EHR in an outpatient mental health setting

Transcription

1 EHR in an outpatient mental health setting

2 Clinic Background Adult outpatient community mental health clinic founded in 1954 in St. Paul, MN, by a member of the Hamm family who was a social worker. The clinic was originally started as a place to provide mental health care to the brewery s 350 employees. Hamm Clinics focuses on mental health care for adults, particularly the underserved and those who are unable to afford the full cost of care

3 Client Population Active client population just under ,000 visits annually 30% on MA or Medicare 25% have no insurance Typical client has a diagnosis of anxiety or depression or a combination of the two A few severely persistent mentally ill clients

4 Personnel 16 clinical staff members (LP, LICSW, LMFT) 3 psychiatrists 4 students (social work, psychology) 1 psychology fellow 2 psychiatry residents 10 operations staff

5 Financials $2.3 million annual budget Income sources roughly divided in thirds: endowment, individual donations, patientgenerated revenue Expect to qualify for Meaningful Use reimbursement this year

6 Low Tech and Changing Hamm Clinic has a deep focus on relationship among colleagues and with the clients Technology can interfere with relationships; the more connected one is, the more isolated one can become However, technology is necessary. The question becomes how to use it Clients are not there to feed data to the EHR

7 Why the move to EHR? The Main Reason: eprescribing mandate deadline January 2012 only considered fully integrated EHRs Chance at Meaningful Use incentives for MDs Other Good Reasons: Improve client care Centralize and standardize charting Improve and upgrade business efficiencies If not now, when? Time and money were available

8 How we did the first EHR The first EHR selection and implementation process was exemplary: Strong RFP Good planning and attention to detail Experienced consultants and staff Good participation throughout the clinic Ample financial and political support Plenty of time

9 First EHR experience The selected EHR won the on site demo and the RFP process, hands down 8 member EHR committee voted unanimously and without discussion for the chosen EHR Implementation and go live went well Migration from paper charts went smoothly Some problems in psychiatry, but all was well

10 How do we use the EHR? Hamm implemented practice management in November of 2010 and the fully integrated EHR in April We use it for: eprescribing Charting and documentation Billing Scheduling Business intelligence Applied clinical research and education

11 Declaring something is wrong Despite very helpful and quick tech support, large and small problems persisted and new ones emerged Bi weekly support calls continued to be necessary for a year Long weekly calls for eight months after that All areas of the EHR were affected: billing, scheduling, clinical, eprescribing Clinic was like a product development site

12 Over time, we learn the system and we learn its problems Fundamental inadequacies identified in all parts of the EHR, thoroughly discussed with vendor, and allowed to remain or promised changes never occurred Integrated third party vendors intractable and unreachable Changes in the terms of agreement: what comes with the system, what does not

13 Lessons Learned Finding an EHR is similar to making a hire for an important position all the best effort and planning does not necessarily result in the best EHR Test everything, and pay particular attention to things that can t be tested, e.g., erx Track your support calls and ongoing issues a year later, the history is invaluable

14 Why the move to the second EHR? Database is a four letter word and they always exasperate everybody, so why change? Move to a security strategy we think is stronger Improve efficiency of the billing process Predictable and reliable business relationship Improve accuracy of erx and psychiatry charting NOTE: therapists were happy with first EHR

15 How we chose the second EHR Smaller committee: IT, MD, COO, Clinical Coordinator, Billing, Front Desk Lead (no food!) Limited to vendors currently in Minnesota Reviewed the research and finalists of first effort Focused on what we needed an EHR to do; didn t compare to old EHR Contacted the sales people of the systems that interested us (no cold calls allowed)

16 2 nd Go Live August 1 More knowledgeable about what works Work flows Policies and procedures Addressing bottlenecks with the fresh start Can t avoid loss of productivity a second time Glad the paper charts are gone, regardless

17 Research and EHR For 13 years Hamm Clinic has used the OQ.45 to track patient outcomes for our research efforts With advent of new and efficient test administration and scoring, OQ is becoming part of clinical treatment and decision making Particularly useful for training program Combination of clinical data and OQ scores provides new learning

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