On November 12^th, Senator max Baucus gave us some insight into where healthcare reform in this country will be headed under the new leadership.  He published a white paper, Call to Action Health Reform 2009. 

In this document he laid out a plan that had three main goals:  1)  Ensuring health coverage for all Americans; 2)  Improving health care quality and value; and 3)  Achieving greater efficiency and sustainable financing.  In the white paper he discusses that we may have reached a tipping point where the main stakeholders in the process – consumers, businesses, labor, providers, plans, manufacturers and state and local governments – cannot afford the cost increases and cost shifting any longer and are willing to engage in serious reform efforts. 

To achieve these goals he wants to set up insurance exchanges that allow all citizens to purchase insurance.  He would allow older citizens to “buy into” Medicare and lower eligibility to those seeking access to Medicaid.  This would increase the consumer volume for many of our clients. 

Key to his whole approach is an increased focus on quality of care delivered versus volume of care delivered.  I see payments in the near future tied to improving outcomes, or as it is known, pay for performance.  To achieve these measures he will increase incentives and investments in healthcare IT (something which President-elect Obama campaigned on).   In his press conference he discussed immediately allowing providers to be incentivized to implement electronic medical records by giving them the same 2% incentive that is now available to Medicare providers for using e-prescribing (see my blog e-prescribing incentives).

Obviously this is in the early stages of development, but I think the train has left the station.

Today I want to be less pedantic than I have been recently and have some fun. I've already written about John Kotter in my blog “A Sense of Urgency”. Now I have gone ahead and read his fable about change, Our Iceberg is Melting. It is about a penguin colony in Antarctica. A group of penguins live as they have for many years. Then one curious bird discovers a potentially devastating problem threatening their home. Initially hardly anyone listens. The fable tells about resistance to change and how dramatic change was successfully brought about. The characters are familiar in our own lives and work. You can even decide which character in the drama describes you best.

 

Kotter believes in the power of stories to communicate important ideas with emotional impact. Read this story. Share it with others on your team. Talk about his Eight Steps and how to accomplish them in your electronic health record implementation. There is even a website with more tips and, of course, materials for sale.

When designing the content of your electronic health record, you have lots to think about. I've just written about data format decisions with some examples.  Databases also permit you to place rule-based controls around Clinician use of options and fields in the EMR. These tools protect data integrity by preventing unauthorized input and protecting content from modification. They help ensure that Clinicians are capturing the same sorts of information and that you are getting the information your organization must have. An effective controls strategy enforces desired content while minimizing the inclusion of inappropriate and unnecessary data. The type and extent of controls also implement your organization's goals and policies.

 

In other words, they are a very useful set of functions in your design toolkit. Now, what do I mean by Controls?  Here is a list of some with examples:

·    Define access to options and fields as for input or "read only"– Denying input access to finalized forms protects the integrity of the content and of accountability. Denying access to (disabling) a time field that auto-fills with the current time prevents fudging the time vital signs were recorded.

·    Make fields required or optional for filing. Required fields ensure completeness and consistency. Optional fields invite the addition of relevant information in consistent formats.

·   Use event logic e.g., "If this response is selected, then this will happen." If the required item “Pain Present Y/N” is clicked “No,” then the initially disabled fields for Intensity and Location remain disabled, preventing extraneous data. If  “Yes” is selected, then the Intensity and Location fields become enabled and required, ensuring compliance with organizational policies about assessing pain in all patients.

 

Hopefully I am giving you the idea. This document shows more examples of Controls with Avatar screen shots.

 

But a caution is in order. Controls must be deployed judiciously. As in so many situations, the path lies in establishing a balance, this time between control and flexibility. All organizations have legitimate data needs. Explaining these needs to Clinicians should be part of the implementation process. At the same time, if content is too tightly controlled e.g. all or most fields are required, Clinicians will feel overly constrained with little room for expression of their professional expertise. They will resent the software for turning them into robots. Nobody wants that.

I realize that I jumped right in writing about EMR design. Without thinking, I just assumed that you would choose to develop content for your EMR that was customized by and for your organization. Obviously, you can opt for using an Off the Shelf solution. Let’s back-up a step and look at the pros and cons of content customization.

 

First the cons: these boil down to time and money. As I wrote earlier, content design is a team effort. It takes many meetings of a diverse staff group to develop a good design. (At UBHC the design workgroup had 29 members who met for a 1/2 day per week for three months.) The staff time costs money. There is no way around that. Also the time involved may extend your implementation schedule. Though this extension is not inevitable if you start the design task early. You can begin even before you select the Electronic Health Record application.

 

The pros boil down to facilitating staff buy-in and getting a better EHR, one that really reflects the information needs, workflows, clinical culture and policies of your organization. These issues are especially relevant to behavioral health organizations where humanistic values are high and industry standardization is low relative to physical health.

 

In my experience, leaders of EMR implementations define their greatest concern to be staff buy-in; so why pass-up the primary opportunity to engage clinical staff. I also have seen that those organizations, which began with an Off the Shelf approach, were invariably dissatisfied down the road. They turned to customization and then had to face the more difficult task of retrofitting their new information flows to accommodate what they already had in place. At UBHC the initial design remains sound eight years after the implementation.

 

So, is customization worth the effort? Clearly, I think it is.

The content of an EMR captures data to serve many masters. These include payors, regulators, accrediting entities, researchers and the organization’s managers. Most of all, however, it must serve the work between client and clinician. In my previous blog, I wrote about the need to recruit a workgroup of clinicians with a broad array of clinical skills and homes. Then what? Well, the next step is to educate them about the technical underpinnings of the project, namely about databases.

In my experience the early leadership in software implementations comes from IT professionals. So, since you are reading this blog about electronic medical record implementation, I assume that you are probably pretty computer savvy and technically informed.  But let me plead with you to assume that the clinicians on the design workgroup are neither. Sure they email, write documents, Google and shop online, but most likely they do not understand what a database is. Since clinical documents are one of the main EMR outputs, they think that the EMR is some sort of giant MS Word document.  Thus they make comments such as “Why can’t you spell-check the whole thing at once?” and they expect to read the clinical information that has been entered by accessing the inputs screens rather than by viewing a report.

When considering data capture and, especially, information flow it is essential for the designers to grasp the database basics: that information is captured in various data types in input screens and stored in columns and rows in tables and that reports pull the information from any available table.  

I have shown many clinicians this simple database schematic. The frequent responses have been as if it were a revelation. They told me that now they “got it;” that they felt enlightened and empowered; and that they were eager to get going on the design task. And all it took was about half an hour. 

As I wrote last time, when you are designing the content of an EMR you have to consider the dimensions of clinical culture, information flow, specific data capture and the use of controls. Good design also means finding solutions to meet the often competing needs of clinicians, management and, yes, the software.  It’s a complex process. I don’t claim to have all the answers, but over the past eight years as EMR implementation manager and then consultant for Netsmart Technologies, I have struggled extensively with the issues. 

First and most importantly, as the project manager for the implementation at UBHC, I did not struggle alone. We cast a wide net to recruit a workgroup of 30 members. The members were supervisors and line clinicians from all disciplines and levels of care as well as the leaders of all stakeholder departments. Here is a list of the participants if you want more details. Our charge was to design the structure and content of our electronic health record. We met for half a day a week for three months. The learning curve was steep. (more on workgroup education next time) The process was intense. The turf issues and, shall I call it, specialty narcissism were very much present. Together they created the major threat of “Content Creep.” This is a situation in which Staff want the details of their specific domains included and in their customary formats. The back-and-forth process eventually made it clear that to accommodate this range of domains would result in content that was too lengthy and complex. The phrase: “That item means 100,000 clicks per year…Is it worth it?” became a regular refrain.

By the time we were done, the participants had had the opportunity to understand the needs and concerns of wide range of functional areas and all LOC.  They were then able to make recommendations based on detailed knowledge of the information needs in balance with the realities of staff time and the software. The focused group process was powerful in setting the stage for the necessary compromises. Patience and determination were essential to discovering the solutions.

 So get your clinical leaders and line clinician “best minds” together and jump in. You don’t have to wait until vendor selection is complete. You can begin the content analysis and struggle now. They are generic.

The short answer to the title question is: everywhere. One definition of corporate culture is "How we do things around here.” It is the collective behavior of people using common corporate vision, goals, shared values, beliefs, habits, working language, systems, and symbols. It is interwoven with processes, technologies, and learning. A successful EMR implementation necessarily impacts all these domains.

In the late 90’s my home organization, UBHC, was being transformed from a community mental health center to a managed care oriented corporation. This meant a dramatic change in corporate culture. An electronic health record was at the heart of this transformation. Here are some examples. Professional identity would be challenged as appointment schedules became centralized and electronic. Clinical information would become more standardized and monitored. Communication would move away from face-to-face, often group settings to electronic methods. There was new attention given to productivity and efficiency. The financial needs of the organization were now a necessary and valid priority, which required all staff’s participation.  Fiscal staff needed to respect the work of the clinician as the source of revenues and clinical staff needed to contribute in the effort to successfully bill services.

The EHR implementation itself became the main vehicle of this cultural change.  Leadership and inclusive process were the key elements. These will be the focus of future blogs.

Also among the clinicians an apt, tongue-in-cheek phrase emerged: “Psychotherapy begins at home.” By this they meant that the frequent psychotherapy themes of recognizing and adapting to change had now become their own challenge. It told a truth that was clarifying, but uncomfortable. 

An effective electronic health record implementation requires oodles of collaboration among every slice and silo of the organization. Ideally such collaboration would be a given. But all staff members are human beings who tend to develop identities and loyalties based in shared relationships and experiences. In other words, locally. Enter turf as a perennial resistance to the change that comes with the move to an EHR.

At the time of our EMR implementation, my home organization had been in operation for more than 25 years. Many of the staff had been there for > 10 years. Place and people already had a long history together.

Factional divisions were plentiful; blaming the other was usual.  Many staff groups believed that their function was the crucial operation and that other functions existed to service their operation's needs.  There were adversarial relationships between programs.  For example, Inpatient staff thought a hospitalization was central to the treatment and that they could more properly diagnose and treat a patient based on their 24/7 observation. Outpatient staff, meanwhile, believed a hospitalization was a disruption in care and that they better understood the patient because of long-term contact in the natural setting.  Then there were fiscal staff who thought clinicians were too lazy to do correct documentation for billing, while clinical staff saw fiscal staff as lacking compassion. … and on and on. I’m sure there are 100’s of choice examples out there.

So what to do?  My condensed answer is to get them in a room together, give them a task and a strict timeline and tell them they must be successful.  Details to follow.

A recent article in the New England Journal of Medicine surveyed 3000 outpatient medical practices on their use of an electronic health record.  Among the many results was the finding that nearly 400 of the practices had already purchased an EHR system, but had not yet implemented it. There are many possible explanations for this. I want to use the finding to segue to talk about motivation and the implementation leadership. (The leadership may be one or several people.  Both configurations can work, and these thoughts pertain to both situations.)

There are many, many elements necessary for a successful EHR implementation (or I wouldn’t have material for an ongoing blog), but the implementers’ determination and energy are the primary forces driving an implementation through to its completion.

The organization’s implementers have to face the resistance of staff, the scope of the task and the personal effort level involved. They will probably develop feelings, such as anxiety, anger, frustration and their own resistance, which may look like procrastination, over planning, even letting themselves be persuaded that an EMR just cannot work in their setting.

The implementation leaders need to discern a personally important mission in the EHR project to support the deep and steadfast commitment that is necessary. As I wrote here in an early blog, for me the mission was to make the electronic health record serve the clinical work. The passion for this mission still energizes me.  

I’d like to hear other people’s thoughts, feelings and ideas about the mission for EMR implementers.

A recent article reports findings that uncertainty about Return on Investment (ROI) is a significant barrier to the adoption of Electronic Health Records. In my last blog, I introduced a monograph, “Measuring the Business Value of IT Investment,” by Craig Symons. He believes that financial measures are not enough when making decisions about IT investment.  In that blog, I presented his view about the lack of precision inherent in the financial measures.

Symons further describes that IT investments often provide intangible benefits which are hard to measure and so are left out of financial measures. Let’s think from the clinician’s perspective: No more trips to the record room; no more searching through pages of lab results for the crucial information or struggling to read months even years of hand-written progress notes to get the big picture of what is going on with a patient. (FYI I worked mostly with schizophrenic people who had long often-complex histories.) Confider that such delving into a difficult case would likely not occur at all with a paper chart because the process is so cumbersome and time-consuming. A well-designed EHR also provides decision support tools and links to the universe of knowledge on the Internet.

Symons also notes that IT investments produce not only immediate benefits but also provide opportunities for future benefits.  Consider the benefits to quality and cost of care in the potential for communicating with other providers. There is also the exciting opportunity to bring web-based interactivity to the patient-provider relationship.

Seems that the intangible and potential benefits truly deserve a place when thinking about an EHR implementation. 

Yet another look at the article on Electronic Health Record implementation from the New England Journal of Medicine. It presents a survey of nearly 3000 physicians in outpatient medical practices nationwide. The results showed that just 4% had extensive electronic records systems in their practices, and 13% had basic systems. The survey asked respondents to identify the barriers to moving from paper to an electronic health record. The second most frequent response after cost was uncertainty about return on investment (ROI).

ROI is a commonly used formula-based numeric measure, but it is not as straightforward as one might think. Sure maybe you can project a definite positive ROI before the fact. The EHR implementation I managed at UBHC was in the black after the first two years thanks to bringing all billing in-house and discontinuing all transcription services. But such initial cost-saving opportunities may not be available to your organization. Your situation may be unclear. Time to pause and think about the place of ROI in IT decision-making.

Using ROI as a factor in decisions about an EHR is problematic. As Craig Symons states in his monograph “Measuring the Business Value of IT Investment,” purely financial measures such as ROI imply a precision that does not exist. He describes that the calculations used in the measures are based on estimates of benefit, which in turn are based on assumptions. So the accuracy of the calculated ROI is only a good as the underlying assumptions. He presents other shortcomings of purely financial measures, which I’ll touch on soon.

Symons presents several alternative approaches to evaluating IT projects. Have a look.

Let’s look again at the article on EHR implementation in the July 3rd issue of the New England Journal of Medicine. It presents a survey done in late 2007 and early 2008 of nearly 3000 physicians in outpatient medical practices nationwide. I discussed in my last blog the results showing that just 4% had extensive electronic records systems in their practices, and 13% had basic systems.

The survey asked respondents to identify the barriers to their moving from paper to an electronic health record. Unsurprisingly, the most frequently mentioned barriers were financial, namely the amount of capital needed and uncertainly about return on investment. The size of the capital investment is a straight up problem. Governmental policy makers, insurers and vendors are all exploring solutions in various brews of requirements and inducements as fit their areas of authority and self-interests. For example,legislation was recently proposed calling for a national inter-operable electronic health record (EHR) system. Some sources consider the proposed legislation could be used as a back door approach to force doctors and hospitals to implement EHRs.

Since you are looking at this blog, I assume you or your organization are at least thinking about implementing an EHR. If funding is currently an insurmountable barrier, you can still begin preparing. Learn more about the benefits others have gotten from EHRs. Think about the areas of greatest inefficiency or communication failures in your organization and how the problems could be addressed by improved processes assisted by an EHR infrastructure. Think about the impact on the organization and the barriers and resistances.

It's not too early. A successful EHR implementation begins in the minds of the leaders.

As to Return on Investment, I'm going to write some thoughts on that one in the next blog.

While there has been much discussion in healthcare policy and political circles as well as media buzz about Electronic Health Records, the actual implementation of EHR’s in the U.S. remains low.  An article in the June 18 New England Journal of Medicine cites a survey done in late 2007 and early 2008 of nearly 3000 physicians in outpatient offices nationwide. The results show that just 4% had extensive electronic records systems in their practices, and 13% had basic systems.

There are lots of details in the article. Here are some highlights regarding usage. There were higher levels of EHR use by younger physicians and those who worked in primary care or large group settings. Interestingly,  providers serving higher proportions of minority, uninsured or Medicaid patients were not significantly different in their EHR adoption than other physicians. Also adoption was higher in the Western section of the country.

Happily, a large majority of the physician users were satisfied with their systems – 93% for fully functional system users and 88% for basic system users.

Among the 83% of respondents who did not have electronic health records, 16% reported that their practice had purchased but not yet implemented such a system at the time of the survey. An additional 26% of respondents said that their practice intended to purchase an electronic record system within the next 2 years. So, many practitioners are on the path to implementing an EHR. It is not too late to be a leader in your field and in your community by joining this group.

Supporting NCCBH in Washington

Last week I attended the NCCBH Hill day in Washington, D.C. to lobby on Capitol Hill for legislation that supports the mental health community.  We addressed many issues effecting the industry (a list of the agenda we addressed can be found at the National Council for Community Mental Health website), but I particularly focused on one that effects the users of our Electronic Medical Record systems:  The Support the Community Mental Health Services Act (H.R 5176/S. 2182).  

This act addresses the need to provide funding to co-locate primary care/chronic care services at CMHCs; to integrate treatment for co-occuring mental heath and substance abuse disorders; to provide funding for workforce recritment and retention; to enhance behavioral health eduction and training; to provide funding for telepsychiatry and patient education; and finally one that directly impact users of electronic health records, psychiatric software, and medication management systems.  This final measure would require the Secretary of HHS to collaborate with the Office of the national coordinator to develop a plan to ensure that components of the National Health Information Infrastructure address the needs of behavioral and substance abuse providers.  

I met with Senator Hilary Clinton, Senator Charles Schumer and Congressman Steve Israel and got very good response from all offices.  We requested that they co-sponsor the legislation and endorse it.  I recommend that each of you communicate with your local legislators and request the same.  It is easier than you think.   

When/Will Consumer Directed Healthcare Impact Behavioral Health?

At Netsmart Connections we spent time talking about the trend toward consumer centric care and involving the consumer in the care process.  We discusssed consumer portals that provide consumers with access to their electronic health record and medication histories.   

As part of that discussion we looked at how the cost of healthcare is impacting the US economy and several changes to the system that are being proposed to address the problem.  Yesterday I had a conversation with Ryan Daniels from William Blair, Netsmart's investment banker.  I have attached two of Ryan's market analyses (his 2007 and 2008 updates on the CDHC impacts to the healthcare provider markets) in which he looks at how Consumer Directed Healthcare (CDHC) is or will be affecting the primary care marketplace.  Although these reports look at primary care primarily, he does speak about how some behavioral healthcare providers are well positioned going forward because they are less dependent on government funding.  This does not apply directly to many of you, but is a trend worth following as we often see funding approaches that are first tried on the primay care market work thier way into the behavioral health markets.

The question to be discussed is if and/or when this trend will impact behavioral health and public health.  I have had several discussions down in Washington as to how these trends will impact the medicaid and indigent populations and I have gotten several different answers:  1) it wont; 2) they will be treated differently; 3) thier HSAs will be managed by someone for them.   It is not clear where this is going, but it is a trend very much worth watching. 

If anyone has any input please contribute to the group.

I’ve been writing about “the clinician” as if this word represents a homogenous group of people. Of course, this generalization is not correct, especially when it comes to individuals facing the move from a paper chart to an electronic medical record.  So I like to divide my one big generalization into three smaller ones.  I find it useful to think of three groups of people and ask:

·       who they are?

·       what is their attitude to computers?

·       what does their motivation look like?

 

This blog will focus on the third I call “the Excited.”  These clinicians are younger, computer-philes from our modern computer culture.  They are the kids of the organization. (Is my age showing?)  They are newer to their work and not greatly invested in established roles and methods.  They are also newer to the organization, and less identified with the organization’s history and culture.

 

When facing an EMR implementation, the excited group will probably be – well - excited.  A wise implementer will draw their enthusiasm and knowledge into the implementation effort.  Make sure they are represented in planning groups and tapped to be local champions. I enjoyed a mentoring relationship with two of our up-and-coming clinicians who became great boosters of the EMR in their clinical units.

 

But, no surprise, with the energy and computer skills comes impatience. These computer-philes are used to interacting with action packed graphics, to intuitively following their bliss through hyperlinks and to expressing themselves extensively on MySpace.  The content of the EHR is structured and controlled through required fields and software procedures.  They need help to be patient with the restrictions of the software.  They need help to see that the content designers are not dolts and to accept that there are legitimate clinical and compliance reasons behind design decisions.

 

It is the implementer’s job to ensure that these two last statements are correct.

I recently had two useful pieces of information come to me that illustrate my thoughts on achieving user buy-in to an electronic health record.

 

One was a tip on blogging from our blog host. It introduced me to the acronym WIIFM. The tip reminded us that readers search for and look at blogs, asking, “What’s in it for me?”

 

The other information was told to me by a nurse turned techie/implementer in a large system with over 10 institutions. She described the implementations in two of their facilities. In one, the implementation focused on creating reports for the needs of the top managers. In the other, the implementation team created reports designed to meet the needs of the clinical staff. For example, they created a shift change document for nurses and a report showing treatment permissions coming up for renewal. She described that in the first facility, the implementation had a difficult time winning over clinicians. In the second facility, the clinicians had a much more positive attitude and the implementation went much more smoothly.

 

I believe WIIFM is an absolutely legitimate attitude for a CEO, a supervisor, or a clinician using an EMR. After all we’re talking about the relationship of a user to an electronic health record system It may be long-term but it is not an intimate relationship.  WIIFM is OK. So, implementers, ignore it at your peril!

 

I’d love to hear more stories about where WIIFM fits into your implementation.

          The case for implementing an EHR depends on your point of view.  In this blog, I want us to consider the question from a CEO’s perspective. CEOs spend much of their time monitoring enterprise performance and preparing for and making decisions. This is as true for executives in health care as for those in automobiles and banking. Volumes have been written about these high level tasks and, for sure, I don’t have new insights to add to that body of knowledge. What I want to highlight is the crucial contribution information makes to CEO oversight and decision-making. Courtesy of Wikipedia, I define Information to be "the result of processing, manipulating and organizing data in a way that adds to the knowledge of the receiver." In the domain of health care, information must include data captured through an electronic health record (EHR).  Here’s how this played out at my home organization, University Behavioral HealthCare (UBHC). 

In the mid 1990’s UBHC faced the surging managed care environment with its demands for effective care at lower prices, its requirements for accountability for documentation and outcomes and its focus on customer satisfaction. Our CEO recognized that in order to succeed in this environment the organization needed to use information to:       

• Establish and monitor care and productivity standards
• Optimize and monitor billing 
•  Identify service supply and demand trends  
•  Measure treatment efficacy and patient satisfaction

He further recognized that to accomplish these tasks, he needed the data to be comprehensive, detailed, high quality, and current. Relevant data from all functions of the enterprise had to be captured electronically for executive management control and reporting purposes. For our CEO this case for implementing an Electronic Health Record System was compelling. 

          By July 2000, an enterprise-wide EHR has been implemented. All staff - 500 clinical and 400 support - worked primarily in the EHR. By 2003, more than 1,000 managerial, fiscal, control, QI and clinical reports were in use. Outsourced billing and transcription costs were eliminated, saving $1.4 m per year. Successful billing was increased 10% through monitoring the billing process for problems which would have previously resulted in denials such as a missing Diagnosis or Progress Note. Gross revenues per clinician FTE increased 50% due to the ability to schedule more efficiently, to track work being done and to assist documentation compliance with reminders and to do lists.
          His commitment to the EHR implementation paid off almost immediately. In a recent conversation with him, he told me that he could not imagine trying to lead and manage the organization without the benefits of the EHR.

During this electrifying political season, there is a flurry of attention being given to Electronic Health Records. Nationwide implementation of  EHR’s is a core component of candidate plans to reform the American health care system. The main reasons put forth include to save money, reduce medical errors, avoid redundant testing, identify previously ineffective treatment,  and provide access to current medications from any point of care.   The media is high profiling phrases such as “interoperability,” “RHIO’s” and “Personal Health Record (PHR).”

 

Adding to the intensity of the EHR discussion, the federal government is proposing penalties for EMR non-adopters. Our largest technology companies, namely Microsoft and Google, are charging into competition to capture the hot property of the PHR.

 

Some of the enabling technology for these high level goals is in place. Some crucial components are not. What are the providers of healthcare to do? More particularly, how can those contemplating software for behavioral health, addictions, MRDD and public health approach the question of why should they embark on such an undertaking? Here is my thought. To borrow a saying:

 

Plan globally and for the future………Act locally and for the present

 

An organization’s top planners must be aware of the national vision and policy trends concerning EHRs. They must be informed about technology trends. Only then can they define their own plans and make decisions. For example, they should not cast their lot with a vendor which cannot demonstrate its ability to lead or at least keep up with technical developments over the long haul.

 

But long term visions seldom motivate people to undertake the demanding sort of change involved in an EMR implementation. To achieve buy-in, leadership needs to define goals that address immediate challenges facing the organization. This requires thinking clearly about the organization’s environment, mission and resources. I’ll write about defining these goals in upcoming blogs.

The Vision of Connected Care

Connecting care between departments in an agency, between agencies and between different types of care givers (behavioral health, public health, primary care, social services etc) is designed to improve the quality of care provided to consumers, to reduce the quantity of medical errors (and the costs associated with them) and to improve national defense by more rapidly identifying disease outbreaks.

In addition, Connected Care is designed to achieve another major goal:  bringing the consumer into the care process using consumer portals to provide access to their electronic health records and eventually connecting them to personal health records. 

The genesis of Connected Care at the national level started in 2004 when President Bush outlined his vision of every American having an electronic health record within 10 years and has accelerated as agencies begin to envision the benefits to their clients (listen to what providers are saying).  The figure below provides a real world scenario of how a consumer could use Connected Care:

As consumers move between community mental health centers, county behavioral health agencies, state inpatient psychiatric hospitals, and local public health departments, the goal is to seamlessly transfer clinical data between electronic health records.  Initially this information would contain diagnosis, active medications and reason for referral.  If we can accomplish this, we can dramatically reduce medication errors which cost the country nearly $100 Billion annually.  In future blogs we can discuss each of these areas in more detail.  If you would like to see more information right now visit some of our pre-recorded webinars.