"San Francisco Officials Cite Some Hurdles With Otherwise Smooth EHR Implementation"
Health IT Law & Industry Report ISSN 2151-2884 Source: Health IT Law & Industry Report: News Archive > 2010 > Latest Developments > State Developments > California: San Francisco Officials Cite Some Hurdles With Otherwise Smooth EHR Implementation California San Francisco Officials Cite Some Hurdles With Otherwise Smooth EHR Implementation SAN FRANCISCO—The San Francisco Department of Public Health(SFDPH) had a few administrative hurdles that stood in the way of an otherwise smooth implementation of its new $11.2 million electronic health record (EHR) system, an official told BNA Nov. 23. SFDPH Community Behavioral Health Services (CBHS) in July replaced its “outdated” patient-management Behavioral Health Fiscal and Clinical System with the Avatar software suite, developed by Netsmart Technologies Inc., hoping to cut costs and improve patient care, the health department's chief financial officer, Gregg Sass said in an interview. CBHS's previous records system was implemented more than 20 years ago, and was designed to operate on the Digital VAX platform utilizing the VMS operating system and the non-relational RDB database. The CBHS program, with about 2,500 providers, provides services to roughly 22,000 mental health patients and approximately 14,000 substance abuse clients. “This was a huge undertaking on our part; it has far reaching impact on an awful lot of people,” he said. “My concern going into this was there was plenty of potential for confusion and problems, but the process went remarkably well.” Characterizing his department's Avatar implementation as “not particularly problematic,” Sass, who is responsible for SFDPH's agencywide finances, billing, and health information technology (HIT), conceded there were initial challenges getting some providers to use the Avatar system properly, in addition to delayed payments to the programs' private provider network. The city is using Avatar CalPM to maintain patient records, e-prescribe, bill for services, and report quality of care and other measurements required by the California Mental Health Services Act (MHSA). That law, created by the passage of Proposition 63 in 2004 to expand mental health services through taxes on wealthy Californians, calls for health care quality improvement through EHR implementation and the beginnings of health information exchange (HIE). “We think the system is doing what it's supposed to do,”he said. “The system is operating as advertised.” SFDPH paid for the $11.2 million system with $5 million in state grant money and savings the department realized from the hospital-services contract it negotiated, Sass said. “We could do this in our base-budget and [did] not have to go back to the city for more money,” he said. SFDPH contracts with San Francisco General Hospital, city clinics, community groups, and private therapists to provide mental health and substance abuse services to residents. Program contractors, including counselors and social workers, are connected thorough an Avatar EMR network they use to monitor patients and the city uses it to tally provider payments. Copyright 2010, The Bureau of National Affairs, Inc. Reproduction or redistribution, in whole or in part, and in any form, without express written permission, is prohibited except as permitted by the BNA Copyright Policy. http://www.bna.com/corp/index.html#V 1 Health IT Law & Industry Report ISSN 2151-2884 Start-Up Problems Shortly after SFDPH began using Avatar in July, officials said they noticed a steep decline in the number of claims filed through the system as compared to the volume submitted before the program went paperless. Accounting officials said they noticed in September that claims for payment on mental health services had dropped 55 percent. Meanwhile, claims for substance abuse treatment dipped 32 percent. “In the first weeks of implementation, you want to track what comes in, and there was a big fall-off in the first couple of weeks,”Sass said. Sass attributed the drops to system-inputting difficulties involving about “half a dozen high-volume contractors” who had trouble adjusting to the new system. “Immediately, we started to work with them, and now we see a volume of claims processing of where it should be,” he said. Also to blame, Sass said, was the “incredibly elaborate”patient assessment page that proved to be cumbersome to providers. The page had too many information fields for providers to fill, Sass said. About half of the data elements are slated to be eliminated from the assessment page, he added. “It was unwieldy for people on the front lines, trying to manage patients,” Sass said. Another obstacle SFDPH encountered during project implementation was blamed on contractors being “mismatched” by the EHR system, which produces their payments for services. Originally, about $450,000 in contracted provider payments were delayed. SFDPH is using a third party to issue the overdue payments, a process that was still in progress on Nov. 23. Sass said he was notified about a week ago that 50 percent of the backlog was resolved. By Chris Rizo Copyright 2010, The Bureau of National Affairs, Inc. Reproduction or redistribution, in whole or in part, and in any form, without express written permission, is prohibited except as permitted by the BNA Copyright Policy. http://www.bna.com/corp/index.html#V 2