Kristin Sunanta WalkerCEO

Scott LloydPresident

kristin@everythingehr.comScott.Lloyd@mtmservices.org

What’s Your Problem? You or Your EHR!You or Your EHR!

M ki Th Ri ht D i i f ASpeaker Name

Title

Making The Right Decisions for your Agency

Organization

The Impacts of Implementing the Wrong EMR/EHREMR/EHR

Access - The Key for Success

Client Calls for Help 

Assessment Appointment 

Wait Time # 1

Treatment Planning Appointment 

Wait Time # 2

Client Arrives for an Open Session

Wait Time # 3

 

Client Arrives for an Open Session

How did We Get to Here?

S t N iSystem Noise –Anything that keeps staff from being y g p ff f gable to do the job they want to do: 

Helping consumers in need!Helping consumers in need!

How did We Get to Here?

Areas of System Noise

1. Dealing with consumers angry about the wait2. Dealing with a poorly functioning EMR3. Dealing with No Shows/Late Cancellations

1. Medication Call Ins2. Rescheduling/Crisis Events3. Direct Service Production Hits

4. Naturally Occurring vs. Structured Downtime

What We Do To Help Teams • Collaborative Documentation – MTM has trained over 500 teams on this concept that utilizes

Progress Note Flow / 7 5 Minute Completion Time

pdocumentation in session to better engage the consumer and confirm that the service provider and recipient are on the same page in regard to the direct and progression of the services being delivered. This process boasts a 97% approval rating from consumers and care providers, and works for all types of services including med team services.

Progress Note Flow / 7.5 Minute Completion Time 

• Same Day Access – MTM has moved more than 500 teams through this process that allows teams to offer assessments on the same day they are requested, without a scheduling delay or waitlist. This process greatly improves consumer satisfaction and engagement while also eradicating no shows in

Requires a Solid Diagnostic Assessment that can be completed in 60 minutes or less

process greatly improves consumer satisfaction and engagement, while also eradicating no shows in the assessment process!

• JIT Prescriber Scheduling An offshoot of Same Day Access now implemented with teams in more• JIT Prescriber Scheduling – An offshoot of Same Day Access now implemented with teams in more than 10 different states, this process allows teams to move a consumer from their diagnostic assessment to a psychiatric evaluation within 3 to 5 days, greatly increasing engagement and reducing no shows and cancellations. This move improves that consumer's experience and the staff member's quality of life by removing obstacles like non-billable med call-ins that generate high levels of

Requires a Solid Psychiatric Evaluation that can be completed in 60 minutes or less

frustration. A properly set up JIT program will generate positive clinical and financial results within the first few months, one of our teams saw a 10 to 1 return on their investment in the first 90 days of operation!

It’s Not About the Nail

Top EMR Fails:

– Slow Boot Times– Doesn’t Work in the FieldDoesn t Work in the Field– Format/flow does not match up with a good

clinical flow for the session– Click, Click, Click, Click, Click, Click, Click….– Crashing at time of form submissionCrashing at time of form submission– Never fully implemented (Have you checked for lawsuits?)

It’s Not About the Nail

Are you in De-Nail? (Intentionally misspelled)

• Do you know how much $$ we have spent?• Do you know how much time we have in?• Do you know how upset staff would be?• We looked at all the others before.

• What it feels like to be a Consultant….It’ N t Ab t th N il!It’s Not About the Nail! (Source http://www.jasonheadley.com)

It’s All About the 80%

• “Unfortunately, most executives don’t recognize that consumer IT and enterprise IT are different animals. They don’t understand that they must play the pivotal role in thedon t understand that they must play the pivotal role in the critical decisions that shape enterprise IT — decisions that they leave to the likes of Yahoo, Apple, Google, and Vodafone in the consumer world.”

Source - https://hbr.org/2015/12/executives-get-the-it-they-deserve

• Loose translation – Any EHR/EMR can stink if you set it up incorrectly!

Are o reb ilding hat doesn’t ork no ?

It’s All About the 80%

• Are you rebuilding what doesn’t work now?– Knowing what you want is 80% of the set up!

GAP A l i / D M i– GAP Analysis / Data Mapping

– Can your Vendor Build it?

It’s All About the 80%

Will your system give you the ability toWill your system give you the ability to measure data/outcomes?

CCBHC Metadata Requirements for your agency

It’s All About the 80% CCBHC Metadata Requirements for your agency and/or any DCO agencies

1. Number/Percent of clients requesting services who were determined to need routine care

2. Number/percent of new clients with initial evaluation provided within 10 business days, and mean number of days until initial evaluation for new clients 

3. Mean number of days before the comprehensive person‐centered and family centered diagnostic and treatment planning evaluation is performed for new clients 

4. Number of Suicide Deaths by Patients Engaged in Behavioral Health (CCBHC) Treatment 

5 Documentation of Current Medications in the Medical Records5. Documentation of Current Medications in the Medical Records 

6. Patient experience of care survey 

7. Family experience of care survey 

8. Preventive Care and Screening: Adult Body Mass Index (BMI) Screening and Follow‐Up 

9. Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents (WCC) (see Medicaid Child Core Set)g g y y / ( ) ( )

10. Controlling High Blood Pressure (see Medicaid Adult Core Set)

11. Preventive Care & Screening: Tobacco Use: Screening & Cessation Intervention 

12. Preventive Care and Screening: Unhealthy Alcohol Use: Screening and Brief Counseling 

13. Initiation and engagement of alcohol and other drug dependence treatment (see Medicaid Adult Core Set) 

14. Child and adolescent major depressive disorder (MDD): Suicide Risk Assessment (see Medicaid Child Core Set) 

15. Adult major depressive disorder (MDD): Suicide risk assessment (use EHR Incentive Program version of measure) 

16. Screening for Clinical Depression and Follow‐Up Plan (see Medicaid Adult Core Set) 

17. Depression Remission at 12 months 

• Will your system give you the ability toIt’s All About the 80%

Will your system give you the ability to measure data/outcomes?

Making that All Important SelectionMaking that All Important Selection

It All Begins Before You Start Demos• The research and demo process can tell you almost

everything you need to know about an EHR vendor. Do you have time and the staff to traverse this rocky road on your y yown?

• This isn’t your first rodeo with an EHR. Work with vendors that have nothing to hidethat have nothing to hide

• You have a problem? Some vendors WILL solve it. How much pain, time, $$ will it take to create solutions for your

i ti ?organization?• Are you buying a Yugo that looks like and runs like a

Yugo because it’s “inexpensive” but boasts a lot of g pfeatures? (This will cost you more in the end) or are you buying a Yugo that looks like a Ferrari?

How We Vet an EHR – The Dreaded RFIOur guiding principle is “Trust, But Verify”

– Sales demos can represent a vendor’s best marketing efforts– Sales reps will explain everything s/he wants you to know– References must be current and include an experienced user

base, but they don’t (necessarily) give you the real picturey ( y) g y p– An advisor can share what is going on with all the vendors in

the marketplace because we study them– Go beyond the vendors “sales speak” What an advisor can– Go beyond the vendors sales speak . What an advisor can

ask and get answered that no agency can– What tools should your organization use to create a unique

request for information?request for information? – Where did your vendor selection come from?

Who Created the Product and Why?Who Created the Product and Why?• Is a founder a clinician using the product in their own successful

Behavioral Health organization?I f d d d ft i ?• Is a founder a degreed software engineer?

• How can you document company profile?– Staff profiles and credentials – Staff size or how many actual employees work for this vendor?

• What is “unique” about what they have to offer the field of behavioral health? – Wrap Around Care Coordination, Artificial p ,Intelligence, etc.

• Founders are major contributors in the field of Behavioral Health –such as invited speakers at events like NatConp

• Staff are recognized leaders in Behavioral Health: authors, counselors, certified billers and coders, former insurance auditors, etc. Quality leadership attracts qualified personnely p q p

Who is the Face of the Company? ?What is their Representation?

• Is CEO a speaker at national conferences about Behavioral Healthcare Technology an invited guest on radio shows or theHealthcare Technology, an invited guest on radio shows, or the author of multiple publications in Behavioral Health?

• Is CEO front and center in their marketing material?• Has the CEO built company to be comprised of multiple vendorsHas the CEO built company to be comprised of multiple vendors

selling and supporting the product - or - are they staffed appropriately for the size of all of the agencies using their EHR?

• Has the CEO been able to acquire funding to enhance their product?

• Is there a Board of advisors/directors that actually use the product on a daily basis, meet regularly to enhance the product, are industry experts specific to mental health or is a list of random people onlyexperts specific to mental health or is a list of random people only there to make a small vendor look like a large organization?

• Is the product Behavioral Health specific?

Where are their Dollars Spent?• On Capterra, Software Advice, Technology Advice (All great lead generation p , , gy ( g g

organizations where EHR vendors pay a premium to be listed so you will find them), Google Ad Words and/or on development of their product

• Pushing a nonsensical and false marketing agenda• Leaving a trail of vendors and clients that have tried, and failed, to work with

this company and its software• How important is supporting the solo provider vs. multi-county agencies?• Cleaning up poor reviews of their product, such as multiple complaints of “slow

loading” on public sites vendor blaming agencies for having slow Internet• Adding features already in most products – playing catch up with their

technology vs trail blazing new initiatives involving coordination of caretechnology vs. trail blazing new initiatives involving coordination of care• Leaving agencies without the ability to bill a single claim in over a year but still

able to obtain a great testimonial from the agency in exchange for free services?

• Forcing agencies to pay monthly and on-going fees when they leave a system while claiming publicly they “never hold data hostage”?

How Current is Technology?I d t b b d b b d?• Is product browser-based or web-based? – Does it need to be installed on every device for optimal use? – How many times has the software program been rewritten since

initial creation?– Will it meet CCBHC requirements, integrated care, etc. with the

same new technology that general EHRs are using (browser-based tools developed in the last 3 years)?

– It Doesn’t Work if You Can’t Click It! – Are users expected to adjustIt Doesn t Work if You Can t Click It! Are users expected to adjust screen resolution to fit the EHR or has the vendor developed a product that auto-adjusts to EVERY device?

• Can the program be used optimally on all mobile platforms (Cross-Platform)?Platform)?

• Beware of extra fees for the functionality you need. Windows platforms have gone the way of the typewriter. Look at what has dominated every industry with browser-based solutions (TurboTax, Netflix, Amazon, Salesforce com and the general EHR market)Salesforce.com, and the general EHR market)

• Are they still “pulling and pushing” those 835/837 text files? Direct integration with multiple clearinghouses is a must

Company Trajectory• How long have they been in the EHR business? Has the company

seen a steady increase in its staff size over their tenure?seen a steady increase in its staff size over their tenure?• Have they rewritten their user interface recently?• Can you see steady company growth over time?

– Are they positioning to be bought out by a larger, general EHR?Are they positioning to be bought out by a larger, general EHR?– Would a general EHR even be interested in their technology?

• The “Whoops!” Factor. Why consultants know which vendors have cost agencies thousands of dollars over-promising and under-deliveringdelivering

• What does their trajectory mean for the end-user?– Are their fewer staff than in your own practice?

• Will the personnel or outsourced vendor that just sold you the• Will the personnel or outsourced vendor that just sold you the product also be doing support, training, and implementation?– Do they have separate departments dedicated to training,

support, client satisfaction, and development? • Do they have stellar staff who have worked with competitive

vendors??

• Have the staff of larger EHR vendors left? Which vendors do they end up working with?end up working with?

Let’s Compare!C A F d d b li i i d ft iCompany A: Founded by clinicians and software engineers

– Steady growth every year. Surpasses the Fortune 100 or Fortune 1000 mark with an excellently staffed organization and stellar credentials – staffed by YOUR PEERSy

– Rock solid implementations (user renewal rate at 90% or higher)– Did not start significant marketing campaigns until they were

stable enough and their grassroots efforts built a solid user base in all fifty statesin all fifty states

Company B: Not founded by a clinician or software engineer– Organization started around the same time as company AOrganization started around the same time as company A– Fewer than 15 employees to date– 80% of their revenue is used to purchase leads and market the

productIn whose technology should your organization be involved? Whose organization should have FULL ACCESS to patient mental health records?

It’s Not Always a Vendor Problem

• There are great EHRs devoted to Behavioral Health on the market todayon the market today

• Perform due diligence using a checklist• Consult with an independent advocate for your p y

agency, not just the EHR vendor• Has an advisor ended their praise of an EHR vendor?

A k th h ?Ask them why?• Is your agency culture ready to support an EHR

change?change?

Think you’ve found the perfect EHR?  Please introduce me to your Uncle Big Foot that rides Unicorns over Rainbows!

JW3

Slide 24

JW3 Joy Wanden, 7/31/2015