Part 2 Challenges
Many provider and organizational issues surround Part 2. Two issues that often arise are confusion and technical barriers.
Confusion About Part 2
Providers and organizations are often confused about whether and how they must comply with Part 2.75 To be subject to Part 2, a provider or organization must be federally assisted and provide alcohol or drug abuse diagnosis, treatment or referral for treatment. 76 As such, a general medical facility or provider that does not hold itself out as a substance abuse provider is not subject to the rule, despite the fact that substance abuse information may be present in a patient’s record.77 If a program holds itself out as more than one kind of treatment provider, only substance abuse treatment information is subject to Part 2.78 Part 2 also does not apply to alcohol or drug abuse information from private, commercial insurance or employee benefits that are not federally subsidized.79
Given the frequency with which mental health information and substance abuse treatment information overlap, a major misconception is that Part 2 applies to mental health providers as well as substance abuse providers. Mental health providers, however, are not subject to the Part 2 regulation unless they also hold themselves out as substance abuse treatment providers, in which case only the substance abuse information is subject to Part 2. For example, Part 2 does not apply to information about bipolar disorder or schizophrenia unless a federally-assisted drug and alcohol treatment program collected that information.
Technical Barriers to Sharing Part 2 Information
One of the most significant barriers to exchanging information under Part 2 is the fact that EHRs and HIOs are not designed to easily segment access to information.80 Many EHRs do not have discreet fields in which to enter sensitive information, or information may be in free-text format, making it difficult to distinguish among different types of data. Similarly, many HIOs lack the capability to segment or limit access to sensitive information. Moreover, even if a provider has the ability to segment data, once the information passes to an HIO, most HIOs do not have the ability to limit access to providers named in a Part 2–compliant consent form. Because it is difficult to build or alter systems to segment access to data and because behavioral health providers have not historically been eligible for federal health IT incentive programs, there is relatively low adoption of EHRs among behavioral health providers.