From Selling to Advising: A Word From Our CEO – Updated

Written by Kristin Sunanta Walker on August 15, 2014. Posted in Behavioral / Mental Health Information, Behavioral Health / Mental Health EHRs

I was recently asked to describe the moment when I stopped selling electronic health record (EHR) software and truly became an advocate for providers in the world of behavioral health and record cycle management. How had this happened? Why?

Doing research for my organization, something important had become apparent: The behavioral healthcare market is not the most profitable of healthcare markets, and nor is it likely to become so. As a matter of fact many EHR vendors avoid serving this community entirely. And, although there may be many reasons for this, one obvious factor is that public mental and behavioral health patients are among the poorest of patient communities. Behavioral health providers receive some of the lowest in insurance reimbursements. In addition to these facts, mental health advocates find that the rules and regulations they must follow are stringent and highly-regulated.

This awareness became the tipping point for me personally. It is the day I stopped simply selling the software for one of the small EHR vendors I had been working with and started becoming an advocate for providers. I dove headfirst into studying the internal workings, the marketing, and the pricing structure of every behavioral health EHR I could find. I began looking for the competitive advantages of multiple products sold and each one’s weaknesses and strengths in every process within the behavioral health cycle. I did not just study its most highly-marketed features but also the drudgery of day-to-day data input. I investigated every company’s organizational structure, its staffing levels, the qualifications of its founder to represent the market, and the adaptability of its software developers. I looked for fair and reasonable personnel policies as a measure of the CEO’s commitment. I wanted to understand whether or not the leadership focused simply on profit or honestly cared about its customers. I studied how quickly each firm had adapted to recent upgrades in technologies, like moving from Windows-based software to The Cloud or from PC’s to tablets and smartphone platforms, as a predictor of its action when new technologies might emerge. Did they really rewrite their software to perform well in a browser or did they slap on a workaround that costs extra and isn’t really designed for web browsers? Are they even in a web browser? Are we still installing software?

After some time I saw first-hand how willingly each company listened to customers who were experiencing problems, which ones seemed to want to turn the tables and insist it was the providers’ staff who were “not using it correctly”. How often did the EHR vendor treat real complaints as a mandate to change their own product? How did they react when a process was truly not working out as well as the developers had expected? I made site visits to individual providers and sat with the staff to experience exactly what they were seeing and I listened carefully to what frustrations and successes they felt every day at work. I listened and observed.

It is the day I changed my focus from a single company to a business model of my own that would always offer multiple options. I vowed to offer choices when a provider asked me to help them select their EHR. I accepted that every provider and every one of their clinicians is unique and they deserve to have a real voice in the electronic healthcare system they use to process their client’s records. I also began to acknowledge that behavioral health practices can simply outgrow their current system’s capabilities–even one I might have sold them years ago. I accepted that no single system would be right for every client and I would want to be a part of their changing needs over the long term. It is the day I became a consultant not just a salesperson.

Those who know me understand that when I believe in something I throw my entire being into it. I have worked as a volunteer for more than half of my life and always in the mental health field. I enjoy working with people that discuss emotions and make a career out of the complexities of human behavior. I will do what is best for a provider which means introducing multiple products and services. The vendors I gladly represent know this. They thank me for being honest. They welcome my observations and they listen to my input. They are also professional when they are not the product that is chosen by my clients.

Every business is a BUSINESS. What providers need to be mindful of is that behavioral health EHR companies are not in the non-profit sector. The fees they charge must represent the actual costs of the company’s investment in research and development, the on-going processing of their system, and the labor their staff invests in making it all work smoothly. I am proud to recommend those that understand the difference between the two business models and work hard to keep their costs competitive.

A note to providers – there are EHR companies that flat-out lie. I am sure you are shocked!

I was rather overwhelmed when I began opening my eyes to the complexities of mental health EHRs. Eventually I found technologies that were designed to make the working life of a clinician easier. I began to focus on those that were affordable and yet robust. I wanted to work with companies that really enabled providers to focus on patient care. It became imperative that most, if not all, of the EHRs I refer to my clients have a CEO that is an actual mental health provider running a successful mental health practice, using their own software. The organization must also be heavily staffed by providers.

The saying by Maya Angelou rings true, “When you know better, you do better.”

It was also imperative for me to know how an organization working with behavioral health providers and housing mental health records handles their internal human resources. How have they handled anyone reporting mental health issues working with their organization? How have they handled behavior amongst their staff that involves bullying, harassment, and other actions that are detrimental to anyone’s mental well being? Do they speak the same language as the community they serve? Staff credentials are important. Would I want my own or anyone’s mental health records housed in their software and accessed by their staff?

Some things to watch out for when researching an EHR organization:

Inconsistency with their message.

A tiny staff but a huge “advisory board” (one that doesn’t make sense and full of people that have never used the actual product on a daily basis, if at all). Vendors please beware who seeks you out as a partner. Your reputation is on the line. Your clients deserve your due diligence.

Is the staff size of the software organization smaller than yours? How many people are in each department? How many are employees as opposed to subcontractors and how many people are in each department? Ten separate people in support, training, and development lets you know this company puts their funding into being properly staffed to handle your patient mental health records.

Desperation marketing. Our team calls this the “Golden Retriever” marketing agenda (love us, love us, love us). No offense to actual Golden Retrievers.

Old technology; i.e., software that has to be installed in order to use it and an old, complicated, and slow user- interface.

Major emphasis on support, support, support. This means you are going to need a lot of support. Support and training staff for EHRs work overtime especially when a product has programming glitches. I remember one head of support lamenting to me, “everything that is done in this EHR is done the cheapest way possible and I am left holding this thing together.”

Software designed for Windows but slapped into a browser interface instead of rewriting the software to work optimally in a web browser. Providers, did you know that it is imperative for software vendors to rewrite their software entirely and multiple times in order to stay on top of technology? How many times has a rewrite been done?

Insular and limited work history of who they say are staff (check out the employees on LinkedIn). Qualifications such as:

Mental health providers

Certified billers/coders

Former Medicare/insurance auditors

Software engineers

Multiple experiences in the EHR and software industry

This serious financial investment in personnel simply won’t exist in their profiles. I bet you’ll be surprised at just who is giving you advice on important matters such as patient treatment, HIPAA, coding, and the like.

A virtual cottage industry of add on products (which you must pay extra to use). EHR companies that are taken seriously are able to obtain funding. They don’t need a million add on products to function. They take the time and have the funding to build that functionality into the software.

Expect you, the provider, to pay for the development of functionality that exists in all of their competitors products.

Who does come to us for help on their Behavioral Health EHR search or with questions about EHRs for mental health? Behavioral Health providers, of course. Mental Health Organizations. Mental Health EHR vendors. HIO’s. Ancillary product and service vendors for behavioral health. Venture capital and angel investment firms. Revenue cycle management/billing organizations. Colleges and universities.

The bottom line is that every provider needs to know exactly what technology is available to them. Do your research and ask for help. You cannot make an educated decision about software without fully investigating what is already on the market. We are happy to consult with you. Typically, in a short phone call, our team can review the vendors at which you are looking, assess what your needs are, and then begin to assist you in finding which software and/or billing company would best serve you.

As always, I am here to help.

Kristin Sunanta Walker

CEO, everythingEHR

Founder, Mental Health News Radio Network

kristin@everythingehr.com