Community Mental Health Center of Ottawa County (CMHOC), located in Holland, Michigan, is a public provider of services for people with developmental disabilities, serious mental illness, and substance use disorders. The organization is accredited by the Commission on Accreditation of Rehabilitation Facilities (CARF), and offers a range of programs from five locations throughout the county. CMHOC is one of 46 community mental health centers in the state of Michigan; it encompasses about 105 staff members, two-thirds of them clinicians, and serves 3,200 active consumers of its services every year.
CMHOC has been using an electronic health record (EHR) from the Lisle, Ill.-based Netsmart, since 2005. Like many behavioral healthcare providers, CMHOC has had to adapt to funding reductions as well as significant changes in regulations, payment models and reporting data. Rich Francisco, deputy director of CMHOC, spoke earlier this year with Healthcare Informatics Editor-in-Chief Mark Hagland, regarding the organization’s journey into automation-facilitated population health management and care management. Below are excerpts from that interview.
Tell me about the implementation and optimization of your EHR.
I came on board in 2011. The decision was made in 2005 to go to an electronic health record system, and at that point, they had switched from an old QS system to Netsmart. That’s when the decision was made to go paperless. And in 2011, when I came on board as the IT coordinator, they were on a version of Netsmart, Avatar, that had not been updated for some time. So my first order of business was to get it up to date. We skipped several versions of the software, including versions introduced in 2004 and 2006.
So there was a huge project we started with, which resulted in our decision to switch our parent module to using a practice management system. It was called the “flip project,” because we wanted to flip the two. myAvatar PM (practice management) module. We used to use MSO, which was the outward-facing provider module. Netsmart went through a thorough evaluation of how the product was being used, and that’s how we went with this.
What were some of the key issues involved in the transition for your organization?
The biggest thing we were trying to move away from was a heavy reliance on paper. Even in 2011 when I arrived, we were still very dependent on paper; we had a project, the health information management project, which involved converting our forms from paper to electronic, into the EHR. We’re talking about hundreds of forms, from assessments to tracking forms.
What kinds of efficiencies and benefits have you and your colleagues obtained in from getting away from paper in behavioral healthcare?
The biggest savings we achieved was achieving immediate access to information, and being able to analyze a lot of the data right away, and being able to report off it and analyze it, that’s one of the biggest values. We’re just getting to the point now where we’re beginning to be able to develop profiles of consumers in the system. And because we’re capturing all that data in the EHR, we’re able to develop a single view of a patient. And we’re able to track our costs through the system. We look at outliers through utilization management. And without going electronic, we could never have done this well.
But now, we’re able to run a good utilization management committee, in which we’re able to look at utilization and cost data, and benchmark our performance against the performance of peer community health centers, and that allows us to make decisions regarding practice. The fact is that behavioral healthcare has been years behind physical healthcare in digitization, because we didn’t have the incentives coming out of the meaningful use program.
So you’re trying to catch up, and do good population health and care management?
Yes, that’s absolutely right. Back in 2011, one of the first things I did was to sign a contract with Netsmart to pursue meaningful use. In the early stages, we were making sure we had all the elements in the EHR that would allow us to participate and get the incentives. So we had registered five prescribers in the 2011-2012 period, when we started the process of evaluation. We made sure to evaluate all aspects of the solution, from security issues, to making sure all of our prescribers, including our doctors, were registered.
I saw the value in it, because, first of all, we could shore up our EHR. And I said, we need to do this now, we need to invest in the product now, to make sure we’re compliant. And that was a good decision, because we’re able to report the data we need to report.
How many of your clinicians were eligible for meaningful use?
We have three who are registered—two nurse practitioners, and a psychiatrist.
Was it difficult to get them certified for meaningful use?
The product that we’re using had all the components. What was hard was the registration of prescribers. We had one who was already registered at a different agency, so we couldn’t claim them. Also during that time, we had registered agency-wide for meaningful use; so how did we get them to sign the funds over to us? Because we signed up as an agency, not as individuals, per the eligible professionals. That was the hard part.
So your EPs have received some funding from the meaningful use program?
Yes, that’s correct.
What have been the biggest lessons learned so far on this journey?
I would say it’s knowing your costs. It’s always been very difficult in BH to know your true costs. We’re operating off this historical model of basing funding on what it was in the previous year. Now, with everything accessible in the EHR, we’re able to leverage data in utilization management, to determine our costs. Is it at the level we should be, or over- and under-utilizing? Now, we have reports that tell us.
Have you been sharing data with any other community behavioral health centers in Michigan?
Yes, we’ve been participating with the Michigan Health Information Network (the East Lansing-based statewide health information network); we’re in the testing phases of getting admissions, discharge, and transfer data. That’s going right into the care record; and it would alert us to admissions, discharges and transfers, for our patients. It’s a one-way communication; they feed us the ADTs [admission, discharge, and transfer data].
And in the state of Michigan, we’re broken into regions. And we have five community health centers within our region; we’re one of five. And we’re exchanging data. Our data goes up to the regional entity, and we utilize another product for analytics, on that regional level.
What should healthcare IT leaders from any organization that you might collaborate with, know?
The biggest thing for me is to be able to share records with an agency that needs it, in the case of a transfer of care, or our provider network knowing that they’re entering physical health or being transferred to another care provider, being able to share that data. So from our local inpatient hospital here—let’s say one of our consumers presented at the ER; they should have our records in the ER. And there’s some effort taking place at the state level now, with that. But that should also be taking place at the local level.
What’s next for you and your colleagues, in all this?
For me, it’s really shoring up our outcomes basis and value basis. We’d like to become more standardized in terms of our local efforts. I’d really like to be able to have a standardized recommendation for level of care, that comes out of the ANSA—the Adult Needs and Strengths Assessment—[the a multi-purpose tool developed for adult’s behavioral health services to support decisionmaking, including level of care and service planning, to facilitate quality improvement initiatives, and to allow for the monitoring of outcomes of services]. I’d like to be able to have a standardized output for level of care, out of that assessment, utilizing data. We’re also evaluating other tools for other assessments as well. These assessments might be for substance abuse; might be for the assessment of children. The next step would be to come up with an appropriate level of care, using these standardized assessments, and then to develop a standardized recommendation. But the algorithms need to be built in.
Given the kind of progress that you and your colleagues at CMHOC are making, how fast will such progress be evolving forward across the U.S. healthcare system, in the next few years?
All of our partners have rolled out the ANSA in some fashion. We rolled out the ANSA for our organization, in the past year. And the region has hired Integrated Health Analytics, it’s a PhD statistician with a couple of master’s-level statisticians, to produce the algorithms we need to determine level of care. We should have a standardized protocol for recommendations for next level of care, out of that. In Michigan, it’s all recommendations, because it’s delivered for patient-centered planning.