- EHR adoption and health data exchange have steadily increased across most care settings as a result of the EHR Incentive Programs.
While the benefits of exchanging patient medication histories, visit summaries, and medical condition information are widely known, providers are only recently becoming more interested in incorporating behavioral health data into primary care.
Last year, researchers in a study published in the Journal of American Medical Informatics Association (JAMIA) began investigating the lack of behavioral health data in primary care EHR technology.
Researchers found that 27.3 percent of patients with depression and 27.7 percent of patients with bipolar disorder lacked a diagnosis of their mental illness in their primary care EHRs. In addition, data about mental health patient-provider encounters occurring in non-primary care settings were often nowhere to be found in the primary care record. Furthermore, nearly 90 percent of acute psychiatric services at hospital facilities — often representing the most severe treatment of mental illness — were not present in the EHR whatsoever.
The absence of behavioral health data in primary care EHRs ultimately results in incomplete picture of a patient’s health and could lead to information gaps having significant impact on patient care delivery. Integrating behavioral health and other data types into primary care EHR technology is imperative to mitigating these information gaps and avoiding potential inhibitors to positive patient health outcomes resulting from improperly managed mental health.
Despite a growing awareness of the importance of behavioral health data to primary care providers, behavioral health data sharing continues to lag behind that of less sensitive information due to various legal and technical barriers.
Specifically, 42 CFR Part 2 has posed a formidable challenge. The federal rule establishes parameters for health data use in mental health and substance abuse disorder treatment and was designed to prioritize the privacy of patients seeking medical care.
In addition to legal complications, health IT infrastructure is often lacking at behavioral health care settings. In a 2015 report, ONC found only 2 percent of psychiatric hospitals had adopted sufficient EHR technology as of 2012.
“While 20 percent of community mental health centers had EHRs in all of their clinic sites in 2012, only 2 percent of community mental health centers reported that they could meet the requirements of the EHR Incentive Programs,” stated the federal agency.
However, numerous stakeholders from the private and public sector have launched or thrown their support behind targeted strategies to boost behavioral health data exchange and enable improved EHR integration of this data.
HHS addresses overly-burdensome 42 CFR part 2
One such effort came at the start of this year when HHS issued a final rule allowing for less stringent policies surrounding behavioral health data exchange.
The Substance Abuse and Mental Health Services Administration (SAMHSA) updated 42 CFR part 2 with a rule titled the Confidentiality of Alcohol and Drug Abuse Patient Records.
“SAMHSA wants to ensure that patients with substance use disorders have the ability to participate in, and benefit from health system delivery improvements, including from new integrated health care models while providing appropriate privacy safeguards,” the federal department stated in the final rule.
Implementing the provisions allowing for less administrative burden in behavioral health data exchange will likely cost over $70 million in 2017. However, the update presents several opportunities to improve healthcare for mental health and substance abuse patients.
For one, HHS expects the update will allow those suffering with substance abuse disorders to engage in integrated healthcare technology models and participate in health information exchange. Secondly, HHS predicts substance abuse disorder patients will have the opportunity to participate in coordinated care organizations, leading to improved population health management.
“The modifications modernize the rule by facilitating electronic exchange of substance use disorder information for treatment and other legitimate health care purposes while ensuring appropriate confidentiality protections for records that might identify an individual, directly or indirectly, as having or having had a substance use disorder,” stated HHS.
Government entities on the state level are also taking an interest in improving behavioral health data exchange.
Last month, the California Health & Human Services Agency’s Office of Health Information Integrity (CalOHII) published State Health Information Guidance to provide legal clarification regarding protected health information sharing.
Specifically, CalOHII aimed to assist healthcare providers, patients, and stakeholders in better coordinating care for mental health and substance abuse disorder patients.
“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,” stated the document.
CalOHII built its guidance on five foundational elements:
- coordination of care
- the limiting of information blocking
- patient data access
- the patient’s right to be informed of a provider’s practices regarding uses and disclosures of his or her healthcare information
- the patient’s right to authorize the disclosure of their health data
With the public sector working to resolve limitations imposed by 42 CFR part 2, healthcare institutions, and its private counterpart can begin its own efforts to improve behavioral health data exchange.
SHIEC supports behavioral health data exchange across network
Health information exchanges (HIEs) play a hand in enabling more practical, timely health data exchange to participating healthcare organizations and their patients.
Networks of HIEs can be even more effective in standardizing new kinds of health data sharing, and one network-of-networks this year has offered membership to an HIE collaborative making strides in behavioral health data sharing.
The Strategic Health Information Exchange Collaborative (SHIEC) extended membership to Reliance eHealth Collaborative to confirm the initiative’s support of behavioral health data exchange and advance the sharing of mental health and substance abuse-related information across the network.
Reliance supports communities in Southern Oregon and provides a publicly-available HIE for any healthcare organization in the area interested in securely sharing information.
"SHIEC's strength lies in the diversity of our membership, and I'm very excited to welcome Reliance into our group," said SHIEC interim executive director Pam Matthews. "Reliance has been doing some really interesting work with incorporating behavioral health and substance abuse treatment into their HIE ecosystem.
SHIEC hopes other members of its network will follow in Reliance’s footsteps and promote secure behavioral health data exchange across community healthcare facilities.
“We anticipate this trend continuing as HIEs support providers and their community with transitions of care and chronic care management activities,” Matthews continued. “By working with HIEs who are already pioneering this field, other SHIEC members can learn from Reliance's experiences as they expand their services into this area."
While specific HIE collaboratives such as Reliance have already started improving behavioral health data exchange, some legal barriers still bar behavioral health facilities from engaging fully in health data sharing and access.
Health IT companies receive assistance for behavioral health data reporting
Before behavioral health facilities can fully participate in HIEs and benefit from health data exchange, providers need to have access to EHR technology.
While more behavioral health facilities have gained access to the necessary infrastructure to access patient EHRs in recent years, technical barriers still remain. Specifically, behavioral health data reporting has proved a hindrance to bringing behavioral health facilities up to speed with the rest of the healthcare industry.
A Massachusetts-based institute aims to change that.
This month, four vendors of certified EHR technology (CEHRT) received support to improve the EHR reporting capabilities of behavioral health facilities through a combined $193,000 grant from the Massachusetts eHealth Institute (MeHI) at MassTech.
eHana, Netsmart Technologies, PsyTech Solutions, and Qualifacts Systems will each work with four behavioral health organizations across Massachusetts to devise and implement interfaces between their EHR platforms and the Children’s Behavioral Health Initiative (CBHI), a state repository of behavioral health data.
The grant — offered through the Child and Adolescent Needs and Strengths (CANS) Interface Development Grant program — will replace manual processes for behavioral health data reporting for 40,000 reports a year.
“Now more than ever, we need to find ways to use technology to help clinicians better manage, track, and provide enhanced services to children and their families dealing with significant behavioral, emotional, and mental health needs,” said Massachusetts Secretary of Health and Human Services Marylou Sudders. “By investing in digital health solutions such as these, we can leverage providers’ electronic health records and ease the reporting demands on the providers that are treating these kids, allowing these organizations to place more effort where it matters, on day-to-day treatment and case management.”
The EHR interfaces will utilize the HL7 standard to improve behavioral health reporting workflows, laying the groundwork to surmount one more persistent challenge to behavioral health EHR use and data exchange.
With stakeholders across the industry working toward improved behavioral health EHR access, use, and data exchange, healthcare organizations may soon close the gap between behavioral health facilities and other care settings in the industry.