A critical psychiatric practice serving up to 500 patients daily is facing a crisis. This state-funded facility, dedicated to providing essential mental health services to a vulnerable population, is being strangled by technological limitations and data blocking practices.

The Data Blocking Dilemma

Data blocking, a practice prohibited by the 21st Century Cures Act, is significantly impacting the ability to efficiently manage patient care. Despite regulations aimed at promoting interoperability and data access, psychiatric facilities face substantial obstacles in scheduling and rescheduling appointments due to the lack of FHIR Workflow requirements in their current EHR/EMR system. This limitation not only affects their operational efficiency but also directly impacts patient care, especially for those with complex needs who require flexible scheduling options.

Limitations of Current EHR Standards

The facilty’s EHR system, designed specifically for psychiatric patients with diverse medical conditions and care plans, struggles to fit within the confines of current interoperability standards. The Office of the National Coordinator for Health Information Technology (ONC) has set standards for data export, but these standards fall short in addressing the unique needs of psychiatric practices3. Complex relationships and behaviors, crucial elements in psychiatric care, are not easily exportable via ONC standards, leaving critical gaps in our ability to provide comprehensive care.

The Need for Customized Solutions

Each office and practice team within healthcare organizations operate with a unique taxonomy, reflecting the specialized nature of psychiatric care. However, the current FHIR standards did not anticipate EHRs with such diverse and specific requirements. This mismatch between standardized data models and the realities of psychiatric practice creates significant barriers to effective data management and patient care coordination.

Vendor Limitations and Patient Care

The current EHR vendor, provides limited access to the data needed to innovate and improve patient care. The system is read-only and lacks APIs or other access points for patient-specific information crucial for external vendors to assist in patient care. This restriction severely hampers the ability to implement automated scheduling and engagement systems that would significantly benefit the poor and homeless patients.

The Impact on Patient Care

The consequences of these technological limitations extend far beyond administrative inconveniences. For vulnerable patient populations, the inability to efficiently schedule appointments and access comprehensive patient data can lead to missed opportunities for intervention and care. In psychiatric practice, where timely access to care can be critical, these barriers pose a serious risk to patient well-being.

A Call for Change

As healthcare providers committed to serving our community, we call for urgent changes in EHR standards and vendor practices:

1. Enhanced FHIR standards that account for the complexities of psychiatric care and diverse practice models.
2. Mandatory implementation of FHIR Workflow capabilities in EHR systems to facilitate efficient appointment management.
3. Greater flexibility from EHR vendors in providing API access and customizable data export options.
4. Recognition of the unique data needs in psychiatric care by regulatory bodies and standard-setting organizations.

The path forward requires collaboration between healthcare providers, EHR vendors, and policymakers to create systems that truly serve the needs of all patients, especially those in mental health care settings. Only by addressing these challenges can we hope to leverage technology to its fullest potential in saving lives and improving outcomes for our most vulnerable patients.