Skip Navigation

Winter 2012, Volume 20, Number 1

Health Information Technology


Health Information Technology ... What It Means for You

By Sandy D. Cogan

As the Nation strives to increase access to affordable care, technology is playing a key role. Both health information technology (HIT) and its corollary, electronic health records (EHRs) are central to improving the delivery of services so that that all Americans— including those with behavioral health conditions—benefit from health care system reform. What does this mean for behavioral health service providers and consumers?

The potential benefits are enormous. Through effective use of health data, Americans will have access to a robust health care system that provides higher quality care, increased cost-efficiency, and improved access to patient-centered, affordable care.

However, many behavioral health providers, as well as consumers and their families, have real concerns about how EHR systems and real-time access to sensitive medical information can be achieved while fully protecting their confidentiality. Providers and consumers want to know how to use promising new technologies securely while simultaneously safeguarding the privacy of EHR information.

Recently passed legislation, including the Affordable Care Act (ACA) and the Health Information Technology for Economic and Clinical Health Act (HITECH), which was enacted as part of the American Recovery and Reinvestment Act (ARRA) provide support and incentives for States and communities to integrate behavioral health care with primary care through the effective use of HIT. These federal incentives are leading primary care providers to embrace EHR systems.

Most behavioral health providers were not included in the initial financial incentive programs, leading to slower adoption of these innovations. Their late start in transitioning from paper to electronic records is also due to concerns about protecting sensitive information, the expense of EHR systems, and a history of independent operation from the broader medical health care system.

Guiding Confidentiality

Concerns about protecting the confidentiality of sensitive behavioral health information are long-standing. Language within the Code of Federal Regulation (42 CFR Part 2) has guided providers of services for substance use disorders (SUD) for more than three decades. (See Behavioral Health IT Resources.) These regulations, enacted in the 1970s, ensured that individuals with SUDs were not deterred from entering drug treatment for fear that their treatment records would be used to judge them or criminally prosecute them for drug use. 42 CFR Part 2 protects the privacy and confidentiality of treatment records residing in substance use treatment facilities. The regulations, which predate the 1996 Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule, strictly prohibit the unauthorized disclosure and use of records maintained in connection with any federally assisted alcohol or drug use treatment program. Only with a patient’s expressed consent or a court order can information be released to a third party.

In contrast, the HIPAA Privacy Rule, established primarily to reduce waste and fraud in the health insurance industry, permits use and disclosure of patient information for treatment, payment, and health care operations, as well as certain other disclosures without the individual’s prior written authorization. Under HIPAA, a mental health exception requires patient authorization before disclosing psychotherapy notes.

HIPAA, 42 CFR Part 2, and applicable State laws that regulate the confidentiality of mental health treatment information raise questions for providers about patient confidentiality regarding disclosure of EHR information. For example, providers want to know how to handle release of information in the case of a medical emergency or when the information is needed to avoid possible harm that may result from drug-drug interactions.

In June 2010, SAMHSA responded to these questions through release of a frequently asked questions (FAQs) document, “Applying the Substance Abuse Confidentiality Regulations to Health Information Exchange."

Additional provider questions resulted in a second set of FAQs, developed in collaboration with the Legal Action Center. These FAQs about 42 CFR Part 2 were introduced at a regional stakeholder meeting in December 2011 and posted on SAMHSA’s Web site.

H. Westley Clark, M.D., J.D., M.P.H., Director of SAMHSA’s Center for Substance Abuse Treatment (CSAT), cautioned that the 42 CFR Part 2 FAQs are explanations and not legal documents. He added that they also explain how 42 CFR Part 2 could affect primary care providers who conduct screenings, hold interventions, and write prescriptions for medications appropriate for patients with substance use problems. SAMHSA is continuing to work with the behavioral HIT vendors and treatment provider communities to address these and other issues related to using HIT to share sensitive behavioral health information.

SAMHSA has initiated multiple efforts to foster development of technologies to support behavioral health care.

“Our goal is to help enhance the quality and expansion of behavioral health services,” Dr. Clark said, “so that Americans with addiction or mental health issues will be able to reap the benefits of health reform.”

A Closer Look at HIPAA and 42 CFR Part 2

The Health Insurance Portability and Accountability Act of 1996 (HIPAA), with amendments included in the Health Information Technology for Economic and Clinical Health(HITECH) Act

HIPAA Consent Requirements
Federal Confidentiality Regulation of Alcohol and Drug Abuse Records (42 CFR Part 2) 42 CFR Part 2 Consent Requirements

For more information, visit "SAMHSA Enhances Technology Efforts" and

Share This Article:

Featured Articles
SAMHSA's Budget Affirms Commitment to Behavioral Health

Health Information Technology ... What It Means for You

As the Nation strives to increase access to affordable care, technology is playing a key role.

Embracing Health IT

SAMHSA Enhances Health Information Technology Efforts

Two of SAMHSA’s eight Strategic Initiatives encourage the development and expansion of health information technology (HIT).

Embracing Health IT

Embracing Health Information Technology

As our country invests in the widespread adoption of health information technology (HIT), it is important to note the vast improvements this technology will bring to integrated, prevention-focused, health care delivery nationally.

Behavioral Health IT Resources

Behavioral Health IT Resources

For more information, visit our resources page.

Also In This Issue
SAMHSA's Budget Affirms Commitment to Behavioral Health

Using Social Media to Save Lives

Suicide, the Nation’s 10th leading cause of death,1 is a preventable public health problem. Family members and friends of someone having suicidal thoughts may not know how to help, but SAMHSA and its grantees are using social media and smartphone apps to help them connect people to lifesaving services.

SAMHSA Releases Two New Resources

Study Finds One in Five American Adults with Mental Illness

One in five adults age 18 and older in 2010 experienced mental illness in the past year, affecting 45.9 million adults across the United States, according to a Substance Abuse and Mental Health Services Administration (SAMHSA) report released in January.

SAMHSA Releases Two New Resources

SAMHSA's Prevention Day 2012

More than 1,700 substance abuse professionals, grantees, and community partners gathered at the National Harbor in Maryland on February 6 for SAMHSA’s Prevention Day. Each year, Prevention Day is part of the Community Anti-Drug Coalitions of America’s (CADCA’s) Annual National Leadership Forum.

SAMHSA Releases Two New Resources

SAMHSA Celebrates Behavioral Health Advances Over 20 Years

In 2012, SAMHSA is celebrating its 20th birthday—and the progress the behavioral health field has made in prevention, treatment, and recovery. Since SAMHSA was created in 1992, the behavioral health field has changed dramatically.

SAMHSA's Budget Affirms Commitment to Behavioral Health

SAMHSA's Budget Affirms Commitment to Behavioral Health

The Fiscal Year 2013 budget reflects a continuing commitment to SAMHSA’s role in behavioral health.

SAMHSA Releases Two New Resources

SAMHSA Releases Two New Resources

Check out the latest in SAMHSA’s Treatment Improvement Protocol (TIP) series.