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Crisis Care Support: The Behavioral Health Information Network of Arizona Breaks New Ground

February 10, 2016
by Mark Hagland
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Major strides forward in caring for the seriously mentally ill in crisis are being facilitated by the first statewide behavioral HIE

Major strides forward are being made at the Behavioral Health Information Network of Arizona (BHINAZ), a behavioral health information network (HIE) owned by community providers in Arizona. BHINAZ specializes in the exchange of data, both physical and behavioral health data. “We’ve been focused on a pretty robust consent model and the exchange of data, and making sure that our providers can get the data they need for the services they provide,” says Laura Young, BHINA’s executive director. Recently, says Young, “We’ve been really focused on our crisis project, which entails getting providers who are involved in caring for seriously mentally ill (SMI) individuals through clinic-based care, involved, and providing information to crisis hotlines, first responders, mobile teams.”

In April 2015, Young gave an interview to HCI Managing Editor Rajiv Leventhal about the creation of the Behavioral Health Information Network of Arizona. “In Arizona and in other states, we have Regional Behavioral Health Authorities (RBHAs),” she noted, “and in Maricopa County, where I live, the RBHA contract of $7 billion over five years—for behavioral health services passed out from federal funds to the state and then out to designated behavioral health agencies— was up for bid. In the past, the challenge has been when those agencies lose those contracts, they pack up their data with them, so there are issues with continuity of care and being able to access information about patients and clients. There was a feeling that the way to go was start working on an HIE for behavioral health.”

In that interview, Young added, “So the HIE is stakeholder-owned, comprised of seven nonprofit organizations.  It’s very much at the community level, driven by behavioral and community health providers. Our approach comes from the bottom up rather than top down, so we are able to be at provider level and insert the HIE directly into the practice and do workflow and training right at the organizational level.”

Young, who participated as a panelist recently on a panel entitled “Interoperability & HIE: Strategies for an Evolving Health System,” at the Health IT Summit in San Diego, sponsored by the Institute for Health Technology Transformation (iHT2—a sister organization to Healthcare Informatics, under the Vendome Group corporate umbrella), spoke recently with HCI Editor-in-Chief Mark Hagland regarding the current initiatives taking place at BHINAZ. Below are excerpts from that interview.

You referenced at the Health IT Summit in Miami that your organization has been focusing strongly on health information exchange in crisis mental healthcare situations. Is consent an issue in such situations?

Consent actually doesn’t really apply around these situations, because they involve genuine crises, such as potential suicide situations, for example. And a crisis hotline might do a little bit of triage such a situation. But if the patient seems genuinely in crisis, the hotline can look up information on the portal, see if they’re a danger to themselves or others, find out if they’re voluntarily in treatment or involuntarily court-ordered into treatment, per a criminal proceeding, for example. We worked with a consortium of providers, and they needed to see that element. So we actually had to retrofit our HIE, to add in additional pieces of information around whether people are a danger to themselves, to others, or “SMI”—seriously mentally ill. That’s a designation that comes usually from the Medicaid managed care company. When that designation occurs, regional behavioral health authorities, or RBHAs, pick up the spend both for physical and behavioral health for patients who are on Medicaid. So if they get that designation, everything is paid for. And once they’ve been given that designation, you’re always considered SMI.

Laura Young

So the crisis providers want to know those pieces of information. They also want to see information on contacts. And who their guardian is—that might be different from a family member, for example, there might be a designee from a court who is the guardian.

So you’ve standardized a data set for such situations?

Yes, so when we connect people, we say, these are the pieces of data needed. It’s an extra 11 data elements that our crisis providers wanted. So, things like injectibles—when you’re given a prescription for methadone treatment, you might be prescribed methadone, but in the medication module, they’re not always documenting the administration of methadone, there might be a documentation of a one-time prescription. But on the phone, they’ll want to know when the last time the person got the injection. And it turns out that isn’t always standardized. So we work really hard to standardize that and bring it forward as a data element. And providers in a non-emergency setting might want that information with consent also.