EHR Optimization & Workflow Redesign for Behavioral Health Providers

Webinar 2

April 18, 2019

National Council for Behavioral Health Montefiore Medical Center

Northwell HealthNew York State Office of Mental Health

Netsmart Technologies

Presenters

Sharon Bari - Program and Curriculum Education Manager at NYeC sbari@nyehealth.org

Nicole Casey – Director of Healthcare Advisory Services ncasey@nyehealth.org

Okechukwu (OK) Ogbutor –Quality Improvement Specialist

oogbutor@nyehealth.org

Barry Z. Samel-President of IMA Systems, LLC

zevi@imasys.com

About NYeC

• New York eHealth Collaborative (NYeC, pronounced “nice”) is a non-profit organization, working in partnership with the New York State Department of Health as the designated entity to improve healthcare through health information exchange (HIE) across the state. NYeC leads the advancement of the Statewide Health Information Network for New York (SHIN-NY), which connects seven regional networks, or Qualified Entities (QEs), allowing participating healthcare professionals, with patient consent, to quickly access electronic health information and securely exchange data with any other participant in the state.

• Health Care Advisory Professional Services (HAPs) team provides technicalassistance to stakeholders in implementing technologies and processes toimprove healthcare delivery in New York State.

Services Provided by NYeC

• HIT Webinar Series1. Health IT 101 for Behavioral Health

Providers2. EHR Optimization & Workflow Redesign for

Behavioral Health Providers3. Quality Improvement and Value Based Care4. Behavioral Health Performance Measures5. Health Information Exchange for Behavioral

Health Providers

• Office Hours

• Vendor Workgroups

• RHIO Toolkit

• Learning Management System

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Learning Management

System

Educational Webinar Series

Office Hours

RHIO Toolkit

Vendor Workgroup

Learning Objectives of This Webinar

1. Define Behavioral Health processes, administrative and patient workflows

2. Understand the Behavioral Health EHR reporting structure and how to create customized reports

3. Understand best practices for working with your EHR vendor to optimize the use of your EHR functionality

Opportunities for PAT Movement

• TCPI Change Package – 2.4. Optimal Use of Health Information Technology (HIT)• Innovate for access (PAT Milestone 17)

• Other PAT Milestones affected by this work• Share information through technology (PAT Milestone 10)

• Use technology supporting evidence (PAT Milestone 1)

• Use technology for partnerships (PAT milestone 9)

• Drive efficiency through technology (PAT Milestone 1, Milestone 18, Milestone 22)

Learning Objective 1

1. Define behavioral health processes, administrative and patient workflows

2. Understand how Behavioral Health EHR reporting is structured on an EHR and how to create customized reports

3. Understand “best practices for working with your EHR vendor for optimal use of the EHR functionality

Use of Health IT in Your Organization

Health Information & Data -Demographics

Result Management - Tests Order Management –

E - Prescribing

Decision Support - Clinical Decision Support

Electronic Communications and Connectivity – Direct

Messaging

Patient Support – Patient Portal/Education

Administrative Processes –

Practice Management/Billing

Reporting – Data Analytics/ Public Health Reporting

Dashboards

Case Management

Foresight Family Physicians - Use Case

• 2014 - EHR implementation documenting client visits

• 2017 - Joined a practice consortium – new EHR approach• Use health IT as a tool not just for

documentation – required staff retraining

• Data entered in structured fields• Population Health• Quality Reporting• Identify Gaps in Care

• EHR optimization led to workflow changes to address gaps in care and improve care

• https://pcmh.ahrq.gov/page/using-health-information-technology-support-quality-improvement-primary-care

A Case Study of Transitioning to Health IT Generated Data

Documenting Visits

Using EHR Generated

Data

Transformation

Training + Workflows over Time

Example of A HCBS Behavioral HealthWorkflow Diagram

Company Information

Billing Configuration

Practitioner/Staff Profile

Security and Access Control

Alerts/Rules Configuration

Completion ofPaperwork

• Patient Information Sheet

• Confidentiality/ HIPAA/etc.

• Consent for Services

• Consent to Release Information

Electronic Chart

Adult BH HCBS Provider

Assessment

Individual ServicePlan

Authorization Form

MCO AuthorizationResponse

Progress Note/CarePlan

Extended Additional Discharge Service Service

1. Align the goals of leadership and the EHR user

2. Optimize hardware/software solutions for provider use

3. Optimize administrative and patient workflows

4. Optimize teamwork

5. Leverage EHR-use data

6. Optimize information flow throughout the medical neighborhood

7. Foster a relationship with your EHR vendor

Seven Key Components to Successfully Optimize Your EHR

• What standard measures are supported by the EHR system’s existing reporting tools

• deviations from national or community standards

• Helps with early identification of potential reporting problems

• Many practices use current EHR reporting capabilities or supplement them with additional analytical tools

• Additional analytical tools may have limitations due to howdata is stored within the database infrastructure or becauseof reporting functionality weaknesses

Establish Baseline Reporting Capabilities

• Engage the team• Meet with staff

• Map the current workflow

• Define workflow problems

• Develop strategies

• Identify super-users

Team-Based Approach

Electronic Medical Records

Business process

and workflow

Specialty content and

workflow

Establish Internal Protocols to Prepare for Client Visits

• Improve Efficiencies/Protocols

• Construct a client visit check list

• Review encounter documentation with prep time prior to client visit

• Review roles and responsibilities with teammembers working to the maximum of theirlicenses

• Confirm measures and access to data

• Assess data quality

• Understand data quality issues (i.e., perform a data quality review).

• Develop strategies and tactics to resolve the issues and enable performance reporting that accurately reflects the quality of care

Using Performance Measures for Data Reporting

• Structured Data from Templates• Identify workflows to capture critical data and reduce burden• Data capture for meeting reporting requirements

• Create Patient Registries• Patient tracking and monitoring• Identify and address care gaps

• Care management• Snapshot of your entire client population and focus on individuals

with chronic/acute illness• Standardize screens and reports• Flags and alerts when out of range• Satisfy reporting requirements

• Updating dashboards and data following client visit

Reports and Dashboards

Action Items

• Work with your team and as a team

• Develop workflows that serve you

• Shift tasks appropriately

• Maximize efforts to learn and use your EHR

• Capture the data that is needed and confirm that data meets reporting requirements

• Use patient registries and reports

EHR Optimization Strategies

Tips to optimized utility of your EHR

• Team based approach

• Establish protocols

• Advance preparation for client visits

• Document the encounter on the EHR

• Create patient registries and reports for tracking

Learning Objective 2

1. Define Behavioral Health processes, administrative and patient Workflows

2. Understand how Behavioral Health EHR reporting is structured on an EHR and how to create customized reports

3. Understand “best practices for working with your EHR vendor for optimal use of the EHR functionality

IMA is a boutique software company whose mission is to work collaboratively with our clients and embrace their challenges as our own. Barry runs the company which his father Michael Samel started some 30 years ago. Barry has a Master’s degree in Information Technology from Johns Hopkins University and has spent his entire professional career designing software solutions for the Behavioral Health sector. He has a passion for creating simple solutions to complex problems and is deeply involved in the development of imaServe. He continues to take his vision for the software forward to create quality products that make our customers lives easier while adhering to rigorous standards.

We are focused exclusively on Behavioral Healthcare providers in New York State. We have an incredible team of professionals who have the experience and knowledge to accomplish our mission

• Our History• 1976: We were established as a customer software company• 1990: We rolled out imaServe Gen 1, our Behavioral Health EHR and Billing application• 2014: We introduced imaServe Gen 3, our Web based EHR• 2019: 95% of our business is serving Behavioral Health providers in NY State

www.imasys.com

Presenter: Barry Samel, President of IMA Systems LLC

Reporting from Your Behavioral HealthEHR

How do you leverage your Behavioral Health EHR tosatisfy your reporting requirements?

What is in the EHR: Providers Perspective

• Demographics

• Episodes of Care

• Clinical Documentation

• Claims data

What you need to report

• Compliance

• Patient Care

• Supervision

• Productivity

• Revenue

• Clinical Quality Measures (CQM)

The Roadmap

• Know your EHR

• Translate the EHR data to the reporting code sets

• Examples using eCQM and HEDIS

• Define your reporting requirements

• Partner with your EHR Vendor

My EHR• Caseload: Face sheets, Registration &

Program Enrollment• Appointments• Assessments & Tools• Treatment Plans• Progress Notes & Services• Vitals, Lab Results, Medications, and

Allergies• Events and incidents notifications

My Reporting tools: Different methods to access my data

• Basic: Online Lookup & Spreadsheets• Intermediate: Ticklers & Dashboards• Advanced: eCQM & HEDIS• External tools: Crystal Reports & MS

Power BI

Know Your EHR

Clinical Data Code Sets• CPT: Encounters https://www.ama-assn.org/amaone/cpt-current-

procedural-terminology• HCPCS: Encounters, and Results

https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets/in dex.html

• LOINC: Results, Interventions, and procedures (https://loinc.org/)• SNOMED CT: Diagnosis, Encounters, Results, Interventions, and

Procedures https://www.nlm.nih.gov/healthit/snomedct/• RXNORM: Medications

https://www.nlm.nih.gov/research/umls/rxnorm/• ICD: Diagnosis

https://www.cms.gov/Medicare/Coding/ICD10/2018-ICD-10-CM-and-GEMs.html

Revenue Code Sets• Adjustment Reason codes http://www.wpc-edi.com/reference/• Remittance remark codes http://www.wpc-edi.com/reference/

Non Standardized Code Sets• Clinical Event Notifications-external sources (Hospitalizations)

• Revenue: Receivables, Write-offs, Denials

• Technical: Audit Trail: Event log and change log files

Translating the EHR Data to the ReportingCode Sets

CMS 160 Depression Utilization of the PHQ-9 Tool

Description

The percentage of patients 18 and older with a diagnosis of major depression or dysthymiawho have a completed PHQ-9 during each applicable 4-month period in which there was a qualifying visit

The data definitions: See ushik.ahrq.gov (registered users)

• Age 18: Age at the start of period, end of period, or date of service

• Major depression: Group of ICD codes• Dysthymia: Group of ICD codes• PHQ9: LOINC code for PHQ9

• Qualifying visits: CPT codes for qualifying visits

Exclusions

• Patients who died, who received hospice or palliative care services, who were permanent nursing home residents, with a diagnosis of bipolar disorder, with diagnosis of personality disorder

An Example Using eCQM

NCQA HEDIS:https://www.ncqa.org/hedis-2018-measures/

• Each measure has a value code set associated with it that specifies code sets for the data

• Includes some previously atypical use of the code sets• BMI: Set BMI as a diagnosis• Tobacco use: CPT codes to

indicate smoking status• Screening for Clinical

Depression: HCPCS codes

NCQA HEDIS Measures

External reports

• Know the technical requirements

• Understand how your EHR data maps to these requirements

Internal reporting

• Understand what the recipient is really looking for

• Multiple approaches: There is usually more than one way to get at the information being requested

• Incremental: Start with a basic report, review the results, then add the complexity one step at a time

Define Your Reporting Requirements

Levels of Engagement:

• Training

Invest in training to learn what reporting tools are available

• Consulting

Engage them in consulting to help you translate your requirements into simple and meaningful reports

• Collaborating

A partnership with your vendor is the basis for successful outcomes

Partner with Your EHR vendor

Learning Objective 3

1. Define Behavioral Health processes, administrative and patient Workflows

2. Understand how Behavioral Health EHR reporting is structured on an EHR and how to create customized reports

3. Understand best practices for working with your EHR vendor for optimal use of the EHR functionality

• Identify the need (i.e. Training, enhancements/configuration and bug fixes)

• Identify a point person at the organization (i.e. Superuser)

• Understand the vendor organization and how to contact the appropriate personnel (“Help Desk vs Account Manager”)

• Identify community partners that use the same EHR vendor and explore collaboration in getting the vendor engaged and committed to a timeline

• Understand the vendor’s software development life cycle (Roadmap)

Vendor Engagement Strategy

Vendor Work Groups

• Office Hours• Receive personalized technical assistance and attention to your Health Information

Technology (HIT) needs

• Date: April 17, 2019

• Session 1: 11am – 12pm

• Session 2: 1pm – 2pm

• Vendor Workgroup Launch• Come collaborate with other organizations utilizing your EHR and learn best practices on

how to optimize your system

• Date: April 29 – May 6, 2019 at 2–3pm

• Third Webinar Quality Improvement and Value-Based Care

• Date: May 28, 2019 from 12 - 1 PM

• Learning Management System Organizations may access the LMS library of resource material by sending an email to CareTransitions@TheNationalCouncil.org

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Learning Collaborative Opportunities

Questions

Resources

1. Agency for Healthcare Research and Quality: Using Health Information Technology to Support Quality Improvement in Primary Care

2. The Office of the National Coordinator for Health Information Technology: Capturing High Quality Electronic Health Records Data to Support Performance Improvement

3. The Office of the national Coordinator for Health Information Technology: Health IT Playbook

4. The Office of the National Coordinator for Health Information Technology: How Will Adopting Electronic Health Records Improve My Ability to Care for Patients?

5. U.S. Department of health and Human Services, Health Resources and Services Administration: Managing Data for Performance Improvement

Thank you!

www.CareTransitionsNetwork.org

CareTransitions@TheNationalCouncil.org

The project described was supported by Funding Opportunity Number CMS-1L1-15-003 fromthe

U.S. Department of Health & Human Services, Centers for Medicare & MedicaidServices.

Disclaimer: The contents provided are solely the responsibility of the authors and do notnecessarily represent the official views of HHS or any of its agencies.

IMA Systems, LLC

Creators of

Thanks you

www.imasys.com

Zevi@imasys.com

Serving New York State for over 30 years

Contact us for all of your EHR needs

40 Worth Street, 5th Floor / New York, New York 1001399 Washington Avenue, Suite 1750 / Albany, New York 12260