50 States of Interoperability: Why One-Size-Fits-All Tech Solutions Can’t Bridge Gaps in Behavioral Health – MedCity News

As state agencies and healthcare providers face increasing demands to address behavioral health (BH) needs across the U.S., interoperability challenges continue to stand in the way.

Manual reporting processes, siloed systems and duplicative data entry are all common problems disrupting BH care and coordination across the country. These challenges unfortunately trickle down, creating cumbersome administrative burdens and patient care delays. Meanwhile, the lack of consistent BH data standards poses a major barrier to the exchange of information across stakeholders. 

These issues are so universal, the Office of the National Coordinator for Health Information Technology (ONC) and The Substance Abuse and Mental Health Services Administration (SAMHSA) have committed more than $20 million over the next three years toward addressing them. Through a series of SAMHSA grants focused on substance use treatment and mental health services, the initiative will identify a set of BH data interoperability standards (USCDI+), making it easier for providers to measure, evaluate and report on the care they provide. 

These standards will be critical to advancing BHIT interoperability. But while states and providers alike look forward to a more consistent approach to data collection and management, many are still unsure of how we’ll get there. Even with standardized criteria, providers and states all operate in a wide range of technological sophistication and capabilities. The tools they use likewise employ various processes, data and file types.

Variation in capacity, resources and infrastructure will make these standards challenging to implement nationwide. While providers and administrators struggle to identify the best next step to meet new standardization rules, they need a strategy tailored to the intricacies of their program, based on their specific data workflows — which might look vastly different state to state. 

Designing a tailored BHIT solution

For public health programs to succeed in interoperability, they must understand their specific pain points and capacity for change. For instance, in Colorado, the Behavioral Health Administration (BHA) identified a barrier in its mission to provide comprehensive, equitable and accessible behavioral health services to its citizens: medication-assisted treatment (MAT) admissions. 

Although Colorado had services readily available to help its population, the intake process was cumbersome. Administrators had to manually collect information and match behavioral health needs to resources, causing patients to sometimes wait for days to be enrolled in a life-saving treatment program. The existing process did not consider the various formats of data sources needed for this undertaking: PDFs, proprietary MAT registries, spreadsheets and more. 

While Colorado was using some technologies available to them, the tools were not cohesive, causing delays with the intake process for providers, patients and state administrators. 

Once they identified this acute challenge, the BHA worked with their public health technology partner, to understand the state of current workflows and technological need. Thus, the state’s centralized registry was born. 

Designed to streamline data collection and automate patient intake and program matching, the MAT registry enables decision support, automatically de-duplicates patient records and normalizes data from existing disparate sources to create a more impactful reporting and analytics process. 

Conversely, organizations in Michigan are utilizing technology to increase access to behavioral health directly to patients. Family Health Care, a Federally Qualified Health Center, leveraged virtual health solutions in Mecosta, Missaukee, Newago, and Wexford counties to expand access to substance use disorder and opioid use disorder treatments. These counties are not only facing a provider shortage, but many patients reside in areas where lack of public transportation poses a significant barrier to access. By offering treatment via telehealth, transportation and geographic location were eliminated from the equation entirely, allowing more patients to receive the care they need.

The Upper Peninsula of Michigan faced its own set of challenges. Long travel distances, lack of health literacy and a substantial shortage of psychiatric care providers made access to behavioral health burdensome for patients. Great Lakes Recovery Center collaborated with a digital platform to connect Medicare, Medicaid and MI Health Plan members to their care teams. By leveraging the virtual health platform, patients can now set appointments, receive notifications and reminders, and flag their needs to providers. Similarly, providers were able expand their care and impact outside of their offices allowing them to follow up on appointments and send alerts and treatment information directly to patients. 

Colorado and Michigan are prime examples of areas that took time to examine barriers and implement dedicated solutions to better serve patients and staff. But what works well in one state or county might not necessarily solve every BHIT need across the rest of the nation. 

Addressing the full BHIT spectrum 

While one state might have a lot to learn from its neighbors’ approach to BHIT, the administration that tries to copy directly from another state’s data playbook will likely wind up with an ill-fitted strategy that doesn’t suit their program long-term. One-size-fits-all solutions simply can’t address all the nuances across this wide range of technological capabilities and BH complexities. 

That’s why, for this new SAMHSA/ONC initiative to work — and for BH data exchange to mature overall — new IT solutions must be tailored to fit the unique needs of each state health administration and its provider partners. Understanding and addressing the entire tech spectrum of these groups will ensure that new solutions alleviate, rather than exacerbate, the administrative and interoperability burdens they face. 

For example, BH entities with limited technological capabilities need simple digital front-end solutions to replace cumbersome paper-based processes, with solutions like automated SAMHSA reporting. Meanwhile, at the other end of the spectrum, those with more sophisticated IT systems need a robust solution that connects the dots between existing digital tools to help manage integrations and streamline data exchange across platforms.

While there’s no singular playbook to guide the path toward BHIT interoperability, state administrators and healthcare providers must be willing to collaborate with the experts to tailor their approach to data exchange. Ultimately, a standardized approach will eventually run into issues in a space as complex and nuanced as behavioral health itself. Although taking the time to design a customized solution might seem daunting, it’s the only path to sustained success for interoperability initiatives across our 50 united, but unique, states.

Disclaimer: The author’s employer is a public health technology partner for the Colorado Behavioral Health Administration (BHA).

Photo: erhui1979, Getty Images

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