When President Obama signed the Affordable Care Act (ACA) into law in 2010, the act contained billions of dollars in incentive payments to encourage health care providers to embrace digital technology, specifically electronic health records (EHRs). As a result, about 91 percent of eligible hospitals and 75 percent of eligible office-based providers have achieved Stage 1 Meaningful Use objectives with their EHRs, according to the Department of Health and Human Services (HHS).
The key, however, is eligibility. Most mental health providers and behavioral health facilities were left out of the pool of providers eligible for HHS incentive payments under the act. Psychiatric hospitals, outpatient behavioral health clinics, and emergency clinics have no access to the federal funds that offset the costs of implementing an EHR program, a major hurdle toward implementing digital technology. The question remains: Can mental health care go digital?
Challenges in Mental Health EHRs
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Privacy issues are key challenges facing health informaticists and software developers when designing mental health care EHRs. Unlike with other medical illnesses and conditions, patients seeking treatment for mental illness, addiction, substance abuse, or other behavioral health disorders may face backlash from employers or potential employers if that information is inappropriately shared.
In addition, mental health patients fear discrimination from other health care providers if their conditions become known. According to a survey by the Depression and Bipolar Support Alliance, more than half of patients surveyed worried that their medical care providers might be prejudiced against them if these clinicians knew they as patients were receiving treatment for mental illness.
Privacy advocates are particularly concerned about EHRs that include a section on history and current treatment plans. These sections may include potentially harmful information about a patient’s family members and current or ex-spouses and their conditions that require extra protection against inappropriate access.
Digital Goals for Mental Health Providers
Despite the challenges, many of today’s mental health professionals would prefer to see broad implementation of EHRs across the behavioral health spectrum.
A mental health professionals coalition is actively lobbying Congress to include their services in the categories of providers eligible for incentives. These professionals have had limited success. In 2014, five bills never made it out of committee. Rep. Tim Murphy, R-Pa., is introducing a new version that will extend incentives to mental health providers.
The Office of the National Coordinator (ONC) for Health Information Technology (HIT) is scheduled to release new guidance on information sharing in late 2015, which could pave the way for mental health professional incentives.
Ultimately, seamless sharing of patient information across the medical and mental health care continuum is the most desired outcome. According to Laura Fochtmann, member of the American Psychiatric Association’s Committee on Electronic Health Records, sharing the same health record across both disciplines is especially important, since many patients with chronic health conditions also suffer from mental health and substance abuse disorders.
Many EHRs for mental health professionals exist on the market, but most lack the integration and information-sharing capabilities with other health systems that mental health providers want most. Until and unless Congress acts to change the health care law, broad implementation for mental health providers is unlikely.