When Rosemary was brought to her local emergency department for treatment, she was homeless, diagnosed with pneumonia, and struggling with addiction. When it came time for her to be released, the hospital identified a housing program for Rosemary (not her real name) that seemed like a good match for her needs. Her doctors were uncertain, however, about whether they could share all, some, or none of her medical records with the housing program. They were also unclear about how to handle disclosure of her addiction disorders to the primary care clinic where she would be receiving her medical care.
These are the kinds of confusing legal and administrative obstacles that frustrate attempts to coordinate behavioral and physical health care. Hospitals, physicians, clinics, health plans, drug treatment centers, and mental health care facilities rarely have the comprehensive data necessary to understand patients' complete health histories and the care they receive in other settings.
To advance the safe and legal sharing of patient data, CHCF is embarking on a new effort with the California Office of Health Information Integrity (CalOHII). With CHCF's support, CalOHII will develop and disseminate official state guidance on the use, disclosure, and protection of sensitive health information — especially mental health and substance use disorder information. This non-mandatory guidance will create business terms of engagement for clinics, hospitals, county systems, and repositories of patient records known as health information exchanges. CalOHII's efforts will fill a critical need for guidance for behavioral health integration initiatives at the state and local levels.
Many factors impede the sharing of patient data for the purposes of care coordination, but one that frequently rises to the top is the lack of clarity about what's legally permissible, particularly when it comes to behavioral health data. Misconceptions about the Health Insurance Portability and Accountability Act (HIPAA), the federal regulations that govern disclosure of substance use treatment data, and other federal and state health data privacy laws, frequently stand in the way. Health systems may get conflicting guidance from their legal counsel. Providers are sometimes so concerned about liability that they shrink from sharing any data at all. To help explain current regulations and laws, CHCF published Fine Print: Rules for Exchanging Behavioral Health Information in California in 2015.
CHCF's goal is that CalOHII guidance will encourage the safe, effective, and legal exchange of data to achieve better health outcomes and coordination of care. The formal guidance document, expected in mid-2017, will outline the state's interpretation of current laws governing how data can be shared, with whom, and for what purposes. Importantly, it will focus more on what providers and health care systems can do than on what they can't do. CalOHII will be soliciting input and guidance from stakeholders over the coming months. If you would like more information, contact Elaine Scordakis, CalOHII assistant director and project lead.
CHCF believes strongly in accelerating effective, integrated care for all Californians. Advancing safe and legal patient data-sharing while protecting individuals' privacy rights will be a huge step toward achieving that goal. I look forward to sharing the results of this important project as they become available.