Health Information Exchange: What does it mean for psychologists?

Are you aware that mental health treatment might be included as part of your state’s health information exchange (HIE)? All New England states have an HIE as part of the federal Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009.

The goals of the HITECH Act are to improve quality, safety, and efficiency of health care; engage patients in their own care; increase coordination of care; improve population health; as well as ensure privacy and security.

Each of the New England states has received federal funding to create an HIE and states are in varying stages of “readiness.”

In Rhode Island, it is called CurrentCare and residents can voluntarily enroll or opt in.

Maine’s HealthInfoNet is also voluntary for patients and may contain specific mental health treatment information with patient consent.

The Massachusetts Health Information HIway is purely a data exchange system (there is no data repository function) and patients are encouraged to speak to their health care provider to ask about what information is shared.

Vermont’s VTHealth Info allows Vermonters to opt out and does not include private psychological treatment but could contain mental health treatment data that is captured in the medical records of larger systems, such as hospitals.

New Hampshire’s Department of Health and Human Services website shows a 2023 Meaningful Use Readiness Letter dated March 10, 2023 to providers noting that New Hampshire is ready for clinicians who have electronic health records on the “Certified Health IT Products List” to send an email to DHHS indicating intent to onboard.

Connecticut’s HIE is called CONNIECT. All psychologists using an electronic medical record were mandated to complete a registration form to CONNIECT by May 3, 2023.

This last bit of information came as a surprise to me, as I caught up with a friend over a glass of wine last month. I reviewed the website, completed the registration form and in short order, received a 69-page legal “simple” data sharing agreement!

To be fair, psychologists would be up in arms if left out of the state HIE and equally irate, albeit for different reasons, when required to participate.

The Pros

There is significant public health benefit to include psychological treatment in analysis using aggregate data. Such information will inform public policy with respect to the influence of psychological factors on physical health.

For example, data analysis using aggregate data that showed that treatment for anxiety reduces emergency room visits in people with panic disorder could theoretically fast track approval of intensive outpatient treatment in this patient population.

Psychological diagnosis, number of psychotherapy treatment sessions, theoretical orientation of treatment and standardized outcome measures of well-being are variables in a public health dataset that could inform research and lead to advances in treatment.

The addition of the existence of the behavioral health provider in the HIE will also expedite communication between health care providers and ensure that psychologists are viewed as a part of the patient’s care team. Psychologists have fought for such recognition for decades. Though traditional methods of communication (e.g. fax, telephone, mailed records) remain an option, psychologists may be left behind if they are not considered part of the HIE care team.

The Cons

Where to begin? In this nascent stage of development, loss of privacy is at the top of the list of concerns that mental health providers have raised about the health information exchange.
A Connecticut Examiner article dated February 25, 2023 noted that Sumit Sajnani, a member of the CONNIE Board of directors was “only looking for specific information” such as “notes on a patient’s progress” and psychiatric diagnostic codes.

While an individual’s medical record might include a great deal of sensitive information, including prescriptions for psychotropic medications, the inclusion of psychotherapy progress notes in the medical record is an unnecessary invasion of privacy.

It seems highly likely that there may be misunderstanding about the relevance of mental health progress notes in the HIE. The information contained in free text that exists in progress notes is of little value to other health care providers (because who has time or motivation to read mental health progress notes?) or to the public health (because data in non-discrete variables is difficult to analyze without extensive cleaning).

Behavioral health data presents a unique vulnerability because of the perceived stigma. Ransomware attacks on mental health electronic medical records have taken place in the United States as well as Europe. Like toothpaste out of the tube, it is not possible to recall data that has been breached. The extent to which psychologists working in independent practice could be held liable for a data breach of mental health treatment in the health information exchange is unclear.

There are costs to independent practitioners participating in the health information exchange. Some states charge a onetime fee to the provider to participate. The costs appear regressive in that they pose a larger burden (relative to resources) on solo providers compared to large health care systems.

As an example, my electronic medical record platform recently informed me that there will be a $14 fee additional per month for connecting to the health information exchange, a 20 percent increase to the annual cost of maintaining the platform. The electronic health record vendors need to recoup the cost of facilitating connectivity between entities but the financial burden is borne by the provider.

The Verdict

Inclusion of mental health variables and treatment in the health information exchange is important for many reasons and especially because of the potential to inform the development of public health policy. At the same time, the United States is in the early stages of health information interoperability. Patients should have the opportunity to opt out from including mental health treatment from a psychologist without opting out for their entire medical record.

Psychologists who participate in their state HIE will help facilitate coordination of patient care and contribute to the overall advancement of the public health.