Hurdles in Adopting and Implementing Integrated EHR in Community-based Addiction Treatment Clinics

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Hurdles in Adopting and Implementing Integrated
EHR in Community-based Addiction Treatment Clinics

• Ron Jackson, M.S.W.
• Evergreen Treatment Services
• Seattle, WA

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Agency Description

• Private non-profit, founded 1973
• 7.7 M annual budget staff of 110
• Clinical programs
• Opioid Treatment Programs (OTPS)
• 1400 patients at three fixed sites (two in
  Seattle one in Olympia) a mobile medication
  unit and a primary care-based program (both in
  Seattle)
• Intensive Case Management (REACH)
• homeless, chronic public inebriates
• Research projects

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Why are we doing this?

• Better able to track staff productivity on
  contract and regulatory deliverables
• Easier access by staff to patient information
• Clinic performance evaluations made easier
• Interoperability with other EHR systems, research
  and clinical

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Vital Considerations

• If you are not moving towards EHR you will be in
  a competitive disadvantage
• Do your homework vendors must add value
• Realize once you take the steps towards an EHR
  you must challenge the way you conduct your
  business

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A Paperless Approach

• Gather Patient Information
• Electronic forms
• Electronic Digital signatures
• Organize Treatment plans and progress notes
• Manage doctor orders medical notes
• Interface with toxicology labs
• Maintain medication inventories
• Bill 3rd party payers' and manage co-pays

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Adoption ProcessWhat are we going to do and how
are we going to do it?

• What are we going to do?
• Limited EHR, e.g., medication dispensing?
• Complete EHR?
• If complete are we going to try to enter all
  existing patient data or some subset?
• How are we going to do it?
• Vendor selection
• Which staff are involved?
• Budgeting for the expense
• Software
• Hardware
• IT staff at agency
• Incremental versus total immersion from Day 1

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Adoption ProcessVendor selection

• What are the key elements?
• Specificity to agencys services delivery
• Softwares history and acceptability to
  accreditation, regulatory and funding agencies
• Training and on-going customer support
• References from current customers
• Durability of software
• Customer support
• Staff and patient acceptance
• Price, while important, is less so than the above

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Implementation ProcessBefore going live

• Selecting a core team and champions
• Examining the differences between EHR software
  and agency forms and processes
• What to change and what to keep
• Iterative process between agency and vendor
• Staff training
• By vendor
• By champions
• Patient notification and support

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Implementation ProcessAfter going live

• Incremental versus total immersion
• If incremental, choosing order of element
  implementation
• Continuing the iterative process between agency
  and vendor on differences between EHR software
  and agency forms and processes problem solving
• What to change and what to keep
• Monitoring performance
• Monitoring staff needs and morale
• Its all about relationships

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Other EHR Concerns

• Management reports
• How to integrate into agency supervisory and
  administrative processes
• Data extraction for use in other databases
• Interoperability with other EHRs?
• Effect on patient outcomes?