Barriers to Adopting HIT Still Substantial, APA Tells Health Subcommittee

Health information technology can play a pivotal role in improving patient safety and quality of care, but several problems and barriers to its use specific to psychiatry are still to be overcome, APA CEO and Medical Director Saul Levin, M.D., M.P.A., told members of the Subcommittee on Health of the House of Representatives Committee on Ways and Means.

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Levin submitted written comments to the subcommittee for its September 14 hearing on “Exploring the Use of Technology and Innovation to Create Efficiencies and Higher Quality in Health Care.”

He said that the successful deployment of health information technology (HIT)—including adoption of electronic health records (EHRs) and the use of telemedicine and telepsychiatry—requires addressing three overarching barriers: lack of true interoperability of EHRs, problems associated with the “originating site restriction” under Medicare, and lingering burdens unique to psychiatry in the Advancing Care Information (ACI) performance category of the new Merit-Based Incentive Payment System (MIPS).

“Interoperability”—the idea that patients’ records are accessible without restriction between health systems and providers—has yet to become a reality primarily because larger EHR vendors view this as a direct threat to their business models, which often center on data collection and retention, Levin said.

“Consequently, smaller EHR vendors, including those who focus on mental illness and substance use disorders, encounter challenges when designing systems since there is little to no incentive for larger vendors to cooperate with them. Thus, psychiatric patients’ records are often kept separate from other health records, preventing the patient’s full health history from being reviewed in one place.”

Levin said that although the Office of the National Coordinator (ONC) for Health Information Technology has taken some steps to addressing the issue, Congress and the ONC could do more by developing a single performance standard for interoperability.

“Such an action, whether taken through legislative or regulatory means, could ensure that all vendors, large and small, have fewer reasons to compete and more incentive to share data, because a single performance standard could be based around payment reform. Such a standard would have to be designed in a way that does not place any undue burden on smaller vendors, especially those designing systems for mental health.”

The “originating site restriction” under Medicare restricts the use of telepsychiatry to a clinical site, such as a physician’s office, outpatient facility, or hospital. Eliminating the restriction would be of particular benefit to psychiatry and the in-home treatment of mental illness and substance use disorders, Levin said.

“This would especially benefit patients with chronic/persistent diseases, as well as those with conditions that have demonstrated greater efficacy of treatment for telepsychiatry versus in-person care. Furthermore, eliminating the originating-site restriction would broaden access to psychiatric medicine for the treatment of mental illness in general by eliminating the stigma of going into the office for treatment.”

Finally, Levin said Congress and the administration need to address lingering problems with the ACI performance category. ACI is a category within MIPS that assesses how physicians are using EHRs to improve the value of the services they provide. It replaces the Meaningful Use Program.

But Levin informed subcommittee members that the new performance category retains some of the features of the Meaningful Use Program that have been especially problematic for psychiatrists. For instance, the performance category calls for “patient engagement” in the use of EHRs that can be difficult or impossible due to the nature of serious mental illness and the symptoms associated with it.

Moreover, he said, many psychiatrists practice within solo or small group settings and have been slow to adopt EHRs compared with large health and hospital systems.

“The reasons behind this tend to be that the EHRs that are specifically designed for mental health are lacking in functionality that would allow the psychiatrist to use the system in a ‘meaningful’ way, as defined by the ACI. EHR systems designed for larger practices tend to be expensive and require greater administrative support to bring online into practice and to integrate into existing workflows, which also is a reason as to why psychiatrists have been slow to adopt. Thus, not having an EHR results in a ‘zero’ score on the ACI category, which will disproportionately, negatively affect small/solo providers and may force some to decline Medicare patients.” ■