Wediko Children's Services

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Wediko Children’s Services delivers behavioral health programs designed to help at-risk children who are struggling with social, emotional, and academic challenges achieve productive and fulfilling futures. Founded in 1934 and headquartered in Boston, Wediko offers school- and community-based therapeutic services to troubled youth and their families in Boston and New York City. Wediko also operates a summer camp and year-round residential school in New Hampshire. 

Challenge

Streamline Documentation Management and Exchange                                      

For more than two decades, Wediko relied on a clerical billing system created specifically for the organization. The outdated platform, with limited interoperable functionality, incorporated an inefficient process for transferring treatment notes into client paper records. The system made it difficult for Wediko to effectively interface with insurance companies, comply with regulatory audit requirements, and exchange information efficiently with providers across the healthcare ecosystem. Since many of Wediko’s clients require in-patient care at some point in their treatment, relying on faxes to exchange information hindered Wediko’s ability to efficiently coordinate their clients’ care.  

The organization realized it needed to adopt advanced technology—a cost-effective, interoperable EHR system—in order to streamline and integrate clinical documentation processes across its in-home therapy teams, outpatient group practice, and school-based clinical services. Wediko also recognized the value of connecting their EHR system to the Massachusetts HIway, the state’s health information exchange, as a way to improve communication with their clients’ other care providers.  

Solution

A Cloud-Based Customizable Platform

Wediko’s leadership team began evaluating potential EHR vendors in fall 2014 and by the following spring had selected a Dr Cloud EHR solution, a secure cloud-based system specifically designed for behavioral and mental health organizations.

Wediko’s leadership designed a step-by-step orientation, rolled out over the course of a full year, in order to teach, onboard, and get buy-in from their staff.

The new technology was introduced to Wediko clinicians and administrators in July 2015, followed by a staff field trip to Google’s Cambridge campus. During this visit, the staff engaged in a full-day training session on synched Chromebooks, which served as the kickoff for a year-long EHR implementation process.

The phased rollout was purposefully designed to provide Wediko clinicians and administrators with a gradual learning curve to master navigation of the system, receiving “booster shots” of support throughout the journey. The workflow migration to the EHR involved a transition from a paper to digital system, but also a broader transition which encompassed a revamp of the documentation processes across diverse programs. By restructuring the documentation process, Wediko staff were able to more easily integrate the EHR into daily work, maximizing the impact from the new technology. 

In addition to a feature-rich, off-the-shelf platform, the Dr Cloud EHR system provided Wediko with the flexibility to integrate customized features to address specific requirements. Wediko leveraged this functionality to advance its approach to clinical documentation. Historically, the organization’s clinicians recorded narrative therapy notes in unstructured Microsoft Word documents, which were then inserted in client paper files. In contrast, the new EHR system delivers Massachusetts standard behavioral health forms in a digital format. The electronic forms, which directly link to cloud-based client charts, are able to prompt the provider, ensuring the inclusion of specific details in every treatment plan. This results in a more comprehensive and consistent view into a patient’s care, as well as improved continuity as a client moves through various phases of treatment. It also enables Wediko leadership to mature its practice by more precisely aligning with state standards and industry best practices.

Support from MeHI & the Commonwealth

Wediko, a nonprofit agency with a small budget for health information technology (health IT), received a grant from MeHI’s eQuality Incentive Program (eQIP) to assist with their adoption and implementation of their interoperable electronic health record (EHR) system. This grant program specifically supports and funds Massachusetts behavioral health providers in their use of health IT to enhance the quality and efficiency of health care and positions eQIP participants for inclusion in larger, state-wide eHealth community efforts. 

Staff Input and Involvement

A unique component of the Wediko EHR implementation was the integration of constructive critical feedback from the user community.

“Social workers are inherently nice, easygoing, nurturing people,” explains Michael Clontz, Director of Boston Programs at Wediko. “They are not naturally inclined to express criticism, but in this case, their candid input was significant for success.”

The organization’s 2015 annual survey of programs included a section about the EHR interface. Wediko collected and consolidated actionable feedback from staff related to user experience, which was then used to initiate an ongoing dialogue with the system vendor. This collaboration led to a solution that is continuously enhanced through user observations and recommendations.

“A successful implementation is dependent on clinicians and administrators. I am really fortunate because I work at a great agency with a strong sense of community. The Wediko staff rose to the challenge. As an administrator, I am very mindful of the fact that it is the clinicians who are on the front lines making this work.”

Michael Clontz

—Director, Boston Programs, Wediko Children’s Services

Impact

Instant Access to Information

The cloud-based EHR system enables Wediko clinicians immersed in remote fieldwork in schools and community environments to input therapy session notes and access client charts in real time. This allows therapists to view not only their current work, but also to review and incorporate the complete client history into critical decisions on treatment plans. Similarly, supervisors and administrators collaborating in team meetings can instantly access digitally encrypted, HIPAA-compliant client charts online, on demand. Cloud-based digital charts provided Wediko with a significant step forward in efficiency. Before the EHR implementation, this information could not be accessed or submitted until the clinician or administrator returned to the office and retrieved it from the paper file. Administrators are no longer burdened with paper-filing activities, which allows them to expand their roles and add value in other areas of client care.

Wediko intends to leverage these improvements to further enhance the organization’s document management processes. After a year of importing information into the system, staffers are discovering better ways to capture data in reports and improve the quality and timeliness of clinical documentation. By the end of the year, the organization plans to launch a client portal for faster access to information and release forms, appointment scheduling, and medication review, inviting Wediko families to participate in, and benefit from, advances in digital communication. 

Looking at EHR implementation benefits from a broader perspective, the system also delivers demographic trend reports on populations served. This visibility leads to a greater understanding of client challenges and the ability to tailor programs that maximize positive outcomes for Wediko’s children and families. 

Next Steps

Collaborative Synchronized Care

In addition to the EHR implementation, the MeHI eQIP grant enables Wediko to connect to the Mass HIway, the state’s health information exchange (HIE). In this instance, the HIway empowers healthcare providers treating the same population of children to communicate electronically and exchange client information in real time. This information sharing is a key element of MeHI’s milestone-based eQIP model, which is designed to help behavioral health providers mature their EHR systems and improve care coordination among behavioral health and physical health providers.

Wediko acknowledges the challenge of identifying trading partners for the HIway, given the emerging technology involved and the fact that many healthcare providers are still in the process of adopting EHRs and bringing systems online. Nevertheless, Wediko is currently using the HIway to communicate with inpatient pediatric and adolescent behavioral health units at Franciscan Children’s Hospital, Cambridge Hospital, and the Home for Little Wanderers.

“Our children typically experience trauma in childhood that at some point may require them to step up into inpatient care. It would be extremely helpful to share information instantly when a child enters or exits this environment,” explains Clontz.

Test messages are sent via the HIway and, while there are some compatibility issues with document attachments, Clontz sees this as an important step in the right direction, away from the traditional and tedious exchange of information via fax. He and his colleagues believe this direct messaging between providers is a cutting-edge development and anticipates significant workflow improvements will come from the ability to instantly import shared information into cloud-based client charts.

The wave of information exchange and integrated care underway in Massachusetts involves linking behavioral health agencies to pediatricians and primary care providers to merge behavioral health data with a child’s overall wellness information. Trauma impacts both the mental and physical health of children well into adulthood. Providers on all points of the care continuum must therefore synchronize their efforts to optimize integrated care delivery. Today’s digital health technology provides the infrastructure for real-time exchange of critical healthcare information. The team at Wediko is passionate about actively participating in the evolving landscape of collaborative care, and MeHI is proud to be able to support their journey and mission through the use of health information technology. 

For more information about Wediko Children’s Services, visit wediko.org