SAMHSA Grant: Improving Opioid Treatment Program Patient Continuity of Care through Data Interoperability

The statutory authority for this program prohibits grants to for-profit agencies, and SAMHSA is further limiting competition to certified OTPs. The object of this grant program is to expand interoperable EHRs to a very specific behavioral health care provider – OTPs. There is considerable variation in the way that OTPs develop their record systems to fit the needs of their programs – OTPs know exactly what is needed in their EHR systems. Some OTPs acquire EHR systems from large vendors and tailor them to their needs. Other OTPs have developed and built their EHR systems “from the ground up” so that they are entirely specialized to that one program. OTPs are best suited to analyze the characteristics of the health information exchanges in their regions and how those factors apply to their staff and patient population needs. As such, OTPs are uniquely qualified to maximize the resources provided under this grant.

In addition, SAMHSA’s Strategic Initiative on Health Information Technology is focused on ensuring the behavioral health system, including states, community providers, and peer and prevention specialists, fully participates with the general healthcare delivery system in the adoption of health information technology (HIT) and interoperable electronic health records (EHRs).

SAMHSA has been working to develop Health Level 7 (HL-7) standards for behavioral health information to be included in a standard continuity of care document. All grantees will be expected to provide feedback to SAMHSA on the standard data elements that are needed to be shared across OTPs to support high level clinical care.

The behavioral health treatment field, like all health care providers, is enhancing patient health record systems to incorporate interoperable EHRs. Over 1,260 OTPs provide medication assisted treatment for substance abuse disorders (opioid dependence and addiction) with methadone and buprenorphine to hundreds of thousands of patients every year.

As behavioral health service providers, OTPs face specific and unique challenges in recordkeeping systems. OTPs must conform to federal confidentiality rules, which significantly restrict the distribution of patient health information. In addition, OTPs are subject to specific recordkeeping requirements set forth by federal (SAMHSA/CSAT, Drug Enforcement Administration), state, and local licensing agencies, and accreditation organizations. OTPs face special needs to continue care to patients displaced by disasters. Accordingly, OTPs, as a subset of behavioral healthcare providers, require substantial and specific assistance to migrate to interoperable EHR systems.

Informal assessments suggest that OTPs have been slow to develop and adopt integrated EHR systems. There are few multi-state and multi-provider EHR software systems. Many OTPs use EHR systems that were developed and customized to provide electronic medical systems for just one OTP. Moreover, the majority of programs are patient self-pay and have not historically accessed either private insurance benefits or Medicaid benefits for patient care coverage. As such, only a few OTPs have explored or taken steps to achieve “meaningful use” incentives under the Health Information Technology for Economic and Clinical Health (HITECH) Act. OTPs, as a subset of behavioral healthcare providers, require substantial assistance to migrate to interoperable EHR systems. For example, under SAMHSA regulations (42 CFR § 8.12), OTPs must assure that their record systems, including electronic health record systems for information sharing, are in compliance with the federal confidentiality regulations. The history of localized disasters also indicates a need to improve the capacity for OTP health record systems to respond to instances when programs are closed for extended periods of time, and patients need to relocate.

OTP-CoC grants are authorized under Section 509 of the Public Health Service Act, as amended. This announcement addresses Healthy People 2020 Substance Abuse Topic Area HP 2020-SA.