The benefits of using electronic health records in behavioral health settings are many, but there are challenges, too, say those in the field.
Long before meaningful use dollars were on offer, the Mental Health Center of Denver, a private nonprofit contracting with the state of Colorado to provide community mental health services to those needing them in Denver and Denver County, recognized the inevitability of needing to implement an EHR.
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“We purchased it because we have a very forward-thinking CEO,” said Mary Peelen, the manager of health information systems at MHCD. “He just knew that sooner or later, you’re going to have to spend the money to do it.”
MHCD spent the initial money back in 2003. Over the years, the organization has maximized its EHR system by adding various components to it to get the most out of its capabilities, Peelen said.
MHCD’s EHR system streamlines various processes, allows staff and clinicians to have nearly instant access to data from any of the center’s 28 sites and lets information be shared between sites and clinicians.
The system has been such a success for MHCD that it is now looking to upgrade its decade-old model with something newer, Peelen said.
[See also: Operational considerations for becoming a behavioral health home]
EHRs have many capabilities, but from a financial perspective, there are certain basic benefits, said David Klements, president and CEO of Qualifacts, an EHR provider for the behavioral health market.
EHRs have components that allow for automated practice management and scheduling and provide a system for documentation. With an EHR, every service that is delivered, Klements said, is accounted for.
They also have capabilities that allow for the building of rules within the system that help behavioral health organizations avoid audits and take backs, he said. The rules set up in the EHR can make sure that required documentation is completed before services can be billed.
Meaningful use dollars are also available if eligibility is met, Klements said. “While not huge windfalls like there might be in some of the other areas of healthcare, for private, (for) nonprofits that are putting technology in place (those MU dollars are) not an insignificant amount.”
Despite implementing an EHR in her practice, Debra Kissen, a psychologist who owns Light on Anxiety Treatment Center of Chicago, said the financial incentives for using EHRs in a private practice setting are lacking. She uses hers to keep basic information online and quickly access information.
“If I had more time, it would be nice to use the systems to full capacity, like tracking clinical data and noticing trends … kind of outcome measures,” she said, “but right now I don’t think the industry is rewarding those kind of behaviors.” She said the financial incentives reward her for direct clinical care but not for integrating the EHR into her daily practice.
Even though she doesn’t believe the financial incentives are there for private practice, Kissen said using EHRs have value for the behavior health industry.
“I do think it’s tremendous value on a quality level,” she said. “I think so much of mental health … is about the data. … in terms of preventive (care), if you can track clients before the big manic episode, before the OCD gets out of control, you could save a lot of money and increase life satisfaction if … mental health care was more effectively managed... the incentives for any kind of preventive care (are) not aligned for providers right now.”
Like Kissen, Bob Williams, MD, a director at Deloitte Consulting, sees the potential for the use of EHRs to improve access and quality of care on a clinical front, but a business case for their use in behavioral health is a tougher sell, and largely depends on the setting.
Behavioral health organizations generally have a tough time getting funding because they operate on thin margins, and implementing EHRs is expensive, he said. And while using an EHR can provide tools to streamline processes and drive clinical protocols, he’s not so sure they’re more efficient than the processes already in place to handle the complexities found in behavioral health.
“There is a clinical case for sure,” he said. “But I think the business case around that – it depends on who we’re talking about – which business we’re talking about.
“I think the business case for the state or the federal government or society at large is very positive because it does help people to function more effectively and independently and to avoid overuse of the system for other things.
"When it comes to the business itself of running a mental health center or running the system that helps to provide those services – I don’t know how much more efficient it is,” Williams said. “I think it’s safer and more effective. I’m not sure how much more efficient it is.”