Willis said providers often avoid sharing information because they misunderstand the rules, particularly those governing substance use records. That reluctance can leave clinicians without important details about a patient’s medications, medical conditions, or safety concerns.

“Patients often assume that we're all communicating, only to find out that later that their provider is missing a vital piece of information,” Willis said. As a result, patients can feel unsupported and may believe they must manage their own care coordination.

Willis said the problem is not always the regulations themselves, but how providers interpret and apply them. Even when information can legally be shared, uncertainty can lead organizations to take a more restrictive approach than necessary.

Technology and workflow challenges add to the problem. At Presbyterian, most clinical records are electronic, but consent forms authorizing information exchange remain on paper. Forms can sit waiting to be scanned, be uploaded to the wrong chart or section, or expire without staff noticing.

The process can make it difficult for providers to confirm that they have permission to communicate with outside clinicians, slowing care coordination and limiting access to relevant records.

Silk said similar fragmentation occurs across virtual behavioral health services. Many digital health companies build systems that allow information to move easily among providers within their own platforms, but that information often does not connect with the broader healthcare system.

Patients may receive behavioral health services through an employer-sponsored benefit, an online platform or another service outside their usual health system. When they return to their regular providers, information about that care may not follow them.

“Behavioral healthcare is part of healthcare, and it's part of your record,” Silk said, emphasizing the need to connect information from virtual services with primary care and other providers.

Panelists said improving data exchange requires more than technology. Patients must understand what information is being shared, why it is being shared and who will have access to it.

Willis said Presbyterian works to explain its integrated care model from the beginning, including how psychiatry, medical, dental and behavioral health services may access information. Conversations about consent should continue throughout care rather than end when a patient signs a form.

“The more that I am able to explain to a patient so that they understand and can process the information, the more informed choices that they get to make about what happens with their information,” she said.

That approach also means respecting patients who agree to limited information sharing. Willis described patients who authorize communication with another provider for a specific appointment or a narrowly defined purpose. Honoring those boundaries, she said, can help build confidence over time.

Silk said trust also depends on whether patients believe a service delivers meaningful clinical benefits. He noted that patients may share sensitive information with digital platforms or chatbots without fully considering what happens to their data, making clear communication and appropriate safeguards especially important.

Virtual care presents additional privacy considerations. Willis said patients receiving treatment remotely may not realize who else can hear their conversations or how a session could be recorded or shared. Providers must help patients understand those risks.

While privacy protections are essential, panelists stressed that withholding information can also put patients at risk.

Willis described how symptoms that appear to indicate depression may actually be related to an untreated physical condition, such as sleep apnea. Without access to medical records or communication with other clinicians, behavioral health providers may miss underlying causes.

She also said patients may disclose substance use differently to their medical providers, psychiatrists, and therapists. When those clinicians do not communicate, important details can remain siloed and affect treatment decisions.

The challenge is particularly important for patients who need coordinated treatment for substance use disorders or other complex conditions.

At the same time, Silk said virtual behavioral health services can improve access for people who might otherwise go without care. Online cognitive behavioral therapy and other digital services may help patients with anxiety and depression, while remote treatment can offer flexibility for people who face transportation barriers, stigma or limited local services.

Willis said virtual therapy has been especially valuable for some teenagers and people in rural New Mexico, where concerns about being recognized while seeking treatment can discourage patients from accessing in-person services.

“It's not for everyone, and you have to be careful and mindful of privacy and how you do it and who's doing it,” she said. But having virtual care as an option can provide meaningful benefits.

Panelists called for clearer expectations from healthcare organizations and purchasers when selecting virtual behavioral health services.

Silk said organizations should establish desired outcomes and make data exchange and integration requirements part of vendor contracts from the outset. If a health system expects a virtual provider to coordinate with primary care, that expectation should be explicit, along with performance measures to assess whether it is happening.

Willis emphasized the need to improve staff understanding of privacy regulations so frontline workers can explain them confidently to patients.

“If they don't understand that, then when they're trying to explain it to a client or a patient, they're stumbling,” she said. “That does not build trust.”

She also called for electronic health record systems that better reflect the needs of the organizations using them, rather than relying on one-size-fits-all packages.

The discussion closed with a broader call to address the perception that behavioral health information is inherently more sensitive and therefore should not be shared. Although specific protections remain important, panelists said providers need to better understand when sharing is permitted and how coordinated access can improve care.

Ultimately, the panelists said, the goal is not simply to exchange more data. It is to ensure patients receive connected, effective care while retaining a clear understanding of and control over how their information is used.