Bridging the Gap Between Behavioral Health and EHRs in New Jersey

The need for electronic health records (EHRs) designed specifically for those suffering from mental health and substance abuse issues has never been greater. Patients living with diabetes and cardiovascular diseases are twice as likely to suffer from depression than the general population.1

Hurricane Sandy, last year’s Nor’easter, foreclosures, unemployment, and the economy are just a few of the many external stressors and life traumas that may contribute to increased incidence of behavioral health conditions. And that doesn’t take into consideration personal stressors.

The burden of behavioral health disorders is compounded by the prevalence of multiple conditions among those who are already chronically ill.

Coordinating care for behavioral health patients presents a challenge

The increasing volume of patients, combined with the complexity of care being provided to behavioral health patients with other conditions, is taking its toll on the resources of not-for-profit behavioral health organizations (BHOs).

Coordinating care between BHOs and primary care providers (PCPs) is integral to improving care delivery and patient outcomes, and can be achieved through the integration of EHRs, health information exchange (HIE), and other technologies.

Behavioral health organizations have special health IT needs

Few behavioral health organizations, however, have adopted EHR systems for several reasons, including:

  • provider resistance
  • privacy laws
  • the lack of qualified IT and project management, and
  • ineligibility for the Medicare and Medicaid Incentive Payment Program.

In other words, there is a market need that hasn’t yet been filled by developers and manufacturers of EHRs and there are significant barriers to adoption of health IT.

Regional Extension Centers are active partners with providers in EHR adoption

In an effort to meet this need and overcome these barriers, and to address broader meaningful use and interoperability challenges, ONC established Regional Extension Centers (RECs) to help providers and organizations adopt EHRs and meet the Meaningful Use requirements.

The New Jersey Health Information Technology Extension Center (NJ-HITEC) is the Garden State’s REC and continually provides services, resources, and expertise to help physicians, PAs and nurses use health information technology securely and efficiently.

There are gaps in adoption of EHR systems among specialists

Although NJ-HITEC has made tremendous strides and surpassed its goal of 5,000 members, it provides these beneficial services cost-free only to primary care providers. These PCPs include physicians practicing:

  • Internal Medicine
  • Family Medicine
  • Obstetrics and Gynecology
  • Gerontology, and
  • Pediatrics.

Through NJ-HITEC’s outreach efforts, field experience, and other sources, gaps in the adoption of EHR systems have emerged.  In New Jersey, a Health IT Action Team (HAT) launched recently to identify solutions and close these gaps. The team includes:

  • the NJ Health IT Coordinator
  • State Department of Human Services (DHS)
  • Division of Medical Assistance and Health Services (DMAHS)
  • Department of Health and Senior Services
  • Department of Banking and Insurance
  • the Office of Information Technology, and
  • NJ-HITEC.

The NJ action team has a plan to fill gaps with Medicaid Specialists  

The action team has identified service delivery gaps – including for those with behavioral health issues – and embarked on a plan, approved by the NJ HIT Coordinator, to enter into a partnership with New Jersey Medicaid.

With guidance from the Centers for Medicare & Medicaid Services (CMS) ,2 New Jersey’s Medicaid program has been working to fill some of these gaps and created the Medicaid Specialist program that began in January 2012. This program made services available for up to 500 Medicaid Specialists.

The Medicaid Specialist program is already helping specialists achieve Meaningful Use

Although the program was funded to help 500 Medicaid Specialists over a two year period, we reached the provider participation target a mere nine months later in September 2012. Moreover, at the end of 2012, the Medicaid Specialist Program had helped 199 providers attest for the first year of the Medicaid Incentive Payment Program.

The initial year of the Medicaid Specialist Program focused on provider education, enlistment, and registration in the incentive program. In 2013 the program will help specialist providers and practices adopt EHR technology and achieve Meaningful Use.3

Medicaid Specialists are integrating EHR technology into behavioral health care

The Medicaid Specialists have been working to integrate the use of secure EHR technology into behavioral health organizations and are working collaboratively with the New Jersey Association of Mental Health and Addiction Agencies (NJAMHAA).

The result: By the end of 2012, 34 BHO member organizations with 293 eligible providers are now in various stages of EHR implementation and Medicaid EHR Incentive Program process.

NJ-HITEC’s role in assisting the behavioral health organizations in their EHR implementation and helping them achieve Meaningful Use and the associated federal incentive payments may not ultimately solve the resource dilemma these organizations face. However, it is certainly an important step forward to narrow the interoperability gap between primary care providers and behavioral health providers and, ultimately, in improving care delivery to these patients.

We believe there are potential long-term benefits when Health IT is properly implemented across the board to all specialties and that our efforts in New Jersey are helping to prove this point.

Please leave any comments below.

 

1 Egede, L. E., Zheng, D., & Simpson, K. (2002). Comorbid depression is associated with increased healthcare use and expenditures in individuals with diabetes. Diabetes Care, 25(3), 464-470.

2 CMS SMD# 10-016.  Center for Medicaid, CHIP and Survey & Certification. “Re:  Federal Funding for Medicaid HIT Activities”. 17 April 2010 <http://downloads.cms.gov/cmsgov/archived-downloads/SMDL/downloads/SMD10016.pdf>.

3 William J. O’Byrne, Thomas Jordan & Stuart Dubin. “Effective Use of Regional Extension Center (REC) Partnerships with Health IT Leadership & State Medicaid Agencies”. April 2012 < http://www.njhitec.org/include/downloads/White_Paper_Medicaid_3-10-12&Medicaid-Letter.pdf>.

4 Comments

  1. Robin Williams says:

    This article makes a good highlights on the need for electronic health records (EHRs) designed specifically for those suffering from mental health, diabetes and cardiovascular disease . I understand the extra sensitivity around the subject, but at the end of the day if you’re able to provide better care by having the full-view and all information about a particular patient, then I believe the records should be shared.

    • Bebet Navia says:

      Well said, Robin. There are truly valuable initiatives surrounding Behavioral Health by a vast array of organizations and states as well as the federal government, highlighting and disseminating these efforts will not only demonstrate support but hopefully increase resource and improve upon the delivery and effectiveness of the initiatives.

  2. Krish says:

    As per a report by Kansas Health Institute, on average, patients with serious mental and behavioral illness die 25 years sooner than average population. This happens due to poor management of chronic diseases like heart disease and diabetes. The report further stated that patients living with such diseases are twice more likely to fall prey to sever depression. A proof enough to draw conclusion that taking care of behavioral health is as important as keeping blood pressure in control.

  3. It’s a nice move by EHR and other state human and health departments to fill gap and helping specialists in integrating technology for medical and health care.

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