EMR Variations: Is certification necessary?

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We spent the holiday weekend at the Georgia Tandem Rally, our favorite organized bicycling event. This year, 102 tandem teams from 15 states rode the tandem-friendly, hilly terrain around Athens, GA. During the 135 miles of riding, I had plenty of opportunity to reflect on why I enjoy riding a tandem bicycle so much…especially in the company of other tandems.

Tandem bicycling used to be the venue of the middle-aged, but younger folks with children riding along have become much more common participants. The result of the addition of these younger riders to the mix is a wonderful continuum in strength, speed and power. Even those of us who have never been fast (having started our tandem careers around our half-century birthdays), are able to be carried along by the power and enthusiasm of the younger riders. There are few more fun things for this otherwise very slow cyclist than a double pace line of tandem bicycles moving quickly along a traffic-free country road. We are all made stronger and faster by the quick moving youngsters and no one feels bad when we drop back to do our own thing at our own slower pace. Variation in team strength and endurance is part of what makes this kind of riding fun; each individual tandem is a successful team riding to their own particular tune.

In fact, the dramatic variation in tandem teams reminded me strongly of the similar variation among our customers. We have in our mix many solo providers, even more mid-sized groups, and a significant number of large groups and small to mid-sized agencies. Mental health providers are notoriously independent types; even when they work in groups and agencies they find or found organizations that fit their personal styles. In the 24 years we have been doing our business, we have been amazed at the varied ways in which our customers utilize the tools we provide…behavioral health practice management and EMR software. Indeed, I would venture to say that we have no two customer organizations who use our products identically. Discussion on our user group will readily confirm this observation.

This same variety exists in the arena of software providers. There are companies large and small providing products that also vary markedly in capabilities and in price. Those of us who are small benefit greatly from working with our larger competitors; we are swept along in the tide of change adding the essentials to our products so our smaller customers can continue to meet the ever-more-complex requirements placed upon all provider organizations, no matter their size.

Given all of this variety, I find myself wondering how many behavioral health practitioners will actually need certified Electronic Medical Records (EMR) in order to provide their services and to be able to share their records with other providers electronically. When I look at the list of functionalities and interoperability criteria required of certified products in the ambulatory health arena, I wonder what proportion of our customers could even begin to make use of all those features and communication capabilities…and how many actually require those feature sets in order to do their jobs well. They might be required by funding sources to purchase certified products, but if they are not part of an integrated healthcare organization, they are unlikely to actually need such products.

I spent a good deal of time participating in a work group that developed a behavioral health-specific profile for software products that conforms to the major criteria in the ambulatory EMR set. That conformance profile was adopted by HL7. I must say that the profile includes comprehensive feature sets for the most complex of behavioral health community organizations. It is significant overkill for most individual and group providers.

The Certification Commission for Healthcare Information Technology (CCHIT) has a work group developing criteria and test scripts for certification of behavioral health EMR products. While a draft of these criteria is due by August 2009, this certification will not be available until 2010 at the earliest, and possibly later. This timing and the limited funding available in ARRA to behavioral health providers makes it unlikely that most mental health provider organizations will be able to qualify for ARRA funding to buy behavioral health-specific products. 

My question to myself and to you is, does that really matter? If Behavioral Health certification were in place today, how many of you would be shopping for a certified behavioral health EMR to implement immediately? How many of you have even begun to think about whether and how this whole move to electronic medical records will impact your practice of psychology? of psychiatry? your community organization?

My experience of our customers, of the successful teams of people who currently provide mental health services in various settings in the U.S., is that you will continue to do so with or without certified EMRs. You will find behavioral health electronic medical record products that fit your budget, your workflow and your way of providing services, and that can share essential information with other providers and the healthcare system at large, whether or not the products used by your communication partners are certified.

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