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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 dwanser@ndiic.org http://www.ndiic.com/
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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
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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
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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
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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
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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
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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.
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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
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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)
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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.
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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
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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
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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
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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.
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