Challenges of Integrating Behavioral and Primary Care Using EHRs
by Abdul Aziz Mondal Health Care Services Published on: 21 June 2023 Last Updated on: 24 September 2024
Behavioral health encompasses the advocacy of psychological and emotional wellness, as well as the prevention and management of mental health disorders and substance abuse issues.
The correlation between behavioral health and physical health outcomes, as well as social and economic welfare, is profound. Individuals with behavioral health conditions face an elevated susceptibility to the development of chronic illnesses like heart disease or diabetes and other lifestyle issues like gambling.
In this article, we will shed light on the importance of integrated and holistic care and the challenges that come along with the use of EHRs in this new care delivery method.
What Is The Relevance Of Integrated Care?
The 2020 National Survey on Drug Use and Health revealed that around 17 percent of young individuals had some level of a major depressive incident. Moreover, approximately 11 percent of adults struggled with alcohol addiction.
Limited access to behavioral health services is a major obstacle to treatment, particularly in certain regions of the United States where availability and affordability are lacking.
Lack of awareness and discrimination further compound the problem. Treatment rates in 2020 continued to be subpar, as less than 50% of adults and youth with mental health conditions and less than 10% with substance use disorders received the necessary treatment throughout the year.
Racial disparities in accessing behavioral health care persist, reflecting broader healthcare disparities.
Provider shortages, especially in rural areas, contribute to limited access. The US needs an estimated 7,400 mental health professionals to meet the current demand.
Many other obstacles, such as high costs and gaps in insurance coverage, hinder individuals from accessing specialized behavioral health care.
So, many individuals turn to their primary care providers (PCPs) for behavioral health treatment. But, PCPs often lack the necessary expertise to address severe mental health or substance use concerns.
The integration of care equips primary care providers (PCPs) and related healthcare professionals with the necessary tools to accurately diagnose and treat these conditions. This comprehensive approach has demonstrated its ability to enhance behavioral health access and outcomes for individuals of all ages and diagnoses.
Role Of Technology In The Integration
This integration of behavioral healthcare and primary care has been a game-changer, bringing clinicians and care organizations closer together to enhance the delivery, safety, and quality of care.
Health Information Technology tools have stepped in to benefit this collaboration to a great extent. Electronic health records (EHRs), clinical decision support (CDS), and standards-based interoperability, to name a few, have become the driving force behind this integration.
These tools have revolutionized the way health professionals handle clinical data. They have skyrocketed their quality, quantity, and completeness, making standardized clinical information more accessible and valuable than ever before.
Electronic Health Records: The Gamechangers
Electronic Health Records (EHRs) EHRs enable the effective management and consolidation of user-centric records as a central database. Their use in both behavioral and primary healthcare has seen a rise in the past decades.
Behavioral health EHR systems combine the forces of psychotherapy, regular clinical norms, and behavioral health practice management tools into a single, dynamic environment. Here, providers and medical professionals join forces, collaborating using cutting-edge behavioral health workflows.
In the case of primary healthcare, the use of EHRs has been booming. A report published by HealthIT.gov in 2021 revealed that an overwhelming majority of non-federal acute care hospitals (96%) and approximately four out of five office-based doctors (78%) had embraced certified Electronic Health Records (EHRs).
This signifies remarkable progress compared to the statistics from 2011, where only 28% of hospitals and 34% of physicians had implemented EHR systems.
In an integrated system boosted by the use of EHRs and other technological tools like telehealth, the collection of information empowers primary care providers (PCPs) to gain a holistic understanding of the patient’s well-being, facilitating improved coordination and collaboration with behavioral health providers.
According to Accumedic, health data is now becoming accessible to certified healthcare providers across various practices and healthcare organizations, thanks to the role played by EHRs.
EHRs offer decision support tools that can assist PCPs in identifying and managing behavioral health conditions. These tools can encompass an array of resources, such as clinical guidelines, screening questionnaires, and alerts that raise awareness of potential medication interactions or contraindications.
The use of EHRs also facilitates the gathering and examination of community health data.
By consolidating and analyzing anonymized patient data, healthcare organizations can detect noteworthy trends, patterns, and areas where symptoms related to behavioral and primary health may not be generally observed.
The EHR Shortcomings
The effective use of electronic health records (EHRs) has the capability to streamline information exchange and bolster clinical activities, resulting in improved quality of care and cost reduction.
However, the integration of behavioral health and primary care faces obstacles due to variations in language, classifications, codes, data reporting requirements, and regulations.
While EHRs can help enable teamwork, communication, and task delegation through features like instant messaging and evidence-based templates, they may also pose barriers to other team-based care activities due to limited functionality and interoperability.
Traditional medical settings rely on quantitative data. But, behavioral healthcare often involves narrative progress notes. This distinction presents a significant obstacle when it comes to using EHRs, as they rely on structured data formats for standardization. The absence of a structured information format in mental healthcare hinders the effective integration of EHRs.
Moreover, EHRs often lack interoperability with other systems, including tablet devices used for behavioral health screening surveys. The absence of interoperability presents difficulties in documenting patient encounters, obtaining essential information during care delivery, and effectively communicating information between primary care and behavioral health providers.
While EHRs offer significant potential, addressing these barriers is crucial to maximize their benefits and ensure seamless integration of behavioral health and primary care for improved patient outcomes.
The Workarounds
There are various strategies that can be put to use to overcome the limitations of EHRs in integrating primary health care and behavioral health care:
Interoperability Solutions: Establishing interoperability standards and encouraging the adoption of Health Information Exchange (HIE) platforms can ease the seamless sharing of data between different EHR systems. This promotes improved coordination and collaboration among primary care and behavioral health providers.
Customization of EHR Templates: Modifying EHR systems to incorporate customizable templates specifically designed for behavioral health assessments and progress notes can enable the capture of narrative information while preserving structured data elements. This ensures that both quantitative and qualitative data are effectively documented.
Mobile and Telehealth Solutions: To address the gap between primary and behavioral health care, mobile applications and telehealth technologies can be utilized. These tools enable remote monitoring, virtual consultations, and secure communication, effectively connecting healthcare providers and patients.
By integrating these solutions with EHR systems, relevant data can be captured and made easily accessible to providers. This integration facilitates seamless communication and enhances the overall quality of care by ensuring that healthcare providers have access to up-to-date patient information, regardless of geographical limitations.
Conclusion
The introduction of technology is always motivated by the aim of increasing productivity and cutting expenses within an enterprise. The emergence of electronic health records (EHRs) and other Health IT tools has brought about a significant transformation in the medical field and continues to rapidly advance.
But it is still a long way to go. The use of EHRs and their implications are still being studied and have not reached maturity yet. Medical professionals need to be clear about their goals and objectives before incorporating such management tools into their practice.
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