The Office of the National Coordinator for Health Information Technology Health IT Playbook

Section 11

Specialists

In this section

Learn how health IT is used in behavioral health and pediatric care

Specialists have unique electronic health record (EHR) needs for clinical documentation and care coordination with other specialties, subspecialties, primary care, and other care settings.

Historically, very few specialists have adopted EHRs, but that’s changing with the advent of specialty templates and modules optimized for specific specialties, such as ophthalmology and dermatology. EHR options for multi-specialty groups are also evolving and gaining adoption in certain specialties.

This section provides EHR and health information exchange guidance for specialists.

It also offers:

  • Workflow tools
  • Case studies
  • Best practices

The behavioral health system provides treatment and services to care for individuals’ behavioral health, substance use disorders, and mental disorders. A significant number of people rely on this system:

  • An estimated 26% of Americans age 18 and older are living with a mental health disorder in any given year, and 46% will have a mental health disorder over the course of their lifetime
  • According to the National Survey on Drug Use and Health (NSDUH), 24.6 million Americans reported current use of illicit substances and another 17 million reported using alcohol heavily over the past month
  • Approximately 40% of adults with "severe" mental illness — such as schizophrenia or bipolar disorder — received no treatment in the previous year and 60% of adults with any mental illness did not receive treatment
  • More than 80% of the individuals who met criteria for substance use treatment did not receive treatment
  • Individuals with serious mental illness (SMI) and substance use disorders (SUD) tend to have higher rates of chronic physical health conditions than individuals without a behavioral health disorder

Improving timely access to health information can improve care, but there are significant challenges related to health IT for behavioral health providers. Adoption of health IT in behavioral health care is significantly lower than other specialties. Reasons for this may include (but are not limited to):

  • A lack of interoperable information systems
  • A lack of resources to invest in and maintain health IT systems
  • Limited expertise of health IT systems
  • Reluctance by providers to engage in the exchange of behavioral health data
  • The complexity of privacy laws and the effort it takes to manage data disclosure consent requirements
  • Ineligibility for EHR incentive programs

How health IT can support behavioral health

Several types of technology support behavioral health care, including telebehavioral health (discussed further below), care management and care coordination platforms, and health IT functionalities. Health IT capabilities that serve critical roles for behavioral health include (but are not limited to):

  • Data segmentation: the tools to sequester from capture, access, or view certain data elements that are perceived by a legal entity, institution, organization, or individual as being undesirable to share1
  • Privacy management: technologies and best practices that protect individuals’ privacy, including de-identification and encryption of data, restrictive access to protected health information, and security measures in underlying technical platforms2
  • Medication management: capabilities that provide oversight on potential adverse medication side effects and medication non-adherence tracking3
  • Practice, treatment, and therapy modules: technology-based assessment and intervention tools that supplement existing care methods and services4
  • System access controls: capabilities to manage access rights for systems and controls to ensure the relevant personnel have appropriate data access5
  • Audit logs: security audits using audit logs and trails to record key activities and detect discrepancies6
  • Clinical decision support (CDS): tools and behavioral health screenings to assist clinicians with potential intervention and treatment7
  • Communication tools: tools, such as secure email, that allow providers and individuals to send and receive sensitive health information

Refer to the Health IT Playbook’s Certified Health IT section for more information on the role and benefits of certified health IT functionality and capabilities. Refer to the Privacy and Security section for information on privacy and security standards; permitted access, uses and disclosures of health data; preparing for audits; and tips for cybersecurity.

Educational Module for Behavioral Health Providers

Integrating health IT into behavioral health care can improve care coordination and patient outcomes. The information and resources in this module will help you adopt and implement health IT in your practice.

Go to the Educational Module for Behavioral Health Providers [PDF - 5.4 MB]

Educational Module for Behavioral Health Providers

Understanding Certified Health IT

Overview
Infographic that explains how the social, psychological, and behavioral health certification criterion supports clinical processes

Who it’s for
Patients, clinicians and hospitals, and developers

When it’s used
To understand the behavioral health capabilities and functionalities in certified health IT

Download the Understanding Certified Health IT infographic [PDF – 2.7 MB]

SAMHSA-HRSA Center for Integrated Health Solutions

Overview
This national training and technical assistance center promotes the development of integrated primary care and behavioral health services

Who it’s for
Practice administrators and health IT implementers

When it’s used
To search for health IT tools that support behavioral health and primary care service integration

Visit the Center for Integrated Health Solutions website

Stratis Health’s Health IT Toolkit for Behavioral Health Agencies

Overview
Adapts health IT implementations to behavioral health needs and requirements

Who it’s for
Practice administrators and health IT implementers

When it’s used
To get tools for each stage of behavioral health IT implementation: assess, plan, select, implement, maintain, and optimize

Check out the Health IT Toolkit for Behavioral Health Agencies

Behavioral health patient engagement

Recent studies have determined that behavioral health service integration produces greater engagement in care and, in turn, drives more favorable outcomes.8, 9, 10, 11

For example, documenting and following individuals’ preferences, promoting active and informed participation tailored to their abilities, attending to their emotional needs, and supporting their autonomy can establish rapport and increases the likelihood that they will engage in treatment. Strategies including education, communication, and shared decision-making approaches can generate positive health outcomes.

Just as for physical health, patient engagement and activation for behavioral health begins at the reception desk and continues through the course of the provider visit. Training the practice team to show empathy and compassion when interacting with individuals seeking behavioral health services is a vital part of delivering person-centered care. Including individuals’ perspectives by facilitating patient advisory groups on how to improve health care services and policy also provides the opportunity for engagement, education, and progress.12, 13

The consent management process should be tailored to the needs and abilities of individuals seeking behavioral health services, and it should include education about rights and tracking consent across providers.14 Consent must be decided on by the individual with full knowledge of the risks and benefits of sharing or withholding information. Consent management simplification, such as a standard consent form and electronic signatures, can streamline the process, minimize burden, and promote trust.15

Refer to the Playbook’s Patient Engagement section for fact sheets, research briefs, strategies, and up-to-date information on initiatives and trends for patient engagement.

Consent2Share

Overview
Online consent process that allows patients to share their health information with specific providers

Who it’s for
Patients and patient advocates; clinicians and practitioners

When it’s used
To establish consent processes and policies

Visit the Consent2Share website

Referrals, Handoffs and Good-byes

Overview
Resources including scripts, tips, and checklists to address engagement in behavioral health

Who it’s for
Clinicians and practitioners

When it’s used
At the point of care

Visit the Referrals, Handoffs and Good-byes website

Shared Decision-Making in Mental Health Care

Overview
These resources guide users through shared decision-making in mental health services

Who it’s for
Clinicians and practitioners; practice owners and administrators

When it’s used
To learn and use tools to support providers and individuals with tools, information, and resources

Visit Shared Decision-Making in Mental Health Care website

Privacy regulations related to behavioral health

As primary care is often the gateway for individuals to address their behavioral health needs through their primary care provider (PCP) and, as a result, more PCPs are offering integrated behavioral health care services. This presents unique health information exchange challenges due to confidentiality rules surrounding sensitive health information.

Behavioral health information — such as psychotherapy notes, substance abuse treatment records, and psychiatric diagnoses — legally qualifies as sensitive health information. In addition to federal regulations, individual states may have specific laws for disclosing or exchanging sensitive information.

EHRs and health information exchange solutions are evolving in their ability to best capture and segment sensitive health information to facilitate use of health IT to better manage and coordinate care.

To protect behavioral health information, it is important to understand the federal and state laws that govern the privacy of health information.

Health Insurance Portability and Accountability Act of 1996 (HIPAA)

  • HIPAA establishes a floor (minimum) of safeguards to protect privacy of “protected health information” (PHI) and establishes patient rights
  • HIPAA generally does not prohibit the use and disclosure of mental health or any other specific clinical category of information — but psychotherapy notes and correction medical records are exceptions to this
  • Disclosable data includes labs, prescriptions, appointments, and procedures related to mental health care

42 CFR Part 2 (Confidentiality of Substance Use Disorder Patient Records)

  • This federal law governs confidentiality for people seeking treatment for substance use disorders from federally assisted programs

State health information privacy and consent laws and policies vary widely across the U.S., and may impose additional requirements. Learn more about state health IT privacy and consent laws and policies [PDF - 442 KB].

Refer to the Playbook’s Privacy and Security section for tools, resources, references, and information on protecting the confidentiality, integrity, and availability of medical information.

Behavioral health information exchange (HIE) expands access to health information necessary for comprehensive patient care, but requires adherence to the laws referenced above as well as additional considerations for consent management and establishing patient and provider trust.

Refer to the Playbook’s Health Information Exchange section for tools and information on secure HIE, learning guides, and case studies for HIE in behavioral health.

Telebehavioral health

As telebehavioral health — or the use of telehealth to support behavioral health services — accelerates, health IT tools can integrate these technologies into care delivery systems and workflows.16

Recent studies demonstrate the positive health effect and benefits provided by virtual counseling, including convenience, privacy, fewer missed appointments, increased access and choice, and customizable care.17, 18, 19, 20 Moreover, with a shortage of primary care and specialty behavioral health care providers,21, 22 telebehavioral health can link individuals in areas with staffing shortages or mobility limitations to providers in other geographic areas. Virtual behavioral health sessions provide control over privacy and can reduce stigmatization when receiving care at home or another convenient location.

Telebehavioral health involves specialized technologies, software, and devices. Integrating telemedicine and telehealth services requires a critical understanding of regulatory and legal bounds, licensure requirements, and privacy and security standards.

Refer to the Playbook’s Telehealth section for resource links to national organizations and agencies including CMS, ONC, AHRQ, Center for Connected Health Policy (CCHP), the American Telemedicine Association, and the Telehealth Resource Center.

Telebehavioral Health Training and Technical Assistance

Overview
SAMHSA-HRSA Integrated Health Solutions website that provides a training course in 6 sessions with recordings and PowerPoint presentations

Who it’s for
Clinicians and practitioners; practice owners and administrators; health IT implementers

When it’s used
To gain background on telebehavioral health policy and reimbursement, and to learn about technology requirements, implementation, and monitoring

Visit the Telebehavioral Health Training and Technical Assistance website

Telepsychiatry Toolkit

Overview
Resources for understanding training, legal and reimbursement issues, technical considerations, and practice and clinical issues related to telemental and telepsychiatry services

Who it’s for
Clinicians and practitioners; practice owners and administrators; health IT implementers

When it’s used
To learn about the delivery of telemental and telepsychiatry services

Check out the Telepsychiatry Toolkit

50-State Legal Survey of Telemental Health

Overview
Report of individual states’ telemental laws, regulations, and policies

Who it’s for
Providers, clinical directors, and administrators

When it’s used
To help set up telemental health services and policies

Download 50-State Legal Survey of Telemental Health [PDF – 60.4 MB]

ONC partner resources

The Office of the National Coordinator (ONC) works with various federal agencies to support behavioral health IT. This section provides resources to support adoption of health IT and care coordination in behavioral health. For example:

A Guidebook of Professional Practices for Behavioral Health and Primary Care Integration: Observations from Exemplary Sites

A Guidebook of Professional Practices for Behavioral Health and Primary Care Integration: Observations from Exemplary Sites

Overview
This guide helps primary care and behavioral health professionals identify best practices for developing integrated care. Eight high-performing primary care organizations with integrated behavioral health participated in the study

Who it’s for
Primary care and behavioral health practices

When it’s used
To learn about integrating behavioral health into primary care organizations

Download A Guidebook of Professional Practices for Behavioral Health and Primary Care Integration: Observations from Exemplary Sites [PDF - 1.2 MB]

Case Studies of Health IT for Behavioral Health Integration

Overview
Real-world examples of health systems and group practices that have adopted health IT tools for integrative purposes

Who it’s for
Behavioral health and primary care providers

When it’s used
To find examples of health IT for behavioral health and primary care integration

Visit the Case Studies of Health IT for Behavioral Health Integration website

1 Williams A.B. (2013, September 26). Issue Brief: Behavioral Health and Health IT. Retrieved from https://www.healthit.gov/sites/default/files/bhandhit_issue_brief.pdf [PDF - 372 KB]

2 Guide to Privacy and Security of Electronic Health Information (2015, April). Retrieved from https://www.healthit.gov/sites/default/files/pdf/privacy/privacy-and-security-guide.pdf [PDF - 1.3 MB]

3, 7 Behavioral Health Roundtable: Using Information Technology to Integrate Behavioral Health and Primary Care (2012, September). Retrieved from https://www.healthit.gov/sites/default/files/bh-roundtable-findings-report_0.pdf [PDF - 396 KB]

4 Center for Substance Abuse Treatment: Using Technology-Based Therapeutic Tools in Behavioral Health Services (2015). Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK344038/

5 Weich, D. (2013, August 26). Role-based Access Control in Healthcare. Retrieved from http://www.healthcareitnews.com/blog/role-based-access-control-healthcare

6 AHIMA: Privacy and Security Audits of Electronic Health Information (2014 Update). Retrieved from http://bok.ahima.org/doc?oid=300276#.Wbenk617HdQ

8 Kessler, R., & Stafford, D. (2008). Primary care is the de facto mental health system. In Collaborative medicine case studies. (pp. 9-21). Springer New York.

9 Robinson, P., & Reiter, J. (2007). Behavioral consultation and primary care. Springer Science+ Business Media, LLC.

10 Collins, C., Hewson D.L., Munger R. and Wade T. (2010) Evolving Models of Behavioral Health Integration in Primary Care. Retrieved from https://www.milbank.org/wp-content/files/documents/10430EvolvingCare/EvolvingCare.pdf [PDF - 552 KB]

11 Gruman, J., Jeffress, D., Edgman-Levitan, S., Simmons, L.H., and Kormos, W.A. (2011) Supporting Patient Engagement in the Patient-Centered Medical Home. Retrieved from http://www.cfah.org/file/CFAH_PACT_WhitePaper_current.pdf [PDF - 64 KB]

12 Truesdell, N. (2012, September 11). Practical Strategies to Engage Patients with Integrated Health Care. Retrieved from http://www.mehaf.org/news-room/blog/practical-strategies-engage-patients-integrated-health-care/

13 National Alliance on Mental Health: Engagement, A New Standard for Mental Health Care. (2016, July). Retrieved from https://www.pcpcc.org/sites/default/files/NAMI%20Engagement%20Report.pdf [PDF - 706 KB]

14, 15 Manatt, Phelps & Phillips (2014, January). Integrating Physical and Behavioral Health: Strategies for Overcoming Legal Barriers to Health Information Exchange. Retrieved from https://www.manatt.com/uploadedFiles/Content/4_News_and_Events/Newsletters/IntegratingPhysicalandBehavioralHealth.pdf [PDF - 177 KB]

16 Telehealth Resource Centers: A Framework for Defining Telehealth. Retrieved from https://www.telehealthresourcecenter.org/sites/main/files/file-attachments/telehealth_definintion_framework_for_trcs_1.pdf [PDF - 1 MB]

17 Godleski, L., Darkins, A., & Peters, J. (2012). Outcomes of 98,609 US Department of Veterans Affairs patients enrolled in telemental health services, 2006–2010. Psychiatric services, 63(4), 383-385.

18 Wagner, B., Horn, A. B., & Maercker, A. (2014). Internet-based versus face-to-face cognitive-behavioral intervention for depression: a randomized controlled non-inferiority trial. Journal of affective disorders, 152, 113-121.

19, 20, 21 Gleit, L. (2017, June 19). The Role of Telemedicine in Mental Health. Retrieved from https://www.healthitoutcomes.com/doc/the-role-of-telemedicine-in-mental-health-0001

22 Mental Health Care Health Professional Shortage Areas (HPSAs). (2016, December 31). Retrieved from http://www.kff.org/other/state-indicator/mental-health-care-health-professional-shortage-areas-hpsas/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D

Pediatricians — both primary care and pediatric subspecialists — also face unique challenges in the areas of functionality, documentation, and privacy when it comes to implementing and using health IT.

For example, documentation needs for pediatric practices include:

  • Growth charts
  • Weight- and age-based dosing
  • Clear indication of smaller units of measure
  • Pediatric normal ranges for vitals, labs, and other measurements
  • Mother-baby documentation
  • Gestational age

Pediatric practices also deal with specific privacy requirements around parental involvement for adolescents and consent, or for custodial, foster, guardian, or adoptive care.

Below you will find a key resource to support pediatric practices’ electronic health record (EHR) implementation and optimization, and health information exchange participation.

Children’s Electronic Health Record Format

Overview
Information for EHR developers and others about critical functionality, data elements, and other requirements needed for pediatric EHR systems, especially those enrolled in the Children’s Health Insurance Program (CHIP)

Who it’s for
Pediatricians and EHR vendors

When it’s used
To find guidance on capturing EHR data elements and standards most relevant for children

Visit the Children’s Electronic Health Record Format website

Content under development

We plan to expand this section over time, so check back periodically for additional resources. Have suggestions for making the Playbook better? Please share your feedback with us.

Section 11 Recap

Use health IT to support specialty care delivery, coordination, and documentation.

  • Find resources for behavioral health IT
  • Find resources for pediatric health IT

Join the conversation.

Do you have a tip or suggestion for using health IT to support specialty care that's worked well in your practice? Share it here!

Content last updated on: February 28, 2018