Through our work of installing enterprise software in social service agencies, we've noticed that many providers use a myriad of connected (and not so connected!) applications. Client information often “lives” on paper and in e-mail messages, Excel spreadsheets, Access databases, accounting software, and legacy case management systems, just to name a few. Thus, staff members often have to update the same client data in two, three, or more different systems.
For example, we recently moved to our software an agency that had 12 different case management systems (one for each program area). None communicated with one another even though many served the same client population. The agency was maintaining the same core demographic information in multiple systems, so when a client's address changed, data managers changed it in each system that included that client. These types of “silo” systems introduce many problems, such as duplicate data and information falling through the cracks.
We all know of agencies that use many different systems to manage their client information-and perhaps yours is one of them. At first glance, it might seem that agencies should replace all the silo systems with just one single application, but that is not necessarily the solution. There is nothing wrong with using many different applications as long as they support your centralized core system rather than serve as silos for different client groups' information.
For instance, there is absolutely nothing wrong about using Excel as a data-analysis tool linked to your core enterprise application. There is a problem if an application such as Excel becomes the central data repository. In fact, I recently observed two nurses sharing the same Excel spreadsheet back and forth to look up patient data (Not only is this a major HIPAA violation, but Excel was never built to be a multiuser system).
The best health information solutions centralize client records and leverage peripheral systems to do the tasks that they do best. This view is based on our experience and is supported by publications from Microsoft, Oracle, and other industry players. For example, in a white paper from Microsoft, William D. O'Leary and Dave Meyers propose a model that distributes the different functions of an integrated solution across multiple application platforms.1 While you certainly could build your own e-mail client into your EHR, you would do better by just leveraging an existing e-mail application within your system. You could build your own accounting software, but why not take advantage of one that already has proven its worth? In other words, let somebody else do the heavy lifting when possible. Leverage all the applications in a modern, integrated solution. And if a legacy application can't be integrated into the overall system, find one that can.
While I am not attempting to endorse one particular vendor, the reality is that Microsoft has its foot in many camps of relevance to EHRs, including server operating systems, database software, mail servers, productivity software, and integration software, just to name a few. These all can be integrated with EHR vendors' products to create an integrated system. By providing an integrated framework, rather than individual silo applications, vendors accomplish the best of both worlds: an integrated solution from a data perspective, but individual applications each perform the tasks they do best.
Health and human services organizations can have multiple systems for managing client information as long as they are not functioning as individual silos of client data, but rather working collaboratively to augment each application's strengths. The key to facilitating such an information architecture is to embed a person-centric enterprise solution at the system's core. Modern enterprise solutions for behavioral healthcare and other human services agencies incorporate Web services and other open standards to facilitate this arrangement. Such architecture gives you the best of both worlds. You get an integrated solution that allows all of your client data to remain in sync, while still leveraging the strengths of other technologies such as spreadsheet programs, document management applications, financial systems and, yes, even paper, as both “electronic paper” and electronic pens (which work with regular paper) come of age.
Even Brande is the President and CEO of Handel Information Technologies, Inc., the maker of RiteTrack, an enterprise software platform for child, family, and American Indian social services. Handel IT is a member of the Software and Technology Vendors' Association (SATVA).
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- O'Leary WD, Meyers D.U.S. Public Sector Connected Health & Human Services [white paper]. Microsoft; 2008. http://download.microsoft.com/download/2/5/0/250e30bf-0d81-4141-bf8f-4e4ad222fbfd/Microsoft_Connected_HHS_White_Paper.pdf.
Behavioral Healthcare invites information technology vendors, including members of the Software and Technology Vendors' Association (SATVA), to contribute to this department.
Behavioral Healthcare 2009 June;29(6):42