Are We Close to Having Bidirectional Behavioral Health Data Exchange in Colorado?

Exchanging behavioral health data is imperative to improving care coordination for these vulnerable patients – but doing so carefully within current boundaries of the regulations will take some time and a concerted effort. Here’s an update on progress so far.

Since early 2014, CORHIO has been convening a Behavioral Health Information Exchange Work Group with participations from state health officials, behavioral health centers, private physician practices, and other relevant membership organizations. The group has been working diligently to thoroughly understand the current regulations about information sharing and exploring best practices for exchanging sensitive and specially protected patient information. (For background on CORHIO's behavioral grant from the Rose Community Foundation that is supporting this work, see New Grant Funding to Enable Improvements for Behavioral Health and HIE in Colorado.)

Ambiguity Surrounding Behavioral Health Information

The work group has conducted a thorough review of all the regulations surrounding behavioral health patient privacy and data sharing. An important conclusion they came to is that the regulations are not as black and white as many think. The regulations governing Substance Abuse Treatment Data (42 CFR Part 2) for instance, only apply to programs who “hold themselves out” as providing substance abuse treatment. This definition is ambiguous leading some organizations to wonder which parts or their organization’s data – or if all of their organization’s data – are subject to the regulation. (For more information, click here.)

“We have to dispel some of the misnomers and myths. There’s more flexibility than I think a lot of people believe,” says Chris Habgood, Director of Public Policy and Planning, Office of Behavioral Health. “There are some simple business practices, like Memorandums of Understanding (MOUs) in accordance with HIPAA and Qualified Service Organization Agreements (QSOAs) in accordance with 42 CFR Part 2, which could solve these issues. In certain circumstances, MOUs or QSOAs could allow two agencies to directly share information without getting patient releases.”

The work group, led by Toria Thompson, CORHIO’s Behavioral Health Information Exchange Coordinator, is also meeting with community behavioral health centers to discuss their needs in-depth. “What became clear as we began working with the various centers is that the data within their EHRs was not segmented to take advantage of the ability to share data through CORHIO,” she says. “Until providers are certain they won’t inadvertently share substance abuse treatment data with us, they’ll need to consider all of their data under the 42 CFR Part 2 regulations.” (For more information on 42 CFR Part 2 regulations and proposed changes, click here.)

Next Steps

Now that we have a solid understanding of the regulatory landscape and the needs of local providers, CORHIO continues to work toward finding a way for 42 CFR Part 2 data to be managed and shared securely following regulations. A few other HIEs in the country have successfully tackled this issue and Thompson has begun meeting with them to understand how they built this functionality.

On the provider level, several local behavioral health centers are seeking clarification from their legal counsel on segmenting their data to enable sharing through an HIE. It’s hoped that they could begin sending a limited dataset – for instance, a limited set of a patient’s mental health data, into the HIE. If they could do this, behavioral health data could be shared between Colorado providers through upcoming CCD exchange functionality being added to CORHIO.

“Because of some of the barriers we’ve created artificially in sharing of information, we may have actually slowed down the process for early identification and coordinating of treatment,” says Habgood. “Having that sharing of information can really benefit the individual so they can get all of their health care needs met quickly.”

To learn more, see Moving Forward with the HIE in the Behavioral Health Community.