Workflow Redesign for Behavioral Health Providers

1. Workflow Redesign for Behavioral Health Providers Provided By: HealthInfoNet Based on: Workflow Design Templates & Instructions developed by the Health Information Technology Research Center (HITRC) Practice & Workflow Redesign Community of Practice at the National Learning Consortium at HealthIT.gov. Adapted for Behavioral Health Providers by: The Behavioral Health EHR Action Taskforce Workgroup, funded by the SAMSHA Grant

2. Workflow Re-Design in a Behavioral Health Setting The Behavioral Health EHR Action Planning Workgroup identified six workflows in a behavioral health setting that can be re-designed when moving from paper to an EHR. As a first step in optimizing work-flow re-design, in collaboration with the implementation team, you and your practice staff can review these six workflows and map how they are currently performed in your office: • Client Referral • Client Check-in • Intake Visit • Office Visit • e-Prescribing • Client Check-Out

3. Mapping the Current WorkflowInstructions • Analyze current workflow. – Document the practice’s existing paper workflows for: Client Referral; Client Check-in; Intake Visit; Office Visit; e- Prescribing; Client Check-Out • Solicit clinician and staff input regarding roles in current paper workflows • Involve everyone who handles paperwork in the analysis and redesign • Review and finalize documentation of current workflow • Ensure that the final diagram incorporates the entire “paper trail”

4. An Easy Strategy to Map an Existing Workflow • For each workflow, identify every staff member who is part of the workflow. • Have each staff member note every specific action they perform within the workflow. • Avoid filling out a workflow for a co-worker, as details may be overlooked or forgotten. • Have each action performed by each staff member recorded on a post-it note. • Write only one work-flow action per post-it note. • Arrange the post-it notes in order of the workflow. • The detailed actions of each staff member, recorded on post-it notes and in order of occurrence, provides a template for your practice’s existing work-flow.

5. Examining Areas for Improvement • After mapping existing workflows, the staff should ask themselves the following questions: • What are the best steps in the process? • What makes those the best steps? • What are we doing right? (Best can be defined by practice goals and vision, such as efficiency, client satisfying, etc.) • What steps could use improvement? • What are the least effective? • What makes those steps the least effective? • How could we improve those steps? • Use the answers to these questions to aid in planning a future workflow with the new EHR

6. Key Steps to Optimize Workflow Redesign • Identify waste and opportunities in current workflow; then redesign workflow • Recognizing the steps that should be changed to improve office functionality; the redesign will reveal the practice’s needs regarding EHR system selection and training • Identify and implement the EHR system and new workflow • Enlist the necessary support and work with the right EHR vendor to implement a system that meets the practice’s needs; ensure proper EHR implementation through staff training on the new workflow • Analyze new EHR workflow and refine as needed • Continue to monitor the EHR-driven workflow and adjust the workflow to optimize efficiencies

7. Client Referral This template covers the Client Referral Workflow. This sample workflow, available in excel, can help you and your practice staff detail the workflow you would like to follow for the Client Check-In when the EHR is implemented. The sample template includes: • Administrative capture of demographic, insurance, class status & entry into EHR • Program eligibility crosswalk with referral to alternate program if indicated • Sending/Receiving applications and consents

9. Client Check-In This template covers the Client Check-in Workflow. This sample workflow, available in excel, can help you and your practice staff detail the workflow you would like to follow for the Client Check-In when the EHR is implemented. The sample template includes: • Entry of Client arrival into the EHR • New client administrative tasks • Returning client administrative tasks • Recording Insurance and updates into the EHR • Electronic communication to clinician that client is ready

11. Intake Visit This template covers the intake visit workflow. This sample workflow, available in excel, can help you and your practice staff detail the workflow you would like to follow for an intake visit when the EHR is implemented. The sample template includes: • Client arrival at the office and sign into the EHR. • An example of when to discuss the Opt-In of Behavioral Health Information into HealthInfoNet, Maine’s statewide Health Information Exchange (HIE) • How the Clinical provider and administrative staff interacts with the client and EHR

12. Intake Visit

13. Office Visit This template covers the office visit workflow. This sample workflow, available in excel, can help you and your practice staff detail the workflow you would like to follow for an intake visit when the EHR is implemented. The sample template includes: • Client arrival at the office and sign-in into the EHR. • An example of when the clinical provider can utilize HealthInfonet, Maine’s statewide Health Information Exchange (HIE), to review client’s health record to optimize clinical assessment • How the Clinical provider and administrative staff interacts with the client and EHR

15. e-Prescribing This template, available in excel, covers the workflow for e-Prescribing to help practice staff map out their own e-Prescribing workflow. Steps to include: • Populate an EHR with the current medications and existing medication allergies for the patient; • Enter an order in the EHR, including updating medication history, checking drug formulary data (if enabled), and selecting the medication; • Transmit the prescription order to the pharmacy, which may be manual (by the patient), fax/e-fax, or electronically (e.g., through the e-Prescribing networks available); • Process the prescription at the pharmacy; and, • Pick up by the patient

17. Client Check-Out This template covers the Client Check-Out workflow. This sample workflow, available in excel, can help you and your practice staff detail the workflow you would like to follow for Client Check-Out when the EHR is implemented. The template focuses on what steps need to be taken to: • Complete visit documentation; • Enter orders for Medication Management, Labs, Clinical Follow-Up in the EHR; • Schedule any follow-up appointments; and, • Receive information regarding Opt-In/Opt-Out to the state Health Information Exchange and send to HealthInfoNet

19. Questions/Comments Gemma Cannon, MSW, CPHIT HealthInfoNet Service Coordinator gcannon@hinfonet.org HealthInfoNet Website: www.hinfonet.org

20. Behavioral Health EHR Implementation Toolkit • Adapts tools for Behavioral Health Practices from EHR Implementation Resources on HealthIT.gov (developed for Medical practices). • Adjustments to tools made by the Behavioral Health Action Planning Workgroup • Follows the Six-Step Approach to EHR Implementation on HealthIT.gov • Includes BH-focused changes to: Downtime Documentation, Scanning & Pre-load Worksheets, Sample Workflow Templates, Chart Migration Worksheet, & Practice Office Flyers