The benefits for a behavioral healthcare organization tying into a health information exchange (HIE) are clear and practical. The path to being ready for participation in an HIE, however, is a bit more complicated.
The quick and efficient sharing of patient health information with electronic health records (EHRs) makes it easier to provide a better-informed, higher quality of care, which, in turn, allows behavioral health providers to be ideally positioned for a value-based payment model. Such a smooth operation requires significant groundwork first, though, as providers need to address items ranging from their existing information infrastructure to workflows to state and federal privacy policies and laws.
Two experts spoke recently with Behavioral Healthcare to share their insights on the primary challenges behavioral healthcare providers face in positioning themselves to participate in an HIE and the steps they can take to ensure a successful transition.
Melissa Kotrys is CEO of the Arizona Health-e Connection (AzHeC), a non-profit, public-private partnership that drives the adoption of health information technology (HIT) and operates Arizona’s statewide HIE that encapsulates multiple smaller networks. The statewide network includes 189 total participants, including 64 behavioral health providers, that exchange patient data.
Mark Belanger is director of advisory services for the Massachusetts eHealth Collaborative (MAeHC), a Waltham, Mass.-based not-for-profit that works with healthcare providers in the New England region to implement EHRs and HIEs. MAeHC currently is working to unite a group of 42 organizations in New Hampshire and formalize their structure for helping patients in three counties. In MAeHC’s home state of Massachusetts, meanwhile, the organization has engaged with the state’s departments of mental health and public health to provide technical assistance to 14 certified community behavioral health clinics that are preparing to shift away from a fee-for-service system to a hybrid payment model.
1. Basic change management
Regardless of the type of patient data management system a provider is using, any kind of shift to a new system should not be taken lightly, Belanger says.
“Any organization in any sector of our economy that has never gone through moving from one electronic system to another or from paper to an electronic system has to learn an application and be trained up in using computers and has to adjust the way they do their business in their clinical work to match what’s possible with computers,” Belanger says. “That’s not to be underestimated. It’s very difficult.”
Kotrys recommends providers start by reviewing their existing technology to determine whether it can support an HIE connection. EHRs should be compliant with national interoperability standards, which most HIEs require. Working in tandem with your EHR vendor is a key part of the process, she adds.
“One of the challenges we see with behavioral providers—and, really, every provider—is that they want to connect to the HIE, and then when talking to their EHR vendor, they discover limitations, whether that’s resource limitations, technical limitations, etc.,” Kotrys says. “They should find out from their EHR vendor what any costs are, what are the ways in which they like to connect, what data can be easily shared with an HIE. Start to have that conversation.”
2. Policy awareness
Next, Kotrys recommends reviewing privacy laws in your state, as well as federal regulations such as 42 CFR Part 2, all of which can impact processes a provider has internally with respect to obtaining patient consent for information sharing.
“There are tougher rules on privacy, security and disclosure than any other place in our economy, including financial services,” Belanger adds. “This information is considered highly sensitive in many cases and carries a myriad of federal and state privacy protections that have be understood by the staff.”
Often, the organization managing HIEs can provide guidance on applicable privacy laws and regulations.
In Arizona, AzHeC offers HIE services free to all organizations except hospitals and health plans. While funding sources offer a financial subsidy to cover HIE participation costs for behavior health providers, Kotrys says those organizations still must account for other costs, such as fees paid to their EHR vendor. In some states, Medicaid supports lowered or free HIE services or subsidies related to EHR costs.
But regardless of grants and funding streams available, Kotrys’ message is clear: Be thorough in preparing your budget.
“In most scenarios, [providers] need to understand what that [cost] is because the financial implications could be a pain point,” she says.
4. See the future
Lastly, Kotrys says providers should review existing workflows and consider how they can incorporate real-time access to patient data.
“We find most people—and again, this isn’t limited to behavioral health, but I think it may be more prevalent in behavioral health—they have processes in place that rely on information that may be outdated, coming in later, and they really have to re-engineer the process and the way they take in information to make the best use of HIE information,” she says.
Related, Kotrys says to be prepared to dedicate time to properly training staff on how to take advantage of your organization’s HIE participation.
“If you don’t dedicate the appropriate time, then the value you receive from the HIE is going to be less as a result,” Kotrys says.