The Office of the National Coordinator for Health Information Technology
Solicits Comments on Behavioral Health Related Topics for Stage 3 Meaningful Use
On November 7, 2012 The Office of the National Coordinator for Health IT (ONC), released a Request for Comments (RFC) regarding the Stage 3 Definition of Meaningful Use of Electronic Health Records (EHRs)[1]. There are a number of topics within this RFC that are of importance to the behavioral health community including consent managementin electronic health information exchange and access to prescription drug monitoring program data. The ONC will be accepting comments until 11:59p.m. ET on January 14, 2013.As a behavioral health consumer, it is critical to the community and the health care community at large that your voice is heard. Please take the time to review and comment on the HITPC’s preliminary list of recommendations but specifically on the topics below.
Background
The Health Information Technology for Economic and Clinical Health Act (HITECH Act), a part of the American Recovery and Reinvestment Act of 2009 (ARRA), created an incentive program to stimulate the adoption of and ’meaningful use’ electronic health records (EHR) in the United States. Under HITECH, eligible health care professionals and hospitals can qualify for incentive payments when they adopt certified EHR technology and use it to achieve specified objectives. The Centers for Medicare and Medicaid Services (CMS) and The ONC are responsible for defining the minimum requirements that providers must meet to achieve meaningful use of EHR technology and defining the standards and criteria for certification of EHR technologies.
Consent Management
A number of federal and state privacy and confidentiality laws restrict the disclosure of sensitive health records including those pertaining to behavioral health, HIV status, genetic information, reproductive rights, and adolescent treatment, among others. These laws often protect individuals from the most vulnerable segments of our society. Many health information privacy and confidentiality laws, including those for substance abuse treatment information (42 CFR Part 2) () and similar state mental health privacy laws, establish detailed requirements for obtaining patient consent for sharing health information. Currently, most primary care EHR systems do not have the capacity to manage these consents or to control the re-disclosure of select types of information as required. This lack of capacity constitutes a significant barrier to the integration of primary care and specialty behavioral health care.
The integration of primary and behavioral health care is essential for achieving the three-part aim of the National Quality Strategy for better care, healthy communities, and affordable care. HIT, the infrastructure for health reform, is the vehicle through which health information is exchanged and coordinated and is an essential tool for advancing behavioral health and overall public health. ONC is soliciting comments on the following(refer to page 29 (MU04) in the RFC):
- How can EHRs and HIEs manage information that requires patient consent to disclose so that populations receiving care covered by these laws are not excluded from health information exchange?
- How can MU help improve the capacity of EHR infrastructure to record consent, limit the disclosure of this information to those providers and organizations specified on a consent form, manage consent expiration and consent revocation, and communicate the limitations on use and restrictions on re-disclosure to receiving providers?
- Are there existing standards, such as those identified by the Data Segmentation for Privacy Initiative Implementation Guide, that are mature enough to facilitate the exchange of this type of consent information in today’s EHRs and HIEs?
Prescription Drug Monitoring Programs
Prescription drug use, misuse and overdose is one of the fastest growing health epidemics in the United States. To address prescription drug abuse, many states have established Prescription Drug Monitoring Programs (PDMPs). PDMPs are statewide databases designed to be used as a tool by health care providers to identify and intervene in cases of potential prescription drug abuse. The databases collect, monitor, and analyze electronically transmitted prescribing and dispensing data submitted by pharmacies and healthcare providers. PDMPs collect a considerable amount of useful information that can help providers identify patients with prescription drug abuse problems; however, many states do not use these databases adequately. Providinghealth care providers withreal-time access to the information contained in the PDMPs will facilitate the use of this information at the point of care. ONC is soliciting comments on the following:
- Certification criteria: EHR technology supports streamlined access to the PDMP data (refer to Objective SGRP 125 on page 21 of the RFC)
For example:
- Via a hyperlink or single sign-on for accessing the PDMP data
- Via automated integration into the patient’s medication history
SAMHSA encourages all behavioral health stakeholders to send comments to ONC on these important issues to ensure that the voices of the behavioral health community are heard.
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