Major strides forward are being made at the Behavioral Health Information Network of Arizona (BHINAZ), a behavioral health information network (HIE) owned by community providers in Arizona. BHINAZ specializes in the exchange of data, both medical/surgical and behavioral health data.
“We’ve been focused on a pretty robust consent model and the exchange of data, and making sure that our providers can get the data they need for the services they provide,” says Laura Young, BHINA’s executive director. Recently, says Young, “We’ve been really focused on our crisis project, which entails getting providers who are involved in caring for seriously mentally ill (SMI) individuals through clinic-based care, involved, and providing information to crisis hotlines, first responders, mobile teams.”
The HIE is stakeholder-owned, comprised of seven nonprofit organizations, at the community level, driven by behavioral and community health providers.
Young participated recently on a panel discussion entitled “Interoperability & HIE: Strategies for an Evolving Health System,” at the Health IT Summit in San Diego, sponsored by the Institute for Health Technology Transformation—a sister organization to Behavioral Healthcare and Healthcare Informatics (under the Vendome Group corporate umbrella). She spoke recently with Healthcare Informatics Editor-in-Chief Mark Hagland regarding the current initiatives taking place at BHINAZ. Below are excerpts from that interview.
You referenced that your organization has been focusing strongly on health information exchange in crisis mental healthcare situations. Is consent an issue in such situations?
Consent actually doesn’t really apply around these situations, because they involve genuine crises, such as potential suicide situations, for example. And a crisis hotline might do a little bit of triage such a situation. But if the patient seems genuinely in crisis, the hotline can look up information on the portal, see if they’re a danger to themselves or others, find out if they’re voluntarily in treatment or involuntarily court-ordered into treatment, per a criminal proceeding, for example. We worked with a consortium of providers, and they needed to see that element. So we actually had to retrofit our HIE, to add in additional pieces of information around whether people are a danger to themselves, to others, or “SMI”—seriously mentally ill. That’s a designation that comes usually from the Medicaid managed care company. When that designation occurs, regional behavioral health authorities, or RBHAs, pick up the spend both for physical and behavioral health for patients who are on Medicaid. So if they get that designation, everything is paid for. And once they’ve been given that designation, you’re always considered SMI.
So the crisis providers want to know those pieces of information. They also want to see information on contacts. And who their guardian is—that might be different from a family member, for example, there might be a designee from a court who is the guardian.
So you’ve standardized a data set for such situations?
Yes, so when we connect people, we say, these are the pieces of data needed. It’s an extra 11 data elements that our crisis providers wanted. So, things like injectibles—when you’re given a prescription for methadone treatment, you might be prescribed methadone, but in the medication module, they’re not always documenting the administration of methadone, there might be a documentation of a one-time prescription. But on the phone, they’ll want to know the last time the person got the injection. And it turns out that isn’t always standardized. So we work really hard to standardize that and bring it forward as a data element. And providers in a non-emergency setting might want that information with consent also.
This process went just went live in early January. We had been working on it for six months, and we had the providers connected, and crisis call lines, mobile teams, psychiatric urgent care centers. Some of the organizations we don’t have yet, still, are jails, and we want to do some pilots in the emergency departments (ED) also because a lot of these folks hit the ED a lot. One person had hit the ED 50 times in a month. So if we can incorporate their data, a lot of times, they can get to more suitable care settings. Sometimes the ED isn’t the appropriate place for psychiatric care. Yet a lot of times, they end up just sitting in an ED for 72 hours and then get discharged.
The other piece of this that’s really crucial is that whenever our patients do engage with our crisis system, an alert goes out to their treating provider, if they’ve contacted crisis service providers or EDs. So we get the case managers involved early, so they can get them into less highly acute locations for care, and also engage them so they’re not going back to the ED for care the next time. So the crisis emergency management system we’ve designed, now we’re helping others implement, as consultants.
This is also a great point for getting into behavioral health exchange, because the consent piece doesn’t even have to be implemented.
How many parties have been connected so far?