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Behavioral Health and the EMR

January 20, 2011
by Mark Hagland
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Why One Psychiatric Hospital Went Open-Source

Sigurd Ackerman, M.D., is president and medical director of Silver Hill Hospital, a 129-bed inpatient psychiatric hospital in New Canaan, Conn. Like many leaders in behavioral healthcare, Dr. Ackerman found when seeking an updated electronic medical record (EMR) system for his standalone psych hospital (which is affiliated with the medical school at the Yale University School of Psychiatry, that the options were relatively limited, and in many cases not advanced enough for his institution’s needs. Dr. Ackerman spoke recently with HCI Editor-in-Chief Mark Hagland regarding his organization’s experience on its EMR journey.

Healthcare Informatics: Was this your first EMR?

Sigurd Ackerman, M.D.: No, this was our third. I got here about eight years ago. In the late 1990s, one of my predecessors had brought in an EMR, but for various reasons, the medical staff didn’t like it and essentially didn’t want to use it, so the hospital in effect just dropped it. It appears that there was inadequate preparation and training the first time around. So basically, everything went back to paper [after the failure of the first implementation]. Meanwhile, we had a couple of good people here, and they had developed a business and registration system from [the Boca Raton-based] Eclipsys [Corporation]. And there was a lab system and a pharmacy system, but no clinical system. Actually, the first thing I had to do was to bring e-mail into the hospital, in 2003. They were still on voice-mail. Then, around 2004, I decided it was time to look at an electronic record. I had previously been at St. Luke’s-Roosevelt in New York and had brought in an EMR in the mid-90s. During my time at that organization, we had put together a task force to look around the country for an EMR solution; and what we found in the 1990s was that the big, proprietary, off-the-shelf systems did not have much for psychiatry. They’re great if you’re with the department of surgery or whatever, but apparently, there’s so little revenue to work with in terms of the psych hospitals, that there hasn’t been much development.

Sigurd Ackerman, M.D.

So we went with a psychiatry-specific EMR developed by an academic medical center. It had all the stuff you’d need, screen by screen, and it had great drop-downs. We brought that in around 2004 or 2005, and spent a lot of time selling the idea to our staff, and training people, and it actually worked well. And we got to the stage where we thought we would do order entry and link everything to lab and pharmacy, but found out you almost couldn’t do it. For example, there was no way to look at clinical episodes; it was just one big clinical flow in the system. So you couldn’t look at the last admission. You couldn’t interface that system with anything or work with episodes, so it really only worked as an electronic chart. We were 80-percent paperless, but I decided that the only way to move forward was to abandon that system, which had cost about $800,000 including training and all its components.

So we looked again, and found the same thing all over again. But this time, I came upon the fact that there were now a couple of companies that had gotten the Vista system from the VA [the federal Veterans Administration health system], through Freedom of Information. And so I hired a very good consultant with whom I had worked in New York City a couple of times, and he had helped hospital systems go live over the years. And I was also the president of the hospital, so I had that experience as well. So he was a huge help and helped us vet the idea of the system, and Medsphere per se [the Carlsbad, Calif.-based Medsphere Systems Corporation], because I was very concerned about going with a new company, etc. But in the end, we liked what we saw.