The "As-Is" Electronic Health Record (EHR)
A highly placed woman in a major New York City social services agency impressed me with her wisdom recently. She said that she didn't want to have a committee build an Electronic Health Record (EHR) from scratch, even though that's possible with the software the agency selected. The facilities would use whatever came from the software manufacturer wherever possible. During the purchase process, she had seen that the vendor had fine-tuned solid functionality over the course of many years and the result was a pretty good product even though some of her staff might want it to operate a little differently.
EHR software is generally manufactured with a number of workflows in mind, and some software can be modified to work virtually any way the staff wants to use it. These days the difficulty can be in where to draw the line and accept what the vendor suggests.
In this age of screen and functionality design tools and report writers that moderately tech-savvy professionals can use, this was the voice of experience speaking: too much design slows the EHR implementation process and can detract from consumer service. If treatment professionals on a software implementation team are obsessing about adding data elements, logic and reports to the system, they spend less time focusing on the mission of the facility they work for: serving the consumer.
Here's how report writers and customization tools pay off: A lot of consumers depend on government and charitable funding to get the help they need. Sometimes these funding sources are not used by many professionals or treatment facilities, so software vendors will charge extra to meet reporting needs that facilitate getting paid...everybody needs to buy shoes, and the vendor's development option may be quite expensive. A design tool or report writer in the right hands may be able to produce what's needed at a fraction of the vendor cost in order to assure a consumer's services are paid for.
So, this is the dilemma. Many software products include tools delivered to make at least minor modifications to EHR software's "out of the box functionality". Most treatment organizations keep their professional staff busy helping consumers, so they're not the ones to be using those tools. The simple solution to getting needed functionality on line is to hire an EHR professional, who does this sort of work for a living, cheaper than the vendor. These folks are certainly available, and as long as they have guidance from both the executive and professional levels, they can usually help minimize disruption of services to consumers during and beyond software implementation. It's also in the interest of minimizing disruption and getting the EHR functioning in a reasonable amount of time that an agency should consider using as much "out of the box" software functionality as possible. For the minor changes (adding a data field, modifying a screen or writing a report), the design tools and report writers come in mighty handy and avoid future development fees.
When an agency purchases an EHR, it makes sense to assure it comes with a flexible, powerful design tool. Sometimes work flows change, and management seems to forever be asking for more information displayed in a different manner to meet some requirement or another. Two years down the line, new fields or even an entire form may be needed to meet the need for only a few people to do the input, and fewer people to see the reports. The financial reward of the new features or functionality may not justify what a vendor charges; a person on-staff or consultant who knows the built-in design tools can limit the new fields and reports to just the right people if the design tool is good and the EHR security rights comply with current technology standards.
Since mental health and substance abuse treatment professionals should be busy helping consumers, a reliable EHR professional to help with additional functionality needs to be accounted for...both present in the workplace and with a line in the annual budget.
Another great thing about purchasing an EHR right now is taking advantage of groovy technologies like SmartPhone connections, functionality that forces users to meet the rules of HIPAA, HITECH, and other acts or agencies, and patient access to their own medical records over a secure internet connection. Professionals seeking an EHR need to be cognizant that the bulk of the features and functionality they want comes with the system. Development is expensive and generally takes a long time. So, make sure what you want and need is in the contract, and whatever's not in the contract can be built with the design tools that come with the system.
Getting the EHR to fit a specific organization's needs can be an expensive undertaking, and tying together standard elements involved in purchasing and implementation of the software is important down to a very granular level...it's good to know what you're getting yourself into.