One of the major goals of health reform is to improve the quality of care through better use of clinically relevant information. To be compliant with emerging reimbursement incentives, providers will have to demonstrate that they are managing the health of their patients through the meaningful use of data available through Electronic Health Record (EHR) systems.

The definitions and rules for this major innovation are being worked out now, and final decisions about what patient information will and will not be in standardized data depositories called health information exchanges (HIE) and in the Medicaid Management Information Systems will be made in every state in a matter of months. These decisions and the enormous systems that will be built based on them will dominate virtually all aspects of health care delivery, finance and research for a long time.

These two system transformation initiatives will result in healthcare reimbursement systems moving toward integration with certified, standards-based electronic health records. This will require the transmission of both claims and qualitative patient information. Those providers unable to do so will become increasingly marginalized.

It is easy to get lost in the jargon and technology challenges, but the critical choices that will be made are policy, not technical. Therefore, the most senior treatment providers, consumer representatives and State substance abuse Directors must be actively involved. This is not happening in most States. The consequences may be quite dire for the specialty addiction providers and the people they serve.

• Federal strategy and funding will favor provider entities that are full participants in the electronic systems. That is part of the reasoning behind ONDCP’s plan to promote the integration of addiction screening and some care into federally qualified community health centers. There are many good clinical reasons to favor health care integration around the needs of patients, but information systems will be a powerful tool for forcing the issue.
• Parity for addiction and mental illness treatment is now the law of the land, but it will be implemented in the context of the emerging electronic medical records systems and rules. If specialty treatment providers do not have the infrastructure in place to participate, they will be left out. Having their own specialized electronic records—as many now do—won’t work because many of the small vendor or home-grown systems now in place may not be able to communicate with the statewide health information exchanges or Medicaid Management Information Systems. If specialty provider systems can’t communicate both financial and qualitative data, it is unlikely the providers will be paid.

In some instances, the planning and implementation entities for the new health exchanges and Medicaid systems have a perception that the comparative isolation and the confidentiality requirements of specialty addiction treatment providers introduce a layer of complexity that may slow down planning and delay implementation. As a result, they seem perfectly content to leave specialty substance use disorder information out of the new systems. That will hurt patients with substance use disorders because the doctors who treat them will lack critical information about their patient. In fact, the technology exists for protecting patient record privacy, confidentiality and security. Further, a recent article in Behaviorial Healthcare* by Renée Popovits shows that current confidentiality requirements do not really protect patients.

If State substance abuse leaders get actively involved now, they can help ensure that the systems get developed in a timely fashion and contain the privacy safeguards that are important for patients with substance use and other sensitive medical problems.

There are federal funds to support participation by key State officials in this critical planning process, and federal rules require that the special needs of the patients served by specialty addiction treatment centers be taken into account. However, time is running out. They need to act now.

David Wanser is Visiting Fellow at the Lyndon B. Johnson School of Public Affairs, University of Texas at Austin. He is a former director of substance abuse services for the state of Texas and a past President of the National Association of State Alcohol/Drug Abuse Directors (NASADAD).

David Rosenbloom is Director of Join Together and a Professor of Public Health at the Boston University School of Public Health. From 1973 to 1985, he was Commissioner of the Department Health and Hospitals for the city of Boston.

*Popovits, Renée M., JD. (2010). Confidentiality law: Time for change? Behaviorial Healthcare, 2010 April;30(4):11-13.

Editor’s note, June 14, 2010:  For a complimentary reading on this subject, see also: “Wake-up Call for Treatment Providers and State Addiction Directors,” by Benjamin Chambers, published June 8, 2010, in the Reclaiming Futures Every Day blog.