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HIEs are increasingly connecting providers centered around primary-care, but what about behavioral data?
These days, you don't have to look far to find a healthcare organization that touts the importance of treating the "whole" patient. Providers throughout the country strive to include patients' mental and emotional wellbeing when responding to their physical ailments. However, pursuing a holistic approach to patient care is often easier said than done, especially if providers do not have access to information that encompasses a patient's emotional and mental state. It's difficult for primary or specialty care physicians to deliver comprehensive care if they are unaware of a patient's behavioral health condition or mental illness.
The lack of behavioral health information exchange
Although many physician practices are beginning to participate in health information exchanges (HIEs) to enable well-informed, collaborative care, theyare usually focused on sharing clinical data that provides background on a patient's physical health, including the person's health history, current medication list and any active treatment plans. Very few include behavioral health information, such as data on crisis intervention plans, substance abuse programs or treatment from a mental health provider. Yet these conditions can dramatically impact a patient's treatment adherence. Behavioral health therapies also have the potential to conflict with physical interventions, resulting in medication incompatibilities and other dangerous situations that put patients at risk.
Consider the patient who recently had knee replacement surgery. As the specialist is deciding how to address the patient's pain during recovery, he is unaware that the individual has issues with substance abuse and has been in and out of rehabilitation. The physician prescribes a narcotic for pain, not realizing that it could cause problems for the patient and his or her long-term recovery.
If the physician has access to behavioral health information from an HIE, he can look up the patient's substance history and make a decision tailored to his or her rehabilitation path when prescribing pain medication.
Similarly, what if a primary-care physician has a patient with diabetes whose blood sugar is not responding well to medication? The patient is repeatedly visiting the hospital with dangerously high blood sugar. If the provider does not know that the patient also struggles with depression and has difficulty with medication compliance, she may believe there is something wrong with the patient's insulin dosage and prepare to alter the prescription. However, if the provider has access to the patient's behavioral health history, she can rethink the decision to change the dosage, and instead partner with the patient's behavioral health provider to work on improving treatment compliance.
There is work underway
The Behavioral Health Information Network of Arizona (BHINAZ) a statewide HIE, is one of the only HIEs solely dedicated to sharing behavioral health data in the country. Sponsored by seven nonprofit behavioral health organizations, BHINAZ gathers and communicates data among a wide range of service providers - including substance abuse programs, crisis professionals, children's behavioral health specialists, and general mental health practitioners.
To date, BHINAZ's primary focus has been to enable stronger crisis care and other mental health treatment. For example, in the state of Arizona, if a patient reaches out to a crisis care provider connected to the BHINAZ database, the provider can quickly access the patient's behavioral health history to review current treatment and medications, enabling more targeted and effective therapy.
BHINAZ is also starting to explore data exchange with physician practices. However, due to the sensitivity of this kind of information and the difficulties in addressing patient privacy concerns - patients can be more hesitant about sharing behavioral health data with their primary-care physicians - the work with physician practices is taking more time to implement.
There are also financial hurdles to overcome. Physician practices often have limited budgets, and may need to prioritize HIE participation and interoperability functionality required to participate in an HIE. In these cases, they tend to partner with clinically-focused repositories as opposed to behavioral health ones.
Despite the challenges, the potential benefits of behavioral health information exchange should not be ignored, and physician practices should commit to discovering ways to access this information. As a first step, physicians can find out whether their state or region has behavioral health HIEs, and learn necessary steps for connecting with these organizations. Although participation in these exchanges may not be as straightforward initially as a standard HIE, the effort to improve patient outcomes will be worth it in the long run. As organizations gain regular access to mental health data, they can round out their patient profiles, allowing providers to gain a robust picture of their patients and deliver more comprehensive and holistic care.
About the Author
Laura Young is the executive director at Behavioral Health Information Network of Arizona (BHINAZ).