Patient behavioral health data has been successfully exchanged across state lines, opening the door to further interoperability of such data, according to a new report released by the Office of the National Coordinator for Heath IT.
Federal and state privacy laws make it particularly difficult to exchange substance abuse and behavioral health data, since those laws are more stringent than HIPAA. What's more, they require consent for most disclosures and re-disclosures, according to Jon Rancourt, a public health analyst for ONC's Office of Health Information Exchange, and H. Westley Clark, director of the Substance Abuse and Mental Health Services Administration (SAMHSA) Center for Substance Abuse Treatment in a blog post announcing the report. As a result, behavioral health data is often excluded from HIEs, causing patient data in an HIE to be incomplete.
To attempt to combat this problem, seven states created the Behavioral Health Data Exchange Consortium in partnership with ONC and SAMHSA. The consortium created policies and procedures to address federal and state law privacy issues, and educated providers as to how to exchange the data; providers in the pilot then were able to successfully exchange test data using the Direct Project's messaging protocols.
"Demonstrating the ability to exchange behavioral health data electronically is a huge step forward to reduce disparities for patients with specially protected information who have been left out of previous HIE initiatives," the report's authors wrote. "This study shows that when data are needed for treatment, no barrier should exist for exchanging that information electronically as long as all parties adhere to the state and federal requirements for the disclosure of that information."
The seven states in the consortium are Alabama, Florida, Kentucky, Michigan, New Mexico, Nebraska and Iowa.
The report recommended that similar programs enable "push" transactions using Direct rather than "pull" (query) transactions to comply with these more restrictive laws and to work on "scalable trust." It also recommended that state law differences for disclosures be resolved.
The report also acknowledged that technical barriers need to be overcome, such as the inability of electronic health records to segment data that requires specific processes for disclosure.
There have been concerns that the inability of EHRs to share data will impede patient care and that Meaningful Use will inadvertently create care disparities. The government has struggled in the past about the extent to which it should regulate interoperability.