Update on Electronic Health Records and Health Care Technology

How to deal with electronic health records (EHRs) is at the top of the list of physician concerns, according to past AMA President Jeremy Lazarus, MD. The first psychiatrist to lead the AMA in over 70 years, Dr Lazarus addressed the Assembly at the American Psychiatric Association (APA) Annual Meeting in New York in May.

EHRs are also an important issue for the APA; the Substance Abuse and Mental Health Services Administration (SAMHSA); American EHR, Health Level Seven International (HL7); and the Office of the National Coordinator (ONC), which directs our national effort to bring information technology to the country’s health care system. The APA Assembly voted to oppose the use of financial penalties for physicians who decide to not adopt EHRs in their practice. It remains unclear what impact this could have within Medicare and Medicaid, which have adopted a complex system of incentives and penalties to prod physicians and other health care providers into adopting the use of EHRs.

SAMHSA has been developing a set of technologies that would provide a standard method for EHRs and health information exchanges to tag records and data elements on the basis of their content, privacy needs, and redisclosure limits, so that patients would be able to control more granularly which aspects of their personal health information are shared and which retain a greater degree of privacy. Called Data Segmentation for Privacy, or DS4P, this open source software has been successfully piloted in a half-dozen different settings and is currently being implemented in one of the largest EHR vendors in the country. Patients are able to establish consent preferences that would follow along with each document so that their preferences will be respected, since the information resides in various systems. This evolution is expected to enhance consumer trust of these technologies.

The ONC Health IT Policy Committee is currently considering the establishment of a list of features that EHRs would need to meet the needs of behavioral health professionals. A voluntary ONC certification program for behavioral health EHRs is also under consideration.

The APA joined HL7 as an organizational member last year to ensure that the needs of psychiatrists and their patients are promoted within this international standards development organization. Most health IT products use various HL7 standards that result in greater interoperability between different products. HL7 developed standards for behavioral health EHR functionalities in 2008. Members from the APA, HL7, and SAMHSA are now working on a revised set of standards.

AmericanEHR, an EHR rating company established by the American College of Physicians and Cientis Technologies, is continuing to work with the APA to collect the experiences of psychiatrists and other physicians who use EHRs. This provides a useful tool for psychiatrists who are considering purchasing an EHR service.

The APA Committee on Mental Health Information Technology (CMHIT, formerly the Committee on EHRs) met on May 5 to review progress in these and other areas. Members from the CMHIT are actively involved in the above SAMHSA, ONC, HL7, and AmericanEHR projects.

The CMHIT has heard from APA members about the limited EHR product choices that are usable and contain the capabilities needed for a psychiatric practice. In fact, the most recent available data from the Centers for Medicare & Medicaid Services show that only 7% of psychiatrists are participating in one of the Health Information Technology for Economic and Clinical Health stimulus programs, which pays physicians for adopting certified EHRs. This compares with 30% for physicians overall. As a result, the committee has planned an EHR vendor webinar on June 27 to discuss psychiatrists’ needs with vendors and to encourage a more fruitful collaboration.

The committee is also embarking on a collaboration with other technology interest groups from other mental health organizations to combine forces in areas in which we have mutual interests, such as EHRs and patient privacy.

Those interested in more details about any of these areas can contact Dr Daviss at drdaviss@gmail.com.

This article was originally posted on 5/23/2014 and has since been updated.

Disclosures:

Dr Daviss is Past Chair of the Department of Psychiatry at Baltimore Washington Medical Center and Clinical Assistant Professor at the University of Maryland School of Medicine. He is Chair of the American Psychiatric Association (APA) Committee on Mental Health Information Technology and the APA Assembly Representative for Maryland, Chief Medical Information Officer for M3 Information, and President of Fuse Health Strategies. Twitter: @HITshrink.