IT Vendor Survey: Readers` Choice

Anasazi Software—Responding to doctors' needs

In March, Anasazi Software, Inc., rolled out the Doctor's Homepage. The new solution provides Surescripts-certified e-prescribing functionality as well as a single resource for doctors to receive appointment notifications, track potential drug-to-drug and drug-to-food interactions as well as side effects, and report changes in clients' health. Anasazi President/CEO Mike Morris explains that the Doctor's Homepage aims to offer the convenience that physicians enjoyed with paper charts-all of the information in one place. This allows prescribers to save time, which Morris says is critical; he notes that his mother's doctor retired after his clinic implemented an electronic health record because he felt it took him too much time to work through. The Doctor's Homepage is the first stage of a new interface that Anasazi is creating and this month the company is launching the Clinician's Homepage. This month also marks Anasazi's 20th anniversary as its first customer, Austin Travis County Mental Health Mental Retardation Center in Texas, was also the first to go live on the Doctor's Homepage.

Askesis Development Group—Software has to be more useful

“The data is pretty dreadful on clinician buy-in in this market, and it is up to us to make the software as useful, helpful, and intuitive as purchasing an airline ticket,” says Sharon Hicks, president and CEO of Askesis Development Group, developers of the PsychConsult suite of products. “Our company is committed to thinking from the clinician's point of view.”

“In our market,” Hicks continues, “it never really has been easier for the clinician upfront. There's always a little more work for the clinician on the front end to make things work more smoothly on the back end.” With that in mind, Askesis has taken advantage of what may well be the largest IT beta-testing group outside of Microsoft. The company is backed by two major players in the healthcare field: the University of Pittsburgh Medical Center (UPMC) and the Highmark Insurance Company based in western Pennsylvania. Both are organizations in the multibillion dollar range, and UPMC-specifically its nationally renowned Western Psychiatric Institute and Clinic-provides a large testing pool of clinicians interested in furthering the behavioral IT state-of-the-art. Hicks, along with Vice President of Operations Sharon Bauer, are staff alumni of the Clinic and say they bring that perspective to all product development

Beta testing of new PsychConsult products is conducted not only by the Clinic, but by customers who volunteer for the role. Askesis periodically conducts customer conferences in Pittsburgh and invites them to “play with the prototypes.” A typical example was recent development of the PsychConsult treatment plan module, which involved a dozen customer organizations spending two days with company engineers to devise the most useful approach, testing it with other customers, and incorporation of their feedback in the final product. “Just before that, we had billing directors coming into re-engineer our accounts receivable module,” Hicks notes.

Right now, Askesis is working on software modifications that would make record-keeping less “visit-centric.” According to Bob Teitt, director of Marketing and Business Operations, “One customer can move through various levels of care quite often-inpatient to residential to partial hospitalization to outpatient to medication management-and what's needed is a way to get quick access to the relevant client data when you need it.”

Hicks and her team are also attacking broader issues. “The next big thing clinically,” she says, “is a push toward integrating behavioral healthcare with physical healthcare. We have to make sure our software supports customers' moves in that direction.” A second major issue, of course, is representing customers' interests in current debates and negotiations over American Recovery and Reinvestment Act funding and software certification. “We're working hard to figure out what's in it for clinicians.”

Credible Behavioral Health Software—Integrated wireless mobile is the way to go

Host the data, then let customers access it anywhere they want. That might be the mantra of Credible Behavioral Health Software, according to President and CEO Matthew M. Dorman, who maintains that his company offers the only full-service product with an integrated mobile data access solution in the market in wireless connect or disconnect modes. Staff using a laptop, a netbook, even a Smartphone can access client data when and where they need it, he says.

The key to this is the ASP/SaaS model, which Credible has specialized in since the company's founding in the year 2000. Aside from the more obvious advantages of ASP-budget-friendly, predictable monthly payments for both customer and vendor, maintenance and upgrades provided-Dorman notes the major advantage of ASP-enhanced security. “It most likely exceeds the data security that any behavioral agency could afford to provide on its own,” he says.

“There are two types of security,” Dorman explains: “First, physical security-our product is protected by ServerVault, with servers locked in a steel vault one story below ground level, armed guards, and a backup power supply good for six weeks. Second, there's data security, also protected by ServerVault, which exceeds U.S. Department of Defense standards, and features security logs for everything-intake, discharge, progress notes, release of information authorizations. Customers will know who the last person was who touched the record.”

The nine-year-old Credible has about 75 customers, encompassing profit and not-for-profit provider organizations and county community service boards in sizes ranging from a few employees to nearly 500. “No states, no MCOs-we serve the community behavioral healthcare side,” says Dorman, adding that Credible markets two versions of its product, one for smaller agencies, the other an “enterprise” version for larger organizations.

Like so many in behavioral healthcare, Credible is waiting for the day when vendor certification standards specific to the behavioral field are issued. “It looks as though it's going to be February 2010, after which we'll be rolling out certified products in the fall and winter. We're 95% covered now for any standards we expect, but we're just waiting to see what that added 5% will require.”

The Echo Group—Inherent flexibility is a hallmark

How do you prefer to access an electronic health record system: via client/server? hosted online using an Application Services Provider (ASP) or Software as a Service (SaaS) model? With Echo Group products, you can do either, says Vice President of Business Development Joseph Viger. “Flexibility is our hallmark.”

Customers might find themselves in greater agreement concerning Echo's newest product: the Visual Health Record (Echo VHR). “Throughout our 28-year history we have been interested in data-driven management and clinical care,” says Viger. “We knew that the marketplace was looking for an EHR that was easier to use, and we believed that a visually-oriented approach would provide better information for clinical decision support with less end-user training required. After 18 months of development, Echo created the VHR which provides one-click data, quick comprehension of clinical history, visual alerts guided by color coding, and flexibility in how customers can organize and present the data. In brief, it breaks from traditional software views created as columns and rows and mimicking paper paradigms to offer a visual timeline of clinical data.

Echo also offers software solutions to clinical documentation tasks such as progress notes, treatment planning and customer tracking. Its “structured progress notes” feature allows Echo-or even individual customers, if they so desire-to customize progress notes in line with government, third-party payer, and accreditation agency requirements. “Echo's Windows Designer tool gives us that capability,” says Viger, “so that we or the customer can incorporate as much structure and logic as necessary in creating notes to meet all the requirements. It beats trying to find the right note from a pile of paper on someone's desk and adds to efficiency and regulatory compliance.”

Other new developments in Echo's product line this year include functionality to merge duplicate client records, evidence-based treatment plan content, and integration with DrFirst - Rcopia e-prescribing tools.

Echo also offers its Transaction Management outsourced billing. “Echo's billing service can be used in conjunction with our EHR products or not,” says Viger. “Electronic or paper-we'll take the data any way we can get it.” he adds. “The Transactions Management group will work the entire revenue cycle for the customer, from charge creation, through billing and payment.” And do so, apparently, flexibly.

Netsmart Technologies—Putting the “meaningful” in “meaningful use”

Come the fall of 2010, behavioral healthcare providers will have to demonstrate “meaningful use” of EHR elements, according to federal government standards, to qualify for federal financial incentives. At least that's the goal Netsmart Technologies has for its customers, as it spearheads a lobbying campaign to gain equal recognition for the behavioral field as it enters this new era of IT funding and certification. And, says Kevin Scalia, executive vice president of Corporate Development, Netsmart prides itself on being already qualified-CCHIT-certified since 2006, Health Information Exchange (HIE)-ready, offering computerized physician order entry (CPOE) and e-prescribing products, and developing usable outcomes data-in key components of “meaningful use.”

Scalia says it's fitting that Netsmart should assume a leadership role in the new era, since among behavioral IT vendors it is one of the oldest (around 40 years of age) and largest. Scalia adds that Netsmart provides enterprise software for 40 state mental health system EHRs and 18,000 customers overall. Netsmart is also behavioral health's largest SaaS EHR provider.

Newest in the company's suite of “Connect” products are ConsumerConnect and CareConnect. ConsumerConnect provides a portal for consumers to access their treatment plans, medication histories, appointment schedules and more, while communicating with their care team. With CareConnect, Netsmart's HIE service, providers can create and share referrals for consumers that need to move between care providers, request information from other providers, and receive information through a Continuity of Care Document (CCD), an EHR component that Netsmart has modified to better support behavioral health requirements. The next EHR-ready step, says Scalia, will be to publish Netsmart's CareConnect standards so that other software providers can build interfaces with CareConnect customers to achieve true integration. Longer term, Netsmart views CareConnect as the foundation for a national HIE for behavioral health.

Scalia maintains that, in some cases, the ASP/SaaS model has gotten an undeservedly negative reputation when it has been provided in a less-than-secure environment.

“With the inclusion of features like biometric access, server redundancy, power source redundancy, multiple Internet connections, audits, background checks on all SaaS staff, and all-around levels of security, the SaaS model is extremely safe, secure and cost-effective,” says Scalia. “We host entire statewide systems, such as New York's OASAS, a 12-county behavioral health consortium in the State of Washington, and 11 county systems in California. People have confidence in the security and reliability of the system. It's important that providers evaluating SaaS systems consider the security and reliability track record of potential vendors and such items as SaaS 70 Type 2 certification and ISO 270001 and 270002 compliance.”

For now, says Scalia, Netsmart's central focus is on building the country's confidence in behavioral healthcare sector IT as fully worthy of society's support.

Unicentric: The pen is mightier than the keyboard

The concept behind one of Unicentric's principal products, called xInk, is actually a throwback. Rather than staff keyboarding in a client's information for, say, a progress note, the staff member pulls out his/her handy pen and writes the information down. Except this “pen” is different: The xInk Digital Writing System translates handwriting electronically and populates the notes throughout the health information system. “It's distracting for a client sitting there having someone keyboard information,” explains Unicentric CEO Evan Indianer. “Standard note-taking by hand is more comfortable and acceptable.”

How “standard” it is in xInk format, incorporating as it does electronic handwriting recognition, translation of ink strokes made on paper to an online form, and generation of a .pdf as if you scanned the page, is debatable, although humans do have to cooperate a bit. “In terms of handwriting recognition, if humans can read it, the machine can read it,” says Indianer, “but people do have to write legibly, and some have in fact trained themselves to do so when they realized the benefits of the system.”

xInk is one component of a suite of products Unicentric calls its Case Management Platform. This also encompasses staff time management, appointment tracking, voice recognition, e-prescribing and treatment plans. Another major feature is a document management system that uses bar codes to route portions of the client's health record to the correct files. For organizations serious about moving to a paperless environment, old records can be scanned and bar coded quickly, for accurate delivery to EHRs.

Unicentric's system is EHR-ready, in that each client's records are encrypted individually so that they can flow throughout the system and be shared by third-party systems, but can be read only by those with the proper authorization. Within the organization, meanwhile, the system can be adapted to local ways of doing business, rather than forcing the locals to adapt to it. “This is the approach we adopted from our inception,” says Indianer, “because we realized it was important that the system be embedded in customers' operations. Flexibility and comprehensiveness are key.”

Behavioral Healthcare 2009 September;29(8):22-25