I Need an EHR

The landscape of healthcare is changing, and so are the tools providers need to survive in it. It’s becoming increasingly critical for human services organizations of all types to adopt an Electronic Health Record (EHR) that meets Interoperability requirements.

EHR software, at its core, is a relational database. Here’s an article by our CEO, Marlowe Greenberg, that sheds some light on the benefits of implementing an EHR.

Relational Databases and Why You Need Them
Purchasing and using a database can be one of the most difficult yet rewarding experiences for any organization, nonprofit or for-profit. One reason is that databases usually handle a substantial portion of what the organization considers its mission-critical information. If the database doesn’t work, or breaks down, it could become a crisis for the organization. In my capacity as the CEO of a database software company that works exclusively for human service organizations (a majority of whom are nonprofits), I have learned a great deal about what my customers go through on their way to choosing a database. I hope you can benefit from my experiences.

Relational databases can be thought of as powerful versions of a regular database, like Excel. Whereas Excel is very good at keeping track of simple one-to-one relationships between different pieces of data – for example, “What is John’s social security number?” – it is not capable of keeping track of one-to-many, or many-to-many relationships. These kinds of data relationships are much more complex, but much more useful for nonprofits. A relational database can answer a question like, “How many people in Program X are taking medication that is about to run out, and what medication is it, and how many of those people do not have a doctor’s appointment scheduled?” Try getting Excel to answer that question.

Dealing with the Past
When people first approach me, it’s often with a grudging recognition that they “have to do something” about the state of technology in their agency. Typically, this person is a Deputy Director, an IT professional, or a consultant hired for the purpose. Whoever they are, they usually seem less than excited by the prospect of working through all the details involved in finding a way to use databases productively and cost-effectively. Most of the people who approach us have already tried several different kinds of technology to solve their data tracking needs. Some have built their own database (now unusable because the person who built it has long since left), some are trying to use Excel (and can’t track most of the items they would like to track) and many are unhappily using paper and pens (letting a lot of their consumers fall through the cracks and not billing for all of their service work). Many people in the nonprofit sector have had unfortunate experiences with technology, and they are appropriately wary of companies promising them “flawless transitions” and “affordable solutions.” Because they work in the nonprofit field, they understand how complex this sector is and how difficult it can be to actually save time and money using new technologies.

But it is precisely because the nonprofit field can be so complex that makes it such a perfect candidate for a large relational database. Today there are several companies making relational database software specifically for nonprofits. Some of these companies offer their software as a service over the Internet and some offer their software in traditional form, loaded onto your computer. In any case, all these companies are attempting to bring the power of relational databases to nonprofits. One of our customers was attempting to use Microsoft’s Access program but was having trouble getting it to issue the reports she needed. Relational databases were able to solve her problem because once data is entered into a relational database, you never need to enter it again, and it can be sliced and diced any way you want. Another customer was having trouble keeping track of vacant beds because his agency was so large. Again, relational databases are able to track data from multiple sources and aggregate information on their own. We solved this Executive Director’s problem by establishing a twice-weekly automated email that tallied the number of vacant beds, agency-wide.

It’s the Relationship, Not the Product
Usually, once nonprofit staff begins to understand the power of relational databases and the substantial cost saving inherent in Web-based software, their attitude shifts considerably. Most of this shift, however, has as much to do with people beginning to trust companies like mine as it does the product itself. The banking industry doesn’t experience this trust hurdle. Banking is a mature enough industry that no one questions its reliability. We give banks our money and trust them to keep it safe and keep an accurate count of it – even though we have never met the people who do that. Because of the newness of some technology, however, nonprofits often feel differently about their data. Using a third party to provide software means, in some cases, that your data will be held somewhere else and your technical support will come from someone else. This transition can be a difficult one to accept.

After reading about all the precautions that we take with our customers’ data, another of our customers exclaimed that her agency would have never thought of all those safeguards and even if they had, could never have afforded them. It is often the case that nonprofits feel as though their data is safer and more secure when it’s with them. In reality, however, nonprofit data will almost always be safer and more secure with a company whose only job is to keep that data safe. We would never expect software companies to do as good a job of providing social services as nonprofit agencies. Likewise, we should never expect nonprofit agencies to do as good a job protecting data as software companies.

In my experience, people want honesty about technology’s total cost. This seems obvious, but total cost can be a difficult thing to assess in this sector. Companies that sell client-server software (which you must maintain on your own servers) often do not mention the cost of those servers or the wide-area network that you must establish to use their software. ASPs often do not mention the cost of Internet connections when they tell you how much their software is. But in both cases, it is important to remember that these costs are not optional. Having said that, there are external costs associated with every single technology option. Building your own database also means having someone around to troubleshoot, customize, and support it, not to mention having someone to conduct staff training and provide continuing software development.

Reality Bites: Implementation and Training
There is one central unpleasant realization that agencies experience when implementing a large-scale database application for mission-critical activities: There are a lot of politics involved in something that seems like it “should” be devoid of politics. For example, information technology staff is often privately concerned about being “replaced” by a comprehensive Web-based system. As a result, they may try to defend their importance to the agency. Fiscal or accounting staff often wants a kind of “firewall” to exist between “social service” data and fiscal data. As a result, they may try to remain apart from the process of using an agency-wide database. Lastly, because using a database often provides an opportunity for the agency to improve its business processes, the line staff may have difficulty adjusting to these improvements. For a time, the new system may seem less efficient than the old one. Of course, if your time frame is short enough, every change is less efficient than no change. That doesn’t mean change should never be undertaken. Our work suggests that it is important to understand and realize the benefits of a new system over the long term – 6 months or a year – not just tomorrow.

The Light at the End of the Tunnel: Usage
So, is it worth it? With all the time and money and political machinations and business process changes and relationship building and all the things that can and will go wrong, is it worth it? Absolutely. Relational databases have been used by the corporate world for years, and with very good reason. No human being – or group of human beings – can keep track of all the millions of pieces of data in a large organization and all the ways that data relates to all the other data. There is simply no substitute for an enterprise-level database. After your initial investment of time, money, and energy, relational databases will end up saving you substantial time and money forever. This technology will enable you to issue reports at the touch of a button, figure out how much vacation Sally has left, and how long it’s been since John wrote a progress note for Jim Smith. This technology will increase your billing to funding streams by enabling you to get reimbursed for every service you provide. This technology will allow your staff to spend more time with clients and less time filling in the same Social Security number over and over and over again. In short, the question is not IF you should start using a professional database at your agency, but rather: WHEN will you start using a professional database at your agency?
This article originally appeared in TechSoup.