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. 2024 Jun 7;19(1):48.
doi: 10.1186/s13722-024-00477-3.

Using 42 CFR part 2 revisions to integrate substance use disorder treatment information into electronic health records at a safety net health system

Alexandra R Tillman  1 , Emily Bacon  2 , Brooke Bender  2 , Dean McEwen  2 , Joshua Blum  2 , Matthew Hoag  2 , Kenneth A Scott  2 , Rachel Everhart  2 , Rebecca Hanratty  2 , Laura J Podewils  2 , Carolina Close  2 , John Mills  2 , Arthur J Davidson  2
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Using 42 CFR part 2 revisions to integrate substance use disorder treatment information into electronic health records at a safety net health system

Alexandra R Tillman et al. Addict Sci Clin Pract. .

Abstract

Background: Regulations put in place to protect the privacy of individuals receiving substance use disorder (SUD) treatment have resulted in an unintended consequence of siloed SUD treatment and referral information outside of the integrated electronic health record (EHR). Recent revisions to these regulations have opened the door to data integration, which creates opportunities for enhanced patient care and more efficient workflows. We report on the experience of one safety-net hospital system integrating SUD treatment data into the EHR.

Methods: SUD treatment and referral information was integrated from siloed systems into the EHR through the implementation of a referral order, treatment episode definition, and referral and episode-related tools for addiction therapists and other clinicians. Integration was evaluated by monitoring SUD treatment episode characteristics, patient characteristics, referral linkage, and treatment episode retention before and after integration. Satisfaction of end-users with the new tools was evaluated through a survey of addiction therapists.

Results: After integration, three more SUD treatment programs were represented in the EHR. This increased the number of patients that could be tracked as initiating SUD treatment by 250%, from 562 before to 1,411 after integration. After integration, overall referral linkage declined (74% vs. 48%) and treatment episode retention at 90-days was higher (45% vs. 74%). Addiction therapists appreciated the efficiency of having all SUD treatment information in the EHR but did not find that the tools provided a large time savings shortly after integration.

Conclusions: Integration of SUD treatment program data into the EHR facilitated both care coordination in patient treatment and quality improvement initiatives for treatment programs. Referral linkage and retention rates were likely modified by a broader capture of patients and changed outcome definition criteria. Greater preparatory workflow analysis may decrease initial end-user burden. Integration of siloed data, made possible given revised regulations, is essential to an efficient hub-and-spoke model of care, which must standardize and coordinate patient care across multiple clinics and departments.

Keywords: 42 CFR Part 2; Data integration; Electronic health record; Hub-and-spoke; Substance use disorder treatment.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Hub and Spoke Model diagram for integrating substance use disorder engagement, treatment, and recovery care from multiple entry points, Denver Health, Denver CO, 2023
Fig. 2
Fig. 2
Timeline for electronic health record data integration, March 2021 – January 2023. Denver Health, Denver CO.
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