- Health information exchanges enabled connections across the care continuum, but behavioral health providers still face challenges integrating their work with that of primary care to improve patient outcomes. New resources made available by the Office of the National Coordinator for Health Information Technology details strategies for addressing these obstacles in the way of improved behavioral health data exchange.
These challenges range from legal (e.g., privacy rules) to technical (e.g., low health IT adoption in behavioral health settings.
Back in September, Toria Thompson of Colorado Regional Health Information Organization (CORHIO) explained how a federal rule governing patient health data used in the treatment of substance abuse orders — 42 CFR Part 2 — made behavioral health data exchange more complicated that its HIPAA-enabled counterpart.
"When you're dealing with someone who is receiving services to treat a substance use disorder, you can't do that. In fact, the patient is in the center and has to be the traffic cop about who gets to see that more restricted protected information," said CORHIO’s Behavioral Health Information Exchange Coordinator.
As for technical barriers to behavioral health data exchange, last year’s ONC report to Congress on health IT adoption found that office-based physician information sharing with behavioral health providers represented a meager 11 percent of all health data exchange activities. As for hospitals, 28 percent reported sending summary of care records to behavioral health providers while 16 percent reported having received this type of data.
As for the internal health IT capabilities of behavioral health providers, the 2015 ONC report found the following as of 2012:
As of 2012, only 2 percent of psychiatric hospitals had adopted EHRs. 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. EHRs that do not meet these requirements might not have the safety- and quality-enhancing functionalities of certified EHR technology. In addition, these systems might not be fully interoperable with certified EHR technology, or have the privacy and security functionalities needed for behavioral health providers to exchange health information across the continuum of care.
How then does behavioral health data exchange improve?
In Arkansas, the Office of Health Information Technology (OHIT) has developed an onboarding process for connecting behavioral health providers to the state’s HIE, the State Health Alliance for Record Exchange, and its tools that include Direct secure messaging.
“Because this provider population often lacks access to robust electronic health records (EHRs) and other health IT systems, OHIT’s initial onboarding efforts are focused on increasing access to SHARE’s clinical portal and DSM to give providers a basic set of tools they need to obtain data about their patients,” the ONC brief states.
“An emerging use case for Medicaid RSPMI providers is to utilize DSM to support the referral process,” it continues, “ensuring that the appropriate data follows patients as they transition between behavioral and physical health providers.”
The process includes hands-on training with OHIT field staff to incorporate health data exchange into behavioral health provider workflows. “This approach helps OHIT to familiarize users with HIE and increase utilization of SHARE services,” the brief states.
Down the road, the state organization will work to help comply with 42 CFR Part 2 as behavioral health data exchange expands, potentially including the development of a separate system handling behavioral data separately. “OHIT’s intent is to provide secure and compliant access to the patient’s consolidated clinical record, including behavioral health data, therefore providing a comprehensive view of the patient’s healthcare needs,” the brief concludes.
Meanwhile, state officials in South Carolina have taken a community-based approach to get behavioral health providers connected to the South Carolina Health Information Exchange (SCHIEx).
“One of SCHIP’s key lessons learned from engaging with the mental health community is that training providers is not always sufficient to reach full adoption and acceptance of SCHIEX, especially if other stakeholders in the community are not already using SCHIEx themselves,” states the ONC brief.
The realization led to the creation of the “Communities of Care” Model by the South Carolina Health Information Partners, the operators of SCHIEx. The first step set up a hub of health systems, hospitals, physician groups who will in turn reach out to mental health providers:
Once an anchor organization is onboarded, SCHIP engages with other stakeholders along the care continuum and conducts community-level trainings about SCHIEx and the value of HIE. This approach brings all of the stakeholders to the table to demonstrate how each member of the community can benefit from the participation of the others. It also showcases all of the different providers that contribute to a patient’s care, which can stimulate communication and coordination between stakeholders.
Similar to OHIT in Arkansas, SCHIEx has plans to expand its efforts to address provider health data exchange workflows and use of HIE services.