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
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
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.
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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>.