Last month I wrote an article about movement toward Electronic Health Records (EHR) in the behavioral health community. I was stunned by your silence on the issue. So much of my energy for the past two years has been focused on EHRs, their use in general medicine and in mental health, that I was very surprised that our readers were not interested in discussing EHRs. I am not sure whether the booming silence was a reflection of denial about movement toward these products, lack of information about them, or some other factors. So let’s start with some information.
In May, 2003 the President’s New Freedom Commission on Mental Health reported that the mental health community has been much slower to adopt Electronic Medical Records than the general medical community in spite of the potential benefit for consumers being just as great. The Commission concluded that a substantial effort should be made to develop the infrastructure to support interoperable electronic medical records and personal health records, and that the behavioral health community should move forward with adoption of appropriate products.
Early in 2006, a SAMHSA (Substance Abuse and Mental Health Services Administration)-funded Behavioral Health EHR Profile Workgroup, a multi-stakeholder effort to develop an EHR Conformance Profile for behavioral health began work. I joined that workgroup early in 2007 and participated through the adoption of a standard for Behavioral Health EHRs by HL7 this past summer. The Certification Commission for Healthcare Information Technology (CCHIT) has formed the necessary workgroup to develop testing and certification standards for Behavioral Health EHRs and plans to begin such certification by summer 2010.
The thinking about EHRs and their benefit are multiple. Primarily, they are believed to improve the quality of care by minimizing errors and duplication, by providing decision support for the provider, by offering evidence-based practice options, and by making all that information available rapidly to other providers. Adding Personal Health Records (PHRs) into the mix and connecting everything by way of a National Health Information Network (NHIN) or Health Information Exchanges (HIEs) will provide real-time information access for both consumers and providers of health care services.
The election of Barack Obama has spurred lots of discussion about the direction that healthcare reform will take. He mentioned electronic medical records in speeches and debates, but there is not yet much information about how he will pursue policy in that arena. The current financial crisis and recession will undoubtedly take priority over healthcare reform, but the cost of healthcare makes it a pressing issue for everyone.
I have heard providers talk about EHRs in widely varied ways. Some (including some of our customers) have used software products to maintain their clinical records for years and would not want to practice without one. Some clinicians believe that such a product would create obstacles to best care of their clients. Others are concerned about workflow interruption and the amount of time it might take to utilize an EHR. And those of us who work in the industry and are clinicians by training have major concern about privacy and security of health records generally and EHRs in particular.
What are your thoughts about EHRs? Do you see them becoming a part of the picture for your organization? Do you have a plan for purchase of such a product? Do you already use an EHR? How well does it do the job for you? Please let us know your thoughts. What providers think and how they plan to behave will control how this all unfolds.
You can comment on this post by clicking on the title of the post and entering your Comment in the form below.
Thanks for your thoughts.
Amaro Laria, PhD says:
I’ve been searching for a EHR system to adopt in our behavioral health group practice in the Boston area and have been disappointed by the lack of information available in general about EHR systems that are designed taking the particular needs of behavioral health practices in general. Although there seems to be a call for for behavioral health practices to join the 21st century w/ EHR syatems, there’s very little assistance available to small practices like ours that make this affordable. Any information that anyone can offer about affordable ways to implement a EHR and e-billing system for a behavioral health group practice will be most appreciated.
Kathy says:
Thanks for your comment Dr. Laria. Since this is an old post, I am not sure many folks will see your note. If you would like, I will have the salesperson from Synergistic Office Solutions (SOS Software) drop you a note.
carol mcgee says:
Very briefly, I believe Electronic Health Records would reduce errors, increase speed, and increase accessability to records, especially with computer portals. Dr. H. Bonem, you are an excellent psychologist and will not be forgotten.
Debbie Pietsch says:
We have just completed our conversion of a step toward EHR. We have converted all of our patient files to PDF files and do not have paper files anymore. We have 21 providers and two offices. We too were taking files back and forth between offices and spending way too much time looking for files. It was a little time consuming at first but are already seeing the time we are saving and easy access to files. We will recoup the money spent in less than a year and from that point will save money in staff, paper etc. We can at some point convert to a full blown EHR. Most therapists and physician are pleased and love the system. There was quite a bit of resistance at first but everyone is seeing with the volume that it was inevitable. It just takes a little adjusting.
Paula says:
We have been thinking about going electronic especially because we have 3 office locations and we have MD’s actually dragging charts from one office to another via suitcase/bins. My concern is that I want to keep the billing and medical records and scheduling as part of the same programming. For MD’s we need to be able to scan all documents, past records, etc into the patients record, we have tickler and notes that are sometimes put in charts to remind MD’s of issues to discuss with patient and then prescriptions – making sure a copy is saved and being able to print prescriptions. So coordinating and testing projects to make sure these features are available plus knowing the cost to institute it are where we are at. I would love to go fully electronic but its testing it out to make sure a program meets all our needs is the tough part.
Kathy says:
So it looks like cost, time, and security/confidentiality are the biggest reasons SOS friends have avoided EHRs so far. I wonder how those who use EHRs have dealt with these issues. When I practiced, we developed Case Manager so I could speed up doing treatment plans and progress notes. At that time, there was no thought of sharing the record with anyone else except in the most standard of ways, i.e. printing something out when my client gave permission for that. Greater complication is certainly on the horizon.
Carolyn Stimel, Ph.D., ABPP says:
It has been my experience that most psychologists, unless administering a large practice, have not wanted or needed to deal with EHR yet. Florida is looking at some legislation about it but it is in the very early stages. Other states are a bit further along. What I have heard consistently is that it is very difficult to figure out how to add behavioral health records to an EHR system and maintain confidentiality limits. On one hand, folks see the benefit of having an ER be able to know what diagnoses and medications are if someone arrives unable to give a history. On the other hand, no one wants their psychotherapy info posted on any type of central system. FPA is monitoring as best we can what the legislature might do, but we are still in early days.
Carolyn Stimel, FPA Director of Professional Affairs
Whitney Matson says:
We are using an EMR and I find it very disapointing. We are in residential treatment and offer a wide variety of services psych, therapy, medical, and nutrition. Finding all of this in one package that is affordable and works as advertised is quite difficult. If the right product is out there is is hard to find in the sea of options.
David Thompson says:
I agree with the two previous responses concerning the costs and complexity involved with EHR. I don’t even have time to maintain my practice website the way I’d like to do so, much less single-handedly manage the steps necessary to implement EHR. I’ve often looked wistfully at the SOS CaseManager product, but the same issues apply. I’d have to upgrade to a network and network version of the software (plus additional hardware), and I just can’t afford to do it with my practice overhead and other business challenges. I’ve implemented two networks in my offices, however, and am gradually trying to position myself to make the leap.
Bill Wallace says:
I have been using SOS OM for 15 years and find the accounting software excellent. Recently we expanded to a 3 person network version. We have no clerical or support staff on site and very much appreciate the support we receive from SOS. However, switching to network has increased the complexity of our maintaining the operations significantly. Our server crashed in July (our backup was fine) but we have still not regained network function. The problem is that there is simply not enough time, in the midst of delivering clinical services, to do the “computer work” to restore the network, even with the wonderful tech support. Moving to EHR feels like an exponential leap in complexity and computer maintenance/fragility of the system.
Howard Bonem says:
As a manager of a large group, the cost of EHR scares me. Also, I am worried that this will add another level of complexity to my systems management which, until now, I have done myself. Our margins are so thin that any additional expense is difficult to undertake.
By the way, we are also involved in the development of an acute geropsychiatric hospital. I just received a quote for a complete EHR/Billing system configured for a psychiatric setting and allowing up to 10 simulataneous users. The cost would be $76,000! That’s a lot of $690 per day inpatient days.