The 2010 Behavioral Healthcare IT Vendor Survey

Welcome to our annual survey of information technology vendors and their growing range of products and solutions for the behavioral healthcare industry. While many of the players and technologies seen here will be very familiar, the landscape of the marketplace has changed dramatically over the past year.

It all started in October 2009 with the announcement of the interim final rules for implementing parity in mental health and addiction treatment. Then, the subsequent passage of national healthcare reform in March brought about even more change-that is, until July, when the announcement of simplified final Stage 1 criteria for demonstrating “meaningful use” of electronic health record (EHR) systems was released. Providers that demonstrate such use qualify for incentive funding for adoption of their “certified” EHRs under The Health Information Technology for Economic and Clinical Health (HITECH) Act, a provision of the American Recovery and Reinvestment Act (ARRA) of 2009.

However, as David Raths explains in the article What will ‘meaningful use’ mean to us? in this issue, current HITECH incentives target only individual “eligible providers” in behavioral health, not larger organizations such as psychiatric hospitals. As he explains, legislation introduced in the House (in April) and Senate (in August) seeks to level the incentive playing field.

Changes to this year's survey

At first glance, this survey may look a lot like the 2009 survey-but we've made some important changes.

First, our 2010 survey divides our list of technology vendors into two different parts: those who offer products built around electronic health records (EHRs) and those whose products serve other, more specialized needs.

Second, our target markets category is divided into three sections: providers, managed care/payers, and governmental agencies (city, county, and state) to let you know where vendors are targeting their sales efforts. When considering new technology, these groupings may help narrow your search.

Third, in the Customer Locations section, we tally up the number of U.S. states in which a company has customers, since behavioral healthcare delivery and reimbursement requirements are generally defined and managed at the state level. Some companies have a strong nationwide presence, while others focus on just a few states. There are a number of newcomers to the survey and these are marked in the U.S. states category with an “N,” signifying that the company or its product is new to the U.S. behavioral healthcare market.

Notes about system architecture

The two dominant system architectures, at least for EHRs, are those of Application Service Provider/Software as a Service (ASP/SaaS) and Client/Server.

Adopting software built on the ASP/SaaS model continues to grow in popularity for providers who would rather outsource the responsibility for supporting an EHR platform. The ASP/SaaS model enables a user organization to utilize (by purchase or long-term subscription) a package of software that is hosted by the vendor and open to the user organization via the Internet.

Target markets

Many larger behavioral healthcare organizations have in-house information technology groups and therefore can support a Client/Server approach, which generally offers the greatest opportunity to customize an EHR or software package for an organization's specific requirements.

Increasingly, groups of organizations are adopting EHR systems through “collaboratives” or partnerships. For larger collaborative partners, the arrangement may mean that they can leverage existing investments, personnel, and vendor relationships with like-minded, smaller providers to expand their system, generate income through implementation support, or defray system costs. Smaller organizations-often attracted through existing professional relationships-gain by leaning on the experience of other partners facing the same software, processes, and business challenges.

The survey details two more system architectures as well: systems that run on a terminal server connection and systems that operate “standalone,” with all functionality available through a single PC.

Product functionality

Much recent attention has focused on issues of “certification,” the process by which certain key functions of an EHR system are to be tested and verified to ensure the system's capability to meet “meaningful use” criteria by a third party certifying body. This opens the gates for more successful implementations and is a prerequisite to qualify for ARRA-HITECH incentive funds.

We hoped to capitalize on that attention by identifying those vendors whose EHRs were to be certified by CCHIT. At the time we started the survey, it was the only clear certification option available. However, during the course of the survey, some things changed. To the relief of all, the Stage 1 meaningful use criteria were simplified. At the same time, it became clear that there would be multiple organizations providing EHR certifications.

Most of the EHRs listed in the survey are likely to become certified, but some may not. For those involved in selecting EHRs or considering meaningful use upgrades, caveat emptor, let the buyer beware-at least until the certification process picks up steam. Ultimately, every vendor's claim of certification will be able to be validated on the Web sites of the certification organizations.

One might wonder, “Why not certify?” For large vendors, it's not a question but a cost of doing business. But numerous small and mid-sized companies are weighing the costs of developing (and certifying) key product features against customer preferences and certification costs. And, although the final Stage 1 meaningful use incentive criteria will make success easier to achieve for many providers, they remain an all-or-nothing investment for the vendors, who must commit to supporting all of them regardless of the subset chosen by each customer. So again, caveat emptor, at least for now.

Finally, our survey has sharpened its focus on product functionality in two broad categories: case management/clinical functions and administrative/financial functions. This year, we carefully asked about the “functions performed” by various products, hoping to help you highlight products that, for example, provide dedicated patient screening tools versus a storage location for in-house forms; perform document imaging versus manipulation of existing image files; or keep lists of patients, staff, or assets versus utilize real-time locating system (RTLS) technology that pinpoints exactly where they are.

As before, we asked vendors to tell us exactly how the functionality was provided: included/built into their main product (solid box); offered in another of their products (solid color box with white “O”); or available through a partnership with a third party (white box with color “3P”).

All functions surveyed are listed in approximate order of their availability in the chart. Case management and clinical functions surveyed include:

• Case management

• Treatment plans

• EMR/EHR

• Patient scheduling

• E-prescription

• Disease management

• Patient assessment

• Patient/staff/asset tracking (RFI/RTLS)

• Personal health record

• Telehealth

Administrative and financial functions surveyed include:

• Generate reports and documents

• Document imaging and management

• Dashboards

• Billing service/clearinghouse

• Workforce management

• Revenue cycle management

• Accounts payable/general ledger

• Managed care/payer software

• E-learning

• Enterprise resource planning

To accommodate your questions, as well as additional comments or clarifications from the vendors surveyed, Behavioral Healthcare will make the latest copy of the survey available online at www.behavioral.net/2010ITSurvey.

Have questions or comments? Read the latest from the Behavioral Healthcare editors and contributors online at www.behavioral.net or join our fast-growing discussion group, Behavioral Healthcare magazine, at www.linkedin.com. Talk to you there!

Behavioral Healthcare 2010 September;30(8):14-17