There is widespread agreement about the value of integrating mental health and substance use disorder treatment with primary care. Behavioral health integration has the potential to dramatically improve health outcomes, particularly for people with complex needs.

But it will not be easy to achieve integration without the sharing of patient health information and data, and there are legal barriers to doing so. Federal and state laws designed to protect the privacy of patients receiving mental health or substance use disorder (SUD) treatments can make sharing health data — and thus coordinating care — very difficult. Out of concern that they might be violating laws, some health care team members have refused to share any information at all, to the detriment of the patient’s health. For many other providers and patients, uncertainty about what’s permissible and what’s required slows efforts to achieve coordinated and integrated care.

Last fall, the California Health Care Foundation (CHCF) announced its support for a project to describe what patient information may and may not be shared, and under what circumstances. This project has borne fruit. Last week, California published helpful guidance for sharing behavioral health information. The California Office of Health Information Integrity (CalOHII) developed the State Health Information Guidance (known affectionately as “the SHIG”). It represents the state’s authoritative (but nonbinding) direction on when, where, and why mental health and substance use disorder information can be exchanged.

The SHIG is aimed at providers, administrators, care coordinators, social workers, and medical information officers — basically everyone involved in the tricky business of working toward integrated care while respecting the sometimes-confusing laws that protect sensitive patient information. We are proud to partner with CalOHII and the California Health and Human Services Agency (CHHS) on this project. The SHIG is a compelling example of how philanthropies can collaborate with government to accelerate work that neither could do alone.

CHCF and CalOHII embraced this project to remove obstacles and help accelerate the welcome trend toward greater integration of behavioral health services, including efforts to provide more medication-assisted SUD treatment in primary care. New state initiatives, like Medi-Cal’s Whole Person Care Pilots, which aim to coordinate care across traditional silos for people with complex needs, will also be well-served by this guidance. Finally, the SHIG should help health information exchanges grapple with the sharing of data controlled by multiple legal structures.

The SHIG incorporates recent amendments to federal regulations that control disclosure of SUD treatment information. Many providers have found these regulations, commonly referred to as “Part 2,” to be the most challenging to deal with. The SHIG illuminates how and when SUD treatment data can be shared under those rules.

The project began last fall with stakeholders suggesting the real-world scenarios that form the basis of the document. It incorporates feedback from health care providers, health information exchanges, health plans, county counsel, and patient and privacy advocacy organizations, among others. It doesn’t include every scenario or answer every question, but we think it’s a significant advance that lays the groundwork for ongoing dialogue about appropriate sharing of health information.

Please take a look at the SHIG and let us know what you think.

Inquiries can be directed to Elaine Scordakis, assistant director at CalOHII.

Catherine Teare

Catherine Teare is associate director of CHCF’s People-Centered Care team, which works to ensure that Californians — particularly those enrolled in Medi-Cal — receive responsive, comprehensive, and coordinated care that supports their health and well-being. She leads the foundation’s work on behavioral health care, including behavioral health integration in primary care and behavioral health interventions for high-cost populations. She also manages projects related to the county role in health care delivery and oral health care. Read More

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