August 1, 2015

Electronic Health Records and Behavioral Health Services


This post explores some of the advantages and disadvantages of electronic health records as they pertain to behavioral health services.

Technology has played a significant role in the way healthcare providers conduct business. Technology has changed the way providers communicate with their clients as well as their interactions with other service providers. The days of hand written progress notes, quarterly reports, and treatment plans will soon be coming to an end. Federal laws will soon require all providers to have some form of electronic health record (EHR) in order to bill for services. Some may also use the term electronic medical record (EMR) to describe the transition in policy.


Electronic health records allow providers to document services more efficiently and provide quicker services. Our society is moving toward more paperless forms of documentation. EHR significantly reduces the amount of paper used by service providers. In theory, this should reduce paper expenses and be better for the environment. The jury is still out on this one in my opinion. Some people still like to print out reports to proof read (like myself) instead of reading a computer screen. In my particular line of work, we often send out treatment plans and supplemental assessments to other providers on the treatment team. Of course this involves printing out the assessments and either faxing or mailing out the assessments. Some providers allow the use of email to send and share patient information. Providers should make patient/clients aware of the risks involved with email and have them acknowledge this in writing before using email. Government agencies are often the target of hackers and should take extra caution when handling patient information.

The mandatory use of electronic health records will have the greatest impact on small businesses and service providers. Many agencies that provide services to individuals with mental health and intellectual disabilities are very small and have extremely limited budgets. Many of these agencies are family-owned and are already operating paycheck to paycheck with Medicaid billing. In addition to the cost of purchasing a software system, they also have to train all the staff members that are responsible for writing progress notes, treatment plans, and reports. Staff members that are responsible for processing billing also need to be trained. There is often a learning curve when implementing a new system which can lead to mistakes. These mistakes can lead to delays in billing and/or loss of billing during the learning phase.  

Advantages
1. Less Paper Usage- Medical records are maintained electronically and reduce the need for paper charts. Although paper charts will never be eliminated completely, electronic health records can maintain about 80% of the assessments and other information online instead of bulky hard copy charts.

2. Faster Billing/Service- Electronic health records allow services to be provided more efficiently. Doctors can submit prescriptions to pharmacies electronically for faster processing.

3. Better Organization- Reports can be store in patient charts online instead of hard copy charts. Electronic health records reduce the need for bulky paper charts. Electronic records also provide a back up if the records are destroyed or lost accidentally.

4. More Flexibility- Electronic health records provide additional flexibility when completing assessments. This is especially true for social workers, counselors, and clinicians that work with clients in the home. Clinicians can now complete assessments, progress notes, and other information on the spot via laptops and tablets. Documentation can be completed in real time instead of the next day or several days later. The result is a more accurate medical record.

Disadvantages
1. Initial Costs- Transitioning to an electronic health records system often involves a great deal of initial start up costs. These costs include purchasing a program, computers, and training of employees. However, there may be some incentive programs available for Medicaid and Medicare providers to assist with the costs.

2. Technical Difficulties- Any electronic records system is susceptible to technical glitches such as system freezing and crashing. In my experience, these problems typically happen towards the end of the month when everyone is on the system finishing up reports for the billing cycle.  These problems can lead to delays in payment for services provided. Hackers and cyber thieves are always on the prowl and medical records are always a target.

3. Upgrade Costs- Any electronic health record system will require periodic upgrades to maintain performance. These upgrades are also needed to maintain security against viruses and other threats to private patient information. Changes in federal, state, and local regulations also dictate certain changes and upgrades to the electronic health record. 

Electronic health records are here to stay as our society continues to develop new technology. These developments are designed to allow us to work smarter, not harder. The key is to find the right program for your organization. Shop around and find a program that is user friendly, affordable, and meets all of the compliance requirements.