Understanding a Client's Risk Level Is Difficult or Requires Too Many Steps
One of the biggest indicators of how well your EHR is meeting your organization’s needs can be seen in triage capabilities. The right EHR for mental health providers helps to identify individuals who need care the most with in-the-moment risk scores by allowing users to define risk factors and customize rules for managing clients according to characteristics, such as past suicide attempts or hospitalizations in the past 30 days. These capabilities provide faster risk screening and routing so that behavioral healthcare providers can triage care where most needed.
An EHR designed around behavioral health workflows also makes it easier to then tie these screening activities to related assessments within the records and continue the efficient information capture through treatment planning, monitoring and ongoing progress notes. Behavioral health providers also can benefit from tools that will take clinical data and provide diagnostic support, integrate appropriate clinical guidelines, prompt with meaningful reminders and aid reporting by prepopulating reference information.
Telehealth Visits Require Leaving the Platform
According to a report published by Fortune Business Insights, the behavioral healthcare market is predicted to grow from $77.62 billion in 2021 to $99.40 billion in 2028. This means that organizations must find ways to serve more clients. Telehealth and mobile access play an important role in making staff available to a wider geographic area and on a more flexible schedule.
But not all telehealth visits work the same. When an EHR requires clinicians to move between different systems, it creates frustrating complexities and needless delays. Modern EHRs for mental health providers allow clinicians to instantly conduct a telehealth appointment without leaving the platform. This seamlessness in transitioning between in-person and virtual care delivery is a better use of time and results in less provider frustration. Over the course of each day, the capability can have a significant impact on overall productivity and the experience of delivering care.
Coordinating Information Across Care Settings Remains a Challenge
Being able to share records with other providers is a critical need for behavioral health providers. A client diagnosed with a mental health condition, substance use disorder or other behavioral health condition often will have other co-existing health issues. In fact, 6 in 10 adult Americans have one chronic disease, and 4 in 10 adult Americans have two or more. Further, it is expected that people living with multiple comorbidities will more than double by 2050.
As an example, a client diagnosed with an eating disorder may have cardiac irregularities. In this case, the behavioral healthcare provider and primary care physician and/or cardiologist working together will best serve the client. Risk factors in the client's life, such as a change in activity level, may prompt joint discussion of a medication shift or other interventions. As care continues to become more integrated, those providers whose data is protected—but not siloed—in a behavioral health EHR will be best positioned for success.
Understanding Impact of Payment Change Remains Elusive
The business environment for behavioral healthcare is becoming increasingly complex. Value-based care arrangements depend on accurate documentation that demonstrates the link between intervention and outcome.
To keep pace with this shift in payment, EHRs with evidence-based prompts specific to behavioral health will be a differentiator. To identify measurement-based best practices, EHRs will need to recognize differences among subsets of client populations receiving interventions. Dashboards must be intuitive and reflect the specific metrics most important to the organization and user. Contract modeling also becomes more complex—and requires a more sophisticated EHR designed for behavioral health—to effectively project total costs of care.
Clinicians Are Struggling to Adapt Their Processes to the EHR
One of the most overlooked aspects of an EHR’s impact on an organization’s competitiveness is user experience. Observe the way your EHR is used at your organization. Does the home screen look the same for every user, regardless of role? Do your clinicians pause to find a screening tool? If the clinician steps away for a moment, do they need a few moments to pick up where they last were?
These are all small “tells” that the behavioral health EHR isn’t aligned well around user workflows. When researchers with the Office of the National Coordinator for Health Information Technology interviewed 43 behavioral health clinicians and health IT administrators to analyze EHR adoption barriers and facilitators, the importance of EHR usability was clear. Of the top seven barriers, three are connected to user experience: computer literacy, EHR system complexity and steep learning curve.
EHRs with an intuitive user experience can ease the burden on staff. Always assess your EHR by its ability to support clinicians in practicing how they want to practice. The right EHR will work nimbly with the clinician’s preferred behavioral health workflows, auto-populating and bringing just-in-time information rules-based best practices and insights to the forefront as needed, so they support the natural way a clinician works.
Accurate Health Tracking and Outcomes Measurement
Mental health providers, substance use disorder clinicians and others practicing in behavioral health settings need infrastructures that can effectively reflect a client's health before and during treatment. This will require accurate and complete capture of client demographics; appropriately timed screening, diagnostic and assessment workflows as well as structured data in progress notes.
The right EHR will also provide easy access to a client's current and previous test results. Real-time transparency decreases the likelihood of inefficiencies and preventable errors, such as test duplications or diagnoses formed by incomplete information. Simplifying management of this information can improve client care and increase the efficiency of testing and coordinating care with other providers.
Workflows that Enable Evidence-Based Interventions
Assessing treatment progress and recognizing the need for intervention or follow-up is a critical component of behavioral health treatment. To that end, alerts with triggered workflows are important. An effective EHR will notify providers about needed screenings and assessments at certain points of care or when symptoms dictate. In addition, the EHR should supply clinicians with evidence-based decision support. Evidence-based prompts can be built into the behavioral health workflow to provide timely access to practice protocols, which in turn helps providers align their care plans with clinical best practices. With these behavioral health workflow supports, organizations can increase their opportunities for meeting quality goals over time.
Seamless Data Capture and Alerts to Support Payment
Quality metrics change over time. Thus, for your organization to have the most flexibility, your EHR should be able to configure billing as needed to payer-specific business rules for claims payment and automatically capture associated data. Behavioral health and mental health documentation software needs to consider the entire data set required for payment. As an example, pre-built alerts can help meet regulatory requirements, such as the Physician Quality Reporting Initiative (PQRI), as they notify providers that they need to complete associated data elements to optimize billing functions associated with the value-based contract.
Open API Technology to Enable Efficient Care Coordination
A secure, open application programming interface (API) is used for different software applications to safely communicate with each other––a critical feature for the exchange of healthcare data among providers. For behavioral health providers, coordinating care with primary care physicians and others is crucial for clients’ health. A mental health care client management system needs to reflect the full continuum of care being provided and how that interaction impacts client care plans. With some payers structuring payment around episodes of care, the ability to collaborate becomes only more urgent.
Strong Communication Systems to Support Client Engagement and After Care
The success of any treatment plan depends upon the client's level of engagement. Things like ease of appointment scheduling, ability for clients and providers to communicate directly with each other and the capability to directly share forms and other information—such as screenings—through a client portal all can positively impact care outcomes. Workflows that automatically trigger follow-up alerts for appointment scheduling can reduce the likelihood of gaps in care.
Performance Analytics and Meaningful Business Intelligence
Behavioral health organizations depend on meaningful data to identify performance trends, recognize best practices, and drive widespread improvement. The right technology will support gathering and tracking quality performance at an individual and population level. What’s more, business intelligence needs are complex with value-based arrangements. Providers must be able to determine and predict the true costs of care. The right EHR will also help when calculating likely performance scenarios under different contract terms and with different client populations.
Support for Evidence-Based Practices and Decision Support
Behavioral health providers should look for an EMR/EHR that provides support for evidence-based practices without disrupting their preferred workflow. For example, providers should be able to track client progress within the EMR/EHR, such as through the use of PHQ-9 questionnaires. The provider should be able to view a graph of a client's scores over time to determine whether adjustments to the treatment plan should be made. Behavioral health/psychiatry EMR templates that enable efficient chart evaluation, follow-ups, medication management and more should be integrated into the system.
Ease of Adjusting to Changing Reimbursement Landscape
Providers participating in value-based reimbursement contracts with payers must have the ability to conduct target costing and model risk. When negotiating rates, they also need to be able to determine margins and profitability. The scheduling system should be embedded in the platform and capture appropriate billing data from the scheduler. Session information should automatically be carried over from the scheduler and the progress note so that your practice can generate an accurate and complete claim.
Risk Identification and Steerage
Risk identification is critical in behavioral health, but it is usually derived from claims or encounter data. Providers should be able to develop a risk model using data available in the EMR/EHR. As discussed earlier, the right technology allows providers to set risk scores using past hospitalizations or suicide attempts, comorbidities or other parameters. With that information, the system can alert providers to clients who should be triaged for immediate care and appropriate follow-up. This enables providers to maximize their workforce and deploy the right staff to care for those most in need.
Embedded Telehealth
According to the Health Resources & Services Administration, 153 million people live in areas with high shortages of mental health professionals, making access to services difficult, if not impossible. Telehealth expands a provider’s reach and can improve access to care for those who do not live within proximity of a provider. Of particular benefit is the ability to have telehealth embedded into the behavioral health EMR/EHR to reduce the amount of time clinicians spend switching between systems or troubleshooting. This provides a seamless experience for providers who have already become comfortable with the EMR/EHR.
Enhanced Business Analytics
To manage costs and support profitability, behavioral health practices need to be able to track and analyze the performance metrics that matter most to them. These can include clinician performance, claims denial management or shifts in client population health. Real-time analytics should be available and driven by role-based access rules so only appropriate staff are able to view them.
Scalability
Consider an EHR’s ability to easily grow with changes across your organization. Solutions that easily facilitate configuration based on role, function or practice type versus individual set-ups are far easier to implement across many users.
The best technology will also feature a customizable modular design. The most effective way to introduce a new EHR platform is to work with templated workflows and then adjust by user preference or preferred process.
Also, a common foundation eases the training burden and makes it easier to implement changes across the system. Modules that introduce best practices into the organization’s processes can also support improved clinical and financial performance. A behavioral health EHR needs to be adaptable to the organization’s needs, so it continues to be functional as number and type of clinical programs and users increase over time.
User Experience
Functionality can greatly affect an end user's experience. If a clinician doesn't have usable or easy-to-navigate charting processes and documentation options, the clinician is likely to find the system cumbersome and disruptive to their way of providing care.
In a Medical Economics study, at least 70% of physicians unhappy with their EHRs preferred to switch to systems that were more "user-friendly" but were deterred by costs, EHR training curves, and a lack of superior options. A few functions that positively affect user experience and can help practices implement a new platform successfully are:
- Tailorable templates designed for behavioral health
- Pre-built template options
- Adaptable operations
- User defined workflow processes
- Just-in-time access to information, such as screening and assessment tool results
The configuration of an EHR should ultimately be designed to promote better coordination of care and to reduce the workload of clinical and administrative staff.
EHR Training
The quality of a training approach will significantly affect user adoption. Insufficient or ineffective training will often result in users not understanding or making full use of the technology’s capabilities. Users may believe that the new EHR is hard to operate and navigate, is missing features that would allow some processes to be automated, is overly complex or has a poor design.
The best way to implement effective EHR training is to:
- Create EHR training plans based on the needs and workflows of the practice’s end users
- Simplify the training approach and cater to the user’s current technology literacy skills
- Schedule ongoing training
- Turn quick learners into super users (having designated department staff that can answer questions after the implementation and support phases significantly aids EHR high adoption success)
Making time for training is a critical component of implementation. Organizational leaders should consider scheduling learning sessions by temporarily restructuring everyday workflows. This necessary step may feel intrusive to a team already busy with daily operations, but the benefit will make EHR training far more efficient. If possible, trainees should have blocks of dedicated, uninterrupted learning opportunities to best accommodate their learning styles.
EHR Support
Often, behavioral health EHR implementation falls short when it comes to ongoing training and technical systems support. An organization should have a plan for maintaining success after it goes live with the new platform. Although end-users may receive proper training, they are also likely to have questions or need additional guidance the more they use the system and encounter unique situations. Ongoing communication with an EHR support representative can help move your team beyond basic user comfort to mastery, which ensures that the potential of the system is reached. Be sure that the system includes on-demand, context-sensitive “Help” documentation.
While live support after the EHR implementation is essential to continued success, it is equally as important to maintain the system by taking steps, such as:
- Performing general risk assessments regularly
- Having an administrator review audit logs
- Staying on top of system updates
In addition, it should be easy to reach your EHR vendor’s support teams and expect timely responses to your queries. To make it easier for the technology to adapt and align with organizational changes, your vendor should also support a continued relationship.
Behavioral Health Medical Billing and Collections
Because of the variety of billable services—such as types of treatments, length of sessions and care across specialties—behavioral health medical billing can be complex and more difficult to standardize than physical healthcare. As a result, clients’ behavioral health needs may exceed what an insurance company is willing to cover, leaving providers to balance an effective treatment plan with adequate payment. Unfortunately, due to the many regulations surrounding behavioral health medical billing, many providers fail to collect all that they are owed, with some estimates putting the percentage of successful collections for services rendered between 75% and 85%. Inefficient or incorrect documentation can further complicate matters. Services that are not coded properly can lead to claims that are denied and wasted time on appeals. Furthermore, missing a payer’s timely filing deadline can result in lost payment.
One of the most meaningful ways the right behavioral health EHR can improve the billing and collections process is by reducing the risk of human error. There are more than 68,000 codes in the ICD-10-CM — much more than one person can be expected to memorize. By using an EHR, your organization can be better assured that the right code is entered for the right service. Submitting a clean claim expedites the payment process by ensuring that the insurance company and the client pay the correct amount.
Clinical Efficiency and Workflows
A behavioral health EHR can automate existing manual processes, such as intake forms and client histories. The ability to submit forms digitally allows the client to complete them ahead of time, and that information automatically updates to the EHR. This also means that providers can spend more time caring for clients when they’re in the clinical setting. EHRs with behavioral health templates can also allow providers to document common symptoms more quickly than filling them in manually.
Business Intelligence
Nearly 30% of the world’s data volume is generated by healthcare organizations, and a single client generates almost 80 megabytes of imaging and EMR data each year. Mining this data can provide valuable insights that lead to higher quality client care and improved business operations. Integrating business intelligence into an EHR enables better care coordination and risk stratification, provides potential medication interaction alerts and can aid in the development of treatment plans.
Value-Based Care and Reimbursement
With the healthcare industry’s steady transition to value-based payment, providers must be able to demonstrate that they are improving clients’ outcomes and experience in order to collect payment. Value-based care has six key elements:
- Safety
- Timeliness
- Effectiveness
- Efficiency
- Equitableness
- Client-centeredness
EHR platforms can help providers achieve each of these elements by making accurate client information more readily available. A comprehensive view of a client’s health allows providers to potentially identify mental illness or substance use disorder earlier and consequently intervene as quickly as possible. Furthermore, screening and assessment tools built into EHR solutions allow providers to effectively document and track any changes to a client’s health status throughout the course of treatment.
Cloud-Based Benefits
Cloud-based EHR solutions eliminate the need to manage on-premises servers and hire IT staff to support this technology—a significant benefit. Depending on the size of the organization and its client load, staffing and hardware costs can become daunting quickly and possibly grow significantly each year. With cloud-based solutions, the EHR is managed remotely by the vendor. Money that would have been spent on managing in-house servers and staff can be allocated elsewhere.
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