Using HIT to Achieve EHR Interoperability
Only about 17 percent of physicians today are using Electronic Health Records (EHRs) in their practices.1 When it comes to community behavioral health providers, the percentage of clinics with full use of EHRs is less than 8 percent.2
This low percentage is a problematic statistic, as EHRs can provide higher quality of care and increased cost savings for healthcare organizations and their patients. However, an even greater barrier to truly realizing the benefits of EHRs lies in that fact that most of the EHRs in use today lack interoperability.
Interoperability means that, with the appropriate permission, health professionals working in different areas can access the same patient’s record. For example, if a patient who is dealing with both mental and physical ailments such as schizophrenia, diabetes, and high blood pressure, is being treated by a psychiatrist at a Centerstone clinic, his psychiatrist could access his records regarding his recent trip to Vanderbilt Medical Center’s Emergency Room for panic attacks and his visits to a podiatrist for his foot ulcer.
I believe four elements are essential to creating interoperable Health Information Technology (HIT) systems:
  • compatible, uniform data standards,
  • uniform information privacy and access policies,
  • a data architecture standard that assures interoperability for purchasers of software, and
  • provider engagement.
When these elements are incorporated and functional interoperability is created, it can achieve the following:
  • prevent costly and harmful polypharmacy issues, the potentially dangerous use of multiple medications by a patient,
  • streamline care so that two different providers aren’t providing duplicate services, and
  • reduce unnecessary and time consuming paperwork.
Within our work at Centerstone Research Institute, as we’ve worked to merge three different community mental health centers’ electronic health records, we have discovered firsthand that in-house interoperability can quickly result in better quality care, better patient satisfaction, and cost savings.
In an attempt to spur EHR use in the United States, the American Recovery and Reinvestment Act of 2009 (ARRA) budgeted over $19 billion to promote effective use of HIT. This was a laudable effort, but, regretfully, the writers of this bill neglected to ensure that all of a patient’s healthcare providers –– both mental and physical — would be able to access funds. Community behavioral health providers were excluded from accessing the $17 billion in Medicare and Medicaid incentives to encourage EHR use.
Unless this is changed, many individuals with depression, schizophrenia, and other mental disorders will not be able to reap the benefits of having interoperable providers for both their mental and physical healthcare needs. Imagine the reaction if all oncologists or cardiologists were excluded from this kind of funding. 
Certain groups such as The Healthcare Information Technology Standards Panel3 and Health Level 74 have developed excellent standards, which will allow healthcare providers to communicate quickly and securely because they will be using the same “language”—much like different banks do with ATMs. However, none of this will work if providers are not engaged.
To fully engage in this issue on an organizational level, providers need to purchase and utilize interoperable systems using uniform data standards. On a state level, providers must advocate for information access regulations and policies appropriate for the 21st century. On a national level, we must ensure that all healthcare providers are eligible for funds that assist them in utilizing HIT effectively.
With these changes, organizations can fully achieve interoperability among a patient’s service providers and build the important electronic infrastructure that will help us save money and time and provide better care.
1DesRoches, et al (2008). “Electronic Health Records in Ambulatory Care — A National Survey of Physicians.” The New England Journal of Medicine, Volume 359(1):50-60.
2Rosenberg, L. (2008, May 14). Electronic Health Records: How they Effect Mental Health and Behavioral Healthcare Organizations. Retrieved on June 15, 2009 from
3Jones, L. (2008, July 24). Statement of LeRoy Jones, GSI Health, Philadelphia, Pennsylvania. Testimony before the Subcommittee on Health of the House Committee on Ways and Means. Retrieved on June 16, 2009 from mental-health-articles/electronic-health-records-how-they-effect-mental-health-and-behavioral-healthcare-organizations-917527.html.
Dennis Morrison, PhD is CEO of Centerstone Research Institute.