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Electronic Health Records (EHR) and Consolidating Priorities

Mental health and addictions professionals require tools. For a couple decades, Terry McLeod has been a trailblazer providing those tools in the form of Electronic ...Read More

I’m no professional, but I’d say prioritizing can make or break us in mental health and addictions treatment.

OK, so my work as an Electronic Health Record (EHR) Consultant has a very professional aspect, but I’m not a mental health and addictions treatment professional. We all have priorities, but it seems to me that the mental health and addictions treatment professionals’ priorities are likely to be based on criticality and probably carry more weight in the grand scheme of things than an EHR Consultant’s.

Let’s look at a day in the life of a sample mental health clinic. Our sample professional can be faced with priority list of tough choices about a whole caseload of consumers, and in the moment talking with a consumer who is experiencing suicidal ideation; this case creates its own ever-changing list of priorities. Simultaneously, the Chief Financial Officer (CFO) of the organization has a stake in our sample professional’s priorities for the day. The CFO’s priority is in making sure the professional’s work gets paid for with the highest rate of return. Yet another item in this day would be passing muster with audits in order to keep the money once treatment has been delivered and the bill paid to that professional, a situation that deserves its own spot high on the priority list. Our sample professional is still concerned with her consumer, whose welfare remains the top priority, however, after that she will likely cooperate to assure the other two priorities are met. The CFO and auditor both maintain their number one priorities, too, which can seem like a conflict.

So, all the priorities are on each other’s lists, it’s a matter of perspective as to which item floats to the top. In the end, the entire team involved in this day-in-the-life description needs to agree on one set of priorities…what comes first and how much energy should be devoted to getting each item on each list of priorities done.

When it comes to the EHR implementation, these daily scenarios need to be weighed for organization-wide importance and ordered realistically on the organization-wide list. Without team cooperation, what’s best for the entire organization may fall to the wayside and priorities may change enough to run out of budget before the EHR is fully implemented. A team needs to be forged; flexible and intent on doing the most for the organization with the available budget. Some items will be left off the list because money tends to run short before work.

The mission of the EHR is to document consumer treatment, bill for it and account for where the money goes; the mission of an EHR implementation project manager is to configure, train, comment, cajole and lead all these people to a happy consolidation of priorities that will satisfy them all in the end – at least mostly. It’s a tough job, satisfying many masters in an ever-changing environment, and if we don’t get agreement on consolidation of priorities at the outset, our project may be doomed. Sometimes priorities are mismanaged and the job is left unfinished with users struggling with a partially implemented EHR.

How can that happen?

When software configuration is out of kilter or the software’s procedures don’t dovetail with the organization’s, there are a number of factors that can be affected. Discoveries of inappropriate design and configuration come up during implementation and if the project manager and team aren’t responsive and willing to negotiate priorities, it leads to unexpected development costs. Sometimes the perfect solution is sacrificed for the good-enough solution.

Because difficulties like these are ignored, too many EHR implementation projects have been left incomplete, and that hurts the EHR manufacturers’ reputations, as well as hurting the professionals and support people who rely on the software to inject some efficiency into the flow of their work. A solid consolidation-of and agreement-upon priorities is the first step, and to avoid leaving a project unfinished, a balancing act comes into play. The team needs to stick to their guns and implement according to the original consolidation of priorities as closely as possible. When that goes off-track, the project usually requires more time, work and resources to live up to changing priorities OR some items on that priority list are dropped off with a plan to address them later (complete with a scheduled date)

I recently encountered the effects of an extensive issue where consolidation of priorities was not well done and consequently ineffective. In the Mental health and addictions treatment world, the number one reason not to use the EHR is a lack of “user friendliness”, which can mean about anything you want it to mean. Some of the project was completed, but not all. Managing schedules for consumers and professionals was left incomplete. Billing and posting payments was left about half done.

Consolidation of priorities to even make the implementation work for a team like the one described above was ineffective…gotta keep on top of that.

We want our highly skilled professional team described above to stick around, so configuring and implementing the software with “user friendliness” in mind becomes imperative. Since our EHR wasn’t implemented and managed to meet a set of negotiable, consolidated priorities, the list may have been unrealistic for the budget. The team may not have had a realistic appraisal of the number of man hours required for the job, or explosive growth may have gobbled up a bundle of the team’s time that was supposed to be devoted to the implementation. Priorities were not met, plans to meet them didn’t get made immediately upon realization that was happening.

Consolidating priorities has to be a joint agreement among all the players and needs to be revisited and re-negotiated on the inside of the organization. There has to be some give and take and a clear view of what’s best for the entire organization. If reality changes the priorities, a new plan with an adjusted budget needs to be agreed upon and approved.

…Easy-peasy, right?

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