Headline

The integration of substance-use records into electronic health records, following the easing of federal confidentiality rules, aims to improve care coordination and program monitoring.

Context

In 2020, federal authorities added record-keeping and data-sharing flexibilities to the federal confidentiality regulations protecting people with substance use disorder (SUD) — Title 42 Consolidated Federal Register part 2 (42 CFR part 2). The change updated the rule to reflect the evolving SUD care landscape and growing evidence on effective integrated physical-behavioral health care models, which benefit from information exchange across primary and other specialty providers. This study explores the implementation of these flexibilities on the electronic health record (EHR) of a hub-and-spoke model in a safety-net health care system in Denver, Colorado.

Findings

The Denver Health hub-and-spoke model consists of outpatient treatment programs for methadone and buprenorphine (“hubs”) and outpatient medical practices for buprenorphine (“spokes”). The model engages patients where they are and facilitates access to these medications for opioid use disorder and other services. In response to the 2020 Part 2 revision, Denver Health was able to obtain consent from their patients and move SUD records from protected spreadsheets and siloed databases into their system-wide EHR, which is used by all hubs and spokes.

Denver Health worked with an EHR consultant and its clinical leadership to streamline SUD patient referrals and eliminated redundancies in SUD-related documentation, in an effort to enhance patient care coordination. Additionally, the integrated EHR seeks to support future program evaluation and population health surveillance, such as the health system’s new SUD data dashboard.

Takeaways

Health systems and providers looking to enhance care coordination of their patients with SUD should consider integrating SUD records into broader health system EHRs, based on the final rule issued in February 2024 that modifies behavioral health confidentiality regulations.