P&P April Issue 2018

technology speaks By Elaine Scordakis

State Health Information Guidance on Sharing Behavioral Health Information

T he California Office of Health with support from the California Health Care Foundation, created the State Health Information Guidance (SHIG), an authoritative but non- binding guidance from the state of California. The SHIG explains when, where, and why mental health and sub- stance use disorder information can be exchanged and provides clarification of state and federal laws. It is written so anyone with a situation that has been analyzed in one of the SHIG scenarios can read and apply it to help alleviate challenges commonly reported when sharing patient’s behavioral health information to coordinate care. The SHIG grew out of comprehensive research, drawing from a broad group of stakeholders that reflects cross- industry insights and experience, to get a clear understanding of the problems different groups were facing in the field. The result of the research is the SHIG, a guidance containing 22 sce- narios derived from real-user stories, which clarify how laws apply to actual situations that arise for care providers. The SHIG is broad in scope and intended for use by physical health care providers, mental health and substance use disorder providers, emergency service providers, care- givers and care coordinators, social services, law enforcement, payers, and patients. The SHIG helps to reduce complexity and confusion, allowing users to understand how laws and statutes apply to their actual situations. Users will easily understand the narra- tives, illustrations, and decision trees outlined in the 22 scenarios. Information Integrity (CalOHII),

patient information and coordinating care. The user stories helped inform the development of the 22 field-based scenarios within the SHIG. To our knowledge, no state has ever attempted such a project before and there were few blueprints that exist as models. Some assumptions for the SHIG are based upon a white paper, “Fine Print: Rules for Exchanging Behavioral Health Information in California” 1 published by the California HealthCare Foundation. The white paper described the more overarching reasons why behavioral health infor- mation is not shared to include costs associated with health information technology, federal and state law con- fidentiality requirements, disparate electronic health rhecord systems that do not talk to one another, and an entrenched culture of not working together as one care team. Due to the short project period, CalOHII decided

The process for developing the SHIG began in September 2016 when CalOHII invited stakeholders from across the California health care industry to participate in the launch of the project. CalOHII received feedback about current obstacles to sharing behavioral health information. One stakeholder shared that, “the laws are nebulous on what can and can’t be shared.” Another stakeholder stated, “Trust levels between providers, patients, payers, and vendors are low.” The SHIG addressed these obstacles by clarifying state and federal laws, resulting in increased and growing trust between providers, patients, payers, and vendors. Stakeholders from more than 20 health care organizations served on the SHIG Advisory Group. The advisory group members developed almost 50 user stories from the stakeholder data, based on their professional experi- ences with the issues, obstacles, and opportunities associated with sharing

See California on page 35

Image courtesy of California Health Care Foundation

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