Mental health care providers face almost a completely different regulatory environment in this country than their clinical healthcare counterparts, which can make integrating the two points of care difficult.
Lots of factors feed into that phenomenon, but none more so than the difficulty sharing patient data between the two types of providers, according to a recent report by the Bipartisan Policy Center. Among other things, most mental health care providers don't even use electronic health records (EHRs)—which shines an entirely different light on the interoperability crusade.
The HITECH Act, which incentivized most physical healthcare providers to adopt some form of EHR system, excluded mental healthcare and substance use disorder (SUD) providers. As a consequence, those providers mostly haven't upgraded their systems.
"The Health Information Technology for Economic and Clinical Health Act (HITECH) of 2009, which was part of the American Recovery and Reinvestment Act of 2009, provided billions of dollars in subsidies for medical providers to purchase and maintain electronic health records, but the act did not make incentive payments available for mental health and SUD providers. While the adoption of electronic health records has increased among other healthcare providers and entities, adoption by mental health and SUD providers has lagged," the Bipartisan Policy Center wrote in its report (PDF).
Furthermore, regulations for SUD providers are set up specifically to avoid information sharing. The Confidentiality of Alcohol and Drug Abuse Patient Records statute, written in the 1970s, kept SUD records separate from other parts of the patient file.
This was done to protect the privacy of SUD patients so they wouldn't fear seeking treatment. That was a reasonable rationale, as unauthorized disclosure of SUD treatment can have major implications on the career and personal life of a patient.
However, in the era of the opioid crisis, those laws can also stop clinicians from getting all the information they need.
"Today’s opioid addiction crisis has highlighted the need for easier data sharing. Primary care practitioners, for example, have no way of knowing about a patient’s SUD and accompanying treatment unless the patient discloses that information during a visit. By contrast, the Health Insurance Portability and Accountability Act (HIPAA) allows patient information to be shared in order to provide care coordination," the organization wrote.
The Bipartisan Policy Center offered four options for policymakers to increase care coordination with mental health care:
- Expand the substance use report (mandated by the 21st Century Cures Act) to make future recommendations to Congress.
- Direct federal funding to mental healthcare facilities.
- Permit funding from the HITECH Act to go to mental health and SUD providers, then encourage or require those providers to adopt EHR systems.
- Provide more guidance on HIPAA updates.