1 Developing and Implementing Electronic Health Records for Behavioral Health Services Strategic Planning for Providers to Improve Business Practices October 21-23, 2009 Dave Wanser, Ph.D. Executive Director National Data Infrastructure Improvement Consortium

2 Assumptions  States and Counties are updating data systems to improve compliance with reporting requirements and mandates for electronic health records  States and Counties will increasingly need timely access to linked performance and financial information for management and accountability purposes  These expectations will extend to providers  Governmental entities will become the leaders in making universal deployment of EHRs a reality

3 How do Shareable EHR Systems Assist States and Counties?  Quality/standardized record keeping;  High levels of data quality due to business rules and edits  Mechanisms to facilitate service networks;  Ability to monitor compliance and performance;  A way to combine, clinical, research, and financial data; and  State and Federal reporting. Quality data on a timely basis

4 How do Shareable EHRs Help Providers?  Standardizes clinical records  Improves proper evaluation and placement of clients  Tracks services provided  Determines client progress during treatment  Submits claims to the State or County  Immediate access client records  Fulfills State and Federal reporting requirements with high quality data Quality client care

5 Reality Check  There will be universal adoption of EHRS in all aspects of healthcare  Substance abuse prevention and treatment is healthcare  Patient clinical information will need to be transferable, and data systems will need to be interoperable across providers and settings  Health Information Exchanges will be important gateways for sharing clinical information

66 What is an EBHR?  It’s a complete, or nearly complete clinical record.  It is relational – the various parts of the record are integrated and interactive with the rest of the record  It is real time  It allows immediate access to quality measurement and performance accountability

77 States Approaches to EBHRS  States that have implemented statewide EBHRS  States that are planning to within the next year  States with a high level plan without a firm date  States taking a hands-off approach  States not ready to think about it.

88 Success Factors for States that Have Implemented EBHRS  Executive engagement throughout the entire process  Dedicated IT resources  Clear vision and guiding principles  Cross-functional workgroup with facilitation  Oversight team meets weekly  Holding to agreed upon timelines  Modest beginning with build out  Multifaceted training and support functions

99 Myths About EBHR Implementations:  There is an off the shelf solution  This is a technology project  Our needs are unique  EBHRS are just like paper records – only on a computer  It’s best to plan the entire system out and implement all at once  It solves all our problems (it only solves some problems)  It can be done in a few months  It will take years (although it could happen if success factors are ignored)

10 Principles for Successful Selection, Procurement and Implementation  Perfect is the enemy of good  One of the most significant challenges of EBHR deployment is clinical process transformation  Leadership must be engaged and support needed organizational and process change  Workgroups require multidisciplinary engagement  There are significant tradeoffs for variation  Workflow changes are enormous and no consultant or vendor can help in this area  Oversight or “management team” is essential to manage change control  Not a technology project… Yet the solution must still fit within the State’s technical infrastructure.

11 Currently Available Administrative Features in Many State Implemented EBHRS  HIPAA Compliant  Billing Based on Services Provided  Financial and Clinical Eligibility  Capacity Management  Provider Level Security Administration  Outcome Measures  Federal Reporting Mechanism  Desk Audits without Travel  Extensive Data Analysis for Outcomes, Trends, etc.  Decision Support – in it’s infancy

12 Features of Current State & County Hosted EBHR Systems  Adult and Children’s Screening and Assessment  “Smart” Treatment Plan and Review  Admission, Discharge, and Follow-up  Progress Notes and Client Progress  Billing  Case Management and Automated Messaging  Wait List and Capacity Management  Drug Court interface  Web-based user training  Co-Occurring State Incentive Grant, ATR Voucher System, and SBIRT documentation  Prevention Services  Automated Referral and Release of Confidential Information  Mental Health and psychiatric emergency services  Reports and Downloads, including automatically generated provider specific reports

13 How is ARRA Meaningful Use Relevant to Behavioral Health?  A major focus of meaningful use is the use of quality data to improve care  Improving the quality of care will be dependent on the availability of structured data  Developing, sharing and continually improving a common EBHR reference model will provide substantial opportunities to move behavioral health treatment from personal opinion and tradition to data based decision support

14 Take Aways  Does your organization have a data strategic plan?  Does your organization have a means to use timely data to improve clinical practice?  Is your state leadership at the table in discussions about HIT and HIE?  Have you sought assistance in planning?  This is a pass-fail quiz. Passing score is answering yes to all 4 questions.