Because most counselors have flown under the “meaningful use” radar so far, they may not be familiar with the term health information exchange (HIE). Moving forward, however, it will be important for counselors to educate themselves because the model for provision of care in the United States continues to move toward that of interoperability and integrated care. In this article, I discuss the basics of HIE and the reasons that counselors need to understand it.
The picture of how HIE came about is complex. It developed over many years and includes previously existing Medicare and Medicaid programs, programs created by the Affordable Care Act, as well as the Health Information Technology for Economic and Clinical Health (HITECH) Act. The overarching goal that resulted in the genesis of HIE was that of interoperability as a critical component of improving the quality, efficiency and safety of health care delivery while reducing its overall costs.
As described on the HealthIT.gov website, interoperability is generally accepted to mean the ability of two or more systems or components to 1) exchange information and 2) use the information that has been exchanged.
The promise of interoperability is that health care providers can readily share and use each other’s information in the provision of services. This means that if you visit your primary care physician (PCP), who then sends you to a specialist, that specialist should be able to receive your records from your PCP before you arrive. In other words, there is no need for you to cart your records around and report the entire story over again. There is no need to repeat tests that have already been completed. This also means that in emergency situations, a hospital should be able to quickly access your medical history and know exactly what medications you are currently taking.
From a big-picture standpoint, interoperability also means that data can be aggregated more quickly and effectively to track things such as outbreaks of the flu or other illnesses. These are just a few examples of the benefits of interoperability, but they illustrate why it is considered critical to the mission of the Affordable Care and HITECH acts.
The Meaningful Use program and HIEs
How critical is interoperability? In 2010, the State Health Information Exchange Cooperative Agreement Program was created, which led to $548 million being awarded to states for the purposes of establishing and improving state-managed HIEs. In April 2015, Congress declared it “a national objective to achieve widespread exchange of health information through interoperable certified EHR [electronic health record] technology nationwide by December 31, 2018.”
The Meaningful Use program was created to provide incentives for EHR adoption by eligible professionals. The program also includes reimbursement penalties for those who do not participate. (For more, see tameyourpractice.com/blog/meaningful-use-and-mental-health-professionals.) Although the Meaningful Use program tasked providers with adopting EHRs that could exchange information, that process has been slow, and it is not always efficient or effective. In addition, counselors have not been included in the incentives or penalties for meaningful use (the same holds true for all mental health providers apart from those who prescribe medications).
HIEs are meant to speed up the achievement of interoperability while also filling in gaps and providing a central repository of records. Providers who haven’t fully achieved the ability to exchange information with other providers can at least provide it to the HIE. For example, rather than a hospital having to query multiple providers for records, it can query just one system, the HIE, to get vital information about a patient. The time savings in emergency situations can also save lives.
Implications for counselors
So, if counselors haven’t been a part of meaningful use, why do we need to pay attention to it? The fact is that despite of our exclusion from the Meaningful Use program, the national engine pushing for all health care providers to achieve interoperability has still been running. States have been incentivized to help move that engine along too, and their ability to continue to fund their programs is attached to milestones.
To that end, states are increasingly enacting measures requiring participation in HIEs or other programs in an effort to achieve widespread interoperability. For example, here in North Carolina where I am located, participation in HIE has been mandated for any health care provider receiving state funds. This includes not only those who accept Medicaid, but also those who work with employees of the state (through a plan currently managed by Blue Cross Blue Shield of North Carolina). As of this writing there are over 700,000 people in North Carolina dependent on the State Employees’ Health plan and almost 2 million Medicaid recipients. Counselors will be able to continue serving those clients only if they meet the HIE mandate deadlines (currently June 1, 2018, for Medicaid and June 1, 2019, for state employees).
Other states have or are pursuing similar measures. The following website links to each state’s respective HIE website so that counselors can stay up to date on developments: healthit.gov/topic/onc-hitech-programs/state-health-information-exchange.
Before proclaiming, “I don’t accept insurance” and turning the page, read on. In some states (such as Minnesota), mandates have been applied to all providers, regardless of how payments are received. (Minnesota’s mandate has since been amended to provide some exceptions and currently carries no penalties.)
Perhaps more important, as other providers experience the benefits of efficient and timely exchange of health information, they are looking to partner with other providers who already possess this capability. In the future, providers who cannot exchange health care information through their EHRs or HIE may find themselves receiving fewer referrals from other health care providers. This same effect may also be experienced with clients as they begin to understand and appreciate the value of having all of their health care data conveniently accessible in one location, most likely through their PCP.
The momentum for EHRs and interoperability is also being bolstered by other initiatives, including reimbursement based on outcomes. As part of the Affordable Care Act — and currently primarily associated with the Medicare Access and CHIP Reauthorization Act of 2015 (see tinyurl.com/MACRA2015) — is a move toward merit-based payments for providers, as opposed to the current service-based payments.
In a merit-based payment program, providers are paid more when achieving efficient, effective outcomes instead of being paid for providing individual services. In other words, providers are incentivized to work harder to help clients achieve positive outcomes rather than “rack up charges” by providing multiple services. Participation in these programs currently requires a data management system that can not only track but also report outcomes electronically. It is likely that similar programs will find their way into the commercial insurance market and beyond in the future.
Exploration of this topic would require an article of its own. I bring it up here to note that the forces behind this movement — and their reasons for pushing for all health care providers to use electronic records and achieve interoperability — are myriad and regularly making progress.
These topics take on additional weight when combined with other initiatives. For example, we can strengthen our argument that counselors should be able to join the ranks of mental health professionals who provide services for Medicare recipients if we demonstrate an understanding of current reporting and reimbursement policies.
As the world becomes further steeped in technology, it is important that counselors keep up. This will allow us not only to keep pace as providers and businesspeople but also to better serve our clients.
- I recently did a webinar with the American Counseling Association titled “Private Practice: Choosing a Best-Fit EHR” (see aca.digitellinc.com/aca/sessions/10741/view). It was telecast May 16 and is now available on demand. In the webinar, I explain how counselors can select electronic practice management resources to meet the unique needs of their practice and explore how to avoid costly mistakes.
- Are you considering an EHR to meet your technology/HIE needs? Be sure to check out the freely available reviews on my website at tameyourpractice.com/EHRReviews.
Rob Reinhardt, a licensed professional counselor supervisor, is a private practice and business consultant who helps counselors create and maintain efficient, successful private practices. Before becoming a professional counselor, he worked as a software developer and director of information technology. Contact him at firstname.lastname@example.org.
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