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‘How Many of you are Using Electronic Health Records?’

November 15, 2011
by Dennis Grantham, Editor-in-Chief
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Technology adoption key to proving the value of treatment-and getting paid, says Clark

When H. Westley Clark, MD, JD, MPH, CAS, FASAM, director of SAMHSA's Center for Substance Abuse Treatment, asked the question during his keynote presentation at the 2011 National Conference on Addiction Disorders (NCAD), relatively few attendees were able to raise their hand.

During his presentation, “Does Health Information Technology Have a Place in Addiction Treatment?” Clark said that too many treatment providers still haven't implemented EHRs-even though they “need to have the ability to document what they do.”

“People want to know what they are getting,” noted Clark. “Stories are not enough; we need data, a sense of quality. Otherwise, how are we supposed to learn that people are getting better?”

Clark discussed the need for better quality measures, suggesting that measures need to be in place to determine if the best decisions are being made to deliver patients the highest quality of care.

While Clark said the primary role of the HIT effort is “supporting behavioral health aspects of the EHRs based on standards in the system,” he added that it also needs to be able to exchange the data and analyze quality in order to demonstrate its worth in respect to funding.

Clark also voiced the need to first create the infrastructure for interoperable EHRs, including privacy, confidentiality, and data standards.

“That is one of the underlying issues,” he said. “We have increasing accessibility to EHRs, but it raises this issue of trust and confidentiality.”

Policymakers to move on key IT concerns

In another NCAD session, Clark said that policy makers are also considering a variety of methods for electronically managing the patient consent process required by CFR 42, Part 2, the federal confidentiality statute that governs access to addiction treatment records. While the method to be used is not yet known, Clark asserted, “That can be done, and it will be done.”

Clark also indicated that decision makers have “no consensus yet” on the behavioral health content to be required in the proposed electronic “CCD,” or continuity of care document, that has been proposed as part of an interoperable patient EHR. However, he pointed out that a meeting of policymakers, scheduled for January, will consider the issue.

As the federal government takes steps to advance the adoption and use of healthcare information technology, Clark said that providers must do the same or risk longer-term financial losses.

“People in this field don't need to be worrying just about ‘how do I qualify for incentives?’” said Clark, noting that the Meaningful Use requirements, such as interoperable patient records, are intended to provide data needed to drive better, more cost-effective treatment decisions.

He made clear that adopting EHR technology will also be the key to participating in future payment systems. Whether or not providers decide to participate in the Meaningful Use incentive program, Clark suggested that they consider a more basic technology question: “People here need to be looking at, ‘how am I going to get paid?’”

Proposal would create EHR “safe harbor”

Dealing with the potential for discovery of medical error reports in EHRs may soon be a bit easier for providers thanks to a “safe harbor” bill HR 3239 introduced by U.S. Rep. Thomas Marino (R-Pa.).

The bill, called the Safeguarding Access For Every Medicare Patient Act, is designed to provide certain legal safe harbors to Medicare and Medicaid providers who participate in the EHR meaningful use program or otherwise demonstrate use of certified health information technology.

“Many providers are reluctant to use electronic records because they believe that the practice will make them more vulnerable to unnecessary legal action,” asserts Marino. “Every time a doctor or hospital chooses not to participate because of these fears, our seniors lose another provider. This protects access for seniors in the Medicare and Medicaid programs.”

The new bill would, according to Marino, create a system for reporting errors by providers when using electronic records that would prevent information about the error, or actions taken by the provider to remediate that error, from being used as a legal admission of guilt.

He asserts that the bill would also prevent records from being used in legal “fishing expeditions,” while ensuring that parties responsible for errors would be held accountable. The measure also places time limits on the filing of lawsuits and offers providers protection against libel or slander suits.

Behavioral Healthcare 2011 November-December;31(8):40