Health information exchange (HIE) is a hot topic – from a strategy, tactical, and tech perspective. Why? Without data exchange between provider organizations, integrated care coordination for individual consumers and for populations is not possible. And this puts independent specialist organizations at strategic risk (see Specialist Options In An Integrated Care Management World and ‘Integrated Care’ & Strategy).
The state of HIE is rudimentary right now. The executives of many organizations that are operating health home initiatives or managing readmission prevention programs have data exchange initiatives “in process” – but are stuck with a manual process right now. (For more on the state of HIE, see Are We There Yet? A Look At Three State Health Information Exchange Initiatives, Without HIE, Participation In ACOs Is Limited, and HIE Not Only Improves Efficiency – It Saves Lives).
Amidst these difficulties, it was interesting to learn more about the success of a behavioral HIE that is up and running in the session, Health Information Exchanges (HIEs): How Behavioral Health Agencies Can Survive In A Sea Of Systemic Change, at the 2015 OPEN MINDS Technology & Informatics Institute.
The Behavioral Health Information Network of Arizona (BHINAZ) was incorporated in June 2013 – a for-profit stakeholder-owned organization owned by seven nonprofit organizations to facilitate exchange of health information between behavioral health organizations in Arizona. The concept had an initial HIE pilot with Jewish Family Children’s Service and Quality Care Network. BHINAZ currently has data sharing relationship with Jewish Family & Children’s Service, Partners in Recovery, Lifewell Behavioral Wellness, A New Leaf, Chicanos Por La Causa, EMPACT, Community Bridges, and Assurance Health and Wellness.
The successes – and challenges – of developing and operating the behavioral health HIE were presented by Laura Young, Executive Director and Robin Trush, M.A.O.M., Director of Operations, BHINAZ/Behavioral Health Information Partners. There were a few key takeaways for any other group of behavioral health organizations thinking about establishing a similar exchange.
Opt-In Model to Meet Requirements of 42CFR – To both meet the federal requirements of 42 CFR and permit health information exchange, BHINAZ has a well-developed set of processes. The key is the opt-in model for consumer consent to datasharing. Once a provider organization decides to participate in the exchange, they must notify their consumers and give them the ability to “opt in” for sharing their data through the HIE. Patients can revoke consent at any time. BHINAZ currently has an opt-in rate of 78%, and monitors the individual rate for each provider in the system with special attention given to on-boarding to get and keep the necessary opt-ins.
“Break The Glass” Provisions in Emergencies – To address emergencies, BHINAZ has a “Break the glass” provision. This allows the organization to share even protected information with emergency responders if the situation warrants. That information can be made available regardless of consent status for valid emergency situations.
Future Integration With Physical Health – The larger Arizona system is one that focuses on integration (see Maricopa County’s Emerging Integrated Care Management Model), and last year BHINAZ began working on HIE-to-HIE connections to Mercy Maricopa Integrated Care and to Health Information Network of Arizona. The BHINAZ HIE currently receives physical health data from other exchanges. However, Ms. Young and Ms. Trush noted that the key moving forward with bi-directional integration, would be to adopt a slightly different model, like a query-based exchange so that behavioral health data can be released to physical health providers in non-emergency situations.
For more on health information exchange and integrated care coordination models, check out the upcoming session, The Challenges & Opportunities Of Moving To Integrated Care Management, at the 2016 OPEN MINDS Performance Management Institute, on February 11 in Clearwater Beach, Florida.