HIT Final Report Executive Summary
Getting involved in an electronic health information exchange (HIE) involves many pieces – from establishing partnerships and protocols to updating electronic health record systems and educating clients. HIEs play an important part in integrated care, as they can facilitate care coordination in improving both the patient experience and their treatment outcomes. The SAMHSA-HRSA Center for Integrated Health Solutions (CIHS) worked with behavioral health organizations in five states to get involved in HIEs and developed an array of resources other organizations can use to work through the barriers of sharing behavioral health data. Resources include reports from each state’s initiative, sample training manuals, consent forms, continuity of care documents, provider guidelines, and client brochures.There is an ever growing recognition that behavioral health must be included in the nation’s efforts to meet the Triple Aims of Better Care, Better Health and Greater Value.
Forty-seven individual behavioral health organizations received HIT supplements to their Primary Care Behavioral Health Integration (PBHCI) Grants in September 2011. These organizations which were provided a significant amount of technical assistance and individual support made significant progress in a very short time. Eighty-seven percent of these grantees were able to meet their deliverables within the twelve month grant period. It should be noted that this would not have been possible if they were not provided financial and staff resources through CIHS to assist them in this effort.
Behavioral Health providers require the same kind of hands on assistance as is provided to medical providers who are eligible for Meaningful Use Incentives and receive free services from the nation’s Regional Extension Centers (RECs). CIHS staff noted and you will see in the report that the needs of these behavioral health provider organizations and the interventions they require are the same as those that are provided to medical providers under the Meaningful Use Incentive program. They lack HIT staff and other resources and require significant hands on assistance. The need and focus on workflows, organizational redesign, staff education and training all mirror medical provider practices. Disparities in the availability to technical assistance services were encountered and it was noted during the implementation process that not all RECs see behavioral health providers as being their target population. The RECs are not incentivized to provide technical assistance services to these providers as they are not their “target provider population” and subsequently the providers are left to their own resources.
Many of the providers did maximize the resources available through CIHS and of the providers in these organizations have become eligible for MU Incentives for their providers (physicians and in some cases under Medicaid nurse practitioners) in their organizations.
Our congratulations go out to these providers and their staff in performing so well under short timelines and accomplishing the ability to reap the benefits of utilizing technology to improve care and begin to communicate and share information with their medical partners.
The Health Information Exchange/State Designated Entity (HIE/SDE) component of this supplement was also successful.Prior to the implementation of this award there was no state HIE in the nation that was sharing behavioral health information (mental health and substance use) through the HIE. The five states who received the sub awards have paved the way for the future. The future is now and it is moving forward quickly. Five states Illinois, Kentucky, Maine, Oklahoma and Rhode Island now share mental health information. Two of these states, Rhode Island and Kentucky are reprogramming their systems and are ready to share substance use information through the HIE shortly.
These five states with the input from their legal advisors, providers and consumers in their respective states, representatives from ONC and SAMHSA and other members of the team led by CIHS staff during the year long project have also established a Sample 42 CFR Part 2 Compliant Consent Form that is computable in a HIE environment that can be utilized as a framework by other states. Many other artifacts, tools and resources are also available.A barrier or obstacle that still requires clarification is the wording of the “To Whom” section of the Consent Form. The states have proposed wording that they have determined to meet the requirements of 42 CFR Part 2 and allows the flexibility to share information in the current HIE environment and still provide the patient with control over his/her record.
Additional support to behavioral health organizations and to health information exchanges is needed to continue this intensive work. Continued progress to eliminate the digital divide between behavioral health and medical providers is necessary if we are going to provide high quality care and value to patients with medical and behavioral health conditions. The work of CIHS was one of the first major initiatives to show that information can be shared and the value it bring to patients and providers. Let’s not stop here. We need to keep the ball moving forward.