National Council Magazine - Winter 2009 - 54

Tech Notes Sharing Patients Requires Sharing Data Michael R. Lardiere, LCSW, Director of Health Information Technology and Senior Advisor on Behavioral Health, National Association of Community Health Centers he integration of behavioral health and primary care and the expansion of health information technology are two issues that are gaining increased momentum, especially in the context of national dialogue on economic recovery and healthcare reform. Both are critical to heal many of the ills of our troubled healthcare system. I view these issues as being very much intertwined, and it will be difﬁcult to improve the system unless we take a holistic view of how we provide treatment and share data. INTEGRATE OR NOT? Sharing data is at the heart of the problem, whether primary care and behavioral health services are provided at a single site or relationships and referral mechanisms are established to provide them at separate facilities. The latter is a much more difﬁcult and, it seems, inefﬁcient approach, because many studies have shown that drop-out rates from a referral to treatment are as high as 50 percent. Integrated behavioral health and primary care can be provided in a primary care setting or in a behavioral health setting. Some core components of integrated care seem to surface again and again in discussions on this subject. In an October 2008 meeting at Morehouse University sponsored by the Health Resources Services Administration, the Substance Abuse and Mental Health Services Administration, and other federal partners and supported by the Carter Foundation, a large number of federal agencies, along with private, for-proﬁt, and nonproﬁt providers, discussed primary care and behavioral health integration. Discussion around which models are most effective, which 50 / NATIONAL COUNCIL MAGAZINE • WINTER 2009 T Think outside your own practice or organization. Ask yourself, “If I were receiving data from someone else and wanted to provide good-quality care to my patient, what would I need?” or, “What would another provider to whom I am referring my patient need to provide good-quality care?” Think of the core components of information sharing and how we make that work. payment structures support those models, and other factors will continue; however, until all providers are on a level playing ﬁeld, it will be difﬁcult to determine the optimum system in which to provide integrated behavioral health and primary care. What I see as the core components are identiﬁed in the ﬁgure below. Those components include colocation, communication and collaboration among the primary care and behavioral health providers, shared problem lists, shared treatment plans, shared medication lists and lab results, joint decision making, and communication across systems. The patient sits in the middle, and it really does not matter whether his or her healthcare home is in a primary care setting or behavioral healthcare setting. Where the patient needs to be treated depends on the severity of his or her illness at that particular time. The two systems have great opportunity to work together to improve patient care as well as share expertise, staff, and best practices to improve the quality of care provided to our patients. PATIENT TRACKING So how do we best serve patients, assuming that we do have provider organizations that wish to work together in collaborative partnerships? I do not think collaboration can be accomplished without the use of health information technology. Even at a basic level, keeping a disease registry to track shared patients and ensuring that needed and scheduled services are received requires some level of HIT. There can be a large percentage of shared patients between health centers and community behavioral health centers given that there are >> More than 1,200 health centers >> In more than 7,000 locations >> Serving more than 18 million people, of whom > 7 million are uninsured (1 out of every 7 uninsured patients in the country) > 6.4 million receive Medicaid (1 out of every 8 Medicaid patients) > 1.4 million have Medicare > 12.7 million are below the Federal Poverty Level, and

National Council Magazine - Winter 2009

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