WHEN

In 2004, President Bush issued an executive order requiring fully operational EHR adoption throughout the healthcare industry by 2014. He also established the Office of the National Health Information Technology Coordinator and charged it with developing a “health information technology infrastructure” that “reduces healthcare costs resulting from inefficiency, medical errors, inappropriate care and incomplete information.” In November 2006, the Medicaid Commission completed its second and final set of recommendations to Congress, recommending that EHRs, including compatibility among different healthcare providers, be required for all Medicaid beneficiaries by 2012. Congress will focus on healthcare information technology during its 2007 legislative session.

Today, EHR adoption is slow among healthcare providers in general - one study shows that only eight percent of community health centers are using full electronic medical record systems. A September 2006 National Council quick poll of community behavioral health providers across the country indicates that just under eight percent have implemented the EHR with clinical components fully functioning, while 32 percent have implemented the EHR with billing components in place. Another 11 percent of providers are in the process of installing an EHR. Lack of funding and the complex demands of multiple payer and reporting systems are the biggest barriers to EHR adoption in behavioral and mental health patients.

WHY

EHR adoption is expected to reduce healthcare costs by up to 20 percent, significantly cutting back on the approximately 25 cents of every healthcare dollar that is now spent on record keeping and “administrivia” (according to James Kretz, MA, a senior survey statistician at SAMHSA’s Center for Mental Health Services).

The National Council quick poll revealed that 26 percent of behavioral healthcare and mental health organizations with functional EHRs realized improved quality assurance. Twenty two percent had been able to reduce billing errors and 17 percent realized improved clinical productivity with EHR implementation. Providers also point out that the EHR offers critical support to the service improvement process. The EHR promotes the application of protocols and guidelines, helps to maintain contact with individuals who move through a complex system and who are hospitalized in local or state hospitals, lose stable housing, or become entangled in the criminal justice system.

Most of all, the EHR holds the promise to reduce the enormous financial burden of paperwork and reporting duplication. We know the problems of a paper-based system and certainly the substantial and cumulative economic impact.

A study of one community mental health center in California found a host of inefficiencies that could be easily overcome with adoption of an EHR.

- 3,000 to 10,000 hours of care, with an annual value between $360,000 and $1,000,000, were going undocumented.

- 25,000 to 42,000 hours of clinician time, with an annual value of $2.2 to $3.7 million, were lost due to inefficiencies in the manual paperwork completion process.

- 13,000 to 20,000 hours of support staff time, with an annual value between $500,000 and $700,000, were spent on unnecessary medical records work.

HOW

Implementing the EHR is a difficult challenge in any healthcare organization. In behavioral healthcare and mental health, it’s particularly difficult because of the extraordinary regulatory burden placed on provider organizations by the combination of federal, state, and local funding sources. In Oregon, as counties were completing their specifications for the EHR, one county identified 188 different forms that they use on a regular basis.

Providers must recognize that the adoption of EHRs is much more than simply purchasing software. It represents a cultural and technological revolution. Members sharing their experiences in this issue of National Council News highlight that there are two keys to successful implementation - outstanding leadership and intensive project management. The organization’s leadership must drive the revolution, recognizing that it impacts every aspect of the organization’s structure and staff. The project manager must especially focus on bringing all facets of the organization together to collaborate on EHR implementation.

Providers going down the EHR path are rightly concerned about the lack of standards for software and hardware. The federal Behavioral Health Treatment Standards Group at the Substance Abuse and Mental Health Services Administration is working to address this very concern. BHTS comprises mental health and addiction treatment providers, the National Council, national trade associations, technology vendors, and federal organizations. This group was convened in 2004 to ensure that the national standards-setting process for the EHR reflects the needs of behavioral healthcare stakeholders.

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