Computer-based registries, Integration and FQHCs

I bet you're all way ahead of me on this. But recently I have begun to realize the essential role computer-based registries will play in the integration of behavioral healthcare and primary care. As you know, the Federally Qualified Health Centers (FQHCs) will be key players on the primary care side for our patients. FQHCs will screen for and even provide some SUD/MH services. They'll refer some patients to specialty agencies for more in-depth treatment, while providing some medication management along with treatment for co-occurring illnesses such as diabetes, depression, heart disease, and chronic pain.

So how will information flow back and forth between an FQHC and a SUD specialty agency? In some cases it will be through a common electronic health record (EHR). In many cases, the two agencies will have different EHRs. In yet other cases, the FQHC will have an EHR and the SUD agency won't. But in all these cases, one thing is true. Patients will receive better treatment if each agency knows what the other is doing. The substance abuse confidentiality regulations such as 42-CFR Part 2 present a challenge to this information sharing. Electronic registries offer one way to partially meet this challenge.

Registries are cool because they can work with all sorts of record systems, electronic and otherwise. What's more, they're not very expensive to develop and operate. I'm not saying they're cheap, but they are reasonably priced. Providers at all sites can enter data on services provided and patient response. With patient permission, that information can be easily shared across sites. The registry can send an alert if the patient is not responding well. For example, when an FQHC refers a patient to an SUD specialty agency, the registry provides a convenient means for transferring important information as part of care coordination.

These data can be used for a variety of populations and patient-specific purposes including tracking and status monitoring. Providers could enter treatment, adherence, and response data on a routine basis and have it displayed (numerically and graphically over time) for not only the SUD but also for key co-occurring illnesses.

The registry could also analyze data. From the registry, both agencies can easily aggregate and examine information about their patient population in several different ways (i.e. by patient, health problem, appointment dates, attendance at medical appointments, medication adherence, and behavioral adherence, over time and within a certain period). For instance, the registry could examine the full list of patients; print out a summary table of their status (e.g., appointment attendance), and identify patients needing attention.

Alerts. Providers could receive summary data before a patient's visit along with notifications if patient's indicator exceeds pre-defined thresholds. This would allow a timely intervention.

Treatment communication. The registry can store data on key treatments and outcomes at and between FQHC or SUD specialty visits and automatically share that information between agencies.

It's easy for an engineer who knows nothing about treatment to say, but these capabilities seem pretty important. If you agree, it might be useful to explore an electronic registry. I bet a lot of you already have. If so, share your thoughts with us.

Dave Gustafson
Director, NIATx