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Pinpointing a solution

January 1, 2008
by Douglas J. Edwards, Editor-in-Chief
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Georgia agencies form the Peachstate Information Network to achieve common IT goals

Left to right: frank fields, ceo of river edge behavioral health center and pin board member; shannon harvey, pin project manager; tod citron, ceo of cobb/douglas counties community services boards and pin chairman; victor bowers, cfo of avita community partners

Left to right: Frank Fields, CEO of River Edge Behavioral Health Center and PIN Board Member; Shannon Harvey, PIN Project Manager; Tod Citron, CEO of Cobb/Douglas Counties Community Services Boards and PIN Chairman; Victor Bowers, CFO of Avita Community Partners. Tom Mileshko Photography

In 2001, the Cobb and Douglas Counties Community Services Boards in Georgia built an electronic health record (EHR) system. Tod Citron, the agency's CEO, admits that at first the endeavor was exciting and produced real benefits. For example, the agency has been paperless for seven years. But when the in-house system programmers left to start their own software business, Citron found himself in the “unenviable position of not only being a human services provider, but also being in the software support business de facto.”

While the clinical components of the EHR system worked very well, others, such as the billing and authorization modules, did not. “We ended up building all these work-arounds, and my agency was literally billing out of four different electronic systems,” Citron says. “We should have been billing out of one system.”

Citron's initial experience with EHRs was harrowing at times, but it did lead to bigger and better things. At the annual conference of Georgia community services boards about three years ago, Citron shared his experience with the leaders of the River Edge Behavioral Health Center and Georgia Mountains Community Services (now known as Avita Community Partners). “Each of us was in some different place in regard to an electronic health record pursuit,” recalls Citron. By that time Citron was determined to move away from the internally built system and was seeking an off-the-shelf solution instead. He notes, “We were busy enough serving the 14,000 people who walk through the doors on an annual basis. Trying to support software as another part of our core business with limited dollars was just too much.”

While Citron's agency struggled with its EHR system, River Edge and Georgia Mountains each were shopping around for an EHR product, as they had only billing and registration software. The agencies’ executives recognized the cost savings and increased efficiencies they could realize by jointly selecting an EHR product, and eventually they joined together to form the Peachstate Information Network, Inc. (PIN).

Collaboration wasn't new to the three agencies, as they had pulled their collective weight before. “PIN essentially was born out of previous positive collaborative experience among the partners,” explains PIN Project Manager Shannon Harvey, LCSW. “In the past, we had come together around managed care contract language negotiations and secured bigger wins with a larger footprint.” The agencies’ “footprint” in Georgia is indeed large: Together they annually serve 30,000 Georgians with behavioral health disorders and/or developmental disabilities in 23 counties in the state's mountainous northeast, metro Atlanta, and rural/suburban central regions (their service areas are not contiguous).

It's certainly no walk in the park for one behavioral healthcare organization to choose an EHR system, so imagine trying to coordinate the requirements of three agencies—with more than 1,000 anticipated IT system users. PIN knew it couldn't do it alone. With consultation from IBM Healthlink, Harvey formed cross-agency, cross-functional groups to map out business work flows and compare them to national best practices. The agencies learned much from each other, discovering that 90% or more of their business operations are the same. To guide the groups’ work, the agencies’ CEOs identified nine directives (table) to help keep the groups on track. “Whenever a group started to chase rabbits, we came back to the key directives,” notes Harvey. As a result of the group decision-making process, the agencies decided to focus their software selection criteria on core scheduling and registration, clinical, and billing functions.

Table. Directives of the PIN member agencies’ CEOs

  1. Everyone will use electronic scheduling.

  2. Payer source drives authorizations and scheduling, except for life-threatening crises.

  3. Move as many nonbillable (nonrevenue generating) data-gathering processes as possible off staff who can bill (generate revenue).

  4. Do no more by phone than is required, if the activity is billable face-to-face.

  5. Automate everything that will maximize efficiency.

  6. Maximize revenue (and cash flow).

  7. CEOs will fully support moving electronic with all staff and contractors.

  8. Collect no more data than absolutely required to meet contract requirements, deliver good care, and support strategic planning.

  9. We will have one, uniform medical record and general ledger numbering structure across all PIN agencies.