EHR Q&A: Answers to Mental Health Practitioner’s
Most Frequently Asked Questions
By Jill Squyres, PhD
Lately, there’s been a lot of
buzz about electronic health records.
Here are answers to some of the most frequently asked questions about
EHRs as they relate to mental health practice.
What’s the difference between an EHR and an EMR? What
does this have to do with PII and PHI?
The digital age in health care requires us to keep track of a
veritable alphabet soup of acronyms!
While the terms EHR and EMR are often used interchangeably, by the most
stringent definition, EHR (Electronic Health Record) refers to all of a
person’s health information maintained in an electronic format. EMR (Electronic Medical Record) generally
refers to a patient’s chart maintained by a health care practitioner or
organization. An electronic document
that includes data entered by a health care provider as well as information
added by the patient would be an EHR by this definition. Many people are starting to use the term EMR
to refer to both as a convenience because when typing in Microsoft Word, the
spell check function automatically changes EHR to HER! PII stands for personally identifiable
information and PHI is protected health information, both of which are included
in the EMR. HIPAA guidelines require us
to take careful security measures to protect PII and PHI.
Do mental health care practitioners have to use an EMR?
Currently, counselors and psychotherapists
are not required to use EMRs. However
there are many benefits to an EMR that may outweigh any drawbacks. Physicians currently have guidelines
requiring them to adopt EMRs.
I’ve heard the government will pay you a lot of money if you
start using an EMR. Is this true?
Medicare and Medicaid have initiated an
EHR (this is the term these programs use) adoption program that offers
substantial cash incentives for meaningful use of electronic health records. Detailed meaningful use criteria have been
developed by Medicare and Medicaid. At
the present time, none of these criteria pertain to mental health practitioners
so we are not eligible for these incentive payments. However, mental health professional
organizations, such as the American Psychological Association, are lobbying
government agencies to have mental health care criteria included in the next
stage of meaningful use incentives.
What are the benefits of using an EMR?
EMRs can make managing client
documentation much easier and more convenient.
Most EMRs also include an entire suite of practice management tools
including a scheduling calendar, billing module, and online insurance claim
filing in addition to the standard chart.
Progress note templates and intake, assessment, and treatment planning
forms are often included as well. Of course,
all documentation kept online saves paper, filing space and shredding costs. Records requests can often be accommodated by
faxing the documents directly from your practice computer, saving on mailing
costs, paper and postage. EMR developers
are now adding integrated video conferencing modules to their software to make
initiating online sessions a point and click option. Online EMR’s offer the added convenience of
being able to access your client’s chart and contact data from any device
anywhere with internet access.
If I use an EMR does it have to be online?
There are several different types of
EMR software. One type is stand-alone
software that you load on to one personal computer. This software does not require an internet
connection and all of your data is stored on the single computer it’s loaded
on. Of course, frequent back-ups to a
hard drive, data CD and / or a thumb drive will be necessary if you are using
this type of system to protect against loss of all of your patient data. From a HIPAA compliance standpoint, this type
of system is the most secure, although a stand-alone computer can still be
stolen or accessed by unauthorized personnel resulting in a data breach. The risk of losing all of your data in a
disaster or computer crash is an important consideration from a risk management
stand-point as well. While there are
security issues to consider with web-based systems or online back-up, it is not
acceptable professionally to lose all of your clients’ mental health care
information because your computer died or you experienced a natural disaster or
fire.
How do online EMRs work?
Online EMRs are generally accessed over
the internet through a secure browser window.
Most will work with any browser software although some programs will
only work on PCs, not Macs.
Traditionally, EMR software has not worked on tablets, PDAs or smartphones,
however, many vendors are adding apps, which can be purchased for an additional
charge, for convenient access on mobile devices. Large medical practices and
hospitals often purchase software that is loaded onto a dedicated server which
may be physically located on their premises but this is not an affordable
option for private practitioners or small group practices. This set-up allows for an online record that
is only accessible to devices on the facility’s private network.
Can I be sure my online EMR is HIPAA compliant?
The developer of your software should
provide documentation of their security measures and compliance with HIPAA
standards. Any browser window accessing
an online EMR should have an address beginning with https: instead of the usual
http. Your EMR software vendor should
also require you to sign a business contract attesting to their security
measures for HIPAA compliance.
What about all of my paper notes?
Of course, you can keep all of your
paper notes filed the same way you have traditionally kept them and start
keeping records electronically from the date you implement your EMR. Many clinicians purchase a scanner and scan
in old records so the paper copies can be disposed of. Most EMR software allows for easy uploading
of paper documents. Some clinicians even
continue to write their notes on paper and then scan them into the client’s EMR
when they close out the appointment.
I’m already spending a lot on running my practice. Is it expensive to adopt and EMR?
There’s
a lot of competition in the mental health electronic record market, which helps
keep costs down. For the most part, you
will pay more for extra features like patient portals, billing features like
automatic credit card payments and insurance filing, templates and state of the
art interfaces. The cost for most
software is charged as a monthly fee although some companies charge an
additional fee to get your account and data set up. This set up fee can also include transferring
data from old software to your new EMR, which may look expensive but can cost
much less than paying someone hourly for data entry to get you up to
speed. The typical monthly cost ranges
from $60 - $150 per month depending on what features and technical and
administrative support you want from your software provider. There are also free options, which are not
specifically designed for mental health providers but can be easily adapted to
our needs.
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Text copyright 2012 by Jill Squyres, PhD. All Rights Reserved