New billing processes, reporting requirements, and accreditation standards present behavioral healthcare leaders with multiple data management challenges as they juggle competing priorities. This article presents some key issues facing organizations as they begin using electronic data more and more, as well as key characteristics of those that successfully manage electronic data.
Specific electronic data management challenges can be state- or region-specific. For example, Oklahoma and Ohio each have statewide electronic systems through which all persons served in the public behavioral healthcare system must be registered. In Ohio data from client and staff outcomes surveys must be sent electronically to regional boards and then to the state.
Such new data processes and requirements add to existing requirements related to clinical, medical necessity, and risk management documentation. In some organizations, the implementation of new data-reporting systems may occur separately from the development of clinical systems. In other words, clinicians and their charts might exist in one reality, while the organization's electronic data exist in another, so each system evolves separately.
Behavioral healthcare organizations should take a step back and consider the ways that developing these systems concurrently can enhance the entire agency and its daily clinical processes. Although some are implementing a full electronic medical record, most find themselves in a limbo—trying to bridge the gaps between their existing paper records and evolving sets of electronic data.
For many organizations, the traditional paper clinical record stands as a consistent, ongoing tool. Clinicians turn to the paper record to obtain accurate information about the people they serve. Many external audits focus on the paper record, so internal reviews follow suit.
Thus, gathering, reporting, and analyzing electronic data tend to be reinforced inconsistently. Electronic billing data are exceptions, as billing data obviously tend to receive a lot of attention. Yet all electronic data must be consistently reviewed internally and externally to monitor and reinforce core data processes.
Gary Cuddeback, PhD, MSW, MPH, of the University of North Carolina at Chapel Hill's Cecil G. Sheps Center for Health Services Research, helps organizations implement grant-funded initiatives, and funding entities call upon him to conduct evaluations during and after projects. He notes that for many organizations gathering, reporting, and analyzing data for specific projects begins and ends with the project's funding, even if the data might be helpful in measuring client outcomes and guiding performance improvement.
“Data management becomes a stop-and-go, externally driven process,” he explains, “which is much less likely to be perceived as useful or helpful by the frontline clinicians who are asked to gather the data in the first place.”
Proactive data management
The table summarizes the characteristics of organizations that face substantial data management challenges versus those that are more successful. An organization might consider several steps for proactive, rather than reactive, data management.
Ask your organization's leaders how they approach data and their management. Are they convinced “external data requirements will go away, just like others that have come and gone,” or are they energetic and passionate about data as an emerging tool? If the former, show them the importance of approaching data management proactively.
Understand your data system(s) and the flow of a data element from when it's gathered to how it's reported. Don't be afraid to ask basic questions, as sometimes the most straightforward processes are not as simple as they seem. This exercise will help you identify areas where your organization can improve its electronic data management.
Examine how colleagues in your region or state are handling these transitions. Contact someone who seems to be doing it well, and ask if you can come and see how he does it.
Ask clinicians what they would like to see from the data. Find out what data your organization collects, and ask clinicians to meet with you to identify data that would be helpful to them. If clinicians know the data can help rather than haunt them, they will be more motivated to accurately collect information at the outset.
Ask the people you serve and community stakeholders what data would be meaningful for them. Also ask how they would like to see this information, such as in newsletters or reports or on Web sites.
Before gathering and tracking new data elements, consider whether they are mandated, measurable, marketable, and/or meaningful. To warrant the effort required to gather, enter, monitor, and report any data element, it should meet most—if not all—of these criteria.
Objectively examine the data-tracking requirements impacting behavioral healthcare organizations, and use required data to improve clinical processes. Leadership and persistence are the first steps in making this happen.
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