In the Beginning. The Electronic Medical Record has been a possibility in behavioral healthcare world that I have worked in for a dozen years. Its first incarnation was a two headed beast comprised of a server of scanned records indexed against the data records in the CMHC/MIS. Its technology legs were wobbly and its functionality was limited, but it was an EMR. It was also cost prohibitive, but not for the reasons that would hold now. The terminals needed to display the records were at the time, high end and expensive. Clinicians regarded using a computer as 'going over to the dark side". Unless a center's director had rock solid leadership skills and lots of money, it wasn't gong to happen. The first few customers to buy it were able to show some impressive cost savings. Other big centers didn't seem to care. As time moved along, the clinical tasks generating the medical record became web based. Scanning was limited to external documents. The wedding of the Unix database technology and the web services became ever more elaborate. This make the technical demands on the provider staff ramp up by an order of magnitude. The last time I worked with the product, some three yeas ago, a provider board raised the money to do it right, but the company, CMHC Systems had been acquired and the staff who knew how to support it were let go. I was so determined to get in the EMR business, I found an administrative services unit that was providing support for the product for three centers. They agreed in principal to do the support so the effort could go forward. At that point, the internal resource shortfalls of the provide overtook the promise of success and the effort fell apart. The Real Deal is not in Reach The next installment in my effort to get EMR into a behavioral healthcare provider involved Next Gen. Net Gen is a practice management and EMR vendor for group practices and hospitals. They are also moving into the community health center space. They have been able to gain competitive recognition for the EMR product so that it can be vended as a top tier product. There are two problems with using them in behavioral healthcare. They need to keep focused on their core market as it is very competititive. Their pricing has been on a per physician model. The customer was a large, well managed west coast provider. Their team would not open the door to a product that had a mainstream medical profile. They cose a capable, small provider with a well supported web based product. It's cliincial offering was well sort of an EMR. In Reach and Out of Reach Netsmart is a product that has gained a reputation for a robust clinical workspace environment. It's not a full fledged EMR, but it did support the clinical process in some detail. But for this client, there are issues of claiming and reporting that have first priority. This means a rapid conversion process that leaves a lot of processes based on workaround behind. The conversion and reacquisition of core processes on the new system are extremely intensive, but ultimately successful. There was a need to take a 'time out' so the processes of the new system could by repetition, begin to extinguish the recollecton of how things were done before. And then the recession hit. The implmentation would have to go forward with only limited oversight by the team. At the same time as the recession put the clinical workstation on the slow track, the stimulus raised the bar on what the goals for healthcare EMR should be. Not only should it be a working Medical record on-line, but it should interface with a National Health Information Network. The Once and Future EMR In 2003, the careful student of the HIPAA regulation process would find that the American National Standards Institute X12 (healthcare) committees had laid the groundwork for every conceivable health transaction. Then, it looked like the future. But, only a year later, the Bush administation had moved on to a very different national security driven model of a National Health Information Network. And this prototype system would likey have remained just that if a Repubican had been elected president. But Barack Obama was elected and the prototype became the template for a massive and rapid overhaul of the entire healthcare system. Add to this, legislation that established parity for behavioral health coverage. Clearly, behavioral healthcare would not be left outside the circle. Yet it was. The Stimulus bill does not include Behavioral Healthcare services in the provision for incentives for EMR meaningful use. At the same time forces that are entirely new offer unprecidented opportunities. The inevitability of the dominance of big vendors provided by vendor sponsored certification was effectively blown up by the government on July 16, 2009. There are at least three different free/open source solutions available for BH EMR. Where will this lead? BHEMR.com I am starting the blog, BHEMR to provide a place where these competing forces can be considered and the 'state of play' for BH EMR assessed. Wish me luck. Wish us all luck. |