I’ve had a somewhat unique interest in the behavioral health world ever since I started working with EHR software because the first EHR I implemented had to merge a health center together with a counseling center. As such, I was really excited to get a chance to interview Dr. David Lischner, CEO and Founder of Valant Medical Solutions. Those interested in Behavioral Health EHR software will enjoy this interview.

Can you tell us a little bit about how Valant Medical Solutions came about?
I founded Vālant with the purpose of helping behavioral healthcare providers manage their practices more efficiently. After graduating from residency in 2002 I started a group practice and became disappointed with the solutions available to psychiatrists for managing their practices. I knew that in order to successfully run and grow my practice, I was going to have to be as efficient as possible and utilize technology to my advantage. After unsuccessfully searching for software that fit my needs, I partnered with my brother who is a software developer to create the Vālant EHR.

Being a newer EHR company, what assurance can you provide psychologists and psychiatrists that your EHR is on solid footing?
First off we are the fastest growing behavioral health specific EHR on the market – and don’t plan to change that any time soon! We have been in business since 2005 and have over 1,100 providers and close to 2,000 users across the country using our product. Our product is fully certified and HIPAA compliant.

Secondly, we are 90% through a very successful round of financing, and it is clear that we have become the market leading solution for behavioral healthcare practices. We are on very solid footing.

Why do behavioral health professionals need a specialized EMR? What does Valant provide that other traditional EHR software don’t include?
It all comes down to the understanding and knowledge we have of the market. That “domain expertise” is expressed in every interaction and every feature of our product. Psychiatrists again and again tell me that we just get it, and that the product “understands how I work”, in a way that other vendors and products do not.

As an example, our new module release: Mobile NotesTM, is designed for capturing outcomes data relevant to a behavioral health clinician and using that data to not only improve care, but also auto generate narrative for the provider. That functionality is simply not present in other EHR’s and couldn’t be provided within large multidisciplinary EHR’s.

Behavioral healthcare providers want speed boats that are fast and have a very specific purpose rather than big cruise ships that have a little bit of something for everyone.

How many psychiatrists and other mental healthcare professionals do you have using your EMR?
We have over 500 psychiatrists and over 1,100 providers using our product. Including solo practices, public community health centers, mobile practices, and large group practices.

What’s Valant’s approach and thoughts on the HITECH Act and meaningful use? Do you see many mental health professionals getting EHR incentive money?
We have had over 20 providers successfully attest for meaningful use and a number of them have already received their checks. Our approach is unique in that we support “ease of meaningful use” in both our product and our support processes.

We have practice success managers that monitor the progress of our doctors and coach them along to help them achieve success. It’s not enough to simply buy a certified product. It’s important to assess the vendor and product’s ability to help you achieve success. We view the attestation process as a partnership with our doctors, treating their success as our own.

What advantages do you see for mental health professionals that have an EMR versus those that still chart on paper?
I think 3 of our biggest advantages are: greater efficiency, better patient outcomes and more revenue capture. Our newest module: Mobile Notes, delivers rapid note creation at the point of care that is faster than paper documentation. It includes automatic narrative generation from patient outcomes questionnaires and leverages an IPad’s voice recognition capability for the narrative sections of the note. It’s the perfect note creation tool for a behavioral healthcare provider and even before its release, has pried many doctors away from paper and pen.

Mobile Notes also allows practitioners to track outcomes data for their patients, providing the ability to monitor patient progress over time. This ability is not only helpful when assessing treatment plans and communicating progress to a patient, but may also become required in the future. As an example, United recently announced that over 70% of their codes would be pay for performance.

Who are Valant’s biggest competitors and what differentiates Valant from other behavioral health EMR?
I’d say that for the private practice psychiatry market, it is now mostly a race between ICANotes, Valant, and Practice Fusion.

ICANotes has been around for a number of years. I remember being impressed by a demonstration even before Valant was founded. They have had a nice system for converting check boxes into narrative. Some users are very happy with the way they can create intake notes and progress notes with just clicks. They’ve clearly developed a nice system for doing this that has generated a loyal following. It is still fundamentally a client-server product rather than a web based system. Also, when I last looked, they had not added a practice management module. [Update: Sandy Crowley commented that ICANotes does have a practice management capability.] We’ve addressed the narrative generation issue in our v5.0 release and have tied it to outcomes measures pushed from a patient portal. So we’ve combined 3 processes into one, which we think creates something much, much bigger and more powerful than check box to narrative generation alone.

The most common reason that Psychiatrists go with Practice Fusion is the price. The basic EHR without practice management is free, however the user will have to suffer through ad pop-ups and accept that your anonymized patient data is now owned by Practice Fusion. [John's Editorial Comment: Practice Fusion does have advertising, but does not use pop up ads as part of that advertising. Practice Fusion does have research rights to the data, but the doctors own the data. I'm sure many see research rights to the data as Practice Fusion owning the data, but it's worth highlighting that physicians own the data on Practice Fusion as well.] It’s an option for practices that are not bothered by this and are OK with a system that is largely text based and not optimized for behavioral healthcare.

Our big differentiator now, is our newest module release. I know that I am repeating myself. (Can you tell that I am excited about our newest release?) I really do think it is going to change the way we (clinician) practice. It will allow us (behavioral health practitioners) to get our notes done more rapidly and easily, engage better with patients, and allow us to incorporate outcomes tracking into our clinical practices.

You’ve recently launched a number of mobile initiatives, can you tell me what mobile solutions you offer mental health providers?
We were the first in our market to release a pure mobile version, which we now call Mobile Calendar. It includes a calendar with syncing to smart phones or any other calendar and key clinical information and demographic information necessary to support care when you are away from your office.

We also now have Mobile Notes, which is a more robust version of Mobile Calendar. It takes outcomes measures completed by patients on their PC or mobile devices and converts the data into narrative and then takes advantage of the iPad’s native voice recognition capabilities to support rapid note creation at the point of care.

And what mobile health options do you provide their patients and clients?
We now have Vālant Patient PortalTM. Allowing clinicians to send intake forms before the first appointment. Patients will receive push reminders to fill out intake forms before initial appointments and outcome measures before follow-up appointments. All of this is done via a secure patient platform that is branded to the practice. Patients are also able to confirm upcoming appointments, update demographic information as well as view CCDs.

5 years from now, what will differentiate Valant’s EMR?
Well it’s worth taking a step back and asking what the EHR landscape will look like in 5 years. Nearly all providers will be using EHR’s. EHR’s will be connected. Patients, hopefully, will have some control over how their data is utilized and who gets to see their data. Providers will think of EHR’s as tools that support them and work for them at the point of care. An EHR will that keep providers connected, educated and prepared. Patients will have their own set of tools that work seamlessly with EHR’s that help keep them healthy and connected to their providers. All this should be in the service of improving patient outcomes, keeping patients healthy, and improving the quality of work for healthcare providers. I believe in that vision.

By staying within the behavioral healthcare segment and not trying to be all things to all providers, Vālant will have a better chance of fulfilling this vision for our providers and their patients. It’s a big enough challenge as behavioral healthcare is 7% of the entire $2.6 Trillion healthcare market.

So in summary, we’ll be very deeply imbedded within the vertical market of behavioral healthcare and will ultimately be a platform that connects providers, patients and other areas of medicine, as they adapt to the changing healthcare landscape. We’ll continue to offer a set of tools to our providers and patients that improve provider life and work quality, the value of healthcare, and patient health.

A new study published in Health Affairs has confirmed what I, at least, have suspected for some time about physicians and their EMRs.  The study, which surveyed 3,996 physicians, found that while 91 percent were eligible for Medicare or Medicaid Meaningful Use programs, only 11 percent of those intending to apply had their act together.

Researchers, who analyzed data from the 2011 mail survey supplement to the annual National Ambulatory Medicare Care Survey, found that 51 percent of respondents were planning to apply for MU Stage 1 incentive programs. However, it seems that only 11 percent of doctors planning to apply have a capable enough EMR set-up to support up to two-thirds of Medicare Stage 1 core objectives.

Now, this was not completely unexpected. In the final Stage 1 MU rule, CMS had estimated that 10 to 36 percent of Medicare eligible pros, and 15 to 47 percent of Medicaid eligibles, would end up meeting the agency’s criteria.

And it should be noted, the HealthAffaits authors remind us, that about 124,000 eligibles had registered in 2011, and that CMS had paid out $275 million to 15,000 participants. Also, Medicaid programs paid out about $220 million to about 10,500 physicians.

Still, you can’t bury poor performance like this in a pile of data. Clearly, a program is lacking something important just over 1 in 10 physicians manage to set themselves up for Meaningful Use cash — especially if  they were trying hard to do so.

The problem with news items like these is that they don’t get into what’s holding physicians back. It’s actually a bit disappointing that the HealthAffairs study didn’t offer any red meat on the “Why Can’t Doctors Qualify?” issue, as we all know that talking about problems doesn’t make them go away.  (I do admit that in the world of public policy at least, simply underscoring a problem gives rulemakers ammunition to dig deeper into an issue.)

Still, I’d love to know what you’re seeing out there in terms of unprepared physicians. Are we talking practices that got fast-talked into buying inappropriate or junky technology?  Lack of understanding what they bought?  Slow-moving practices that are on the right track?

For those of you who aren’t familiar with the now a year old Hospital EMR and EHR, you should check it out and subscribe to the email list. The site has been growing like gang busters and people are loving the content on that site. I’d wanted to do a hospital EHR focused website for a long time. Certainly there’s a lot of cross over between ambulatory EHR and hospital EHR, but there are also unique differences in the hospital EHR environment that were definitely worthy of their own discussion platform. Plus, we like to cover other aspects of hospital IT.

One of the recent series that Anne Zieger started on Hospital EMR and EHR is called the Top Hospital HIS Vendors by Revenue. She’s already covered the top 3: McKesson, Cerner, and Siemens. She’ll be going through the rest of the Top 10 Hospital HIS vendors by revenue over the next weeks.

It’s really fascinating and amazing to see the enormous revenue numbers that each of these companies produce. Even more amazing is that we’re really only at the beginning of EHR adoption. There is so much of the EHR market that still is out there waiting to implement an EMR solution.

Of course, the real question is which vendor is going to capture this market share and which company will eventually be created that will take the market share from the incumbents. I’m sure it’s hard for many to believe that some upstart company could take down these large companies, but it will happen. That’s the cycle that occurs over and over again. Although, I will make the prediction that we won’t see much jostling in the hospital EHR space during the HITECH EHR incentive money time frame. The opportunity to take market share will likely happen post EHR incentive money.

I previously posted about Patient Recruitment & EHR where I talked about some of the intricacies of patient recruitment and use of EHR for clinical study patient recruitment. While I’m certain that EHR will be a major player in the patient recruitment of the future, I saw a tweet today that made a great case for social media being the go to platform for patient recruitment today.

Here’s the tweet from @JeffBrittonMD:

Facebook accounted for 70% of patients recruited for Epilepsy Contraception study; far greater reach than other ad methods #AANAM

— Jeffrey Britton (@JeffBrittonMD) April 24, 2012

70% of patients were recruited on Facebook. That number hit me when I saw it. Although, after thinking about it a little bit it makes a lot of sense. The real key to Facebook recruitment is that they know a lot of information about you which advertisers can use to target their ads. So, it makes perfect sense for Facebook to work for patient recruitment.

I think we’ll see other social media channels prove beneficial to patient recruitment as well. Although, it’s still early for many of the other platforms that I think will prove most valuable. Keep an eye on Twitter to start. Also, don’t underestimate the power of mobile apps and even a physician’s social media presence.

For those of you who don’t follow all the inside EHR “baseball” that’s happening right now with Allscripts, you might want to check it out. If you use one of Allscripts various EHR software (do they have 6 EHR softwares now? I lose count) then you really want to pay attention. Here’s my cliff notes version of what’s happened for those who don’t want to research the details. Half the Allscripts board left and so did the CFO. It appears it was an Eclipsys departure with the previous Allscripts board members and CEO Glen Tullman remaining. After this happened the stock (MDRX) plummeted.

While to those inside the EMR world will realize that this isn’t a death knell for everything Eclipsys related, many who don’t know how important the Eclipsys software is for Allscripts could easily see this a different way. Of course, in the heartless world of publicly traded companies and CEO’s doing what they can to prop up stock price, you never know what action they might take next.

The best evaluation I saw of the Allscripts situation is that it is very likely that Allscripts and Glen Tullman will use this stock drop to start making even more drastic moves. For example, we all know that they don’t need that many EHR software and so none of us should be surprised if they choose to sunset 1 or more of their EHR software. Yes, that’s right. Your EHR software isn’t safe even if you buy it from a large EHR vendor like Allscripts (see also when GE ceased operations of Centricity Advance).

Think about it from Allscripts perspective. It takes A LOT of extra resources to ensure that multiple EHR software products are even just meeting the meaningful use and certified EHR requirements let alone actually creating innovative new EHR software features. Cutting out an EHR software will provide a huge cost savings to Allscripts going forward.

Why is this the topic of Meaningful Use Monday? I think this is an incredibly important topic related to meaningful use, because I can already see the physicians and practice managers hitting my website if Allscripts chose to cease their Allscripts MyWay EHR offering (I have no indication that Myway is gone. I’m just speaking hypothetically). I’m quite certain that many physicians and practice managers will wonder how an EHR vendor could sunset or stop developing an EHR software that is certified for meaningful use.

It’s quite simple: Meaningful Use and EHR Certification are NO guarantee of an EHR software’s long term viability.

I have a section in my EMR selection e-Book about ensuring the viability of your EHR vendor. I’ll admit that it’s not an easy task and is more art than science given our limited information about MANY EHR vendors. However, it’s worth considering the long term plans of an EHR vendor and a particular EHR software in that vendor’s quiver. Although, meaningful use and EHR certification do nothing to help you in that regard.

One final warning: we’re just at the start of EHR vendors going out of business, EHR vendors being bought by larger vendors, EHR software being closed down, EMR software being sunset. I give it another year before the Tsunami of EHR software mergers, acquisitions, bankruptcies, fire sales hit our shore. Although, the early warning signs are there and so we should prepare for the oncoming wave. The challenge is knowing where you can find high ground.

I’m traveling in what I consider the heart of healthcare IT: Boston. Everywhere you turn and look there’s healthcare all around. I’ve seen multiple vans with Partners on them. I even had a mobile health story in the Delta magazine I checked out on my flight out. Although, I’m not actually in Boston for work. I’m just here on vacation with my wife. So far I’ve done a pretty good job enjoying the vacation and not working. We’ll see how the last couple days go.

Don’t worry Boston, I’ll be back in two weeks for Health 2.0 Boston and we’ll get all the #HITsm crew together for some healthcare IT fun. Yes, bad planning on my part, but I do have an affinity for visiting Boston.

Ok, enough of the sidebar. Now to the usual round up of Healthcare IT tweets:

RT @hphealthcare: Voice recognition is gradually being implemented into #EMRs. bit.ly/JcuitK

— Nectar Plaitis (@NectarPlaitis) April 30, 2012

Is there an EMR where you can’t use voice recognition? I wrote a post on that a long time ago where the answer was no. They can all use voice recognition. Although, as I’ve written about the deep embedding of voice in some EMRs, it’s also true that not all EMR voice recognition is created equal. So, check it out if you like voice.

RT @tbtam Are EMR’s medical devices? If so let’s treat them like devices. I agree. Dr. Wes drwes.blogspot.com/2012/04/why-el…

— rlbates (@rlbates) April 29, 2012

My answer is that they’re not medical devices. I think we have more than enough regulation in EMRs and I haven’t seen that regulation actually improve EMR software. So, I’m against more EMR regulation.

T2: ACO’s may want to share data through #HIEs, but typical EMR makes that near impossible… #hitsm

— Don Rosenthal (@DonRosenthal) April 27, 2012

It’s true that many EHR vendors hold the blame for not exchanging data even if they put on nice demos at the Interoperability exchange at HIMSS. How about next year the interoperability showcase at HIMSS can only show actual implementations of real exchanges? I wonder how different it would be.

Top National Hospitals 100 Hospitals Thomson Reuters list have more #healthIT and more advanced #emr j.mp/K60Obd

— Nick van Terheyden (@drnic1) April 26, 2012

This top lists are always fun to click and rarely have much value. Although, to me it probably mostly shows a correlation by the money made and the IT implemented. The more money they have the more likely they are to implement healthcare IT.

To get MU stage 1 money you must be at Stage 4 of EMR implementation #hcsm #Convo12

— Nick van Terheyden (@drnic1) April 23, 2012

Stage 4? You have to have completed every EMR stage (ie. Full implementation).

Our next entry in Healthcare Gadget Friday is the iMPak Health Journals from Meridian Health and NoMoreClipboard. You may remember that I called the iMPak Health Journals the most creative technology I found at HIMSS 12. As such I wanted to write more about how they worked.

Here’s a picture I took of the iMPak Health Journal:

It certainly looks pretty simple and it is. That’s done by design. You basically use the iMPak health journal by pressing down on the blue and red circles. Pressing these “buttons” kind of reminds me of the musical greeting cards you get. When you’d press it down the music would start playing. This works very similar. Although, you push the red button to start and then each of the blue buttons represent a response to a healthcare question. It’s as simple as that. You hold down the buttons and it records your answers.

Then, the next time you go for an appointment or through an NFC (near field communication) connection to your cell phone (almost all new cell phones will have this technology) the data is uploaded electronically to the NoMoreClipboard website. From there all of the data can be processed and seen by yourself and your doctor.

I’d hoped to have a video where you could see the use of the iMPak journal, but I wasn’t able to get one that did a nice demo. What I found so creative was how simple it was to collect data from a patient. They didn’t need to download an app. They didn’t need to buy an expensive device that they’re only going to use for a limited time.

Turns out that there are a lot of potential uses for these journals. Some areas that might find them useful are: Insurance Companies, Hospitals / Health Systems, Pharmacy Benefit Management, Pharmaceutical Companies, Employer Benefits Management, and Retail Pharmacies. Here’s a video which shows how it can be used:

One challenge that still exists with this device is getting patients to remember to use the device. A built in alarm that would go off to remind them to answer the questions could help to solve that problem. Although, the journal is so portable, I’d hate to have the alarm go off as you carry it around in your purse or something.

I’ll also be interested to see how many patients lose their iMPak journal or just forget to bring it to the office for their appointment. This isn’t an issue if they’ve been uploading their data using their own cell phone, but would be an issue in those cases where they’re uploading the data in the office.

The biggest competitor to this product is the various mobile health apps that are cropping up. One day I can see the mobile health apps really taking over this space. However, there are still many patients who don’t carry a smart phone or that can’t/won’t go to the hassle of downloading an app to track this stuff. In those cases, I find the iMPak Health Journal a really creative solution to getting the data to be able to provide better patient care.

Full Disclosure: NoMoreClipboard is an advertiser on this site.

For some reason I’ve been recently talking and reading more and more about patient recruitment. I’ve been fascinated by the creative ways that those doing the clinical studies use to be able to recruit patients that fit the very specific needs of most clinical studies. Plus, I’ve been amazed at how much money is required to be able to recruit patients for these studies.

There’s so many interesting quirks involved in the whole patient recruitment business. In most cases, it’s very large companies trying to recruit individual patients. Many of the chronic patients want to know about and be involved in the clinical study. In many cases, it can lead to a great mutually beneficial outcome for both the company that’s doing the clinical study and the patient who receives care that they wouldn’t have otherwise received. Of course, there are A LOT more intricacies involved in patient recruitment, but those are a few of them.

The biggest challenge with patient recruitment is usually finding the right patients for the clinical study. I think we’re on the brink of technology largely solving this problem for clinical researchers.

EHR Software for Patient Recruitment
When you think about the volume of data that’s going into an EHR system, you can see how valuable the granular EHR data could be in identifying which patients are eligible for a certain clinical study. Certainly there are plenty of nuances to when and how you can use this information. I won’t get into those in this post, but I think it’s quite clear that EHR software will be essential to patient recruitment in clinical studies.

I’m sure that some won’t like to hear this. My first response is that this doesn’t have to be a bad thing. In fact, if done right it can be a great thing. We just need to be involved in the discussion so that patient recruitment with EHR software is done the right way. My second response is that this is going to happen whether people like it or not. Instead of trying to stop it, we should focus on how to make it work well for everyone.

As I posted previously, I’m a very big proponent of healthcare IT companies using social media. Plus, as I mention in the column, I think you have to be careful to ensure that the voice of the company is involved in the social media efforts. Otherwise, you’ll lose your authentic voice and your social media efforts will be a fail. The best way to do this is through good training of your staff with smart outsourcing of certain aspects of your social media.

I believe that every healthcare IT and EHR company could benefit from social media, but I don’t think all healthcare IT and EHR companies should do social media. In fact, the company with the wrong culture will see bad results if they start using social media. Here are some issues a company might have that would make them not want to do social media:

Those Who Can’t Commit – If you can’t commit to social media, then don’t start. It’s better to do nothing then to have something laying their half done. For example, a blog should have at least 1 post a week. Anything less and you lose momentum and lose your audience. Twitter should be updated multiple times a week, but more importantly you need to make sure you respond to any relevant @ replies that you receive on Twitter. Don’t underestimate what I call the content beast. No matter how much you think you’re ahead, you’ll be surprised when it needs to get fed again. Be ready to commit to feed it regularly.

Those Overwhelmed by Their Email – This is partially related to the first point, but I think that your ability to manage your email is a good sign of whether you’ll be able to handle social medial or not. Starting into social media ends up adding more and more channels of information to be processed. If you have trouble managing one channel, email, then you’re likely going to feel extremely overwhelmed adding in multiple social media channels. Plus, most of those social media channels leverage email to some extent as well, so it will just make your email abyss even greater.

Those Who Don’t Care About Their Customers – This is a hard one for someone to understand and realize, but a few are self aware enough to realize it. The point is that if you don’t care about your customers to your very core, it will be seen in your communication on social media. I’m sure that most companies will wonder how this is possible because they’re so focused on the customer, but trust me they exist.

Those Who Suck – Sorry I couldn’t think of a better word, but it’s the only one that I think describes these companies. If your company has bad support, a poor sales process, and other related issues you don’t want to be found on social media. Imagine the questions that you’ll get if this is the case and your inability to properly respond to them. It makes for an ugly situation.

Those Who Can’t Take Heat – Some companies can’t take any sort of criticism. Instead of learning from the comments, they get confrontational. Sure, there will be some in social media who may make outlandish statements. Some people can’t resist the urge to start a confrontation. I’m certainly not perfect in this regard, but the best healthcare IT companies are humble in their approach to it. They correct when needed, but appreciate feedback from those who might see the world different than they do. A lot of good can come out of frank social media discussions. It’s not always about being right.

Those Who Drank the Kool-aid and Are Afraid of Those Who Haven’t – I must admit that these people always give me a good laugh. You might know the type of person I’m talking about. They’ve only worked for one company in healthcare IT (or maybe only one company ever) and they’ve been to one too many Ra Ra company meeting where all that they’ve heard is the good side of the story. I actually think social media is great for these people since it will help them to expand their mind. They just shouldn’t be the face of the company social media. I should probably add the other extreme: the long term jaded healthcare IT professional. I actually love these people on Twitter since they provide incredibly valuable insight. Although, you have to be careful having them as the face of the company.

I’m sure we could look at other characteristics that would prevent a company from deciding to participate in social media. I’d love to hear your thoughts and comments on this subject. Some stories would be quite interesting as well.

Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money. Check out Lynn’s previous Meaningful Use Monday posts.

When the EHR Incentive Program was first announced, many providers told me that while they might be willing to forego the potential incentive payments for meaningful use, they could never accept the 2015 penalties (AKA “adjustments”) for non-compliance. Back in 2009, 2015 seemed far in the future—but for those motivated by penalty avoidance, it’s time to make sure that meaningful use is within your grasp. 

The Proposed Rule for Meaningful Use Stage 2, (page 13771), defines the timeline for the assessment of penalties. The safest way to avoid the 2015 penalty is to successfully demonstrate meaningful use in 2013. (Yes, 2013—this is not a typo!) Failing that, a provider whose first year of participation is 2014 has until October 1, 2014 to successfully attest, which means that he/she must begin the 90-day reporting period no later than July 3 of that year. For future year penalties—that increase by 1% annually—the pattern would be the same: full calendar year reporting two years prior or 90-day reporting in the year prior to the penalty assessment.

Bottom line: You cannot wait until 2015 to be a meaningful user if you are concerned about the penalties. And if you haven’t embarked on the EHR adoption process yet, 2013 will sneak up on you very quickly!