Seventy-nine percent of Massachusetts physicians engaged in patient care demonstrated proficiency in the use of electronic health records (EHR) by the Jan. 1, 2015, deadline required by a state law to maintain their license to practice medicine, according to the Massachusetts Medical Society’s Media Relations Manager Richard P. Gulla.
That means they achieved “meaningful use” certification for meeting objectives to receive financial incentives from the Centers for Medicare and Medicaid Services to defray the costs of setting up health information technology systems. Eligible providers are entitled to a maximum of $44,000 under Medicare and $63,750 under Medicaid. The last payment year is for 2016.
But behavioral health care providers don’t make the list of eligible providers for either the Medicare EHR Incentive Program (doctors of medicine or osteopathy, doctors of podiatry and optometry, chiropractors) or the Medicaid EHR Incentive Program (physicians, nurse practitioners, certified nurse-midwives, dentists, physician assistants in a physician assistant-led Federally Qualified Health Center or Rural Health Clinic meeting established percentages of Medicaid patients).
The lack of federal subsidies and mandates has led to ambivalence surrounding the pursuit of EHR adoption. And many psychologists have real concerns about security and confidentiality of patient mental health records.
“There’s a lot of uncertainty and a lack of clarity because that’s the current state of things,” said neuropsychologist Mary Coakley-Welch, Ph.D., who has a solo practice in Lexington, Mass.. Coakley-Welch said she has not had a reason to adopt EHR; she sends her reports to referral sources through the mail or by fax or an encrypted email program.
But the current state of things is changing in Massachusetts. A law passed in 2012 mandated that by January 2017 all health care providers will be required to fully implement interoperable EHR systems that connect to the Commonwealth’s Health Information Exchange, a state-wide network for transmitting health care data among providers, hospitals and other entities called the Mass HIway.
While adoption of health IT among primary care and specialty care providers is progressing well, other sectors including behavioral health and long-term and post-acute care organizations show only a 55 percent adoption rate, according to the 2014 Massachusetts eHealth Institute (MeHI) Provider and Consumer Health IT Research Study.
A 2012 state law, Chapter 224, made Mass. the first state to require physicians to achieve meaningful use by 2015 as a condition of maintaining their license to practice. The law allowed physicians renewing their licenses before March 31, 2015, and those who showed hardship in implementing the requirements to ask for waivers. Chapter 224 expanded MeHI’s role to advance the meaningful use of health IT and complete the statewide implementation of EHRs by helping all providers connect EHRs to the Mass HIway.
Unlike the case with physicians, there are no incentives for psychologists who comply or negative consequences for those who don’t. Instead, it seems officials are letting market forces serve as motivation.
“Psychologists will likely want and need to adopt EHRs in the years ahead, in order to continue doing business with physicians and hospitals and coordinate care for behavioral health patients,” said Maeghan Silverberg Welford, chief of staff for the Massachusetts Technology Collaborative, which oversees MeHI.
In 2007, Minnesota enacted legislation that required all health care providers to implement an interoperable electronic EHR system by Jan. 1, 2015. The law does not tie implementation to licensure and has no disciplinary actions in place for those who fail to comply.
Even so, in late May, after an outcry from solo practitioners, the Minn. Legislature passed an amendment exempting solo practitioners and cash providers from having to invest in health IT systems and EHR implementation.
“It created quite a furor and people were upset I think about being told what to do for one thing,” said Minneapolis clinical psychologist Trisha Stark, Ph.D., who chairs the Minnesota Psychological Association’s EHR Task Force.
“Some people were upset about privacy and security, feeling like state of the art for EHR isn’t far enough along, that privacy and security for their patients wasn’t there. They were concerned about cost, though cost is a factor but there are some products for behavioral providers, for solo providers that are fairly reasonable. They’re like $70, $60 per month which is reasonable. It’s not like what you hear quoted for physicians, $20,000 or something like that.”
Stark uses a $70 per month cloud-based EHR system for her solo practice. “I find it takes less time to document my sessions now that I have an EHR,” she said. “I’m on my third version.”
Stark, 59, earned a certificate in leadership in health information technology at the University of Minnesota and has been working on EHR education initiatives since 2008.
She acknowledged that much of the resistance to health IT has come from members of her state’s psychological association in her own age bracket. She said there may be other options for those who are within five years of retirement and don’t want to invest resources in EHR, such as using health information exchanges using direct secure messaging to exchange documents.
What would be Stark’s advice for other state psychological associations on educating colleagues about EHR? “To educate their members early about the implications and to take the pulse of their membership about what they want in terms of advocacy,” she replied.
The Massachusetts Psychological Association has scheduled an Oct. 9 workshop that will cover information about transitioning to EHRs. It will address how to develop documentation strategies for interacting with medical homes and other medical health care delivery systems.
By Janine Weisman