How four Vermont agencies leverage a single EHR platform for data-driven, coordinated care

While service delivery and approaches to care may vary, four Vermont-based provider agencies share similar goals – provide quality, effective care and improve the lives of those they serve. In addition to shared goals, United Counseling Service, Northwestern Counseling and Support Services, Washington County Mental Health Services and Lamoille County Mental Health Services believe in the power of care coordination using integrated, data-driven technology.

The answer to making this integrated approach a reality? Collaborating with members of Vermont Care Partners (VCP) to implement a single, unified electronic health record (EHR) to be used across all four agencies. This project, known as the Unified Electronic Medical Record Vermont (UEMRVT), is one of collaboration, compromise and vision.

The why

Why would four agencies implement a unified platform? It’s become clear the benefits are many, but one of the most notable is collaboration and integration. A connected, data-driven system used across the four organizations enables providers to coordinate care through real-time analytics with clinical decision support at their fingertips to support value-based care.

“Coming in as a unified front allows us to be forward thinking, pushing the state to look at regulations and processes to make necessary change,” Heidi Starr, Configuration Analysis Manager, UEMRVT said. “With four agencies reporting data the same way to the state, it increases our leverage and gives us a bigger bargaining chip than one agency alone.”

Forming a united entity when working with the state is a major plus when it comes to reporting, regulations and innovation within Vermont. Rather than operating as four different agencies, UEMRVT allows the organization to pose a consolidated front as data sharing, clinical workflows, billing operations and documentation are done similarly through the unified EHR platform.

Starting this summer, the Vermont agencies are required to report Developmental Services (DS) encounter data to the state. The ability to maximize data collection, reporting and analytics through the unified EHR serves the united agencies well, as they’ve worked together to determine how they want to collectively report this information in the same format to the state.

With four agencies reporting data the same way to the state, it increases our leverage and gives us a bigger bargaining chip than one agency alone.”

Heidi Starr, Configuration Analysis Manager, UEMRVT

Where it all began

The UEMRVT project started with the VCP trade association, which is made up of a statewide network of 16 member agencies – 10 designated and six special servant agencies. Members of the VCP continue to work together to provide state leadership for an integrated, high-quality system of comprehensive services and supports.

Through their commitment to excellence and innovation, the VCP embarked on the UEMRVT project in collaboration with the designated agencies. Among the four agencies, there are over 2,800 staff serving more than 20,000 clients across a care continuum including behavioral health, substance use, IDD, mental health, residential and more.

Choosing a partner and platform

Selecting both a partner and a technology solution to serve as the unified EHR was a meticulous and collaborative journey.

“We had a very thoughtful process to approach this,” Todd Bauman, CEO Northwestern Counseling & Support Services said. “We worked closely with VCP to identify what we were all looking for in an EHR – what did our EHR have to have, things that were non-negotiable.”

Some of those designed non-negotiables and key features within the EHR included:

• Interoperability capabilities
• Data analytics
• Mobility
• Strong end-user experience
• Dynamic billing components

Once the group nailed down what they were looking for, they wrote a 100-page RFP. Then, the official search began. Seventeen vendors applied for the partnership, therefore in order to find the best fit, each agency formed a local team of clinicians, finance representative and compliance experts to assess and score each vendor’s demonstration. After careful consideration and collaboration, only one vendor fit the bill. The Netsmart team and myAvatarTM EHR platform was named the partner and technology of choice for UEMRVT.

“We combined all of the information we gathered, the demos and everyone’s inputs, and we landed on Netsmart.” Bauman said. “We all collectively felt they could best meet our needs.”

Through partnership with Netsmart, the four agencies are able to leverage the single myAvatar platform, reducing operational costs while simultaneously connecting the state’s providers. By leveraging the integrated platform, the Vermont group can more easily access connected care, streamline common workflows and produce quality data for analysis leading to improved clinical outcomes and administrative efficiencies.

Maintaining governance and structure

“Everything we did was to ensure we had a strong level of standardization across our entire system so we could leverage that talent to tell one story moving forward,” Bauman said.

With four agencies and one EHR, there is sure to be some differences of opinion, so the UEMRVT group developed a team charter that clearly articulates their collective mission and vision. A centralized governance committee continues to meet regularly, including one person from each agency.

The committee members each get one vote. In order to facilitate an accurate presentation from each agency, the members coordinated with their respective EHR committees, which included people from billing, help desk, and a lot of clinicians. There was also a team of configuration specialists, which was a little unique to Vermont. This allowed them to build the EHR with strong support from Netsmart to best fit their unified structure.

Throughout this process the group has learned that just because they all agreed the data needed to be aggregated, the four agencies can operationalize how they would collect important health formation depending on what works best for their team.

The benefits are clear

The benefits of collaboration through a unified EHR continue to unfold for the UEMRVT agencies, one of the most notable being improved internal operations. The project allowed UEMRVT agencies to dig into each other’s worlds while assessing their own to consider better practices and new ways of doing things.

“We all tend to work within our own bubbles, and often times we are doing the same thing year after year because that’s the way we’ve been doing it,” Lorna Mattern, Executive Director, United Counseling Service of Bennington County said. “It’s not until we stop and take a critical look at our processes to see where we could improve efficiencies, which this project forced all four of us to do.” Additional benefits include the ability to pool resources and skillsets including administrative support, additional technology, shared funding and workforce coverage. The UEMRVT project also empowers the agencies to pool billing resources and standardize billing practices, in turn cutting down on billing issues.

It’s not until we stop and take a critical look at our processes to see where we could improve efficiencies, which this project forced all four of us to do.

Lorna Mattern, Executive Director United Counseling Service of Bennington County

With benefits come challenges

However, with all good things, there are challenges: change management, accepting compromises, growing pains, adjusting to new normals. But one of the primary challenges was translating everything these four agencies do into an EHR, including service offerings, billing structures and more.

“I will never forget all of us sitting in a room, listing all the services each of us provide. It was kind of an, ‘Oh wow’ moment,” Mary Moulton, CEO, Washington County Mental Health Services said. “We all learned a new language. We really respect each other and our teams. We’re all going to be really pleased we have this system in the long run.”

What’s next?

“One of the big things we’re doing is continuous improvement,” Starr said. “All four agencies are live, and we have a great working system, but there’s always room for improvement.”

They’ve pulled together specialized workflow groups to discuss the forms and workflows within myAvatar. How can they work with Netsmart to make workflows more efficient, user friendly and state-guidance driven? Moving forward, the united agencies are looking forward to more collaboration, innovation and growth – hoping to grow the unified approach across Vermont.

“It was well worth any challenges that came with it,” Mattern said. “Hopefully others will join on in the future now that we have this foundation set.”