Success Stories

NYU TIER® Implementation

The New York University Child Study Center has been using Sequest Technologies’ TIER® product since 2001. We purchased the behavioral workflow package along with the integrated billing product. We’ve approached the implementation of the TIER® product in a staged implementation with certain modules being built based on priority.

The first component to be completed (and highest on our priority) was the Billing Module. The Billing module replaced our legacy billing system, Therapist Helper. To appreciate the unique billing implementation experience versus other clients, you need to know that the NYU Child Study Center is a fee for service treatment center. We do not accept any insurance and as such did not need many of the included features (such as HFCA billing and EDI) associated with a “regular” practice. That being said, there was no shortage of challenges we presented to the Sequest staff prior to bringing billing live. Overall, as a “unique” client in this area for Sequest we constantly challenge them and ourselves to build a customized product while Sequest maintains the core functionality for future upgrades. Some of those features that have been included in version upgrades and unique to us are: (1) split billing, (2) beginning balances, and (3) client credits.

The next component to be developed (currently in limited production) is the behavioral workflow module, which is the electronic health record. We began using the workflow module to document progress notes, referrals, medication administration, diagnosis, and demographic information. Some of the key areas of improvement have been in data management, business process, and clinical care.

Our center is divided into three functional areas: (1) clinical, (2) research, and (3) education. Each area had individual records (demographic or clinical) that many times were never in synchronization. Now if a patient is recruited through research and has completed the trial and needs clinical care follow-up, we have all the pertinent demographic/clinical records. Duplicate information is rarely created. Additionally data from the clinical area is used to assist in research efforts (recruitment & grant proposals) and educational material development.

Quality assurance is often a time-consuming process that often has the best intentions but fails in the process. For instance, it was entirely cumbersome to find out how many patients did not have an updated diagnosis. Data is now accessible via Crystal Reports or TIER® forms to determine which patients have provisional diagnoses. In addition we use TIER® to reinforce clinical policies. A perfect statement of this is one provider’s assertion that he “never forgets to write a progress note” now.

At the end of the day what you expect from any electronic record is a system that provides a value proposition alternative. My experience has been that an electronic health record that simply mimics a paper record will fail. In order to drive user adoption the record must do everything a paper record does and more. It must assist in the formulation of treatment, drive clinical decisions, and deliver data immediately. For example, I’ve customized the Client Facesheet in TIER® to show basic demographic data, diagnoses, medications, staff assignments, progress notes, and treatment plans. This aspect of customization in the program allows infinite variations to deliver your “best of breed” product to your consumers. In our case, my consumers wanted a “snapshot” view of patient data with access priority documents.

As the project lead and day-to-day developer of TIER® for the NYU Child Study Center, I can attest to the remarkable dedication and team-oriented approach the Sequest staff provides in each step of the development process. Their ability to support large clients while providing personal service is reassuring. In addition having worked as a consultant in the field and served in the same capacity, I can vouch for their professionalism.

The New York University Child Study Center is dedicated to the understanding, prevention and treatment of child and adolescent mental health problems. The Center offers expert psychiatric services for children and families with emphasis on early diagnosis and intervention. The Center’s mission is to bridge the gap between science and practice, integrating the finest research with patient care and state-of-the-art training supported by the resources of the world-class New York University School of Medicine.

David Fu
Project Manager, Clinical Services
NYU Child Study Center