- The California Health & Human Services Agency’s Office of Health Information Integrity includes a litany of use cases in the recently published State Health Information Guidance to illustrate numerous instance where sharing protect health information is feasible legally and in the patient’s best interest.
Though non-binding, CalOHII intends the guidance to assist healthcare providers, patients, payers, and other stakeholders in coordinating care of mental health and substance use disorders.
“The SHIG offers authoritative guidance to provide legal clarification for sharing patient information while protecting patient privacy,” the document states. “Removing obstacles may result in increased coordination of care to help patients achieve better health outcomes, but coordination of care requires patient information to be shared in an appropriate, secure, and timely manner between different types of health providers.”
The state agency bases its guidance on five principles deemed “foundational” for sharing behavioral health data.
The first is coordination of care: “Behavioral health information should be shared to the extent allowed by federal and State laws to address patient care needs involving medical, behavioral and even socioeconomic issues.”
Because patients with behavioral health conditions most likely receive treatment from a multitude of providers across disciplines, their mental health or substance abuse data must be part of an integrated care plan that gives members of the care team access to important information.
The second principle in rooting out information blocking:
Blocking exchange of or choosing not to disclose information when doing so is clearly in the best interests of the patient and allowed by law is generally discouraged. Providers of behavioral healthcare services generally have a responsibility to develop a therapeutic relationship with a patient and that may appropriately lead to limiting the disclosure of patient information, such as information protected by the psychotherapist/patient privilege. Within the scope of this responsibility, however, providers are encouraged to discuss with patients why some forms of sharing might be in the patients’ best interests.
Patient access is the focus of the third principle so that the patient remains informed of his care although certain circumstances may lead to a request being denied if that decision eliminates “substantial risk of significant adverse or detrimental consequences” for the patient.
The fourth principle holds the patients have a right to be informed of “a provider’s practices regarding uses and disclosures of his or her healthcare information.”
“A patient has a general right to receive notifications regarding how a health provider or organization plans to use and disclose patient health information, even when not specifically addressed in State regulations,” the document continues. “HIPAA privacy regulations provide additional guidance on how to accomplish this, including through the Notice of Privacy Practices.”
Lastly, the fifth principle stipulates that patients maintain the right to authorize the disclosure of their health data:
An adult patient generally may provide permission for a provider or organization to share his or her personal healthcare information, including behavioral healthcare records, for a wide variety of purposes. When in the best interests of the patient and allowed by law, the State strongly encourages the exchange or disclosure of information. Even when State and federal statutes and regulations prohibit disclosure of healthcare information unless authorized, behavioral healthcare providers are encouraged to discuss with patients why authorizing a disclosure or the sharing of information may be in the patients’ best interests.
The exchange of behavioral health data is made complicated by a federal rule (42 CFR Part) which mandates strict governance of patient health data used in the treatment of mental health and substance abuse disorders. Unlike protected health information use and sharing under HIPAA, behavioral health need must be treated separately and therefore introduces technical barriers to behavioral health data exchange.
California appears ready to addresses these legal barriers head on.