The Switch to EHR: What You Need to Know

Trusandra Taylor, M.D., M.P.H., FASAM, discusses the future of EHR.

Trusandra Taylor, M.D., M.P.H., FASAM, discusses the future of EHR.

The workshop “The Interface of Electronic Health Records and Addiction Medicine: What You Should Know and How It Will Affect Your Practice,” gave an overview of electronic health records (EHR), advice for switching over, and a review of confidentiality and legal issues. Oh — and the knowledge that it won’t be so bad.

“Once you do it, you’re never going to want to go back to paper,” said Richard N. Rosenthal, M.D., Chairman, Department of Psychiatry, St. Luke’s Roosevelt Hospital Center, New York.

As of 2008, 44 percent of physicians were using EHR for billing, but less than 10 percent had full, comprehensive systems. Now there are incentives and federal assistance centers to help practitioners switch.

Trusandra Taylor, M.D., M.P.H., FASAM, Medical Director, JEVS Human Services, Philadelphia, explained that providers could get incentives to adopt EHR-certified technology. The Medicare incentive provides up to $44,000; the Medicaid incentive up to $64,000. Both amounts are available this year and next, and the incentives change in subsequent years.

An audience member advised not trying for the incentive this year if you don’t already have a system that can easily be adapted or upgraded. Instead, aim for October 2012.

Providers who need assistance in adopting EHR can contact one of the 62 Regional Extension Centers set up by the U.S. Department Health and Human Services, or get information online at

Dr. Taylor noted the distinction between Electronic Medical Records — which are legal records of the provider and do not contain info from other providers — and Electronic Health Records, are owned by the patient, can contain information from multiple providers, and are a subset of each provider’s EMR.

Who owns the medical information in electronic records is a gray legal area. Dr. Rosenthal explained that historically, clinicians and insurers owned the container — the paper — and patient had the right to see it and correct it. Now, “It’s a trickier business. HITECH (Health Information Technology for Economic and Clinical Health Act) doesn’t resolve who owns the information, nor does federal, state, copyright. or patent law,” he said.

Dr. Rosenthal gave advice on how to evaluate EMR/EHR vendors. He said major components of the records system should be based in your institution’s operating system; contain state of the art security; and be customizable, with a flexible database you can tweak.

“You need to be able to control your data,” he said.

Most importantly, the system must let you bill with ICD-10. “Come 2013, everyone’s going to be coding with ICD-10 — if you don’t, you won’t get paid.”

Dr. Rosenthal also discussed how the issues of confidentiality and disclosure relate to electronic records and addiction medicine.

Addiction treatment programs are HIPAA-covered entities and must abide by the privacy rule — and they also fall under 42 CFR.

Dr. Rosenthal elaborated on 42 CFR. “It’s super-confidentiality. It requires that providers of addiction medicine be held to higher standards of confidentiality than psychiatric records, far higher than general medical encounters.”

In answer to an audience question, Dr. Rosenthal gave an example of how a certain treatment might be handled, records-wise.

“So with a patient getting treatment for hepatitis, their expectation is medical treatment, not addiction treatment. So it’s not covered by 42 CFR, but ‘Yes’ on HIPPA.”

However, he said if you’re giving suboxone treatment, then that’s under 42 CFR, and you have to get them to fill those out. “It’s a pain, but welcome to the 21st century.”