In 2001, Heritage Behavioral Health in Decatur, Illinois, won a prestigious Davies Award for the development of a computerized medical record that significantly improved its client operational services, especially in the areas of documentation and support information. Heritage was the first behavioral health organization to win a Davies Award. Behavioral Healthcare recently interviewed several Heritage officials (see sidebar) to find out what they’re up to six years later. What we learned is that the agency still views its IT operations as a work in progress, and continues to implement new methods to run more efficiently.
Today, upgraded software is helping Heritage automate and streamline vital functions, including client registration, scheduling, assessment, treatment planning, service documentation, medication information management, billing, and statistical reporting. Heritage's electronic client record (ECR) includes four software components: Clinician's Desktop (by Echo Group), Revenue Manager (Echo Group), InfoScriber (Netsmart Technologies), and Crystal Reports (Business Objects).
In the past six years, what have you learned about the ECR?
Heritage:What we’ve learned is that implementation is an ongoing process. Implementation doesn’t end with the first iteration, but continues and continues and continues. The more we have in the system, the more we want from the system.
As part of this continuous implementation and improvement process, how have your IT operations saved money for your agency?
Heritage:We’re not sure that really happens. What we do know is that our IT improvements have produced many benefits. Before implementing the ECR, it took us about 30 days to document and submit a bill. Now it takes us about a week. Most importantly, it's just a lot easier for staff to know what's going on with clients. For example, we’ve got information in our ECR that wasn’t in paper records, such as data that help staff assess whether particular individuals represent a suicide or homicide risk. Staff now can make these assessments even after hours and off-site by using their laptops or home computers and an Internet connection. We customized our clinicians’ software several years ago to include that risk assessment information, and we didn’t have this remote access capability six years ago.
How does remote access to risk assessment data improve an individual's care?
Heritage:Having remote access to the ECR enables providers out in the field or at home to make better judgments about sending a person to the emergency room. Even when not in the office, providers can share information, including the client's current drug regimen, with ER physicians, and thereby improve outcomes.
What other key ECR improvements have you made in the past six years?
Heritage:The area that has changed the most in the past six years in the ECR relates to compliance. It's now set up so that billing cannot be electronically completed unless there is an active treatment plan. In other words, we can’t create a charge or bill for a service without an active treatment plan. The software will prompt the clinician to review the treatment plan and make sure that it becomes active. That may mean contacting the client, updating the treatment plan, and obtaining required signatures. So it's a way of making sure that we’re not sending billing without an active treatment plan, which would cause problems with our auditors. We probably prevented about $60,000 of such billing from happening last year.
When you won a Davies Award in 2001, one of your ECR's components was particularly helpful in enabling immediate formulary checking. Any upgrades on that front?
Heritage:In the past two years, we utilized that system for polypharmacy situations, which involve multiple prescriptions in the same class for the same patients. The reports derived from the software now allow us to review that data in our monthly physicians’ meetings. We now can compare the prescribing patterns of our psychiatrists to best practices. The software also automatically sends us medication recall alerts. Finally, through the software, we now use the automated medication administration record (MAR) for all our 24-hour residential programs as well as our medication clinic.
How else has the ECR system been particularly helpful lately?
Heritage:In the past few years, we’ve generated reports that show us if there are any data errors, particularly in regard to financial information on clients. Now we’re able to correct this immediately rather than after there has been an error and rejection of the bill. This is very important because our state funders are performing monthly trend reports on our contracts. If we appear to be underbilling on any given month, they have the power to shift funding to another provider. Our ability to submit accurate demographic and billing data on a timely basis keeps us fiscally sound.
How is the ECR helping with staff productivity?
Heritage:All staff must comply with certain productivity standards, and now they’re able to run a series of productivity reports every day that help determine how many hours of service they’ve actually provided to clients, enabling administrators to get a better handle on caseload efficiency. It allows supervisors to determine high-utilization patterns that may be hindering staff from adhering to treatment plans for certain patients. It also allows us to better review typical caseloads and outliers, and to determine whether certain clients can be transferred to lower-level care providers or have their cases closed.
Has the upgraded software dramatically improved caseload reporting?