Blog: More Systems, More Problems: One CEO’s Way Back to One
Editor-in-Chief
Nobody sets out to run two EMRs, but it can happen one reasonable decision at a time. You add a new level of care, get a pricing quote that stings, or visit a conference booth with a convincing demo. In a recent Kipu webinar, roughly 60% of attendees said they were running two or three systems across their organization, and Wade Muhlhauser, founder and CEO of Plugged In Recovery, was candid about how he became one of them and what it took to get back out.
Plugged In grew from a single sober living home into 14 homes, seven treatment centers across four brands, and a continuum that runs from detox to alumni follow-up. Somewhere in that growth, outpatient landed on a different platform than residential. The lessons from unwinding that decision can help you save time and money.
The seams are where care breaks
The cost of a second system rarely appears on an invoice. You find it at every transition between levels of care. At Plugged In, a GAD-7 or biopsychosocial completed in residential didn’t follow the client into outpatient. When someone needed to step back up, their outpatient notes stayed behind, and staff re-entered history by hand to get utilization review done.
Those gaps are a clinical risk before they’re an operational one. Wade says, “Things get missed when they’re in two different systems.” A client who disclosed something in one setting could present differently in the next, and nobody had the full timeline in front of them to notice. Medications, medical logs, and risk flags were reconciled by people rather than carried by the record.
If you’re evaluating your own stack, ask yourself where the handoffs are, and what happens to the chart at each one? If the answer involves a spreadsheet or a re-keyed profile, you have found the seam.
Let the people closest to the patient decide
When Wade decided to consolidate, the pushback came from leadership and billing, not clinicians. Leadership raised sunk cost, and the billing team preferred the other platform’s workflow. Wade and his team listened to these valid and legitimate concerns, but in the end, neither was the deciding factor.
He says, “When you talk to any of the clinicians, any of the BHTs, any of the people who are having those patient-interfacing connections, every single one of them said we’d prefer to be on Kipu.” Training staff on two systems, and watching them relearn where reports lived every time they moved between sites, was adding friction to a workforce already at risk of burnout.
The people who end up carrying that friction are the same ones who sit with a patient through a bad night, who notice the shift in someone’s mood at a smoke break, and who hold the relationship that makes treatment work. When Wade weighed an easier billing workflow against their daily experience, the choice made itself. Pay attention to who is advocating for which system, and ask what their day looks like once the decision is made.
Consolidation becomes a playbook
The payoff came when Wade began to see that training had moved to a single learning path, and staff were able to float between facilities without relearning anything. Then Plugged In started acquiring treatment centers, each running on its own platform, and the consolidation Wade had already lived through became a repeatable process. His team now knows exactly how to move an acquired center’s CRM, call tracking, EMR, and alumni program onto the systems Plugged In already runs.
He says, “I did it the wrong way and had to eat the crap sandwich. But I’m glad I got that out of the way early with my own center, because now I have the exact playbook.” For any organization planning to grow by acquisition, or to sell to one, that playbook is an asset. Buyers want infrastructure everyone already knows and trusts.
One record is what makes outcomes count
With the full patient journey in one place, from the first call to post-discharge check-ins through alumni engagement, Plugged In can measure what actually matters. Wade says, “Anybody can stay sober while you’re in a treatment center. What happens when you leave our door tells me exactly the effect I had on them.”
That visibility changes what the organization notices. After several alumni relapsed following untreated toothaches, Plugged In started scheduling dental work during treatment, where pain management could be handled safely. Patterns like that only surface when post-discharge data lives alongside the clinical record.
It also changes payer conversations. A longitudinal dataset is what lets Wade walk into a rate negotiation with evidence of fewer emergency visits and better long-term stability, rather than hoping for a 3% increase. He is clear that value-based contracts are only worth signing with true quarterly check-ins and real transparency on hospital utilization, and that case can’t be made from two disconnected systems.
A month of pain, years of relief
For anyone currently on two or three systems, Wade advises, “The two weeks or one month of pain that you’re going to have to go through is going to save you the next three to five years.” If you were among the 60% nodding along during the poll, you already know.
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