- While many inpatient and ambulatory care organizations and providers are maturing in their EHR use, their counterparts in behavioral health continue to lag behind in their use of the technology for documenting and coordinating care delivery.
This technology gap has led some proponents of behavioral health integration to claim that current EHR systems do not appropriately support the clinical workflows of these specialists. However, others have more recently called attention to the fact that the technology itself needs time to mature to suit the needs of behavioral health and the expansion of the care continuum to include non-primary care providers.
In correspondence published in the Journal of the American Board of Family Medicine, two researchers from the Department of Family Medicine at the University of Vermont College of Medicine have questioned the conclusions from a September article by Cifuentes et al. that found many EHR-related challenges tied to integrating behavorial health and primary care.
"Though based on a limited convenience sample of practices, their conclusion leads readers to assume that in integrated care, EHR issues are not fully resolved," write Rodger Kessler, PhD, and Juven R. Hitt. "There are 3 concerns with the conclusions: EHR issues are not fully developed in many areas of medicine; integrated care cannot function without integrated EHRs; and multiple examples of well-developed, transparent, bidirectional EHRs exist in multiple integrated family medicine practices around the country."
According to the UVM duo, the conclusions of Cifuentes et al. speak more to the ability of behavioral health and primary care integrators to address administrative rather than technical challenges:
EHRs are still in their youth (or adolescence), and have not yet grown into the hopes that many have for them. Templates for documentation, ease of use, interoperability, ability to extract data fields, use as part of care algorithms, and responding to the multiple needs for functionality for a broad range of users are among the current issues being considered. Applications for behavioral care within EHRs suffer the same and perhaps greater frustrations of all EHR users: how to use the available technology to meet their needs. These frustrations are often administrative rather than technical issues. The priority and pressure for developing integrated behavioral care systems is just emerging.
In their discussion of EHR challenges, workarounds, and solutions for integrating behavioral health and primary care, Cifuentes et al. called attention to limitations in EHR design and usability as a hindrance to integration efforts.
"Similar to prior research, our study found that EHRs generally lack features essential to support key integration functions such as documenting and tracking longitudinal data, working from shared care plans, and template-driven documentation for common behavioral health conditions such as depression," they observed.
"EHRs also had poor registry functionality and could not be electronically linked with freestanding registries," Cifuentes et al. continued, "making it difficult for practices to monitor and track patients with specific behavioral health conditions, medication regimens, and those receiving specialty mental health services outside the practice."
Kessler & Hitt, however, point to several primary care/behavioral health integration efforts that have proved successful despite these deficiencies in EHR design and usability, efforts that point to the need for strong leadership and transparent plans for optimizing EHR technology to benefit their clinicians.
"In summary, a behavioral presence in EHRs is associated with the same growing pains as any other EHR user groups, amplified by the recency of integration development," they claim.
As organizations such as the American Academy of Nursing have argued, EHR vendors must work with EHR end-users to address and mitigate obstacles to clinical efficiency raised by EHR use. That being said, the examples of successful integrators of primary care and behavorial health demonstrate that these shortcomings in EHR technology are surmountable with the right mixture of know-how and can-do.