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Money: the biggest barrier to EHR adoption

August 20, 2012
by Dennis Grantham, Editor-In-Chief
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While many providers feel relief at the Supreme Court's ACA decision, it appears that relief of a different kind will be needed to get them to reconsider their reluctance to adopt electronic health record (EHR) systems. How is that kind of relief spelled? M-O-N-E-Y.

Top three barriers to EHR implementation
Among 500 member organizations responding to the 2012 National Council HIT Adoption and Readiness for Meaningful Use in Behavioral Health Survey, 51 percent of respondents identified one of three financial concerns as their primary barrier to EHR adoption:

30 % Upfront costs of implementation

12 % Ongoing maintenance costs

9 % Lost revenue during transition

Following these concerns were worries about personnel and skills: a lack of staff dedicated to support implementation, a lack of staff project-management skills, a lack of system-selection skills, resistance by providers to adoption, and lack of dedicated staff for system maintenance.

Though nearly half of respondents reported that they offered some form of addiction treatment (outpatient, residential, or inpatient), just four percent cited “privacy concerns” as a primary barrier to EHR adoption.

Regulations governing eligibility for federal “meaningful use” EHR incentives have been available for over two years now. However, a surprising 28 percent of respondents were “uncertain about which of their staff is eligible"(18 percent)” or “did not know because they have not reviewed the criteria (10 percent).”

For those who are unsure about Meaningful Use eligibility, there are decision-making resources available at and

Behavioral Health Information Technology Act of 2012 offers hope of expanded incentives
Those familiar with the Meaningful Use incentives for EHR adoption know well that since these were announced in February 2009 as part of the American Reinvestment and Recovery Act (ARRA), the participation of behavioral health organizations has been limited.  Unlike acute care hospital organizations, for example, behavioral health organizations have had only limited access to EHR incentives, based on their total number of eligible providers (typically, physicians or nurse-practitioners).  

Advocates fought unsuccessfully to address this problem in the previous Congress. Now, they are at again, perhaps with better prospects for success. On June 28, H.R. 6043, the Behavioral Health Information Technology Act of 2012, was introduced by Representatives Tim Murphy (R-PA) and Tim Ryan (D-OH).

This amendment would extend eligibility for Medicare/Medicaid incentive funds for the "Meaningful Use" of electronic health records (EHRs) to behavioral health, mental health, and substance abuse treatment professionals and facilities not previously eligible in the HITECH Act, a component of the ARRA of 2009.


Specifically, the Behavioral Health IT Act would:

Expand the types of providers that are eligible for the Medicare funding incentives for the Meaningful Use of EHRs to include:

-Clinical psychologists

-Licensed social workers


Expand Medicare Hospital Meaningful Use incentive funding eligibility to include:

-Inpatient psychiatric hospitals


Expand Medicaid Hospital Meaningful Use incentive funding eligibility to include:

-Mental health treatment facilities

-Psychiatric hospitals

-Substance abuse treatment facilities


A similar piece of legislation, (S. 539) was introduced in the U.S. Senate in March 2011 by Sen. Sheldon Whitehouse (D-RI).

SATVA demonstrates “ultrasensitive” health information interchange
In a development of potential importance to the evolution of state-based health information exchanges, Anasazi Software and Valley Hope Assocation, both member organizations of SATVA (the Software and Technology Vendors’ Association), demonstrated how to exchange “ultrasensitive” health information summaries (HL-7 compliant CCD or “continuity of care documents”) between different EHR systems.

The systems were located at organizations in different states, while interchange was conducted in compliance with the federal confidentiality requirements for substance use treatment information detailed in 42 CFR, Part 2.

Working through SATVA, the two organizations developed common consent and authorizations of disclosure formats which they, on behalf of SATVA, have offered to share publicly as a standard for industry adoption.  According to Anasazi CEO Michael Morris, the formats developed to comply with CFR 42 Part 2 disclosures would, with little modification, readily support similar disclosures involving genome, HIV/AIDS, or other “ultrasensitive” health information.

The CCD to be exchanged in such transactions is an HL-7 standard electronic document containing structured patient identifying information, plus essential treatment information. Exchange of CCDs between providers not only can cut the time required for intake and assessment of new patients, but offers near-instant updates of EHR-based patient records.

A webinar detailing this process is available at and a demonstration is found at