Man pondering imponderables

Behavioral health data exchange faces tech, privacy obstacles

A recent report of a successful pilot of interstate behavioral health data exchange by a coalition of states demonstrated that some technical and operational barriers remain before such data can be exchanged nationwide.

According to the report by the Office of the National Coordinator for Health Information Technology (ONC), the barriers center on a single key issue: privacy. Both federal and state privacy laws have created complex challenges for sharing behavioral health information electronically, the ONC report noted. For example, privacy protections may require written patient consent prior to the disclosure of such information, even for treatment.

The project was conducted through the Behavioral Health Data Exchange Consortium. Representatives from seven states – Alabama, Florida, Kentucky, Michigan, New Mexico, Nebraska and Iowa participated. The consortium was supported by ONC through the State Health Policy Consortium, part of ONC’s State Health Information Exchange Program and managed by RTI International.

At the end of the project, providers in Florida and Alabama successfully exchanged information, and frameworks for exchange were established in three additional states.

While the ultimate goal of the project is to exchange standardized, machine-readable data, the pilot tests used summary care information in PDF format in order to overcome current limitations of electronic health record (EHR) systems, which cannot effectively segment behavioral health data from other clinical data today. Information was sent via the Direct exchange a set of standards, policies and services that enable simple, secure transport of health information between authorized care providers.

“Once the EHR system reads patient data, those data become part of the patient record and could be redisclosed along with other patient information if requested by a third party,” noted the report. The report concluded that several barriers remain, both on the technical and operational side, to creating a nationwide exchange of behavioral health data.

On the technical side, “EHR systems must begin to provide a mechanism for segmenting and/or flagging data that require specific processes for disclosure or redisclosure,” according to the report  “Without such functionality, it is incumbent upon providers to understand the requirements for manually segmenting this data.”

"In addition, widespread understanding and agreement about the requirements for consent and disclosure of behavioral health data are still major challenges to overcome … the majority of providers do not know how to appropriately manage the receipt and redisclosure of this information,” added the report.

The report listed three overarching recommendations to improve behavioral health data exchange:

Align policy with the technical capabilities of EHR systems, including the ability to segment machine-readable data and create a more robust technology framework with the ability to both push and pull data.

Increase general understanding of exchanging behavioral health data, including increased training of the primary health care provider population regarding document storage and access controls for behavioral health information.

Include behavioral health data exchange in discussions about scaling health information exchange networks, such as establishment of policies and procedures for specially protected behavioral health information exchanged over a nationwide network.

The pilot project served as a catalyst for additional information exchange. Florida is now connected with Direct implementations in Alabama, Georgia, Louisiana, South Carolina, Michigan, West Virginia and Wisconsin. In Michigan, Michigan Health Information Network Shared Services plans to conduct two small scale pilots of the exchange of behavioral health information

About the Author

Kathleen Hickey is a freelance writer for GCN.

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