What Does System Change Mean for Behavioral Health EHRs?

Those of us who work in behavioral health know that being able to manage system change is simply a part of the job. In those years when we did everything on paper, the changes were often administrative, and had little to do with our clinical work. We were able to help clients by developing a plan and assisting the patient with creating change. No one expected us to have quality measures built into the plan that gives back data on cost and success with our patient. Times have definitely changed in relation to how clinical practice is implemented.

Behavioral healthcare is varied in how services are provided and how they are measured. For many years, residential care was used for substance abuse, crisis stabilization, juvenile justice and psychiatric care. Patients went to a program and stayed for a period of time. When it was thought they were ready to return to the community, they were sent home. Now, many of those same types of patients are being served in the community with a limited use of residential beds.

Cost of care has become increasingly important as the behavioral health budget shrinks in both the public and private sectors. Payers want to know what they are getting for the money spent on service delivery. The days of per diem based care are gone, and now we are dealing with unbundled rates that pay for specific services based on patient need, rather than program requirements. Value has become the driving force for successful programs. More importantly, the ability to demonstrate value to justify payment is crucial to ongoing patient care.

No longer can all of this be done on paper. Organizations that continue to resist the change to electronic behavioral health records will not be able to meet the demands of value-based care. As it becomes more critical to demonstrate value, clinicians must have the appropriate tools to create person-centered plans that are based on clinical assessment, patient input, and then attach the projected cost of accomplishing the plan.

The electronic record cannot be simply punch and go. The record must have the capability to support the gathering of information, allowing clinicians to fully document care in a format that empowers client and family interactions, enable robust reporting and data aggregation, and enhance clinician-clinician communication. For example, if substance abuse counselors in an agency were using a record that gathered information in the same way, there would be greater continuity of care and a more consistent patient experience.

An electronic health record should be able to help with interoperability. The system must be able to communicate with, and exchange information, with outside groups such as hospitals and primary care physicians. This will allow for the gathering of appropriate health information that will assist in the development of a plan for the patient. As the trend toward integrated care continues to grow, it will be critical for providers to have electronic records that allow integration and collaboration to support quality care goals and the measurement of those goals.

Before considering the purchase of an EHR, the organization should take a hard look at implementation. Clinicians should be involved in the selection and set up of the system. This is very important, because of the different sensitivities and nuances involved in behavioral health.

It is also important to consider how the system will be used. Will the technology be used only for gathering data to enhance treatment planning and communication between providers? Will it drive better reporting and encourage interoperability? Is it some combination of tasks that will be important? Taking time to develop a strategy and then designing the technology to support the strategy is best practice.

Organizations should consider their workflows before selecting an electronic record. A system that expects you to follow their pre-set workflows and is not able to include your own workflows will not meet the demands of your payers or your staff. As with any kind of technology, it will not fix ineffective workflows. Organizations will need to install workflows that support well-designed processes and optimal care.

While implementing an electronic behavioral health record may appear challenging, the advantages gained will be well worth the work. Organizations that take the time to find a dependable vendor, and do a planned system implementation, will successfully implement an electronic behavioral health record.    

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