Treating drug addiction with drugs is nothing new.
Disulfiram, more commonly known as Antabuse has been around to help folks stop drinking since the 1920s…it makes the abuser sick if they drink. Methadone has been used for opioid treatment since the mid-1960s. These days, medications like Naltrexone are used to treat both opioid and alcohol dependence. The word is these drugs take the edge off the craving, which can be a key motivator to relapse.
A difficulty in the past has been in actually tracking the prescriptions and medical treatment associated with treatment. In the 1990’s I worked with Gus Johnson, who invented a low-cost, comprehensive software system that tracked methadone and other medication prescriptions and administration with a link to specific consumer records; everything from writing the doctor’s order to dispensing was handled by the software, automatically saving all treatment records. Since then, a few companies like Metha-Soft and SMART have been moderately successful, resulting in a number of specialty software programs that work just fine for these purposes. These software programs are very focused to the clinic environment, and may not seek certification required to participate in ARRA funding to pay for software upgrades.
Where are the affordable comprehensive Electronic Health Records (EHRs) for small agencies? It’s getting tough for a clinic to focus only on opioid treatment or just alcoholism, since clinics are becoming increasingly involved in associated behavioral health and physical health issues. Larger software companies with an enterprise approach to electronic documentation and workflow management are certainly available, some with associated addiction treatment functionality, while others may not see an advantage to developing all the special features required in addiction treatment. Playing in that ballpark usually involves developing a bundle of said development by the software company, plus screen design and reporting tools that come with the system. If that advantage isn’t available, professional organizations generally get stuck with a never-ending series of development fees. In either event, some skilled human being needs to get paid for the development (good news for MindHealthBiz, since that work is part of the business).
Enter the almighty dollar.
Today, addiction treatment for a high number of consumers is funded by Medicaid, and not as many, but some, by Medicare. As incentive to use the EHR, beginning in 2015, Medicare payments will start to decrease for treatment agencies not using a certified EHR in a meaningful way. Medicaid doesn’t seem to have the same across the board penalty, but Medicaid programs are in financial jeopardy. Medicaid payments may also be affected for consumers who also have Medicare coverage. The skeptic in me suspects the decreases pioneered by Medicare may follow in future Medicaid adjustments.
Decreasing funding makes it tougher still to pay for the software update required to deliver an effective EHR and billing engine to professionals with all the right functionality for outcomes tracking, billing, etc. All this functionality is great stuff that benefits the consumer, however it all costs money in one way or another.
The upshot of this discussion is that smaller agencies need certified Electronic Health Records in order to improve their technology and track prescribing of these new medications. Enterprise (software that handles all an agency’s data and reporting needs) EHR software vendors are in a rush to get certified, so they can quite simply stay in business. In order to do that, the software is required to have an electronic prescribing capability, along with the ability to share patient data with Regional Health Information Organizations, (RHIOs), Health Home networks (http://www.health.state.ny.us/health_care/medicaid/program/medicaid_health_homes/)and organizations providing or tracking care to consumers from multiple care providers. The kinks are currently being worked out regarding consumer confidentiality, and that will be successful, I have no doubt. Smaller, specialty software vendors like the companies mentioned above have quite a challenge ahead of them.
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