Behavioral health data 'burdens EHRs'

'Behavioral health and primary care differ in their language, classifications, codes, data reporting requirements, and regulations'
By Mike Miliard
10:48 AM

We've heard often lately that for population health to truly live up to its promise, behavioral health data will need to be much better integrated into the care process. But in their current state, at least, EHRs still might not be the best tools to help.

A recent study led by University of Colorado researchers and published in the Journal of the American Board of Family Medicine suggests that integration of behavioral health and primary care is still somewhat problematic thanks to EHR limitations.

"Almost half the U.S. population will meet the criteria for a mental health disorder during their lifetime," researchers write in the report, Electronic Health Record Challenges, Workarounds, and Solutions Observed in Practices Integrating Behavioral Health and Primary Care. "However, less than two thirds of these individuals will receive treatment. The prevalence and need for treatment of behavioral health disorders, which affect a broad percentage of the population, makes the case for integrated care."

But as primary care providers team up with behavioral health clinicians in pursuit of that patient-centered care, an EHR's ability to deliver the "complete, current, just-in-time information" necessary to all those who need it isn't quite there yet, according to the JABFM study.

They perform well on the clinical side, by and large. But because "behavioral health and primary care differ in their language, classifications, codes, data reporting requirements and regulations," EHRs could also "pose barriers" to optimal primary/behavioral care integration.

"Evidence examining the role of the EHR in team-based care is mixed," researchers write. "On the one hand, EHRs may facilitate teamwork, communication and task delegation through the use of instant messaging, task management and evidence-based templates for symptom-specific data collection. In contrast, EHRs may be a barrier to other team-based care activities because many systems lack the functionality and interoperability to support care management and population-based care, such as through the use of interprofessional care plans and registry management tools."

In their study, the researchers looked at 11 diverse practices – eight primary care clinics and three community mental health centers  working toward integrated care.

Of them, eight primary care practices used a single EHR; three practices, meanwhile, used two different systems – one to document behavioral health and one to document primary care information.

"Practices experienced common challenges with their EHRs' capabilities to 1) document and track relevant behavioral health and physical health information, 2) support communication and coordination of care among integrated teams, and 3) exchange information with tablet devices and other EHRs," according to the study. "Practices developed workarounds in response to these challenges: double documentation and duplicate data entry, scanning and transporting documents, reliance on patient or clinician recall for inaccessible EHR information and use of freestanding tracking systems."

The good news? "As practices gained experience with integration, they began to move beyond workarounds to more permanent HIT solutions ranging in complexity from customized EHR templates, EHR upgrades and unified EHRs."

Nonetheless, the report generally found that "integrating behavioral health and primary care further burdens EHRs."

Technology vendors should work in cooperation with clinicians to better design EHR products that feature functions, such as "documentation and reporting to support tracking patients with emotional and behavioral problems over time and settings, integrated teams working from shared care plans, template-driven documentation for common behavioral health conditions such as depression, and improved registry functionality and interoperability," researchers wrote.

Nonetheless, they conceded it wouldn't be an easy task: "This work will require financial support and cooperative efforts among clinicians, EHR vendors, practice assistance organizations, regulators, standards setters and workforce educators."

Read the full report here.

See also:

Behavioral health's EHR conundrum
Epic links with behavioral health EHR
How accountable is the care without behavioral health?
Implementing an EHR in the behavioral health setting