A coalition of states, in partnership with the Office of the National Coordinator for Health Information Technology (ONC) and the Substance Abuse and Mental Health Services Administration, successfully completed a pilot project for the interstate exchange of electronic behavioral health data using Direct. This activity illuminated some of the real challenges with using Direct, both technical and operational, but ultimately demonstrated that such exchanges can be performed.

The project was conducted through the Behavioral Health Data Exchange Consortium, which is releasing its final report (and addendum) today.

Many providers and patients wish to electronically exchange behavioral health data. However, federal laws (such as 42 CFR Part 2, the federal rules protecting the confidentiality of certain information related to treatment for substance abuse) and state laws that provide important privacy protections have created complex challenges for sharing behavioral health information electronically.

These privacy protections may require written patient consent prior to the disclosure of such information, even for treatment. This is more restrictive than the “floor” of permitted information uses set by the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule.

“The objective of the consortium project was to execute at least one successful pilot demonstrating the ability of providers to exchange behavioral health data electronically across state lines,” the report states.

As part of the pilot project, multiple successful exchanges of de-identified data were conducted between behavioral health providers in Florida and Alabama. These exchanges employed checklists, created by the consortium, for making and responding to requests for behavioral health information.

Embracing the Challenge of Exchanging Behavioral Health Data

A group of enterprising states recognized the challenges associated with electronically sharing behavioral health information and wanted to work toward solutions. Thus, five states came together and formed the Behavioral Health Data Exchange Consortium, with financial support from ONC.

The consortium eventually included representatives from seven states:

• Alabama,
• Florida,
• Kentucky,
• Michigan,
• New Mexico,
• Nebraska,
• Iowa.

The report provides details about the project’s plans, challenges, successes, and products. Highlights include:

• A set of policies and procedures that can be used by providers to exchange behavioral health information with other providers in different states using Direct exchange protocols;
• A description of multiple efforts to test and execute the policies and procedures, including exchange between providers in Alabama and Florida;
• Educational materials for providers who want to electronically exchange behavioral health data, tested intensively by New Mexico and used by participants in state pilots; and
• Lessons learned to support the acceleration of interstate electronic exchange of behavioral health data between providers.

ONC and SAMHSA held a webinar to discuss this report and other topics related to the exchange of behavioral health data on May 21, 2014. 

The Behavioral Health Data Exchange Consortium was supported by ONC through the State Health Policy Consortium, an activity of ONC’s State Health Information Exchange Program and managed by RTI International.

For more information concerning this project or other work of the State Health Policy Consortium, contact John Rancourt at john.rancourt@hhs.gov.

For more information on the Substance Abuse and Mental Health Services Administration and its work on health information technology, contact Dr. H. Westley Clark at westley.clark@samhsa.hhs.gov.