Electronic health records: Psychology seeks profession’s inclusion as “meaningful users”
by Legal/Regulatory Affairs and Government Relations Staff
September 30, 2010 — As federal rules to implement the Health Information Technology for Economic and Clinical Health Act of 2009 (HITECH) take effect, professional psychology is advocating for the full inclusion of psychologists under the Act’s incentive programs.
The HITECH Act of 2009 significantly expanded the U.S. government’s efforts to establish a national electronic record keeping system, a process that will still take many more years. Such a system could enable authorized health care professionals and hospitals to, among other things, access centralized information such as lab test results and medication lists to provide safer and more efficient patient care. Other benefits of electronic health records, or EHRs, include:
Having patients’ information all in one place rather than having it spread among various providers’ offices. This should improve treatment and reduce errors.
Use of security software that can, for example, automatically check a patient’s newly prescribed medication against the patient’s allergies and existing medications and let the prescribing provider know if the medication is contraindicated.
Improved convenience, for example, by facilitating prescription orders while the patient is in the office, so that the patient can pick the order up promptly after the visit.
Unfortunately, despite the American Psychological Association Practice Organization’s (APAPO) advocacy efforts, the Act excludes psychologists and most other non-physician providers from receiving Medicare and Medicaid incentive payments and grant funds to adopt electronic health records.
The Centers for Medicare and Medicaid Services’ Electronic Health Records Incentive Program Final Rule, also referred to as the meaningful use rule, went into effect July 28, 2010. The rule establishes definitions of meaningful use, which are qualifications for obtaining additional Medicare and Medicaid reimbursement to implement EHR systems for eligible professionals (EPs). The rule defines EPs as medical doctors, osteopathic physicians, dentists, dental surgeons, podiatrists, optometrists and chiropractors. Though incentives are offered in the early years, failure to meet the meaningful use requirements within four years will result in penalties against EPs.
In order for EPs to qualify for Medicare and Medicaid incentive payments, they must meet the standards set out in the meaningful use rule. To be a meaningful user of EHRs, eligible professionals must implement certified technologies/procedures to electronically share with other entities certain patient information, such as medications, allergies and clinical information like blood pressure. They must also record and be able to electronically share information that relates to certain clinical quality measures identified in the Rule, such as smoking cessation, hypertension and weight screening.
Meaningful use standards will be implemented in three stages, each of which will build off the previous stage. Stage one, which is anticipated to begin in 2011, will establish uniform standards regarding what information should be shared, and the mechanisms for sharing it that must be followed by all EHR software and users. Stage two will focus on the electronic transmission of orders, diagnostic test results and patient care summaries. Stage three, which is projected for 2013, is less defined but will focus on promoting improvements and quality in existing EHRs.
“Even though psychologists are not currently eligible for incentive funding under the meaningful use rule, they will be impacted by the shift in general record keeping practices across the health care industry,” said Maureen Testoni, JD, senior director of legal and regulatory affairs in the American Psychological Association (APA) Practice Directorate. Testoni points to the growing use of electronic patient care summaries and electronic transmission of test results that enable unaffiliated providers to share information, thereby supporting continuity of care. She states, “At some point in the future, psychologists will be compelled to demonstrate similar progress in order to do business with physicians and hospitals.”
Securing a place for psychology
The APA Practice Organization (APAPO) is working to secure a place for mental and behavioral health professionals in the HITECH Act rules. The APAPO is an active member of a coalition supporting the passage of H.R. 5040, the Health Information Technology Extension for Behavioral Health Services Act of 2010. The legislation was introduced by Representative Patrick Kennedy (D-RI), and has gained bipartisan support.
If implemented in its current form, H.R. 5040 will add clinical psychologists to the definition of meaningful users, and will set aside $15 million in exclusive grants for mental and behavioral health implementation. Psychologists who do not participate in Medicare programs will be eligible for mental health grant funding.
As a direct result of APAPO efforts, the coalition has also attained a Senate sponsor for the legislation. Senator Sheldon Whitehouse (D-RI) and six democratic co-sponsors introduced S. 3709 on August 5, 2010. The Senate bill does not include the $15 million in exclusive grant funding but does recognize and support the inclusion of mental and behavioral health providers as meaningful users for the purpose of incentive payments.
According to APAPO Government Relations staff, both pieces of legislation are gaining momentum; staff is actively communicating with members of Congress to gain additional co-sponsors. APAPO is currently putting together a cost estimate of the fiscal impact of the legislation to present to Congress. The cost estimate, which should be completed by mid-October, will evaluate the cost-benefit to the U.S. health care system of including mental and behavioral health professionals in the program.
Health information exchanges
While the role of psychologists in federally supported EHRs is being clarified, psychologists can still benefit from progress in this area by becoming involved with Health Information Exchanges (HIEs) that are currently under development in all states. HIEs allow providers to share critical health information with other appropriate entities, even if all the entities have different computer systems. HIEs are supposed to include strong security and privacy provisions intended to maintain the integrity of the information being shared.
Currently, 56 states and territories have been awarded over $550 million in funding to support HIE infrastructure. Delaware became the first state with an operational HIE in May 2007; more than 85 percent of all lab work and hospital data in Delaware is tracked and maintained by the Delaware Health Information Network (DHIN). Authorized users such as emergency room doctors have real-time access to the information to verify and review test results and medical histories so they can make more informed decisions about health care.
Other states are in varying stages of HIE development. Under the funding provisions, states are required to consult with health care providers, which as defined by the Public Health Service Act includes psychologists, regarding implementation strategies.
“Though the federal government is currently encouraging states to focus their HIEs on e-prescribing, structured lab results and patient care summaries, the goal is to expand HIE capabilities to include many more types of services,” said Testoni. “It is important for psychologists to get involved in their states at this early stage to make sure that their interests are being addressed,” she added.
To access a list of entities that have received federal funding under the State HIE Cooperative Agreement Program, psychologists can visit the website for the State Health Information Exchange Cooperative Agreement Program. In addition to the Practice Central website, psychologists may find the following sites helpful for keeping up-to-date about the progress of current legislation and other developments related to electronic health record keeping:
The Office of the National Coordinator for Health Information Technology