2015 EHR BUYER S GUIDE For Behavioral Health and Human Services Providers
CHAPTER TITLE SUMMARY 1 Introduction Are you in the early stages of investing in an EHR? We have created this guide to simplify your selection process and help you choose the solution that will provide better care for your clients. 2 The Benefits of an EHR Complete with an ROI analysis template, this tool will help you determine why your organization needs an EHR. 3 Meaningful Use and EHR Incentives Motivated by Meaningful Use incentives? Use this list to make sure you re asking vendors the right questions about their Meaningful Use readiness. 4 Top 7 EHR Selection Tips These tips will provide the right questions to ask to discover your potential vendor s processes and ensure that the system meets the needs of every department within your organization. 5 The Complete EHR Requirements Checklist Not sure what features are necessary and which are just pointless add-ons? This requirements checklist will make sure your EHR has the features you need. 6 The Qualifacts Difference Rapid deployment, lower cost of ownership, and customized configuration, are just a few reasons why your colleagues are choosing CareLogic Enterprise EHR. Contact us to receive a free RFP template. 7 Why Qualifacts? Designed specifically for behavioral health and human services providers, the CareLogic EHR expertly meets the needs of behavioral health programs and state requirements.
Introduction EHR adoption rates are quickly rising among behavioral health and human service providers. According to a recent study by SAMHSA, 94% of states are implementing or are planning to implement electronic health records in state psychiatric hospitals and are also planning to support their use in community mental health systems 1. If you have recently entered the vendor search for an EHR solution, it s easy to become overwhelmed with the various options on the market. We have created this guide to simplify your selection process and ultimately help you choose the solution that will provide better care for your clients. "Characteristics of State Mental Health Agency Data Systems." The Substance Abuse and Mental Health Services Administration. N.p., n.d. Web. 17 Apr. 2014.
You may still be on the fence about how the investment in an EHR solution would benefit your organization, clinicians, and most importantly, the quality of care. While many of the benefits are quantifiable, make sure to consider the numerous intangible benefits as well. Increase Productivity Productivity will improve dramatically with less time spent on administrative activities and more paid time spent seeing clients. This should be taken into account when you consider your return on investment. On Worksheet A, you can use the peer benchmarks or add your own targets for productivity. Improved Quality of Care With the increase in efficiency, more time can be spent on direct care, which strengthens your business model and solidifies your agency s value to the community. Your EHR should always support your end goal your commitment to your clients. Financial Benefits If you or your organization are still unresolved on the investment, consider conducting a Return-on-Investment (ROI) analysis to compare the technology costs with the financial benefits for your organization. What does ROI mean? The ROI rate represents the multiple of the investment you will earn. For example, if the investment is $1,000 and the benefit is $2,500, the ROI rate is 150 percent. That means you will earn 150 percent of the total investment in financial benefits as a result of making the investment, all of which will drop directly to your bottom line. In short, if the annual gains are positive, invest in an EHR as there is a direct financial benefit. If the ROI percentage is very high, waste no time.
Cost vs. Benefits Start by collecting all the data you can from vendors about the cost of the EHR. This includes both the upfront investment and the recurring costs. The type and amount of these expenses will vary depending on what system you are evaluating, and if the solution is Software-as-a-Service or On-Premise. Software-as-a-Service SaaS is a subscription-based model for accessing an EHR system. As opposed to purchasing licenses and hardware all upfront, with SaaS, the software is hosted from a remote, secure datacenter and delivered on-demand to users via a secure, HIPAA-compliant Internet connection. SaaS minimizes providers up-front financial commitment as well as ongoing costs and resource load by having the vendor perform the following functions: o Hosting and supporting the software and servers o Implementing all ongoing system upgrades or patches o Purchasing new system-related hardware o Maintaining compliance and disaster recovery plans o Providing 24x7 helpdesk support SaaS is Changing the Game for Behavioral Health Providers A successful SaaS vendor s goals are aligned with the provider s goals in at least two ways: SaaS vendors are paid a subscription for their software over time as opposed to a large up-front license payment. This structure motivates SaaS companies to scope a project accurately and provide strong training, testing and validation which leads to the completion of each project phase in the shortest period of time possible. As a result, behavioral health and human services providers realize the value of their solution more quickly. With the vendor s and provider s goals aligned under the SaaS model, the biggest obstacles to success are overcome as each implementation becomes profitable for the vendor at the same time that the customer starts to receive value from the system. Agencies quickly recognize benefits from their systems investment as users quickly become effective on the system. The SaaS Investment For SaaS, you can discount the subscription costs in year one, because the expenses should not begin until after the implementation is complete. Adjust this discount accordingly for each vendor based on their implementation time. You can use Worksheet A below to determine the investment of a SaaS solution in the first three years. 1. Delivering a project on or ahead of schedule 2. Providing a high level of competency for the agency s users after go-live
Worksheet A: The Investment Year 1 Year 2 Year 3 a) Initial Investment (Add 1 3, below) $ $ $ 1. Implementation, Training & Data Conversion $ $ $ 2. Software Licenses (On-premise only) $ $ $ 3. Hardware Purchase(On-premise only) $ $ $ b) Ongoing Software Costs (Multiply 1 and 2, below) $ $ $ 1. Subscription (SaaS) or License Maintenance Costs (On-premise only) $ $ $ 2. Implementation Filter (% of the year that Subscription costs are incurred) 50% 100% 100% c) Hardware Maintenance & Replacement Costs & IT Staff (On-premise only) $ $ $ TOTAL INVESTMENT PER YEAR ( = a + b + c): $ $ $ On-Premise An On-Premise solution means the server, client, and the application are all hosted and managed by your organization itself. When speaking with various vendors, you may also hear this model described as a client server systems, local office system, or an out-of-the-box system. With an On- Premise solution, you should consider the cost and time of the computer hardware, the supporting software (anti-virus and anti-malware, for example), as well as data backups. Depending on the size of your organization, IT support may be required and upgrades are done at both your organization s convenience and expense. ADDITIONAL FINANCIAL BENEFITS Increased Billed Revenue Billed revenue will increase as your EHR automatically captures and generates claims for every billable service provided. Users typically see a sudden increase in billed units after they go live with a solution because records of services provided no longer get lost in the shuffle. This can be difficult to estimate because you don t know today how many services are being missed. A conservative estimate is a 10 percent increase. Increased in Collections An EHR can check and catch billing errors before the service occurs and validates all claims before they are sent, drastically reducing denial rates and increasing collections for all payers. The likely increase depends on your current denial rate and your contract with each payer. Use the peer benchmarks for Medicaid and create your own targets for
Medicare, private insurance and self-pay. Self-pay collections will jump dramatically after you implement a solution, as the system will show the amount due at the time of service, prompting collection on the spot, rather than requiring an invoice to be generated later. Decrease in Medicaid Recoupment You can also expect your annual Medicaid recoups to decrease because your system should validate numerous clinical checks at every service and for each providers caseload. For example, a system should alert you when a treatment plan is set to expire or if a scheduled service is not included in the plan. For each of these categories, enter the information in the spaces provided on Worksheet B below. We have provided the example in the first row as a guide. The example agency has entered their current annual billed revenue of $2,000,000. This represents only 85% of total billable services provided. The total potential is $2,000,000 divided by.85 or $2,352,941. This agency predicts an increase of 13 percent based on the peer target of 98 percent. Multiply.13 by the total potential revenue to arrive at $305,882, the calculated annual revenue increase. Calculating the Net Return on Investment Lastly, you will combine worksheet A and worksheet B to determine the net ROI. In worksheet C, enter the total annual cost (from worksheet A), and the benefits realized (from worksheet B). Then, simply subtract the annual investment from the benefit to see your return on investment in annual dollars. This number represents your total gain (or loss) in revenue after paying for your technology investment. Finally, divide that number, the total gain, by the investment to get the ROI percentage. This number can be used to measure the efficiency of the investment as well as a useful metric for comparing multiple investment options. DOWNLOAD FULL WORKSHEETS HERE
For most providers, Meaningful Use incentive programs have motivated their recent search for an EHR solution. Under the Health Information Technology for Economic and Clinical Health (HITECH) Act, eligible health care professionals and hospitals can qualify for Medicare and Medicaid incentive payments when they adopt certified EHR technology and use it to achieve specified objectives. Some of these objectives are called "meaningful use" objectives, which simply mean the measurable benchmarks providers must meet to qualify for the incentive payments. These meaningful use requirements vary between the Medicare and the Medicaid incentive programs. If you re motivated by Meaningful Use incentives, make sure to ask the following questions to all vendors you are evaluating. The questions will help you assess the vendor s Meaningful Use readiness and ensure your selected system is ready for all stages of Meaningful Use, for maximum incentive receipt. QUESTIONS TO ASK EVERY EHR VENDOR ABOUT MEANINGFUL USE 1. Will the updates for all stages of Meaningful Use be made to the EHR automatically at no additional charge? There are three stages of Meaningful Use, and each stage will require new functionality as the requirements increase. The vendor should make the required changes and perform the necessary testing automatically and at no cost to the customer. Confirming these changes are included in the original EHR purchase price ensures you keep all the Meaningful Use incentives you receive. 2. How have the Meaningful Use measures be integrated into the system? The Office of the National Coordinator (ONC) for Health Information Technology identified a set of standards for the certification of EHR technology, but how the vendors meet those standards was not specified. This means there is great variance in how the measures have been integrated into the EHR systems. Ask each vendor to show you the workflow you would use to meet the Meaningful Use measures. If the workflow is too complicated or requires double entry, it is unlikely your staff will consistently document the encounters
and therefore may not be able to meet the measures. Look for how the vendor integrated the measures into the workflows. Is it logical and efficient? Did the vendor stay mindful of the clinician workflow and the importance of not disrupting productivity? 3. How will you assist us in registering and attesting to Meaningful Use? Demonstrating meaningful use of a certified EHR requires good processes, efficient workflows and thorough reporting. Does the vendor have Meaningful Use experts on staff to assist you in meeting the measures? Will they help you determine eligibility and suggest the most effective practices for ensuring you satisfy the requirements within the stated reporting periods? Are they dedicated to making sure all their customers receive the maximum incentive payments? 4. Does the EHR include the reports required to determine when you have satisfied the measures? The EHR should include reports that will automatically calculate your status in meeting the measures by applying the correct formula to the data. Be sure these reports are included in the original purchase price and you will not be charged extra for this service.
Now that you have decided to implement an EHR system within your organization, use our selection tips to evaluate each vendor. These tips will provide insight into your potential vendor s processes and will ensure that the system meets the needs of every department within your organization. action! 1. ASK TO SEE WORKFLOWS VERSUS FEATURES WHEN VIEWING DEMOS Seeing a demonstration of the functionality in the context of typical workflows will provide insight into how seamlessly your staff will be able to transition to your new EHR. See the features in 2. INCLUDE A CLAUSE IN YOUR CONTRACT THAT STATES YOUR SYSTEM WILL BE AUTOMATICALLY UPDATED WHEN FEDERAL REGULATIONS CHANGE, FREE OF CHARGE. The vendor should be responsible for updating the system to accommodate federal regulation changes. Be sure all future changes are included in your initial purchase. ICD 10, HIPAA 5010, and each stage of Meaningful Use are just some of the federal changes that should not require additional software purchase or upgrades. 3. FIND OUT EACH PROSPECTIVE VENDOR S AVERAGE IMPLEMENTATION TIMELINE AND ASK TO SPEAK TO CUSTOMERS ABOUT THEIR EXPERIENCE IMPLEMENTING THE SYSTEM Speak to customers who experienced varying implementation lengths to get a sense for the vendor s process and what makes for the most successful implementations. 4. ASSEMBLE A SELECTION COMMITTEE THAT INCLUDES EXECUTIVES AND END USERS FROM ALL DEPARTMENTS INCLUDING FRONT OFFICE, CLINICAL, AND BILLING. A diverse selection committee will ensure you take into account all day-to-day functions and requirements when evaluating vendors. Selecting a system that can mimic your existing workflows will minimize disruption and will ensure a quicker user adoption. Additional white papers can be downloaded from the Resources section of our website, http://www.qualifacts.com
5. REQUEST A DEMO UTILIZING YOUR AGENCY S COMPUTERS AND INTERNET CONNECTION. When conducting on-site demonstrations, the best way to test the software is in your current environment. If considering an On-Premise system, have the vendor use your equipment to perform the demo. If considering a web-based system, have the vendor use your agency s Internet connection so you can test page loads and overall system reliability. 7. ONLY EVALUATE COMPLETE MEANINGFUL USE CERTIFIED SYSTEMS. This will ensure you are eligible for the maximum EHR incentives. Plus, the Meaningful Use requirements are similar to many accrediting board requirements so the fully certified system will help you achieve accreditation in the future. 6. ASK HOW MUCH TIME THE VENDOR WILL SPEND ON-SITE DURING THE FOUR CRITICAL POINTS OF IMPLEMENTATION. 1) Set-up & configuration 2) Training 3) Go-live 4) The first month-end close. Hands-on support and face-to-face time with the vendor is essential for successful and timely implementation. Additional white papers can be downloaded from the Resources section of our website, http://www.qualifacts.com
Use this checklist to evaluate each EHR vendor. This list represents the must-haves in an EHR system and vendor partnership. Put a check mark next to the requirement the vendor fulfills and then tally the results. On-Site, Hands-On Implementation A face-to-face implementation provides your staff the best training possible and allows your agency to move through the implementation process efficiently, saving you both time and staff resources. Transparent Pricing Pricing should include: training, unlimited support, upgrades, license fees, escrow, all desired modules, and any third-party applications. Extensive Report Writing Capabilities Report writing should be left in the hands of your organization, with an easy-to-use report writer that requires minimal training and provides a vast array of reporting capability. Customer-Built Forms that Supports Efficient Workflows To ensure a seamless transition to your new EHR, the vendor should provide a way to customize and build forms to support your current workflows.
Customer-Led Product Enhancements To make certain product enhancements are prioritized by the needs of the customer base, the vendor should provide a client portal where existing customers can provide product feedback and vote on new functionality. Health Information Exchange Capabilities In the new era of health information technology, the vendor should be actively participating in the exchange of information between behavioral health and primary care providers. Meaningful Use Updates & Resources The vendor should provide all necessary functionality updates for each stage of Meaningful Use at no additional cost to you. And, the vendor should have experts on staff to assist you in registering for Meaningful Use, ensuring you receive the maximum incentive payments. Customer References The vendor should provide at least three customer references that are of similar size and that provide comparable programs to your agency. Your best bet for assessing fit is talking to other agencies.
Qualifacts' CareLogic Enterprise solution, which is at the core of its SaaS offering, is unique in that it offers a highly sophisticated enterprise application with easy-to-use technology. The success achieved by Qualifacts customers with their accelerated implementations and rapid adoption by users is driving the growth of Qualifacts across the country. Rapid Deployment By eliminating the up-front work required to install hardware and software, time to "go-live" is reduced and value derived more quickly for the provider. The average time to implement CareLogic is 5 ½ months. Reduced Administrative Burden Qualifacts manages all network maintenance and upgrades from day one, so the agency s IT staff is free to work on its own strategic initiatives. There s no need to focus on system maintenance a distraction and cost that makes sense to avoid with all the other priorities agencies face or hire expensive and difficult to retain computer programmers. Lowest Cost of Ownership Qualifacts' CareLogic features the lowest start-up costs possible. Agencies avoid costly hardware purchases and infrastructure investment. Qualifacts implementation model protects organizations against costly project overruns common with on-premise solutions. Continuous Innovation Traditional software applications grow less efficient and useful over time while SaaS applications improve. All Qualifacts customers use the same platform with new features provided regularly at no additional cost, including upgrades to participate in the EHR Incentive Programs of Meaningful Use. So as long an agency is a client of Qualifacts, its EHR will be state-of-theart allowing it to maintain a competitive advantage in today s constantly-evolving healthcare environment.
Advanced Physical and Data Security Qualifacts SaaS application meets or exceeds all HIPAA requirements. Information is maintained in a SAS70 certified, N+1 redundant data center, staffed 24x7x365 and outfitted with mantraps and biometric security. Qualifacts partners with VeriSign, the world s largest trust services provider, using the most powerful commercial encryption available. Additionally, Qualifacts does not cache data in users PCs or laptops, so a lost or stolen laptop will not lead to the compromise of confidential data. This professional-level technology and security would otherwise be out of reach for most providers, but it s standard for Qualifacts customers. Configuration Not Customization Qualifacts highly configurable platform provides a tailored solution without the up-front or ongoing cost of custom software development. Customers receive the benefits of flexibility without the challenges of developing and supporting custom code. SaaS is More than just On-Demand Some behavioral health and human services software vendors claim to deliver ASP or SaaS but, in fact, do not. A true SaaS solution (like Qualifacts CareLogic) requires a multitenant architecture across a common code base and server infrastructure for all customers to maximize efficiency and Qualifacts is extremely proud that its SaaS platform is empowering behavioral health and human services providers across the country to realize the goal of accelerated EHR implementations without disruption to staff and clients. Providers know they need to implement EHRs and by selecting Qualifacts, which shares their goals, agencies are ensuring their success in EHR implementations. If you would like to know more about Qualifacts and its customers success stories, please contact the company at info@qualifacts.com or (866) 386-6755 and one of our team members from your area will contact you.
UNMATCHED CUSTOMER SUCCESS o 65% faster implementations vs. industry average (~5.5 months vs. ~12 months) o $11.4 million of Meaningful Use incentives collected by customers o $400k average working capital gains within first 60 days WE RE HERE TO HELP! Contact Qualifacts now to receive a FREE RFP Template to complete your vendor selection process at (866) 386-6755 or email info@qualifacts.com. HIGHLY ENGAGED USER COMMUNITY o 97% of CareLogic customer organizations are engaged in the user community LARGEST BEHAVIORAL HEALTH CLINICAL DATABASE IN THE COUNTRY o +52,000 active users across 29 states o ~21 million services delivered to ~750,000 patients over the last 12 months o ~13 million customer claims for ~$1.7 billion annually; growing 30% each year