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Mental Health Providers Struggle to Adopt EHRs for Lack of Incentives, Advocates Say

Wednesday, January 23, 2013
By Alex Ruoff

 

Despite a growing body of evidence on the benefits of health information technology use by mental health providers, the perennial effort to extend federal health IT incentives to mental health providers faces an uphill battle, advocates told BNA.

Behavioral health professionals with access to electronic health record systems reported lower readmission rates for their patients, a study published in the December 2012 issue of the International Journal of Medical Informatics found.

The study's conclusion supports the argument long made by behavioral health provider organizations that EHR systems can improve the quality of care to mental and behavioral health patients.

But, behavioral health care providers are severely limited in their ability to adopt health information technologies largely because they are excluded from participating in the Medicare and Medicaid EHR Incentive programs, Rebecca Farley, director of policy and advocacy at the National Council for Community Behavioral Healthcare, told BNA Jan. 14. Mental health providers struggle to afford the cost of adopting EHRs without the incentives, she said.

“Just getting the technology in place is the big challenge,” Farley said.

EHRs Improving Care
The field of psychiatry, in particular, and mental health providers, in general, have lagged behind other medical disciplines in adopting EHR systems, the study found. Mental health professionals also rarely coordinate care despite evidence that doing so improves the quality of care being delivered.

The study's researchers looked at 18 large hospital systems and found 44 percent maintained most or all their mental health records electronically, and 28 percent made patients' mental health records, in either electronic or paper format, available to non-psychiatric physicians.

Only 22 percent of hospitals maintained all or most of their mental health records electronically and made those electronic records available to non-psychiatric physicians.



“This study suggests that to ensure a higher quality of care for psychiatric patients we must be willing to consider not only parity of coverage but also of record modernization and accessibility,” the researchers said.

 

More than 64 percent of all hospitals have adopted some kind of EHR system, according to data from the Centers for Medicare & Medicaid Services.

The hospitals where mental health records were not stored electronically had significantly higher readmission rates for psychiatric patients, 7 percent versus 5.1 percent, the study said. Readmissions rates at hospitals that did not make electronic mental health records available to nonpsychiatric staff were also higher compared to those that did, 13 percent and 8 percent respectively.

“This study suggests that to ensure a higher quality of care for psychiatric patients we must be willing to consider not only parity of coverage but also of record modernization and accessibility,” the study said.

Extending Meaningful Use
The “meaningful use” program does not currently include incentives for behavioral and mental health professionals, substance abuse professionals, psychiatric hospitals, behavioral health centers, and substance abuse treatment facilities.

For three consecutive years legislators in the House and Senate have introduced bills to extend the meaningful use program to such professionals but none were acted on (see previous article).

Rep. Tim Murphy (R-Pa.) introduced the Behavioral Health Information Technology Act of 2012 (H.R. 6043) in June 2012 and Sen. Sheldon Whitehouse (D-R.I.) introduced the Behavioral Health Information Technology Act of 2011 (S. 539) in March 2011.

Sen. John F. Kerry (D-Mass.) Sept. 12 introduced the Medicaid Information Technology to Enhance Community Health (MITECH) Act of 2012 (S. 3539) to extend Medicaid EHR incentive payments to clinics and providers serving large uninsured and low-income populations as well as some mental health facilities (see previous article).

Efforts Ahead
Staff from Murphy's office told BNA he will likely reintroduce the bill this year. In a statement, Murphy said Congress should examine the expanded use of health IT “as part of a review of the federal role in mental health policy.”

Farley said her group plans to work with Murphy and other co-sponsors of the Senate bill this year, but she acknowledged there is little federal money to spend on expanding the meaningful use program.

The previous bills seeking to extend EHR incentive program participation to mental health providers have faced similar budget issues (see previous article).

The Office of the National Coordinator for Health Information Technology has been working with the Substance Abuse and Mental Health Services Administration (SAMHSA) to develop a portfolio of behavioral health quality measures that could be adopted by the meaningful use program (see previous article).

SAMHSA is working to develop a national behavioral health quality framework to guide these changes. An initial version of the framework is expected to be released in 2013, SAMHSA said.


The International Journal of Medical Informatics study is available for a fee at http://www.ijmijournal.com/article/S1386-5056%2812%2900219-5/abstract.

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