Email UpdatesThe Lexicon defines an organized clinical approach to integrating behavioral health and primary care. This framework is built on several key components, including documentation of a unified care plan, treatment and referral activities, and supports for patients and families in shared electronic health records (EHRs) and disease registries. The Office of the National Coordinator for Health Information Technology (PDF - 1330 KB) (ONC) notes that health information technology (health IT) “enables and supports most of the functional components necessary for clinical integration of physical health and behavioral health.”1
The AHRQ Academy’s Guidebook of Professional Practices and Provider- and Practice-Level Competencies clearly highlight many of the ways health IT contributes to the effective delivery of integrated care. These include using the EHR to:
- Identify where a patient is in the integrated workflow (e.g., patient is with primary care clinician, behavioral health clinician, referral status),
- Support communication across all members of the care team and report performance data to payers and other organizations,
- Track referrals and communicate important health information between primary care and referral providers, and
- Support patient education (e.g., showing patient trends in clinical measures on screen, sharing visit summaries).
Registries are also very important for patients, including those with chronic health problems, to:
- Track patient progress over time,
- Provide reminders of the need for followup,
- Help adjust treatment as needed, and
- Support population health management.
A range of other forms of health IT can be used for important functions, such as:
- Email and apps to communicate between patients and the care team,
- Personal health records (PHRs) and apps to support patient self-management and to link to peer and other community support services,
- Health information exchanges (HIEs) to share information across wider networks of providers,
- State prescription drug monitoring programs (PDMPs) to support medication-assisted treatment for opioid use disorders,
- Decision support tools (in the EHR or apps) to support evidence-based clinical care, and
- Data from EHRs, registries, and other sources to support ongoing quality improvement.
Unfortunately, most available EHR platforms do not effectively support the integration of behavioral health and primary care. Organizations must often adapt systems intended to support general medical services to provide the functionality needed for behavioral health care, and the reverse is also true. Integrated practices often need specialized templates for shared care plans, information release forms that meet Federal and State privacy regulations, and other purposes.
The Academy prepared a few case studies to demonstrate how selected organizations have developed their health IT systems to support the integration of behavioral health and primary care. Progress in these areas has been rapid as vendors and providers alike recognize the importance of integrating behavioral health and primary care.
Protecting patients’ privacy and sharing information are closely related. Numerous Federal and State regulations define what information can be shared with whom and under what circumstances.
Key Federal regulations include the Health Insurance Portability and Accountability Act (HIPAA) that applies to all health information. Also, the Confidentiality of Alcohol and Drug Abuse Patient Records (42 CFR Part 2) regulations apply specifically to privacy of information for people receiving publicly funded treatment of substance use disorders. The substance abuse confidentiality regulations are being revised, and further changes are expected.
These regulations can create significant barriers to sharing important information, but some technologies have successfully shown they can fully meet all requirements.2 Anyone attempting to integrate behavioral health and primary care should also learn the relevant state privacy regulations, which can sometimes be more strict than Federal regulations.
References
- Bequette T, Rader S. Behavioral health integration: health IT considerations. Webinar presented for ONC SIM Resource Center; 2016. www.healthit.gov/sites/default/files/onc_sim_resource_center_webinar032916 (PDF - 1330 KB). Accessed May 4, 2017.
- Substance Abuse and Mental Health Services Administration. Health IT for Behavioral Health Professionals. Last updated January 4, 2017. Accessed May 4, 2017.