizational change management and clinical and business workflows.

    Regulatory Compliance

    Patient confidentiality remains a top priority in behavioral health. Due to the ultra-sensitive nature of behavioral health information, the HIPAA Privacy and Security Rules offer more protection for both patients and providers.  Most notably, Rule 45 Part 164 allows providers to deny patient access to psychotherapy notes and restricts organizations from releasing patient notes to a third party payer for reimbursement considerations.

    As the industry shifts to new technology for increased efficiency and better patient care, provider and payer organizations must create, implement and govern a set of guiding principles to adhere to HIPAA rules, and restrict unauthorized access to patient records.  Although new technology provides a means for strengthened security through use of audit trails, encryption and access controls, it’s up to each organization to maintain compliance, educate users on HIPAA awareness and to safeguard technology such as networks, servers, mobile devices and the EHR itself. Maintaining compliance, particularly in multi-entity organizations, can be a challenge so it’s important to form a security task force to assess vulnerabilities and threats, establish security metrics around all technology, and develop enterprise wide HIPAA guidelines to eliminate potential unrestricted access and protect patient records.

    •  HIPAA Education and Awareness Training
      • Educate users on HIPAA Privacy and Security Rules. Create user agreements, documentation and training courses geared towards HIPAA awareness and compliance.
      • Develop an internal non-compliance process and enforce the rules.
    • Establish Guidelines to Protect Patient Information
      • Mobile Devices
        • Create a User Agreement that clearly defines device rules and guidelines, especially for employee owned devices.
        • Define the rights of users and organizations for mobile devices, including remote wipe capabilities.
    • Technology Safeguards
      • Implement features that allow control of technology
        • Password Protection
        • Auto Lock
        • Role/User Based Access Controls
    • Security Metrics
      • Define metrics and create a baseline to measure key performance indicators for security
        • Antivirus, Antispyware, Firewall, Scans
        • Risks Analysis and Audits

    Meaningful Use

    The introduction of the Medicare and Medicaid EHR Incentive Programs to provide financial incentives for the “meaningful use” of certified EHR technology, has led behavioral health providers to move from paper based medical records towards EHRs.  Initially, during the program’s inception, behavioral health organizations found themselves left out; however, through increased legislation, the program has been extended to include behavioral health professionals.

    Meaningful Use Stage 2 includes new Clinical Quality Measurements (CQM) that impact behavioral health providers. The EHR will enable the data capture and report generation to support metrics in these behavioral health categories.

    1. Alcohol Use
    2. Drug Use
    3. Autism
    4. Suicide
    5. Depression
    6. Trauma

    Environment

    Changes in behavioral healthcare are happening not only on a national level, but also at a state and local level. Organizations must stay abreast of these changes and understand the impact on how data must flow in and out of an EHR to meet reporting requirements.

    • The Behavioral Health Information Exchange (BHIE) is live and will enable healthcare providers in Arizona to access physical health and behavioral information at point of care based on a patient’s permission.
      • Patients have the choice to Opt In or Opt Out giving them the right to choose what, if any data can be shared with their physical and behavioral health providers.
    • The State of Arizona has progressed towards an integrated care model to better serve and provide coordinated care for physical and mental health to individuals with Severe Mental Illnesses (SMI).  Sharing patient health information through the BHIE is key to enabling improved care and outcomes.
    • Through the Greater Arizona initiative, Arizona Department of Health Services is planning to consolidate the Regional Behavioral Health Authorities (RHBA) into three Geographical Service Areas; Northern, Southern and Maricopa County.
      • The restructuring of the Geographic Service Areas is aimed at creating a cohesive network of physical and behavioral health providers within a region to increase patient access and care coordination. One major challenge that stands in the way of achieving total integration is getting providers to adopt EHR solutions.
    • The Affordable Care Act requires that all insurance policies sold on the Federal Healthcare Exchange as well as Medicaid patients include mental and behavioral health treatment as one of the ten essential benefits. The EHR must accurately capture each patient’s payer information so there are no delays in billing and reimbursement.
    • There is an increase in mergers and acquisitions within the behavioral health industry, including Southern Arizona Mental Health Corporation and Compass Behavioral Health Care that jointly formed the Pasadera Behavioral Health Network.
    • As healthcare moves towards integration, organizations are looking for new ways to reduce cost, expand service offerings and provide better patient care. Mergers bring many changes to an organization particularly around technology such as:
      • Conversion to a single EHR
      • Interoperability
      • Data Migration
      • System Uses

    Systems Implementation

    Developing the right approach to implement an EHR solution requires careful planning and consideration with respect to organizational structure, staff availability and support capacity. A common strategy for multi-entity organizations is a phased approach, where the new technology is implemented by functional area or pilot site. This approach allows multi-entity organizations to stabilize the new technology and develop the right support structure for subsequent entities. The table below depicts a best practice phased implementation approach where core functionality is implemented first, followed by two additional phases with more advanced functionality as users become increasingly comfortable with the system.

    Phased Implementation Approach

    Capture

     

    Another more risky approach is known as “Big Bang.”  This approach is typically selected by organizations that do not have multiple entities, or are under some time constraint. The table below details key considerations when selecting an implementation strategy.

    Considerations for Selecting Implementation Approach

    Phased

    Long Term

    Limited disruptions to staff/patients

    Managing two systems/methods

    Ability to adjust processes before introducing next phase or department

    Big Bang

    Short Term

    Increased disruptions on staff/patients

    Increased disruptions on staff/patients

    Initially decrease staff productivity

    Limited patient engagement during go live period

    Organizational Change Management

    Any new change in business, especially a change enabled by technology, can be overwhelming for any organization. Preparing for change will help increase user buy in and enable faster realization of benefits. A best practice for planning and implementing an EHR system includes a robust approach to Organizational Change Management. Individuals typically go through a natural acceptance cycle based on the Prosci® ADKAR® Model. Capture2

    The key is to identify and assess key stakeholders and influencers, and monitor their progress through these stages.  Some individuals will struggle with new technology and resist change, having an answer for “what’s in it for me?” will help progress their acceptance. The importance of aligning clinical adoption with the new EHR system cannot be underestimated and must be carefully planned, implemented and monitored.

    Clinical and Business Workflows

    Implementing a new EHR will transform behavioral health operations; preparation and readiness will ensure the overall success of the project.  Workflows in these major treatment areas are impacted by implementing an EHR:

    1. Mental Health, Chemical Dependency and Intellectual Disability Outpatient
    2. Residential/Inpatient Treatment
    3. Supported Residential
    4. Crisis Services
    5. Prevention Services
    6. Medical/Physician Services
    7. Foster Care

    A strong understanding of current workflows, future workflows based on system functionality, and the gaps that emerge will serve as the guide for focused communication and training plans. For users that are new to technology, there may be some preliminary training to introduce them to a laptop, desktop, tablet, mobile device, etc. The communication and training plans should focus on areas that have the greatest impact on patient care, billing and that have significant changes when compared to current state.

    Conclusion

    Behavioral health organizations must take a comprehensive approach for planning and implementing an EHR system.  Careful attention must be paid not only to the new technology, but also business and clinical workflows, and most importantly to people who will be using the system. External drivers such as regulatory compliance and environment are also key areas of consideration when configuring the system and designing reports and queries.  Finally, making sure the right approach is taken for the implementation, whether phased or big bang, will ensure project success.

    MSS Tech Photos

     

     

    Jeff Brevik, Senior Consultant, has over 6 years’ experience in the implementation and delivery of complex Electronic Health Records (EHR) solutions to healthcare providers nationwide.To find out more about how MSS can help your organization implement your EHR System, contact us at info@msstech.com.

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    Cite this blog post:
    MLA: Brevik, Jeff. “Implementing Electronic Health Records System in the Behavioral Health Industry” MSS. MSS. Blog. 08 April 2015.
    APA: J Brevik. (2015, Jul 2). Implementing Electronic Health Records System in the Behavioral Health Industry