According to a World Health Organization survey, the pandemic has disrupted or stopped critical mental health services in 93% of countries at a time when funding for mental health services is woefully short, with most countries spending less than 2% of their national health budgets on mental health services.
In the United States, the shortage of mental health services occurs at a time when more attention is being paid to the issue, especially the interplay between mental health and overall physical health. The importance of care coordination as a patient moves among primary, acute and post-acute care settings has come into sharper focus, with new regulations coming into force that require behavioral health hospitals to notify primary care physicians when a patient is admitted, discharged or transferred.
Although implementation of the regulation has been delayed until May 1, many behavioral health facilities still do not have adequate admission, discharge and transfer (ADT) protocols in place.
Behavioral health has unique data needs
Despite increased societal acceptance of those receiving mental health services, a stigma that has been codified in federal regulations remains. However, the move toward value-based care and its focus on the spectrum of care services has underscored the importance of including behavioral health as a patient moves among care settings.
Part of the attitudinal change can be attributed to the recognition that physical health impacts mental health and vice versa. A landmark meta study from Oxford University showed a significant increased mortality risk for a range of mental health issues equivalent to heavy smoking. Life expectancy decreases eight to 10 years for heavy smokers, compared to between nine and 24 years for those with substance abuse issues and seven to 11 years for patients with recurrent depression.
Often, people with depression self-medicate with drugs or alcohol, creating co-occurring conditions that can be particularly difficult to treat or can lead to inpatient care. However, the behavioral health hospital has not been required to notify the primary care physician of the admission or the discharge, which can create other significant health issues if the patient doesn’t self-report the admission. Patients with acute mental health issues often receive powerful medications to control symptoms that can interact with other medications a primary care physician has prescribed, leading to drug-drug interactions.
Increasing opportunities to coordinate care
The regulations of the Substance Abuse and Mental Health Services Association (SAMHSA) do not line up precisely with HIPAA, which has created disparities in reporting requirements and privacy of information. SAMHSA announced in July it was updating the Confidentiality of Substance Use Disorder Patient Records regulation, 42 CFR Part 2.
The regulation was first adopted in 1972 to protect patients from stigma or bias because of experiencing substance abuse issues. But substance abuse often co-exists with other mental health disorders — not to mention any physical maladies patients may have. The increased focus on coordinated care brought the issue to the forefront, with many providers and groups such as the American Hospital Association advocating for changes.
The Centers for Medicare & Medicaid Services has finalized a rule that requires all hospitals, including behavioral health and critical access hospitals, to send admission, discharge, and transfer (ADT) notifications to providers primarily responsible for a patient's care as part of Condition of Participation (CoP) rules. The expressed goal is to improve care coordination and patient health outcomes while decreasing care costs and improving patient and provider satisfaction.
Using an ADT system can reduce costs and the potential for human error, as such solutions have been shown to reduce patient readmissions by up to 18%. Electronic records systems for behavioral health are not as robust as EHRs used by hospitals, so there may be technology gaps. Behavioral health hospitals need a unified communications solution that can send and receive electronic faxes, direct secure messages, continuity of care documents and other patient information.
As many as 90% of healthcare organization still use standalone fax machines to send and receive patient data and protected health information (PHI). The physical fax machine has many issues that include the potential for a data breach by transmitting information to an incorrect wrong number or by retaining data on machines when they’re taken offsite for repair or scrapped. The paper fax can also sit on the fax machine leading to latent care follow-up. Additional steps may also be required to convert a fax to a format that can be stored as part of the patient electronic health record.
Even with the continued push toward interoperability and care coordination, obstacles remain to exchange data efficiently and effectively, given the wide variety of technologies and types of data being exchanged. Technologies that offer a full suite of interoperability and workflow applications can automate ADT alert notifications and can help behavioral health hospitals send these timely transition messages to primary care providers. Additionally, a communications platform that includes digital cloud fax can bridge the gap between disparate technologies and allow providers to send information in a HIPAA-compliant format that can easily be ingested into the patient record.
Bevey Miner serves as health IT strategy/chief marketing officer for J2 Global Cloud Services, the creators of the Consensus healthcare data-sharing platform and eFax Corporate, a HIPAA-compliant healthcare fax technology firm.