Electronic Health Records

Health informatics is the investigation and application of computing and other information technology (IT) to health care, health education, and biomedicai research. Primary uses of IT in providing health care are customized software designed for practice management; services integration through the use of regional computer networks for client referrals and provider communications; direct provision of services on computers in the form of interactive interventions for clients; providing information via Web sites or e-mails; and business management of, and quality assurance for, treatment modalities.

A key link in many of these IT applications in health care is the electronic health record (EHR), an extension of the electronic medical record out of the hospital or medical practice into the wider community health care environment where most substance abuse treatment occurs. The client health record is central to electronic practice management, referral networks, and quality assurance. The role of EHR in quality assurance is highlighted in the 1999 report issued by the Institute of Medicine estimating that up to 100,000 Americans die each year as a result of medical errors, more than of breast cancer or of motor vehicle accidents. One in every five of those fatal errors results from a lack of immediate access to patient health information.

The U.S. health care industry has been late in adopting IT compared to other economic sectors in the United States and compared to health care providers in other industrialized countries. For example, U.S. financial and banking services typically spend 5% to 6% of revenues on IT, whereas health care organizations spend 3% to 4%. Denmark provides universal health care to its citizens with most of their health information kept in a single system that can be accessed and updated by an individual's primary care doctor and other medical professionals. Despite a late start, U.S. spending on health care IT now exceeds $30 billion annually, and IT has achieved clear priority status in health care policy throughout all levels of government and in health care organizations.

Implementation of EHRs for clients receiving treatment for addiction entails several barriers beyond those that have slowed implementation in other areas of health:

• 1.
  The legal and regulatory environment for substance abuse services is more restrictive and complex.
• 2.
  Due to the social disapproval of substance abuse, confidentiality and security of health records are particularly critical.
• 3.
  Most substance abuse treatment is provided outside the main system of medical care.
• 4.
  Substance abuse is comorbid with mental and physical health problems as well as social problems, including homelessness, unemployment, interpersonal violence, and incarceration.
• 5.
  Many substance abuse clients as well as providers are on the wrong side of the "digital divide."

In terms of the regulatory environment, EHR for substance abuse clients requires significant additional efforts in terms of the Health Insurance Portability and Accountability Act (HIPAA) requirements, information security, client management regulations and procedures, mandatory reporting, and interface with the criminal justice system. The information that an individual is in treatment for addiction can affect employment, insurance, housing, social relationships, and other aspects of that individual's personal well-being beyond the addiction itself. Therefore, confidentiality [Page 358]is a paramount concern for clients who risk significant life losses if their addiction becomes known to people important in their lives.

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