California Report Assesses Data-Sharing Landscape for Community-Based Providers
A new study has found that although California’s state agencies have created robust IT systems that serve as the system of record for community-based service providers, those systems do not readily interface with EHRs to facilitate cross-sector care coordination.
Data exchange 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 exchange capabilities of behavioral health and social service providers left out of HITECH funding continue to lag significantly behind.
In 2022, the Department of Health Care Services (DHCS) engaged the University of California’s San Francisco (UCSF) Clinical Informatics Improvement and Research group to conduct research on a subset of California's mental health, substance use disorder, and social service organizations to help assess their basic data exchange capabilities.
The state systems that were included in the assessment include:
• The 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 Health Records System, which manages people transitioning out of incarceration.
The California Advancing and Innovating Medi-Cal (CalAIM) was a key factor motivating DHCS to conduct this research. As the report notes, CalAIM is a multiyear initiative to improve the Medi-Cal program by integrating healthcare service delivery with mental health, substance use disorder, and social services. The program is intended to support complex patient populations served by many local organizations with distinct priorities, financial incentives, and technical capabilities.
Here are a few 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) facilities report using "exclusively electronic” methods to store and maintain health records.
• The majority of skilled nursing facilities (SNFs) reported “always” using non-electronic methods to receive information about incoming patients from discharging providers, including phone conversations with the discharging hospital (71%), faxes sent by the discharging hospital (65%), and records physically brought in 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 also have set standards and processes for data collection. Continuum of Care Organizations use the Homeless Management Information System and must collect “Universal” or “Common” Data Elements to qualify for federal funding, the report said.
The most common data elements captured across services provider types are race/ethnicity, housing status, language spoken, and contact information. Other information, such as food insecurity or behavioral health diagnoses, is collected if it is core to the service being provided.
The report suggests that to effectively establish reliable and secure data exchange capabilities at scale, a comprehensive mapping of the technology systems and data collection practices within the behavioral health and social services sectors is crucial. This foundational step will enable these sectors to integrate more seamlessly into broader data exchange networks, ultimately enhancing coordinated care for those with complex needs.
