BEHAVIORAL HEALTH PATIENTS PRESENT EVEN GREATER CHALLENGES Perhaps the most challenging issue confronting health information exchange relates to the management of individuals with substance abuse and behavior health conditions. More than any other population, the proper integration of physical and behavioral health information is essential. Due to laws governing such highly sensitive health information, the Substance Abuse and Mental Health Services Administration (SAMHSA) has identified a “digital divide” separating behavioral health, substance abuse and physical health data exchange . Trust networks are required to facilitate such complex data sharing. In the interval, it is clear that obtaining patient informed consent (when feasible) remains the surest means of effecting such optimal care plans.
that provide meaningful insights. Some of these datasets, including NEMSIS, are of only marginal utility because they are not linked to hospital data or claims data. Meanwhile, much of the value EMS could bring by assessing a patient’s environment and social conditions in the home and in the community is generally not captured in those datasets. EMS systems could be a valuable source of information on individual and community non- medical factors that could provide greater insight to the continuum of care. INCIDENT-BASED REPORTING Traditional EMS data systems are based on individual incidents, and not by patient. As a result, it is often not clear whether any patient involved in a specific incident has previously been attended to. Unlike the familiar “medical record number” that stays with a patient across multiple encounters, patients who encounter the same EMS agency twice will often have two different incident ID numbers that usually will not be linked in any meaningful way. Consequently, patients with multiple calls for assistance, special resource needs, complicated medical histories, or other historical factors that could affect their current call for help may not be promptly recognized. Perhaps the most challenging of all issues is accurate matching to longitudinal patient record systems – consider the fact that Houston, TX (population 3.4 million) has nearly 70,000 individuals who share the same first name, last name, and birthday. INABILITY TO EXCHANGE INFORMATION Whether or not patients can be linked across incidents, it is very rare for an EMS agency to be able to collect data on patient outcomes, either in the short term (What happened in the ED after a patient was dropped off? Was the patient admitted?) or in the long term (Did the patient survive? Did he or she recover?). This is because there is an almost universal lack of integration
1 “The Current State of Sharing Behavioral Health Information in Health Information Exchanges.” National EHealth Collaborative. Last modified September, 2014.
between prehospital and in-hospital electronic medical record systems.
This has important implications for quality assurance and improvement initiatives. In the era of value-based purchasing, EMS agencies need to understand if their actions have an effect on a patient’s health care utilization downstream, and ultimately the cost of care. This will be essential information in order to enter into risk-based contract agreements for new or existing services. DATA SECURITY & PRIVACY CONCERNS Of course patient information needs to be protected, and the risk to that protection increases the more we try to share or exchange information. Data breach is an increasingly common occurrence in the financial world and is just starting to gain
MOUNT SINAI HEALTH SYSTEM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
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