Psychiatrists have lowest EHR adoption rate of all specialties

Yikes! I've been silent here for close to a year. This is what happens when you get used to the appeal of short-form blogging (twitter). But you can only say so much in 140 characters.

Anyway, I tweeted yesterday about the low rate of electronic health record (EHR) adoption among psychiatrists (7%) and @ShellyVAdams asked for a link; so here is a bit more detail. Jonathan Wolfe has a piece in Psych News coming out next week with more details.

The HITECH Act's funding for EHR adoption for eligible providers does not cover most mental health professionals (eg, social workers, psychologists, counselors, community mental health centers (CMHCs), etc), other than psychiatrists and some nurse practitioners. Because many psychiatrists practice in CMHCs, it is not surprising that the rate is lower.

Click on the image below to go to the original source (page 38):

FYI: The average for solo practice physicians in 2012 is about 30%.

Public Comment by Feb 4: ONC Health IT Safety Plan

ONC recently released its Health IT Patient Safety Action and Surveillance Plan for public comments, which are due by Feb 4, 2013. Comments can be sent to ONC.Policy@hhs.gov.

The report can be found HERE, as well as a brief Fact Sheet.  The report is related to the IOM's 2011 recommendations from Health IT & Patient Safety: Building Safer Systems for Better Care.

Highlights

Patient safety objectives

1. Use health IT to make care safer 
2. Continuously improve the safety of health IT

Increase the quantity and quality of data and knowledge about health IT safety

1. Make it easier for clinicians to report patient safety events and risks using EHR technology.
2. Engage health IT developers to embrace their shared responsibility for patient safety and promote reporting of patient safety events and risks. 
3. Provide support to Patient Safety Organizations (PSOs) to identify, aggregate, and analyze health IT safety event and hazard reports.
4. Incorporate health IT safety in post-market surveillance of certified EHR technology through ONC-Authorized Certification Bodies (ONC-ACBs).
5. Align CMS health and safety standards with the safety of health IT, and train surveyors. 
6. Collect data on health IT safety events through the Quality & Safety Review System (QSRS).
7. Monitor health IT adverse event reports to the Manufacturer and User Facility Device Experience (MAUDE) database.

Target resources and corrective actions to improve health IT safety and patient safety

1. Use Meaningful Use of EHR technology to improve patient safety.
2. Incorporate safety into certification criteria for health IT products.
3. Support research and development of testing, user tools, and best practices related to health IT safety and its safe use.
4. Incorporate health IT safety into medical education and training for all health care providers.
5. Investigate and take corrective action, when necessary, to address serious adverse events or unsafe conditions involving EHR technology. 

Promote a culture of safety related to health IT

1. Develop health IT safety priority areas, measures, and targets.
2. Publish a report on a strategy and recommendations for an appropriate, risk-based regulatory framework for health IT. 
3. Establish an ONC Safety Program to coordinate the implementation the Health IT Safety Plan. 
4. Encourage state governments to incorporate health IT into their patient safety oversight programs.  
5. Encourage private sector leadership and shared responsibility for health IT patient safety.

Meaningful Use Attestation by Psychiatrists

The ONC released a spreadsheet recently of all the eligible providers (Medicare and Medicaid) who attested to Stage 1 Meaningful Use (MU) of certified electronic health records (EHRs). I downloaded the results and did some pivot table magic to see which EHRs are being used by physicians identifying their specialty as "psychiatry."

There were 285 people who said they were compliant with Stage 1 MU. Interestingly, there were others who identified themselves in other ways. Three were "Community Mental Health Centers," even though HITECH specifically included them (but a doc there can attest, so I guess it's ok); they used Meditech and HCA. Five identified as "psychiatric" (Cerner, Design Clinicals, Siemens, and Wellsoft). And 16 as "psychiatric unit (Epic, Cerner, NextGen, McKesson, GE, HCA, Meditech, Midas+, Siemens). Here is data on the 285 identified as "psychiatry." If I get ambitious, I'll come back and hyperlink the names.

[edit 2/26: the links are in the Clinical Psychiatry News version of this article]

After discounting the large system products (eg, Epic, Cerner), you can get an idea about the EHR products being used in outpatient private practices.

Vendor Name	EHR Product Name	Total	% of all Psychiatrists
Epic Systems Corporation	EpicCare Ambulatory - Core EMR	129
	EpicCare Inpatient - Core EMR	2
Epic Systems Corporation Total		131	46.0%
Practice Fusion	Practice Fusion	22
Practice Fusion Total		22	7.7%
Cerner Corporation	Health Sentry	8
	Millennium Powerchart, Healthe Exchange, IQHealth, Health Sentry, Cerner Health	1
	Powerchart and Cerner Healthe	8
Cerner Corporation Total		17	6.0%
Allscripts	Allscripts ED	1
	Allscripts Enterprise E HR Modular	2
	Allscripts Enterprise EHR	2
	Allscripts ePrescribe	1
	Allscripts MyWay EHR	1
	Allscripts PeakPractice	1
	Allscripts Professional EHR	5
Allscripts Total		13	4.6%
Community Computer Service, Inc.	MEDENT	9
Community Computer Service, Inc. Total		9	3.2%
Valant Medical Solutions, Inc.	Valant Premium Psychiatric Suite	9
Valant Medical Solutions, Inc. Total		9	3.2%
DrFirst	Rcopia MU	8
DrFirst Total		8	2.8%
MedSeek, Inc.	eHealth ecoSystem	8
MedSeek, Inc. Total		8	2.8%
WellCentive	WellCentive Registry	8
WellCentive Total		8	2.8%
eClinicalWorks LLC	eClinicalWorks	6
eClinicalWorks LLC Total		6	2.1%
ICANotes, LLC	ICANotes EHR/EMR for Behavioral Health	6
ICANotes, LLC Total		6	2.1%
NextGen Healthcare	NextGen Ambulatory EHR	5
	NextGen Inpatient Clinicals	1
NextGen Healthcare Total		6	2.1%
McKesson	Medisoft Clinical	4
McKesson Total		4	1.4%
e-MDs, Inc.	e-MDs Solution Series	3
e-MDs, Inc. Total		3	1.1%
MedPlus, A Quest Diagnostics Company	Care360 EHR	3
MedPlus, A Quest Diagnostics Company Total		3	1.1%
UNI/CARE Systems, Inc	Pro-Filer(TM)	3
UNI/CARE Systems, Inc Total		3	1.1%
AmazingCharts.com, Inc.	Amazing Charts	2
AmazingCharts.com, Inc. Total		2	0.7%
Greenway Medical Technologies, Inc.	PrimeSuite	2
Greenway Medical Technologies, Inc. Total		2	0.7%
MedCPU Inc.	Meaningful Use Advisor	2
MedCPU Inc. Total		2	0.7%
Meditab Software, Inc.	IMS	2
Meditab Software, Inc. Total		2	0.7%
MTBC (Medical Transcription Billing Corporation)	MTBC-EHR	2
MTBC (Medical Transcription Billing Corporation) Total		2	0.7%
Nuesoft Technologies, Inc.	NueMD EHR	2
Nuesoft Technologies, Inc. Total		2	0.7%
Office Ally	EHR 24/7	2
Office Ally Total		2	0.7%
TheraManager LLC	MaestroMed	2
TheraManager LLC Total		2	0.7%
Waiting Room Solutions	2011 Waiting Room Solutions Web Based EHR and Practice Management System	2
Waiting Room Solutions Total		2	0.7%
ADP AdvancedMD	AdvancedMD EHR	1
ADP AdvancedMD Total		1	0.4%
athenahealth, Inc	athenaClinicals	1
athenahealth, Inc Total		1	0.4%
DrChrono.com Inc.	drchrono EHR	1
DrChrono.com Inc. Total		1	0.4%
GE Healthcare	Centricity EMR	1
GE Healthcare Total		1	0.4%
HealthFusion	MediTouch EHR	1
HealthFusion Total		1	0.4%
Henry Schein Medical Systems	MicroMD EMR	1
Henry Schein Medical Systems Total		1	0.4%
Ingenix	Ingenix CareTracker	1
Ingenix Total		1	0.4%
IOS Health Systems	Medios	1
IOS Health Systems Total		1	0.4%
iSALUS Healthcare	OfficeEMR	1
iSALUS Healthcare Total		1	0.4%
Medical Informatics Engineering	WebChart EHR	1
Medical Informatics Engineering Total		1	0.4%
SuiteMed	Intelligent Medical Software (IMS)	1
SuiteMed Total		1	0.4%
Grand Total		285

Hmm, the numbers are cut off. I placed this here in a Google Doc so you can see all the data.

IOM to Address Safety of EHRs

Scot Silverstein from the Health Care Renewal blog posted about IOM's recently announced contract with ONC to "identify best policies and practices for improving healthcare safety when using electronic health records."

"Perhaps these studies should have been initiated, say, ten years ago, or at least before the beneficence of health IT and its capacity to revolutionize medicine was openly promoted by the past and current Administrations (the current one going so far as to institutionalize penalties for non adopters)?"

The IOM consensus study, entitled "Patient Safety and Health Information Technology," will be conducted by NAS staffers Samantha Chao, Joi Washington, and Erin Wilhelm:

"The IOM will review the available evidence and the experience from the field on how the use of health information technology (HIT) affects the safety of patient care and make recommendations on how public and private actors can maximize the safety of HIT-assisted health care services. The IOM's final report will be both comprehensive and specific in terms of recommended options and opportunities for public and private interventions that may improve the safety of care that incorporates the use EHRs and other forms of HIT."

While I agree that this effort should have been done long ago, I am glad to see it being addressed. There is much polarization about whether EHRs are the best thing since sliced bread or the worst thing to hit medicine since managed care. Perhaps this IOM study will address both the pros and cons of EHRs from a provider's perspective (though I don't think any of the study staff are providers). Health care providers need to have a voice that can be heard by the vendors and governments when we find that given instances of EHR usability are inefficient or unsafe, and maybe this study will recommendations to address this current gap.