Using third-party hosting for electronic health records is generating benefits for community mental health agencies in Michigan.
Saving money is one plus. PCE Systems built an EHR system for the Washtenaw Community Health Organization (WCHO) and Community Support and Treatment Services that produced $3 million in savings in two years, stemming from the elimination of positions via staff attrition.
WCHO manages public mental health and substance abuse funds and handles clinical services and authorization for treatment and inpatient psychiatric services, said Jeremy Nelson, WCHO’s chief information architect. Community Support and Treatment Services provides mental health services under a contract with WCHO.
Washtenaw and other counties in southeastern Michigan use a customized PCE system they have named Encompass.
The company’s hosted approach has other advantages. Because PCE handles software development, budget-conscious agencies don’t have to seek expensive talent.
Most county agencies find it difficult to compete with health maintenance organizations and insurance companies that can pay top dollar for information technology specialists, said Bill Riley, chief information officer at the Oakland County Community Mental Health Authority.
But by working with PCE, agencies tap into a deeper and broader talent pool. “That is a better proposition for us,” Riley said.
The hosted model also means agencies don’t have to manage data centers. “We get to concentrate on other things,” he said. “We can take on a more strategic role” in informatics.
Lynne Dunbrack, a program director at IDC’s Health Industry Insights, said hosted EHR solutions are catching on. “We’re seeing [hosting] gain more traction,” she said. “Hosting helps reduce the total cost of ownership…and makes costs much more predictable.”
— John Moore
At a time when many organizations are installing commercially packaged electronic health record systems, agencies in about a dozen Michigan counties have adopted customized solutions. They’ve also opted for a hosted approach rather than an internal deployment. And they are pursuing a collaborative design initiative that takes a page from the open-source model.
The campaign is producing results. One health agency said the system paid for itself in two years, generating $3 million in savings. Other benefits include the elimination of incidents involving lost or missing charts and improved accuracy in complying with state and federal reporting requirements.
In addition, third-party hosting lets organizations avoid information technology infrastructure costs and the need to recruit specialized talent.
Much of the EHR emphasis in Michigan has been in the area of community mental health, although it also includes primary care.
Michigan’s unconventional effort has been several years in the making. One project began in 2003, when the Washtenaw Community Health Organization (WCHO) sought to automate clinical records. It did not explicitly seek an EHR — at least not initially.
“We didn’t know we wanted an electronic health record,” said Jeremy Nelson, WCHO’s chief information architect. “But we wanted something that could hold all clinical information. That evolved into EHR.”
The organization issued a request for proposals for a Web-based system that could grow and keep up with the business, Nelson said. The organization offers mental health and substance abuse counseling and primary care services to Medicaid and indigent patients.
After reviewing five proposals, the organization selected PCE Systems, a custom software developer based in Farmington Hills, Mich., in May 2003. The system, dubbed Encompass, was launched several months later with physician notes, claims payment data, insurance information and treatment planning, among other components.
Custom approach Nelson said the system has the advantage of easily incorporating frequent updates, which is important in light of ever-changing Medicaid rules and state and federal government reporting requirements. The state government audits community mental health agencies annually. If auditors find problems, agencies must develop corrective action plans if they want to continue receiving state funding.
“The ability to make changes and corrections based on site visits and audits from the state is very important,” Nelson said. “If the [agencies] had to wait six months to a year for the system to be updated, they would be out of compliance.”
WCHO’s approach piqued the interest of health authorities in neighboring counties, and in 2004, Lenawee, Livingston and Monroe county agencies decided to adopt Encompass.
“Those agencies wanted to stop duplication of effort,” Nelson said. “They wanted to collaborate and work together.”
The three agencies and WCHO decided to adopt standard forms and processes and spent three months standardizing nine clinical forms, Nelson said. Psychiatric evaluations, treatment plans, progress notes and medication review notes, among others, will have common formats in Encompass.
Other counties use PCE-built EHR systems that differ from Encompass. “There are variations between us,” said Bill Riley, chief information officer at the Oakland County Community Mental Health Authority. “Our systems can look quite different.”
He said the differences are especially apparent on the clinical side because different agencies have different philosophies of care.
They also emphasize different processes and have different clinical intensities. In contrast, health maintenance organizations operate under similar models and can use commercial software, he said.
But in community mental health, PCE’s willingness to customize is a plus. “There is a core product, but what they really sell is the ability to customize,” Riley said.
Collaboration Although PCE’s EHR product accommodates differences, Michigan users are now seeking commonality for a collaborative design effort. In summer 2007, Michigan agencies launched the PCE Collaboration Group.
The group meets monthly to discuss opportunities for creating components that can be shared. Nelson said 10 such projects have been identified and two standard components have been released so far: a complaint module and an incident-reporting module.
For community mental health agencies, state law defines the complaint- and incident-reporting process. That structure lends itself to a common development approach.
Lynne Dunbrack, a program director at IDC’s Health Industry Insights, said she believes Michigan’s cooperative design approach is fairly unusual. But she added that it makes sense for agencies, particularly those with limited IT resources and budgets, to create a system that can be used collectively.
For future projects, Riley said he plans to propose a standard approach to a data warehouse, adding that he believes 80 percent of a warehouse could be standardized from one prepaid inpatient health plan to another.
A plan typically consists of multiple community mental health agencies, and Riley said the agencies could tap the warehouse’s data to discover trends in patient utilization and cost, for example.
To turn a software concept into reality, the collaboration group designates a lead agency for each project. That agency establishes a workgroup with representatives from the various mental health agencies.
The group comes up with a preliminary design for a given EHR component, and the lead agency reports back to PCE and the larger collaboration group for approval and training suggestions, Nelson said.
The fees agencies pay to PCE generally include the price of new modules, and each agency pays a one-time implementation fee and a monthly fee for hosting and development.
The amount varies based on the size of the agency and the level of customization required, Nelson said. Some items, such as a module WCHO sought for a homeless shelter, require an additional fee, he added.
Although the collaboration group is developing a standard that many agencies can use, the state has declined to set clinical documentation standards.
“The group is creating a best-of-breed, bottom-up approach to a standard,” Nelson said. “It is a very collaborative group, and people are willing to give up their territorial needs to get something better for all.”
Government Health IT will present Liesa Jo Jenkins, executive director of CareSpark, in an eSeminar at 11 a.m. Thursday, Oct. 16, where she will share her experiences and insight into building a health information exchange that enhances community health, rewards regional collaboration and drives economic progress.
