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:
- 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.
- What is an electronic health record (EHR)?
- What is meaningful use?
- Meaningful Use and Mental Heath Professionals
References
- APA Practice Organization. (2013, Sep). Make Psychologists Eligible for HITECH Act Incentives. Retrieved Nov 3, 2013, from APA Practice Central: http://www.apapracticecentral.org/advocacy/state/leadership/slc-fact-hitech.aspx
- Centers for Medicare and Medicaid Studies. (2013, Jun 26). EHR Incentive Programs. Retrieved Nov 3, 2013, from CMS.gov: https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/index.html?redirect=/EHRIncentivePrograms/15_Eligibility.asp
- HealthIT.gov. (n.d.). What is an electronic health record (EHR)? Retrieved Nov 20, 2013, from HealthIT.gov: http://www.healthit.gov/providers-professionals/faqs/what-electronic-health-record-ehr
- Minnesota Dept of Health. (2013, Jun). Guidance for Understanding the Minnesota 2015 Interoperable EHR Mandate. Retrieved Nov 20, 2013, from http://www.health.state.mn.us/e-health/hitimp/2015mandateguidance.pdf
- Reinhardt, R. (2013, Mar). Meaningful Use and Mental Health Professionals. Retrieved Nov 20, 2013, from Tame Your Practice: http://www.tameyourpractice.com/blog/meaningful-use-and-mental-health-professionals
- US Dept. of Health and Human Services. (2009). Health Information Technology for Economic and Clinical Health Act . Washington, DC: Author.
Hi,
I’ve been thinking about the records question a lot recently, and having just purchased a Samsung tablet, was hoping to run my office from it, including all my records. I had read somewhere there was maybe one hipaa compliant records app, would love to know more. Haven’t found any apps via the app store with Samsung.
I would like to be on your list, if you have one. I was going to sign up above, but wasn’t sure if I was opening myself to a clearinghouse, or just yours. I’m really just wanting this notes/records keeping information for now.
Thanks for your time.
Beth Strong, MA, LPC
Denver
Thanks, Roy, for making sense of these issues and for making the information accessible. I am amazed at how little colleagues and patients have known about The ACA (myself most definitely included). I’ve been looking for an answer to the following question regarding Electronic Health Records and the ACA: will having these records electronically networked mean that providers (and their business associate support staff) who treat the same patient will automatically be allowed access to each others’ notes/records about the patient? Or will the patient still have to authorize providers to grant access? Of all the changes that the ACA is presenting our profession, the prospect of having patient counseling notes openly available to other providers makes me the most nervous. Thanks for your guidance.
Hi Mariel. I don’t know the details there, but I’m going to go out on a limb and say that I don’t think a clinician in one health system (e.g. Portland Providence, Kaiser, etc.) could just go perusing records in another health system. There are these things called Health Information Exchanges (HIEs) that EHR systems do/will use that facilitate communication between separate health systems’ EHRs. The HIEs contain summaries of patient encounters. I find it highly unlikely that a clinician could go perusing whatever summaries they wish without some kind of authorization. For getting full records, the classic system of requesting and sending records will still happen — it’ll just be much, much smoother.
Perusing records within a health system is a different issue, and not necessarily governed by any particular standards (or at least not the standards that define how EHR works.) This is probably where the biggest privacy concerns lie.
Thanks, Roy. I hope there is a way to answer these questions more exactly as the ACA unfolds. A patient’s right to choose about who can access their PHI seems potentially very much at risk here, at least within a particular health system as you say. I appreciate all the new HIPAA regulations that require providers & health systems to guard PHI electronically, and these new rules are spelled out pretty thoroughly (though I would be lost without translators like you & a few others). I don’t doubt that the process to exchange information will be smoother, especially for emergency care situations.
But at the risk of sounding like a skeptical contrarian, I just don’t believe this situation is as rosy as it’s so often painted to be. I’m thinking of clients who have very sensitive, deeply guarded personal issues that affect their health (e.g. incest, ACOA, other trauma) and who would NOT want their primary care docs (or podiatrists, opthamalogist, etc.) to have access to. I also believe that most professionals would never go looking unnecessarily, but that doesn’t mean they couldn’t.
The main issue to me is a patient’s right to choose. Where are the patient right’s advocates on this? I may be late to the discussion, and maybe other counselors have had similar concerns sufficiently addressed. I look forward to being better informed. Thank you so much for providing this forum.
Advocates are definitely there. I’m not following that too closely, but you’re not the only one with concerns.
I can say that most health systems have special protections to prevent those who don’t need to know from seeing MH progress notes. That is likely to become a standard of practice if it isn’t seen as one, already.
Thanks again, Roy. Your response is much appreciated. I will watch with great interest how all the new changes unfold this year and look forward to the discussion.
Hi, Beth. The link above only subscribes you to our list. No clearinghouses. :)
Hi Roy,
Any thoughts on updating this article, given the changes brought forth under MACRA and the untimely demise of the bill to allow the rest of us to qualify as EPs?
Hi Sean,
Thanks for your interest in an update! We update our free articles as and when the opportunity arises amidst our commitments to CE course development and updates, conducting HIPAA-propriateness reviews and serving the members of our support service. It is on our list to update, though, and we’ll likely update it sometime this year.
Are LMFT’s now mandated to keep EHRs
At this time, the article’s info on EHR mandates are still relevant. :)