EHRs for Prescribing Health Clinicians
Behavioral and mental health providers perform a wide range of services for their patients, in some cases including prescribing medication. Prescribers in this field face different challenges than those in the medical field, and for that reason need an electronic health record (EHR) system specifically tailored to the needs of psychiatrists and nurse practitioners.
Understanding the benefits EHRs provide to mental health clinicians is the first step in improving patient care and choosing the right health information technology to use in your practice.
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What Is a Prescribing Health Clinician?
Broadly speaking, a prescribing health clinician is anyone authorized to write prescriptions for medication. This includes professionals in any setting, including pain management, family medicine, rehabilitation medicine, internal medicine and more in addition to psychiatric and behavioral health prescribers.
Those prescribing mental health medications face some challenges other prescribers typically do not. One of the unique challenges is that these clinicians are almost exclusively prescribing psychotropic medications, which are typically closely monitored at a state level by a prescription drug monitoring program (PDMP).
Each state has its own PDMP, except for Missouri, and each state's reporting requirements differ. Pennsylvania's requirements, for example, mandate that every licensed prescriber register with the state PDMP and report on all prescriptions of controlled substances from Schedule II through Schedule V. In contrast, Nebraska's PDMP was totally voluntary and only collected data on emergency room visits until 2018, when it became the first state to require that every prescription be reported to the program.
Prescribing mental health clinicians also face the challenge of needing robust documentation to receive proper reimbursement for their services. As mental health treatment with medication is less linear and more nuanced than treatment of a physical ailment, providers must be as thorough as possible in documenting the outcomes of each course of medication.
Different Types of Behavioral Health Clinicians
There are significant restrictions on who can prescribe mental health medications. Psychologists, for example, can only prescribe medication in five states:
- New Mexico
The following clinicians can prescribe psychotropic medication and should become familiar with behavioral health EHRs that can integrate with various PDMPs.
Psychiatrists have the highest level of training. They are licensed doctors of medicine or doctors of osteopathic medicine, and complete residency training in the field of psychiatry. Psychiatrists can provide the full range of mental health care from diagnosis to therapy, prescriptions and medication monitoring.
EHRs allow psychiatrists to create detailed documentation that supports their clinical decisions, including prescribing medications as well as other courses of treatment. A robust EHR comes into play during every stage of treatment and can improve practice management by providing more efficient workflow options. When used efficiently, an EHR improves care by:
- Reducing the time and effort spent on documentation.
- Providing near-instant access to more complete patient records.
- Communicating seamlessly with other medical providers.
An EHR with a patient portal provides the opportunity to engage better with patients. They can view their own health information, send and receive messages and sometimes even schedule appointments through the portal for greater convenience.
Psychiatric Nurse Practitioners
A psychiatric or mental health nurse practitioner (NP) can perform many of the same functions as a psychiatrist. These clinicians must have a Master of Science (MS) or Doctor of Philosophy (Ph.D.) in nursing with a specific focus in psychiatry. They can perform assessments, establish diagnoses and provide therapy.
NPs can prescribe medications in all 50 states as well as the District of Columbia, but the independence with which they can do so varies greatly by state. There are 22 states where NPs have "full practice authority" and can prescribe without supervision from or collaboration with physicians. In the other states, some level of consultation with a physician or psychiatrist is required.
Mental health NPs in states without full practice authority rely heavily on communications with supervising psychiatrists. EHRs make that communication more seamless by allowing NPs to share and request information on patients to whom they are prescribing mental health medications.
A psychiatric pharmacist is a type of advanced-practice pharmacist, specializing in the delivery of mental healthcare. Clinicians certified by the Board of Pharmacy Specialties are trained to:
- Design, implement, monitor and modify patient treatment plans.
- Provide education to patients and healthcare professionals.
- Provide leadership in improving the health of people with mental illnesses.
Psychiatric pharmacists are focused on medication management. They are often sought out when a patient has a complex medication regimen that requires careful monitoring. A psychiatric pharmacist evaluates how patients respond to treatment with mental health medications, and makes adjustments to the treatment plan to optimize its effectiveness.
In cases of multiple medication management, psychiatric pharmacists must have as much information about the patient as possible to avoid possible drug interactions. Working with an EHR for integrated behavioral health allows these clinicians to see all of a patient's relevant history in one place, giving them the information needed to prescribe as safely as possible.
What Is E-Prescribing?
For most of medical history, prescriptions have been written out on slips of paper. This approach comes with multiple disadvantages, with a huge one being the tendency toward illegibility. In its most basic definition, e-prescribing is simply a means of creating and sending prescriptions electronically. However, e-prescribing benefits have expanded as technology advances. The following are tangible benefits prescribing clinicians can enjoy by switching to eRx prescriptions.
- Preventing errors: Illegibility leads to a significant chance of a patient receiving the incorrect drug or dosage. E-prescriptions are clear-cut and can eliminate callbacks for clarifying questions from the pharmacy.
- Improving clinical support: E-prescribing platforms can help prescribers create the right eRx prescription by requiring clinicians to fill out fields for the dosage, frequency, strength and route of the medication and suggesting the most common combinations.
- Increasing reconciliation speed: The prescribing clinician can see, at a glance, a patient's medication history and the software can typically flag drug interactions before they ever happen.
- Tracking fulfillment: When a patient receives a handwritten prescription, there isn't a way to determine whether the prescription was actually filled. With eRx prescriptions, clinicians can track fills and refills to help patients better manage their medication.
- Reducing lost prescriptions: It's not uncommon for patients to simply lose a paper prescription before filling it. E-prescriptions are sent directly to the pharmacy, eliminating this time-consuming issue.
- Improving PDMP reporting: Clinicians can use e-prescribing software to determine how many controlled substances a patient is taking, reducing the chances of prescribing too much medication and making it harder for patients to go doctor-shopping.
E-prescribing has benefits for patients, too. They can feel safer knowing that their prescribing clinician has all the information necessary to make effective prescribing choices, but they also have a better experience thanks to the electronic transfer of the prescription. Typically, a patient has to wait around after their appointment for a clinician to write or type out the prescription. Then they have to take the prescription to the pharmacy, where they wait around some more. When clinicians create eRx prescriptions, the process of creating the prescription is quicker, and the prescription is automatically sent to the pharmacy so patients can receive their medication more conveniently.
Since the introduction of the Health Information Technology for Economic and Clinical Health (HITECH) Act in 2009, there have been a variety of related incentive programs designed to encourage the adoption of e-prescribing and other health IT. The current program prescribing practitioners can participate in is the Merit-based Incentive Payment System (MIPS). One of its quality measures is the Promoting Interoperability category. Clinicians can earn points for demonstrating meaningful use of EHR technology certified by the Office of the National Coordinator for Health Information Technology (ONC).
To earn points in the Promoting Interoperability category, clinicians must create and transmit prescriptions electronically. Bonus points may be awarded for using certified EHR technology (CEHRT) to query the relevant PDMP for the prescription of Schedule II opioids and for verifying opioid treatment agreements.
EHR Requirements for Prescribing Practitioners
In response to the opioid epidemic, almost all states have current or planned mandates regarding e-prescribing that prescribing mental health professionals must follow. Each state differs as to when its mandate began or will begin, and what it requires prescribing clinicians to do. Here are five examples of e-prescribing requirements.
- Arizona: Will require e-prescribing for all Schedule II opioids starting in 2020.
- California: Will require e-prescribing for all prescriptions starting in 2022.
- Minnesota: Has required e-prescribing for all prescriptions since 2011, but has no penalties for non-compliance.
- North Carolina: Will require e-prescribing for certain targeted controlled Schedule II and Schedule III substances starting in 2020.
- Pennsylvania: Has required e-prescribing for all controlled substances since 2019.
On the federal level, the SUPPORT for Patients and Communities Act (H.R. 6) will require the use of e-prescribing technology for all controlled substances prescribed under Medicare Part D starting in 2021. It's essential for all prescribing mental and behavioral health professionals to implement an EHR that integrates with e-prescribing technology.
EHRs With Integrated E-Prescribing
For truly integrated behavioral health services, prescribing clinicians need an EHR that comes fully integrated with a trusted e-prescribing solution. Many incentive programs, state and federal law require e-prescribing, and it can dramatically improve the accuracy of prescriptions. Although it is possible to use both an EHR and a separate e-prescribing software, there are some compelling benefits to using an integrated solution.
Seamless Error Detection
When your EHR is connected directly to your e-prescribing solution, all the information the program needs to check for errors is already present in the system. There is no wait time for information from the EHR to migrate to the e-prescribing software, so you can be instantly notified of any drug interactions or other red flags in your patient's medical history. This also eliminates the need to spend excessive time looking through patient records to find interactions or errors manually, saving time and uncertainty in the process of prescribing mental health medications.
A certified EHR integrated with e-prescribing software helps give you peace of mind on the compliance front. Because all the information is being transmitted within a HIPAA-compliant system, you don't run the risk of making a compliance mistake in transferring protected health information (PHI).
In terms of compliance with PDMP requirements, integrated e-prescribing software can either automate the process of reporting or make it significantly easier to transmit the required information to your state's monitoring program.
Implementing new technology solutions is always a big investment, no matter the size of your practice or healthcare organization. EHRs with integrated e-prescribing work somewhat like a "bundle," where packaging two products together results in a lower cost to you. Additionally, the improved efficiencies in your workflow will result in better productivity and more time to treat more patients.
The Best EHR for Prescribing Clinicians
Selecting an EHR as a behavioral health clinician can seem challenging, especially with the extra requirements you face if you are a prescriber. ICANotes is the leading EHR designed specifically to meet the needs of prescribing clinicians in all areas of practice, including documentation, billing, coding and optional e-prescribing integration. Instead of struggling to work within the confines of an EHR designed for doctors, you can work with a platform that is fully customizable and tailored to the provision of behavioral health services.
ICANotes is integrated with the award-winning DrFirst EPCS Gold e-prescribing system, allowing prescribing clinicians to optimize workflows, increase practice efficiency and boost overall productivity. To find out more about how the extensive capabilities ICANotes will change the way you practice and prescribe, see it in action with a live demo or experience it yourself with a free trial.
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