Health information exchange: HIE for Behavioral Health
By Laura Young
Many states and communities are forming health information exchanges (HIE) to promote greater care coordination and collaboration across healthcare settings. Most of these repositories capture traditional clinical data, pulling from hospital and physician practice records, but behavioral health data is conspicuously absent. Historically, this lack of data has stemmed from a fragmented healthcare system. With the shift to value-based care, looking at many different aspects of a patient’s health is important and can help providers improve patient safety and outcomes.
The Behavioral Health Information Network of Arizona (BHINAZ) is the first-of-its-kind statewide HIE dedicated to behavioral healthcare, designed to share information with mental health professionals throughout the state and eventually with providers of physical healthcare as well. Sponsored by seven nonprofit behavioral health organizations, BHINAZ gathers, routes, and queries data from a wide range of service providers, including substance abuse programs, crisis professionals, general mental health practitioners, and children’s behavioral health specialists, in three separate repositories for clinical data, documents, and patient consent.
BHINAZ’s behavioral health HIE helps its member organizations and patients realize numerous benefits by gathering, analyzing, and leveraging information about the entire patient to improve safety and enhance outcomes.
Improving Safety and Cost
BHINAZ’s mission is to fill the gap that exists in traditional HIE and allow behavioral health organizations to share critical information just like their physical health counterparts. Doing so allows providers to treat patients holistically, addressing their entire being from a healthcare perspective. BHINAZ is now connected to “The Network”—the Arizona HIE for physical health data. Once testing is completed, providers will be able to receive admit, discharge, and transfer notices for their patients, and access further clinical data on patients through The Network. That said, because of the significant privacy and security concerns associated specifically with behavioral health data, providers in the state felt that a separate tool focused solely on mental health information was necessary.
Having this data helps BHINAZ enable greater collaboration and more responsive crisis intervention between behavioral health organizations, ensuring the most appropriate care, preventing duplicative therapies, and helping clients move past crises faster. This not only elevates patient care statewide, but also enhances safety and streamlines cost.
For example, when an individual enters a crisis center, the provider can access BHINAZ, check if the patient has been seen by other behavioral health professionals in the state, and download his or her comprehensive treatment history. That lets the provider develop the most appropriate therapy and avoid duplicating services. In addition, the system alerts the individual’s other mental health providers that the patient is in crisis, allowing them to offer real-time input into the individual’s care. If the patient enters the hospital, the system again notifies mental health providers so that the appropriate discharge and follow-up appointments can be made, preventing situations in which patients leave the hospital unsupported.
As an HIE, BHINAZ also facilitates information continuity. For example, the state of Arizona awards behavioral health contracts every five years to companies that serve as payers for the regional mental health community. In the past, when contract negotiations resulted in a change in vendor, all patient information stayed with the original vendor, and practitioners lost access to it once the contract turned over. This lapse in information put patients at risk, sometimes resulting in negative health outcomes. To avoid such information loss, BHINAZ has committed to retaining patient information regardless of the contracted vendor. This gives providers consistent access to data, ensures better care continuity, and prevents at-risk patients from slipping through the cracks.
Lessons Learned
Since BHINAZ is the first HIE devoted to mental health information, there was no proven model to follow, so the organization had to feel its way through the process. Creating a behavioral health HIE to support information aggregation and exchange was not without its challenges. Consent was one of the biggest hurdles BHINAZ faced. The organization spent 18 months determining the best way to obtain consent, taking into account patient preferences, technology considerations, and legal requirements. Course correction occurred along the way, but ultimately a secure method for collecting consent was developed in BHINAZ’s electronic health record (EHR), allowing patients to opt in to the HIE for 365 days or until they turn 18, whichever comes first.
In addition to working through consent logistics, BHINAZ also developed a strong education program to assist providers in recruiting patients into the system. Educational materials describe the intent of the HIE and why patients should participate. They also address frequently asked questions, particularly around how the organization ensures data privacy and security. Additionally, a 90-second animated video was created to help clients further understand the tool’s purpose, benefits, and security. To aid mental health organizations, BHINAZ created step-by-step instructions on how best to approach the patient and obtain permission.
Besides consent, another key focus was how the organization would embed the resource into existing provider workflow. A comprehensive HIE, such as BHINAZ, is only effective if providers use it—otherwise, it is just an unwieldy data repository that falls short in delivering value. Many HIEs zero in on the need to establish connections with providers, neglecting to fully consider how they will incorporate the data into their daily practice.
To make its HIE more relevant and useful, BHINAZ asked participating organizations to be part of what they are building, involving them in pilot programs to refine how the data is structured, interfaced, and used. The organization gave providers the option to have certain data elements delivered directly to the EHR in addition to viewing the data at a portal level. In the EHR, they can see a comprehensive patient record, including data from all providers served by the HIE. By partnering with providers, BHINAZ is learning the best ways to embed the HIE into workflow, such as setting up alerts for when patients are in crisis and offering easy ways to check and navigate the tool.
In addition to working closely with mental health professionals, BHINAZ also selected a technology vendor that was willing to collaborate with the organization and address its unique and evolving needs. Not every vendor is capable of capturing and securing behavioral health data—for instance, some software platforms have limited or no support for capturing of consent. Thus, the organization needed to choose a company that could start them along the path and evolve as the HIE grows.
A Work in Progress
BHINAZ is relatively new, but it has the potential to substantially enrich mental health services in Arizona. Ultimately, the organization hopes that both behavioral health and physical health organizations can deliver more holistic and collaborative care by leveraging the HIE to construct a more detailed picture of patients. By using robust technology that supports a seamless interface, embedding the tool into provider workflow, and encouraging patients to participate in the program, BHINAZ aims to serve as an invaluable resource in enhancing patient care and safety throughout the state.
Laura Young, executive director of BHINAZ, is an information technology expert with over 25 years working in the IT industry across clients in government, nonprofit, education, and healthcare. With degrees in information technology and health services management, Young has been a leader in the healthcare IT sector for more than nine years, with a specific focus on clinical IT and HIE systems. Young may be contacted at laura.young@bhinaz.com.