Vital Signs: Could healthcare IT be the key to better addiction treatment?

In a new, landmark report on addiction, the U.S. surgeon general made a solid argument for the role of health information technology in improving the treatment of patients with drug or alcohol abuse as well as behavioral health problems.

Dr. Vivek Murthy's office pushed for greater health IT adoption and use by providers of alcohol, drug abuse and behavioral health treatment. But it took no position on a pending federal rule that could relax the current strict privacy protections covering the medical records of many patients receiving those treatments.

The report, Facing Addiction in America: The Surgeon General's Report on Alcohol, Drugs, and Health, highlights a fundamental health IT dichotomy: Patients get better care if their records are shared among providers, but patients won't seek treatment if they believe their information will be widely disclosed.

An estimated 23% of the U.S. population age 12 and older—some 67 million people—have engaged in binge drinking. Meanwhile, 10.2%—about 27 million people—used illicit drugs or misused prescription drugs. And more than 40% of people with a substance use disorder also have a mental health condition, the report said.

Yet only 10% of individuals with a substance use disorder receive specialty treatment for it and fewer than half (48%) with both a substance abuse disorder and a mental health condition receive treatment for either, it said.

Social stigma often deters individuals from seeking care, Murthy said in preamble to the report.

“For far too long, too many in our country have viewed addiction as a moral failing,” Murthy said, adding that perception deterred people from seeking help.

According to an earlier federal survey, 12% of persons age 12 or older who had alcohol or substance abuse problems didn't seek treatment due to a possible negative effect on their employment. Other fears include arrest, loss of child custody and loss of insurance coverage, the report said.

Health IT could bridge an information gap between general healthcare providers, providing both with up-to-date medical histories of patients and facilitating communication, the report said.

Historically, care for substance abuse and behavioral health has been separated from care for general healthcare, in part because of different payment methods, meaning the two systems have not routinely exchanged clinical information. The federal program that offered incentives to adopt electronic health records also largely bypassed specialty drug and alcohol treatment and behavioral health providers.

The Mental Health Parity and Addiction Equity Act of 2008 and the Medicare Access and the CHIP Reauthorization Act of 2015 “are incentivizing data sharing between the two care groups,” the report said.

In February, HHS proposed relaxing a 1970s-era federal privacy rule—42 CFR Part 2—that protects patients seeking substance abuse treatment. The rule, which is far more stringent than HIPAA, requires providers to obtain a patient's written consent prior to the disclosure of addiction treatment records to another provider. Providers receiving those records, similarly, must get a patient's consent again before they can to send those records to other providers.

Some substance abuse treatment and behavioral health specialists as well as privacy advocates oppose relaxing the rule, suggesting a general consent form will become the default form used for obtaining consent for releasing all patient records. That means vulnerable patients many inadvertently sign away their more stringent privacy protections, said those who were opposed.

Other providers and advocates welcome the change, however, hoping it will make interoperability easier.

The final rule is expected to be released soon.

The surgeon general's report made no mention of the pending rule revision, but did stress the need for vigilance in maintaining special privacy protections for these patients, including technology fixes that enable providers to share patient records protected by 42 CFR Part 2.