5THINGS TO CONSIDER. When Selecting Your New (Next) EHR. September Netsmart

Transcription

1 September THINGS TO CONSIDER When Selecting Your New (Next) EHR

2 Using an electronic health record (EHR) is the first step to improved healthcare for your clients. In most cases, it allows organizations to provide efficient, coordinate care. As new legislation and standards continue to be established and changed that, among other things, require behavioral healthcare organizations to demonstrate outcomes and meet clinical quality measures, providers are being forced to sit down and calculate the cost of non-implementation, or less than optimal implementation, of an EHR. This cost assessment is critical in deciding if your organization is in the market for a new EHR solution. A quality EHR implementation should have concurrent positive impact on the clinical, information and administrative aspects of your agency. Ask yourself: Have we been able to improve the clinical productivity of our staff? Have we been able to reach the industry standard billing collection rate of about 90 to 95 percent of net revenues (Robertson, 2007)? Have we lost Meaningful Use (MU) dollars because our EHR is not certified to current standards? Have we experienced unanticipated on-going expenses on system customization, report development or consulting? Does our EHR provider fully understand the unique environment of behavioral health and offer clinical strategies and support for items such as consumer-directed care, closed-loop medication processes and clinical decision support? Does our EHR provider have the knowledge and resources to help us expand our scope to integrate behavioral health and primary care to treat the whole person? Depending on your answers to the questions above, it may be time to explore your options. But industry research shows that more than half of all first-time EHR implementations fail (Patti Renner, 2009). What s stopping your organization from becoming a statistic? Here are five things to watch for when selecting your EHR: 5. Workflow Design & Functionality 4. The Implementation Process 3. Cost vs. Return on Investment 2. Meaningful Use Certification 1. EHR provider vision, strategy and client relationships 5 Things to Consider When Selecting Your New (Next) EHR September 2014 Page2

3 5 WORKFLOW DESIGN & FUNCTIONALITY The EHR is a product that has to be innovative and rapidly changing with the healthcare community, said Sushil Pillai, Milwaukee County program manager. The product is growing in relevance and becoming ever more important to our environment. The current generation of EHRs are more efficient and effective than their predecessors and a good solution should touch all aspects of your organization: clinical, operational and financial. But when you talk basic function, most EHRs are created similar. You want an EHR that is safe, efficient and certified, with an intuitive user interface. Every healthcare setting has its own unique needs. A good EHR will support advanced clinical workflow and best practices for that setting, rather than just collecting data on existing processes. The second order effects of easily accessible data support executive decision making and improve collaboration and efficient workflow across the organization. Additionally, if the system gives you access to big data, benchmarking and analytics capabilities will provide good measure in comparing and implementing behavioral health community best practices. You become a better clinician and/or administrator when you have the most current knowledge at your fingertips! Healthcare is a team effort. Often, the team members are in different departments or even different organizations. Electronic health records provide the mechanism for all team members to understand current state and collaborate around a care plan focused on wellness and recovery for the individual. Studies show that coordinating care today could save the nation as much as $580 billion over 25 years, according to UnitedHealth Group Center for Health Reform and Modernization. If you are in the behavioral health, substance use treatment or a similar community, it is important to look for an EHR that provides or a vendor that is working to provide a end-to-end chassis for clinical content, expanded clinical decision support capabilities, opportunity for closed-loop medication management, the ability to accelerate primary/physical care integration and better consumer-directed engagement and care. In 2014, expanded mobility workflows have become increasingly relevant. Look for an EHR that supports clinicians work from anywhere. Is the solution available for mobile devices? 5 Things to Consider When Selecting Your New (Next) EHR September 2014 Page3

4 CASE STUDY: Ability Beyond For more than 60 years, Ability Beyond has led the field in supporting people with disabilities by providing person-centered, cutting-edge, cost-effective services to over 2,300 people annually. Working across Connecticut and New York, the organization focuses on deploying new technologies and approaches to provide support and opportunities for people with disabilities. Your IT staff want to know that the EHR will be up and running within a defined period of time and that it will be intuitive and user-friendly, so staff can get information they need without relying on IT staff for routine reports and client-specific information. Likewise, technology staff should ensure the vendor provides role and venue-specific staff training. Administrative efficiencies through automation are an important benefit of a successful EHR deployment. Many organizations reduce or re-deploy administrative staff as they send out cleaner claims through the electronic system. This ensures they get paid in a timely manner, reducing time between service delivery and reimbursement. In 2011, Ability Beyond implemented Netsmart s myevolv CareRecord EHR solution. The results, according to Ability Beyond s performance improvement manager, Lori Ruckel, are striking: myevolv has contributed to a 25 percent decrease in cost per person served. Supervisors now have an additional four hours per month available to focus on the needs of the staff instead of doing paperwork. Staff efficiency has increased by 5 percent, reallocating one extra day per month, per person, in the field to support clients instead of doing paperwork. The organization has saved 60 payroll hours per week through reduced administrative support. Training on myevolv takes 87 percent less time than training with their previous EHR. The product is growing in relevance and becoming ever more important to our environment. Sushil Pillai, Milwaukee County 5 Things to Consider When Selecting Your New (Next) EHR September 2014 Page4

5 4 IMPLEMENTATION PROCESS Pick an EHR supplier offering an implementation that includes a proven methodology based on industry best practice and knowledge across domains. A unique combination of an integrated methodology ( how ) and skilled expertise ( who ) during implementation, will decrease variance and reduce ongoing optimization requirements. Make sure the vendor is prepared to kick-off with a clearly defined and detailed project plan driven by the provider. Projects that start off from day one with clear expectations on the timeline, objectives, and required resources will see quicker, more predictable implementations. Collaborative, upfront goal setting and on-going communication provides a clear picture of project status throughout the implementation and leads to predictable outcomes. Go-live is an extremely important milestone, but it should not be the end of engagement between your organization and your EHR provider. How can you make important decisions at the front of the project at a time when you know the least about the solution you are planning to implement and the solution vendor knows the least about you? Make sure the vendor provides a process to optimize the system after go-live. Once you understand your solution, you can better know about how it might integrate with your workflow and that leads to greater innovation and enhanced results. Make sure optimization is built into the implementation methodology. 5 Things to Consider When Selecting Your New (Next) EHR September 2014 Page5

6 3 COST VS. RETURN ON INVESTMENT Purchasing an EHR can be expensive and you should be careful to watch for hidden costs. IT must be involved in the decision, so it can determine whether or not your organization has the hardware infrastructure needed for the implementation in place or if the purchase will require upgrades or additions. Other items that should be evaluated before purchase: Will training cost more? What is included in the package? How are these items packaged? Some vendors offer training, support/maintenance, and updates as part of the purchase. Another consideration is whether the EHR provider offers cloud hosting. Cloud computing shifts costs from capital expenditures to operational expense, which helps cash flow. Organizations pay only for the resources they need, when they need them....i accomplished what I planned to accomplish. If done right, you should be able to realize a return on investment (and more) from your EHR purchase. For example, most organizations underestimate the financial impact of just minor Rebecca Smith, Chief Information Officer, Henderson Behavioral Health improvements in their collection rates; an organization that bills $20 million in net revenues annually can gain $1 million per year if it improves its collection rate by 5 percent. This does not include money recouped by payers because there were problems with the billing, which is a problem a good EHR is expected to eliminate. Other ROI to watch for is whether or not the EHR will reduce errors, such as medicine management errors, and increase patient engagement; these are items that are proven to improve care, thereby reducing costs. According to a report by the Center for Advancement of Patient Safety, the highest percentage of prescribing errors (49 percent) occur with admission reconciliation failures. Improper dose/quantity and extra dose errors most often occur with transition reconciliation failures and the highest percentage of omission errors (76 percent) occur with discharge reconciliation failures. An optimized EHR can help with all of that. Rebecca Smith, chief information officer for Henderson Behavioral Health, said it is essential an organization take a hard look at ROI and establish baselines before an EHR implementation. You want to be able to measure, said Smith, to say, I accomplished what I planned to accomplish. 5 Things to Consider When Selecting Your New (Next) EHR September 2014 Page6

7 2 MEANINGFUL USE (i.e. tracking, reporting mechanisms) The American Recovery and Reinvestment Act of 2009 authorized the Centers for Medicare & Medicaid Services (CMS) to provide incentive payments to eligible professionals and hospitals that adopt, implement, upgrade or demonstrate meaningful use (MU) of certified electronic health record technology (HealthIT.gov, 2014). As technology continues to advance, new legislation standards continue to be established through the Affordable Care Act (ACA), with ICD-10, DSM-5 and MU Stage 2, among others. MU funding is the largest pool of money available to eligible professionals and hospitals and selecting an EHR that is not certified for MU attestation can result in a substantial loss of dollars. Each eligible professional (physician, nurse practitioner or physician s assistant) is eligible to receive $44,000 in total incentives from Medicare (and $63,750 under Medicaid) for demonstrating meaningful use of their organization s EHR; incentives are annual. Some of the items an EHR will need to offer to be MU certified include the ability to e-prescribe, to electronically exchange patient health information and to report on clinical quality measures. However, though the incentive payments authorized via the MU requirements are attractive, it is important to realize that the MU requirements define the future of electronic health records and interoperability. All providers will ultimately be affected by the MU requirements, regardless of whether they receive any incentive money. So, picking a provider that can provide support and guidance to prepare for the future is critical. Ask: If you don t understand MU attestation, is there someone who can provide you information and support? The type of MU certification of an EHR should be easy to verify with a vendor before moving forward with a purchase. EHR technology developers are required to disclose certain information about their certified products. This information includes the date the product was certified; the product version certified; the unique certification number or other specific product identification; the clinical quality measures to which the product was certified; any additional software the product relied upon to demonstrate its compliance with certification criteria; and the certification criterion or criteria to which an EHR module had been certified (Posnack, 2014). 5 Things to Consider When Selecting Your New (Next) EHR September 2014 Page7

8 1 EHR PROVIDER VISION, STRATEGY AND CLIENT RELATIONSHIPS Eighty-six percent of buyers will pay more for a better customer experience, according to a CEI Survey (Crandell, 2013). EHR implementation success is often predicted by the EHR provider s customer service approach, its investment in the industry and the competence and dedication of its people. Look for a provider with a highly collaborative approach to assessing the needs of your organization, to designing and implementing the new system and to continually partnering with you to improve your organization s quality, operations and clinical service delivery. The big thing people in our field want is to make their jobs easier and have their revenue increase, while providing quality care, Melissa Larkin-Skinner, Vice President of Inpatient Services, Manatee Glens A good EHR provider can often be spotted upfront. For example, will they visit your facility to do a live demo more than once, if necessary? Can it provide client success stories, testimonials and references? Does it invest in improved customer service? Does it collaborate with you from the very first point of service? It is important find an EHR provider than understands your community s unique assessment and treatment methodologies, and the types of information that needs to be captured by an EHR for your success. Ask if the provider has experience in the behavioral health, primary care, public health, developmental disabilities, child and family services, substance abuse or other relevant sectors. Is the provider engaged in the industry in ways other than as a vendor? Does the provider support related non-profit organizations? Does it understand the legislation affecting the industry and, when necessary, advocate for provider legislatively? 5 Things to Consider When Selecting Your New (Next) EHR September 2014 Page8

9 Is it a company that is forward and future thinking, staying one step ahead so it can grow with your organization as a long-term partner? Does the provider s vision and strategy align with yours? It is also important to look at the EHR provider s customer service methodology. Some vendors go-live and move on to the next client. Look for a provider that has a client support team, a process for handling support tickets that is fair and efficient, and active user groups for collaboration and sharing best practices. Vice President of Inpatient Services at Manatee Glens, Melissa Larkin-Skinner, said her organization -- a top 100 company in its region in Florida, with approximately 500 employees and an average annual revenue of $29 million -- looked for a strategic partner and not just a vendor when it chose Netsmart a couple of years ago. A true EHR partner, she said, needs to know what is going on in the business and make sure the developments they are making with a solution or new solutions will meet the needs of their clients and their clients clients in the future. Conclusion The EHR solutions on the market have many features and functions, but the complexity, applicability and cost to implement one cannot always be justified by a particular organization. Finding a solution that is scalable and soundly built will allow your organization to succeed at a faster rate versus failing due to cost constraints. Consultants who are skilled at designing the right system for the right healthcare environment is a huge benefit, but the system must be able to work within an organization s needs and budget. An EHR vendor with an integrated offering of solutions that has the ability to build upon the EHR foundation is something to look for as you begin the EHR evaluation process. Solutions that can evolve as your organization evolves are essential. References Crandell, C. (2013, January 21). Customer Experience: Is It The Chicken or Egg? Forbes. Retrieved from christinecrandell/2013/01/21/customer-experience-is-it-the-chicken-or-egg/ HealthIT.gov. (2014, April 4). EHR Incentives & Certification. Retrieved from HealthIT.gov: Patti Renner, P. R. (2009). Why Most EMR Implementations Fail: How to Protect Your Practice and Enjoy Successful Implementation. Streamline MD. Posnack, S. (2014, February 11) Edition EHR Certification Includes New Transparency Requirements. Retrieved from Health IT Buzz: Robertson, Z. N. (2007). Key revenue cycle metrics. HFM. Retrieved from pdf U.S. Department of Health and Human Services. (n.d.). Key Features of the Affordable Care Act By Year. Retrieved from HHS.gov/HealthCare: Netsmart s Contributing Experts: Doug Abel, Executive Vice President, Solutions Delivery Kristen Guillaume, Vice President & General Manager, Public Sector Carol Reynolds, PMP, Senior Vice President, Client Experience A special thanks to Rebecca Smith, CIO of Henderson Behavioral Health, and Sushil Pillai, program manager for Milwaukee County, whose thought-leadership deeply influenced this paper. 5 Things to Consider When Selecting Your New (Next) EHR September 2014 Page9

10 About Netsmart Netsmart is committed to helping health and human services providers deliver effective, outcomes-based care with Netsmart s CareFabric solution, a tightly woven framework of innovative clinical and business solutions and services that supports integrated, coordinated delivery of health services across the spectrum of care. More than 23,000 client organizations, including 450,000 care providers and more than 40 state systems, use Netsmart solutions to help improve the quality of life for more than 25 million people each day. Netsmart is pleased to support the EveryDay Matters Foundation, which was established for behavioral and public health organizations to learn from each other and share their causes and stories. For more information, visit Learn more about how Netsmart and the CareFabric solution are changing the face of healthcare today. Visit call , follow us on Twitter, like us on Facebook or visit us on YouTube. CareFabric is a trademark of Netsmart Technologies, Inc. 5 Things to Consider When Selecting Your New (Next) EHR September 2014 Page10