A Plea for the Integration of Social and Behavioral Health Data in EHRs
When Meaningful Use was drawn up to exclude behavioral health providers, the impact that this decision would have on increasing the divide between medical and behavioral health care providers was probably not fully considered.
Health IT Analytics recently published an article by Jennifer Bresnick, Social, Behavioral Data Must Be Included in EHRs, Nurses Say highlighting the problem. It’s a good read.
Bresnick reports, “Largely ineligible for the EHR Incentive Programs and somewhat ignored by mainstream primary care health IT developers, behavioral health providers have been slower to adopt EHR technology that might facilitate health information exchange.”
Effectively, we’ve put primary care and medical care providers on a high speed train en route to a modern digital connected world of data and interoperability (the train hasn’t quite arrived yet!) while leaving behavioral health providers back at the station. As we arrive closer at the destination, we are now noticing that the distance between these groups is a real problem.
People don’t have just medical or mental health problems. The two are totally dovetailed, with social problems also having a significant impact on both. In her article, Bresnick tells us of the American Academy of Nursing’s new policy brief and call to action, stating that “Electronic health records are incomplete and potentially insufficient for use in population health management programs when they are missing social and behavioral data”.
Yet, not only are the EHRs failing to amalgamate the required data, but also many behavioral health providers don’t currently have the tools, infrastructure, budgets, training… in place to quickly catch up and join the digital health ecosystem.
Even the legislation and privacy policies around mental health data (whilst arguably historically driven by the right motivation) commonly now impede the way forward.
Hindsight can make us odious as well as smart. So, let’s move on from what’s been done wrong, to what we can do to make things better.
For starters, there is hope that pending legislation will expand meaningful use eligibility to psychologists and inpatient psychiatric hospitals. The Helping Families in Mental Health Crisis Act of 2015 includes several other provisions related to the adoption of health information technology and health data exchange, alongside the meaningful use eligibility. The proposed bill addresses provider access to protected health information (PHI) for people with serious mental illness and confidentiality of records, balanced against the need to improve care coordination. In its Federal Health IT Strategic Plan 2015-2020, the Office of the National Coordinator for Health Information Technology made increasing behavioral health EHR adoption an aim.
These are all good steps forward.
Surveys of behavioral health providers consistently demonstrate that the costs of EHR implementation and adoption are leading causes for failing to implement the technologies, so it is essential to free up funds. Meaningful use incentives would do that, to some extent. It’s also noteworthy that a failure to find the right system is also a barrier to adoption. That’s a plea for other companies to join mehealth’s efforts and provide health IT solutions that address the clinical needs of behavioral health providers.
The Health IT Analytics article eloquently sums up the AAN’s vision of how we should move forward with the following statement:
“The Academy urges EHR vendors, health systems, and clinicians to collaborate on developing standards that will enable providers to collect behavioral and social determinants of health that can be readily integrated into EHR workflows.
Stakeholders must work together to create connections between social and behavioral healthcare organizations and the primary care ecosystem in order to develop a richer portrait of patient challenges and needs.
By implementing an industry-wide effort to better integrate socioeconomic and behavioral health data into EHR technologies, stakeholders “will begin to address the global changes that must be made in clinical practice to assure EHRs capture and permit sharing of contextual patient information, promote shared decision-making, enhance appropriate inter-professional planning/providing of health care services, and facilitate monitoring of patterns of health and outcomes of care for entire populations,” the brief concludes.”