EHR adoption in behavioral health: Less a matter of “if” than of “how”

Leveraging "open source" EHR technology can substantially reduce the cost of acquiring an EHR system for behavioral health.

by Sigurd Ackerman, MD, and Irv Lichtenwald

There are a bevy of beneficial and documented reasons for behavioral health providers to implement an electronic health record (EHR) – the most notable is the increased productivity EHRs provide. The problem has been justifying these benefits when weighed against costs in both time and money. As a result, most institutions have opted to stay with inefficient paper records—but times are changing. In the near future, they may no longer have a choice when it comes to implementing an EHR. The question will be less about “if”, but “how” and “how fast”.

Here’s why. Medicare has started to deny or delay reimbursements to inpatient behavioral health centers unable to document adequately that initial assessments, treatment plans and progress notes were conducted and maintained in a timely and complete manner. While the applicable benefit policy has been in force for more than five years, many organizations are only now seeing increased scrutiny of record keeping by the federal government and The Joint Commission, a private accreditation entity for hospitals and behavioral health organizations. The amount of information sought by Medicare reimbursement officials is increasing and detailed, forcing many behavioral health institutions to manually document and store an overwhelming amount of paperwork. This is truly an unsustainable process.

The genuine threat of losing funds may finally spur the widespread adoption of EHRs. As one healthcare executive recently shared, “We need to get ‘ologists’ talking together, build the infrastructure and use mobile tools so that they can collaborate.” Doing so will require engaging on four fundamental objectives:

  • Create a robust data warehouse that can efficiently and accurately gather and digitize patient information.
  • Share that data with all stakeholders in accordance with HIPAA and other pertinent policies and regulations.
  • Ensure the data is mobile and accessible wherever and whenever it’s needed.
  • Enable patients to “take the data home,” and empower them with the ability to manage their own health care.

    While these may not be groundbreaking goals, they reveal that healthcare is still talking about information technology and improved data management in theoretical terms. Traditional EHR and communications platforms remain too costly for most. Even among behavioral healthcare organizations with the budget for such a system, the required implementation time becomes too prohibitive for them to realize a timely return on their investment.

    The proprietary nature of traditional EHR platforms requires specialized IT environments created by well-trained vendors and systems integrators. The cost and design of these platforms can require provider staff to retool practices, policies, and procedures to conform with system requirements. At this point, some organizations will want to cry “Uncle.”

    But there is simply too much at stake to quit.

    A proven and affordable solution is already in use in the form of “open source” EHR technology developed by the U.S. Department of Veterans Affairs (VA).  Known as VistA, this enterprise-wide clinical information management solution was recognized by the Institute of Medicine of the National Academy of Sciences as one of the best health IT systems available.

    VistA is the most widely used EHR in the world, comprising more than 100 software modules that include computerized provider order entry (CPOE), bar code medication administration (BCMA), clinical documentation, pharmacy, laboratory and radiology. The system also includes specific modules vital to behavioral health providers, including intake assessments, treatment plans, progress notes and discharge summaries.

    Because it was developed by the federal government, VistA is available to the public for almost nothing through the Freedom of Information Act. Enterprising companies are now continuing to develop VistA to affordably meet the needs of all kinds of healthcare environments, including behavioral health.

    For example, Silver Hill Hospital, a behavioral health facility in New Canaan, Conn., collaborated with Medsphere to produce the first built-from-the-ground-up Vista-derived EHR system specifically for behavioral health hospitals. The OpenVista Multidisciplinary Treatment Plan (MDTP) software coordinates mental health care across members of the care team and supports patient progress management, eliminating the need to scour and cross-reference a library of paper records.

    The new MDTP module enables better, more integrated, patient care through improved access to patient information from a variety of sources. With this platform, Silver Hill has almost eliminated the late transfer of medical records, and the EHR’s computerized provider order entry (CPOE) and bar code medication administration (BCMA) modules enable clinicians to enter and confirm patient data at the bedside, greatly improving efficiency and patient safety.

    Behavioral healthcare providers and technology developers have an opportunity to meet the demands of patients by improving the quality of care. In VistA, an “open source” enabling solution for such a transformation exists; its effectiveness is well documented and the up-front cost to acquire it is quite low. For this reason, more providers are considering this type of solution. And we are more excited about what is possible with it than ever.

    About the authors:

    Sigurd Ackerman, M.D. is president and medical director of Silver Hill Hospital, and Professor of Clinical Psychiatry, Columbia University College of Physicians & Surgeons. He can be reached at

    Irv Lichtenwald is CEO of Medsphere Systems Corporation, developer of OpenVista®, a portfolio of clinical support products and services that leverages VistA, an EHR system created by the Department of Veterans Affairs. He can be reached at

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