As integrated primary care and behavioral healthcare services come to the forefront, healthcare organization leaders must establish strong EHR use to enable better care coordination between the two specialties, finds a study published in the Journal of the American Board of Family Medicine.
According to the research team, integrated primary and behavioral healthcare is increasing in popularity, both because it is better supported by value-based payment systems and because it delivers necessary treatment to those managing behavioral health disorders.
Sixty-seven percent of individuals with behavioral health disorders do not receive the care that they need, but when their care is integrated into the primary care setting, that issue typically improves.
“Most patients with BH conditions, including children, are seen in medical settings, most commonly primary care (PC), presenting the need and opportunity to replace separated systems of care that do not adequately meet the needs of patients with integrated, ‘whole-person’ care,” the researchers explained.
As integrated care models continue to emerge, the research team sought to identify best practices for their establishment and growth. To that end, the team conducted feedback interviews with 11 Colorado-based primary care practices integrating behavioral health into their workflows.
Following a three-year test period and retrospective qualitative interviews, the researchers gleaned five common themes:
(1)frame integrated care as a necessary paradigm shift to patient-centered, whole-person health care;
(2)initialize: define relationships and protocols up-front, understanding they will evolve;
(3)build inclusive, empowered teams to provide the foundation for integration;
(4)develop a change management strategy of continuous evaluation and course-correction; and
(5)use targeted data collection pertinent to integrated care to drive improvement and impart accountability.
Specifically, the research team found that strong EHR use was critical to care coordination between patients and primary care and behavioral health providers. Creating a substantial health IT infrastructure was among one of the primary suggestions between each of the participating healthcare organizations.
“Establish standard processes and infrastructure necessary for your integrated care approach: workflows, protocols for scheduling and staffing, documentation procedures, and an integrated EHR,” the researchers said, citing one of the common recommendations for integrated primary and behavioral healthcare.
Healthcare organizations should use health IT and EHRs to standardize office scheduling, ensuring that there is enough time for both primary care and behavioral health specialists to treat patients. Respondents also suggested organizations integrate templates into their existing EHR to allow behavioral health specialists to input and organize patient data into one electronic file.
Using the EHR to integrate behavioral and primary healthcare will not always be an easy task, respondents cautioned. Getting all providers on the same technology page will require a significant EHR overhaul, but it is integral to ensuring providers can work together within the same setting to improve patient care.
“Get an EHR that meets the needs of those in this negotiated relationship, and be prepared for the expense and time it takes to work,” one respondent said.
The researchers also found that most providers suggested using EHR data for practice improvement.
“Choose relevant measures, establish processes to obtain and analyze data, and determine your methods to quickly and routinely apply what your analysis shows to improve future performance,” one respondent suggested.
In addition to leveraging health IT and EHRs for better care coordination, the researchers also acknowledged the philosophical aspect of integrated healthcare. Bringing behavioral health into the primary care setting will require a considerable cultural shift, respondents said, and healthcare organization leaders should be ready to implement those changes.
For example, organization leaders will need to appoint smaller team leaders who believe in the integrated care mission and will be able to direct other care providers.
“Adaptive leaders support their team, rather than direct them,” the researchers explained. “The innovators' messages on identifying leaders at all levels and ensuring all members of the team have an equal voice echo these principles.”
Practices should also focus on building empowered teams that trust one another across different specialties; developing a strong management style that supports integration; creating a standard set of expectations, language, and definitions; and framing care integration as a necessary aspect of delivering quality care to patients.