Why a Behavioral Healthcare Facility Transitioned to an EHR System

Despite climbing EHR adoption rates across the healthcare industry, adoption and EHR implementation within the behavioral healthcare sector is woefully behind, leaving many clinicians to use outdated paper charts.

Mental and behavioral health are growing and indispensable fields of medicine. According to a recent Commonwealth Fund brief, roughly 25 percent of US adults report a mental health diagnosis, such as depression or anxiety, or experience emotional discomfort. Additionally, the US has the highest suicide rate and second-highest drug-related death rate compared to other high-income countries.

But according to the ONC Health IT Dashboard, only 49 percent of psychiatric hospitals have certified EHRs, compared to 89 percent of rehabilitation centers, 87 percent of children’s hospitals, and 59 percent of long-term care hospitals.

Rogers Behavioral Health, a behavioral healthcare hospital in Oconomowoc, Wisconsin, was one of the countless behavioral healthcare facilities without a dedicated EHR. Brian Kay, director of clinical effectiveness at Rogers, hypothesized two major ailments to behavioral health EHR adoption.

“If the concept of using data to help drive an individual's care throughout treatment is not introduced, you're going to have a little bit more difficulty with the adoption of an EHR,” Kay said.

“Next, there's not the sophistication with many of the EHR providers to help integrate multiple disparate systems into one in how you have that exchange of data in a meaningful way.”

Before its Cerner EHR implementation, Rogers relied on a rudimentary EHR system that lacked detailed sophistication and technology. That, coupled with the practice’s clinicians turning to paper charts,  was an issue because Rogers based a lot of its work around measurement-based care.

“We have patients in through structured forms and assessments answering questionnaires on their symptomology,” Kay described. “Then, we utilize that to drive care. If you look at those adoption rates of measurement-based care across the country, only about 17 percent of psychiatrists and psychologists use that to drive care.”

Because Rogers has doubled its workforce and added close to ten clinics, its implementation was unique, Kay said.

“We did a big bang implementation method where we just flipped it on overnight and had the new EHR system live in all of our clinics the next day,” Kay described. “Having that type of implementation method created a few early adoption issues, but we've gotten over the hurdle on those quite a bit.”

Although the Rogers health IT team and its EHR vendor worked together pre-and post-implementation to provide continuous support to the clinicians, EHR training on one workflow was a major early adoption issue.

“We had some issues with transitioning them over from a dictation system for all of their transcripts, and then also in behavioral health using more structured data entry than free-text narratives,” Kay explained. “Most of our clinicians would write very long free-text notes, so moving them over to those structured forms or Cerner terms power forms provided some adoption barriers.”

However, Kay said the implementation process went as well as it could.

“The year since we've done the implementation, we have learned a lot and retooled some of our forms and our workflows so we could make the system easier to interact with,” Kay added. “But overall, it was a pretty painless experience, which is rare to hear.”

Following extensive training post-implementation, clinicians had a positive response to the new EHR system. One EHR workflow also allowed clinicians to access clinical notes from any level, from intake to residential, to partial to intensive outpatient care.

“Once we started getting clinicians off of the dictation system and had them use the workflows within the new EHR system, it's been overall positive,” Kay explained.

“Our clinicians could now see what are the notes on that previous level of care, driving better care coordination, as they're moving through those various levels of care. That was not possible on a hybrid system and it’s been very positive in their life that they could see the decisions that were made and cut down on some of the dual entry that was happening in those multiple levels of care.”

While some behavioral health facilities are reluctant to implement an EHR system, Kay said the ultimate result is worth going through the growing pains.

“EHR adoption in behavioral health far outweighs the pain of that initial implementation phase,” Kay added. “We are seeing better care coordination for our patients, which is getting them better and stronger in ways that we haven't been able to do so before. From the sheer data side to the insights that we're mining out of these large data sets is truly changing the field of behavioral health, which we wouldn't have been able to do without the EHR.

Kay believes once an increased number of behavioral health facilities transition to EHR systems, the sector will be able to leverage patient data to improve care quality and patient outcomes.

“That's one of the underlying things in adopting an EHR is how do we start looking at some of these more global insights, particularly in behavioral health,” concluded Kay. “As soon as more providers are willing to adopt, we're going to see more things that we've never seen before, which is good. It's a good example of how we better the field.”