Investing In Your EHR Technology For Future Success - OPEN MINDS

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Investing In Your EHR TechnologyFor Future SuccessResults Of The 2018 Behavioral Health EHR SurveyJune 18, 2019P r e s e n t e d b y : J o e N a u g h t o n - Tr a v e r s , S e n i o r A s s o c i a t e , O P E N M I N D S a n d M a t tD o r m a n , F o u n d e r & C h i e f E x e c u t i v e O f f i c e r, C r e d i b l e B e h a v i o r a l H e a l t h S o f t w a r 15 Lincoln Square, Gettysburg, Pennsylvania 17325 717-334-1329

AgendaI.II.III.IV.Introductions & Overview2018 Survey Results On Behavioral Health Electronic Health Record (EHR)Implementation, Purchasing, Functionality, & NeedsImportance Of Investing In EHR Functionality To Increase Competitive EdgeQuestions & Discussion 2019 OPEN MINDS2

I.Introductions & Overview 2019 OPEN MINDS

Expertise Technology management, operations, finance Electronic health record keeping system development,implementation, and reporting optimization Investment banking and management consulting Political and government understanding and knowledge Product launch and expansionMatthew M. DormanFounder & ChiefExecutive Officer, CredibleBehavioral HealthSoftware, Inc.Highlights Founder & Chief Executive Officer, Credible BehavioralHealth Software E-Commerce, Lockheed Martin Health & HumanServices Grew Credible from a start-up to a financially stablecompany with over 425 Partner Agencies spanning 36states, annual revenues exceeding 35,000,000 andmore than 175 staff nationwide Worked on Capitol Hill for US Senator Paul Sarbanesand for Senator Al Gore’s Presidential campaign 2018OPENMINDS2019OPENMINDS 4

Expertise Strategic planning and metrics-based management Technology selection, contract negotiations, andoperational implementation Electronic health record keeping systemimplementation and reporting optimization Corporate complianceJoe Naughton-Travers,Ed.M.Senior Associate, OPENMINDSHighlights Vice President, Hill Associate Business administrator, Universal Health Systemfacility Assisted numerous health care and social serviceorganizations with information system design,development, and implementation Expertise in operations improvement and OIG andHIPAA compliance 2018OPENMINDS2019OPENMINDS 5

II. 2018 Survey Results On Behavioral Health Electronic Health Record(EHR) Implementation, Purchasing, Functionality, & Needs 2019 OPEN MINDS

Survey Objectives & OverviewThe 2018 survey of behavioral health organizations was conducted to study theirexperiences in implementing an EHR system and choosing functionality.The survey was distributed via e-mail to over 5,700 behavioral health providerorganizations over the course of three months. A follow-up call was conducted foreach unique contact.There was a 9% completion rate 2019 OPEN MINDS

Key Findings From Behavioral Health Provider Organizations1234 More provider organizationshave purchased an EHR —increase year over year,rising from 80% to 87% Organizations that have notmade the purchase arerecognizing the need for anEHR — only 22% reportedNo need as their reason fornot purchasing compared to35% in 2017 Steady rise in providerorganizations reporting theirEHR as fully implementedover the last three years —from 69% to 77% Most implementations taking6-12 months to complete. 51% report staying with theirEHR because it is meetingtheir needs Cost has become a majorfactor in EHR decisions 36% (#1 reason) of providerorganizations cite they havenot purchased an EHR dueprice 22% (the second highestreason) of respondents thathave had their currentsystem for 6 years citeresistance to change due tohigh perceived cost Organizations still notviewing their EHR as astrategic investmentdespite most providerorganizations having anEHR and having the Core 4functionalities fully orpartially implemented The percentage reportingthis view of their EHR hasdeclined over the last threeyear from 19% to 15% 2019 OPEN MINDS

12018 EHR Purchase StatusBehavioral HealthProviderOrganizations:EHR PurchaseStatus, 2018 87% of behavioral health providerssurveyed have purchased an EHR Of those who have not purchasedan EHR, the primary reason wasdue to expense (44%) In comparison to 2017, thepurchasing percentage hascontinued to rise with 87% ofprovider organizations purchasingan EHR, compared to 85% in2017 The top reason for not purchasingan EHR has shifted from aperceived lack of need, to a offunds to purchase2%87%87%4%5%13%5%1%6%13%4%2%1%3%Has Purchased An EHRHas Not Purchased An EHRToo ExpensiveLimited TimeNo NeedImplementation ChallengesOther 2018OPENMINDS2019OPENMINDS 9

2Behavioral HealthProviderOrganizations:EHR ImplementationStatus, 2018 Of behavioral health providerorganizations who purchased anEHR, 77% describe the EHR as fullyimplementedThe majority (37%) of EHRimplementations took 6-12 months tocomplete full implementation, similarto trends seen in both 2016 and2017 (35% and 44%); Although 2016reports show most implementationsoccurring in 3-9 monthsThe number of providerorganizations reporting fullyimplemented EHRs has continued toclimb — rising from 69% to 77%;while the number of respondentsreporting their EHR is not yetimplemented has remained mostlyconsistent (ranging from 4% to 6%over the last three years)2018 EHR Implementation Status28%77%18%19%13%5%16%Partially ImplementedNot yet implementedFully implemented EHRLess than 6 months6-12 months12-18 monthsMore than 18 months 2018OPENMINDS2019OPENMINDS 10

3Behavioral HealthProviderOrganizations:Factors ImpactingPurchase, 2018 Cost is the driving factor in notpurchasing an EHR 34% of organization quote priceas the driving factor in delayingthe purchase of a new EHRsystem26%51%19%23%34%Existing EHR Meets Current NeedsPurchasing a new EHR is too costlyPurchasing a new EHR requires more staff time than isavailableImplementation of a new EHR is too challengingOther 2018OPENMINDS2019OPENMINDS 11

4Behavioral HealthProviderOrganizations:Views On EHRSystems, 201825%20%20%19% A declining number oforganizations see an EHR as astrategic investmentThere has been 4% declinesince 2016 in organizations thatsee an EHR as a strategicinvestment18%17%17%16% 16%15% 19%16%18%16%15% 15%15%13%11%10%11%10%9%10%5%0%*A payerrequirementNecessary forproviding datato clinicalmanagersA strategicinvestmentNecessary forbillingA tool toNecessary to A tool to reachimprove qualityregulatorysecureof careMeaningful Use compliancefunding 2018OPENMINDS2019OPENMINDS 12

PurchasingThepercentage oforganizationsthat havepurchased anEHR hasincreasedfrom 80% in2016 to 87%in 201846% oforganizationsthat haveimplementedan EHR didso 6 or moreyears ago25% oforganizationsnamedtelehealth asa service theyare planningfor next yearOf those thathave notpurchased anEHR, 22%cite no need,a 13%decreaseOf thoseorganizationsthat have notpurchased anEHR, 44%cite “tooexpensive”,up from 20%last year 2019 OPEN MINDS13

Additional Functionality ImplementationOnly 50% ofrespondingorganizationshave fullyimplementedcloud-basedstoragefunctionality68% oforganizationssaid inpatientfunctionality wasnot neededDatamining/businessintelligencefunctionality hasbeen fullyimplemented for29% ofbehavioral healthorganizationsBoth mobile andintegrated carefunctionality werereported as fullyor partiallyimplemented by39% oforganizations 2019 OPEN MINDS14

77% Of Providers Report Their EHR Is Fully ImplementedSteady climb in the percent of thosewith Fully Implemented %20%18%10%Fully implementedPartially implementedNot yet implemented0%6%Fully implementedPartially implemented201620174%5%Not yet implemented2018 2019 OPEN MINDS

Top Reasons Organizations Have Not Purchased An EHRProviders are acknowledgingthe need for an 22%18%15%22%10%5%Limited TimeToo ExpensiveNo NeedImplementation ChallengesOther36%35%35%0%8%8% 7%5%0%Limited timeToo expensive2016No need2017Implementationchallenges andconcerns2018 2019 OPEN MINDSOther

Overall EHR Implementation & Timelines87% of behavioral healthorganizations havepurchased an EHR systemalready Of those who have not, 66% givethe reasons as either that EHRsystems are seen as tooexpensive (44%) or not needed(22%)There is considerablevariance in implementationtimelines with the largestgroup (19%) implementingin 6-9 months Again, more than one out of tenproviders (12%) reportedimplementations of two years orlonger 2019 OPEN MINDS17

Months It Took To Fully Implement The EHR (From ContractExecution To Go Live)12%Over half ofimplementationtake 3-12 months9%8%0%5%1-3 months16%10%15%9%21%19%8%14%9-12 months12-15 months18%18-24 months1-3 months3-6 months6-9 months9-12 months12-15 months15-18 months18-24 months24 months4%24%20%18%13%8%8%19%30%Most implementationscontinue to take 6-12months18%14%16%3-6 months15-18 months25%9%6%6-9 months8%20%6%8%7%8%11%12%12%12%24 months201620172018 2019 OPEN MINDS

EHR Implementation Delay FactorsTwenty-nine percent (29%) of providersreport the delays as being due to acombination of themselves and EHRvendor, with another 26% attributing it tointernal organization challenges.Additionally one out of five providersreported that the delay was due to otheragency initiatives taking priority over theEHR implementation project itself. 2019 OPEN MINDS19

Top Reasons Organizations Report Their EHR Is Not FullyImplemented40%Top Reason35%20%29%30%25%34%30%While delays from both the vendor and the internalprovider organization remain high, there has been anincrease in delays from the vendor and a decrease in otheragency initiatives taking 10%12%10%8%5%Both delays from our internal organization and from our EHR vendorDelay from our EHR vendorDelays from our internal organizationFunctionality not equal to what is neededOther agency initiatives have taken priority0%0%Both delaysDelay from our Delays from our Functionality not Other agencyfrom our internal EHR vendorinternalequal to what is initiatives haveorganization andorganizationneededtaken priorityfrom our EHRvendor201620172018 2019 OPEN MINDS

The Four Core EHR FunctionalitiesClinicalSchedulingBillingReporting 2019 OPEN MINDS21

Core EHR FunctionalityAs reported in the past, the four corefunctionalities of an EHR systemcontinued to be defined as clinical,scheduling, billing, and reporting —all of which are necessary to remaincompetitive in the changing healthand human services landscape.45% of providers continue to indicatethat all four of the critical areas offunctionality were fully implemented,while rates of implementation foreach of the Core 4 functionalitiesindividually continue to rise 2019 OPEN MINDS22

Core EHR Functionality Not Fully ImplementedClinical, scheduling,and billingfunctionalities havebeen prioritized ormore successfullyimplemented byprovidersWhile the criticalfunctionality ofmanagementreporting is fullyfunctional in just 60%providersRoughly 10% ofproviders reportedthat one or more ofthese core functionalareas is plannedfor implementation,but not completed yet 2019 OPEN MINDS23

Core Functionality ImplementationCore lyImplementedPlanned, but notimplementedNot g77%13%7%3%Reporting60%32%7%1% 2019 OPEN MINDS24

EHR’s Clinical FunctionalityPlanned, ButNotImplemented4%90%Not 0%41%32%30%25%19%15%20%10%FullyImplemented81%0%5% ned, ButNotImplemented2%0% 0%Not Needed2018 2019 OPEN MINDS25

EHR’s Scheduling FunctionalityPlanned, ButNotImplemented8%80%Not Needed6%70%71% iallyImplemented2016201712%8%Planned, ButNotImplemented7%3%6%Not Needed2018 2019 OPEN MINDS26

EHR’s Billing FunctionalityPlanned, ButNotImplemented7%90%Not ed, ButNotImplemented3% 3% 3%Not Needed2018 2019 OPEN MINDS27

EHR’s Reporting FunctionalityPlanned, ButNotNot 1%8% 7Planned, ButNotImplemented5%0% 1%Not Needed2018 2019 OPEN MINDS28

Organizations With Core 4 Functionalities Fully Or Partially Implemented –Reports On Planned & Implemented Additional FunctionalitiesOrganizations with the Core 4 implemented are stillfocusing on Data Mining, Business Intelligence, andPatient/Client tient/Clinical PortalMobileCloud-Based StorageManagement OfMedical/HealthHomes20162017Management OfPrimary Care2018Data Mining/BusinessIntelligence**Inpatient**Integrated Care* Response option not included in 2017 survey 2019 OPEN MINDS29

III. Importance Of Investing In EHR Functionality ToIncrease Competitive Edge 2019 OPEN MINDS30

Technology Investments Must Be In Sync With Strategy &Strategic ROI"If you don't know where you are going, anyroad will get you there."- Lewis CarrollYour tech strategy can’t be“successful” without having anoverall organizational strategy 2019 OPEN MINDS

The Strategic Part Of Technology Planning The Strategic Technology plan identifies technological infrastructure needed fororganization to reach its strategic objectives Should demonstrate (and quantify) that proposed technology investments deliver returnin: Increased revenues Improved performance Reduced operating costs Improved stakeholder preference or market positionStrategic planning is yourorganization’s process of continuallyassessing its internal capabilities andthe external environment (payers,consumers, and competitors) in orderto determine how best to use its limitedresources to meet your strategicobjectives. 2019 OPEN MINDS32

Technology Infrastructure To Optimize Value Of Consumer CareEngaging ConsumersReducing Service CostPatient portals,websites, andweb-basedconsumer toolsAutomatedconsumer outreachTech ehealth andtelemedicineRemotemonitoring 2019 OPEN MINDS33

Technology Infrastructure To Support Performance ManagementGetting The NecessaryDataElectronichealth recordsHealth informationexchange and dataaggregationPatientregistriesConsumer referraltrackingOptimizing OrganizationalPerformance, CareCoordination & PopulationHealth ManagementPerformancemonitoring andmanagement and health riskstratificationAdvanced populationanalytics and clinicaldecision support 2019 OPEN MINDS34

Shifting Role Of Technology In Health & Human tform ForCompetitiveAdvantage 2019 OPEN MINDS35

The Shift From The Functional To The Strategic The result of compliance focus of the past ten years – less focus onusability and clinical effectiveness From ‘cost’ to ‘investment’ From ‘administrative management’ to ‘imbedded in service lines’ Essential for competitive advantage – and market positioning - over thenext five years 2019 OPEN MINDS36

IV. Questions & Discussion 2019 OPEN MINDS37

Turning Market IntelligenceInto Business AdvantageOPEN MINDS market intelligence and technical assistance helps over 550,000 industry executives tackle business challenges, improve decision-making, andmaximize organizational performance every 15 Lincoln Square, Gettysburg, Pennsylvania 17325 717-334-1329

EHR Implementation Status, 2018 5%. 18%. 19%. 28%. 13%. 16%. 2018 EHR Implementation Status. Not yet implemented. Fully implemented EHR. Less than 6 months. 6-12 months. 12-18 months. More than 18 months Of behavioral health provider organizations who purchased an EHR, 77% describe the EHR as fully implemented The majority (37%) of EHR

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