- Epic Implementation
After about 15 months of planning, meeting, coding, optimizing, and preparing, we went live on Epic a week ago. We had Cerner before that, and a homegrown CIS before that. The initial CIS was mostly labs, rads, and dictations as I recall. With Cerner PowerChart and FirstNet, we added nursing documentation, MAR, and some clinical documentation, though we had a hybrid system that included a paper chart for all non-dictated physician documentation (mostly progress notes, as H&Ps, consults, and DC summaries were dictated) and paper physician orders. A handful of small, contained areas (Peds, OB, Psych, ED) did do CPOE, but expanding that to the rest of the hospital, and our many community-based physicians, was untenable.
Now we have (mostly) abandoned paper documentation, with all physician documentation being done by either phone dictation, templates (using Notes and/or Notewriter plus/minus partial dictation), or Dragon. We are piloting Dragon Enterprise with a small number of physicians, otherwise they are using their own licenses. Still having network connectivity problems with wireless devices, especially BYODs -- particularly those of the Apple persuasion. And ironing out printing issues.
Overall, the switch has gone amazingly well. I attribute this to excellent executive support, mandatory classroom (not online) physician training (8-12 hours), extensive clinician involvement in the build, and heavy at-the-elbow support.
- Maryland's Behavioral Health Integration
In 2011 we kicked off an effort to combine the Department of Health and Mental Hygiene's two administrations -- Mental Hygiene Administration and Alcohol and Drug Abuse Administration -- into an integrated administration which is expected to be called the Behavioral Health Administration. The Joint Chairman's Report lays out much of the rationale, as well as the challenges. Health Secretary Joshua Sharfstein MD MPH, previously Baltimore City commissioner, then a stint at FDA, has led an admirably open, transparent, stakeholder-rich effort to shape this integration effort.
The past 3 months have been heavy with 2-to-3-hour long Workgroup meetings. I've been attending many of these meetings (maybe a third to a half), representing the Maryland Psychiatric Society. The main points I've been making mostly revolve around ensuring mental health parity and integration of primary care. Besides the large overall Workgroup, there have been four, more focused, workgroups (links have meeting agenda, minutes, resource documents). Their charges are as follows:
- Systems Linkage:
Purpose: To make a recommendation on those factors that should be present to promote "integration." For example, should there be a shared electronic health record among all providers within an MCO? What factors indicate “integrated” care, and what factors indicate “collaborative” care?
- State/Local and Non-Medicaid Workgroup: Purpose: To make a recommendation on what services/financing should be left outside a “Medicaid” integrated care model to accommodate non-Medicaid eligible populations, or non-Medicaid-eligible services. This Workgroup will also make a recommendation on the roles that state and local government should perform depending on which services/financing are left outside of the Medicaid financing model, as well as how to support and interface with selected model.
- Evaluation and Data WorkgroupPurpose: To determine what data is available and relevant to the ultimate recommendation on the model, and to make a recommendation on potential measures to evaluate any selected model.
- Chronic Health Homes Workgroup Purpose: To make a recommendation on a new “Health Home” service under the Affordable Care Act, and make a recommendation on how the new service could be developed to support any integration model. For example, this workgroup would help define the service; define the population eligible for the service; and define the provider qualifications to deliver the service.
- Maryland Health Benefit Exchange
Maryland is among the earliest states to respond to the ACA's requirement of health insurance exchanges that include qualified health plans (QHPs) which must include a minimum set of essential health benefits (EHBs). This process has been unfolding extremely quickly over the past three months, with several meetings per week across all the advisory committees, as well as the governing Board. I've served on the Plan Management Advisory Committee, which has completed its work and submitted a Summary to the Board and to the legislature. Over 200 pages of public comments have been submitted to the Board, which met last week. Ensuring that there are requirements to demonstrate Parity compliance, as well as adequate provider network standards, has been the main focus of mental health advocates.
The other advisory committees include Navigator, Continuity of Care, Financing, and Exchange Implementation.
- Maryland Health Information Exchange
The MHCC Policy Board continues to slog through its policy discussions. The current list of policies is in a .pdf document here. We've also been working on draft regulations for HIEs in Maryland. Initial public comments on these draft regulations are available on the HIE website.
I'll try to post a bit more often here, but you can also keep an eye on Shrink Rap, Clinical Psychiatry News, and a new column on health IT to start soon in Psychiatric News.
Thank you for reading.