Testimony before the Health Information Technology Policy Committee

							Testimony before the Health Information Technology Policy Committee
Tuesday, October 27, 2009

Hello, my name is Christina VanRegenmorter, and I am with Centerstone Research Institute, a non-profit
that works to discover the most effective research-based practices for behavioral health disorders & to
increase the dissemination of these practices within Centerstone, the largest provider of community
mental health care in the United States and throughout our industry. Thank you for devoting this week’s
meeting to considering the needs of safety net and non-physician providers of healthcare.

I am here to ask that you consider the limitations of a national health I.T. structure that does not include
most community mental health providers. As a family caregiver for someone with multiple physical and
mental disabilities, I am personally familiar with the consequences of the lack of interoperable mental
and physical health records. It has been very costly to my family and to many others across the nation.
Currently in the U.S., mental illness is the second biggest contributor to disability adjusted life years1
exceeding the burden of cancer and all respiratory ailments. Just major depression alone is the 2nd
leading source of disease burden on our economy and alcohol use is 4th .

The crisis in the U.S. mental health system has many causes, but in order to start solving the crisis, all
mental healthcare providers need to have access to fully interoperable health information technologies
(Health IT). A nationwide survey of 440 behavioral health organizations conducted by my organization
found that currently, less than half of community mental health centers have fully implemented clinical
electronic record systems. Even more alarming, only 8.2% of community mental health providers
surveyed have systems that are interoperable with medical & primary care systems and the survey
showed that the primary barrier to implementation is the cost of Health IT.

Health information technology is a key component of community mental health centers being able to
provide both research-based and cost-effective care. Currently, community mental health centers are
excluded from the stimulus funding to create a nationwide Health I.T. infrastructure. This is highly
problematic. Without having access to electronic records that are interoperable with medical & primary
care systems, community mental health providers cannot prevent polypharmacy, cannot track
outcomes, cannot engage in cost-effective chronic disease management with their patients, and cannot
be held accountable for using best practices.

In order to start transforming the highly fragmented U.S. mental health system, we believe that it is
essential that this committee consider the needs of community mental health providers. They are the
nation’s safety net providers for people with mental illness, serving a primarily Medicaid population with
a very high proportion of chronic mental and physical health ailments. For those diagnosed with a
serious mental illness, community mental health centers are their medical homes with CMHC physicians
providing or coordinating their medical care.

1
    Murray & Lopez, 1996 in Surgeon General’s Report on Mental Health
I have three requests for this committee.
    1) As you work to define the meaningful use critera for our nation’s Health I.T. infrastructure, I ask
         that that you consult with community mental health centers and ensure that these providers
         have Health I.T. meaningful use provisions that are specific to their tasks in providing and
         coordinating care for people with serious mental illness.
    2) I also urge you to put together a recommendation to ensure the inclusion of physician and
         nonphysician providers of community mental healthcare in the definition of meaningful users. In
         the community mental health centers I work with, only 5% our clinical providers are
         psychiatrists or nurse practitioners. However, in order to provide researched-base care to the
         people we serve, we know that 100% of our clinical providers need to be using Health I.T.
    3) I ask that you consider, as a committee, advocating for a fix in the recovery act so that
         community mental health providers have access to funds to engage in the upcoming national
         Health I.T. infrastructure.

As Dr. Pincus alluded to earlier in his presentation, there is currently a 13-17 year delay in the use of
mental health research findings in clinical settings2. This delay creates the disturbing reality that 70% of
the 33 million Americans seeking help for behavioral health and addiction disorders receive
inappropriate care for their conditions. Even more disturbing, those with serious mental illnesses die 25
years sooner than the average individual’s life3 – leading to a life expectancy that would be more
appropriate in Mali than in my hometown of Nashville, Tennessee.

I believe that Health IT is an essential foundation to enable needed transformative changes in mental
health service and delivery. I solicit your support in ensuring that mental health providers and the
people they serve are able to benefit from your efforts. I and my colleagues are prepared to assist you in
any way possible in developing criteria that are inclusive of community mental health providers and
their vital role in delivering quality care.

Christina VanRegenmorter, MSSW
Communications and Policy Coordinator
Centerstone Research Institute
44 Vantage Way
Nashville, TN 37228
cell: 615.972.1770
office: 615-463-6253
fax: 615-463-6242
Christina.vanregenmorter@centerstoneresearch.org

2
  Institute of Medicine. (2006). Improving the Quality of Health Care of Mental and Substance-Use Conditions.
Washington, DC: National Academies Press.
3
  National Association of State Mental Health Program Directors (NASMHPD) (2006, October). Morbidity &
Mortality in People with Serious Mental Illness. Alexandria, VA: Author.