Evaluation of an Electronic Health Record (EHR) Tool for Integrated Behavioral Health in Primary Care

Abstract

Background: Integrating behavioral health into primary care can improve care quality; however, most electronic health records are not designed to meet the needs of integrated teams. We worked with practices and behavioral health (BH) clinicians to design a suite of electronic health record tools to address these needs (“BH e-Suite”). The purpose of this article is to examine whether implementation of the BH e-Suite changes process of care, intermediate clinical outcomes, and patient experiences, and whether its use is acceptable to practice members and BH clinicians. Methods: We conducted a convergent mixed-methods proof-of-concept study, implementing the BH e-Suite across 6 Oregon federally qualified community health centers (“intervention clinics”). We matched intervention clinics to 6 control clinics, based on location and patient panel characteristics, to assess whether process of care (Patient Health Questionnaire-9 [PHQ-9] and Generalized Anxiety Disorder-7 screening) and intermediate outcomes (PHQ-9, Generalized Anxiety Disorder-7 scores) changed postimplementation. Prepost patient surveys were used to assess changes in patient experience. To elucidate factors influencing implementation, we merged quantitative findings with structured observations, surveys, and interviews with practice members. Results: Implementation improved process of care (PHQ-9 screening). During the course of the study, change in intermediate outcomes was not observed. Degree of BH e-Suite implementation varied: 2 clinics fully implemented, 2 partially implemented, and 2 practices did not implement at all. Initial practice conditions (eg, low resistance to change, higher capacity), process characteristics (eg, thoughtful planning), and individual characteristics (eg, high self-efficacy) were related to degree of implementation. Conclusions: Health information technology tools designed for behavioral health integration must fit the needs of clinics for the successful uptake and improvement in patient experiences. Research is needed to further assess the effectiveness of this tool in improving patient outcomes and to optimize broader dissemination of this tool among primary care clinics integrating behavioral health. ( J Am Board Fam Med 2018;31:712–723.)

<p>The role of medical data in efficient patient care delivery: a review</p>

“…The access to accurate and complete clinical information is the main component of effective decision making 69. This is facilitated by decision-support EHR tools - BPAs - and designed for behavioral health integration with the needs of health care institutions and the benefits of improving the patient experiences,36 for instance, alcohol use 30. The system can be used to update the current condition of a patient as input to obtain a corresponding recommendation for medical tests, possible diseases, and treatment plans 69.…”

“…The EHR application improves the process,36 trustworthiness, safety, and efficiency of patient care delivery 29. Hence, implementing standardized policies, processes, and procedures for an appropriate health care data management system that advances the quality of health services and efficiency,34,37 avoids non-value adding activities,34 and ensures major quality and safety improvement 16,17,23,34.…”

User Perspectives on Barriers and Facilitators to the Implementation of Electronic Health Records in Behavioral Hospitals: Qualitative Study

“…A previous study suggested that 3 prominent barriers to the adoption of mental health care EHRs should be considered: complex privacy-related laws and regulations, inadequate financial incentives, and assistance for psychiatric providers [2]. Another study suggested that EHRs designed for mental health care must satisfy the needs of clinicians for the successful uptake of necessary information and improvement in patient experience to disseminate them efficiently [13]. Although a number of studies have evaluated the effectiveness of EHRs, there have been few studies on barriers and facilitators to the adoption of mental health care EHRs from the perspective of mental health clinicians, nurses, pharmacists, and administrative professionals in mental hospitals.…”

Translating Research into Agile Development (TRIAD): Development of Electronic Health Record Tools for Primary Care Settings

“…The TRIAD method led to the development of the BH e-Suite, which was found to be acceptable and easy to use by BHCs in subsequent pilot testing, and improved care delivery. 21 This tool was subsequently adopted by OCHIN Epic for release to OCHIN’s 640 CHCs, suggesting that the TRIAD method is promising as a research and development approach.…”