. "6 Ensuring the National Health Information Infrastructure Benefits with Mental and Substance-Use Conditions." Improving the Quality of Health Care for Mental and Substance-Use Conditions: Quality Chasm Series. Washington, DC: The National Academies Press, 2006.
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Improving the Quality of Health Care for Mental and Substance-Use Conditions
those of AHRQ, the Centers for Medicare and Medicaid Services (CMS), the Food and Drug Administration (FDA), the National Institutes of Health (NIH), the Indian Health Service (IHS), HRSA, and the Centers for Disease Control and Prevention (CDC), among others. There is no listing for the Substance Abuse and Mental Health Services Administration (SAMHSA) and its IT initiatives (Thompson and Brailer, 2004). A subsequent July 2005 update still contained no listing of SAMHSA’s IT initiatives (ONCHIT, 2005). Moreover, although SAMHSA is listed as a partner in the federal government’s Consolidated Health Informatics initiative, it is not listed as a member of any of the work groups consisting of staff from many federal agencies, including CMS, ARHQ, IHS, CDC, NIH, the Department of Defense, the National Library of Medicine, the National Aeronautics and Space Administration, the Social Security Administration, the Environmental Protection Agency, the U.S. Agency for International Development, and the National Center for Health Statistics, that have established vocabularies and standards for demographic, diagnosis and problem list, encounter, medication, interventions and procedures, billing, and other types of data (OMB, undated).
In addition, health care for M/SU conditions was not strongly represented among either the applicants or awardees in AHRQ’s 2004 awards of $139 million in grants and contracts to promote the use of health IT through the development of networks for sharing clinical data, as well as to support projects for planning, implementing, and demonstrating the value of IT. Of the nearly 600 applications for funding, only “a handful” had any substantial behavioral health content, and of the 103 grants awarded, only 1 specifically targeted M/SU health care.4
Finally, leaders of SAMHSA’s predominantly public-sector Mental Health Statistics Improvement Project (MHSIP) initiative (discussed below) note that MHSIP has not been “at the table” when broader data initiatives have been developed (Smith et al., 2004). Moreover, SAMHSA has identified important features of health care for mental conditions that are not captured in datasets approved under the Health Insurance Portability and Accountability Act (HIPAA). SAMHSA plans to address these issues through its Decision Support 2000+ (DS 2000+) initiative (Manderscheid and Henderson, 2003). Alternatively, these issues could be brought before the standards-setting groups referenced in the HIPAA legislation and used to inform the development of HIPAA-approved datasets that would serve both the private and public sectors. Moreover, because primary care providers are increasingly providing care for mental conditions, these impor-
Conversation with Scott Young, MD, Director of Health Information Technology, Agency for Healthcare Research and Quality, November 1, 2004.