Are you ready for an EHR?

A Few Questions
I'll warn you at this point that if you are looking for a simple answer to the question of EHR readiness, you're not going to find it here. Why not? Well, if you haven't already noticed, I tend to start most of my conversations with a question and that's mainly because I find that although answers are in high demand, their applicability to unique situations (i.e. YOUR situation) is variable at best, and in most cases, not at all. In other words, "If you've seen one EHR project, you've seen one EHR project."

What you will find here are some things to consider, a few reality checks, and a closer look at some of the nuances of EHR's specifically within Behavioral Health Care Organizations (BHCO's).

I haven't really addressed the ONE question YOU should be asking yourself right now, so let me get it out of the way.

Q: "Mr. Dickson, what do you know about this anyway, and what gives you the authority to speak about the subject?"

A: "Please, call me Thad, and take anything and everything you read on this blog with a grain of salt, a pinch of prudence, and a healthy dash of skepticism.

I'm a technology consultant and project management professional (PMP, Dickson, License #281274), working actively on EHR / technology projects with behavioral health care organizations in and around Washington State.

The Project Plan
The first thing to consider regarding an EHR Project is the project plan. I know, it seems obvious, but sometimes the most obvious things are the ones that get missed. Have you developed a plan, and taken measures to ensure that success factors like stakeholder groups, a project charter, the project definition, a purpose and need statement, goals, outcomes, and budgets are in place? How about grant writing plans to support an EHR procurement / implementation process? Do you know what EHR stands for, what it is, how it's different from an EMR or a PHR (see post PHR, EHR, EMR Soup), and specifically what this all means for your organization? Have you allocated / anticipated financial resources not just for the procurement of external systems, but for the development and execution of the project plan? Do you know where your organization is today in terms of computer (hardware, software, network) systems, clinical staff computer literacy (training requirements), and where you would like to go in the future? Have you written this plan down, shared it with stakeholders, communicated it with your board, and incorporated it into your strategic plan?

Motivating Factor
What I find with organizations deciding to embark on an EHR project, is that there is at least one, and usually several motivating factors that precede the decision to start an EHR project. Most CEO's don't sit up in bed suddenly at 3 AM and exclaim out of the blue "Aha! What we need is an EHR!! Let's start tomorrow!" Although, the recently released stimulus bill does suggest that the Obama administration will prioritize Healthcare Information Technology (HIT), which is causing many healthcare CEO's to sit up and pay attention. In the draft plan, $1.5 billion would be allocated for Community Health Centers and health information technology would be given $20 billion to help jumpstart efforts to computerize health records and decrease costs due to medical errors. Read more about the stimulus bill on the Committee on Appropriations website.

[This is a another topic of discussion, and instead of going into it here, I'll suggest you read Dr. Leavitt's op ed on the matter. Dr. Leavitt is chairman of the Certification Commission for Healthcare Information Technology, a nonprofit organization with the mission of accelerating the adoption of robust, interoperable health IT. ]

Another motivating factor may be that your legacy medical billing system broke last week and reminded you, the CEO, that the last remaining person on earth that still knows how to work on that system is out of the country on a skiing vacation, doesn't actually work for the organization, and may not be planning on returning, ever.

Maybe the motivating factor is that your clinicians are complaining of excessive paperwork, long hours, difficulty finding and accessing information, and tired arms from lugging around the stone tablets onto which their client crisis plans are etched.

Yes, I know, you're waiting for the good news, and here it is; You can start somewhere. You can take steps to help your organization become more efficient, improve your clinician's ability to deliver care, and in turn improve the safety and quality of services to your clients. And where do you start? If you guessed "The Project Plan," you are right and you may proceed directly to the list of do's and don'ts.

If you guessed go shopping for EHR's on ebay, bid $895,000 on "Seamless, integrated, easy to install, user friendly, backwards compatible, CCHIT certified, HIPAA compliant X12N 837 transaction friendly EHR system, shipping included, free training" then please re-read section one of this post. Note - CCHIT, HIPAA, and EDI 837 are all relevant guidelines / factors / standards to consider when embarking on an EHR Project, and I don't mean to diminish their importance by virute of mentioning them in the above sentence. My point is that it takes more than just those buzz words for an EHR Project to be successful.

Do's and Don'ts
Where do I start? Here are some basic Do's and Don'ts.

• Do - define the project, parse into manageable components, and develop a scope, schedule, and budget.
• Do - involve your grant writers early in the process of articulating the project definition, what it's for, and why it's needed.
• Do - define what an EHR is for your organization, involve your staff (stakeholders including senior management, IT staff, clinical staff, billing staff, board members, grant writers, medical staff, intake staff, and anyone else I left out) in the process to understand their pain points and prioritize needs. Pay particular attention to project expectation management.
• Don't add the responsibility of managing an EHR project to a full time employee's already hectic work load. It's just too much to ask, too much to do, and goes directly in the column titled "why this probably won't succeed."
• Don't forget that your clients are at the center of your organization's purpose, and that good EHR projects / systems carefully consisder how quality of care can be improved as a result of the project.
• Don't be in a hurry. This will take a while, and how long it takes will depend on how you define this. An EHR project is a journey, with many destinations along the way. This will drive your grant writer crazy, and possibly others. Help your grant writer succeed by creating milestones and looking at an EHR within the context of a program, made up of specific projects, with time lines, budgets, and milestones.

Here's another take on what to expect from an EHR project, provided by the Mental Health Corporations of America, Inc. (MHCA) and Software and Technology Vendors Association (SATVA) in their joint paper entitled "Planning Your EHR System: Guidelines for Executive Management." This was published in 2005 / 2006, but I find its content a good overview, even in a quickly evolving marketplace.

• There is no easy way to move from a paper system to an EHR, but you have it within your power to make the implementation smooth and positive.
• Without CEO/executive management support and involvement chances for success drop dramatically.
• Despite your perception on the front end, your business processes will change, and they will change for the better as a result of EHR implementation.
• Compliance with HIPAA and other regulatory requirements will be much easier to manage and maintain with an EHR than with a paper record.
• You will have more data, especially real time data, available to you.
• The system you choose will be only as good as the effort you and your staff invest in its implementation.
• The culture of your organization will change significantly. Resistance to that change in culture will probably be greater than you anticipate.
• There is tremendous potential for the EHR to enable and facilitate significant improvements in clinical practice, client safety and client outcomes.
• The clinical and economic justification, or the Return On Investment (ROI), will become evident.

So, now that you've made it this far, I'll let you ask yourself again, "are you ready for an EHR?"

tsd.