EHR Implementation in a Behavioral Health Clinic
Five Question Fridays:
Interview with Anthony Centore, Director, Thrive Boston Counseling.
Thrive Boston Counseling is a Cambridge, Massachusetts-based provider of individual therapy, life coaching, couples and marriage therapy. Its mission is “to facilitate dramatic improvement in persons’ mental health, happiness, relationships and life success such that clients passionately tell others about our services.”
— Thank you Dr. Centore, for agreeing to participate in our series about EHRs and their impact on health care professionals. What motivated you to start using an EHR?
It is in our “DNA” at Thrive to continually try new things that might improve the high-quality of care we provide our clients and patients. We thought that an EHR system would help us to better organize records, and would make records easier to retrieve when there are client requests.
— Was everyone on board with this? If not, how was the decision made?
Everyone was on board from the beginning. However, once implementation began, feet started dragging. Our therapists want to focus on client care, not on learning new software. As it turns out, the system we chose (like many we have tested since) is not nearly as user friendly as we would have liked, and the learning curve was brutal.
— How did you select the EHR you’re now using?
As a mental health counseling practice, we bill less per-clinician than other medical practices. Unfortunately, many of the solutions we looked at were priced much too high as they charge several hundred dollars per user per month. Such cost structures will never be realistic for a mental health counseling practice.
— Who was involved in selecting the EHR?
As the director of the practice, it was my job to solicit feedback from the team to determine what features would be helpful. The final selection was mine.
— Describe the process?
I had a hard time finding other counseling centers to recommend a program. Most aren’t using EHR, and others weren’t using a program that made sense of our practice. For one, we wanted to find a web-based program we didn’t need to have installed on each computer, and this eliminated a lot of options. Price eliminated many more. Trying out demo-versions eliminated almost the rest. In the end, there was only one or two programs we could find that would work for us.
–When did you start your EHR implementation?
We started September 1st of this year (2009).
— Are you done?
For now, I think we’re done. But we’d be open to trying another program in about a year, if we find something that looks easier to implement, more affordable, and better suited for our needs. I think it will take us some time to feel up to it after the hassle switching over to the first program caused.
— Are you still using paper or did you make a complete transition to paperless?
We use paper only for the first session, for some intake documentation. After that, it’s all online!
— What do you like about your EHR?
I think it has improved our note-taking overall. In addition, it’s easier to view a history of sessions at a glance. It’s starting to make billing simpler–but that’s after 3 months of set up. It’s nice not to have a growing mountain of filing cabinets in the office.
— What do you dislike about your EHR?
It takes much long to train new counselors to use the EHR system, and it’s not intuitive. There’s a lot of conversation during the training process that sounds like, “It doesn’t make a lot of sense, but you need to click here, then here, then this drop down here, and ignore this, this, and that, because those choices don’t apply to us.”
— What kind of support have you received from your EHR vendor?
The support has been helpful. They’re available to talk by phone during normal business hours.
— Can you elaborate about the support you receive?
They are there to walk you through the program, which is nice. However, I don’t have my counselors call them anymore because they teach too much–much of which staff doesn’t need to know. After two hours of phone calls with support, they are overwhelmed with what they think they need to learn, and don’t know the basics. To train Thrive Boston Counselors adequately, I now bring new hires through 25 minutes in house training, which I need to go through with them usually twice over a one-week period.
— Anything else to add?
When someone is trying to sell me on an EHR or Practice Management system, I’ve found that asking the following basic question stumps 99% of them. The question is, “If a client arrives and pays $100 cash for their appointment, how do I quickly log that into the system?” The answer to this question–if it’s not “our EHR system doesn’t deal with the payment side of things”–often takes over 15 steps and sounds like this: “No problem! Simply click here, then scroll down to the bottom, then select the second tab on the left, then the third drop down option, then here, then there, select the patient, select the appointment, click billing options, enter a diagnosis and procedure code (necessary even for cash pay), enter the amount, click submit, go back to the billing page, click edit, then apply, then confirm. Done!”