The Health Insurance Portability and Accountability Act clearly dictates its federal ruling on patient privacy: Whether it’s a physical or electronic health record, patient health information is confidential and secured. But these lines can be more oblique when it comes to mental and behavioral health. Is it good case management to practice complete confidentiality with patients? How does privacy impact coordinated care?
For the most part, mental health EHR has helped facilitate secure and confidential exchange of information between providers within patients’ continuum of care. However, alongside HIPAA, certain state and federal laws can complicate the process, sometimes keeping mental health patients from getting the services they need. Such was the case in Iowa, where a group of law students came up with an innovative solution.
A helping hand
The Johnson County System of Care Group is an Iowa City-based network of caregivers that works with patients who have fairly significant medical, mental health and substance abuse disorders. Over the years, the network had run into trouble with the specifics of privacy laws however, especially when it came to sharing information with law hospitals, social service agencies, emergency shelters or law enforcement. What information could be shared? What was legally confidential?
According to Michael Flaum, M.D., a clinical professor of psychiatry in the University of Iowa Hospitals and Clinics, these different groups all interpreted healthcare privacy laws in different ways.
“Some of us are more likely to pick up a phone and call another agency and ask for information, while others are reluctant to do that for fear of violating privacy laws, or because they don’t want to bombard a patient with a lot of information and paperwork,” Flaum said. “We found there are real barriers and perceived barriers to good communication. We have to make sure the only barriers are real barriers, and overcome the perceived barriers.”
This is where a group of law students at UI stepped in. At the Johnson County System of Care Group’s request the students worked under supervisor Leonard Sandler, a clinical professor of law at UI, to create a handbook and toolkit that would help the mental and behavioral healthcare providers navigate the sometimes confusing privacy laws. Since then, the students have been conducting workshops for various care providers, agencies and consumers around the state, providing every corner of the mental health community with the necessary legal roadmap to provide the care patients need.
Drawing up the map
Sandler and the 10 law students working on the project spent seven months researching both federal and state healthcare privacy laws. These focused primarily on HIPAA, among other laws dictating privacy parameters for patients of substance abuse as well as the Iowa Code Chapter 228, which governs how mental health records are shared in-state. According to the students, the resulting mass of information was incredibly confusing. There were significant contradictions and large gaps, meaning that a simple checklist of yes or no answers to frequently asked questions was an impossibility.
What the team did instead was design a series of flowcharts. These highly visual aids not only presented a clear picture of where the gaps were and how to navigate around them, they helped the team understand that there was actually a lot more room for sharing of health information than most of the Iowa healthcare agencies thought.
Still, Sandler’s advice to healthcare providers was to bypass sticky laws and talk to patients about the benefits of providing written consent for health record sharing. In the end, creating a wider knowledge base among a patient’s coordinated care group provides the greatest benefit.
Getting the word out
Establishing a strong legal backing for mental health information exchange is important, but so is helping potential patients in need of aid find services. Many groups in need of mental health services may choose to avoid seeking therapy, medication or other healthcare out of concern for privacy – and chief among these is often students. In other cases, students may simply not know how to get mental healthcare in schools should they need it.
According to The Daily Iowan, even at UI, about 42 percent of students don’t know how to access on-campus mental health services. The poll of 676 UI students, conducted earlier in 2013, indicated that 25 percent of students said mental health access was “somewhat good” and 17 percent reported it was “very good.”
In recent years, the college has been doing its best to raise awareness of its variety of mental health services and resources, which include counseling, a crisis center, a domestic violence intervention program, a rape victim advocacy program and others.
Creating a visible mental health service campaign on campus could have many benefits, including clarity about privacy laws, which would in turn assure students of their confidentiality. Secondly, visibility might also work to stem any stigma mental health issues might carry on campus.