EHR Optimization in a Behavioral Health Hospital: A Roadmap for Success

In 2015, Impact Advisors’ Clinical Performance Solutions Service team was hired by a large behavioral health hospital to assist in optimization and adoption of their EHR solution. The organization was faced with lack of adoption of functionality and clinical documentation forms as well as stalled implementation of significant EHR functionality.

After meeting with executive sponsors, Impact Advisors’ leadership staffed a team of clinical EHR specialists to assess the organization’s current state with a requested focus on Clinical Documentation and Medication Management. This effort began with Impact Advisors’ proven methodology: the analysis of people, process and technology. Next, interviews were conducted with operational leads and clinicians in various disciplines that utilized the EHR, along with the Technology Support staff that were leading the efforts. By observing the operational workflow of key personnel, the Impact Advisors team was able to fully understand how the EHR accommodated delivery of patient care for various clinical roles. As a result, the team delivered a detailed assessment report that provided observations and recommendations for all areas managed by the interviewees or the departments that were observed.

This initial phase of work also resulted in a roadmap of itemized initiatives that should be executed as sub-projects for increased EHR functionality and adoption. The recurring theme throughout the identified initiatives: was alignment of the Behavioral Health hospital EHR with industry best practice to ensure that quality would be maintained or enhanced with any modifications.

Over the course of 18 months, Impact Advisors provided assistance to the client with a team that was flexed to supply the appropriate skills in project management, change management and operational readiness to address the top priorities from the roadmap. The Impact team regularly recommended solutions to align with clinical best practice. At times, these solutions seemed unattainable and were met with resistance from both the hospital staff and Operational Leadership.

The following recommendations for EHR Support were also taken to the executive sponsors and approved within the first 90 days:

• Create clinical governance for the EHR with advisory groups formed for each discipline that can make recommendations to the overall leadership
• Add two clinical informaticists to EHR support structure: one for pharmacy, one for provider and staff
• Modify the EHR training program to implement workflow-based training provided by clinical trainers
• Obtain additional resources to develop, build and test operational reports

The first step to move the organization forward with adoption was to utilize the Clinical Advisory Group to review the delivered roadmap and prioritize the approved initiatives. The Top Ten Clinical Documents were identified and sub projects were organized to advance the build and implementation of these critical documents.

An Orders Management sub project was also formed to review orders that were not laboratory, diet or medication types. This effort would support all order entry by licensed providers once the medication management solution was implemented. The Impact Advisors team led the initiative by facilitating sessions to review and standardize the remaining order types, build documentation and then worked with the client DBAs to develop an automated code migration process.

By approaching project management, change, communication and training in new ways, these efforts resulted in several successful implementations. There was a project manager assigned to each sub- project. This resource was not aligned with IT but rather the clinical sponsors, and collaborated with each sub-project team to regularly design, review, test and review training requirements for their initiative. Each initiative had a clinical trainer assigned to the team to participate in the project. Each trainer was expected to fully understand the solution and develop training materials that followed the workflow.Over the next 12 months, great strides were made in improving the adoption and functionality of the system.

The following initiatives were considered big wins for EHR Optimization:

• Establishment of a Clinical Governance structure for EHR resulted in increased clinical ownership
• Engaged Nursing and Providers via Change Management & Operational Readiness methodology
  • Established Clinical Training Program to develop workflow based training delivered by Clinicians and directed by executive Clinical Leadership
  • Developed a Clinical Informatics program under the CMIO to ensure EHR decisions are clinically driven
• Promoted Top Ten Clinical Documents to LIVE and standardized project closure criteria
• Executed successful sub project go lives over 12 months including ADOPTION!
  • Suicide Risk Estimation Tool
  • Enhanced Supervision
  • Informed Consent – phase 1
  • Informed Consent – phase 2
  • Nursing Kardex
  • Omnicell Automatic Dispensing Cabinet for after-hours medication administration
• Mentored various Behavioral Health hospital personnel on Project Management standards for operational readiness and change management methodology through each sub project to ensure a smooth transition once IA contract is complete

As Impact Advisors has mentored the organization’s personnel throughout the project, operational leads have assumed ownership of the EHR. They now provide staff to assist in implementation activities to ensure success. The clinical trainers and informaticists, too, have witnessed the positive impact when project and change management, and operational readiness activities are threaded throughout an implementation. This organization is on track to experience future project success as they continue their EHR Optimization journey.