“The breach between what we know and what we do is lethal.”
— Kay Redfield Jamison, Night Falls Fast
It saddens me, as a former professional in community habilitation and a job developer for people with serious and persistent mental illness (SPMI), to know that people with behavioral health disorders are dying 25 years earlier than the general population, due largely to preventable conditions such as cardiovascular disease, diabetes, respiratory disease and infectious disease (including HIV/AIDS).
The Substance Abuse and Mental Health Services Administration (SAMHSA) cites several reasons for this alarming difference in life expectancy, including barriers to appropriate healthcare, the stigma associated with behavioral health disorders, lack of cross-discipline training between medical professions, and the lack of access to primary care services for this population.
The Problem: A Matter of Access
The issue of access to appropriate healthcare appears to be two-pronged. On one hand, there are people with behavioral health issues who choose to see only their primary care provider. They make this choice perhaps because of the stigma associated with behavioral health, or because they are comfortable with the physician they know. The problem with this practice is that research shows that mental illness often goes undiagnosed and untreated by primary care providers.
In the second group are the people who visit only community-based behavioral healthcare providers. For them, primary care health issues often go undiagnosed or untreated because these settings may not routinely screen for primary health conditions.
The Solution: Integrated Care and EHR
The good news is that a solution to this dilemma has been identified. By now, we have all heard of “integrated healthcare,” a system where a person is seen as one complete human being, with both their physical and mental health treated as equally important. Research has shown us time and time again that behavioral health issues and medical conditions co-occur, and the existence of one can exacerbate the existence of the other.
The success of integrated healthcare is dependent on a high degree of communication and collaboration among providers. The goal is to create a comprehensive plan of care for each individual that combines the person’s biological, psychological and social needs, leading to an improved quality of life for the individual and lower overall healthcare costs for society.
If we agree that it is only through increased communication and collaboration among healthcare providers that we truly can achieve integrated healthcare, then certified electronic health records are key to success. The ability to access a patient’s permissioned health information in a timely manner, in a standardized format, and in a language common to all specialties of healthcare professionals is dependent on the ability to capture and exchange accurate information at the point of delivery of care.
Slow Adoption Rates Must Be Reversed
Whatever happens in the political arena in regard to healthcare reform, the need for certified electronic health records and secure health information exchanges will remain part of the solution. But, despite the HITECH Act of 2009 that put in place incentive payments for providers of CMS-funded services for the meaningful use of certified technology, the fact is that EHR adoption rates have been slow in the behavioral health community.
A Psychiatric News survey, for example, showed that, despite an increase in primary care physicians’ adoption of an EHR, psychiatrists continue to lag behind, with 6.2 percent meeting criteria for a basic system and 5.8 percent for a full system.
Why are psychiatrists so far behind in their adoption of EHRs and their participation in Meaningful Use EHR incentive programs?
One of the concerns I frequently hear is that the measures of the Meaningful Use programs are very “primary care-focused” in nature, requiring clinical workflows that might not be typical in a psychiatric practice, including the taking of vital signs or asking a person’s smoking status. But if we look back at what we know about access to primary care and the fact that behavioral health professionals might be the only providers a person with a behavioral health disorder sees, perhaps taking vital signs or asking about smoking status are good ideas.
A key component of integrated care, after all, is the use of an EHR to capture healthcare information so that it can be electronically shared and exchanged, along with models of delivery that enable person-centered care. This is an especially timely issue given that “medical homes” (or what are more appropriately called “healthcare homes”) and Health Information Exchange (HIE) systems are being set up now. If behavioral health doesn’t have a seat at the planning table, history tells us it can easily be left out – to the detriment of the very people the behavioral health community exists to serve.
We know the problem; we know the solution. Yet we hesitate to take the action that would allow that solution to be realized. For an EHR to deliver on its promise, behavioral health professionals, specifically psychiatrists and APNs, need to pick up the pace on certified EHR adoption and participation in Meaningful Use incentive programs.
BOILERPLATE: Mary Givens is Meaningful Use program manager for Nashville-based Qualifacts, the leading provider of EHR to the behavioral health community. For more information, visit www.qualifacts.com.