1. Hurdles in Adopting and Implementing Integrated EHR in Community-based Addiction Treatment Clinics Ron Jackson, M.S.W. Evergreen Treatment Services Seattle, WA

2. Agency Description Private non-profit, founded 1973 $7.7 M annual budget; staff of 110 Clinical programs Opioid Treatment Programs (OTPS) 1400 patients at three fixed sites (two in Seattle & one in Olympia) a mobile medication unit and a primary care-based program (both in Seattle) Intensive Case Management (REACH) homeless, chronic public inebriates Research projects

3. Why are we doing this? Why are we doing this? Better able to track staff productivity on contract and regulatory deliverables Easier access by staff to patient information Clinic performance evaluations made easier Interoperability with other EHR systems, research and clinical

4. Vital Considerations If you are not moving towards EHR you will be in a competitive disadvantage Do your homework; vendors must add value Realize once you take the steps towards an EHR you must challenge the way you conduct your business

5. A Paperless Approach Gather Patient Information Electronic forms Electronic & Digital signatures Organize Treatment plans and progress notes Manage doctor orders & medical notes Interface with toxicology labs Maintain medication inventories Bill 3 rd party payers' and manage co-pays

6. Adoption Process Adoption Process “What are we going to do and how are we going to do it?” What are we going to do? Limited EHR, e.g., medication dispensing? Complete EHR? If complete are we going to try to enter all existing patient data or some subset? How are we going to do it? Vendor selection Which staff are involved? Budgeting for the expense Software Hardware IT staff at agency Incremental versus total immersion from Day 1

7. Adoption Process Vendor selection What are the key elements? Specificity to agency’s services’ delivery Software’s history and acceptability to accreditation, regulatory and funding agencies Training and on-going customer support References from current customers Durability of software Customer support Staff and patient acceptance  Price, while important, is less so than the above

8. Implementation Process Before going “live” Selecting a core team and “champions” Examining the differences between EHR software and agency forms and processes What to change and what to keep Iterative process between agency and vendor Staff training By vendor By champions Patient notification and support

9. Implementation Process After going “live” Incremental versus total immersion If incremental, choosing order of element implementation Continuing the iterative process between agency and vendor on differences between EHR software and agency forms and processes – problem solving What to change and what to keep Monitoring performance Monitoring staff needs and morale “It’s all about relationships”

10. Other EHR Concerns Management reports How to integrate into agency supervisory and administrative processes Data extraction for use in other databases Interoperability with other EHRs? Effect on patient outcomes?