- While EHR systems and health data exchange solutions have been common tools within hospitals and physician practices for nearly a decade, many behavioral healthcare providers are just beginning to integrate EHR use into care delivery.
Policymakers are also starting to turn their attention to legislation that could potentially support the use of EHR technology in behavioral health. At the same time, major health IT players in the private sector are identifying a new client base comprised of behavioral and mental healthcare providers.
These efforts to include behavioral health in the digitization of the industry at large mark progress toward enabling more comprehensive, complete patient care.
At the 2018 ONC Annual Meeting, Executive Director of the Office of Technology Steve Posnack spoke with EHRIntelligence.com about how federal entities and stakeholders in the private sector are working to promote health data exchange and EHR use in behavioral and mental healthcare settings.
“We’ve always been mindful to make sure that the larger care continuum isn’t getting left behind as we had more acutely focused on the HITECH incentives related to the general ambulatory and hospital providers,” Posnack told EHRIntelligence.com.
While the importance of integrating EHR technology into behavioral healthcare settings has recently begun to gain momentum, Posnack and others at ONC have been working with behavioral health IT developers for some time to see how new technologies can suit the needs of behavioral health providers.
“Long term post-acute care fits under the same spectrum in terms of mix, where on both the mental and behavioral health side there are health IT developers we’ve worked with,” stated Posnack. “We’ve put out some guidance from time to time about how the certification criteria we have today are agnostic for the most part.”
Dating back as far as 2013, ONC released issue briefs and other guidance detailing the relationship between behavioral health, health IT and health data exchange.
However, EHR adoption in behavioral healthcare settings has lagged partly because federal legislation has not included behavioral healthcare in policies intended to drive health IT adoption and use.
“A lot of them weren't part of the original EHR incentives,” said Posnack.
Behavioral healthcare providers may soon have the opportunity to receive federal incentive payments for utilizing health IT in care delivery in the same way providers in hospitals, physician practices, and other ambulatory care settings have been for years.
In June, the House of Representatives passed 25 bills aimed at combatting the opioid crisis, including one piece of legislation establishing a demonstration program to test the effectiveness of federal incentive payments for behavioral health EHR adoption.
According to Posnack, health IT products tailored to meet the needs of behavioral healthcare providers may not differ significantly from products already targeting hospitals and health systems.
“If you're going to do electronic prescribing, if you're going to do computerized provider order entry, those are features that can be part of those products,” said Posnack.
ONC has worked with the Substance Abuse and Mental Health Services Administration (SAMHSA) to produce guidance identifying the needs of behavioral and mental healthcare providers for health IT developers.
“We try to make sure that the technical foundation for some of these players and the health IT developers that are out there in the field can work on the same playing field as the larger, just general commercial health IT developers,” Posnack explained.
Part of the challenge of integrating EHR use and health data exchange into behavioral healthcare centers on the sensitive nature of patient information involved in treating an individual’s mental, behavioral, and substance use needs.
Health IT companies including United Way are developing ways of sharing information that may uniquely suit the needs of providers dealing with sensitive patient health information.
“Folks in San Diego and California are going to do some community based work on the 2-1-1, which is run by United Way,” said Posnack. “We’re seeing a lot of interest in the local sharing of information. That’s one of the areas where we see growth opportunities for health information exchanges.”
2-1-1 is a free, confidential service that enables individuals across North America to find local resources that may assist with financial, domestic, health, or disaster-related issues.
The referral and information helpline and website connects people across communities with health and human services by phone or computer to address needs related to supplemental food and nutrition programs, shelter and housing options, addiction prevention and rehabilitation programs, and other resources.
These services can not only help to address behavioral and mental health needs confidentially, but also certain social determinants of health that may get in the way of an individual’s ability to receive care.
“Healthcare, as the saying goes, is local,” said Posnack. “And a lot of the relationships — especially with the social services — there are a lot of human services components that are now thinking about ways to connect.”
“We could give you the contacts over in Cleveland,” he added. “Some folks in Cleveland have been working on direct transactions among some of the hospitals for different types of referrals, whether it's housing assistance or other types of determinants that affect people’s care.”
Offering patients a way to access local resources to address social determinants of health may help to reduce health inequity and improve patient access to care for those disproportionately affected by socioeconomic or geographic impediments to care.
Additionally, enabling patients to seek these resources themselves without solely relying on physicians for referrals may help to reduce administrative burden on providers.
“For the 99 percent of the times that they're not seeing the doctor, those are a lot of new opportunities where we see the local or regional footprint of certain health information exchanges really having an opportunity to step in,” emphasized Posnack.
In addition to health information exchanges (HIEs) in Ohio, an HIE in Texas has also made efforts to integrate social determinants of health into its exchange for more comprehensive care delivery.
“As we have the opportunity, we partner with our colleagues at the HRSA, SAMHSA, federally qualified health centers, and a few of the other agencies that more directly interact with patients in those particular regions,” Posnack said.