Electronic health record (EHR) adoption has skyrocketed in the last decade for the medical community. Yet behavioral health operators have been left behind.
In fact, only about 6% of behavioral health providers are using EHR systems. Whereas, more than 80% of hospitals use the technology, also referred to as electronic medical records (EMR).
The lack of federal incentives and difficulties for smaller operators to incorporate systems has led to the slow adoption. However, new federal funding, the shift toward value-based care and the focus on outcomes measurement could lead to more EHR implementation moving forward, behavioral health insiders believe.
It additionally helps that EHRs often help streamline back-end processes, too.
“I know more and more companies are using EMRs for behavioral health mostly because of the convenience,” Katherine Nisbet, chief clinical officer at New Freedom Arizona, told Behavioral Health Business. “I remember our records room way back when it was just binders and stacks of paper. I think more people are seeing the need based on space – and not losing documentation.”
Lack of financial incentives
The Health Information Technology for Economic and Clinical Health Act of 2009 gave medical practices financial incentives for implementing EHRs. This led to a massive adoption of EHRs by medical groups, but behavioral health providers were excluded from this legislation.
“Behavioral Health didn’t get the same meaningful-use incentive dollars to implement an EMR,” Alisa Chestler, an attorney and partner at Baker, Donelson, Bearman, Caldwell & Berkowitz, told BHB. “So there was no reason for those providers to rush to implement, … and there was no incentive or reason for the EMR vendors to build around that.”
The cost of purchasing and installing a new EHR system ranges from $15,000 to $70,000 per provider, according to HealthIT.gov. This price tag can make the stakes high for cash-strapped behavioral health providers already dealing with wage hikes and general economic inflation.
“The biggest thing [for providers] is, is it going to do what I want it to do? Because there’s so many options, and there’s the cost related to it,” Nisbet said. “But truly, there’s a cost related to staying on paper record, too, so a lot of it comes down to almost like this trial basis.”
New Freedom Arizona is a 90-day behavioral health program for individuals that were recently released from incarceration. Founded in 2020, the for-profit organization is based in Phoenix, Arizona.
If a provider isn’t satisfied with the EHR it implemented, there is an additional cost to changing. That scenario, at times, can even mean having to run two systems at one time, Nisbet said.
New legislation could help change that paradigm. A bipartisan bill, dubbed The Behavioral Health Information Technologies (BHIT) Now Act, would appropriate $250 million to be used over three years to help fund EHR rollouts.
“Electronic health records are no longer novel technology – they have become a must-have for patients and providers in our modern health care ecosystem,” Rep. Doris Matsui (D-Calif.), who introduced the bill, said in a statement in April. “This legislation will open up the door for more behavioral health providers to get their hands on the hardware, software and training they need to leverage vital technology that supports coordinated, high-value care.”
Fitting behavioral health needs
Behavioral health and physical health providers have different needs. But EHR systems are often a one-size fits all deal.
“I know for me, … a lot of it comes [down to] customizability,” Nisbet said. “How do I customize my EMR to reflect what we do? My population space is a little bit different. We do reentry, men and women coming out of prison, so we have to look at needs a little bit differently.”
While Nisbet’s organizations focused on a very specific behavioral health population, the message still applies to the industry at large.
Additionally, providers need to be thoughtful about the legal and regulatory landscape of behavioral health, Chestler said. Oftentimes, providers are “hit with how complicated it is,” she noted.
For example, providers need to be cognizant of a regulation called “42 CFR Part 2,” which restricts what information substance use disorder treatment providers can share with other clinicians without patient permission. If this kind of information is put into an EHR, it needs to be properly coded so as to not be shared freely.
There are a number EHR systems being purpose built for the field, such as Kipu, Osmind and Kareo, among others. Additionally, many traditional EHR systems are making behavioral health-specific technology. For example, Cerner and Epic both have behavioral health solutions on the market.
“It is a little different environment than your traditional medical care,” Paul Joiner, Kipu’s CEO, told BHB. “There’s more narrative. It’s less binary. … You have to be able to take that into account, and some of the larger, more mature, well-developed systems struggle with some of that variation.”
Founded in 2012, Kipu is a behavioral health-specific EHR provider. The company has raised roughly $20 million in venture funding, according to Crunchbase.
For New Freedom Arizona, which uses Kipu, the patient’s journey is often much longer than with episodic physical health care.
“So the long-term picture looks so much different in charting,” Nisbet said.
EHR’s role in measurement-based care
EHRs could be a major tool in helping behavioral health providers move towards measurement-based care, in turn making them bigger players in the value-based care conversation.
At New Freedom Arizona, the EHR system enables the leadership team to pull completion rates, financial data, effectiveness data and attendance data, Nisbet said.
“It’s a game-changer because I can then look at who’s being effective, who’s not being effective,” Nisbet said. “Is the program effective? Is this type of treatment effective? Are we seeing more of this service being provided or requested because it’s having better outcomes? There’s really a lot to play with, that’s driving from the EMR.”
Other behavioral health leaders have echoed that idea while highlighting the serious need for true outcomes data in the field, including Dr. Taft Parsons. Parsons recently joined CVS Health (NYSE: CVS) as vice president and chief psychiatric officer, after previously serving as enterprise medical director of behavioral health at Humana Inc. (NYSE: HUM).
“As an industry we’re just scratching the surface of quality,” Parsons said in July. “We are starting to see some organizations really kind of delving into different types of measurement-based care where they’re looking at actual clinical outcomes, and the type of treatment being provided. But that’s not the norm yet.”
Indeed, EHR data could also be a key component to value-based care and providing benchmarks for payers, Joiner pointed out.
“Wherever that journey goes, technology is the only way you’re going to be able to do it effectively,” Joiner said. “You can’t do it with manual processes and disjointed systems.”
There are also new expectations around the ability to move data between providers as holistic care becomes a more mainstream practice.
“The movement of data across the levels of care is going to be more seamless than it was in the past,” Joiner said. “Otherwise, you’re not going to be able to measure outcomes across all those levels of care.”
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