Frequently Asked Questions Regarding the 2015 Interoperable Electronic Health Record Mandate
In 2007, the Minnesota legislature mandated that as of January 1, 2015, all health care providers will be required to use an interoperable Electronic Health Record. This means that all providers, licensed and unlicensed, fee-for-service and insurance providers, from private practices to large organizations must meet this mandate. You can find out more information about the mandate through the MN Department of Health.
Providers who deliver any service that is eligible for payment by Medical Assistance, whether the actual payment is Medical Assistance, another insurance, out of pocket, or free, must have an interoperable electronic health record. An EHR product used by a provider must be certified by the Office of the National Coordinator (ONC) if there is a certified EHR available for their setting. If one is not available, a provider must have a qualified EHR. A qualified EHR is one that contains all of the required parts in a certified EHR that are applicable to the provider’s setting. For example, mental health providers would not usually record immunization information, but would need to exchange information about procedures, diagnoses, progress towards therapeutic goals, and treatment plans.
I already keep my files electronically, do I meet the mandate?
It is not sufficient to just keep files in an electronic format. Your health record needs to have the capacity to provide clinical decision support (suggest best practices for a particular diagnosis). It must also be able to capture and query information from Clinical Quality Measures (CQMs) that allows you to track variables related to your client’s diagnosis (i.e. severity of depressive or anxiety symptoms), and exchange information with and integrate information from other electronic sources. Many electronic medical record programs (EMRs) do NOT meet these requirements. Find out more about the differences between an EMR and an EHR.
What happens if I don’t comply with the mandate?
Currently there are no penalties from the state of Minnesota for non-compliance, though there likely will be in the future. Individual associations or licensing boards may have penalties for not following state laws regarding record keeping. However, the biggest penalty is effectively being isolated from the healthcare system and having your practice be irrelevant.
There is recognition that currently there are only a few products for small behavioral health providers, though the landscape is rapidly shifting. Clinicians must demonstrate progress in the acquisition and implementation of electronic health records by January 15, 2015. Progress might include using a decision-making toolkit, defining practice needs, outlining hardware, software, training, and vendor needs, and creating a timeline to meet goals.
How do I find out which EHRs are certified and meet the mandate?
A comprehensive list of currently certified EHRs is available here. Beyond certification or qualification, it is important to ensure that the product you choose is a good fit for your practice, as not all EHRs are designed with the needs of behavioral health practitioners in mind. Also, what works well for an organization or agency may not be the most effective, or affordable, product for a single practitioner or small private practice.
How do I figure out which EHR is right for me?
With so many clinicians working in different settings, with different populations, and with differing requirements in terms of workflow and record keeping, there is no single best solution for behavioral health. Each provider selecting an EHR will need to evaluate their own resources in terms of time, money, skills, and needs (training, unique forms, customized workflows) to determine which program is the best fit for their practice.
HealthIT.gov has a number of tools, worksheets, and resource suggestions to help those working to implement an EHR. More information to asses your practice readiness, plan your approach, and select an EHR can be found here.
There is also a free behavioral health toolkit available from Stratis Health, an independent nonprofit organization, to help providers assess their needs and evaluate EHR choices. More information on their toolkits for specific settings can be found here. While individual providers may find this information helpful, it is largely geared towards bigger agencies. Free trainings have been offered live and by webinar to help clinicians understand how to use this toolkit.
There are ongoing changes in regards to the products that are available and the features that they offer. Clinicians may find it helpful to slow down and see what other options may become available in the coming months, as additional vendors work through the certification process. You may also find it helpful to speak with colleagues about their experiences, both positive and challenging, in working with specific EHRs.
Who can help me in selecting and implementing an EHR?
Using the toolkits and resources provided by Stratis Health and HealthIT.gov will help you to become an informed consumer. It may also be helpful to talk with colleagues who have already implemented an EHR to find out what has worked well for them and what challenges they have encountered in their process. Before signing on with a particular EHR vendor, it may be helpful to speak to their references or current clients to have a better understanding of what it would be like to work with a particular provider.
What do I need to think about when selecting my EHR?
While each provider will have unique questions to explore, some common things to consider are:
- How much will an EHR cost me over the course of a year? Are there additional charges for a biller, scheduler, supervisee/supervisor, or others who need access to my records?
- How am I able to access my records after I close my practice or stop using the program?
- How will client data be imported to / exported from the EHR when setting up or discontinuing service?
- Is the EHR Health Level 7 (HL-7) compliant? (A necessary component to meet certification guidelines and ensure interoperability. If the vendor can’t confirm that they have it, assume that they don’t.)
- What kind of support do they offer for implementation / training and what is the cost?
- What forms / templates do they have available and what is the cost to use them? Are you able to customize forms and templates, and if so, what is the cost for that?
- What safeguards are in place in regards to security and privacy? Can users be given limited access (such as a biller) to protect confidentiality?
- Where is the data stored? Is it a cloud-based system or will I have my own software and servers to maintain?
- What is this vendor’s track record? How long have they been a provider of health information software?
While this list of questions is certainly not comprehensive, it may provide some insight into the types and scope of questions you may want to have addressed before committing to a vendor or product.