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Rogers Memorial Hospital just made history. It is the first standalone acute psychiatric hospital system in the United States to achieve HIMSS 6.
The hospital’s three inpatient campuses in Wisconsin are part of Rogers Behavioral Health, which also includes 10 specialized outpatient locations stretching from Wisconsin to Florida.
“It is a great accomplishment,” said CNO and Vice President of Patient Care Terri Schultz. “We do this for the patient. When you have a consolidated health record and have built in safeguards in the EHR – it only benefits the patient.”
Schultz said the journey to HIMSS 6 started when Rogers decided to purchase and implement Cerner in December of 2013, followed by a system-wide implementation in August 2015. “We had a very successful implementation,” she said. “That set the stage for everything else.”
Unlike many health care facilities in the U.S., Rogers only focuses on behavioral health. Its physicians are psychiatrists, not cardiologists or surgeons. Finding an EHR to tailor to its specific needs – from in-patient to revenue cycle - took some hunting.
“We looked at about 15 EHR vendors,” said Schultz. “We wanted to build a record that met our needs, not one built by someone else, which would have been a requirement with other vendors.”
In building its own EHR, Rogers was able to construct safeguards specific to its population.
“Hospitals have HCAHPS. We have HBIPS. These are publicly reported measures required by CMS. We built some of these measures directly into our EHR to assist the physicians in meeting the standards to help us with compliance.”
One of the most difficult HBIPS measures, pre-Cerner, was listing why a patient was discharged while on multiple antipsychotic medications.
“Before, when we weren’t on Cerner, psychiatrists did not always document why the patient was on multiple antipsychotics at discharge, which was the requirement. Now, they can’t skip this step and must put in an explanation because it’s built into the EHR,” said Schultz.
She continued, “that’s one thing about the EHR – you can build it to meet standards and best practices. Our physicians and staff can’t move on without filling out certain parts of the assessments or forms. That provides better patient care overall and our care is more standardized.”
Prior to implementation, Rogers did not have the dispensing unit connected to the patient record, nor were they able to implement barcode scanning. Now, said Schultz, “we are getting the right medication at the dispensing unit and then getting it to the right patient.”
“Our medication error rate wasn’t huge, but any error is bad; even if small. With the integrated medication solutions, we are hardly making any medication errors now.”
Documentation for behavioral health facilities differs somewhat from their medical care counterparts. One unique documentation that Rogers performs is making the rounds on their patients every 15 minutes and documenting the patient’s location. With the EHR all in one place, the staff is able to make the rounds with an iPad and log entries rather than using a paper form.
“We all have the same chart and that’s huge for us at Rogers as we have expanded our services. We need to have the same forms, the same processes, the same documents. We have built it all so that, even if a patient is in Nashville, they feel like they’re part of the Rogers system.”
As an acute psychiatric facility that sees patients from age four to 100, the way Rogers documents may be different compared to a medical hospital. In provided group therapy sessions, for example, Rogers separates patients by age group and diagnosis or disorder.
In addition, all charting must accommodate four different levels of care – inpatient, residential, partial hospitalization and intensive outpatient. Having the data has led to treatment innovations, especially in the OCD population.
That integrated chart and excellent documentation carries over to the revenue side of Rogers, as well. Before switching to Cerner, Rogers had a coding backlog of several million at any given time. Now, it is less than $50,000 at any given time due to the efficiency created by being able to code from an electronic health record instead of a paper chart.
“Because the whole workflow changed and is now integrated,” Schultz emphasized. Thanks to its Revenue Cycle solutions, it now takes roughly three days to drop a bill.
Schultz and the rest of Rogers leadership aren’t resting on their historic laurels yet. They are currently implementing CareAware Connect, P2Sentinel and single sign-on solutions, and have plans to implement a patient portal and PowerChart Touch next year. But first, they’re waiting to hear if they’ve reached another milestone: HIMSS 6 Ambulatory.