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SAMHSA News - November/December 2006, Volume 14, Number 6


Electronic Records: Health Care in the 21st Century (Part 1)

It's everyone's worst medical nightmare: an unexpected emergency forces you to get health care far from home. The providers know neither you nor your medical history. And they have no access to the records that contain crucial details about your conditions, past treatments, and current prescriptions.

To address this all-too-common problem, the U.S. Department of Health and Human Services (HHS) and other Federal entities are working on a 21st century solution: an electronic health record (EHR). This record is not only complete, it is accessible from anywhere.

But this system, envisioned by President George W. Bush to be fully operational by 2014, raises unprecedented technical and administrative challenges, and privacy and confidentiality issues. It also raises special concerns for people with mental health and substance abuse problems. This is where SAMHSA can help.

SAMHSA's focus is to make sure that the system includes features specifically designed for behavioral health consumers, caregivers, and providers. The Agency is collaborating with a broad variety of stakeholders in the behavioral health field.

SAMHSA's goal is to empower individuals receiving and providing behavioral health care to take full advantage of the opportunities created by the rapidly approaching era of electronic health information and also to receive the protection they deserve for their highly sensitive health information.

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Portable Health Information

The emerging system of electronic health records is part of an enormous change coming to the Nation's health care system. By bringing the latest information technology to health care, this process will also bring other important benefits. These include new levels of responsiveness, safety, and "transparency" in health care (see System Requirements). In addition, this new system promises cost-effective treatments for more people, fewer "wrong doors" to obtain behavioral health services, and far more consumer control over personal health care.

When the new electronic system of health records is in place, planners believe it will transform many important aspects of health care. "The HHS team is hoping that EHRs will help make health care more consumer driven," says Richard Thoreson, Ph.D., a public health advisor at SAMHSA's Center for Substance Abuse Treatment (CSAT) Division of State and Community Assistance. "As a result, current and potential substance abuse clients and mental health consumers may gain new prevention and treatment opportunities."

Paper records now used by the great majority of health care providers across the Nation sit in folders in a single medical office.

"Approximately 25 cents out of every health care dollar is spent on record-keeping and ‘administrivia,' " says James Kretz, M.A., a senior survey statistician at SAMHSA's Center for Mental Health Services.

Electronic health records, however, could be instantly available to any health care provider in the country. Instead of each professional or health care facility maintaining an individual record of visits and treatments, the EHR would contain a complete medical picture, letting all providers know about the entire range of conditions or prescriptions that could affect an individual's health or treatments.

Rather than accumulating pages of disorganized handwritten notes, the EHR would have electronic features that organize information quickly to provide the practitioner with the most important and relevant facts. The EHR would also have additional electronic features that could monitor care to make sure it's timely and appropriate, and it could warn about harmful interactions or other potential errors. And while the EHR protects the confidentiality of information, the system could also collect anonymous data to alert public health officials of a potential epidemic or bioterrorism incident.

Building a national EHR system requires solving a number of technical challenges. Some of the requirements have already been met, and others are in progress (see System Requirements).

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Behavioral Health Concerns

For EHRs to serve all those involved in mental health and substance abuse treatment—consumers, clinicians, administrators, and payers—information regarding behavioral health must fit seamlessly into the overall system. But, says Sarah A. Wattenberg, M.S.W., a public health advisor at CSAT, "the electronic health records that exist today are based on a primary care or medical model," and certain aspects of behavioral health care impose different requirements.

The projected national EHR system, therefore, must be designed to accommodate these features.

"Developing a consensus around standards in health information technology for behavioral health will influence the design of the overall national system," says Kevin Hennessy, Ph.D., SAMHSA's Science to Service Coordinator. "And that requires various segments of the field speaking with one voice to the larger community of experts working on system design."

To advance this goal, SAMHSA has convened the Behavioral Health Treatment Standards Work Group to provide a forum where key stakeholder organizations can discuss how best to advance mental health and substance abuse issues within the evolving national health information infrastructure. These issues include:

  • The need to assure the security, privacy, and confidentiality of the extremely sensitive behavioral health information stored in each person's EHR.

  • The need for information generated by and about behavioral health care to fit seamlessly into the larger national system of EHRs.

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