We recently surveyed our Behavioral Healthcare readers who use EHRs to capture the essence of their experiences to date. The majority of respondents are satisfied with their systems and seem to be putting them to good use.
“The way things are going, it’s almost going to be impossible to not have an EHR,” says Jennifer D’Angelo, chair of the new HIMSS Long Term Care and Behavioral Health Task Force and vice president of information services for Christian Health Care Center in New Jersey. “From an interoperability standpoint, and from a reimbursement standpoint, it’s being required. All levels of care will need to have an EHR for care coordination among all providers.”
Also encouraging is the fact that a small number—less than 10 percent—report being “very unsatisfied.” Overall, the top survey responses indicate that behavioral health professionals view EHRs as assets that improve patient care, which is clearly the goal.
Getting over hurdles
There are a variety of reasons why some centers have yet to make the leap to electronic records, such as uncertainty about the need for EHRs or a lack of funds to make the investment.
Some early iterations of EHR systems might not be a perfect fit for an organization today, inspiring executives to shop for newer products. According to consultant Eileen Casella Rider, principal of EHR Assist, some dissatisfaction could be related to a system’s lack of meaningful use (MU) features: the capability that providers must demonstrate in order to receive federal incentive money to use toward their EHR costs. Not all providers qualify, and not all systems have met the various stages of MU.
“When we first started using EHRs, we didn’t know what we know now about meaningful use, and many systems didn’t have the capacity to do the meaningful use stuff as easily,” Casella Rider says. “For example, a vendor went through MU1, and that was a low bar to jump. But then MU2 came along, and the bar got a lot higher and much more difficult to jump.”
She says more of today’s EHR products are web-based and able to capture the data an agency would need to attest to meaningful use. The best systems also would have a dashboard that is easy to navigate and a smooth workflow process for the clinicians’ daily activities of pulling up patient records, finding pertinent information in them and charting new visit data quickly. Data analysis would be equally important to get the most out of an EHR.
According to Casella Rider, systems that are built with the input of the clinical staff tend to have better workflows than those built more with a technical perspective. Real world functionality is what’s most valuable—to for-profit and not-for-profit organizations alike.
For example, treatment goals should be included in a patient record and made accessible for clinical staff who work remotely in communities where their clients live. Such treatment plans should be at the fingertips of everyone who interacts with patients.
Across all of healthcare, clinicians are re-engineering their workflows to incorporate the use of EHRs. The electronic records were never intended to be digital versions of paper records, but rather, new tools that improve effectiveness and efficiency. In many cases, clinicians view the EHR as disruptive, at least at first.
Typing keystrokes into an EHR is much different than quickly jotting information on a piece of paper. However, recording data once—even if the initial task takes more time—is far more efficient than writing the same point over and over on multiple pieces of paper, says Stephen A. Wood, HIMSS Fellow and consultant with HealthCare Perspective LLC.
“At the individual level, what that one clinician puts into an EHR might be slightly more time consuming, but once you put that into a system view and look at the overall impact on the practice and impact on the client, that is a small price to pay for the ultimate goal. For example, they might have to take another minute or two to document the record, but the fact they can actually find the client record, rather than tracking down charts or not having charts at all, that is a significant time saver.”
As a best practice, D’Angelo recommends that during the initial roll-out, centers have live support on-site to resolve immediate issues for the new users of the EHR system. For example, Christian Health Care Center had vendor support staff available for four weeks after going live and also trained several in-house employees to be “superusers” who could answer fellow staff members’ questions as they arise.
“It’s difficult for a lot of organizations to have dedicated staff to do that, but in the long run, it really helps,” she says.
Superusers should be available to provide assistance immediately as opposed to the staff having to wait for a return phone call to resolve issues. Follow-up should include checking back with staff over a period of months to see what’s working and what problems need to be addressed after the initial roll-out.