Barriers persist in harmonizing EHR systems with substance use disorders

In terms of coordination of care and health information exchange, the treatment of substance use disorders (SUD) are not on the same level as mainstream health care. However, the development of harmonized electronic health record (EHR) systems could help level SUD coordination, according to a report by the National Institute of Health.

The first step is developing consensus-based standards germane to SUD screening, diagnosis and treatment options that are accepted by the federal government’s meaningful use criteria. The standards must have person-level information with data fields enclosing particular vocabulary relevant to SUD treatments.

The reason for the specific vocabulary is so they can be incorporated into harmonized EHRs — ones with standards that yield interoperability. “Specialty SUD treatment systems must implement EHRs that are interoperable with those of mainstream health care,” according to the report. Of course, this is contingent on the current hospital or practice would be using an EHR system — which is not always the case, as paper workflows persist in many medical networks.

One major benefit for of using an EHR system for SUD treatment is the ability for providers and pharmacists to collaborate, according to the report. With a goal of reducing unsafe drug-to-drug interactions, overdoses and even deaths, an EHR system could help organize the goals of prescription drug monitoring programs. As a result, it could enhance patient safety and decrease adverse events.

A second benefit is giving providers who treat SUD patients computerized decision support tools — that is, to present them with standard, evidence-based options for medical decision making regarding individual patients. Having evidence-based guidelines for decision making is helpful for SUD patients who are vulnerable.

Deployment is not without its challenges, though, as SUD treatments bring obstacles that differ from mainstream health care. SUD treatment programs require a certain level of “sophistication and computer literacy” in settings that range in “approach, goals, and size from inpatient detoxification to intensive drug-free outpatient care, to residential treatment, to office-based opiate replacement therapy settings, and so on,” according to the report.

From a technical perspective, whether or not an interoperable EHR in a single-source platform could function is questionable among many specialty settings. Security issues regarding “inbound and outbound firewalls” in disparate practices could pose a problem. Also, as software standards continue to develop for interoperability, maintenance costs could increase.

This is a predicament for SUD practices, which are often constrained in their ability to spend money on the necessary EHR infrastructure, preliminary training, maintenance and user support. Additionally, supporting and maintaining a harmonized EHR system among SUD facilities — regardless of available funds — is thorny based on the tendency of staff turnovers and agency reorganization.

It’s an uphill climb to deploy EHR systems with SUD terminology. Ultimately, in order to achieve a nationwide change for SUD treatment settings, that might be the only viable option. At the very least, it could level the playing field between mainstream health care coordination and SUD health care coordination.