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Solutions from out of the blue

July 20, 2011
by Dennis Grantham, Editor-in-Chief
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Some providers shift to cloud-based EHRs and leave implementation, support problems behind

Five years ago, a team from Lifeways Mental Health Services (Ontario, Ore.) decided to implement a more comprehensive electronic health record (EHR) system. They selected an enterprise solution-one that would run on Lifeways' internal servers and network. They knew that implementing an out-of-the-box EHR would require a lot of IT staff time, but felt the investment was worth it.

“We bought the system. The vendor told us the FTE time they thought it would take. But, despite our best efforts, we just could never dedicate that level of resources to the job. We were never able to realize its full potential,” says Steve Jensen, Lifeways CFO, who led the implementation process. The system was used to schedule appointments and process claims, but did not track clinical information as a true EMR. Reports were difficult to produce. Electronic remittances (837s) required extensive staff time, yet were set up for only a few payers.

InterCommunity finds path to meaningful use in “the cloud”

InterCommunity, a community behavioral health center in East Hartford, Conn, faced a thorny transitional problem. Its 1990s-era practice management, scheduling, and documentation system had been replaced with a new, client-server based EHR solution around 2006. But the transition just wasn't working as hoped, despite the agency's tireless efforts to “finish” the system.

“It was a daily struggle,” recalls InterCommunity CEO Kim Beauregard, LCSW. After three years of effort with the new system, staff and providers were unhappy, because the new system proved cumbersome and difficult to use.

And, the agency had begun to suffer financially. “We couldn't properly track what we were doing, and therefore, we couldn't bill it. We pulled reports, but we couldn't trust what was in them. We put together claims, but couldn't audit them before they went out.”

So, in 2009, Beauregard and her team decided to move on to a new EHR system-one that would eliminate as many in-house staffing, maintenance, and upgrade headaches as possible. Beauregard says they were well prepared: “We had already built the culture of working with an EHR. We knew how to do concurrent documentation live with clients. We had the key pieces in place.”

After a fast-paced search process, the team chose Qualifacts' CareLogic in 2010. CareLogic is a web-based or “cloud” EHR platform that offered a lot of structure, but could be configured to meet the agency's requirements.

The new system proved a great fit and was implemented in four or five months, says Beauregard. Now, after about a year of experience, she says that InterCommunity is “just about there with Meaningful Use.”

Because the CareLogic software is now ONC-CHPL Certified, and is therefore a considered a “qualifying” EHR, the agency's eight eligible providers have only to demonstrate their ability to meet Stage 1 meaningful use requirements. “Just a couple more things and we'll sign the paperwork [for incentives],” she says.

While InterCommunity's road to a successful EHR implementation posed many challenges, Beauregard believes that the agency's results now speak for themselves. “We're a $6.5 million agency-just 75 people-and we've been able to do all of this.”

In early 2009, Lifeways CEO Greg Schneider set out a vision for a complete EHR system, one that would include clinical documentation. He asked Jensen and his team to “consider all the options” for making that vision a reality. So Jensen, together with clinical operations manager Scott Tiffany, system analyst Debbie Petty, and administrator Ray Millar did just that. They evaluated the existing EHR and determined the costs of upgrades needed to meet organizational requirements. Then, they considered the costs and capabilities of other EHR system solutions.

“We looked at all of it,” says Jensen. After considering the total costs of completing and operating the existing EHR system-including servers, staff, and maintenance-the team found that “we could probably move to an entirely new system at a lower cost.” At that point, they began considering the prospective system's architecture: should they go with another in-house, client-server product or a different approach-a “cloud” solution?

Four big concerns

The team sought advice, starting with other Oregon-based providers, who shared a mixed bag of experiences. Jensen said that the team quickly identified that “we had a cost concern, a workforce concern, a viability concern, and an interoperability concern.” On confirming that Lifeways would have just one IT support position going forward, Jensen knew that he had to look for a cloud solution.

But he wasn't enthusiastic. “I dragged my feet on this for months,” he says, worried about the “viability” of an EHR that wasn't onsite. “We asked around: ‘what are the problems that we'll face with security, accessibility, reliability,’” he recalls. “Then, I found that from here in Eastern Oregon, our signals might bounce from San Francisco, to Seattle, to Denver before going back east to the system server. That's a long way.” It took a lot of conversations before Jensen “got comfortable” with the idea.

The “show me” test

Next, the team looked at the field of contenders. “That's when the fun really began,” says Jensen. “Our standard was the ‘show me’ test. We'd ask about a feature and see if the vendor could do it, or if it was ‘in development.’