Implementing an EHR System

Transcription

1 Implementing an EHR System C A R O L P I T T S, P H. D., L M F T, L P C D I R E C T O R O F C O U N S E L I N G C A R E A N D C O U N S E L I N G C E N T E R O F G E O R G I A

2 Context of my Comments Practice size 34 counselors 16 students Experience Paper to electronic records One electronic system to another Director of Counseling/Clinical Director Cultural chaos: Floods

3 Tasks in Making THE CHANGE 1. Understand your center s work culture 2. Understand your center s workflow 3. Decide who chooses the EHR 4. Discern what is needed in an EHR 5. Explore available options 6. Prepare for culture change 7. Choose/train/implement

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5 Understand Center s Culture Shared norms Mission of the organization Offering healing, wholeness and hope to those in need, and educating others for this service. Unspoken rules Underlying assumptions Everyone is savvy with technology or not? Expectations and behaviors that govern the way people approach work and interact with each other It s the way things are done here

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7 In Preparation Highlight the need for culture change Engage leaders who understand culture change Draw on experience of others Recruit advocates from staff Reward those who understand it and promote it

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9 Critical: Understand Current Workflow Detailed process of naming how things work now What happens when client calls for first appointment? How do clients and information flow through the center from intake, ongoing care, to termination? Where are the handoffs, redundancies, workarounds? How do counselors and administrative staff interact, and when? Gain clarity about what works well and what does not

10 Decide Who Decides Who are the stakeholders? Counseling staff Administrative staff CEO, CFO, receptionist, office manager Billing staff Board Clients Team approach works well. Greater buy-in Each perspective brings something different

11 Discern What is Needed in EHR What does the EHR need to do? Mobile access Billing and therapy records Intuitive Outcomes Scheduling Who will use it?

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13 Explore Available Options Type of EHR desired Buy software for server; you maintain it Web- or Windows-based (Pimsy) Browser-based (Valant) What can we afford? Prices vary greatly Set-up costs Monthly costs Add-on costs Get references Talk to unbiased experts Know your needs and desires first

14 But an EHR can t do everything

15 Choose an EHR Negotiate a contract How long? Longer term can lead to discounts, but you are locked in How much is flexibility important? Do you trust the company to be what you need in 5 years? Training Do you need on-site training? Is video training adequate? Be clear about set-up fees, monthly fees, add-on fees Separate fees for administrative staff? How will that change if the number of users changes?

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17 Meanwhile While you are doing this, prepare for culture change within your center Assess computer literacy Be prepared to address fears and anxieties How will this change therapy? How will I manage it? What does it say about how we do counseling? Be prepared for resistance This isn t how I was trained This isn t my theoretical orientation

18 Change If users hate what they re using Change is easier! If users like the way things are Change is more difficult

19 Prepare for Changes in Workflow How can we change our workflow to use the new EHR most effectively? What changes might this mean for jobs? Job descriptions? Personnel? Centralized scheduling? Fee setting? Write-offs? Who can do what? What are the new tasks?

20 As you Prepare for Change Talk about the changes before implementing the system Try to implement some changes before the switch Frame the change in positive terms Not We don t like this, but now we have to do it. Sorry. Assure counselors and administrators that they will have time to learn the system and will undergo training.

21 Plan the Training Time Frame For an organization our size, 6 months Train the trainers Use feedback from this training to tweak the system setup Choose a go live date With a few people to pilot the system live, or With everyone at once Choose time for EHR representatives to come perhaps the go live date

22 Setting up the System It must be customized to your organization even if there is minimal customization available. What to say on statements Who gets permissions to do what Entering all therapist data Entering all insurance company data, contacts, fee schedules Formatting types of notes Setting up the clearing house the interface with insurance companies (Gateway, Navicure, etc.) This also means working with your bank It means providing counselor data as well (license, NPI, etc.)

23 Plan for Two Types of Trainings How to use the new system What the new workflow will be

24 Training to Use the New System Know what options are available Training videos Video conference calls with EHR specialists Sandbox accounts Be open to adapting workflow to opportunities afforded with the new system Create a plan to train staff counselors, administrative staff, billers, etc. Create a timeline for training Individual work, small group work, larger staff gatherings

25 Teaching New Workflow Continue the conversation on the current workflow and how it will change. Create a common understanding for how patients and information will flow through the organization from intake through termination. How will this be different than the current structure? What will be easier? What will be more challenging? Will there be changes in job descriptions? What is needed? What are the new tasks? Recording appointments Completed notes before processing claims Changing CPT codes

26 Caring for the Caregivers Remember that change is difficult for many Address user fears and anxieties Other counselors will see the names of my clients Administrators will be looking over my shoulder How will I get rightfully paid? And how will I know it? How will I know what insurance has paid? The client balance? One person collects the fee, but my income depends on it and I feel like I have no control

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28 Conversion Issues Conversion process is complicated and difficult It takes time even months Do we transfer balances in? What if they aren t correct? What if insurance pays in old system? Do we run parallel systems for a few months? Do we import client records Of active clients? Of inactive clients? If not, how do we retain access to the records?

29 What We Learned Workflow issues are as important or more important than the software First time: We tried to incorporate software into workflow Second time: We incorporated workflow into software Internal trainers counselors and administrative staff. Early adapters who help train the rest of the staff Help locate potential problems internally and in workflow Use a consultant if possible

30 More on What We Learned It is easier to go from one EHR to another However, there is NO easy way to transfer client data Bigger culture change to move from paper to EHR Issues we faced: How do you keep records for 10 years (more for kids) when you change systems? There is no easy backup access. How do you avoid bringing bad data into a new system? What fields translate in the conversion process and what fields do not? Who inputs data that must be manually entered? Additional time and staff needed for conversion process.

31 How Our Workflow Changed Hired a billing company Front desk checks in clients and collects copays in advance Counselors can see their clients have checked in. Counselors use EHR as prime scheduling tool Appointments are entered as they are made Clients get appointment reminders, cutting down on noshow rates

32 How Our Workflow Changed Intake forms changed dramatically. Get used to information in a different form. Still use paper for non-english speakers All students now use EHR Easier to print records requests One client record for different therapists Needed to work out billing issues Who gets paid on past balances when money owed to multiple providers

33 Results of the Conversion Counselors like it. After the learning curve, it is less time-consuming (though perhaps more so than paper records) Ongoing training is important. We do some training at every staff meeting for minutes Keeps the importance of record-keeping in the forefront Updates counselors as EHR continues to expand We learned counselors don t read a lot of s! Adapt gradually, and add dimensions as familiarity grows Medication Measures and measurements PQRS reporting and meaningful use

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