Implementing an EHR in the behavioral health setting
July 14, 2014 in Medical Technology
Behavioral healthcare (BHC) is one of the most varied healthcare settings, encompassing a wide range of services from outpatient substance abuse treatment to full-time, residential psychiatric care. Within these services, the type of care provided also differs. For instance, a single organization may offer group therapy, one-on-one counseling, crisis stabilization and community outreach. Compounding the diversity is the fact that each area has significant sensitivities in terms of both treatment approach and client privacy.
Historically, behavioral health organizations have shied away from implementing an electronic health record (EHR), feeling that the complexity of the care setting precludes technology use. Plus, EHRs have traditionally focused on capturing information about physical medical conditions, and the content for the BHC field has been limited. The expense of an EHR has presented additional roadblocks, as organizations are sometimes hesitant or unable to expend capital for technology. There are, however, challenges for healthcare organizations – providers, facilities and the greater industry – if EHRs are not implemented, especially as behavioral health information becomes a more critical piece of a patient’s longitudinal patient record.
The reality is that selecting and onboarding an EHR that meets the diverse needs of the behavioral health segment can be complicated, but the challenges are not insurmountable. With the right system and a careful, well-considered implementation strategy, BHC organizations can reap the benefits of a tool that efficiently facilitates comprehensive client care and improved outcomes. As Congress once again debates whether to extend Meaningful Use to behavioral health facilities, the time is right for providers to consider implementing an EHR.
There are many advantages to using an EHR in the BHC setting. For instance, a well-designed system can support better information capture, allowing clinicians to fully document care in a format that empowers client and family interactions, enables robust reporting and data aggregation, as well as enhances clinician-clinician communication. For example, if all substance abuse counselors use the system in a similar way, there will be greater care continuity and a more consistent client experience.
An EHR can also help with interoperability. When organizations use a system capable of exchanging information with outside entities, such as hospitals and primary care physicians, they can build a more objective and detailed picture of the client, supporting more informed decisions that take the client’s entire care context into account and limit situations in which a provider is completely dependent on the client and family for health history. As the trend toward integration between primary care and behavioral health becomes more prevalent, it is critical for providers to implement forward-thinking technologies that allow integration and collaboration to support quality care goals.
Key Characteristics of a BHC-Centered EHR
Not all EHRs are ideal for BHC organizations. When vetting potential options, here are some key characteristics to keep in mind:
- Offers robust BHC content. EHRs have historically focused on capturing data about physical conditions (i.e., the patient has a laceration on the right side, is having trouble breathing or is running a fever). To be effective in the BHC setting, an EHR must have in-depth behavioral health content, such as targeted protocols for psychological diseases and drug treatment. The tool must also accommodate the different types of care found in BHC facilities. For example, a residential program may require an EHR to capture information from client appointments as well as group therapy sessions, offsite field trips and/or general rounds.
- Captures free text and more. A chief characteristic of BHC treatment is that clinicians often document information about the client in free text, writing down what they observe and what the client and family shares. A BHC-focused EHR should be able to capture discrete data from the content mentioned above and also be able to seamlessly capture free text, integrating it into the clinical record in a useable way. Systems that capture both discrete information and free text allow clinicians to manipulate and examine the information they enter, and use it to add value to the client’s treatment and achieve better outcomes. They also allow the organization to more easily meet the myriad reporting requirements imposed by funding sources, payers and governmental entities. The efficiencies gained in this manner can allow organizations make better use of limited human and capital resources. Some EHRs include a tool that functions like a pen on paper, so that client perceptions of the care experience don’t change once technology is introduced into the environment—the provider appears to be taking notes like usual and is not turning away from the client to use a computer.
- Delivers interoperability. Sharing information with outside entities is key to creating a comprehensive health record. Organizations should select technology that enables these exchanges in a private and secure fashion.
- Allows for configuration. Organizations should choose a tool that is configurable to the unique needs of the care site but still fosters consistency to maintain a high standard of care.
To get the most benefit from an EHR, behavioral health organizations should take a concerted approach to implementation. Clinicians need to be directly involved in the process—both in selecting the tool and configuring the system. This is even more important than in other care settings because of the variety of sensitivities and nuances involved in addressing behavioral health.
It is also important to keep an eye on the big picture. Will the technology be used predominantly for data aggregation or to improve treatment planning and enhance communication between providers? Will it drive better reporting or encourage interoperability? Is some combination of these goals appropriate? Taking time to develop an overarching strategy and then framing the technology to support that strategy is a best practice.
Organizations should also have a full appreciation of their workflows, including the steps and people involved as well as the timing. As with other kinds of technology, an EHR will not fix ineffective or inefficient workflows. Organizations should use it to enable well-designed processes to support optimal care. When revising workflows, look for any unintended consequences that may emerge. For example, if the organization streamlines the method for gathering information about substance abuse at registration, how will that affect other areas of care? This is where pulling the clinical staff together and mapping processes becomes most critical.
While implementing an EHR in a BHC organization may seem daunting, the advantages far outweigh the challenges. Organizations that commit to thoughtful vendor selection and planned system implementation can successfully navigate the effort and reap the benefits.