September 20, 2016
No, there is no Meaningful Use for behavioral health hospitals, and yes, some mental health clinicians remain skeptical about the proposed value of electronic health records (EHR).
And yet a steadily increasing number of behavioral health facilities nationwide have adopted an EHR to improve patient care and organization performance. According to a recent Behavioral Healthcare survey, most are satisfied with the decision to make an EHR part of their daily routine.
So, does that satisfaction make it a wise value proposition to adopt a behavioral health EHR? This highly relevant question about return on investment (ROI) is not limited to behavioral health facilities, but it might be a more pressing concern for organizations that cannot count on federal subsidies.
What counts in determining ROI?
Because behavioral health care is complex and, more importantly, because it measures value in many non-monetary ways, we have to look at both quantity and quality.
“Some organizations have difficulty determining their EMR project’s ROI,” writes business development executive Carol Turso in Behavioral Healthcare. “Common reasons for this are failing to see an EMR’s strategic benefits and considering the initial cost as an expense rather than as an investment … An EMR is an investment because it provides long-term benefits and may be an important tool for reducing the cost of expenses.”
Turso uses the example of a social services organization that over three years after implementing an EHR reduced bad debt by 93 percent, lowered outstanding accounts receivable of more than 151 days from 24 to 9 percent, and trimmed the time staff spent per week entering remittances and payments from 40 hours to 10 minutes. In every instance, these EHR benefits improve the organization’s bottom line. Even if they don’t technically create new revenue, they are still quantitatively relevant.
Qualitative improvements save time, prevent adverse medication events and reduce errors, which saves money. As the federal government shifts to a reimbursement model based on quality and patients vote with their feet, the qualitative approach starts to look more like a quantitative imperative.
How do non-clinical factors impact the evaluation of ROI?
You can build it, but they may still not come.
So, it’s difficult to exaggerate the importance of behavioral factors in ensuring the value of your behavioral health EHR. You must create buy-in, make clinicians feel as though they have a voice in the process, train everyone effectively on the system and take feedback on how to improve the solution and workflows after go live.
“Realizing full value of the [EMR] system typically depends not only on successful deployment of the system but also on adaptation of other organizational processes and workflows,” says an Institute of Medicine (IoM) paper that seeks to create a standard model for assessing the value of EHRs. “Functionality is also enhanced or constrained by the quality of implementation, including user training and acceptance, as well as the universe of technology with which it is used.”
The good news is that, for most behavioral health hospitals, the investment in EHR seems to be money well spent.
According to the Behavioral Healthcare survey mentioned above, the majority of those with an EHR are satisfied and putting the system to good use. Among all respondents, 23.6 percent said the EHR they use improves patient care, 18.1 percent cited the elimination of paper storage as a prime benefit, and double-digit percentages identified improved care, reimbursement and clinical outcomes as valuable results.
How can we determine if our new EHR is earning its keep?
Every behavioral health organization has to track dollars, cents and hours, so at least in those areas you can use the EHR to monitor change and increase in value over time, even if pre-EHR tracking was less than judicious.
At the core, an ROI evaluation is still a costs-versus-benefits analysis. It’s just a little more complex with behavioral health IT. If you’re not yet working with some sort of tracking system and evaluation scheme, consider starting with a table of costs and benefits. Circulate the list to clinical, administrative and technical leaders and then update until all feel confident the table is comprehensive.
To get a more complete picture of actual value and return, the IoM model looks at three overarching components: expenses, benefits and potential impacts to revenue. Each category is divided up into numerous types in an effort to determine with specificity what is the value of a particular EHR investment.
“… benefits of robust information system implementation might include savings to an organization from the reduction or more effective deployment of full-time equivalents (FTEs) associated with more efficient business practices, decreased morbidity and mortality due to more consistently delivered, high-quality care, avoided complications from improved preventive care, and enhanced patient experience and outcomes through the opportunities afforded by EHRs and patient portals for engagement,” reads the IoM paper.
It’s worth spending some time reviewing the IoM tables if you are questioning the value of your EHR or considering different solutions.
Can you afford a comprehensive EHR with reliable ROI without federal government help?
There are many behavioral health EHRs out there with dramatic differences in both price and payment structure. Some acute care hospital EHRs also adapt well to the behavioral health environment. Yes, some of these systems are expensive and require substantial upfront expenditures for software licensing fees, infrastructure, consultants, network, etc. But other less expensive and robust options require almost no spending upfront if you have the infrastructure in place, and enable you to pay as you go via subscription.
Ultimately, much of the ROI for the healthcare IT system you choose is dependent on how you make it work for your behavioral health facility. Create organizational buy-in (especially among clinicians), evaluate workflows and how they might change to accommodate the EHR, and choose a solution that incorporates behavioral health-specific functionality and is a realistic financial fit.
Put the foundational pieces in place and the likelihood of positive ROI increases dramatically, even if that federal subsidy never materializes.