As a majority of the medical and healthcare community have made the transition to electronic health records over the past decade, behavioral health providers have fallen behind in adopting EHRs in their process, which can cause difficulties for integrating care for behavioral health patients.
At a September public meeting for the Medicaid and CHIP Payment and Access Commission (MACPAC), a panel of experts detailed the reasons for the lack of EHRs in behavioral health, what options are out there now and what changes can be made in the near future to get behavioral health providers up to speed when dealing with records.
The Health Information Technology for Economic and Clinical Health Act (HITECH) was part of the American Recovery and Reinvestment Act of 2009 and created incentives related to healthcare information technology, including incentives for the use of EHR systems among providers.
As part of the incentive program, $35 billion was allocated for Medicaid and Medicare incentive programs encouraging hospitals and providers to adopt EHR systems.
It took two years for the incentive program to get off the ground, but after it did in 2011, EHR adoption increased by 53% among non-federal acute care hospitals in the country.
However, EHR adoption has been limited in behavioral health.
Psychiatric hospitals and office-based physicians practice psychiatry lag behind other specialty hospitals and physicians in EHR adoption, according to the Office of the National Coordinator for Health Information Technology.
Psychiatric hospitals are using EHRs at 46% rate, compared to 96% in general medicine and surgical practices. That same number for office-based physicians practice psychiatry is 61% compared to over 93% in everything from general practice and surgery to urology and cardiology.
A review of these findings from MACPAC found that the reluctance from behavioral health providers to use EHRs comes down to four factors, with the main one being that these practices such as psychologists,social workers, marriage and family therapists, were not even eligible for the incentive program that was passed in 2009. Without the financial incentive and familiarity with the old system, many behavioral health providers stuck with their old ways of recording health and medical records.
Behavioral health providers are usually not included in health information exchanges, which often serve as a catalyst for EHR adoption among other providers.
The two other factors are financial and regulatory-related.
Behavioral health providers are often unable to invest in the hardware, software, and training necessary for EHR adoption due to low operating margins and they’re also “subject to data-sharing regulations beyond Certified Electronic Health Record Technology requirements and may face challenges implementing compliant systems,” MACPAC found.
The panel of experts — which included Jessica Kahn, a partner at McKinsey & Company, and Bebet Herminio Navia Jr. with the New Jersey Department of Human Services, discussed how adopting EHR and sharing information would promote coordinated care and would then improve population health. A healthier population, naturally, also reduces costs.
“I think we have seen and acknowledge the clinical integration that could come from electronic health record use to improve coordinated care, to improve data sharing, to improve clinical decision support, and other kinds of tools that improve population health,” Kahn said. “[The integration] can also help drive cost reductions.”
Kahn said that as the behavioral health field moves towards measurement-based care, supportive EHR systems are essential to improve the quality and availability of health reporting and could “potentially ease the burden of reporting to state agencies or Medicaid MCOs.”
“The ability for these providers to provide high-quality, consistent, standards-based data to support health reporting and, therefore, participate and ease the burden of that reporting to state agencies, to Medicaid, to Medicaid plans is really better done through technology than through chart extraction, manual chart extraction,” Khan said.
During the presentation, Navia talked about how the implementation and creation of New Jersey’s Substance Use Disorder Promoting Interoperability Program, which is completely funded with state dollars and pays substance use disorder providers to adopt EHRs.
The program has been a success, Navia said. In two years, the program has received a total of 204 facility application requests, have 74 active participants with 145 attestations in milestone payments and the state of New Jersey has issued a total of $1.3 million in incentives for these providers.
Brooke Hammond, the director of a behavioral health provider called Integral Care in Austin, Texas, talked about her provider’s experience in how convenient, effective and cost-effective it is to be using EHRs, especially in the age of COVID-19.
Hammond discussed how EHRs make it easier on staff members to keep up-to-date contact information for patients, having an EHR that either has business intelligence tools built into it or have its data easily accessible to external business intelligence tools and how quickly EHRs allow behavioral health providers to “quickly look at diagnostic patterns, all the way down to the individual physician level.”
Hammond did mention how difficult it could be for a provider to drop what they have and seamlessly go to an EHR system.
“It would be highly irresponsible of me to suggest that any behavioral health career organization can one day decide they want an EHR, go out and find one, purchase it, and then put it into place in such a way to make such impactful changes,” she said. “Having a fully functioning, sophisticated EHR that helps drive decision making both at the clinical and the administrative levels is not an easy or inexpensive feat. It takes a considerable amount of resources, both financial and personal.”
Written by Patrick Filbin
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