South Shore Mental Health
South Shore Mental Health (SSMH) provides community-based education, treatment, and recovery programs and services to those who struggle with a variety of mental health issues, developmental challenges, and substance abuse disorders. Founded in 1926 and headquartered in Quincy, SSMH’s team of 700 employees delivers outpatient, mobile, and residential services to 16,000 clients throughout Boston and Southeastern Massachusetts.
Fragmented Systems and Workflows Hinder Organization’s Mission
Operating within a highly decentralized organizational structure encompassing 23 locations plus mobile staff, SSMH realized it needed to streamline technology across programs and services. The nonprofit behavioral health agency recognized the ability of technology to increase transparency, improve process efficiencies, and enhance information sharing to improve the quality of care. To build on the agency’s core commitment to the continuum of care, SSMH also wanted to demonstrate a robust IT capacity that would position the agency to address emerging market opportunities for collaboration and integration of services with health organizations beyond the behavioral health community.
Specifically, SSMH staff often interact with other health provider environments, so it’s important to synchronize EHR systems to support those partnerships. Proper information exchange requires dissemination of the right information, in the right place, in the right format. EHRs need to speak the same language to consume information from other systems. This can present a challenge since many healthcare providers still do not have fully functional EHRs, or are in the midst of upgrades, which inhibits their ability to share information electronically.
Before selecting and implementing an electronic health record (EHR) solution, SSMH began laying the foundation for the transition from paper to a digital system by introducing change management processes and proactively addressing other cultural adjustments within the organization. When it came time for the EHR implementation, SSMH had a strong infrastructure in place and a solid launching point to embark on the transition.
Phased Rollout Minimizes Risk
In 2012, SSMH decided to expand a longstanding relationship with Netsmart Technologies and selected the vendor’s Avatar EHR system, a solution that delivered the comprehensive capacity required to accomplish SSMH’s health IT objectives.
Knowing that a complex system implementation requires significant changes to workflow, processes, and procedures, agency leaders anticipated a learning curve and organizational challenges such as clinical documentation mistakes, billing errors, and potential negative impacts on cash flow during the early days of deployment. To prevent these issues from cascading across services and programs, or potentially disrupting daily operations, SSMH opted for an iterative process that allowed learnings from each clinic rollout to be incorporated in the next clinic’s implementation, improving the process every step of the way. This resulted in a multi-year, phased rollout, which allowed SSMH to implement the EHR in its five outpatient clinics one at a time starting in 2012 and ending in 2016.
Formal training was provided by teams of subject matter experts at each site. As each SSMH staffer mastered the new EHR system, they joined a growing pool of expert ‘super users’ prepared to train and mentor colleagues in the other clinics that were poised for implementation. As with most organizations, there was significant variability in the technological literacy of SSMH staff, with some more comfortable than others with the new system. The mentorship model employed by SSMH helped ease some of the growing pains associated with new data entry processes, standardized workflows, and other adjustments.
After the implementation, the entire staff was able to use the EHR to quickly access client information across all of SSMH’s programs, including the 60 percent of services delivered outside of the clinic environment by clinicians working remotely in communities. Those clinicians can now securely access personal health information via laptops and other mobile devices, while SSMH can ensure compliance with record-keeping and reporting requirements.
MeHI Support Propels Successful Implementation
According to agency administrators, the enhancement of SSMH’s interoperable EHR was made significantly easier as a result of funding and planning support provided by MeHI, the Massachusetts eHealth Institute. MeHI’s eQuality Incentive Program (eQIP) assists Massachusetts behavioral health providers in the adoption and use of health IT to improve the quality and efficiency of care. Support from MeHI staff, along with the SSMH’s use of the Electronic Medical Record Adoption Model (EMRAM) and Transformation Plan tools, proved to be extremely helpful to the agency to move EHR adoption forward and adhere to project timelines and goals. Additionally, MeHI’s annual forums for grantees provided an excellent resource for SSMH to network, share success stories, and learn about educational opportunities.
“The eQIP goals are achievable. It’s an organic process. The program’s flexibility and MeHI’s responsiveness to feedback enable success as grantees progress through the milestones."
—Martha Ryan, Manager of Meaningful Use, South Shore Mental Health
A key part of the eQIP program requirements is to connect organizations to partner care providers to support patients as they transition from one organization to another. SSMH met this requirement by connecting with Beth Israel Deaconess (BID)-Milton via the Mass HIway, the state’s health information exchange, or HIE. SSMH outpatient clinics can now receive discharge summaries and continuity of care documents (CCDs) from BID-Milton and integrate them into their patients’ medical records, thereby improving care coordination for shared clients and supporting reduction in hospital readmissions.
Impact & Next Steps
A Growing Client Portal and Measurable Outcomes
Comprehensive electronic health records are now standard across SSMH, making internal and external information sharing easier and more efficient. Clinicians and administrative staff have better access to patient information, workflows are streamlined, and improved documentation and claim support have reduced the risk of audit exposure.
“We made technology investments to grow our relationships with other healthcare providers. One of the biggest paybacks for our early advancement on the health IT maturity curve is that it positions us to partner with other healthcare organizations… and that gives us a critical competitive advantage.”
—Margaret Carr, Director of Marketing & Development, South Shore Mental Health
SSMH also leveraged health IT to launch a client portal in late 2015. Initial connectivity between the portal and the EHR system provided clients with easy access to their health records. Recent interface enhancements, accomplished mostly by improving workflows, include automated appointment reminders and secure email. Access to health information empowers clients, and the technology improves provider customer service, including more flexible and timely options for clinician/client communication.
SSMH’s approach to using their portal enhances patient engagement, one of the universal obstacles faced by behavioral health providers. Many patients are reluctant to take advantage of, or are unable to access, advanced technology solutions like patient portals, but SSMH’s engagement efforts aimed at increasing portal activity seem to be paying off. Incentive programs, as well as initiating portal registration with clients when they visit clinics for services, have boosted participation rates over last year equaling over 100 new portal users. Increased marketing activity has raised awareness of portal features and benefits. In addition to developing and distributing collateral such as brochures, posters, and handouts; SSMH ran a promotional campaign, which resulted in their best month of sign-ups, totaling 40 clients. They advertised that for any client that signed up for the patient portal and sent an email to the clinic through that channel, received a Dunkin Donuts gift card.
Partnering Opportunities and Advanced Analytics
Looking ahead, SSMH is evaluating comprehensive care management technology solutions with an eye toward opportunities for engagement, streamlined information exchange, and coordination of care with other health providers. The organization also intends to expand the functionality of its analytics systems to incorporate robust qualitative and quantitative analyses of SSMH programs and services.
“Our diverse client community, spread across a large geographic area, will benefit from coordination of care among a broad variety of providers and care managers. We plan to leverage every available opportunity to provide the highest quality of care possible to our clients.”
—Martha Ryan, Manager of Meaningful Use, South Shore Mental Health