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The Behavioral Health EMR Landscape: A Rough Road

KLAS is days away from publishing its first report on behavioral health EMRs, so I’ve looked at the market’s average scores compared with other markets that KLAS monitors, and the results aren’t pretty. In fact, behavioral health is the second lowest of all software markets we track. Clearly, there are some big hurdles to overcome.

Eventually, I compared behavioral health scores with the acute care EMR market to see whether I could compare apples to apples. It seems―in a surprise to no one―that EMRs in general don’t rate very well with providers, but behavioral health EMRs are rated the lowest among EMRs.

What’s Driving the Dissatisfaction?

While provider frustrations stem from a myriad of factors, much of their angst boils down to money. Behavioral health providers don't have the same budget size as hospital systems or even primary care physicians. The slim margins of behavioral healthcare mean practitioners can't afford fancy (read: expensive) systems.

This means the solutions that do exist to meet behavioral health providers’ needs must work within those tighter margins. For example, vendors can’t provide expensive white-glove support. These mental-health-specific vendors also can’t spend as much money on R&D and then pass that cost on to customers. Many multispecialty vendors have to adjust their pricing for behavioral health to even be considered.

In many ways, looking at the behavioral health market feels a bit like stepping back in time. The vendors just aren’t as developed as their physical-care counterparts. This is also true for providers who are adopting technology to replace their paper records for the first time.

Many providers have been using traditional EMRs that they've tweaked to meet their needs. For these early adopters, it’s hard to justify a switch to a behavioral-health-oriented platform. They worry that tailor-made tools will cost more with no guarantee that they will do anything different from their MacGyvered EMRs.

Making Do with What We’ve Got

Tweaking a traditional EMR is necessary given the unique requirements of mental healthcare. One example (of many) is that it’s unlikely your primary care physician will ever be seeing multiple patients all together in the same room. Yet group therapy is common in behavioral health, and for providers trying to capture that in an EMR, it can sometimes feel like a nightmare.

In spite of these difficulties, I don't often hear, "We're missing functionalities in our clinical workflow."  Unfortunately, that sentiment doesn’t carry over to the billing side of behavioral health. While not the focus of this upcoming report, providers frequently brought up the pain of state reporting. Anyone trying to get access to Medicaid dollars must meet different requirements for each state. Because of this, vendors struggle to keep up with regulations, often exclaiming, "Oh, California made another change. And look! New York made another change." These unending shifts in regulation―often on tight deadlines―mean vendors can’t dive deeply into compliance, especially if they don't have a lot of customers in a given state.

Where does Behavioral Health Stand?

I spoke with a behavioral health practitioner, who told me, “You know, we're used to having to scrap for everything. We're used to being left out of the key conversations. We're just used to it.”

Behavioral health providers understand that they’re stuck on older technology. They know their margins are slimmer, and they’ve grown accustomed to the healthcare culture of America excluding them from the conversation. Thankfully, in some ways that is changing, albeit slowly. Hopefully, as KLAS continues to measure the vendors in this space, we can help alleviate some of the pain points that impact behavioral health.