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Starting simple with data exchange

May 7, 2012
by John Morrissey
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Part 1: Ten states open health information exchanges to behavioral health providers who seek interoperable EHRs
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Computerized exchange of behavioral health information can be complicated by the need to comply with specific confidentiality requirements. Federal law, specifically CFR 42 part 2, requires not only that addiction treatment information be carefully protected, but that individuals have the right to allow or suppress instances of its disclosure. And, state requirements governing mental health and addiction data vary widely.

Yet at the same time, quality care depends on the sharing of such information with physical health providers as well as access by behavioral health providers to information about individuals’ physical or medical problems. 

Recently launched federal and state efforts are trying to chip away at the legal and technological hurdles that stand in the way of better integrating and sharing behavioral- and physical health information.

“We don’t have a magic button for exchanging behavioral health data, but we are learning so much in the process of getting ready to mobilize data,” says Lee Stevens, a program manager for health information exchange (HIE) with the Office of the National Coordinator for Health Information Technology (ONC).

The ONC is coordinating attempts by HIE-development programs in Alabama, Florida, Kentucky, Michigan, Nebraska, and New Mexico to reach consensus on “putting the mechanisms in place that will allow that data to flow between unaffiliated providers in a secure way,” says Stevens.
“We’re also finding ways that states can coordinate their consent requirements to actually exchange that data across state lines when it is necessary.”

In a separate initiative, five statewide HIE-development projects, each with a $600,000 grant from SAMHSA, are preparing the way for certain behavioral health information to be created in standard electronic form and viewed or exchanged online.

The National Council for Community Behavioral Healthcare, contracted to operate the program, is supervising and supporting information exchange to and from behavioral health settings in Kentucky, Illinois, Maine, Oklahoma and Rhode Island (Figure 1).

Despite the challenges posed by the need for confidentiality, “there are times when patients want that data to be moved,” says Stevens. “We’ve heard from numerous sources that there are plenty of patients that do want their data exchanged.” In that event, providers must know what’s necessary to exchange such data and develop an understanding of these evolving processes.

“Most everyone now really does consider this data to be completely locked up,” he says. “There’s not an understanding of what it would take to transmit this data if the patient chose to.”

To allow for practical exchange of such data, the behavioral health field would need to have, at minimum:

  • Agreement on, and development of, a list of behavioral health-oriented data elements to be shared.
  • The information technology in place to be able to communicate with other similarly equipped providers.
  • Cooperation of electronic health record (EHR) vendors in adding specific, standardized HIE software.

Behavioral health providers have unique needs

Much of the patient information now being shared electronically by primary-care doctors, medical specialists and acute-care facilities—medications, lab results, current physical illnesses, family history, and demographics—are also of value to behavioral health. Two SAMHSA grantee states operating HIE networks with extensive connections to medical providers—Maine and Rhode Island—are using their funds to extend access to this data to behavioral health providers.

Figure: Goals of SAMHSA grant to five states developing behavioral health/physical health data exchange:

• Develop and implement infrastructure to share behavioral and physical health records.
• Review and make recommendations on elements specific to behavioral health to include in a Continuity-of-Care Document (CCD).
• Work on processing consent directives in ways that comply with federal and state laws.
• Incorporate lab results into infrastructure as structured data.
• Support the use of electronic prescribing.

Source: The National Council

The electronic “envelope” by which EHR data elements pass from one computer system to another is a content and messaging standard called a Continuity of Care Document (CCD), created and maintained by the standards-development organization Health Level Seven, or HL7. Though the CCD allows the gathering and transmission of a wide range of medical data, “behavioral health data is a different thing,” says Gary Christensen, chief operating and information officer of the Rhode Island Quality Institute (RIQI), the state’s HIE operator. “So a standard CCD on its own won’t include much of the behavioral health record.”

One common omission is the bread and butter of behavioral health: the treatment plan. This plan documents physical conditions but also includes patient goals, objectives and the time frames and modalities for achieving them, says Michael Lardiere, LCSW, the National Council’s vice president for health information technology and strategic development. The current CCD standard does not facilitate that type of information, he says. Other shortcomings, noted by the HL7 behavioral health workgroup on which he is a member, include insufficient detail on patient problems and prescribing physicians.