A recent New England Journal of Medicine report cited the lack of electronic health records (EHRs) in psychiatric care settings, showing that only 15 percent of psychiatric hospitals and offices had an EHR system compared to 84 percent of hospitals and 58 percent of primary care physicians. Why is this and how can we accelerate adoption?
One of the primary reasons is the Meaningful Use program that incentivized hospitals and physicians to digitize left out some very important communities within healthcare. Behavioral health, inpatient psychiatric, addiction treatment and post-acute providers were all left out of that funding bucket. While some psychiatrists are eligibleif they work in ambulatory care settings, most are solo or small group practitioners and lack the financial ability to implement and maintain an EHR system. However, the ever-evolving value-based payment models are quickly making EHRs a necessity to not only stay in business, but to ensure successful patient outcomes.
Another reason EHR adoption is low, is 42 CFR Part 2, which governs health information specifically for substance use and mental health information. This adds extreme complications to the world of interoperability, regulations that acute care hospitals are rarely burdened with. For example, if an individual has diabetes, alcohol dependence and depression, restrictions in data sharing for substance use makes it difficult, sometimes impossible, for any of these providers to have a comprehensive view of all three of these chronic illnesses.
It is common that a person with a mental health issue is more likely to use alcohol or drugs than those not affected by a mental illness. The inability to share an individual’s information within their network of providers creates substantial barriers to providing whole-person care.
A fragmented view into a person’s medical information can exponentially increase the cost of care, particularly in those individuals who have comorbid physical conditions like diabetes or chronic heart disease. In addition, there are therapy and workflow concepts that do not exist in any other venue in healthcare. For example, group and private therapy require very different levels of documentation. Residential and partial-hospitals also have unique documentation and billing requirements. Having an EHR that can support mobility is key because most of behavioral health happens where the individuals are – not in an office.
Typical acute care EHR solutions lack the functionality that is unique to inpatient psychiatric facilities. Interdisciplinary treatment plans are one of many examples. Within the IP, an individual could have a care team that consists of a psychiatrist, licensed clinical social worker or counselor, nursing, and/or a care manager. They all own different components of the treatment plan – which will have long-term and short-term goals. It can also include both group and individual therapy sessions. All documentation ties back to the treatment plan. Providers need solutions that allow for this flexibility, including options for group note documentation.
So, how can we help accelerate the adoption of EHRs in psychiatric care to ensure all providers have access to the necessary and relevant information on each individual they serve? The first step is finding an EHR partner that truly understands the requirements to be successful in the current healthcare environment and is agile enough to accommodate future changes. Can they currently share information bi-directionally with other healthcare providers like hospitals, physician offices and health information exchanges?
A good EHR system is interoperable with other systems and providers. It coordinates the care of each individual and supports interdisciplinary treatment plans ensuring that assessments, treatment plans and progress notes weave the golden thread of medical necessity while providing guidance by inserting clinical decision support tools within a caregiver’s workflow.
Providers should have access to actionable analytics and performance measures at their fingertips so they can prove outcomes and cost savings. It is also critical for these inpatient psychiatric facilities to receive parity in funding. Recent legislation creates a pilot program within the Center for Medicare and Medicaid Innovation (CMMI) for health IT incentives (including inpatient psychiatric) for the adoption of EHR technology and the use of that technology to improve quality and coordination of care through the electronic exchange of health information. This is the first positive step in leveling the playing field to financial assist providers.
We believe the time is right to bring the same level of automation to psychiatric care as other healthcare providers have. The right technology is here today and most of the barriers to digitizing have been removed. Now providers just need to find the right EHR partner to help them go beyond basic automation to truly realize the benefits of healthcare information technology.