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Separate HIEs for behavioral health?

October 13, 2011
by David Raths
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Confidentiality requirements lead Nebraska to develop a unique approach to health information exchanges

Largely due to concerns about federal privacy laws, behavioral health providers—even those using electronic health records—have so far been left on the sidelines by nascent health information exchanges (HIEs).

But despite the obstacles, the state of Nebraska has taken a novel approach by creating a network that will enable behavioral healthcare providers to share patient information electronically with each other.

In the planning stages for several years, the Electronic Behavioral Health Information Network (eBHIN) (www.ebhin.org) deals only with behavioral health information.

Developed in partnership with Horsham, Pa.-based NextGen Healthcare, the system connects 11 health centers and clinics throughout Region V, the umbrella for Southeast Nebraska behavioral providers.

With a patient’s permission, certain information is pushed from the EHRs to create a shared behavioral health record, which is accessible to other behavioral health organizations that are also using the HIE. The shared record contains a limited set of data, including demographic information, emergency contacts, diagnosis, substance abuse history, current medications, and insurance information.

A major focus of the project has been making sure the HIE complies with federal confidentiality regulations commonly referred to as 42 CFR Part 2. (Those rules state that without written authorization from the patient, physicians cannot access patients’ substance use history and current treatment regimen, except in cases of emergency.)

“We had to work on the technical and operational approach to be compliant with CFR 42 Part 2,” explains Wende Baker, eBHIN’s network director. “We challenged our attorneys to come up with a way to do this.”

The sticking point was that the HIE couldn’t just keep a list of providers that patients consent to have their data shared with, because those approvals would all have to be updated every time a new provider joined the network. “It would become administratively overwhelming,” Baker says.

Under eBHIN’s operating rules, patients must give consent not only to the first provider who puts data in a shared database, but also to any other providers in the network who seeks to access those records. “Our local chapter of the National Alliance on Mental Illness really saw this as a breakthrough,” Baker adds.

The long-range plan is to include other regions of the state, and then for eBHIN, with patient consent, to offer the shared behavioral health record to other medical settings.
“We are working on using the NHIN Direct capability through our health information service provider, the Nebraska Health Information Initiative, to use secure messaging to be able to do point-to-point communications with other providers and hope to broaden out from that incrementally over time,” Baker explains. In addition, eBHIN expects to aggregate de-identified data from behavioral health organizations to work on continuous performance improvement. The launch of the HIE, she says, “is just the tip of the iceberg.”

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