Health information exchanges (HIEs) represent a potential solution to the problem of interoperability. As large networks that conglomerate data from independent EHRs in standardized formats, they have the capacity to potentially distribute data and collect it in a way that ensures accuracy and validity. HIEs also struggle to establish accurate data feeds with individual EHR systems because the EHRs lack interoperability standards. Though this is true in many smaller primary care practices, it is especially true with community behavioral health organizations.
To further complicate the matter, many HIEs are slow to adopt behavioral health data for fear of additional federal and state privacy concerns. These concerns stem from the sending side as well as the receiving side. But data that doesn’t have anything to do with the specific treatment of substance abuse disorders or the content of psychotherapy sessions can and should be freely and securely shared. This should happen with appropriate patient oversight and in the service of coordinating care for those with behavioral health disorders.
Unless we can overcome privacy concerns and establish robust interoperable EHR systems in behavioral health, we continue to run the risk of further stigmatization and exclusion from the rest of health care. Even worse, patients with behavioral health conditions may not reap the full benefits of expensive, clinical EHR implementations or be harmed by a lack of care coordination that may otherwise be possible.
Clinics and hospital systems can ensure that their EHR is interoperable by asking and requesting that it conform to National Center for Health IT meaningful use 2.0 standards. Parts of these standards include a consistent framework for exporting clinical data and documents to other EHRs and information exchanges.
Starting this year, clinical systems that do not conform to these standards will start to be penalized, which may offer additional incentive to become interoperable. You can also help by ensuring that data you’re putting into the EHR (problem list data, diagnoses, lab orders, vital signs, PHQ9 scores, etc.) are coded correctly and as accurately as possible, and that you and your clinical teams perform these functions consistently.
EHRs are here to stay. Many physicians loathe their complexity and the workflows they’ve interrupted, but they hold enormous promise for better integration of care and services. Some simple steps can help ensure that behavioral health treatments, centers, clinicians and patients continue our integration into the broader healthcare system, and are essential to realizing the provision of holistic care to all of our patients in an evolving landscape of health care reform.
Erik Vanderlip, MD, MPH, is the George Kaiser Foundation chair in mental health and an assistant professor in the departments of psychiatry and medical informatics at the University of Oklahoma School of Community Medicine. He also serves on the American Psychiatric Association Board of Trustees.