The Substance Abuse and Mental Health Services Administration held a meeting in October entitled “2011 Consensus-Building Summit on Electronic Health Records for Behavioral Health.” Invited to the day-long meeting were many national leaders and organizational representatives from numerous relevant organizations. The purpose was “to address the issue of consensus building for data sharing for continuity of care between providers.
Highlights of the meeting, organized by Valerie Mills, Ph.D., included discussions on SAMHSA’s vision for advancing health information technology and EHRs in the behavioral health community, the integration of behavioral health with primary care, concerns and strategies from behavioral health providers, and confidentiality issues concerning the adoption of HIT/EHRs and the consumer. Other discussions focused on differences in clinical experiences with primary care patients versus behavioral health clients, and priority elements to include as core clinical data for EHRs and continuity of care documents (CCDs) in recovery-oriented services, treatment for addictions, and treatment for serious mental illness.
The director of SAMHSA’s Center for Substance Abuse Treatment, Dr. Westley Clark, summarized the day’s goal as “working towards consensus on specific elements of information that should be included in a uniform or standard EHR that has a behavioral health focus and the CCD that we share with the rest of the delivery system.” The CCD, or continuity of care document, is a standard way to represent and summarize clinical data from an episode of care, written in XML (eXtensible Markup Language). Building upon three regional HIT meetings held over the past summer, much of this meeting was spent discussing which types of information are needed by primary care providers, by behavioral health providers, and by patients. Given past discussion in this column about privacy concerns with HIT in mental health and addictions, Dr. Clark underscored SAMHSA’s intent to have behavioral health providers fully participate in the adoption and integration of Health IT within the general health care delivery system.
Michael Lardiere, from the National Council for Community Behavioral Healthcare (NCCBHC), stressed the importance of integration of behavioral health and primary care communication and collaboration. Toward that goal, he described an HIT adoption survey currently underway by the National Council. He also reviewed the 17 components of the current CCD standard, which are:
1. Patient Demographics
3. Vital Signs
4, Problems & Diagnoses
5. Insurance Information
6. Health Care Providers
7. Encounter Information
8. Allergies/Alerting Data
9. Appropriate Results
13. Necessary Medical Equipment
14. Social History
16. Family History
17. Care Plan
At this time, no behavioral health-specific elements are in the CCD. There is an HL7 work group, lead by Madan Gopal from the Arizona Health Department, that is currently developing draft specifications for such elements. This draft is expected to be voted on by HL7 around February 2012.
There were several other presentations before breaking into small groups to develop specific suggestions regarding the psychiatric elements to be included in a CCD. Sherri Morgan, from the National Association of Social Workers, spoke about implementation of HIT in small practices, many of whom are using consumer-oriented software instead of expensive niche products. Anne Watt and Patty Craig, both from The Joint Commission, discussed performance measures including new substance abuse measures for 2012. Vendor incorporation of these and future measures will be facilitated by their Measure Authoring Tool using the Health Quality Measures Format, or HQMF. Bettye Harrison, spoke about CARF’s recent activities, while I represented the American Psychiatric Association and spoke about risks and benefits of HIT implementation for behavioral health specialists. Finally, Lynn Bufka, Ph.D., from the American Psychological Association, led a discussion about confidentiality, the need for data segmentation and other challenges in behavioral health IT.
Three break-out groups developed consensus on which core clinical data are needed to be included in the CCD for serious mental illnesses, addictions, and recovery-oriented services. The strongest themes to emerge centered around building in granular consent management metadata within the CCD document, and greater consumer access to and control of their health information.
From the summary document, nine cross-cutting issues emerged from all three break-out work groups:
1. Vested self-interest in working together
2, Work only within the framework of the CCD/ HL7
3. Linkage of providers to services to problems to results to continuing care plan
4. Usability – work needed on how to read the record, how usable it will be, what views will be there (use of metadata tagging) (an issue to still be addressed/resolved)
5. Need for resolution of data segmentation