Guidelines to implement a $17 billion incentive program aimed at
encouraging the nationwide use of digital patient records could include
barriers for psychiatrists. To avoid such problems, APA is encouraging federal
regulators to issue rules that would allow the largest number of psychiatrists
to qualify for incentive funds while limiting the number subject to Medicare
penalties because they fall short of having a "qualified" digital
Moreover, to achieve the broadest adoption of health information technology
(HIT) by psychiatrists and other physicians, APA is advising regulators to
ensure patient privacy and avoid burdensome requirements.
James H. Scully Jr., M.D., medical director of APA, outlined the
Association's concerns about the proposed regulations in a June 26 letter to
the HIT Policy Committee, a federal panel making recommendations to the Office
of the National Coordinator for HIT. The coordinator is charged with
implementing the federal law, which is part of the American Recovery and
Reinvestment Act of 2009 (ARRA, PL 111-5). The APA letter followed earlier
comments filed with those from the AMA.
The law aims to spur the use of HIT, which by definition includes the
software and hardware needed to operate patient digital records, through
equipment and service refunds available beginning in 2011 (Psychiatric
News, March 20). The law also includes penalties for physicians who have
not installed "qualified" electronic medical record systems by
Among the many issues with which regulators are grappling is how to
determine whether a clinician makes "meaningful use" of a digital
medical record system and so qualifies for federal funding to offset its
"Since physicians will be required to demonstrate that they are
participating in a 'meaningful use' of a certified electronic health record
system in order to qualify for payment incentives under ARRA, it is of
paramount importance that the terms be both clear and flexible," Scully
One problem psychiatrists could encounter is a limited ability to use much
of the e-prescribing feature of a digital record system because federal rules
do not allow controlled substances to be prescribed through such systems.
Limited use of e-prescribing may disqualify psychiatrists from the federal
grants that cover some costs of the digital record systems.
Such regulatory details will be critical in determining which physicians
will qualify for federal reimbursements of up to $44,000 over five years for
their costs in implementing digital record systems.
Another of those issues is public disclosure of mental illness diagnoses.
Although patient privacy is a strong desire in all areas of medicine, the
lingering public stigma involving mental illness causes many patients seeking
such care concern that their records may not remain confidential. To ensure
strong protection of sensitive patient information, APA is urging early
inclusion of technology that can segment "sensitive" information
within the patient digital record. Regulators have planned to phase in such
technological features slowly by 2015, instead of when the HIT funding program
begins in 2011.
"While it may be burdensome for all providers to implement this
heightened privacy feature that early, it may be difficult to retrofit this
functionality after [digital record] adoption is widespread," Scully
The need to speed up implementation of patient-privacy protections was
echoed by Deborah Peel, M.D., a psychiatrist and board member of the
organization Patient Privacy Rights.
"Instead of putting consumer control at the front, [regulators] are
putting consent management at the very back," Peel told Psychiatric
Final regulations for the program are expected later this year.