Behavioral health and social service providers have been dealing with a plethora of non-standard reporting forms and funder requirements for decades. These continue today despite the fact that more providers are adopting electronic health record systems and the need for interoperability with primary care providers is growing.
Why isn’t our field pursuing electronic data interchange (EDI) standardization?
Before I got involved in the field of behavioral health, I worked in the financial services sector, a field that like so many others embraces technology as a means to enhance efficiency, improve communication, and create new opportunities. Because that field embraced digital communication standards long ago, it is possible for the average American to purchase a share of Toyota on the Tokyo Stock Exchange despite major differences in geography, infrastructure, currency and language. Billions of dollars in trades such as this move markets every day, without paperwork, phone calls, faxes or follow-ups.
All of this enables me to sit down at my computer in New York and trade Toyota stock on the Tokyo exchange within minutes. Afterwards, all the necessary reporting data is automatically submitted to the SEC and Japan’s Financial Services Agency through electronic data interchange.
This brings me to a question: If we’ve created such efficient international financial markets, why can’t behavioral health and human services funders and providers electronically exchange information within the same state?
Operating in the Stone Age
Many providers and their funders operate in a relative stone age. Many funding agencies require providers to report client information using paper files, PDFs, word documents, or proprietary database systems that don’t support electronic data interchange (EDI-See sidebar “What is Electronic Data Interchange?”).
What is EDI?
EDI is defined as the structured transmission of data between organizations by electronic means. In layman’s terms, it doesn’t just mean electronic communication—it describes the entire process for how two organizations communicate, including how data is transmitted, how it is formatted, and which software can be used to interpret that data.
For example, in the behavioral health world, a provider’s electronic health system contains demographic, treatment, and other important data. Assuming the funder for that program operates a database that accepts data imports, whether via email or direct file transfer, the provider will also need to format that data in a way that the funder’s system can understand—in essence, ‘translating’ its data into the funder’s language.
This is why ‘going electronic’ in itself does not solve the problem in the behavioral health industry. The solution lies in going beyond ‘electronic’ and creating a common electronic language that all providers and funders can all speak.
Among the fraction of proprietary systems that support EDI, there is virtually no standardization. And, since many providers report to multiple funders and regulatory bodies, the lack of standardization often necessitates that electronic data entered into the provider’s system must be reentered, again and again, into other electronic systems that format and store the data differently.
Duplicate data entry and increased administration costs like these are pure waste. And, while tight budgets are the norm for non-profits, the cost of waste like this prevents investment in important, longer term solutions, such as electronic health record (EHR) software.
So, to return to my earlier analogy, if financial regulations required the average consumer buying a share of Toyota to:
- fax a record of her trade to her broker,
- email a PDF of the fax confirmation to a regulator in Japan, and,
- retain a paper copy for herself in case of a surprise SEC audit,
then traders, banks, and businesses would be screaming for relief. In fact, with processes like these, the supremely efficient financial markets that we have today couldn’t exist.
Numerous systems, numerous problems
Examples of non-standard reporting systems and databases can be found almost anywhere in the behavioral health field, including individual government agencies. For example, the New York State Office for People with Developmental Disabilities (OPWDD) operates two disparate databases—the Incident Report and Management Application (IRMA) and CHOICES, an electronic case management system. While IRMA accepts data electronically, the data is in a non-standard format, requiring providers to contract with vendors to create custom electronic formats.
The CHOICES system, a proprietary system developed by OPWDD and launched in 2010, currently has plans to accept data electronically but lacks an exact timeframe. So, while state providers that own an EHR look forward to being able to use EDI, they must wait for a different set of electronic specifications, then develop solutions to meet them, in order to support EDI. This situation begs the question of whether providers are now double-entering data in CHOICES while a labor-saving EDI solution sits on the back burner.
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