Many sectors of the healthcare industry have adopted or are adopting electronic health records, but the behavioral health sector has been slow to bring the technology on board. Healthcare Finance News Managing Editor Stephanie Bouchard talked to Westley Clark, MD, JD, the director of the Substance Abuse and Mental Health Services Administration’s Center for Substance Abuse Treatment about the benefits to behavioral health of using EHRs.
Q: Are there or will there be financial incentives for behavioral health to implement EHRs?
A: According to a 2008 study by Case Western Reserve University, the long-term cost-savings produced by a national health information network could reach $77.8 billion a year from a reduction in medical errors, diagnostic test duplication and administrative expenses. Therefore, although the initial cost of EHR might be high, the potential long-term benefits for both physicians and their patients are great.
Psychiatrists and psychiatric nurse practitioners are eligible for incentives under the Meaningful Use (MU) EHR incentive program. Other behavioral health providers including psychologists, clinical social workers, licensed therapists, substance abuse treatment providers, etc. are not eligible. In addition, inpatient psychiatric hospitals, community mental health centers, opioid treatment centers and residential substance abuse treatment facilities are also not eligible.
At the same time, many addiction medicine physicians have mixed practices, with addiction medicine only a part of their practice and specialty care or primary care making up the rest. If addiction medicine physicians in these mixed practices meet the patient volume criteria they could be eligible for Medicaid incentives.
Q: What can be done/is being done to raise that awareness?
A: SAMHSA continues to work with the behavioral health community, through grants and other activities, to educate and support them regarding the benefits of EHRs and the importance of their inclusion in an integrated healthcare system. Health information technology is one of SAMHSA’s eight strategic initiatives, and as such it is an integral part of the agency’s programs and initiatives. SAMHSA is committed to ensuring that behavioral healthcare is an active and effective part of a national integrated healthcare system and is working in concert with other federal and state agencies, as well as local and community groups to this purpose.
Among SAMHSA’s activities are two sets of frequently asked questions, created with the Legal Action Council to address concerns regarding confidentiality, particularly 42 CFR Part 2. These FAQs are available on the SAMHSA website and have been communicated and discussed through webinars and conferences with a wide range of providers, both in behavioral health and primary care.
Q: I am getting the impression that electronic health record implementation is not widespread in the behavioral health community. Do you have a sense of how many behavioral health providers are implementing them?
A: The National Council for Community Behavioral Health completed a survey in 2012 on the adoption of EHRs by the behavioral health community. The data here are a little complicated because the data came from BH organizations that often have multiple sites. They found that 65 percent of organizations have some electronic health records at some of their sites. It did not break down how many sites within these organizations have an EHR so the data may be misleading. Twenty-one percent reported being all-electronic at all sites. Importantly, there is a lot of variation in the clinical utility of different EHR systems. This survey found that only 2 percent of organizations’ EHR systems would meet the criteria for the functionality required under the Meaningful Use program.
In addition, since this was not a randomized survey the numbers could be somewhat inflated.
Q: What are you hearing from the behavioral health community about EHRs?
A: Most behavioral health providers see the potential value of EHR but recognize that the field still has more work to do before the full benefit is realized.
There are concerns about privacy and how systems will be configured in order to comply with federal and state regulations governing sensitive health data.
Small providers often don’t have the technical staff to be able to make decisions related to EHRs and determine which are quality products and which will best meet the needs of their individual practices.
Since the behavioral health field is changing rapidly, some providers are hesitant to make a capital investment in these systems ….
Q: What do you see as the benefits/challenges of electronic health record implementation in this field?
A: EHR and HIT more broadly have tremendous potential to improve behavioral healthcare. Integration of clinical decision support has the potential to improve the delivery of evidence-based practices. EHRs will streamline workflows and reduce provider burden, they will improve coordination across providers and with family and peer support and it will improve communication with the patient. EHRs will also improve capacity for progress and outcome tracking and the use of alerts can help to ensure that patients don’t fall through the cracks.
In addition, EHRs will improve the quality of health data collection, which will ultimately lead to more powerful health services research and to the development of better, more personalized treatments.
There is great potential for technology to revolutionize behavioral healthcare but there is significant work to be done to achieve that vision.