EHR Integration Key to Telehealth Expansion for Behavioral Health Provider

Buffalo, N.Y.-based behavioral health provider Horizon Health Services has been fine-tuning its use of telehealth and virtual visits to expand its presence in Western New York. In a recent interview, Jake Haacker, Horizon’s chief information officer and security officer, spoke about how a recent EHR integration has spurred greater use of telehealth.

Founded in 1975, the nonprofit Horizon serves three counties: Niagara, Erie and Genesee, or as Haacker described it, “Buffalo Bills territory.” It has 20 locations providing mental health and substance use disorder treatment including outpatient, residential detox, school services, and several other ancillary service lines. It sees approximately 19,000 patients per year.

Even before joining Horizon, Haacker had several years of experience in the behavioral health industry, including working at a behavioral health EHR vendor.

HCI: I understand Horizon recently adopted a new EHR system. Can you talk about that process?

Haacker: Behavioral health EHRs were a niche probably about eight years ago, and then the larger EHR vendors started buying them up or they started merging. We were on Anasazi, one of the market leaders a few years ago. But then Cerner purchased Anasazi, probably about eight years ago, and that platform was showing its age and it was limiting us. It was definitely a barrier for us to transition to some of the technology solutions we wanted to do. And so, last year, we migrated to what is now called the Oracle Cerner Millennium solution.

HCI: You also went live with Amwell’s Converge platform for telehealth visits and integrated it with the Cerner EHR. What were some elements of the Converge platform that were attractive to your team?

Haacker: 2019 was when we decided that we wanted to install a telehealth solution, so this was prior to COVID. We were able to get some funding from local grant agencies, and we were able to source and partner with Amwell. We were able to implement a stand-alone telehealth solution. Why I'm really emphasizing that is the solution did not integrate into our EHR. We knew that we wanted to get into the virtual healthcare space. It just so happened we went live in November of 2019, and in 2020 COVID hit, so we were able to service all of our patients and not close any doors, not lay off any people and utilize that Amwell platform to service all of our outpatient patients.

Throughout that time, as we started maturing our operations, we wanted to modernize some of our workflows. We knew having two siloed solutions was not going to work. Our vision was to have a single solution, with everything inside of a core stack. In 2022, when we were embarking on the new EHR and migrating over to that new platform, it allowed us to use Converge to integrate seamlessly right into the solution. In our first rendition of telehealth, we found all of these different problems we wanted to solve, and with the new solutions, we were well positioned to solve them. We went live in May 2022 with our EHR, and in July 2022, we went live with Amwell’s integrated platform. That was seamless and a quick turnaround time from a project delivery standpoint.

HCI: From a provider’s perspective, can they launch a telehealth visit with a patient directly from the EHR now?

Haacker: Yes, they are right in the clinical charts from the initial intake to the episode of care via telehealth to the billing. They're able to stay right in their documentation for everything. They're no longer having to pop out, log into another system and, view the record while they're talking to the individual. It's all right there integrated, so data is passing over as well. It's a true bidirectional interface.

HCI: Is there also an ease-of-use factor for the patient?

Haacker:  Totally. With this new Converge platform, Amwell simplified the platform and this integration has reduced our support tickets by 50 percent. Support tickets come from both providers and counselors as well as patients. There were things with the legacy app such as people forgetting usernames and passwords all the time. This new integration has really reduced our support tickets. And when you look at satisfaction rates, we're hovering between 96 and 97 percent satisfaction rates by both providers and the patients. We saw some tremendous improvements.

HCI: I understand that you were able to expand virtual care coverage to more underserved rural areas in Western New York.

Haacker: We really wanted to focus in on the rural communities as well within Genesee and Niagara counties and the surrounding areas, We were able to expand and reach more people. People have social determinants of health issues. We wanted to eliminate a lot of those barriers, such as travel time or car problems. We wanted to provide this care to them in the comfort of their homes or wherever they felt comfortable.

HCI: So how much uptake are you seeing by providers and the patients?

Haacker: Right now we're hovering between 40 and 50 percent telehealth services vs. onsite services.

HCI: Is that in part because it's popular with the providers? Getting all the way up to almost 50 percent virtual visits seems like a huge change from several years ago.

Haacker:  Some counselors and providers really utilize telehealth and find it very engaging. It really comes down to personal preference at times, and patients are the same way. People have really adapted and really find the benefits.

HCI: I also read that this has reduced psychiatric visit wait times by 40 percent. Why does it have that effect?

Haacker:  In a bricks and mortar setting, there are constraints. If somebody cancels, it can be more challenging to shift operations. In virtual care, it's easier to pivot quickly and be able to see patients more rapidly based on caseloads. We were able to free people up and decrease that wait time overall.

HCI: Are there any future projects or anything else you're working on now that you've got this setup?

Haacker:  We view Amwell, as well as Oracle Cerner, as our core backbone to our clinical technology stack. We want everything to integrate into those two solutions. Over the past couple of years Amwellhad has acquired two platform: Silver Cloud and Conversa. Silver Cloud offers digital care pathways and is AI-driven. Conversa is automating those care pathways. Those are two things that we've been working with Amwell on. Again, we're looking for everything to integrate into these solutions. Our goal is for them to be a single platform to help our patients and our and our operations.