When you have timelines in place and milestones to meet, as CIOs always do, the last thing you want is to delay them. But when disaster strikes – and poses a strain on your team’s resources – difficult decisions have to be made; projects need to be put on hold and expectations need to be adjusted.
It’s a difficult scenario for any organization; particularly one specializing in behavioral health, where “patients can be even more distressed and have more anxiety and worry.” For BestSelf, which was formed by the merger of Child & Adolescent Treatment Services and Lake Shore Behavioral Health, meeting this needs of this population is one priority that cannot be put on hold, according to Kevin Wiese. Recently, he spoke with healthsystemCIO about how his team worked to ensure care continuity during the pandemic, all while ensuring a major EHR migration stays on track, and how he has been able to leverage his previous experience in project management. He also discussed the key challenges in going through a merger, how the organization is looking to improve security, and what he enjoys most about working in the behavioral health setting.
- About BestSelf (formed through the merger of CATS and Lake Shore Behavioral Health)
- Migrating to Cerner Millennium
- Leveraging his project management experience: “Involve the right people and get the right input.”
- Assigning committees and super users to “to keep everybody in the loop.”
- Covid-19 response: “We were in a good position to scale our technology.”
- Phone counseling and Zoom group sessions to ensure care continuity
- Reprioritizing during the pandemic – “We have timelines in place and milestones to meet.”
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I’m just trying to guide the process here. We really need clinical and business experts to have the most input when it comes to the decisions on build and workflow and implementation.
We were in a good position to scale our technology. We made some server infrastructure improvements right when we thought we might have to deploy some people to work remotely, and so we were able to get that done pretty quickly.
We’ve worked with some folks who had never used a lot of technology. In some cases, we’ve helped folks create an email address, for example, or instruct them on how to use an app on a smartphone or use Zoom for meetings. It’s been a great experience in that respect.
We have had to reprioritize and put a pause on a few of the initiatives or projects we had going on. Once we reached a steady state from a service standpoint, we started to reengage some of our other projects that were on our roadmap for 2020.
Gamble: Hi Kevin, thanks so much for taking some time to speak with us. Let’s start with a high-level look at the organization so we can get some context.
Wiese: BestSelf is a large, community-based behavioral health organization serving children and adults in Western New York. We serve mostly folks with mental health and substance use disorders, and we provide a full continuum of person-centered trauma and forum behavioral health treatment rehabilitation and recovery services. BestSelf was created in June of 2017 when two organizations merged: Child & Adolescent Treatment Services and Lake Shore Behavioral Health. We have approximately 15 outpatient clinics in Buffalo and surrounding areas, and we provide services in over 70 locations.
Gamble: And you belong to HEALTHeLINK?
Wiese: Correct. We participate in HEALTHeLINK, which is a RHIO based in Western New York. We’ve had a good relationship with them for several years now. We receive data from them and contribute data to the RHIO as well. It’s a fairly large organization that covers multiple counties.
Gamble: What type of EHR systems do you have in place?
Wiese: Our primary EHR system is from Cerner. For a number of years we’ve used Cerner’s Community Behavioral Health platform, and we’re now in the process of transitioning to Cerner Millennium.
We kicked off the implementation back in October of 2019. Right now we’re in the build phase; we’re building the system behind the scenes and preparing it. We’re planning to do some training probably in summer/early fall of this year, and we have a tentative go-live for late 2020 or early 2021.
Gamble: What was the impetus for switching to Millennium?
Wiese: It was a couple of things. One, we had been using a legacy product. It’s certainly not as robust as Cerner Millennium and many other EHR products that are on the market. Secondly, BestSelf is one of the lead organizations in a behavioral health IPA here in Western New York. The four leads all came to a consensus that it would make sense to be on the same EHR platform.
Gamble: What are you focused on as part of the build phase?
Wiese: Right now we’re looking at what’s in our current EHR system, from staff accounts to programs we’ve built in, and schedules. So we’re looking at our current state EHR — extracting some of that data and getting into a format that Cerner can then use to build the new EHR system.
Gamble: Are you working with clinicians or user groups to get their input?
Wiese: In the third quarter of 2019, we developed a Cerner Millennium steering committee that consists of about 10 individuals. We also created around 15 advisory committees within the project that represent various clinical areas of the business. Each of those committees has a lead, along with a few other stakeholders that have input into that particular area of the project.
Gamble: Right. There’s so much that goes into it. Have you been through the experience before of switching major systems?
Wiese: I have. I’ve been with BestSelf about six and a half years. Prior to coming here, I worked for a medical software company for about eight years as a project manager and trainer. I’ve probably implemented EHRs and practice management systems in about 130 physician practices.
Gamble: Have you been able to draw from that experience as you’re planning to transition to Millennium?
Wiese: Certainly. We’re approaching the project with proper planning, and trying to establish and follow good governance principles when it comes to decision making and change management. That means making sure we involve the right people and get the right input. Obviously I’m in the technology area of the business, but I always say that I’m just trying to guide the process here. We really need clinical and business experts to have the most input when it comes to the decisions on build and workflow and implementation.
Gamble: That makes sense. I guess it’s a matter of finding ways to incorporate all of that.
Wiese: Certainly. As I said, we’ve established a committee structure, so we have good involvement there. We’ve also established a super users’ group that will assist us with training. We try to set regular communications even though certain groups may not meet for a period of time. We try to keep everybody in the loop with what’s going on, so they have a sense of involvement in the project.
Gamble: I’m sure that’s a big focus for you right now. In terms of Covid-19, how did BestSelf respond? How was your strategy impacted?
Wiese: We did well overall in our response to Covid-19. We established a response team consisting of about 25 individuals who met daily and discussed everything from technology to workflow to employee and patient health — how we were going to maintain business continuity throughout the pandemic.
We were in a good position to scale our technology. We made some server infrastructure improvements right when we thought we might have to deploy some people to work remotely, and so we were able to get that done pretty quickly. We were doing some telehealth prior to Covid-19, so we just had to scale up our resources and our software to do more of that. We’ve been able to provide the vast majority of our services via telehealth.
Gamble: Can you talk about what it took to scale up?
Wiese: In terms of telehealth, we were lucky in a sense that the majority of our workforce have laptops as their primary computing device, which makes it easier for them to transport the machine to an alternate worksite.
We keep a loaner inventory in IT, and so we surveyed our workforce to find out who didn’t have a device, and were able to deploy notebooks. We purchased webcams for those who didn’t have a camera or desktop machine, for example. And then on the software side, we had to scale up our licensing with the vendor we use for telehealth.
Gamble: Did you run into issues with bandwidth?
Wiese: We haven’t encountered any significant bandwidth issues. We make it clear to the staff that if you’re working remotely, you may not have the bandwidth and the internet performance that have at your worksite. We’ve taken care of and addressed performance issues on the infrastructure side with some enhancements to our remote server. But we also communicated to our clinicians that if you’re working from home, which was the case for a lot of our folks, you may encounter some limitations with performance.
Gamble: Have you spoken with leaders at other facilities about how they’re handling some of these challenges that are specific to behavioral health?
Wiese: I’ve had brief contact with some local colleagues who are working through the same challenges that we are. We haven’t done a ton of communication, because we’ve all been pretty busy at our own organizations trying to meet the needs of the workforce.
But I know that many of them have deployed telehealth solutions. New York State has also allowed us to do phone counseling. And so, if we have clients who don’t have access to the internet, or don’t have a computer or smartphone, we’re still able to carry our counseling through the telephone.
Gamble: And because of what your organization does, I’m sure it’s really important to be able to provide some continuity, or at least make sure you’re able to reach patients who are in need of services.
Wiese: Absolutely, especially at a time like this, when patients can be even more distressed and maybe have more anxiety and worry, considering what’s happening. Our counseling staff has been outstanding. We’ve been reaching out to clients and offering phone counseling or telehealth appointments, and we’ve found that a lot of people are really enjoying the experience. I think in many cases it makes it more convenient for them to get the care they need. They don’t have to travel to an office. And even if they can, some would rather use the technology.
In addition to individual counseling, we’re also doing group sessions through telehealth. We’ve found that our clients have really enjoyed the opportunity to stay connected with other folks who they might not otherwise see since we’re all spending so much time at home.
Gamble: I’m sure that’s incredibly important, because when you think about the loss of support groups, that could be really detrimental.
Wiese: Right. We’ve worked with some folks who had never used a lot of technology. In some cases, we’ve helped folks create an email address, for example, or instruct them on how to use an app on a smartphone or use Zoom for meetings. It’s been a great experience in that respect.
Gamble: And of course, while this is happening, there are other important tasks you have to stay on top of, particularly the EHR initiative. Have you had to do some prioritizing?
Wiese: We have had to reprioritize and put a pause on a few of the initiatives or projects we had going on. Once we reached a steady state from a service standpoint, we started to reengage some of our other projects that were on our roadmap for 2020.
Gamble: I would imagine the transition to Millennium is something you really want to stay on track.
Wiese: We do. And obviously, we’re working with the vendor; we have timelines in place and milestones to meet. And so we prefer not to have to delay those if possible. But the reality is that folks have been consumed with other things, and so we did have to reduce the frequency of some of those Cerner project meetings for a while. However, we continue to do as much planning as we can to keep that project on target.