Making beautiful music together: a behavioral health hospital in Maine and an acute care IS vendor break new ground in IT

Health Management Technology, March, 2005 by Bonnie Thibault

Spring Harbor Hospital, a 105-bed psychiatric facility in Portland, Maine, needed to develop a complete, integrated information system that met the unique needs of a mental health facility. Medical Information Technology Inc. (MEDITECH), an established acute care IS vendor, wanted to break into the behavioral health market. Together, we collaborated to build an enterprisewide system for Spring Harbor that has been up and running successfully for more than a year and has benefited both.

A nonprofit inpatient and outpatient facility, Spring Harbor Hospital is southern Maine's only private psychiatric treatment and recovery center. Specializing in the care of children and adolescents, we also treat adults and those with developmental disabilities. Essentially, we have children on the first floor and adults on the second. We are part of MaineHealth, an integrated healthcare delivery system of 11 entities in south, central and western Maine. Maine. Health includes primarily acute care hospitals, and also a rehabilitation hospital, lab services and a home health network of visiting nurses. We have 450 employees at Spring Harbor Hospital and support another 100-plus clinicians at our affiliate, Maine Medical Center's Department of Psychiatry.

I arrived at Spring Harbor in April 1999, as part of the new management team that would transform a formerly bankrupt for-profit psychiatric hospital, Jackson Brook Institute, into Spring Harbor. At that time, we had two separate databases, 40 PCs (only 20 of which worked), no e-mail, a basic computerized billing system and an all-paper medical records process to serve 2,600 patient admissions a year. We couldn't even share clinical data with Maine Medical Center's psychiatry and emergency departments, which provided most of our referrals.

Our vision was to create an integrated network with a shared database throughout our entire outpatient and inpatient facilities so we could better communicate and make the most of our resources. We also needed to improve our clinical and business processes to provide a better continuum of care for our patients. We had a lot to improve upon.

Unique Behavioral Health Requirements

Behavioral health differs in several ways from acute care, including group therapy scheduling, reimbursement, authorization from payers, and credentialing and billing. While patient confidentiality is always important, it is even more sensitive in the behavioral health arena because of the stigma that persists about psychiatric treatment.

When we started looking for a vendor to provide a complete health information system, we had to find one that could tweak their system to accommodate a behavioral health setting. MEDITECH wasn't even on our original vendor list because we thought of them only as an acute care IS vendor. However, we got more excited about them when we saw their system in action at our affiliate, Miles Memorial Hospital in Damariscotta, Maine, and when we evaluated their system's functionality at the Massachusetts Department of Mental Health (DMH).

Miles, of course, was an acute care facility, and DMH had a very different system of billing the state, but we could see the potential for how the solution could be applied to Spring Harbor. We finally chose MEDITECH because we felt they had more integrated applications than their competitors, and we wanted to have a system like five of our counterparts in MaineHealth, which were MEDITECH facilities.

Our relationship with the vendor has been a whirlwind. We signed the contact with them on Dec. 27, 2001, and to coincide with our fiscal year, we went live with our financial modules on Oct. 1, 2002. Two months later, we rolled out medical records, admissions, scheduling and billing. Today, we have come a long way. We have 250 desktop computers--with nothing older than a P-3800--on an all-Cisco infrastructure. MEDITECH's system is the foundation of our health information system (HIS), but because Spring Harbor needed flexibility, we collaboratively built a unique enterprisewide system that includes:

Group scheduling. Because it was a behavioral health issue and not just specific to Spring Harbor--and it is key to reimbursement in behavioral health--we designed a system that any psychiatric facility could use to schedule group appointments, not just one customized for Spring Harbor. In behavioral health, an organization can't bill a group unless it has a minimum of three participants up to a maximum of 10. Because MEDITECH's software didn't carry this inherent functionality, we designed a system that allowed us to manipulate the data for individuals and for the group as a whole.

Program scheduling. Sometimes adolescents and adults need partial day treatment services, say three times a week from 8 a.m. to 1 p.m. Because we can't bill unless services are bundled in threes, we needed to design a scheduling system that would bundle the information accordingly.

Authorization. In behavioral health, we need to track authorizations at the point of scheduling. For example, if six individual therapy sessions are authorized and a patient cancels one or two appointments, the system needs to track that and put the one or two canceled appointments back into the bucket for use.