Achieving a Perfect State of Mind with WRS Behavioral Health EHR

In August 2009, Christine Karell, APRN opened Mental Health Alliance in Alliance, NE. Her plan was to treat an underserved population at a total of five locations. And although she collaborates with four therapists, she is the only prescribing provider. With 15 to 17 patients that she sees each day, and patients who she treats in the hospital and ER, it is not surprising that she needed a web-based end-to-end Behavioral Health EHR and practice management system.

Overcoming Obstacles

Karell, who doesn’t complain about commuting long distances back and forth between the locations, acknowledged that she has had to deal with a few major roadblocks. “It was a fairly easy transition for the most part. I have a very high Medicaid population; it’s close to 60% Medicaid and even though I had been a provider through Medicaid at the hospital, it took six months to get the credentials,” she said.

Another major challenge Karell faced was dealing with an inefficient EMR that was having disastrous effects on her practice’s bottom line. “We had OptumInsight’s CareTracker (formerly Ingenix) EMR. We had some very serious customer service issues. They did our billing too and they messed that up terribly. It was almost financial ruin because they were not taking care of things. We tried to talk to them and work things out and they were just not responding to our requests. Getting in touch with someone was next to impossible. They would say, ‘We’ll take care of it’ and they wouldn’t or they would say, ‘Talk to this other person’ and just run you in circles. The customer service was atrocious. Last April we took the billing back because they weren’t doing anything for us. And then after a couple more months and continued problems, in June we started looking at other systems. In addition to WRS, I looked at four or five different systems, including CareCloud, ADP Advanced MD, Medi Touch and Psych Advantage,” stated Karell.

Top of the Billing Class

With billing problems threatening her livelihood, it is no wonder that a robust billing module was at the top of Karell’s Behavioral Health EMR wish list. “Debbie Senior, our Office Manager does the billing and she really loves WRS Billing Module because you can see the 1500 claim form and that was the reason for some of the confusion with the other system. We could see what we put in, but we couldn’t see the output. With WRS we see the outputted form so we can do any changes directly on it and manage it more effectively. Our revenues have gone up. Everything is going through. I’m getting paid for my services and getting paid quickly. We weren’t before WRS,” said Karell in her testimonial.

Cloud Coverage

Having a cloud-based system was also high on Karell’s wish list. “Because of the various locations it was important that I could access the system from anywhere. If I see someone in the hospital or ER, I can look up their medication list. I like the ease of use and flexibility of WRS. It gives me the option for different input formats. I really like that you can customize WRS templates and I like the prepopulated defaults. I can customize those and they flow from the other previous notes, which saves time. It has the standard documentation that I do and that saves a lot of time because I don’t have to go through and click on each and every one, each and every time,” said Karell, adding, “For my medication notes and regular visits I mostly free text in that box. For the initial intake I have my H&P format. There are prompts to remind me on (patient’s) history and some of the intake information. I made symptom checklists,” she said.

Let’s Review Results Together

Pointing out in her testimonial that Mental Health Alliance recently started offering pharmacogenomics testing, Karell said, “DNA testing gives us a customized list of what medications are best suited to genetic types and receptor subtypes. We’re using WRS Patient Portal to send those results to patients so they can have that in front of them when I call them to review the results of the tests. You can put the test results on WRS Patient Portal. These tests come in a very user friendly format. It has three columns that are green, yellow and red that shows their efficacy based on their genetic type. Green would be meds that are best suited to their genotype, yellows mean there may have to be dose adjustments for mixed refills, the reds are least likely to be effective and more likely to have side effects. So they can see the worst of all the different medications in those columns as we review what they are currently on, what they have been on in the past and we develop a plan. The technology has been around for three or four years, but it just recently got approved by Medicare and Medicaid within the last six months. That is going to change the utilization of the test, because it is covered. Patients can also view other tests, like CBC or Thyroid tests and WRS sends patients an email notification when we post the lab results on the portal telling patients that they can log onto the portal to look at those results,” said Karell.

In Strictest Confidence

When patients have non emergency questions and they call the office they may feel uncomfortable revealing the nature of their call to the office staff. “Patients message me with their questions through WRS Patient Portal. Some of them don’t feel comfortable talking about some of their issues with the front office staff and they want something more confidential. The portal is secure. I have two small children. I can respond to patients at 10 p.m. or later without waking someone up, but I can still get the patient’s needs addressed at a time that’s convenient for me,” said Karell.

Ease-of-Use is Key

Noting in her testimonial that students do their clinical rotations at her practice, Karell said, “WRS Behavioral Health EHR templates prompt students on the diagnostic criteria for different disorders. If the patient is presenting a problem with depression, the template pulls up the list of different criteria for depression, including hopelessness, worthlessness, decreased energy, sleep disturbances and weight changes. Students can go through and check those different criteria that are needed for a diagnosis of depression. I can just click, and in a sentence format, I can go through and review all of those presenting problems. You can free text in there at any time or make additions. Any check list is not going to be completely inclusive. You can click in there. It may be just a little blurb, but it’s important to have some of those in there too.”

Tracking Prescriptions

“I like the flexibility of how e-Rxs are sent to the pharmacy. That really helps me. Another thing that I really like with WRS E-Prescribing is tracking. It’s easy to see when you wrote the prescription, when it was refilled and it verifies what pharmacy it was sent to. We can also look to see if people are misusing their medications. We can see if they are two weeks early on their prescription. To be able to track prescriptions like that is a nice feature of WRS. The patients like it because they don’t have to make a trip to the pharmacy just to drop the prescription off, and then go to pick it up later. It’s already there so they can just go pick it up.”

Impeccable Customer Service

Poor customer service is not only exasperating; it can negatively impact a practice’s efficiency and hurt the bottom line. “WRS customer service has been very good. Since customer service was a concern from the previous EMR, WRS has been awesome to work with. Every question has been addressed very quickly. Even if they haven’t been able to answer it immediately, at least they respond and tell us, ‘We’re looking into this.’ That was something we didn’t get before. You sent the request in and didn’t hear anything. I understand sometimes you have to look something up, but at least let me know you’ve got it and you are doing something with it,” said Karell in her testimonial.

Getting up to Speed Fast

Treating patients and learning a new system can be vexing. “We had online training and Go to Meetings where we reviewed some different things. The EMR is very intuitive and user friendly. It didn’t take much to get up (to speed). The main thing I had to learn was how to customize the templates, which was easy. It takes less time to chart than before. Initially, you have to reenter some of the history in the system, but once things are set up, it flows very quickly,” said Karell.

Fax Queue Pluses

“I really like the Fax Queue. When we get lab results in and we connect them to a patient, the system automatically sends the results to me to review, so the staff doesn’t have to do an extra step of sending the results to me. It’s automatically sent to my task box so I can review those test results. That really helps when I see a patient,” said Karell.

Eyeing Meaningful Use Incentives

Applying for Meaningful Use Incentives is on Karell’s to do list this year. “We started with WRS on the first of the year. We have a dashboard that monitors the different areas of MU so we can track and make sure we’re in compliance with those criteria and keep up on that. If there are any areas that are dipping we can address those. We will apply this year for MU,”she said.

Keeping up with Coding Changes

Noting in her testimonial that a Behavioral Health practice has different documentation needs than a general medical practice, Karell said, “Even in the diagnosis, there are different requirements. WRS was able to fulfill that. In Behavioral Health there’s a mental status exam and there are specific elements that have to be documented—speech, thought patterns, mood, affect and things that you would be observing. Before last year we had our own separate psychiatry coding. Now we use regular medical office visits. That’s new for me so it’s nice that the code checker looks at those different elements. I was completely unfamiliar with those codes and the requirements for that. That was very helpful.”

Reducing No Shows

No shows. Just the very mention of these two words can cause a physician to wince. WRS automated reminders helps to reduce no shows. An added benefit: it frees up the office staff’s time. “When you have five providers and they each have a load full of clients the time it takes to call all of those people can be extensive while trying to manage incoming calls and people at the front window. It’s been nice to automate that so they don’t have to worry about that. The system is set up to do a call back, so if the patient doesn’t answer, it calls them again up to three times. The system also calls multiple numbers, their cell and home and it sends them an email. That has definitely decreased our no shows,” stated Karell.

Working in all Kinds of Weather

With all of her commuting back and forth to all of the locations, what does Karell do when the inclement weather makes the roads impassable? “With CareTracker we had a few times where the system was down. We haven’t had any problems with WRS. With communication via the system I can work at home. The nice thing about Psychiatry is that it can be done over the phone. We had a blizzard at one location and I was still able to at least do phone sessions with people from home because I could look up their charts and have all of their information in front of me,” said Karell in her testimonial.

Cozy Office Décor

Karell moved her office and switched EMRs at the same time, but to hear her tell it, there wasn’t much to stress over. “I just purchased the building. We moved the first of the year. I bought a new building and started a new  Behavioral Health EMR at one time. It’s quite a big commercial building in a business district. I did some remodeling to make it a homey atmosphere with a very relaxed feeling. My mission is to make people so comfortable and give them quality care. The paint colors and furniture are more homelike versus metal waiting room chairs. The front office is crème color and the walls are peacock teal. The chairs are a brown crème and peacock teal stripe or a leaf pattern. These colors make the room relaxed and homey. A lot of times I see kids and a lot of times their little brother or sister comes along. We have some toys, books and a wide variety of magazines, including some children’s magazines,” she said.

A Satisfied Customer

Finally, when asked to sum up her experience with WRS, Karell responded, “I’m very satisfied. I knew that a physician developed WRS. It’s best to consult with someone who uses the EMR and who knows how to make it flow. The price was very competitive. That was also a benefit. The price was less than our previous system. Having used paper charts before and traveling to other locations, I don’t always have the patients’ charts. Anyone can have access to the system anytime. The receptionist and Medical Assistant don’t have to spend 15 minutes looking for the chart so you can answer the patient’s question. WRS Behavioral Health EHR helps a lot with the workflow.”