Updates

We are actively seeking to speak with program directors and peer service providers to explore cohort-based pilot programs using the Peerakeet platform. Working with your organization and a small group of patients, we can evaluate improvements in peer efficiency, billable peer service hours, reductions in billing kickbacks, and patient engagement before scaling more broadly across your program.

If your organization is interested in participating in a pilot or learning more, feel free to reach out at ishan@peerakeet.com.

Pulse Insights: From Paper Charts to Portals

Ishan Shah, Co-Founder and CEO at Peerakeet

How Health Records Evolved and Why Peer Services Were Left Behind

Modern healthcare runs on records.

Every diagnosis, encounter, and care decision is filtered through documentation systems meant to preserve continuity, enable reimbursement, and protect patient safety. Yet the systems that now define behavioral healthcare were not built with every role in mind. Certified peer services, in particular, sit at the edges of an infrastructure that was never designed to support them.

To understand why peer services struggle within today’s electronic health records, it helps to examine how health documentation evolved and whose work it was originally designed to capture.

Paper Charts and Narrative Care

For much of modern medical history, health records were handwritten. Paper charts lived where care happened. Clinicians documented in narrative form, describing symptoms, circumstances, and patient experience in rich detail. These records were imperfect and inconsistent, but they allowed flexibility and storytelling.

Long before peer services were formalized, peer-like roles existed outside clinical systems. Mutual aid groups, recovery sponsors, and community health workers supported individuals through lived experience rather than diagnosis. Their work was relational, longitudinal, and grounded in trust.

Because these services were informal and non-billable, they were rarely documented within official medical records at all.

Standardization and the Rise of Billing-Centered Records

As healthcare systems expanded in the mid-20th century, documentation began to serve a new purpose. Insurance reimbursement required proof of services rendered. Standardized formats emerged to translate care into billable units. Problem lists, SOAP notes, and diagnostic codes gradually replaced narrative storytelling (Institute of Medicine, 1991).

Health records became less about continuity and more about accountability.

When early digital record systems appeared in hospitals during the 1960s and 1970s, they were designed almost exclusively for physicians, nurses, and administrators. The goals were efficiency, billing accuracy, and risk management. Community-based and non-clinical roles were not part of the design.

Peer services, still largely informal at the time, remained invisible by default.

The EHR Era and Who It Was Built For

The push toward electronic health records accelerated dramatically in the 2000s, particularly following the HITECH Act of 2009, which incentivized EHR adoption nationwide (Blumenthal & Tavenner, 2010). EHRs promised interoperability, safety, and data-driven care. In practice, they reinforced a clinician-centric model of documentation.

EHRs were optimized for:

• Diagnoses and procedures

• Medical necessity language

• Time-based billing

• Compliance and audit readiness

Peer support does not naturally fit this mold.

Peer work centers on trust, shared experience, motivational dialogue, and sustained engagement. These interactions are meaningful and effective, yet they do not translate cleanly into traditional clinical templates.

As states began certifying peer recovery specialists and approving Medicaid reimbursement for peer services, peers were suddenly required to document their work within systems never designed for them. Many were trained to support people, not to navigate complex EHR interfaces or clinical note requirements.

The resulting friction was inevitable.

The Reality for Peer Programs Today

Many peer programs now operate across fragmented tools. Notes may be written on paper, in spreadsheets, or in parallel systems that later require manual EHR entry. Messaging often occurs on personal phones. Scheduling exists outside documentation workflows. Supervisors struggle to maintain visibility into engagement patterns and potential risk signals.

For peers, this often means:

• Less time spent building relationships

• Anxiety around documentation adequacy

• Increased burnout and turnover

For organizations, it leads to:

• Billing denials and delayed reimbursement

• Inconsistent service delivery

• Limited ability to evaluate outcomes or scale programs

The issue is not peer effectiveness. It is structural misalignment.

Why This Matters

Peer services are one of the fastest-growing segments of the behavioral health workforce (SAMHSA, 2024). They fill gaps that traditional clinical care cannot, supporting individuals between appointments, after discharge, and in moments when formal systems are inaccessible.

Yet peers are being asked to operate within documentation frameworks designed decades ago for a fundamentally different type of care.

History shows that health records evolve in response to what systems choose to value. If peer services are to be sustained and scaled, their work must be supported by infrastructure that recognizes relational care as legitimate, measurable, and worthy of investment.

This does not mean turning peers into clinicians. It means building systems that respect how peer work is actually delivered.

The next phase of behavioral healthcare will not be built solely through more clinicians or more appointments. It will depend on whether systems can support the full care ecosystem, including peer services that operate between the cracks.

Modern peer support deserves modern infrastructure. Tools that reduce administrative burden, preserve lived-experience work, and integrate cleanly into existing healthcare environments are not a luxury. They are a requirement for sustainability.

At Peerakeet, we believe the future of peer services depends on closing the gap between how care is delivered and how it is documented.

If you are a peer leader, program director, or behavioral health operator navigating documentation and workflow challenges, we would welcome the chance to learn from you. You can reach Ishan at ishan@peerakeet.com.

References

• Blumenthal, D., & Tavenner, M. (2010). The “meaningful use” regulation for electronic health records. New England Journal of Medicine, 363(6), 501–504.

• Institute of Medicine. (1991). The computer-based patient record: An essential technology for health care. National Academies Press.

• Substance Abuse and Mental Health Services Administration (2024). Peer Support Specialists: A Growing Mental Health and Addictions Workforce. SAMHSA Office of Recovery.