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By Rose Hoban
The deadline is awfully close. By law, June 1 is the day for most of the state’s hospitals, physician’s offices, mental health providers and others to be hooked into the state’s growing health information exchange, known as NC Health Connex.
But for many small physicians’ offices and mental health providers that deadline was looking more like a dead end. If they were not able to get online or at least sign a participation agreement that obligated them to have an electronic health record system and be connected with NC Health Connex by June 2020, they would be unable to submit bills to state-funded health care systems, such as Medicaid and the health plan for state employees.
“This is our number one issue we hear about from members,” said Kay Castillo, the lobbyist for the North Carolina chapter of the National Association of Social Workers.
That’s why Castillo and representatives from other provider groups were at the General Assembly this past week visiting members of the Senate and asking for support for a bill that made it through the House of Representatives in March.
Finally, this week, the Senate Health Care Committee took up the bill.
No mean feat
If you were to watch TV shows such as “House” or “Grey’s Anatomy” you might think that every health care provider is hooked up to the internet, with patient records and histories available with a few keystrokes.
But for many small offices, patient records are still folders stuffed full of clinical notes, X-ray readouts and printouts from lab companies, some of those folders can be inches thick if a patient has a long history.
Getting all that information digitized and searchable on the web is no mean feat. But Sen. Ralph Hise (R-Spruce Pine), who’s been the point person for health care policy in the senate for years, said it’s something that’s necessary.
“For people who went to the hospital on Saturday evening, and their follow up is on Monday morning it would be really important to have that information available to that doctor so they would have… the blood work and tests that are there,” Hise said. As someone who’s watching taxpayer dollars, Hise has long maintained that having those patients repeat tests is wasteful, and he’s been pushing for the health information exchange for years.
“Most people either think we have the data already or don’t understand why we don’t have the data,” said Chip Baggett, a vice president for the North Carolina Medical Society.
One of the big barriers is cost. To get an electronic health record system into a physician’s office can be $50,000 or even as much as $100,000. Many practices that are affiliated with hospital systems have had that task accomplished for them by the hospitals, who are essentially those doctors’ employers. But for a small practice, that pays for its own infrastructure, that out of pocket cost can be prohibitive.
“There are some rural doctors who might be close to retirement or just rural and Medicaid needs all those providers,” said Robin Huffman, head of the North Carolina Psychiatric Association. She explained that those providers might not want to be making a large investment in office infrastructure just before retirement.
Mental health provider confidentiality
Huffman was most concerned about her members, particularly psychiatrists in small practices with one or two mental health providers. For them, the electronic health records are prohibitively expensive and most of the 150 or so vendors working to create electronic health record systems have not created systems targeted for small offices.
They also haven’t created products targeted for behavioral health care and there remain a host of questions yet to be answered for them, especially questions about privacy.
“Psychiatrists are the ones taught not to share communications about patients with other entities,” Huffman said. “We’re the ones who are held liable for divulging information, confidentiality is the standard of practice not only for psychiatrists and all the other mental health professionals.”
There are still broad, unanswered concerns about what information behavioral health providers would be required to enter into NC Health Connex, who would have access to what information and how sensitive data would be protected. Huffman also said there are federal privacy laws such as HIPAA and laws around protecting information about people receiving substance use treatment services that could come into conflict with the state’s requirements to upload data.
“There’s a stigma attached to certain diagnoses,” said psychologist Jennifer Franklin who practices in Durham. She said she was concerned about how a physician might see a mental health diagnosis listed in a patient’s record and treat that patient differently. “It opens the door for discrimination against patients, there so much bias and discrimination already in our health care system.”
Franklin said she wasn’t ready to be connected to NC Health Connex and, based on her concerns about confidentiality, expressed reservations about connecting at all.
“I don’t think a lot of people are thinking about [confidentiality] and how that would play out and affect health care,” she said.
Castillo noted that for practitioners of medicine, the data uploaded into the health information exchange is more straightforward, lab results, reports from diagnostic imaging, medications given and more.
“We’re still trying to figure out what information does a licensed clinical social worker, or a psychologist submit to the state, because they’re not giving shots, they’re not prescribing medications,” she said. “They can say, ‘I see client A, here’s their diagnosis, how often I see them, if any suicide risk,’ but there’s only so much information that you’re collecting that would be uploaded into the system.”
Several year delay
The amended bill passed by the Senate committee Tuesday would push the deadline to 2022 for many providers to obtain electronic health records in place in their practices and to get connected to the exchange.
With easy passage, it’s likely the bill will be approved by the full senate and sent to Gov. Cooper for his signature in time to beat that deadline.
Hise said the discussion has reiterated, for him, one of his concerns that the health care system overall separates treatment for the body from treatment for the head.
“This discussion pointed out… really how far we’ve got to go to integrate physical and mental health,” he said.
And he emphasized that the bill’s passage would only be a delay, not a complete reprieve. Hise pointed out that it’s not just North Carolina that’s pushing practitioners to get digitized and connected, most other payment systems will be requiring connectivity soon.
“You’ve got private insurance coming in the next few years that aren’t going to make payments unless you have the electronic health record and the Affordable Care Act mandates it in the future,” he said. “So while we’re a year or two ahead of those other mandates coming, if people look to the future of their practice, electronic health records and connected EHRs is going to be an investment they’ll have to make.”