Jim Dougherty, vice president of Marworth Alcohol & Chemical Dependency Treatment Center in Waverly, Pa., remembers the mountains of paper his organization used to deal with.
“When you are admitting 1,400 to 1,500 people a year to your residential facility, and 500 a year in an outpatient program, storage of paper can be a significant challenge,” Dougherty says. “We had rooms dedicated to storing paper records and started to think about renting a storage facility that offered climate and humidity control so the records could remain intact.”
Instead, Marworth invested in an electronic health record system in 2005 and scanned all those documents into electronic format—a formidable task. But now rooms previously used for storage of paper records are used for productive work.
“There is no looking back as far as being more efficient,” says Dougherty.
It’s clear that many behavioral health organizations lag behind other providers in adopting new technology, in part because they don’t qualify for the federal meaningful use incentive program to subsidize purchases of electronic health record (EHR), and their opportunity for the Medicaid EHR incentive is limited. A 2012 survey sponsored by the National Council for Behavioral Health found only 2 percent of community mental health and addictions treatment organizations said they were ready to meet meaningful use requirements.
However, the same study found that behavioral health organizations want to facilitate communication with other healthcare organizations, even if they’re not equipped to do it yet.
Despite the financial and organizational challenges, behavioral providers are zeroing in on ways to eliminate inefficient paper processes from their work flow. For those not in a position to purchase a full-blown EHR just yet, there are plenty of other opportunities to break up with paper in the meantime.
1 Historical Clinical Data
As Dougherty says, scanning years worth of paper documents into their new system was a challenge.
“You start to ask yourself if it is really worth it because you are devoting so many resources to cleaning up the documents,” he says.
But there are benefits beyond just eliminating storage headaches. In the era of paper records, he recalls, there was a lot of shuffling of each patient’s paper record between nursing, counseling and medical staff, and an individual record was not always at the fingertips of the person who needed it at any given time.
“It was an ongoing struggle that impacted patient care,” he says. “There was a lot of inefficiency that impacted what we did and how we did it, and now that’s gone. Multiple appropriate people can be in the record at the same time to review treatment plans and progress notes. It improves the work environment.”
2 Electronic Billing
Mark Thurman, CEO of Families Inc. Counseling Services, a group counseling practice with 10 offices in Arkansas, remembers when direct service members were responsible for creating paper billing statements.
The process was inefficient and ineffective, not to mention it caused time lapses in completing billing cycles, he says. Since switching to an electronic health record system, the organization eliminated a step in the process. When the provider writes a clinical progress note, the system automatically creates an item in the billing system.
“It made us more efficient in getting our revenue stream coming in,” Thurman says.
In addition, the claims are cleaner when they go out the door to the payer thanks to the parameters set up within the billing matrix of the IT system, adds Bob Puckett, director of business operations.
“If we identify a common rejection reason, we are able to remedy the error across all 10 locations,” Puckett says.
According to Dougherty, transitioning to completely electronic billing also depends on the organizations you do business with. Some still have paper-based documents.
“I wish I could say 100 percent of our contracts with insurance and managed care companies are electronic, but they are not yet,” he says.
In a paper world, it can be a challenge to keep track of compliance and training requirements for a large staff. Automated systems can help keep track of things such as when treatment plan paperwork is due or when notes have to be signed. Pat Tyler, director of youth and family services for the Bridge Family Center in West Hartford, Conn., says her organization went completely electronic two years ago. The system it uses allows her to set up
reminders so that when a treatment plan is expected, the therapist will get a proactive alert.
“We can set it for two weeks before the treatment plan is due to make sure they have time to meet that deadline, which is useful,” she says.
The system can also run reports and create lists of clients missing progress notes or clients not seen in 30 days. That system helps both with internal auditing and when the center is relicensed by the state every two years.
Also on the compliance front, Dougherty says having electronic records has eased the review processes during Pennsylvania Department of Health licensing and Joint Commission accreditation visits.
“We spend a half hour orienting them to the EHR and then they are ready to go off on their own reviewing records,” he says. “They can function independently, and they tell us it makes their lives easier.”