Applying User Input to the Design and Testing of an Electronic Behavioral Health Information System for Wraparound Care Coordination

Abstract

Health information technology (HIT) and care coordination for individuals with complex needs are high priorities for quality improvement in health care. However, there is little empirical guidance about how best to design electronic health record systems and related technologies to facilitate implementation of care coordination models in behavioral health, or how best to apply user input to the design and testing process. In this paper, we describe an iterative development process that incorporated user/stakeholder perspectives at multiple points and resulted in an electronic behavioral health information system (EBHIS) specific to the wraparound care coordination model for youth with serious emotional and behavioral disorders. First, we review foundational HIT research on how EBHIS can enhance efficiency and outcomes of wraparound that was used to inform development. After describing the rationale for and functions of a prototype EBHIS for wraparound, we describe methods and results for a series of six small studies that informed system development across four phases of effort -predevelopment, development, initial user testing, and commercialization -and discuss how these results informed system design and refinement. Finally, we present next steps, challenges to dissemination, and guidance for others aiming to develop specialized behavioral health HIT. The research team's experiences reinforce the opportunity presented by EBHIS to improve care coordination for populations with complex needs, while also pointing to a litany of barriers and challenges to be overcome to implement such technologies.Among the approximately 15 million young people with mental health conditions, children and adolescents with serious emotional and behavioral disorders (SEBD) are at the greatest risk for negative health and functioning outcomes, including school dropout, drug and alcohol abuse, incarceration, and unemployment (Perou et al., 2013). These youth also consume a disproportionate share of the nation's overall children's mental health care resource. Of $10 billion expended annually by Medicaid on mental health services for Correspondence regarding this submission should be addressed to Eric J. Bruns, University of Washington, Department of Psychiatry and Behavioral Sciences, 2815 Eastlake Ave E, Suite 200, Seattle, WA, 98102; ebruns@uw.edu.. HHS Public Access Author Manuscript Author Manuscript Author ManuscriptAuthor Manuscript children and adolescents, $6 billion goes to treating the 10% of youth with the most serious and complex needs (Pires, Grimes, Allen, Gilmer, & Mahadevan, 2013). A large proportion of these expenses are accounted for by inpatient, residential, and other out-of-home treatment options that may be unnecessary when effective and intensive service options are available in the community (Cooper et al., 2008;Stroul & Friedman, 1996) Tolan & Dodge, 2005) As early as 2003, the Institute of Medicine formally recognized care coordination as a priority area for quality improvement in health care (Institu...

Designing Health Information Technologies for Uptake: Development and Implementation of Measurement Feedback Systems in Mental Health Service Delivery

“…This collection of articles reflects projects in which new technologies or capabilities were developed (e.g., Bruns, Hyde, Sather, Hook, & Lyon, this issue; Steinfeld et al, this issue) as well as examples of adapting existing technologies to meet local needs (e.g., Lyon, Wasse et al, this issue; Nadeem, Cappella, Holland, Coccaro, & Crisonino, this issue). In addition, the articles present process (e.g., Bruns et al, this issue; Gleacher et al, this issue; Lyon, Wasse et al, this issue; Nadeem et al, this issue;) and outcome (e.g., Bickman et al, this issue; Gleacher et al, this issue; Steinfeld et al, this issue) data from MFS development and implementation efforts that reflect the full range of success; from the decommissioning of the Contextualized Feedback System due to ongoing technological and cost issues (Bickman et al, this issue), to moderate uptake of the Team Management System WrapLogic (Bruns et al, this issue), and to 90% penetration of a the mental health progress monitoring tool embedded within the electronic health record at Group Health Cooperative (Steinfeld et al, this issue). …”

“…Specifically, Bruns et al (this issue) describe their user-centered design informed process of developing an electronic behavioral health information system (EBHIS) to support Wraparound care coordination for youth. They detail the core functions of electronic health records, acknowledging the critical importance of integrating measurement-feedback and care coordination functions into the existing (required) infrastructure and workflow.…”

“…They detail the core functions of electronic health records, acknowledging the critical importance of integrating measurement-feedback and care coordination functions into the existing (required) infrastructure and workflow. Bruns et al (this issue) break down their process into replicable phases (e.g., literature review, input from the field, development, etc.) and put forth a theory of impact as it pertains to Wraparound-specific EBHIS.…”

Digital technology and clinical decision making in depression treatment: Current findings and future opportunities

“…Utilizing implementation strategies (e.g., stakeholder engagement) throughout the process of developing and testing these technologies will likely facilitate more successful downstream implementation (Bruns et al, 2016). …”

“…When integrated with provider-facing tools, such patient-facing tools have the potential to extend and streamline care coordination (Bauer, Thielke, Katon, Unützer, & Areán, 2014) by granting a central portal for accessing and modifying information on depression symptoms and treatment. Patients and providers are generally receptive toward tools that streamline integrated care, and most primary care patients are comfortable with sharing this information with healthcare provider teams via smartphone applications (Bauer, Iles-Shih, Ghomi, Grover, & Monsell, 2016; Bauer et al, in press; Bruns, Hyde, Sather, Hook, & Lyon, 2016). Technologies that support communication with treatment providers outside of clinical sessions may promote patient engagement by helping patients feel connected and cared for by providers, even if communications are limited to standardized questionnaires to supplement brief or infrequent clinical visits.…”