In-Depth: Paper to EHR Journey of 3 Behavioral Health Providers

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2. How did you overcome cost barriers in selecting an EHR?

Like most behavioral health / substance abuse hospitals, Evergreen, IntraCare and Silver Hill could not absorb the huge costs of one of the better-known EHRs and the traditional implementation model. Decision makers from each facility emphasized that large, prohibitively expensive systems with unnecessary bells and whistles were never on their radar. Each hoped to find an EHR to cover essential operational needs, including behavioral health workflow support, provided by a cost-sensitive vendor.

“In 2010, as today, we couldn’t afford big systems, and of course they had little application to psychiatry,” explained Dr. Ackerman of Silver Hill, the first of the three hospitals to adopt an EHR. “We had already tried out a system that was a real mistake. Still, I knew EHRs were the future of healthcare. We found Medsphere’s OpenVista. Though Medsphere was new as a company, it already had a successful OpenVista application implemented across the entire Indian Health Service.

“It helped that many of our physicians had trained with Yale and worked with VistA extensively. But, what was most impressive was that Medsphere was willing to support behavioral health workflow modifications and still keep costs low. This flexibility became a valuable component of our relationship.”

In 2013, IntraCare had a physician on staff who had previously used VistA at the VA and found it easy to work with. With his input and advocacy, it was natural for IntraCare leaders to look at OpenVista when researching potential options. Other EHR systems proved to be prohibitively expensive largely because they charged for software, even though the systems would not be installed onsite. None offered capabilities specific to behavioral health services.

But perhaps the biggest game-changer was Medsphere’s “willingness to work financially” with IntraCare, according to Scovill. “We were impressed with Medsphere’s understanding of our financial constraints, and its desire to help us manage costs. Its leaders’ attitude made moving to an EHR possible for us.”

In 2013, the Recovery Center at Evergreen, one provider in the Valley General system, was in an entirely different situation. Faced with loss of support for an existing Siemens system and a looming Meaningful Use incentive deadline, Valley General chose OpenVista for its functional strengths and simplicity. Also, Medsphere promised a streamlined implementation to ensure meeting the Meaningful Use deadline. After a near-record six-month implementation, Medsphere and Valley General met their goal.

While the logical next step for EvergreenHealth was to follow suit, leadership had to be sold on the adaptability and power of OpenVista in a program-based addiction treatment environment. The OpenVista Multidisciplinary Treatment Plan—a tool designed in collaboration with Silver Hill specifically for behavioral health—convinced EvergreenHealth in 2014 that Medsphere was serious about mental health care and that OpenVista was the right platform.

Both Valley General and EvergreenHealth were uniformly pleased with Medsphere’s flexible financial arrangements and low costs. Medsphere’s subscription service enables hospitals to acquire an enterprise EHR without huge upfront costs or backend balloon payments. This fact, in addition to OpenVista’s behavioral health orientation and easy-to-use interface, was central in their final decisions.

3. EHR vendors always promise smooth transitions, but reality often doesn’t measure up. How did your implementations go?

Naturally, each hospital had initial concerns about potential disruption of operations and patient care during an EHR implementation. All remarked that though their transitions were challenging to the organization, as promised, they were also surprisingly smooth.

The reasons?

First, each hospital had an enthusiastic physician “champion” to advocate for the project, and all communicated frequently with clinicians and staff to ensure preparedness and keep everyone on board.

Dr. Ackerman noted that EHRs were relatively rare in 2010, which meant he “had to spend a lot of time selling to physician staff and nurses, which really helped to smooth the process.” Dr. Patz, EvergreenHealth champion, said physicians were a bit wary, but the prospect of eliminating wasted time on paper records was a huge draw. 

“We set up a small interdisciplinary team that was committed to the project, explained Phyllis Qualls, the IntraCare project manager. “Over a period of months, we worked closely with an integrated group of Medsphere’s specialty teams. The training and support Medsphere provided each step of the way and with each user group was extraordinary.”

Added EvergreenHealth Program Director David Anderson: “Yes, Medsphere’s training was great, but learning OpenVista held no barriers for our staff … it was easy to learn and easy to use. There was no question that we would be ready.”

“The actual transition was just flipping a switch,” explained Ackerman. “To avoid a big dump of clinical data at go-live, we just kept the old record. The previous system didn’t have order entry, so our 14 psychiatrists and I got together one night, wrote up all the new orders – a lot of work and a lot of pizza – but that’s all it took.”

Still, internal project managers and Medsphere staff didn’t take the final “flipped switch” for granted at any of the hospitals. With guidance from Medsphere’s implementation staff, they made sure a cadre of internal staff, OpenVista specialists and technical experts were continuously onsite overseeing the transition, including many who worked 16-hour days before and after go-live.

Medsphere’s Customer Care group picked up where the implementation teams left off. Qualls said she “couldn’t be happier with Customer Care. The account executive meets with us regularly, and the support team is very professional, knowledgeable and helpful. They get back quickly when we have questions or issues that need to be resolved. We actually missed the implementation folks when they stopped coming, but the Customer Care group is doing a great job for us now.”