How To Optimize Technology: An OPEN MINDS Seminar On Getting The Most Value From Your Technology Investments

This presentation took place on August 23, 2021 at The 2021 OPEN MINDS Management Best Practices Institute. In this session, Sharon Hicks, Senior Associate and Kim Bond, Executive Vice President at OPEN MINDS, discussed what needs to be addressed to ensure your organization is on the path to maximizing your tech investment, including:

  • How to evaluate new technologies for your organization
  • Engaging staff in a best practice technology evaluation process
  • Determining anticipated financial and non-financial return-on-investments for the selected technology
  • Go or No-Go: Moving beyond pilot to full implementation
  • Ensuring implementation success

Technology Strategy For Sustainability—EHRs Are Just The Start

This closing keynote presentation took place October 27, 2021 during The 2021 OPEN MINDS Technology & Analytics Institute. OPEN MINDS Chief Executive Officer Monica E. Oss gave an up-to-the-minute look at the critical changes in the landscape for serving complex consumers – and what they mean for organizational sustainability post-pandemic.

This session covered:

  • The context for selecting technology in an ever changing and shifting field
  • Critical organizational competencies your organization must have for efficiency and sustainability
  • A framework for data-driven strategy and technology assessment
  • This closing keynote presentation took place October 27, 2021 during The 2021 OPEN MINDS Technology & Analytics Institute. OPEN MINDS Chief Executive Officer Monica E. Oss gave an up-to-the-minute look at the critical changes in the landscape for serving complex consumers – and what they mean for organizational sustainability post-pandemic.

    This session covered:

    • The context for selecting technology in an ever changing and shifting field
    • Critical organizational competencies your organization must have for efficiency and sustainability
    • A framework for data-driven strategy and technology assessment

Making Tech Work

By Monica E. Oss, Chief Executive Officer

Tech investment in health care is big. Eighty percent of health care provider organization executive teams are looking to make additional investments in technology in the next five years (see Future Of Healthcare Report: Exploring Healthcare Stakeholders’ Expectations For The Next Chapter). As a result, the health care tech market is expected to grow from $326.1 billion in 2021 to $821.1 billion by 2026 (see Healthcare IT Market by Products & Services, Components, End-User, and Region).

Currently, tech investments by specialty provider organizations have focused on EHRs (88%) and telehealth platforms (85%). About half of specialty provider organizations have invested in referral tracking systems, health information exchange technology, fundraising tools, ePrescribing tools, and clinical decision support systems (see The Computer Is A Moron and The 2021 OPEN MINDS Health & Human Services Technology Survey). But the changing landscape is changing the tech functionality that specialty and primary care provider organizations need to maintain competitive advantage and sustainability. According to The OPEN MINDS 2021 National Behavioral Health Electronic Health Record Survey, 56% of these provider organization executive teams report having tech functionality gaps—and 21% stated an intention to procure a new EHR (see The Times Have Changed. So Have Our EHR Concerns.). Our team at OPEN MINDS thinks this focus will be on integrated analytics, technologies supporting hybrid care delivery (scheduling, mobile, visit verification, etc.), consumer engagement, and managing alternate reimbursement contracts.

But with more technology come problems of implementation and optimization. First, there are privacy and security issues. About a third of behavioral health provider organizations were cited by Accreditation Commission for Health Care (ACHC) for having incomplete, substandard policies related to protection of patient data (see One-Third Of Behavioral Health Organizations Have Incomplete Policies For Health Information Protection). The ACHC also cited 26% of these organizations for missing documentation, 20% for missing information on staff background checks, and 20% for missing information on staff Hepatitis B vaccination. And the on-line apps in the behavioral health field are not doing much better (see Does Mental Health Privacy Really Matter To Consumers?).

Another issue—adoption of data-driven decision making. A recent survey found that 74% of health care provider organizations use clinical decision support technology—but in limited ways. The key uses of clinical decision support are medication orders (30%), lab orders (24%), and medical imaging orders (20%) (see The Process Matters). And, only 16% of community mental health center executives have adopted measurement-based care (MBC) technology (see 16% Of Community Mental Health Centers Use Measurement-Based Care, Despite Knowledge Of Value).

For more, I reached out to my colleague and OPEN MINDS Senior Associate Joe Naughton-Travers to get an understanding of why, when technology is so critical to the future competitive advantage of provider organizations, are there so many challenges in both adoption and implementation. “I think the biggest issue for health and human services is that organizations usually don’t have a technology strategy and roadmap,” Mr. Naughton-Travers said. “Some organizations are still struggling to get the basic data systems in place (EHR, human resources information systems, and general ledger systems) and others are still a long way off from achieving analytic and performance optimization. In terms of poor management practices, the problem is usually the lack of formal project planning and project management in both selecting and implementing technologies.”

How to plot a path to tech success? He had three recommendations—systematically identify technology gaps, adopt a deliberate adoption roadmap, and make sure you have the right staff to get the job done.

Systematically identify technology gaps—Provider organization executive teams should conduct a regular needs assessment to ascertain what functions they are lacking, and what tech can fulfill that need. This needs assessment should be concurrent with implementation planning for a strategic plan. Answering three critical questions should drive the process: what competency do you need, who on your team will be using the tool, and how will that technology adoption create and drive value for the consumer, the payer, and the care continuum?

Develop a deliberate tech adoption roadmap—Once an executive team has determined the technologies needed to achieve both strategic and business objectives, a timeline for selecting and implementing new tech tools is the next step. Managers need to look beyond “the basics” and identify the technology requirements needed to support strategic plan objectives.

Invest in the right staff—New technology brings new competency requirements among executives and managers. Success requires upgrading the skills of existing team members and/or finding new team members with the competencies to implement, manage, and optimize the new tools. Technology is no longer an afterthought—the entire executive team needs to be involved with ongoing technology planning and optimization.

Mr. Naughton-Travers concluded, “When technology implementations fail to achieve their goals, it’s a “double whammy”—you have spent a bunch of money and the problem you needed to solve still exists. Far too many organizations make this exact, costly mistake.”

For more on technology adoption and implementation, check out these resources in The OPEN MINDS Circle Library:

And for more on getting your “tech game” where it needs to be, mark your calendar for June 14-16 and The 2022 OPEN MINDS Strategy & Innovation Institute in New Orleans, Louisiana. Be sure to check out the session, Technology For Innovation: How Do You Know What You Need?, featuring Julie Sjordal, Chief Executive Officer at St. David’s Center for Child & Family Development, along with OPEN MINDS Senior Associates, Carol Clayton, Ph.D. and Sharon Hicks.

Tech For Success: How To Assess Current Tech Functionality Readiness For Future Growth

By Joe Naughton-Travers, Ed.M.

With my work at OPEN MINDS, I’m often asked by my specialty health care provider organization clients which type of technology is the most important. My answer is always the same: it’s not about the individual technology itself, it’s about how all of the technology platforms come together and “play nice” to manage and optimize overall clinical and financial performance. Without the integration across all platforms, each are merely working in silos without the ability to use each platform’s data as decision-making guides for the organization.

In response, I’ve worked with our team of senior advisors to develop a technology platform framework for specialty provider organizations to aid in planning technology needed for the future. This framework has six domains:

#1 Electronic Health Record & Billing System — The functionality of a comprehensive electronic health record (EHR) software application.

#2 Human Resource Information System & Financial/General Ledger System — These are the two other key software applications for administrative operations. The Human Resource Information System (HRIS) is the software that maintains, manages, and processes detailed employee information and human resources-related policies and procedures. The Financial/General Ledger System is the software that tracks all financial transactions and is used to generate a company’s financial statements.

#3 Hybrid & Community Based Service Delivery Platform — Technology tools that support virtual and community-based service delivery.

#4 Consumer Experience & Engagement Platform — Technologies for enhancing consumer engagement in the health care experience and optimizing consumers’ experience with the system of care.

#5 Value-Based / Risk-Based Reimbursement Platform — Technology capabilities that support measuring value in terms of customer experience and engagement and of the cost and quality of services.

#6 Integrated Analytics & Service Performance Optimization — Software applications for aggregating and analyzing the data from all the other software systems and databases to manage and optimize clinical and financial performance.

Domain #1: A Whole Person Care Record: Comprehensive EHR Software

The first requirement is a comprehensive EHR software application for all the consumers your organization serves, and all the service lines delivered. The EHR must record the demographic and clinical data for consumers, the services they receive, and the corresponding clinical documentation. Additionally, the EHR must:

  • Document all referrals and referral dispositions
  • Support tracking performance and clinical quality metrics
  • Include standard functionality for medical services (e.g., e-prescribing, laboratory orders, and electronic medication administration records)
  • Provide support for the delivery of routine primary care services

Mobile access to the EHR (both on- and off-line) is a must, and clinical decision support for medical necessity, clinical appropriateness for care, evidence-based practices, and payer-mandated clinical pathways is highly desirable. The EHR should be interoperable with the EHRs of other provider organizations to facilitate care coordination. Lastly, the software must handle all of your organization’s billing and accounts receivable operations (including fee-for-service, bundled, case rate, and VBR payment models) and have tools for maximizing revenue collection.

That covers the technical details—the functionality of a good electronic health record. The essential questions to ask about any EHR system are:

  • Does the EHR help you manage whole person care for the consumers you serve?
  • Does it have functionality to monitor physical and behavioral health as well as social determinants of health (SDoH)?
  • Does it aid in care coordination with other provider organizations to achieve the best health outcomes?

If your EHR software application is not addressing these key service management functions, it is time to consider a change.

Domain #2: Managing Administrative Functions: Human Resource & Financial Management Software

The second domain helps provider organizations ensure that key administrative operations—human resources and finance—have the right software applications to meet your organization’s needs. The HRIS (human resource information system) must do more than track employees, salaries, and benefits. The HRIS also should include functionality for job applicant tracking and position control, time and attendance tracking, employee self-service capabilities, and a learning management system. A final requirement is comprehensive support for employee appraisals and development plans.

The financial management software (sometimes called the general ledger or accounting system) should have all the basic capabilities: budgeting, financial reporting, payroll, accounts payable, and fixed asset management. To support VBR contracts, the financial management software also needs to have the capability to aid in the management of the cost-of-service delivery—overall—and for individual health plan contracts. (It will need access to the service delivery data in the EHR to do this.) Lastly, this software application should have functionality for monitoring and managing health plan contracts and other payer contracts.

Domain #3: Delivering Care Conveniently: Hybrid & Community-Based Service Delivery Capabilities

This domain is more than just the telehealth services that your organization has become proficient at delivering during the COVID-19 pandemic. It includes other technologies that support and enhance your community- and home-based care delivery. Telehealth capabilities must be integrated into the EHR itself and should also be available on mobile devices so that community-based staff can bring in additional staff virtually when needed. Electronic visit verification (EVV) is needed to report that staff were physically present at consumer service delivery sites during community-based care. Smart home and remote health monitoring technologies can be used to ensure the health and safety of consumers. Secure communication between staff and consumers should be available in multiple formats (text, email, telephone, and video). Ideally, you would also have technologies that aid in route optimization for staff travel in the community as well as tools for managing these field and remote-based staff.

Domain #4: A Focus On Customer Service: Consumer Experience & Engagement Tools

Technology in this fourth domain is new to many specialty provider organizations. Consumer experience is the subjective response consumers have with any contact with your organization. Questions you might consider when evaluating for consumer experience include:

  • Are your services convenient and easy to access?
  • Are communication and other interactions smooth and painless?
  • Is there a personal touch to service delivery and an impression of quality?

Consumer engagement is when individuals take action to become more informed and more proactively involved in his or her health and the health care services received. There are numerous technology tools to help with both consumer experience and engagement, including:

  • 24/7 centralized access to care
  • An easy to navigate website with the ability to access care and schedule appointments
  • A consumer portal for communication, bill payment, and health record access
  • Web- and app-based self-directed consumer health and well-being technologies
  • Enhanced social media presence
  • Net promoter scoring integrated into all aspects of care delivery
  • Appointment and health check-in reminders via telephone, text, and email

As provider organizations expand their focus on consumer experience and engagement, a key focus is to determine which technology tools they may already have to support these efforts and which they will need to acquire and implement.

Domain #5: Managing Care & Costs:  A Value-Based Reimbursement Platform

The fifth domain of the technology platform framework is technology tools for managing service performance and cost. Provider organizations should assume that most, if not all, of their health plan contracts in the future will be value-based, with both upsides and downsides in terms of payment models. You’ll need technologies that monitor clinical quality metrics in comparison to contract requirements. Will these be in your EHR? In other software applications? In analytic dashboards?

You’ll also need to monitor other contract performance metrics. Examples include metrics to monitor access to care, treatment engagement, telephone and referral response time, and other industry standard metrics such as Healthcare Effectiveness Data and Information Set (HEDIS) and Certified Community Behavioral Health Clinic (CCHBC) requirements. You may also be required to track and monitor SDOH and adherence to evidence-based practices.

Other key questions you’ll want to consider about managing care and cost include:

  • What other technologies can better facilitate your ability to manage care and cost?
  • Can you accomplish this with your EHR and financial management software alone?
  • Do you need to invest in a better telephone system and website?
  • Should you implement separate technology tools for quality and performance tracking that your EHR cannot handle?

This leads to Domain #6—does your organization need business intelligence and data analytic technologies to aggregate, analyze, and present the data in a meaningful way to your staff?

Putting It All Together With Domain #6:  Analytics & Optimization

The last domain uses technology for aggregating your data in a meaningful way to proactively manage your organization. This is accomplished by utilizing business intelligence (BI) or other data analytic software applications that aggregate data for analysis and performance optimization. This is the ‘holy grail’ of performance measurement and optimization, having meaningful data to report your organization’s financial strength and operational performance and to monitor progress towards strategic objectives.

Most commonly, provider organizations begin with using these technology tools to manage and optimize clinical quality and performance metrics through reporting. The next step is to implement the use of dashboards for the board of directors, the executive team, department managers and individual staff. The most sophisticated use of BI software applications for specialty provider health care organizations is for population-health management. Here, BI software applications are used to provide the analytics to improve the health of the overall population of consumers served, to enhance consumer experience, and to reduce costs through consumer segmentation and analytics.

Where To Start In Building A “Next Generation” Technology Platform

The question is how to proceed with planning for and implementing the technology functionality needed to support future growth plans. There is a two-step process—addressing both immediate functionality needs for success in the current market and assessing the technology needed to support your strategic plan.

For the first, addressing immediate functionality needs, we have created a short assessment of ‘must have’ current tech functionality—The OPEN MINDS’ Technology Requirements Checklist – Eighteen Must-Have Capabilities For Specialty Provider Organization Success. To see how your organization stacks up in this preliminary list, go through the checklist.

OPEN MINDS’ Technology Requirements Checklist – Eighteen Must-Have Capabilities For Specialty Provider Organization Success   Yes   No   Working
    On It
#1 Electronic Health Record & Billing System
Does your EHR handle all your health record documentation and billing requirements?
Does your EHR have the capability to share data with other provider organizations (interoperability)?
Does your EHR have mobile access (both on-line and off-line)?
#2 Human Resource Information System & Financial/General Ledger System
Does your HRIS include functionality for job applicant tracking, position control, and employee self-service?
Is your Financial/General Ledger System chart of accounts set-up so that you can report the unit cost and case costs of all the services you deliver?
Does your Financial/General Ledger System include contract management functionality?
#3 Hybrid & Community Based Service Delivery Platform
Do you have secure telehealth technologies in operation?
Do you have electronic visit verification (EVV) in operation?
Do you have technologies in place to monitor or report consumers’ health status (e.g. blood pressure, body mass index, lab levels, etc.)?
#4 Consumer Experience & Engagement Platform
Do you have centralized scheduling or other tools that make it easy for consumers, their families, and referral sources to access care at your organization?
Can consumers communicate securely with their care providers through a web portal, text, or other technologies?
Have you implemented net promoter scores, or a similar measure, to routinely measure consumer experience?
#5 Value-Based / Risk-Based Reimbursement Platform
Does your team have a system for reporting payer-centric and consumer-centric performance metrics?
Do you have technologies in place to report timely access to care and hospitalization readmission performance metrics?
Do you have a system to report other value-based and risk-based reimbursement contract performance measures such as follow-up after hospitalization, emergency room utilization, and use of evidence-based care protocols?
#6 Integrated Analytics & Service Performance Optimization
Do you have software technologies in place that can aggregate data from your EHR, HRIS, and Financial/General Ledger System to report on key strategy metrics?
Do executives and managers have access to real-time dashboards for key performance and operational metrics?
Does your staff know how to interpret and use the data that is available to them for performance management (data literacy)?

This checklist provides an assessment of basic technology-enabled management capabilities. Where there are gaps in these management capabilities, management teams should develop a plan to meet these functionality basics. If there are functionality deficiencies in Domain #1 and #2 (the EHR, HRIS, and GL systems) these should be an area of immediate focus.

Beyond these basic areas of tech-enabled management capabilities, executive teams need to also crosswalk their strategic plans with the tech requirements to support those strategic initiatives. For more on that process, see From Strategic Plan To Tech Strategy: Building Your Crosswalk.

Looking ahead, every executive team member—and not just the CIO or CTO—need to focus on the coming digital transformation of the health and human service field—and the strategy and technology needed to succeed.

The Four Pillars of Strategic Technology Success

By Monica Oss

Many organizations are focused on technology—specifically, which technologies they need, how to best select and implement them, and ultimately, how to ensure that technology investments “pay off” for the organization. My take is that most executive teams know they need to incorporate some of the many emerging technologies into their organization’s operations. The rationale is simple—keeping the competitive advantage and assuring organizational success and sustainability in a rapidly evolving health care market.

But the question is, which technology platforms are needed and how to integrate those technologies into organizational operations? OPEN MINDS has identified what we refer to as the “four pillars of strategic technology success” that management teams need to consider in getting the leverage they need from technology investments.

#1 Technology In Sync With Strategy And Future Needs. It doesn’t matter which technology platforms your organization adopts if the technology doesn’t align with your strategic goals. The question is, how do you decide which technology tools are the best fit for your organization’s future strategies for sustainability and success? The process starts with strategic planning and a clear understanding of your organization’s future market positioning and service lines. A common mistake in strategy is to think about technology as an “addition” to current service delivery models rather than conceptualizing the next generation of technology-enabled services and operations that are possible. How can technology be leveraged to aid in achieving each of your organization’s strategic objectives? What technology is needed to ensure that your organization has its ‘next big thing’ in terms of services and operations for the future? It is in this phase of the strategic planning process that questions about your business model and technology investments need to be addressed.

#2 The Right Technology And The Right Vendor. Once you’ve made the decision about the technology you need, selecting that specific technology from a specific vendor should be a very straightforward process. Unfortunately, it is easy to make the wrong choices. When selecting the technology product itself, it’s essential that you ensure that it actually does what you are looking for! Identify critical functional needs and make sure you’ve seen them demonstrated and confirm with other customers that it really works.

Another key issue is to remember that you’re not only selecting a technology product—you’re selecting a new business partner, the vendor organization. Make certain you know that the company is stable and provides good implementation and support services.

#3 Best Practice Implementation

In our experience, when technology implementations fail, the blame with both the management team and the vendor. Oftentimes, provider organizations are good at delivering services but bad at technology implementation. Budget your technology investments to ensure success—with the right project management tools and staff, and the development and use of effective training materials.

The other variables in successful technology implementation are about ownership. Management teams must assume responsibility for the technology planning and implementation—owning their functional requirements, their workflow processes and staff buy-in, and the successful integration of the technologies into operations.

#4 On-Going “Operational” Management Of Technology

Developing the strategy, selecting the technology and vendor, and implementing the technology successfully are all complex tasks, and the on-going management of all of your technology solutions is also challenging. This is where the “rubber hits the road,” so to speak, in getting the strategic leverage from technology investments. Does your organization have the right structure, operations, and staff competencies to manage and optimize the technologies you’ve implemented? Do you have technology leadership in place to oversee current technology operations and to think strategically about technology decisions?

When technology implementations fail to achieve their goals, there is plenty of blame to go around—the wrong product, an ineffective vendor partner, mangled implementation, and poor operations. I have seen far too many organizations do just this. For CEOs, when any of these factors are “out of sync”—bad vendor selection, bad technology, bad contracts, and implementation delays (or failures)—the results are costly.

Quite simply, executive teams need to assume responsibility for getting technology right—or they will end up assuming responsibility for its failure.

Qualifacts + Credible Named 2022 Best In Klas: Software & Services

GETTYSBURG, Pa. (February 20, 2022) — Qualifacts + Credible, a leading provider of electronic health record (EHR) platforms for behavioral health and human services organizations, today announced the Credible platform has ranked No. 1 in the 2022 Best in KLAS: Software and Services report.

Additionally, Qualifacts + Credible’s CareLogic EHR platform is ranked No. 2 in the 2022 Best in KLAS: Software and Services report.

The Best in KLAS report recognizes software and services companies who excel in helping healthcare professionals improve patient care. All rankings are a direct result of the feedback of thousands of providers over the last year. A Best in KLAS award signifies to the healthcare IT industry the commitment and partnership that the top vendors should provide.

“We are honored by the trust our partners place in us every day, and their success is our highest priority. This recognition from KLAS is a great validation of the remarkable work our teams have done in support of our mission to be an innovative and trusted technology and solutions partner, said Paul Ricci, chief executive officer at Qualifacts + Credible.

“Each year, thousands of healthcare professionals across the globe take the time to share their voice with KLAS. They know that sharing their perspective helps vendors to improve and helps their peers make better decisions. These conversations are a constant reminder to me of how necessary accurate, honest, and impartial reporting is in the healthcare industry. The Best in KLAS report and the awards it contains set the standard of excellence for software and services firms. Vendors who win the title of Best in KLAS should celebrate and remember that providers now accept only the best from their products and services. The Best in KLAS award serves as a signal to provider and payer organizations that they should expect excellence from the winning vendors,” said KLAS CEO Adam Gale.

About Qualifacts + Credible   
Qualifacts + Credible is one of the largest behavioral health and human services EHR vendors in the country. Its mission is to partner with customers to support and extend their ability to deliver quality care and improve the lives of the clients they serve. With more than 20 years of experience its products and services help customers achieve interoperability goals, optimize efficiency, improve productivity, and maximize reimbursement. The company offers several EHRs – CareLogic, Credible and InSync – while collaborating to build an even brighter future for partner agencies and their clients.

About KLAS
KLAS has been providing accurate, honest, and impartial insights for the healthcare IT (HIT) industry since 1996. The KLAS mission is to improve the world’s healthcare by amplifying the voice of providers and payers. The scope of our research is constantly expanding to best-fit market needs as technology becomes increasingly sophisticated. KLAS finds the hard-to-get HIT data by building strong relationships with our payer and provider friends in the industry. Learn more at klasresearch.com.

Think Of Your EHR & Vendor As A Technical Consultant Rather Than Software

It’s common knowledge that it’s less expensive for organizations to retain employees than to hire new ones. According to recent data, it costs as much as 33% of a worker’s annual salary to replace them. When applied to a median employee salary of $45,000, the average cost of turnover comes out to about $15,000 (see Avoidable Turnover Costing Employers Big). The same principle holds true for other areas of your business, but no where is this more evident to behavioral health providers than in their relationship with an electronic health record (EHR) and the companies that make them.

We’re bombarded with stories about EHRs evolving to become more flexible and use more services, such as artificial intelligence, but what do your peers report firsthand? We recently concluded the sixth annual OPEN MINDS National Behavioral Health EHR Survey and found that 53% of provider organizations report their EHR does not have all the functionalities they need. Only 19% report their clinical, scheduling, billing, and reporting and analytics functionalities as meeting their needs. These Core 4 functionalities are crucial to service delivery and organizational sustainability (see Providers Growingly Concerned About EHR Functionalities & The Technologies Needs For Future Service Delivery & Reimbursement: Top EHR Trends From The 2021 OPEN MINDS National Behavioral Health EHR Survey.

Research shows the cause of this dissatisfaction stems from the EHR’s initial implementation within an organization (see Selecting The Right EHR Partner: An EHR Return-On-Investment Analysis). According to a recent white paper, there are two main reasons that an EHR fails to live up to expectations. The first issue is an incomplete EHR implementation. This is when, for one reason or another, the organization has been unable to successfully implement all the components of a system that would move to a completely paperless health record. The second issue is an ineffective EHR implementation. With this problem, all of the components have been activated, but the staff is struggling to use these tools as they were intended.

Both scenarios are exceptionally frustrating for staff who have often been working on the implementation for months, or even years. The immediate response might be to start over fresh with a new vendor, but, like replacing employees, it can be much more expensive to start over with a new EHR rather than working with your EHR vendor to get the one you have to meet your needs. Here are some tips to consider if you’re debating whether to fix or replace your EHR.

  1. Create a technology workgroup. Technology workgroups come in all shapes and sizes and provide numerous benefits to any organization that uses an EHR (see The Benefits Of Technology Workgroups On Program Quality: An EHR Best Practices Community Interview With Bob Puckett). Implementations go awry for a variety of reasons, including lack of organization or staff accountability, and inability to prioritize implementation tasks to move the implementation forward. An effective technology workgroup can help ensure a streamlined EHR implementation and on-going functioning. Some organizations find it best to choose workgroup members based on skillsets and not solely by job title, as is the case with many other organizations. It is imperative for executive teams to keep this work group operational even after the EHR implantation. They may not need to meet as often, but these individuals will be the eyes and ears of the project on the front lines of your organization.
  2. Make a list of your issues. Task your technology workgroup with conducting brief focus groups with your top users to find out what features of your EHR are working as planned and which are not. If staff have created workarounds outside your EHR instead of using what is offered, find out how and why. Is it because the solution built in doesn’t work? Is it too clunky? Hard to use? Buy in from your power users on which necessary improvements are most important will help the project succeed.
  3. Understand future needs from your payers and funders. The reporting requirements for receiving timely payments and grant funding are constantly shifting. As you look at enhancing your system, talk to some of your payer and funding partners to find out what they will need from you in the not-to-distant future. This helps ensure that the changes you make today will remain relevant in the future (see Data-Driven Care: Using Population Health & High-Utilizer Data).
  4. Connect with other clients of your EHR vendor. Most vendors hold user’s group meetings where providers using a specific technology can talk to other users and staff to solve common problems. Before the pandemic these groups often met in person, but many have shifted to an online-only format due to COVID-19. If you’re not already participating, ask your vendor how to get involved. Often, you’ll find that other real-world users of a technology can provide additional insight from the front lines that you can’t get specifically from your sales representative(s). It also helps to sign up for any mailing lists or websites where users can ask and answer common questions.
  5. Talk to your current vendor. Before putting out any requests for proposals or shopping for a new EHR, contact your current vendor and discuss your problems. It’s highly likely that your vendor has seen this situation with another client and may have solutions that would be easier and less expensive than starting over from scratch. If you don’t currently have a productive relationship with your vendor representative, request someone new and/or rethink your main liaison within your organization. Some of the problems may boil down to personality differences between the staff implementing the project and the vendors assigned to your project.

Lay it on the line – explain that you are unhappy and that certain conditions must be met for you to continue with this vendor. Even if your contract doesn’t renew for another few years, you may have a clause in your contract for non-performance. The key is to document everything so that you’ll have the receipts should a break-up become inevitable.

Providers Growingly Concerned About EHR Functionalities & The Technologies Needs For Future Service Delivery & Reimbursement: Top EHR Trends From The 2021 OPEN MINDS National Behavioral Health EHR Survey

Originally presented on October 19, 2021.

We’re bombarded with stories about electronic health records (EHR) evolving to become more flexible and use more services like blockchain, cryptocurrencies, and artificial intelligence, but what do your peers report firsthand? We recently concluded the sixth annual OPEN MINDS National Behavioral Health EHR Survey and found that 53% of provider organizations report their EHR does not have all the functionalities they need. Only 19% report their clinical, scheduling, billing, and reporting and analytics functionalities as meeting their needs. These Core 4 functionalities are crucial to service delivery and organizational sustainability.

In this webinar, OPEN MINDS Senior Associate, Joe Naughton-Travers, shared the results of the 2021 OPEN MINDS National Behavioral Health EHR Survey and discussed what organizations can do to plan for the next advances in health care technology and service delivery. Mr. Travers also discussed the growing concern among providers and what functionalities to be looking at for future service delivery and timely reimbursements.

Download Presentation (PDF)

Top 6 Best Practices For Staying Human While Keeping Your Distance

One of the major developments of the COVID-19 pandemic has been the phenomenal growth of telehealth use, especially in behavioral health care. Telehealth became ubiquitous during the pandemic, and it is predicted that a large percentage of health care will continue via telehealth even after the public health emergency eases. A recent survey by Qualifacts and the National Council for Behavioral Health found that:

  • Before the pandemic, telehealth utilization in behavioral health care was relatively low, with only 2% of organizations providing 80% or more of their care virtually (See COVID-19 and Value-Based Reimbursement: What Do We Know? Where Will it Go?).
  • At the height of the pandemic, 60% of behavioral health organizations were providing 80% or more of their care virtually – due to policy changes reducing barriers to telehealth.
  • A majority of behavioral health care executives expect the increased utilization of virtual services to continue, with an estimated 40% to 60% of their overall services being provided via virtual platforms (See The New Role of Virtual Care in Behavioral Health).

Before 2020, health care was poised to start using more technology to allow consumers to make appointments, share records, and connect with their clinical professionals electronically. However, COVID-19 forced the rapid adoption of many of these services, particularly telehealth (See 21st Century Cures Act Paves The Way For Telehealth To Bloom During Pandemic). It turns out, consumers appreciate the ease of telehealth, especially because it allows them to avoid traffic and waiting rooms. Clinical professionals have also benefited from telehealth, finding that it allows them to see how their consumers are living day-to-day. Another advantage of telehealth is the ability to reduce barriers to care, such as time away from work and the stigma associated with seeking care (See What You Should Be Thinking About Now).

Mental health services were among the quickest health care specialty to switch to online treatment. With data collected between November 2020 through February 2021, 33% of all mental health appointments were conducted virtually. Primary care followed behind, holding 17% of its visits virtually. Pediatrics held 9% of its visits virtually, cardiology 7%, and OB/GYN visits were at 4%.

But despite the popularity and advantages of telehealth, clinical professionals must recognize that telehealth does not work for all consumers and all conditions. Regardless of age, many individuals are uncomfortable using technology, especially for sharing private health information. Also, not all consumers have access to high-speed internet, and therefore must resort to telephone appointments when an in-person visit is not an option. Above all, clinical professionals need to deliver the same personal, human interaction over the internet or the phone as they do in person. To ensure your clinical staff are maintaining a high quality of care without losing the personal touch while virtual, be sure to follow these key best practices:

  1. Establish a baseline for in-person versus virtual visits. Take a hard look at your service lines and consumer populations, as well as any payer requirements, when considering how often to require in-person versus virtual visits once the current pandemic ends. Even if your consumers love telehealth, make sure requirements are clear on how frequently they should be seeing consumers in-person — such as once every four telehealth visits — or whatever is determined to be best for your organization, clinical professionals, and payers. Advise your staff to be up front with consumers about the in-person/telehealth requirements from the office. Many people have anxiety as the world re-opens, and it is best to give people advanced notice of plans and expectations for future meetings.
  2. Acknowledge previous statements. Just like in an in-person visit, encourage your clinical professionals to spend a moment to chat with their consumers, perhaps following up and checking in on what you discussed in your last visit to make sure you both understand where you left off. This also works for clinical professionals as they move from topic to topic during consultations – spending a moment to reiterate an earlier conversation confirms you’re both on the same page. This helps the conversation stay on topic and helps your consumers build a connection with their clinical professionals, even if they have only ever met virtually.
  3. Listen to your consumers. As the world starts to re-open, advise your clinical professionals to check in with their consumers to see whether they would like to continue virtually, start meeting in-person again, or some combination of the two. Staff should realize it is also important to acknowledge any frustrations consumers may have regarding the platform or anything else in their lives. Even during a virtual appointment, it is obvious if someone is upset by the tone of their voice. Acknowledging these frustrations will demonstrate to consumers that their clinical professionals are present, even if they are not physically in the same room. This person-centered care approach will help your consumers feel more connected to their clinical professionals and actively involved in their treatment, which can positively impact health outcomes.
  4. Different policies for different diagnoses. As an office policy, it is also important to think about the consumer diagnoses your organization handles to see what works well digitally. Some treatment plans focusing on talk therapy may lend themselves naturally to telehealth, while others requiring injections or blood samples must be conducted in person. Think through the consumer population your organization treats and set some guidelines for your clinical professionals about how they should plan to handle future visits. For example, children being treated for attention deficit hyperactivity disorder (ADHD) are typically weighed to make sure they are not losing weight due to appetite loss from medication. Set a policy for parents to weigh children at home or develop a schedule for in-person visits.
  5. Explain the technology. All these tech tools are great, so long as everyone can use them. As an organization, be prepared to offer some training to your staff on how to effectively use technologies. If consumers are intimidated by a patient portal, they may be too shy to continue with treatments. It is important for your staff to be respectful of consumer’s tech knowledge and offer guidance without being condescending. Depending on your practice, you could even designate someone in the office to handle tech support for all consumers. Whatever you decide–just make sure you have someone available and willing to reach the consumers where they are.
  6. Do not be afraid to ask questions. Even on a virtual visit, your staff must be able to talk with consumers and engage with them as they would in person. Encourage your staff to make simple small talk to start a conversation, such as commenting about the weather or compliment a new hair style. Even in a virtual world, consumers need to feel connected to clinical professionals, so it is important to show attention to the consumer’s person. Teach your staff basic techniques to recenter and engage again with the conversation should their focus wane briefly.

As the world and industry change and we approach the next normal, provider organizations must embrace the fact that virtual care is here to stay. Incorporating a person-centered approach to care is incredibly important during these times when most of our care is being delivered virtually. To learn more about person-centered care and how to keep your consumers actively engaged in their own health care, view this recent archived webinar, A Stable Connection Should Mean More Than Just a Strong Wi-Fi Signal: How to Keep Care Connections Personal in a Virtual World.

The full text of “athenahealth Creates Online Telehealth Insights Dashboard to Help Practices Benchmark Their Performance and Find Opportunities to Better Meet Provider and Patient Needs” was published March 9, 2021, by athenahealth, Inc. A free copy of this and access to the Telehealth Insights Dashboard are available online at https://www.businesswire.com/news/home/20210309005235/en/athenahealth-Creates-Online-Telehealth-Insights-Dashboard-to-Help-Practices-Benchmark-Their-Performance-and-Find-Opportunities-to-Better-Meet-Provider-and-Patient-Needs (accessed July 23, 2021).
The full text of “Help patients adjust to telehealth by remembering the human touch” was published June 23, 2020, by the American Medical Association. A free copy is available online at https://www.ama-assn.org/practice-management/digital/help-patients-adjust-telehealth-remembering-human-touch (accessed July 12, 2021).

Going Hybrid? Charge Your EVV

By Monica E. Oss

If your organization is one of many that is thinking about moving to a hybrid service delivery model—virtual, in-clinic and in-home—your team will need to learn more about electronic visit verification (EVV). EVV was mandated for all home-based services by the 21st Century Cures Act, passed in 2016. The act required all state Medicaid programs to start using EVV for personal care services (PCS) by January 1, 2020 and for home health care services (HHCS) by January 1, 2023. EVV is essentially electronic verification that in-home service encounters actually occur and documents the type of service performed, the individuals providing and receiving the service, the date and location of the service, and the time the service begins and ends.

For PCS, many states applied to the Centers for Medicare and Medicaid (CMS) for “good faith exemptions” and received an extension until January 1, 2021. States are in different stages of implementation and some already require EVV for HHCS as well (see What Are The EVV Compliance Rules In Your State?) States that don’t implement EVV will have to take a cut in their annual federal medical assistance percentage (FMAP) starting at 0.25 percentage points and gradually increasing to one percentage point (see States Must Use Electronic Visit Verification By January 1, 2020 For Medicaid Personal Care Services).

EVV is required for all Medicaid covered in-home visits for personal care and health care services including nursing; home health aide services; and medical supplies, equipment, and appliances that are delivered via an in-home visit under the state’s home health benefit. States also may choose to require EVV for in-home physical therapy, occupational therapy, speech pathology, audiology, and other services (see Frequently Asked Questions: Section 12006 Of The 21st Century Cures Act). CMS does not require EVV in some instances—when the caregiver and consumer live together, for congregate facilities offering 24-hour services, or for Programs of All-inclusive Care for the Elderly (PACE)—although individual states may mandate otherwise.

While EVV does not specifically track consumers and staff, it does require multiple check-ins by staff at specified times with location identification—through a smartphone app with GPS tracking, the use of a landline phone in the consumer’s home, or signing into a device in the consumer’s home. For provider organizations required to comply with EVV mandates, the level of investment depends on the model chosen by their state. States have five options—an open model where provider organizations use their own EVV systems; EVV systems mandated by health plans; a single statewide vendor to be used by all provider organizations; build and manage a state-owned EVV system; or allow provider organizations to opt to use the state system or their own EVV system compatible with the state’s data aggregator (see EVV Systems Section 1: Requirements, Implementation, Considerations, & State Survey Results).

While the intent of EVV is to avoid fraud and ensure that consumers get the services they are supposed to get, there is widespread concern by consumers and advocacy groups on the practical challenges and alleged threats. For example, caregivers in Arkansas have complained about glitches in the state-mandated EVV app that have resulted in missed service entries and delayed paychecks. The Arkansas compliance requirements also have been criticized for placing undue burden on on live-in caregivers and on self-directed consumers who hire their caregivers directly and manage their own services. And some stakeholders do not like the sense of “constant surveillance.” Consumers complained that having an EVV system was comparable to having a wireless dog fence or ankle monitor (see ‘We Don’t Deserve This’: New App Places US Caregivers Under Digital Surveillance).

Other concerns have been expressed about the EVV impact on consumers—the Arc describes it as a “civil rights issue because of the concern around unintended consequences of impeding upon an individual’s privacy rights.” EVV systems that have video and audio recording functionalities and geotracking are not acceptable (see Call For Electronic Visit Verification Delay Grows Strong Nationwide). The National Council on Independent Living decried EVV for being “based on the archaic and offensive idea that disabled people and seniors are unable to leave their homes.” They criticized EVV for requiring multiple check-ins a day from the same location, for geotracking, and for imposing additional burdens on states (see NCIL Position Opposing Electronic Visit Verification).

What are the implications of EVV for specialty health and human service provider organizations offering home-based services? There are a few big issues to contend with—adopting new technology, creating new service delivery workflows, revising policies and procedures, training staff, and educating consumers and obtaining their input. OPEN MINDS Senior Associate Jason Lippman said, “EVV plays into a lot of digital trends we are seeing all around us—requirements for more data and more accountability. And the systems that work as intended can provide more data for planning and management of resources. The key is designing systems to collect that data that are least intrusive for both consumers and staff, creating efficiencies, and mitigating for unintended consequences and privacy issues.”

Like the EHR requirements of the past decades, the requirements for documentation of services delivered in home-based settings are likely not going to go away. And, it is likely that the EVV requirements will prove to be another factor—like value-based care, interoperability requirements, and hybrid service delivery models and ecosystems—that put larger organizations with better technology planning competencies at an advantage. Mr. Lippman pointed out, “As we gear up for 2023 and wait for the HHCS provisions around EVV to kick in, provider organizations should not put off being prepared—now is the time to start looking into what the state is currently doing with PCS, and to initiate the infrastructural and operational changes that will be required to accommodate digital tracking of remote services.”

For more on EVV preparation and management, check out these resources in The OPEN MINDS Circle Library: