No provider left behind?

Representatives of behavioral healthcare organizations had a chance Aug. 13 to express their frustrations and concerns about disparities in health information technology adoption. During a National eHealth Collaborative (NeHC) panel discussion on barriers to e-health adoption for safety net providers, several behavioral health leaders bemoaned the lack of funding available in the stimulus bill and the exclusion of behavioral health organizations from the “meaningful use” matrix for electronic health records established by the Office of the National Coordinator for Health IT (ONCHIT).

NeHC board member Michael Lardiere, director of health information technology and a senior advisor for behavioral health for the National Association of Community Health Centers, highlighted disparities using results of a 2008 survey some 1,000 federally qualified health centers. He noted that although more than 67 percent of the health centers that responded provide behavioral health services, the majority of those reported that behavioral health services are not integrated with their practice management or electronic health record systems. And, of behavioral health providers that do have EHRs, only 20 percent of the systems are sharing any data. Compounding the problem, Lardiere added, is that 40 percent of survey respondents do not have an IT person on staff to help with implementation and connectivity issues.

Alexa Eggleston, director of public policy for the National Council for Community Behavioral Healthcare, said that most providers are eager to use EHRs and that there are many opportunities for improved outcomes if, for instance, child welfare and addiction services systems could share data. Marrying primary care systems with behavioral health systems would have benefits for both, she asserted.

But, she added, ongoing cuts in state funding to behavioral health providers have only exacerbated their lag in IT adoption. “With very limited budgets, when providers have to choose between funding HR adoption and taking care of patients, they choose to take care of patients.” She stated that the effort to achieve interoperable EHRs as a basis for healthcare reform will be “an incomplete picture,” if funding and support for behavioral health and other safety net providers does not materialize.

Currently, community behavioral health providers are not eligible for incentive funds for using EHRs. The National Council and other groups are hoping there will be legislative fixes and the HITECH Act’s language can be tweaked, so additional groups can be written into Medicaid and Medicare incentive programs. There are also questions remaining about whether incentives would go to individual providers or to organizations.

The meeting also heard via phone call from Steven Daviss, MD, chair of the Department of Psychiatry at the Baltimore Washington Medical Center.
Daviss, who co-chairs CCHIT’s behavioral healthcare workgroup, said members of that group sent comments to ONCHIT expressing their disappointment that the clinical goals for demonstrating meaningful use of EHRs exclude behavioral health. He stressed that since approximately 25 percent of hospital admissions are related to mental health or substance use issues, it is important that measures be designed to address the work of mental health and addiction treatment professionals.