Electronic Health Records

San Francisco's New EHR System Contributing to Administrative Issues

November 19, 2010

iHealthBeat.org - The implementation of an electronic health record system at San Francisco's Department of Public Health has created numerous administrative problems for the city's mental health and substance misuse services, the Bay Citizen reports.

Loss of Information

In July, the department began using an $11.2 million EHR system called Avatar. According to documents obtained by the Bay Citizen, health care providers faced difficulty using the new system shortly after its installation. As a result, health officials might have lost documentation on millions of dollars in services.

In September, the city health department found that claims for mental health services dropped by 55% following the implementation of Avatar, while claims for substance misuse services declined by 32%. The figures raised concerns that health care providers had encountered problems submitting data through the EHR system.

Tracking Down Data

Officials are working to recompile the missing data in time to qualify for state reimbursements from Medi-Cal, California's Medicaid program. San Francisco officials will need to submit correct claims information to the state before deadlines in November and December

This fiscal year, the city health department expects to receive $90.9 million from Medi-Cal for mental health and substance misuse services.

Additional Challenges With EHR System

Anne Okubo, deputy financial officer for the city health department, said problems related to Avatar's implementation delayed about $450,000 in payments to individual therapists. The department used a third party to issue the payments, which still are incomplete.

In addition, some health care providers have said that meeting the demands of the new EHR system impede their ability to spend time with patients and provide quality care.

Looking Down the Road

Netsmart Technologies -- which developed Avatar -- and city health officials said the problems were expected as the city transitioned to a new EHR system. Managers at the city health department also said that they expect Avatar eventually to improve patient care and curb costs.

Fred McGregor -- the health department's senior IT manager for community programs -- said officials are aware of Avatar's issues and are working to redesign the system to streamline its clinical assessment process (Mieszkowski, Bay Citizen, 11/18).