Last April, two health IT vendors—the Horsham, Pa.-based NextGen Healthcare Information Systems and its sister company, Mirth, based in Costa Mesa, Calif.—announced the launch of the Behavioral Health Information Network of Arizona (BHINAZ), publicized by its officials as the first statewide behavioral health information exchange (HIE) in the nation.
BHINAZ was the brainchild of a consortium of behavioral health providers who are customers of Topaz Information Solutions, an authorized NextGen reseller and outsource partner that specializes in behavioral health and social services. Topaz, in partnership with NextGen Healthcare, built specific content within the technology platform to meet specific needs of behavioral health and social services organizations.
Leveraging NextGen’s ambulatory electronic health record (EHR) and HIE, and Mirth Connect— an open source application used for healthcare data integrations—BHINAZ created the legal and operational framework necessary to protect confidentiality while helping to facilitate data exchange and streamline the process for behavioral health providers to obtain and manage patient consent, specifically as it relates to exchanging patient information, officials say. As a result, BHINAZ will provide clinicians throughout the state with a longitudinal patient history at the point of care, making information available when and where it's needed for medical care.
Shortly after the announcement, HCI Senior Contributing Editor David Raths interviewed Laura Young, the executive director of BHINAZ, about the network’s goals and progresses for HCI’s sister publication, Behavioral Healthcare. At that time, the organization was just getting off the ground, with some of the main challenges being around legal and privacy issues with patient consent, as well as connecting to the physical health HIE in Arizona, and of course, cost.
Operating under an “opt-in” consent management model, BHINAZ said that it will ensure that data protected under Federal Law 42 CFR Part 2 is not re-disclosed without proper consent. Within the NextGen EHR, customized behavioral health consent management templates were created by working collaboratively with BHINAZ to include required content management language and capture electronic signatures at the point of care. Using these templates, information is sent to the NextGen HIE, which then dictates specifically what data a given provider can access within the EHR. Patients and clients have the option to choose if they would like their data to be shared with the rest of the closed network at each BHINAZ location. Last year, Young told Raths that, “It really is all or nothing. We are treating all of the data within our HIE as protected 42 CFR Part 2 data. If the client isn’t comfortable sharing their Part 2 data, then we aren’t going to share anything else.”
A year later, HCI Associate Editor Rajiv Leventhal checked in with Young, and the challenges for BHINAZ remain similar to what they were in 2014. Below are excerpts of that recent interview.
Tell me about the logistics behind the creation of BHINAZ?
In Arizona and in other states, we have Regional Behavioral Health Authorities (RBHAs)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.
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.
How is it being funded?
Initially, the money didn’t come from the RHBAs, but that where it’s gone towards now. We do have a subscription model, and when we connect providers, there’s a connection fee with a sliding scale for monthly subscriptions. In working with the RHBAs, and there are now three of them in Arizona, their contracts obligate them to have some sort of HIE technology, and they’re also obligated to do integrated care, for both physical and behavioral health. So it’s turned into a critical thing for them to work with us. We’re contracting with them to connect providers, and they’re covering the cost of connection in exchange. We want providers to put some sort of money into it, otherwise they don’t own the technology and are less inclined to use it to be honest. We are also working on initiatives at the state level to get allocations that would go to our HIE and the physical health HIE in the state.
To what extent has your network grown, and how many organizations are exchanging data?