As regional and statewide health information exchanges (HIE) have formed around the country to share clinical data, many have balked at grappling with the legal and privacy issues around behavioral health or have put behavioral health on the back burner. In Arizona, a group of behavioral health providers have come together to create their own private HIE to share data among themselves and eventually with other providers using the state HIE. Behavioral Healthcare contributor David Raths recently interviewed Laura Young, executive director of the Behavioral Health Information Network of Arizona (BHINAZ), about its goals and progress so far.
BH: What was the impetus for the creation of BHINAZ?
Young: BHINAZ is the brainchild of several community-based behavioral healthcare organizations here in Arizona and it was born out of a couple different driving factors. The biggest one was that the regional behavioral health authority contract in Maricopa County, which is one of the biggest in the country, was coming up for bid. Historically, when those authorities change over to a new organization, the relevant clinical data becomes inaccessible. So there was a need to have a continuity with the client data within the behavioral health community.
We also want to make sure we can have the relevant treatment data available both to behavioral health organizations and physical health organizations to better support the clients they are serving.
Another factor is that in Arizona, our state HIE does not exchange behavioral health data. Because of the complicated privacy laws, this became a priority that they had not yet tackled.
BH: What were the first steps to getting off the ground? Have the biggest challenges in getting it up and running involved technology or policy issues -- or both?
Young: Technology is a moving target. We would roll up our sleeves and begin and then realize we needed other things. So we have course-corrected in putting our HIE together, but most of the challenges we have come across are pretty typical. From a behavioral health perspective, though, we spent a lot of time on legal and policy review, making sure we had covered everything from a consent management perspective. We want to make sure we are receiving the proper consent and have a good mechanism for doing so. We spent a lot of time hammering out our consent document, and then incorporating that in a technical format into our HIE.
BH: I understand that one of your goals is to connect to the broader statewide HIE. Yet Arizona’s HIE is opt-out for consent while your behavioral health HIE is opt-in. Is there a way to reconcile those two approaches?
Young: There is some work that needs to be done there, so we are approaching it in two phases. The first phase is for our HIE to receive data from the state HIE to get the physical health data into our HIE. For that phase, we let the state manage the opt-in. We don’t receive any data that has been opted out. We really are passing the data through our system to connected providers.
Going the other direction, what we envision is that the physical health providers would collect consent at the point of care to receive access to the behavioral health record as a one-off for each provider. How we would do that from a technical perspective has not been fleshed out yet.
BH: Within your HIE, is the information a patient can choose to share all or nothing, or is there a way for them to share some types of data and not others?
Young: It really is all or nothing. We are treating all of the data within our HIE as protected 42 CFR Part 2 data. If the client isn’t comfortable sharing their Part 2 data, then we aren’t going to share anything else.
I will say though that it is granular by organization. For instance, if a client came for a visit to one provider and opted in to our HIE, their data from that visit would be shared out with the rest of the network where there is a treatment relationship. Let’s say a week later that person went to a detox facility. The detox facility would receive their data from that first organization they visited. But if the client decided they were uncomfortable sharing their detox data with anyone, that data would not flow out to anyone in the network. By doing it that way, we have the ability for data to be flowing to some or all of the network rather than an on/off switch, so the clients have some more flexibility.
BH: Do you plan to create a patient portal? Could patients look at their own records or could they use that to change consent options?
Young: It is in our roadmap, but we don’t have that currently deployed. They would be able to see aspects of their personal health record and do things like revoke or execute their consent.
BH: How many organizations are sharing data now and what are your goals for the rest of the year?