Congress Hears Psychiatrists' Electronic-Records Concerns

Although nationwide expansion of health information technology (HIT) is welcomed by physicians, many will hesitate to adopt such digital systems until privacy and cost concerns are addressed, an APA official told a congressional panel.

Robert Plovnick, M.D., M.S., director of the APA Department of Quality Improvement and Psychiatric Services, testified before the House Small Business Committee on July 31 about lingering concerns of psychiatrists and other physicians that are limiting their switch to HIT systems, such as electronic health records (EHRs).

“Protecting and strengthening the confidentiality of the patient-physician relationship is critical to providing the highest-quality medical care,” Plovnick noted in written testimony he submitted to the committee. “This is particularly true with respect to psychiatric care because of ongoing inequities in insurance coverage, employment discrimination, and social stigma for people with mental illness.”

Plovnick spoke during the committee's hearing on ways the federal government could address barriers to the use of EHRs in “small specialty practices.” Also testifying were spokespersons for organizations representing neurosurgeons, pediatricians, ob-gyns, and primary care physicians.

The hearing was the latest effort by government health care policymakers to spur use of EHRs and other digital record systems, since a growing body of research has indicated that significant cost savings and safety improvements are likely to result from widespread HIT adoption.

Continuing physician concerns about privacy and costs, however, have been major barriers to broad HIT adoption. Only about 12 percent of physicians have adopted HIT systems, according to the Congressional Budget Office. A study published online June 18 in the New England Journal of Medicine found that only 4 percent of physicians had adopted fully functional EHRs, and those who had tended to be in larger practices (Psychiatric News, August 1).

“The majority of Americans rely on small practitioners, so it only makes sense that they should benefit from advances in information technology to better serve their patients,” said Rep. Nydia Velazquez (D-N.Y.), in a written statement. “And yet only a handful of them use electronic health records because of the high costs, privacy concerns, and manpower demands associated with these systems.”

Adoption of HIT systems has been limited by continuing concerns about the safety of patient information stored and transferred digitally. The sources of privacy concerns include a 2006 report from the Government Accountability Office that highlighted “significant weaknesses in electronic access controls and other information system controls” within the Department of Health and Human Services including the Centers for Medicare and Medicaid Services.

Such security weaknesses have a larger impact in highly sensitive areas of medicine, such as psychiatry, where patients may be discouraged from seeking treatment or sharing information due to concerns that their information will be improperly disseminated. Effective mental health treatment, as is the case in other medical areas, often requires patients to share sensitive information such as sexual, drug use, or pregnancy history, and HIV status, Plovnick said in his testimony.

“If confidentiality cannot be assured, patients will be reluctant to share information that is critical for their care,” he said.

Another factor limiting HIT adoption is the high cost of such systems. Plovnick testified that a significant percentage of APA members are in solo private practices in which the up-front costs of implementing a HIT or EHR system present a considerable barrier. Cost estimates for implementing office-based EHR systems vary widely among studies, ranging from $25,000 to $45,000 per physician, according to a July Congressional Budget Office (CBO) report. The CBO report also showed that subsequent annual costs for maintaining the system range from $3,000 to $9,000 per physician each year.

“Psychiatrists involved in solo practice—a significant percentage of APA members—often have little or no administrative support staff, further increasing the physician's responsibilities with regard to selection, implementation, and maintenance of the system, and decreasing the time available for clinical care,” Plovnick said.

He noted that psychiatrists have told APA about their financial challenges and privacy concerns through its Corresponding Committee on Electronic Health Records and Corresponding Committee on Confidentiality.

The federal government could address physician concerns over HIT adoption through several steps, such as making privacy the cornerstone of any national HIT effort, Plovnick said. APA also is urging the provision of financial incentives, such as grants, to help practitioners in solo or small-group practices cover the costs of hardware and software.

Congress is considering several HIT bills, including one (HR 6357) that would authorize $115 million in grants and loans annually through 2013, with special provisions for providers in small practices and those in underserved or rural areas. The bill was passed by the Energy and Commerce Committee on July 23.

Plovnick noted APA is concerned that a leading Senate HIT measure (S 1693) lacks strong and consistent privacy and security provisions and “may in fact inadvertently threaten privacy.”

Testimony presented by Plovnick and others to the Small Business Committee is posted at<www.house.gov/smbiz/hearings/hearing-7-31-08-records/hearing%20witnesses%20records.html>. Leading HIT legislation can be accessed at<http://thomas.loc.gov> by searching on the bill numbers, HR 6357 and S 1693. ▪