How can care be coordinated if behavioral health is shut out of meaningful use?

Did you catch the bits of irony in today's FierceEMR? The Certification Commission for Health Information Technology just launched three certification programs for EMRs specific to behavioral health.

The cynic would say that CCHIT is being presumptuous, since federal officials haven't authorized anyone to certify EMRs yet for the "meaningful use" incentive program that, for hospitals, starts in just a little more than two months. Yes, that's true. But the more salient point is that EMRs for behavioral health won't help anyone get to meaningful use unless they're a psychiatrist (i.e., a physician) or, on the facilities side, a general hospital, home-health agency or skilled nursing facility.

As iHealthBeat's Kate Ackerman points out in a column this week, clinical psychologists and licensed clinical social workers are shut out of the program. So are substance-abuse treatment centers, psychiatric hospitals and other mental-health facilities. Don't blame CMS for this oversight, though. The responsibility falls squarely on Congress, which wrote the exclusions into the American Recovery and Reinvestment Act.

It ultimately came down to money. Ackerman reports that lawmakers had to prioritize when the funding available for health IT shrank from $50 billion to about $20 billion. (As you may recall, the original estimate was that the federal incentives would cost a net $19.2 billion, after accounting for efficiency gains that Medicare and Medicaid would enjoy from all the connected docs and hospitals. CMS more recently estimated that it would pay out about $27 billion in incentives over the life of the meaningful-use program, but I'm not sure if that's a gross or a net figure.)

Some psychiatrists I've spoken to believe that EMRs are of limited use to them because a computer could interfere with a one-on-one psychotherapy session or because they simply don't keep a lot of clinical notes. Fair enough, but not every mental health patient is in psychotherapy and not every therapist practices the same way. Plus, for those accustomed to jotting down notes on a legal pad during therapy sessions, wouldn't the iPad or similar tablet computer be a suitable replacement?

A lot of patients stand to lose here. "People with mental health and substance abuse conditions are in desperate need for more coordinated, integrated healthcare," Linda Rosenberg, president and CEO of the National Council for Community Behavioral Healthcare, said earlier this month while pushing for Congress to expand ARRA eligibility. "Having an interoperable system of electronic health information is critical to achieving greater coordination among addiction, mental health and other healthcare providers and to helping consumers manage their own healthcare," Rosenberg added.

I've also heard from people at dental practices who feel left out, and not just because of the money. How can care truly be coordinated if there's no incentive for so many elements of healthcare to adopt EMRs and share patient data?  -Neil