Computer Monitor With Text Saying "Health Record"There is some confusion out there around the “mandate” to use electronic health records, with some believing that all of us in mental health must adopt them by 2014. It is quite true that the 2009 HITECH Act called upon the Office of the National Coordinator for Health Information Technology (their friends call them “ONC”) to make a strategic plan for moving all Americans to having a single health record by January, 2014:

(A) IN GENERAL.—The National Coordinator shall… update the Federal Health IT Strategic Plan… to include specific objectives…:

(ii) The utilization of an electronic health record for each person in the United States by 2014.(US Dept. of Health and Human Services, 2009)

This plan involved the use of “Electronic Health Records,” or “EHR.” The HealthcareIT.gov site describes EHR systems this way:

One of the key features of an EHR is that health information can be created and managed by authorized providers in a digital format capable of being shared with other providers across more than one health care organization… so they contain information from all clinicians involved in a patient’s care.
(HealthIT.gov, n.d.)

It really is a valuable goal. Unifying health records across all providers — if done right — will drastically reduce admin costs, reduce readmissions to hospitals, and allow us easier access to client health histories.

EHR is not the same as an electronic medical record (“EMR”) or Practice Management System. An EMR is simply a system for holding medical records, without the interactions with other systems that we get from EHR. A Practice Management System provides many features to aid practice management besides just record-keeping. A practice management system may contain a fully-fledged EHR, however.

Meaningful Use

The road to EHR has run through a program called “Meaningful Use,” in which the Center for Medicare and Medicaid Studies (CMS) provides incentives for medical clinicians to adopt EHR systems and “use” them in “meaningful” ways. Such meaningful methods of use include using the EHR system for e-prescribing, reporting outcome measures to the government, and other acts of interaction with the medical system at large.

Importantly, the Meaningful Use program only includes “eligible professionals” or EPs. EPs receive significant monetary bonuses for proving that they are using an EHR system meaningfully, where the bar for “meaningful use” is set by the Meaningful Use program. That bar is slowly going up in stages, and EPs must meet the new standards at each stage in order to receive their incentives. Starting in 2015, those EPs who are not meeting Meaningful Use standards will start to see reductions in their reimbursement from Medicare. (Centers for Medicare and Medicaid Studies, 2013)

At the time of writing, the only mental health-related profession that qualified as an EP was psychiatry. This means that counselors, MFTs, social workers, and psychologists cannot receive the incentive payments nor will we be subject to the penalties when they begin. We are simply not part of the program. (Reinhardt, 2013) However, there is a bill in Congress that would add psychologists and social workers to the list of EPs. If successful, those professionals would be able to benefit from the bonuses and also, potentially, suffer the penalties. (APA Practice Organization, 2013) Professional counselors and MFTs are not part of Medicare, so could not be eligible at this time.

Other Issues

EHR is of special interest to clinicians in Minnesota. Even though mental health professionals cannot receive incentive payments for adopting EHR, the Minnesota legislature decided to enact legislation requiring each and every health care clinician in the state, regardless of how they practice, to adopt an EHR system by 2015. Fortunately, this law appears to have no teeth:

The Minnesota Department of Health (MDH) recognizes that some providers may not be able to achieve the 2015 Interoperable EHR Mandate by January 1, 2015. Currently, there is no fine or formal penalty for not complying with the mandate.
(Minnesota Dept of Health, 2013)

Another issue in EHR that is raised by Rob Reinhardt is the question of client privacy. Under HIPAA, EHR companies can legally take the data from these systems, de-identify them, aggregate them, and sell them. There are boons to this practice, but also privacy concerns.

Resources

For further information on this subject, please see these resources:

  1. Electronic Health Records in Mental Health Practice – 2 CE Hour online course by Rob Reinhardt, LPCS NCC and Roy Huggins, MS NCC at the Zur Institute.
  2. What is an electronic health record (EHR)?
  3. What is meaningful use?
  4. Meaningful Use and Mental Heath Professionals

References


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