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Standardized data needed to unlock IT's potential

July 7, 2016
by Tom Valentino, Senior Editor
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Behavioral healthcare is lagging in the use of health information technology compared to medical/surgical healthcare, but the many facets that lead to the disparity in the implementation of state-of-the-art solutions are a symptom of views that date back centuries.

According to an article published in the June edition of Health Affairs, 97% of U.S. hospitals and 74% of U.S. physicians have implemented interoperable electronic health records (EHRs). By comparison, only 30% of behavioral health providers have implemented such IT systems.

In 2009, the Health Information Technology for Economic and Clinical Health (HITECH) Act created an incentive program for providers to implement EHRs and use them in a meaningful way, but did not explicitly address the behavioral health specialty. Moreover, certain behavioral health organizations and non-physician providers were excluded from eligibility.

“The biggest reason probably goes back to the ancient Greeks in terms of the split between mind and body, which was also promoted by Descartes as being two different things and not related,” says Harold Alan Pincus, MD, vice chair of the Department of Psychiatry at Columbia University’s College of Physicians and Surgeons, and one of the Health Affairs article’s authors.

Pincus says behavioral health being left out of the HITECH Act is a perfect example of the historic split. Privacy issues also come into play, as consumers tend to balk at sharing information related to mental health and addiction disorders. Additionally, the lack of standardized data has also made IT implementation troublesome for behavioral health organizations.

Structure and standardization

Pincus and his fellow authors emphasize the need for structured and standardized data “through the use of industry-standard terminologies, classification and coding systems, information models, methods for data exchange, and healthcare publication databases.” A sticking point on this front is the wide range of standards currently in use.

For example, DSM-5 is widely used for behavioral diagnosis. As the authors point out, a recent analysis found up to 70% of clinical modifiers and up to 60% of DSM-5-based findings were missing from other commonly used coding systems, and there has been no systemic effort to date to include behavioral health content in the systems.

“More and more, it’s critical that there be coordinated efforts between mental health and substance abuse, and between both types of behavioral health organizations and general medical organizations in the care of patients,” Pincus says. “People with severe mental illness suffer from significant comorbidities and die up to 20 years earlier than the general population. The bulk of their costs are on the general medical side, so there has to be some way for there to be communication and more of a team effort. To do that, there has to be ways by which information gets shared so there can be a joint effort in how we address these problems.”

Next steps

Authors of the Health Affairs report offered several recommendations for bridging the gap in IT between behavioral health and general healthcare, including the following:

Prioritize structuring clinical information and address significant gaps in terminologies. Beyond integrating behavioral health IT with that of general medical healthcare, standardizing within the field of behavioral health itself first is necessary.

“Behavioral health organizations became a market for a lot of smaller IT companies,” Pincus says. “These smaller companies developed their own products, and they weren’t necessarily thinking about how to be interoperable among themselves or linking to general healthcare.”

Licensing and credentialing of mental health providers should include proficiency in health IT use. Increasing the implementation of health IT isn’t strictly on software vendors to build a better mousetrap, according to the Health Affairs article authors. Clinical social workers and psychologists are among the behavioral health providers for who could be subjected to tighter standards.

Develop EHRs with more comprehensive security options. One area in which software developers can step up their game is by increasing data security and/or offering various levels of clearance for viewing and retrieving data. Heightened privacy concerns have been a significant barrier to health IT gaining widespread acceptance within the behavioral healthcare sector. An EHR system that enables tagging specific data elements with different privacy levels is one way to help alleviate these concerns.

Ultimately, Pincus says, bringing clarity to behavioral health IT will require a strong voice at the national level.

“Unless somebody develops a way of capturing and cataloging that information for some of these technologies and taxonomies, there’s going to be a barrier,” Pincus says. “Most of that is going to be invisible to the people using the system, but there needs to be national leadership to make sure that happens.

There has been one bright spot on this front: In February, the Office of the National Coordinator for Health IT (ONC) and the Centers for Medicare and Medicaid Services (CMS) announced that federal funds would be made available at a 90% matching rate for state expenditures for providers ineligible for meaningful use incentives, including those in the behavioral health sector.

Tom Valentino is Senior Editor for Behavioral Healthcare.

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Comments

Agreed! Standardization is critical for value-based, population health. Part of standardizing is to get everyone using the same system, including the BH EHR vendors and clinicians. Trying to mix the DSM into the ICD-system is confusing and problematic, evidenced by your numbers in the article. The US healthcare system mandates that all HIPAA-Covered Entities use the ICD-system. Even the DSM endorses this practice in the DSM-5. All applicable diagnoses to paint a comprehensive clinical picture for a behavioral health client will be found in the ICD-series, not contained in the DSM-series. Suicidal ideation is an actual diagnosis/code number in the ICD-series that is not contained in the DSM-series. Standardization in Health Information Technology means using the one, unified system that the entire healthcare industry uses. In order for clinicians to do their part, they need EHR systems that really provide the  functioning necessary to produce meaningful BH measures, the codes to depict the comprehensive, oftentimes complex, clinical picture of our consumers.