Jim Dougherty, vice president of Marworth Alcohol & Chemical Dependency Treatment Center in Waverly, Pa., remembers the mountains of paper his organization used to deal with.
“When you are admitting 1,400 to 1,500 people a year to your residential facility, and 500 a year in an outpatient program, storage of paper can be a significant challenge,” Dougherty says. “We had rooms dedicated to storing paper records and started to think about renting a storage facility that offered climate and humidity control so the records could remain intact.”
Instead, Marworth invested in an electronic health record system in 2005 and scanned all those documents into electronic format—a formidable task. But now rooms previously used for storage of paper records are used for productive work.
“There is no looking back as far as being more efficient,” says Dougherty.
It’s clear that many behavioral health organizations lag behind other providers in adopting new technology, in part because they don’t qualify for the federal meaningful use incentive program to subsidize purchases of electronic health record (EHR), and their opportunity for the Medicaid EHR incentive is limited. A 2012 survey sponsored by the National Council for Behavioral Health found only 2 percent of community mental health and addictions treatment organizations said they were ready to meet meaningful use requirements.
However, the same study found that behavioral health organizations want to facilitate communication with other healthcare organizations, even if they’re not equipped to do it yet.
Despite the financial and organizational challenges, behavioral providers are zeroing in on ways to eliminate inefficient paper processes from their work flow. For those not in a position to purchase a full-blown EHR just yet, there are plenty of other opportunities to break up with paper in the meantime.
1 Historical Clinical Data
As Dougherty says, scanning years worth of paper documents into their new system was a challenge.
“You start to ask yourself if it is really worth it because you are devoting so many resources to cleaning up the documents,” he says.
But there are benefits beyond just eliminating storage headaches. In the era of paper records, he recalls, there was a lot of shuffling of each patient’s paper record between nursing, counseling and medical staff, and an individual record was not always at the fingertips of the person who needed it at any given time.
“It was an ongoing struggle that impacted patient care,” he says. “There was a lot of inefficiency that impacted what we did and how we did it, and now that’s gone. Multiple appropriate people can be in the record at the same time to review treatment plans and progress notes. It improves the work environment.”
2 Electronic Billing
Mark Thurman, CEO of Families Inc. Counseling Services, a group counseling practice with 10 offices in Arkansas, remembers when direct service members were responsible for creating paper billing statements.
The process was inefficient and ineffective, not to mention it caused time lapses in completing billing cycles, he says. Since switching to an electronic health record system, the organization eliminated a step in the process. When the provider writes a clinical progress note, the system automatically creates an item in the billing system.
“It made us more efficient in getting our revenue stream coming in,” Thurman says.
In addition, the claims are cleaner when they go out the door to the payer thanks to the parameters set up within the billing matrix of the IT system, adds Bob Puckett, director of business operations.
“If we identify a common rejection reason, we are able to remedy the error across all 10 locations,” Puckett says.
According to Dougherty, transitioning to completely electronic billing also depends on the organizations you do business with. Some still have paper-based documents.
“I wish I could say 100 percent of our contracts with insurance and managed care companies are electronic, but they are not yet,” he says.
In a paper world, it can be a challenge to keep track of compliance and training requirements for a large staff. Automated systems can help keep track of things such as when treatment plan paperwork is due or when notes have to be signed. Pat Tyler, director of youth and family services for the Bridge Family Center in West Hartford, Conn., says her organization went completely electronic two years ago. The system it uses allows her to set up
reminders so that when a treatment plan is expected, the therapist will get a proactive alert.
“We can set it for two weeks before the treatment plan is due to make sure they have time to meet that deadline, which is useful,” she says.
The system can also run reports and create lists of clients missing progress notes or clients not seen in 30 days. That system helps both with internal auditing and when the center is relicensed by the state every two years.
Also on the compliance front, Dougherty says having electronic records has eased the review processes during Pennsylvania Department of Health licensing and Joint Commission accreditation visits.
“We spend a half hour orienting them to the EHR and then they are ready to go off on their own reviewing records,” he says. “They can function independently, and they tell us it makes their lives easier.”
Some clinics that work on becoming 100 percent electronic eventually face one stumbling block: capturing client signatures. Bridge has starting using a feature in that allows clients to sign their treatment plans electronically using a module and a signature tablet.
“They review the plan, then sign on the pad, and it’s saved,” Tyler says.
5 Online Scheduling
Before they moved to an EHR, Families Inc. had an electronic scheduling system—an older IBM AS/400-based platform. However, only clerical staff had access to it. Clinical staff could not remind their clients when their next appointment with the psychiatrist was scheduled unless they called the clinic to ask support staff, explains Puckett. The new system gives clinical staff members 24/7 access to their clients’ appointment schedules. They are able to remind the client or the family of an appointment date—even when the clinician is at the client’s home using a smartphone, laptop or tablet.
Tyler says Bridge therapists use their scheduling software every day. They click on a client’s name in the scheduler and enter a progress note through the interface. She says the scheduler also helps staff track each other down as an added benefit.
If you have a question for somebody, you can look at the schedule and see they will be in at 11 a.m.,” she says. “We know where they are and who their client is at all times.”
6 Human Resources and Internal Communications
For Families Inc., going electronic extended to the documentation in its own human resources department. It can scan paper documentation such as licensure, job description and CPR card, and attach it to each staff record.
“We not only have become paperless on the clinical side of the business but also on the human resources side of the business,” Puckett says. “We no longer have cabinets full of paper personnel records.”
Staff forms in the IT system include performance evaluations, required training modules, orientation feedback forms, safety reports, 90-day new staff surveys and exit interviews. Additionally, the company calendar, policy manuals, newsletter and important announcements are all communicated through the electronic platform instead of using paper, he says.
7 Performance Monitoring & Dashboards
Once the agency’s data was in digital format, Families Inc.’s Thurman took advantage of the software’s reporting capabilities to get a better handle on the operations of the organization’s 10 clinics.
“I can have any type of report built, and it can be refreshed every 15 minutes. I can click a button and see billing for the week, compliance, treatment plans, primary care referrals and schedules, and see trends over time in a dashboard,” he says. “I can choose which reports I want to see on a monthly or daily basis. I can monitor clinic by clinic on compliance issues on a day-to-day basis.”
He adds that the data transparency increases accountability because every professional in the company knows results can be tracked. Measuring drives up performance and fosters better service to clients.
“There’s no guesswork,” he says. “We are all looking at the same thing.”
Experts agree that the transition from paper to digital can be difficult. Marworth’s Dougherty says he gets calls all the time from peers in the industry, asking for advice on moving away from paper. “I tell them to make sure they are committed to the process, starting from the top of the organization, because it is a cultural shift to go from paper to electronic,” he says.David Raths is a Pennsylvania-based freelance writer.