APA Concerned About Terms of Health Technology Law

Guidelines to implement a $17 billion incentive program aimed at encouraging the nationwide use of digital patient records could include barriers for psychiatrists. To avoid such problems, APA is encouraging federal regulators to issue rules that would allow the largest number of psychiatrists to qualify for incentive funds while limiting the number subject to Medicare penalties because they fall short of having a “qualified” digital record system.

Moreover, to achieve the broadest adoption of health information technology (HIT) by psychiatrists and other physicians, APA is advising regulators to ensure patient privacy and avoid burdensome requirements.

James H. Scully Jr., M.D., medical director of APA, outlined the Association's concerns about the proposed regulations in a June 26 letter to the HIT Policy Committee, a federal panel making recommendations to the Office of the National Coordinator for HIT. The coordinator is charged with implementing the federal law, which is part of the American Recovery and Reinvestment Act of 2009 (ARRA, PL 111-5). The APA letter followed earlier comments filed with those from the AMA.

The law aims to spur the use of HIT, which by definition includes the software and hardware needed to operate patient digital records, through equipment and service refunds available beginning in 2011 (Psychiatric News, March 20). The law also includes penalties for physicians who have not installed “qualified” electronic medical record systems by 2015.

Among the many issues with which regulators are grappling is how to determine whether a clinician makes “meaningful use” of a digital medical record system and so qualifies for federal funding to offset its cost.

“Since physicians will be required to demonstrate that they are participating in a 'meaningful use' of a certified electronic health record system in order to qualify for payment incentives under ARRA, it is of paramount importance that the terms be both clear and flexible,” Scully wrote.

One problem psychiatrists could encounter is a limited ability to use much of the e-prescribing feature of a digital record system because federal rules do not allow controlled substances to be prescribed through such systems. Limited use of e-prescribing may disqualify psychiatrists from the federal grants that cover some costs of the digital record systems.

Such regulatory details will be critical in determining which physicians will qualify for federal reimbursements of up to $44,000 over five years for their costs in implementing digital record systems.

Another of those issues is public disclosure of mental illness diagnoses. Although patient privacy is a strong desire in all areas of medicine, the lingering public stigma involving mental illness causes many patients seeking such care concern that their records may not remain confidential. To ensure strong protection of sensitive patient information, APA is urging early inclusion of technology that can segment “sensitive” information within the patient digital record. Regulators have planned to phase in such technological features slowly by 2015, instead of when the HIT funding program begins in 2011.

“While it may be burdensome for all providers to implement this heightened privacy feature that early, it may be difficult to retrofit this functionality after [digital record] adoption is widespread,” Scully wrote.

The need to speed up implementation of patient-privacy protections was echoed by Deborah Peel, M.D., a psychiatrist and board member of the organization Patient Privacy Rights.

“Instead of putting consumer control at the front, [regulators] are putting consent management at the very back,” Peel told Psychiatric News.

Final regulations for the program are expected later this year.

The APA letter is posted at<www.psych.org/MainMenu/AdvocacyGovernmentRelations/GovernmentRelations/APAontheIssues_1/RegulatoryComments/APA-Submits-Comments-to-HIT-Policy-Committee-on-Definition-of-Meaningful-Use.aspx>.▪