Very Human Difficulties in Electronic Health Record (EHR)Technology
We just don't communicate any more!
Mental Health and Addiction Treatment continue to lag behind physical health providers in the race to implement the Electronic Health Record (EHR), and after all these years of helping folks select, implement and optimize the EHR, I see some of the same problems come up as in the early days. Because mental health and addictions treatment are such different lines of business than software manufacture, professionals in these industries still have trouble communicating with one another. To be successful with the EHR these folks need to agree on every form, every data element, and every process as these elements relate to the software. It's a big job, and frankly the reason IT consultants like me get calls to help agencies with their EHR woes.
I'm helping an agency in New York City that serves victims of crime with implementation of their EHR. They do a great job in this hyper-vertical line of treatment. They are smart people who keep up with treatment methods that are proven effective. The EHR will help them in three very important ways:
Intake: First contact with a consumer is critical; victims of various forms of abuse including verbal, physical and rape need the professional to listen, and professionals at this organization are very good at listening and still gathering all the information to validate the consumer has come to the right place for help, to record all clinical information needed to advance the consumer through the intake process and to confirm that the agency will be paid for the services rendered…The challenge comes in maintaining the very human, responsive relationship with the consumer while hunting around in the EHR to record information in the right place.
The solution is assuring solid design of the data entry process that encourages a communication between the professional and the software while the professional's mind is engaged and focused on the consumer's needs. A key to success in designing this process is communications - "No" seems to be a watchword among software vendor implementers; the project manager (whether an employee or consultant like myself) turns the "No" into a "Yes" by virtue of knowing the specific business processes and personalities in the agency and how to manipulate software to meet agency, local, state and federal requirements.
Scheduling: Once the Intake professional and the consumer have made it through the initial phone call, the second stage is to see the consumer within a few days…as pain fades, the importance of the problem can seem to fade, too, so the rule of thumb is to make an appointment within 72 hours of first contact to increase the likelihood of the consumer getting treatment.
The challenge met by the EHR appointment scheduling modules is to bring treatment to consumers when the abuse is fresh in the mind and willingness to recover is at its peak. It's almost a software miracle to keep up with multiple professionals' schedules as appointments are constantly made and cancelled; since information flows at the speed of light within the EHR, everybody knows what everybody else is doing and a central scheduler can make sure staff is kept busy, consumers are not kept waiting, and assure documentation is up to date…and as long as the software is decent, reminder messages can be sent to professionals to make sure their session documentation is up to date.
Treatment Documentation: When an agency is audited, staff can make friends with auditors by having an EHR. When Intake is directly connected to scheduling, Assessments, Treatment Plans, Progress Notes and billing, it's an example of open communication at work; all professionals at an agency who serve a single consumer have the right information at their fingertips to help.
Completing assessments on the computer with the consumer is an easy form of communication; most people have filled out a form on the computer with somebody sometime. Treatment Plans can be more of a challenge. The professional is coming to an agreement with the consumer about a mutually acceptable course of treatment, so it's akin to the contracting process. Professional clarity and consumer transparency can be keys to writing a treatment plan that is destined to succeed, providing outcomes that both professional and consumer desire - what better way to assure this positive outcome than to write the plan together?
Progress Notes are tougher to write with a consumer during treatment because most professionals think that to write the note they would need to have their heads buried in the computer screen as opposed to making eye-to-eye contact with the consumer. That would be pretty lousy communication, so a good project manager will recommend an alternative method of collaborative documentation. When the consumer comes into the room, have the subject for today's session already written down in a note…that way the draft document is already started and if another topic erupts, so be it, you can record that early in the session. Address a few radio-button style questions like satisfying risk management requirements and current mental status then take hands off the keyboard and pay attention to the consumer with some eye-to-eye contact. Close the session with typing a recap into the note. The professional may need to clean up the note later, but so what?
If they need anything, EHR manufacturers and agencies need help communicating, and a good project manager, whether a dedicated internal employee or a consultant, gets the right information from the professionals to the EHR manufacturer in order to make a successful team effort of configuring and designing different agencies' forms. They use the software and have valuable keys to configure it to meet the actual flow of a session serving the consumer.