DrCloudEHR™ helps BestCare achieve Meaningful Use and CARF certification
DrCloudEHR helps addiction and mental health non-profit to effectively transition from paper to digital
With the assistance of EnSoftek and the subsequent implementation of DrCloudEHR, BestCare Treatment Services, Inc., a central Oregon substance abuse and mental health treatment non-profit with seven clinics spread over four cities, three counties, and nearly 200 miles, shifted from being totally paper–oriented in client service case notes, billing, and analytics to an entirely digital system. This allowed BestCare to create an efficient, streamlined workflow for clinicians, increase the depth and breadth of inter-clinic staff communication, reduce the number of clients who fall through the cracks, attain stronger external audit outcomes, and produce a very clear picture of the agency’s productivity and financial situation at any given time.
Overview
BestCare Treatment Services found itself in an environment in which there was an increasing—and shifting—burden of regulations and requirements for client care and billing. Additionally, except for a locally-created spreadsheet software that was becoming more and more outdated as technology advanced, the agency was almost completely paper-driven for files and billing. The outdated spreadsheet software resulted in low business/financial quality and associated analytics that was time-intensive. Having paper-only files and case notes meant clinicians treating clients often found themselves isolated in delivering care and with an incomplete picture of what other care the client was receiving. Another factor in systemic inefficiency was that each of the seven BestCare clinics had created its own way of delivering services, with several instances of the various clinics creating their own forms. Not much was standardized throughout the BestCare system.
Simultaneous to this EnSoftek, Inc., an IT Solutions and Services company solving technology problems for a variety of organizations all over the US including IBM, Nike, Northrop Grumman, Unisys, Fred Meyer, General Services Administration, Multnomah County, OR, and the Port of Portland, OR, among others, was moving into the Electronic Health Records (EHR) arena. Originally focusing on primary healthcare, EnSoftek eventually settled on creating an EHR specific to the behavioral healthcare community. The company needed a partner in that field to assist it in refining its EHR to compete in the behavioral EHR marketplace.
Once these two entities found one another, a close partnership was developed with BestCare agreeing to become the early adopter for the newly developed DrCloudEHR, giving real time, real life input to EnSoftek with the goal to provide a reasonable, enterprise-class EHR solution. For its part, EnSoftek distilled BestCare staff requirements and suggestions into a seamless workflow, refining the software initially for the inpatient and then outpatient, substance abuse clinics, the mental health clinic, and the all-Spanish language clinic came on board.
The Solution
EnSoftek began its efforts by meeting directly with BestCare personnel for interview sessions in which counseling, clerical, and administrative staff all outlined how their paperwork flowed through initial contact, first appointments, assessments, case notes, group sessions, and one-on-one sessions. The software developers conducted subsequent meetings of various end-user groups for a more in-depth understanding of the processes including the business and customer perspective. From this extensive input, EnSoftek staff then created a flow chart that it presented to BestCare for additional input and modification. An online demonstration site was developed on which BestCare staff could practice using DrCloudEHR and give even additional input. There were other issues to overcome as well. 42 CFR, Part 2, was something EnSoftek staff had to research and learn so the correct security oversight could be embedded. The initial template for DrCloudEHR had a strong framework for security and EnSoftek staff had to merely refine it to meet 42 CFR, Part 2, compliance.
BestCare Executive Director Rick Treleaven said he was immediately taken with the responsive nature of EnSoftek staff, observing it listened well to BestCare’s needs and developed innovative ways to address them. For its part, BestCare personnel worked hard at not incorporating the problems in the existing paper process into the new electronic system. As a result, its staff had to be quite clear in the problem it was attempting to solve so that the EnSoftek architects could design the appropriate solutions. Mr. Treleaven later noted he and his staff didn’t discover how much operational pain the agency’s staff had been enduring until they started using the DrCloudEHR solution.
“DrCloudEHR allows greater scrutiny when problems are getting into the system, with paper files, you could get months behind before you find out!” – Mr. Treleaven
The agency had rooms filled with boxes of paper charts. It was very difficult for BestCare staff to find out what was in any particular chart because it might be in one of those boxes in one of those rooms. With DrCloudEHR, all those charts are available online through the agency’s computers.
“We don’t have all those filled rooms now. When there is a critical incident and a client is involved, I can pull up the client’s file immediately from my desk or from my home,” Mr. Treleaven explained. “We have standardization of forms now, along with the Golden Thread embedded into our workflow, both of which were difficult with just a paper system. And getting meaningful data was painful and expensive.“
EnSoftek made it purely cloud-based to leverage the elasticity of the cloud, while providing something that was robust, extensible, always available, and secure.
The implementation process took a little over a year from beginning to end because BestCare facilities were brought online one at a time, each with on-site training. This allowed BestCare staff to learn the software so they could better articulate to EnSoftek their day-to-day activity, to further refine DrCloudEHR. As each facility was brought online, its staff received training on the system and access to a demo site on which to practice prior to going live. This was instrumental in increasing system acceptance.
Benefits
Interviews with many of the BestCare staff indicate that while the process of transitioning from paper to digital was a tribulation, they are vociferous in their praise, feeling that by using DrCloudEHR the agency is stronger, doing better work, and none would want to go back to a paper-based system. Almost to a person, staff cites the ability to better stay on top of paperwork and client activities, substantially increased inter-office communications that help workflows, audits, and most importantly, clients.
Mr. Treleaven has noted his agency is getting better clinical outcomes because of DrCloudEHR. “What we have been able to research in the EHR in detail, there are two factors that really jump out from the data: the quality of relationship between counselor and the client, and the quality of the relationship between counselors at different levels of care,” he said. “The EHR allows greater scrutiny when problems are getting into the system or gaps getting in the way of the counselor creating a strong relationship with the client, and it facilitates communications internally and we can do quality management around that. With paper files, you could get months behind before you find out.”
He stated that he is on DrCloudEHR much more than he would ever be able to look at paper files. For every important strategic contract, he’s able to drill down very quickly and efficiently from the data to individual files, and understand what’s going on within the agency very well, very efficiently. He likes that the productivity reports are simple and don’t require central office involvement. The clinic managers know how to access them and use them in running their facilities.
BestCare clinicians are clear in that DrCloudEHR is advantageous in a variety of instances. Having all the client information available on their desk computers enables the counselors to pull up a client’s file and every case note, every group note is there along with the Individual Service and Support Plan (ISSP).
“It’s a major improvement from having to dig a file out of a cabinet. It’s more convenient,” explained counselor Chuck Roberts.
“There are safety checks to make sure information isn’t left out. It can be accessed anywhere, any time. I don’t have to dig through files somewhere else if I get a call from a different office. I can pull up the file and know everything there is to know about that client and be informative for the person calling. It’s all in one spot. It’s a better form of communication rather than just filing things into cabinets. I don’t have to fax something, they can pull up the same client while we’re talking on the phone to see it. The communication aspect of it is huge!”
Mr. Roberts’ supervisor, Colin Taylor, outlined other benefits. “It used to be that the only view of a client was to the person holding the paper file. Now, I can watch every day to see how this person is doing through treatment. I can follow now because it’s so transparent to anyone in the company. I can go into a person’s file now and there are 3-4 treatment notes in the file every day. I can follow things from anywhere on any client. It’s the golden thing about this software. It’s huge! Group notes are a breeze with DrCloudEHR. They are the best they’ve ever been. There’s so much documentation now. The concept of going to a single place and getting all the information you need is a no brainer.”
The partnership between EnSoftek and BestCare Treatment Services has created an integrated, dependable, scalable solution that can be adapted to changing conditions, supports the agency’s staff, saves staff time and storage space, allows a 360-degree view of the client that can be shared across a wide geographic area. All this while still complying with HIPAA and CFR 42, Part 2, resulting in better audit outcomes, and operating smarter from both a clinical and business aspect.
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