Substance Use Disorder Facilities See Low EHR Adoption Rates

Substance use disorder facilities are behind mental health facilities in EHR adoption rates, according to a study published in ScienceDirect’s Drug and Alcohol Dependence.

However, neither type of facility uses the EHR only. In other words, both substance use disorder and mental health facilities use a mix of EHR and paper note documentation. No more than 25 percent of either facility type in any state across the country reported exclusive EHR use.

Following the HITECH Act’s meaningful use program, EHR adoption increased in both outpatient (85.9 percent in 2017) and inpatient (96 percent in 2017) settings across the country, according to the National Coordinator for Health Information Technology (ONC).

However, according to the study authors, EHR adoption has been slower among mental health facilities, with less than half of psychiatric hospitals reporting certified EHR use in 2016.

While substance use disorder (SUD) treatment can transpire at both SUD and mental health facilities, these two treatment systems are consistently separate when it comes to EHR adoption and barriers. For example, SUD facilities historically face funding and regulatory challenges that differ from MH facilities.

“One factor for this may be cost which is relatively higher in SUD services due to relatively smaller size of these facilities,” explained the study authors. “There are also technical reasons, including lack of SUD-specific common data elements (such as integration of screener and assessment tools), lack of standardized vocabulary, and limited data segmentation (i.e., walling off certain portions of the records) into some EHR systems.”

The research team utilized data from the National Survey of Substance Abuse Treatment Services Survey (NSSATS) and the National Mental Health Services Survey (NMHSS) to evaluate EHR use prevalence at SUD and mental health treatment facilities.

The group of researchers analyzed and compared this data in five stages between the two facilities:

• EHR adoption and exclusive EHR use for both clinical and administrative purposes
• EHR use for clinical use based on the geographic distribution
• EHR use across the two facilities by state
• EHR use for clinical purposes comparing various facility characteristics
• Using and comparing 2017 NSSATS and 2018 NMHSS data, along with 2017 SUD facility data to 2016 MH facility data

When looking at facilities that utilize a mix of EHRs and paper records and those that strictly use EHRs, the study showed significantly less EHR use at SUD facilities compared to mental health treatment facilities.

Less than 25 percent of facilities reported exclusive EHR use for clinical activities, such as laboratory monitoring, prescriptions, and progress notes.

There was also a wide variability among separate levels of EHR use and adoption, with less than a quarter of either facility reporting exclusive EHR use for clinical activity.

Being an inpatient facility, having Joint Commission accreditation, being a private-for-profit, or a public facility were significantly connected to sole EHR use for clinical activities, wrote the study authors. SUD facilities had a stronger association than mental health treatment facilities.

Medicare acceptance was also associated with exclusive EHR use for clinical activities across both facilities and private insurance acceptance was only accepted at SUD facilities.

“Transition to EHR use among US SUD facilities lags behind MH facilities,” concluded the study authors.

“Exclusive EHR use for core clinical activities, a major goal of the recent push for EHR adoption, remains elusive for both types of facilities, with no more than a quarter of facilities in any state reporting such use. Closing this gap may be challenging due to federal regulatory and interoperability barriers. However, certain regulatory and funding initiatives may potentially have a role in overcoming such barriers.”