Despite technology advances in electronic health records (EHRs) and the establishment of interoperability requirements by regulatory bodies, siloed patient information remains an unsolved problem impacting care delivery within behavioral health settings. Data silos are found both within an organization and across organizations, leading to fragmentation of care, costly staff inefficiencies, and care gaps that interfere with outcomes.
Even the most widely used EHRs fail to deliver in behavioral health settings because they were designed for single-author documentation rather than team-centered care. They create data silos, result in duplicative data entry, and fail to deliver structured data outputs that can cross institutional boundaries during care transitions.
Behavioral health lags behind acute care in enterprise EHR adoption due to lack of funding, leaving data silos that are an obstacle to providing efficient care and creating barriers to exchanging health data. Concerns around data privacy for sensitive information and a lack of easy onboarding to health information exchange networks further impede data exchange.
Understanding behavioral healthcare data challenges
While acute medical care and behavioral health facilities face similar siloed-data challenges, behavioral healthcare is unique in that it’s often heavily team-based, making care coordination paramount. Instead of a one-on-one care model between a doctor and patient, behavioral health also integrates group therapy, structured activities, and multidisciplinary care teams who must work together. This treatment team model creates a patient-focused holistic care approach, but it also complicates care coordination and chart documentation.
Transitions of care — such as when a patient enters emergency crisis care, transitions to a short-term inpatient care setting, and then discharges to residential or outpatient care — are challenging. Internal care teams must coordinate, but they often use systems that don’t interoperate. Sometimes, the care transition is to an external agency that either lacks a data-sharing agreement, lacks an integration with the discharging entity, or for which there are other barriers due to different privacy policies, leading at best to incomplete data or at worst to exposed patient information. Faxes and hard copies of chart summaries abound.
Exposing health IT cracks for behavioral health
While behavioral healthcare can be episodic, treatment is often long term or even lifelong. First-generation EHRs weren’t designed for team-based, longitudinal care across care settings. They were made for episodic care — such as a short hospitalization or a quick doctor’s visit for an acute problem — and often began as billing solutions that were focused on maximizing revenue rather than enhancing care delivery.
Acute care EHRs fall short for complex behavioral health needs (as well as chronic disease management, which has similarities to behavioral health team-managed care that takes place over extended periods). Selecting an EHR that is architected for behavioral health, comprised of team care and one-on-one services that can flex across care settings, supports patients through their care journeys.
Collaboration tools enable seamless data flow from referral, to the interdisciplinary treatment plan, to group documentation, to individual notes, and back as part of the “golden thread” of documentation — something that’s possible when the system is built with current data standards, such as HL7 Fast Healthcare Interoperability Resources and United States Core Data for Interoperability.
Balancing data privacy with data sharing
Additional factors, including legal concerns and patient consent agreements, also contribute to data silos. Mitigating data-sharing issues and ensuring EHRs are optimally used requires strong data governance practices, clear policies on sharing data, well-defined consent workflows, and robust staff training.
The behavioral health sector would benefit from a clearer federal privacy policy definition that harmonizes with interoperability standards to define exactly how, when, and with whom to share sensitive behavioral health and substance use data. For example, privacy law requires the redaction of sensitive diagnoses. However, when medications are prescribed, if renal or liver insufficiency goes unchecked for someone with an unshared history of alcoholism or substance use, risk increases.
Until privacy concerns are resolved, facilities and providers must actively create a culture where appropriate data sharing is part of daily operations. It’s important to empower informatics staff members who understand the health and legal landscape to lead the charge and encourage informed, responsible decisions about how to manage and share sensitive data. Adopting systems that adhere to federal standards for health data exchange makes it easier to securely and accurately share information. However, buying a system that can share data is just the beginning — EHRs must be used in a way that fosters interoperability.
U.S. Centers for Medicare & Medicaid Services (CMS) data-sharing initiatives
CMS has made progress in improving interoperability. For example, CMS Conditions of Participation require hospitals, including psychiatric hospitals, to send admission, discharge, and transfer notices to all relevant care providers. In theory, this should help inpatient behavioral health patients receive timely post-discharge follow-up care from service providers they have seen previously. However, it’s often unclear who should be alerted, since many behavioral health patients lack primary care providers, and many community agencies lack systems that can subscribe to the information. Too often, there isn’t anyone receiving a notice who can help coordinate follow-up care. Consequently, patients often fail to receive the care they need to remain successful in less restrictive care settings, or fail to get the support services they need in the community.
Coordination of care is even more difficult when health systems can’t communicate with each other. Data sharing exists between some entities, but it’s a fragmented patchwork, hampered by legacy systems that silo data and lack interoperability features, or can’t talk to each other because they lack either secure exchange network infrastructure or formal data-sharing agreements.
Federal efforts to support exchange networks
Federal efforts aimed at achieving the goal of creating comprehensive nationwide health information exchange networks are finally showing results. A nationwide “network of networks” overseen by the Trusted Exchange Framework and Common Agreement (TEFCA) for Qualified Health Information Networks (QHIN) leverages EHR interoperability regulatory requirements for data standards that can then be securely exchanged. Once completed, certified EHR systems will be able to connect and share data.
While this work is critical to solving some of the information gaps across organizations that lead to delays and disconnected care, it won’t be a panacea for behavioral health providers who have largely been left out of federal EHR incentive programs. Behavioral health data can only be shared if facilities and providers have modern certified EHR solutions and are offered a clear path to join the QHIN networks.
Eliminating behavioral health data silos
Behavioral healthcare is a team effort, and its supporting EHR systems must both be designed for collaboration within an organization and be engineered for next-level interoperability with external agencies to deliver on the promise of continuity of care across the often winding path of the patient journey toward stabilization and recovery.
A combined bottom-up facility-level approach to integrated data and a top-down national-level effort for connected networks is needed to eliminate data silos and deliver frictionless care. Fortunately, there are innovative next-generation EHR solutions that were built to serve behavioral health to connect your siloed data with external data systems via emerging nationwide interoperability networks.
Picture: Benjavisa, Getty Images
Deanne Clark is a Senior Health Informatics Consultant for Juno Health, with more than 20 years of leadership experience in designing, configuring, deploying, and supporting health IT systems nationwide, including within state behavioral health, state public health, the Department of Veterans Affairs, and private sector settings. She is passionate about discovering synergies at the intersection of policy, innovative health information technology tools, and human-centered design for the optimization of clinical workflows, improvement of population health outcomes, and attainment of health equity for underserved communities.
This Fulbright Award recipient’s research and analysis roots underscore her commitment to continuous process improvement, make her a tireless client advocate, and fuel her interest in leveraging emerging technologies from advances in health information exchange to artificial intelligence. Outside of her professional role, you’ll find her seeking adventure, from exploring new destinations, to sailing, and spending time in nature..
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