At its June 10 meeting, the federal Health IT Policy Committee approved some small steps toward improving interoperability between the electronic health records of behavioral health providers and those of other clinicians.
The committee approved recommendations to the Office of the National Coordinator for Health IT (ONC) that it should work to enable exchange of behavioral health data covered under the Confidentiality of Alcohol and Drug Abuse Patient Records Regulations, 42 C.F.R. Part 2. Under these regulations, a federally assisted substance abuse program generally may only release identifiable patient information related to substance abuse treatment services with the individual’s express consent, which has made electronic exchange with other providers challenging.
Deven McGraw, chair of the Privacy & Security Tiger Team, a subgroup of the Health IT Policy Committee, recommended that ONC start a slow technology glide path by piloting voluntary certification criteria that would allow behavioral providers to send documents that other providers could view but not share or consume in their own EHR.
In potential future levels of technology sophistication, the recipient EHR would be able to parse and extract data from structured documents from Part 2 providers for use in local clinical decision support and quality reporting engines, but data elements would have to be tagged and/or restricted to help prevent redisclosure to other entities through manual or automated reporting or interfaces.
The Tiger Team, she added, is not suggesting that use of the technology should be a meaningful-use EHR incentive requirement. However, providers could use the exchange of these documents to meet transitions of care and care coordination objectives in the meaningful-use program. “This is a bit of a baby step,” she said, “but the status quo is zero exchange. The Tiger Team felt strongly that we would be less likely to progress at all unless we take this initial step.”
Definitions for behavioral health
Other work groups reported that more work needs to be done on patient assessment data standards and vocabulary. Larry Wolf, chief information officer of Kindred Healthcare, a Louisville, Ky.-based provider of post-acute care services, co-chairs the committee’s certification and adoption workgroup. That workgroup was charged with recommending a process for prioritizing health IT capabilities for EHR certification that would improve interoperability across a greater number of care settings. The recommendations seek to identify the key heath IT capabilities needed in care settings by providers who are ineligible to receive EHR incentive payments under the HITECH Act.
Wolf recommended that ONC identify vocabulary standards and data definitions to support behavioral health patient assessments, so they can be more easily shared between providers. If gaps exist in available standards, ONC should develop relevant certification criteria, he said.
The committee approved that proposal, as well as Wolf’s recommendation that ONC should track national trends in long-term and post-acute care (LTPAC) and behavioral health IT adoption. Such efforts should include tracking use by functionality and by certification criteria. ONC should use EHR adoption definitions for LTPAC and BH that are consistent with those used in ONC/CMS initiatives, he noted.
A quality measures workgroup, which had been tasked with providing recommendations on potential clinical quality measure (CQM) opportunities for voluntary behavioral health EHR certification, concurred with Wolf’s presentation and reported back to the committee that data standards were too immature to allow for the creation of CQMs at this time. “There are indications that the industry is willing to help standardize common data elements,” said Terry Cullen, MD, informatics director at the Veterans Health Administration, “but there is a lot of groundwork that needs to be done before we move to quality measures. To capture patient assessments, we need to do some basic patient assessment data harmonization and vocabulary standardization,” she said.
On Wednesday, June 11, 2014, the Substance Abuse and Mental Health Services Administration (SAMHSA) will hold a public listening session to solicit information about Part 2 consent.
Find registration information Here.