Paper Social Work In A Digital World


It has been debated for years whether or not incentivizing the behavior of a person is a suitable practice to get him to do something or not.  Some behaviorists argue that incentives mean nothing – if a person wants to do something he’s going to do it whether or not he gets a reward.  Organizations are different.

HITECH Brings About a Digital World

Agencies, especially ones who operate under governmental budget constraints, must be
offered a reason to do something beyond: “You should.”  In 2009, the federal government enacted the Health Information Technology for Economic and Clinical Health Act (HITECH).  This act was part of the nation-wide stimulus package known as the American Recovery and Reinvestment Act.

HITECH’s purpose is to promote the adoption of health information technology in medical care.  The act works by incentivizing organizations to implement electronic healthcare records management systems.  Providers, such as doctors, cannot receive full payments just for adopting and electronic health records (EHR) system.  They must also show “meaningful use” of these systems.

Meaningful use means that these providers must show that adoption of an EHR has significantly improved the quality of care for their patients.  There are 25 metrics a provider must meet in order to be qualified as meeting the meaningful use standard.  These include demographic recordation, clinical summaries for office visits, and even smoking habits for any patient over the age of 13.

However, HITECH only offers incentives for adoption of EHR to select segments of the healthcare industry.  HITECH and the meaningful use incentives neglect to encourage behavioral health providers to convert to EHRs.

Incentives to Digitize Skip Some Segments

Under HITECH, the only behavioral healthcare providers eligible for incentives are psychiatrists and a handful of nurse practitioners.  However, this hasn’t stopped many behavioral healthcare providers from wanting to adopt EHRs or even doing so and wrestling with EHRs which are not set up for the type of care they provide.

Behavioral Health surveyed its readers earlier this year, and it reported that 79.5 percent of them reported using an EHR, but the costs of implementing an EHR are high, especially for smaller firms.  Incentives such as those provided through meaningful use and HITECH could mitigate many issues faced at the micro level of much of behavioral care, especially social work.

Paper Abounds in One Idaho Social Work Office

For Laura and her coworkers at a local behavioral services agency in Idaho, the cost of doing a paper business in a digital world are high.  Laura and her colleagues spend hours developing plans on paper for each client under their purview.

One client file, an Individual Support Plan, can take up to 10 hours, for which Laura is reimbursed only six hours by the state, and consists of:

  1. authorization (TSC/PD agreements, participant rights)
  2. the ISP itself and any addendums
  3. CSRs – written documentation of each job a TSC/PD completes for the participant (such as a visit)
  4. medical assessments
  5. assessment by the TSC/PD
  6. evaluations – developmental evaluations and the implementation plans
  7. information releases
  8. miscellaneous items – guardian documentation, budget appeals, etc.

These files must contain two years of information.  “We have an overflow file for each participant because that much information does not fit in their file,” says Laura.  On top of maintaining a current two-year file on each participant, Laura and her teams are required to maintain at least a seven-year archive for each participant as long as she is with the agency.  Only seven years after a participant has left the care of Laura’s agency can the file be shredded.

If the state agency to which Laura is contracted wishes to see this file, it must be faxed.  When asked why this was the preferred mode of transmittal, Laura responded: “I have heard it is safer regarding HIPAA to fax.”

Security of transmission is an issue for any healthcare provider when considering implementation of an EHR.  Is an EHR truly more secure than a fax machine?  Security among EHRs is a hotly debated issue.  Near the end of 2013, a Virginia health services provider had to inform nearly 1000 patients that their data had been breached continuously for four years by an employee of the organization.  Data breaches such as this are the most common kind –they usually occur because of error or improper training, not malice.

What EHR Can Do for Behavioral Healthcare

However, these types of security issues are rarer today, as EHRs are moving to much more secure lines, and even migrating to the Cloud.  Thus, not promoting their adoption is hamstringing behavioral healthcare workers such as Laura, who must spent hours at the fax machine sending files to their government principal.  In order to better organize the information she produces for her participants, Laura also spends hours creating her own secured digital files.  She houses these on a secure server which only she can access.

Laura uses this type of technology, since her agency cannot afford an EHR, because she has had computers crash, losing information.  The outside server also allows her to mitigate compliance errors, one of the main reasons healthcare and IT organizations have long pushed for EHR implementation.  EHR implementation has the potential to eliminate human error, thus improving compliance in all aspects of healthcare.

Asked to evaluate a handful of EHRs created specifically for behavioral healthcare, Laura was excited to find features specific to targeted behaviors in one.  A second has created solutions specifically for persons with intellectual and developmental disabilities.  “This makes my heart sing!” declared Laura.  “I couldn’t even imagine how nice it would be to have everything tracked in one place.  It would save time plus be able to see if services are being provided according to the plan.”

Until EHR adoption is incentivized in behavior and mental healthcare, Laura and colleagues will be left to their own devices.  Small-scale private agencies like the one for which she works bill their work to Medicaid and their contracting state agency, which also bills Medicaid.  These agencies don’t have the capital to implement EHRs without assistance from HITECH and the federal government.

Published by

H.E. James

H. E. is a writer and researcher living in Boise, Idaho, who has traveled throughout Europe and has spent countless hours in the car travelling the around the United States. She has a varied background, including education and history as well as journalism. She enjoys sharing her passions through the written word. She is currently spending many sleepless nights seeking her graduate degree but always sets aside time to enjoy a good cider. View all posts by H.E. James

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