By Patrick Gauthier, Senior Consultant, Managed Behavioral Healthcare

The RAND Corporation recently released a report expounding the virtues of electronic health records systems’ positive impact on healthcare costs. This hotly debated topic almost always addresses the cost of medical care, hospitalizations, labs, imaging and surgery and almost never includes the cost of behavioral health. Our field’s rate of technology adoption probably has something to do with that. Notwithstanding what the remainder of the report said about the importance of bundling payment for the treatment of an episode of care (which I am very fond of), I want to address this post to the behavioral health provider pondering the adoption and implementation of health information technology.

It is my deeply held belief that electronic health record systems – particularly those that are CCHIT certified and satisfy HITECH standards for interoperability – will enable behavioral health providers to finally address integration issues, use of evidence-based practices, decision support and the management of chronic illness. Sadly, the field is not known for its leadership in the use of technology. The following sections offer up insights and tips for providers who think they’re ready to take the leap now that so many conditions (such as Parity and Reform) are changing around them:

1. What challenges do behavioral healthcare organizations face when implementing EHR systems?

Firstly, the challenges faced by hospitals and ambulatory settings are quite distinct from one another. However, in general, common challenges include:

a. Lack of effective leadership. This is often compounded by leadership existing in one department without there necessarily being any shared vision across departmental boundaries. Effectively, one or more departments that lack sufficient buy-in can bring a project to its knees

b. Bureaucracy which compels staff, managers, executives and outside consultants to spin their wheels while they wait for sluggish decision-making among people who do not fully understand the impact of their own inefficiencies

c. Communication – failure to effectively communicate and brand projects of this magnitude is highly problematic

d. Unrealistic expectations concerning the calendar time involved. These projects take time. Rushing them leads to problems.

e. Failing to effectively evaluate vendors. All vendors have wonderful bells and whistles and can conduct beautiful demos. They all have wonderful booths and give-away’s at trade shows and conferences. Nothing – however - will ever substitute for due diligence, reference checks and site visits to see end-users and actually implemented systems in operation. Hiring unbiased and vendor-neutral consultants is critical.

f. The business realities associated with partners and stakeholders who may not yet be ready to integrate or participate; state and federal budgets that fluctuate wildly during a recession; and internal demands for cost-effective productivity measures that appear incongruent with the dedication of significant staff time to implementation

g. Cutting corners on professional project management, risk management and independent validation and verification.

h. Competing priorities that draw key staff away from implementation activities

i. Assignment of only managers to the project and not subject matter experts from the line-staff level. Involvement of staff and SMEs is imperative

j. Lack of agreement on standards and definitions to be used. This is exacerbated by confusion and myth in the popular media as well as by the wide assortment of definitions within an organization. Just ask ten people to tell you what they think an EMR is and you’ll understand. Add complexities like Meaningful Use and HIE and the misunderstanding and myth-making grow exponentially.

k. Viewing the project as an IT project. Leadership must understand that implementation of an EMR is a clinical and administrative project that requires support and guidance from IT, rather than an IT project that needs support and guidance from the clinical and administrative staff.

l. From a technical standpoint, the need for interoperability, to interface with other internal and external systems is a real challenge. Taking an inventory and identifying what these systems are can be a difficult endeavor. There are significant challenges associated with identifying what systems in your arsenal are interoperable and which are not. Secondly, if you must shop for new systems and/or integrate the new and old, selecting vendors who meet HITECH and CCHIT criteria and are actually proven effective and interoperable is a significant issue.

2. How best to prepare yourself to implement EHR system?

a. Take the time to include the views and voices of multiple stakeholders without succumbing to “analysis paralysis” or the desire to please and hear everyone.

b. Conduct appropriate strategic planning

c. Formulate an effective communication plan

d. Assign a team of subject matter experts and leaders who are both dedicated and undeterred

e. Develop an understanding of Total Cost of Ownership so you don’t become derailed financially later

f. Document core business and clinical processes so you know what it is you are trying to automate

g. Reengineer those and other processes so you know what you really want to automate. Automating inefficient and poor quality processes is not of value.

h. Develop a solid plan to test systems exhaustively prior to any cutover in systems. Test again!

i. Expect to train staff and physicians and support their needs on an ongoing basis

Patrick Gauthier, Senior Consultant, Managed Behavioral Healthcare, is a subject matter expert in behavioral health information systems and data management, quality improvement, as well as social marketing.

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