How technology improves operations

Although the industry has been slow to adopt electronic health records, those who do implement enterprise systems find that they help clinicians to do their jobs better. Real-time reporting, cloud-based solutions and data analytics are just a few reasons providers cite as ways EHRs assist in their day-to-day operations.

Phil McQueen, vice president of IT at Great Circle, a community mental health program in Missouri, says the benefits of an electronic system are superior to the old paper administrative methods. The behavioral health organization works with children and families and offers a wide variety of programs, ranging from foster care case management, educational programs, residential services and physical and mental healthcare. In the 1990s, the organization created software akin to an EHR, but it couldn’t overcome its own limitations. That’s what led to a six-month ramp up to a new EHR.

“It gave us an opportunity to develop workflows for all program offerings, our intake, services and discharge needs as well as aftercare and follow-up,” McQueen says. “We developed workflows for every job, and we were able to be comprehensive and understand what services to deliver but also what were the documentation needs.”

The final implementation of the EHR improved operations on both the point-of-care and back-office levels, he says, by providing data that helped the team understand not only billing best practices but allowed them to embark on cycles of improvement within programs to ensure client needs and goals were met.

Point-of-care accomplishments

Real-time and mobile reporting were keys to the new EHR system, McQueen says.

“The EHR was another evolutionary step forward for us because of our large mobile, young workforce,” he says. “They can accomplish their jobs on their mobile devices.”

Many of Great Circle’s employees work remotely at different job sites, so the ability to report on-the-go is vital. The system can be reached via web browsers while connected to the internet so that employees can document care from anywhere. All employees receive a laptop and a cell phone with a mobile hot spot to connect to the internet while working remotely, and they must enter documentation within three days to allow for expedited billing.

Sam MacMaster, PhD, chief clinical officer of JourneyPure, agrees that real-time reporting is a great advantage of EHRs. JourneyPure is a three-year-old regional provider for substance use disorders and mental health and trauma services. MacMaster says that the organization has always been electronically-based when it comes to reporting. He says the EHR is cloud-based, providing more flexibility for real-time solutions.

“Everyone has access to records at any time. If someone is charting, it’s all happening in the moment,” he says.

That real-time functionality is important for information and data management, he adds. The team knows when and where beds are available, levels of care for patients and the overall current state of the treatment center. Armed with that information, MacMaster says the team is able to make predictions in real time.

“It’s an exponential level of efficiency,” he says. “For clinicians who use paper, there can be some pushback. But once you have a good system employed, the ability to see things in real time and move forward quickly with communication is exponential.”

Anthony Hassan, CEO and president of Cohen Veterans Network, a group of mental health centers for veterans, says his organization also has been electronically-based from the start. However, the network’s EHR system allows for real-time reporting to be taken to the next level.

For example, the organization’s new treatment center in Washington, D.C., will make use of collaborative charting. A flat-screen monitor on the wall will display notes in real time so that the patient can participate with the provider while the treatment plan is updated and homework assignments are discussed.

“It’s not about us. It’s about the patient taking ownership of their care and being part of the process, being more transparent about the treatment and what we’re saying about them,” Hassan says.

The D.C. location is conducting the pilot version of the process to see how patients and providers respond, with hopes of bringing the practice into the culture at large.

Other benefits of EHRs, according to McQueen, include:

• Improved treatment planning. The new system sets up a more individualized treatment plan, with access to best practices for treatment approaches. For example, if therapists with one or two years’ experience are writing a treatment plan, they need to work with a senior therapist. The EHR allows for that interaction to occur.
• E-prescribing. Providers can prescribe and order medications from the EHR, which cuts out a lot of the manual steps and ensures no errors are made.
• E-labs. With the new system, labs can be ordered and results can be stored within the EHR.

Back-office upgrades

Point of care isn’t the only level benefitting from EHRs. The back office also is seeing operational improvements and efficiencies.

McQueen says that funders were a big part of the EHR implementation process at Great Circle, adding to the discussion what they required from a documentation and service standpoint. The finance and accounting department chimed in with what rates needed to be populated in the new system. All that data was collected to arm the EHR with all the forms necessary to link to the billing matrix for a more effective billing system.

He says that the organization primarily bills by two methods. The first method is via commercial insurance through electronic claims. With the old software, the only way to achieve this type of billing was through a clearinghouse system. Now, the EHR can accurately represent services and rates that were contracted with payers to allow for electronic billing.

“By using one system and accepting electronic remittance, you cut out a lot of the manual work,” McQueen says. “It allows us to expand our scope and satisfy commercial insurance requirements.”

The second method of billing is for grants and fee-for-service business. Although Great Circle’s previous system was adept at handling these e-claims, the new EHR has added some efficiency by allowing the ability to develop custom invoices and apply back to patient balances.

“It’s also cut down a lot of the manual work,” McQueen says. “When you are a not-for-profit, having the ability to produce e-claims and bill multiple times in a month can aid in cash flow.”

Areas of improvement

While there are definite advantages to using enterprise EHR systems, sources say that there are also areas left for improvement. For example, in healthcare, each medical specialty has its own nuances.

MacMaster, who has treated substance use disorders for 25 years, says there are few EHRs designed with the addiction industry in mind.

“That’s changed somewhat, but as the industry grows and the technology comes alongside that, I think that [change] will continue,” he says.

Hassan would like to see EHRs become even more provider-friendly with more effective use of drop-down menus and the ability to create better templates.

“It’s already there, but if we can learn an optimal way to provide interface for providers so it’s easier to use and customize, it could take it to the next level,” he says. “There’s always going to be challenges, so we need a way to reduce and minimize the clunkiness.”

In the future, Hassan would also like to see EHRs taken to another level with the use of voice recognition as an added feature.

For McQueen and his team, improvement is always top of mind.

“There weren’t a lot of big [EHR] players in behavioral health because there wasn’t a lot of money to be made in this smaller market, so that’s why we had to develop our own system,” he says.

Because that has since changed dramatically, McQueen says that before the new EHR even went live, the plan was to turn their eyes back to the market to look for innovation. And Great Circle will be well prepared to understand the advantages and disadvantages of new innovations as they appear in the market.

Alicia Hoisington is a freelance writer based in Ohio.