Practice PERSPECTIVE ON
Getting practitioners on board
with electronic records
BY DR. KATHERINE C. NORDAL • EXECUTIVE DIRECTOR FOR PROFESSIONAL PRACTICE
Better health, lower costs, improved care. That’s the Department of Health
and Human Services’ goal for implementation of the Affordable Care Act.
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. n