The amount of behavioral health agencies turning to electronic health records (EHR's) increases each day. While some agencies are required to have EHR’s as part of their contractual obligation with a county or state, others find it an efficient way to handle their documentation. This is true even with small residential facilities (QTRP’s or STRTP’s) that want to move beyond paper charts and have centralized record keeping.
Some agencies think that having an EHR will improve their treatment outcomes, develop better documentation, or improve treatment efficiency. They are sadly mistaken.
No matter what the reason behind the EHR expansion, the GIGO effect can still exist within the agency. The GIGO effect is an abbreviation for the term “Garbage In, Garbage Out”. This is not in any way meant to denigrate the assessments, treatment plans, or progress notes that the staff writes. It is more of an observation I have from over 40 years reading thousands of notes, charts, and the chore of explaining improper documentation to a regulatory surveyor.
An EHR is only a repository of information. Once the information is put into a record, the EHR cannot clean it up nor change it. For instance, a staff member writes a progress note that does not reflect the service provided to a client. That note, once completed, is submitted for approval to their clinical supervisor or a Head of Service. Then the reviewer has to take the time to read the note, review the chart, and see if the note fits the service provided. If a client’s goal is to improve social skills, and the note talks about going to a Starbucks for a Frappuccino, the note does not meet the threshold of indicating the medical necessity or the reason for the service. The note increases staff time to correct, poses a threat for financial recoupment, and doesn’t advance the client’s functioning.
What causes the GIGO effect? Several reasons exist. One, staff are in such a hurry to finish a note they don’t think through the necessary ingredients to put into it. Second, they may lack the skills or training on how to write it. Third, writing a note on paper and pencil is a very different skill than writing it on a computer. Although more staff are computer efficient nowadays, writing a note takes a specific skill set that many clinicians don’t get through school or in supervision. Finally, our WFA (Work From Anywhere) environment impacts the note. The days of going down the hallway to talk to your supervisor about how to write a note are gone. The staff is on their own.
Ask clinical supervisors how much time they spend reviewing notes. Then ask how much time they spend either parsing words to figure out if the note is “good enough” to approve or needs to be sent back. Suppose you are a large agency, and your supervisor has 10 staff under them. Each staff writes five notes a day. That means the supervisor has to approve 50 notes a day and give them each a lot of time to discern the medical necessity. Because of the volume, it’s no wonder that GIGO’s go through the system and end up as audit red flags from counties.
How to solve the GIGO effect? Agencies need to find ways to help staff manage time, spend energy on educating staff in the art of documentation. They also need to examine their EHR system to see if it is intuitive enough to help the staff navigate through it so note writing is not a time-consuming exercise.
Praxes' treatment software, Apogee, works as a complement to the EHR by generating customized skills and interventions. For more information, please contact us.
Got questions? We've got answers.
PRAXES is a nationwide behavioral health software, consulting, and training company. No one in the behavioral health industry has a better reputation, and if you give us the chance, we’ll show you why! At PRAXES, our services improve the efficiency and structure of behavioral health agencies serving children and families nationwide. PRAXES brings over 45 years of administrative and clinical expertise. With more than 100 client companies nationwide, we offer the expertise to advance the quality of behavioral health services. We accomplish these goals through our new clinical decision software, our training of best practices, and helping companies meet regulatory standards. At PRAXES, we believe in being creative and fostering new ways to serve children and their families. Our vision is to empower the families our agencies serve with skills that not only improve their functioning, but help them to thrive in their everyday lives. When you give us the chance, you’ll be connected directly to our friendly staff, so you can expect immediate attention to your inquiry. So, don’t wait, call now!
Dan Thorne has unique perspectives on the field of mental health. As a clinician, he has had over 40 years of experience working with clients in the Southern California area. After obtaining his Bachelor’s degree from the University of California at Irvine, he worked with children in the Orange County Juvenile Hall. Here he honed his earliest techniques on at-risk children. After that, he obtained his Master’s degree in Counseling from California State University, Fullerton.
In the 1990’s, Dan turned his attention to the clinical and administrative side of behavioral health organizations. For three years, he was the Assistant Administrator of Starting Point, a chemical dependency facility in Costa Mesa, CA. In 2001, he took an opportunity to be the Director of Harbor View Community Services Center in Long Beach. When he arrived, the Center had only 80 clients and 13 staff. When he left, there were over 400 clients and 75 staff. Dan created several programs through their contract with the Los Angeles County Departments of Mental Health and Child and Family Services. Under his guidance, Harbor View became one of the leading providers of children’s services in Los Angeles County.
While improving the results of the client’s parents at the Center, Dan reflected on his experiences as a parent. His children themselves had special needs such as mental and intellectual challenges, and Dan knew the toll it takes on the parent. In order to help the child, the parent has to be healthy. From this concept, he created his parenting program. After years of refining it, teaching it to his staff at the Center, and then taking the results and comments from these efforts, he became the developer of the current PRAXES program. It is a culmination of Dan’s personal trials and tribulations as a parent along with empirical results and research of over 40 parenting programs.
Our vision at PRAXES is to advance the strength of parents and caregivers of children with special needs (mental health, intellectual, or physical) through education, support, and empowerment. Thus, they can live healthy and functional lives while caring for the child.
Apogee is a clinical decision software designed to help behavioral health practitioners with their treatment and patient engagement. It provides evidence-based and research-based components. Not only do they consist of elements from such practices as Cognitive Behavior Therapy, Seeking Safety, Dialectical Behavior Therapy, Motivational Interviewing, Functional Behavior Analysis, but also the Intensive Models for Parents, Youth, and Children.
PRAXES has over 30 years of accreditation experience. We know what it takes to get your organization accredited. Whether it’s Joint Commission, CARF, or COA, our team can provide an evaluation of your current status and review the standards which need improvements. We will assist you with the policies, documentation, and training required to be accredited.
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