Beyond fax: provider perspectives on data sharing in substance use disorder care
Abstract Objectives Substance use disorder (SUD) care continues to be hindered by persistent gaps in health information exchange (HIE). This study examined people, organizational, regulatory, and technical barriers to SUD data sharing from the provider perspective and identified key opportunities to improve care through health record interoperability. Materials and Methods Behavioral health providers (52% prescribers) representing 4 SUD treatment organizations in 14 US states participated in 11 focus groups (n = 31) and 5 validation interviews (n = 5) covering scenarios related to SUD Healthcare Effectiveness Data and Information Set (HEDIS) metrics. Thematic analysis, keyword searches, and workflow analysis [using Unified Modeling Language (UML) diagrams] were performed. Results Incomplete data access at the point of care frequently necessitated manual exchange via fax, phone, and secure email. When available, HIE and Prescription Drug Monitoring Program (PDMP) data were helpful, but confusion regarding the release of SUD information requirements in the context of HIPAA (Health Insurance Portability and Accountability Act), 42 CFR (Code of Federal Regulations) Part 2 and state requirements was ubiquitous. UML modeling of 4 core SUD care scenarios rising from participants’ HEDIS examples revealed 3 common data sharing subprocesses. Discussion Fragmented data sharing workflows, and extensive use of non-electronic data sharing methods impact outcomes for individuals with SUD. Interoperable consent management, HIE and PDMP integration with EHRs, and harmonized privacy regulations are provider priorities. Conclusion Mapping provider-identified barriers reveals technical, regulatory, and workflow breakdowns that limit SUD care coordination. Advancing electronic, consent-driven interoperability employing standards is critical to improving continuity of care while safeguarding patient privacy.