Perspective on Practice
Better health, lower costs, improved care. That's the Department of Health and Human Services' goal for implementation of the Affordable Care Act. Psychology as a discipline has much to contribute to this goal. But to do so, we must be able to participate in evolving systems of care. And that includes adopting electronic health records (EHRs).
EHRS are intended to replace a patient's paper records. They differ from office management software in that EHRs are "interoperable" — meaning they enable communication across practice settings and thereby facilitate interaction among health-care professionals. EHRs provide a more comprehensive overview of total patient health, allow greater patient participation in their own care and enable psychologists to demonstrate the value of psychological services by documenting better patient outcomes.
Despite the benefits of EHRs, many psychologists are understandably concerned about privacy and security issues created by greater ease of access to information in patient records. It is important to realize that the primary legal mandates that govern privacy and security issues for EHRs are the same that govern paper records: the HIPAA Privacy Rule and Security Rule. This rule regulates the intended release of "protected health information" as defined in HIPAA, including who can view such information and when. The rule protects against unauthorized access to protected health information and provides guidance if a computer or device with such information is unexpectedly lost or destroyed.
Psychologists who transmit or maintain health information are already subject to compliance with the HIPAA security rule. EHRs contain the same health information that is kept in a patient's paper record, except in electronic form. Complying with the security rule and encrypting records to government standards reduces security risks and protects patients' privacy if security is breached.
Patient health information can be secured above and beyond the protections set out by the security rule. For example, patients and providers can agree on levels of accessibility within EHRs to limit access to certain types of information. More detailed psychotherapy notes can be kept separate from the system or in a segmented (accessible by privilege only) part of the EHR.
So, where are we now? The Jan. 23, 2013, HIPAA Final Rule made minor changes related to EHR use. Specifically, it enhanced patient privacy protections, provided individuals with rights to their health information and strengthened the government's ability to enforce these requirements.
The HIPAA Final Rule modifies the Health Information Technology (HITECH) Act of 2009, which significantly expanded the U.S. government's promotion of a national electronic health records system. The act authorizes the Centers for Medicare and Medicaid Services to provide significant reimbursement incentives for physicians and hospital providers who become "meaningful users" of EHR. Unfortunately, the act excluded psychologists and most other non-physician providers from receiving Medicare and Medicaid incentive payments to adopt EHRs, as psychologists are not included under the definition of an eligible professional. And the HIPAA Final Rule does not provide for psychologist eligibility.
So when more than 500 psychology leaders gathered for the 30th State Leadership Conference in Washington, D.C., March 9–12 (see pages 52–65) a key advocacy message they took to Capitol Hill was: Make psychologists eligible for the HITECH Act incentive payments for implementing EHRs.
Recognizing psychologists as eligible EHR meaningful users under the law will promote integration of psychology and mental and behavioral health care in the health-care system, reduce adverse drug-to-drug interactions and duplicative tests, and provide necessary information to hospital emergency departments for patient triage.
In 1965, psychologists were absent from the Medicare law and it took us nearly 25 years to gain inclusion as eligible providers. We can't afford to be left out of emerging integrated-care systems if we want to participate in health-care reform. A key element to our involvement in the evolving health-care system is inclusion in EHRs.
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