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EHR: Frequently Asked Questions

View questions frequently submitted by APA members who are shopping for an EHR system to meet their needs.

Over the past decade, the successful incorporation of electronic health records (EHRs), e-prescribing tools, and various mobile health (mHealth) related technologies has become an increasingly common challenge for medical practitioners. The current EHR landscape encompasses a broad spectrum of products which further complicates the task for physicians and practices who seek a system that suits their professional needs.

General

At this time, the APA does not endorse any one EHR over another. Understanding that choosing an EHR is often highly personal and unique to a specific practice, the APA recommends using publicly-available information to select an EHR, such as the software clearinghouse Capterra. APA has also partnered with American EHR to provide its members access to peer generated information as it is recommended that clinicians communicate with peers who are practicing in similar clinical settings (i.e., depending on size and scope of practice) when they are selecting a system. Members contact the APA Practice Helpline at 800-343-4671.

The short answer to this is "yes." That is, there are many vendors who purport to serve the mental health community, and some that claim to serve psychiatry specifically. Also, many vendors may not specifically identify psychiatry (or other specialties, for that matter) as their core customer base, but assert that they can create an EHR system engineered for mental health/psychiatry on top of their "base" system, for an additional cost. To review EHRs that are geared toward mental health providers, visit www.capterra.com/mental-health-software.

EHR systems vary widely with respect to cost. Cost is often associated with the platform on which the EHR runs; the number of features (i.e., "bells and whistles") the system has; and also the number of users. For example, many cloud-based systems offer a monthly or yearly subscription to use the EHR. This subscription is typically tied to a per-user-per-month pricing model. Some larger EHR systems (i.e., especially those requiring downloadable software) can be substantially more expensive.

Additionally, some vendors may offer a "base" EHR that offers only essential EHR functions, like billing, scheduling, clinical notes, and coding at a certain price point. Then, you could opt to purchase "add-on" features, such as e-prescribing, pre-populated templates, patient portals, voice dictation, electronic clinical decision-making, and so on. These optional, modular features vary from vendor to vendor.

While many EHRs have electronic prescribing capability built into them, there are some standalone e-prescribing solutions, including the electronic prescribing of controlled substances. To find an e-prescribing solution that works for you and your practice, visit surescripts.com.

There are a number of other considerations of which to be mindful when assessing potential EHR systems.

First, it is a good idea to have a sense of for how long your prospective vendors have been in business. With the rise of Health IT, EHR development and proliferation has almost become a cottage industry, with many small vendors appearing and disappearing over the past decade. When speaking with a potential vendor, be sure to ask for how long they have been in business. As many EHR vendors are associated with larger software developers who have been in the IT business solution space for many years, it is beneficial to have them clarify specifically for how long their EHR tool has been on the market, as well as how many updates or versions there have been since its initial release.

Second, it is often useful to ask a) how many providers/clinicians/health systems the vendor supports and b) how many mental health/psychiatrists use their product. Widely-used software is more likely to maintain current ONC certification, and likely has a larger support staff to help you should something go wrong.

Also, gauging how many mental health professionals use specific software will provide insight into how invested the EHR vendor is into workflow, clinical practice considerations, security, and other issues unique to mental health IT.

EHR System Requirements

Generally, EHR systems are delivered and supported through two primary platforms that are situated in one of two locations: local or cloud.

  1. Local: software that the clinician or staff must download and install onto a server, computer, or computers in the office; or,
  2. Cloud: software that is hosted remotely "in the cloud" by a vendor and accessed using computers or other devices at the point of care.

For local EHR systems that require downloading and installation, the EHR system itself may be hosted on a local server owned by the practice or by the company that sells and supports the software. This is generally a more viable option for larger practices with IT support staff to maintain the server and software.

The cloud option is becoming more common, as solo and small group practices find this is easier to manage and has less of a need to hire IT support staff.

The type of computer that you use to access/maintain the EHR depends on how the EHR is designed and what the vendor offers. For instance, many cloud-based EHRs are compatible with Windows computers, Mac computers, and/or a tablet/smartphones. Some EHRs run solely on Windows; some are optimized for tablet/smartphone. When selecting an EHR, it is important to ask the EHR vendor:

  • which computer(s), devices, or hardware are optimal for their EHR product, and
  • if each version of (or update to) their software is deployed at the same time for all platforms and systems (e.g., if version 7.0 is available on PC, Mac, and Tablet, or if they intend to stop supporting/providing updates for a specific system).

Privacy & Security

Part of adopting an EHR is understanding that much of healthcare policy surrounding electronic records is concerned with connecting multiple providers across a variety of practices in order to share patient health information. The goal of this is to generate the whole health picture of the patient that can be accessed and utilized in multiple care settings. Clinicians who have access to the whole health picture of their patients can make more informed clinical decisions and ultimately raise the trajectory of patient health outcomes.

However, given the uniquely sensitive nature of psychiatric data, it is important to understand how an EHR system can be designed to handle this information. For instance, while the Health Insurance Portability and Accountability Act (HIPAA) provides additional privacy safeguards for psychotherapy notes stored within an EHR, most EHR vendors are also willing to adapt their technology to the needs of individual practices.

To this end, EHR systems are capable of building data segmentation into the record, which allows for greater control by the patient and provider with respect to what information can be shared with other entities. Currently, the nuances of data segmentation are still being developed by health IT professionals in coordination with various Federal rulemaking efforts. While this process is ongoing, the ultimate goal is to assure you and the patient a degree of agency over sensitive health information, which has the potential to decrease the stigma of seeking treatment for psychiatric conditions.

For more information on data segmentation, please visit www.healthit.gov.

Practice Integration

Many EHR vendors are willing to modify their EHR templates to suit your practices. For example, if a practice uses particular screening tools or outcome measures as a routine part of care, many EHR vendors can integrate these into their systems. However, this typically comes an additional cost to you. There is no guarantee that the data gleaned from these measures will be able to be transmitted to the EHR systems used by patients’ care teams in other settings.

This is an important area to explore with a vendor prior to contracting with them. Ask for examples of customization similar to those you might request from the vendor. Or, ask for examples from a practice similar to yours that the vendor has already developed.

You may be using office management software (OMS) to help with scheduling, billing, and other administrative tasks associated with running a practice. However, OMS is not an EHR, as OMS does not generally collect patient health information (i.e., blood pressure; treatment progress; psychotherapy notes; diagnoses and treatment plans). On the other hand, most EHRs also possess OMS functionality in addition to their clinically-driven features.

If you currently use OMS in your practice, but are thinking about adopting an EHR, it is a good idea to call your OMS vendor to ask if they can recommend EHR systems that are compatible with your OMS. EHRs compatible with your OMS can make migrating patient data into the new EHR system a more streamlined process.

You can also call EHR vendors to see if they have experience with migrating data from your OMS into their systems.

While finding an EHR system that is compatible with your OMS is not absolutely necessary, it will save on the time it takes for you to make the transition to electronic records.

EHR vendors typically offer a variety of training modalities when bringing their software packages online in your practice. Some EHR vendors offer on-site training, which may be ideal for offices where multiple staff (i.e., administrative, nursing, physicians) will be using the EHR according to their specified roles in the practice. Other EHR vendors provide pre-packaged "modular" training in the form of online videos and tutorials. Additionally, some EHR vendors may provide live, synchronous videoconferencing sessions to help clinicians and/or staff bring their systems online. In general, different types of training are associated with different price points, with on-site training being more expensive than training conducted remotely.

The type of support offered by EHR vendors varies:

  • Some vendors offer live, 24-hour, phone or online (i.e., "chat") support.
  • Some maintain limited business hours for support, either by phone or online.
  • Some smaller vendors may offer e-mail-based support.
  • Larger organizations may provide on-site support for upgrades or substantial changes to the system.

Vendors may offer these services as a part of the EHR subscription package (i.e., free with a subscription; free for a year after purchase, etc.), while some may offer fee-for-service support.

EHRs and Federal Regulations

The Office of the National Coordinator for Health Information Technology (the "ONC") maintains a voluntary certification process for EHR vendors. The ONC, with guidance from the Centers for Medicaid and Medicare Services (CMS) and other organizations, administers a certification process that seeks to hold EHR products to certain usability, privacy, and security standards, implementation specifications, and other certification criteria. For additional information on the certification process, visit www.healthit.gov

While there is currently no Federal regulation requiring that providers must select an ONC-certified EHR, there are many reasons to do so. First, if an EHR is ONC-certified, it is generally understood that the EHR’s data is maintained in a structured format that allows the data to be captured, shared, retrieved, and transferred efficiently and somewhat uniformly, which allows for the EHR to be used in ways that can support patient care. ONC-certified products also meet rigorous standards pertaining to data security.

Second, if you decide to participate in current CMS EHR Incentive Programs (e.g., "Meaningful Use") or in future quality reporting programs (i.e., the Merit-Based Incentive Payment System or MIPS), the use of an ONC certified EHR product is required in order to avoid downward payment adjustments to Medicare reimbursement claims.

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