TO new study has found that although California state agencies have created robust IT systems that serve as a system of record for community service providers, those systems do not easily interface with EHRs to facilitate cross-sector care coordination.
Data sharing capabilities among traditional healthcare organizations grew substantially with the enactment of the HITECH Act, which committed more than $47 billion in grants, loans, and incentives to accelerate EHR adoption. However, the data sharing capabilities of behavioral health and social service providers that do not receive HITECH funding continue to lag far behind.
In 2022, the Department of Health Care Services (DHCS) contracted with the University of California, San Francisco (UCSF) Clinical Informatics Research and Improvement group to conduct research on a subset of social service organizations, use disorders California Substance and Mental Health Bureau to help evaluate your basic data sharing capabilities.
State systems that were included in the evaluation include:
• Child Welfare Services-California Automated Response and Engagement System (CWS-CARES), which supports children in the foster care system;
• The Case Management Information and Payroll System, which supports older adults who may be at risk of institutionalization; and
• The Correctional Health Care Services Electronic Medical Records System, which manages people transitioning out of prison.
California Advancing and Innovating Medi-Cal (CalAIM) was a key factor motivating DHCS to conduct this research. As the report notes, CalAIM is a multi-year initiative to improve the Medi-Cal program by integrating the delivery of health care services with mental health, substance use disorders, and social services. The program is intended to support complex patient populations served by many local organizations with varying priorities, financial incentives, and technical capabilities.
Here are some snapshots of how leaving these providers out of HITECH funding may have hindered their EHR use and data sharing capabilities:
• Only 18% of substance use disorder treatment (SUDT) centers report using “electronic-only” methods to store and maintain medical records.
• Most skilled nursing facilities (SNFs) reported that they “always” use non-electronic methods to receive information about incoming patients from discharging providers, including telephone conversations with the hospital discharging hospital (71%), faxes sent by the discharging hospital (65%), and records physically brought by the patient (65%). Among SNFs that reported having an EHR, less than 30% reported interoperability with their local hospital EHR.
But many of these organizations are making progress. The report notes that service providers are turning to shared services and systems to support scale and interoperability. For example, many county behavioral health organizations are collaborating with the California Mental Health Services Authority to use the SmartCare EHR platform.
Some organizations have also established standards and processes for data collection. Continuing care organizations use the Homeless Management Information System and must collect “universal” or “common” data elements to qualify for federal funding, according to the report.
The most common data elements captured across service provider types are race/ethnicity, living status, language spoken, and contact information. Other information, such as food insecurity or behavioral health diagnoses, is collected if it is critical to the service being provided.
The report suggests that to effectively establish reliable and secure data sharing capabilities at scale, it is crucial to conduct comprehensive mapping of technology systems and data collection practices within the behavioral health and social services sectors. This critical step will allow these sectors to more seamlessly integrate into broader data-sharing networks, ultimately improving coordinated care for those with complex needs.
