Lessons learned: Challenges implementing a personal digital assistant (PDA) to assess behavioral health in primary care.

Abstract

Multiple barriers to optimal behavioral health care in primary care settings exist, yet it continues to be the treatment setting of choice for most people with behavioral health conditions. This article describes some of these barriers and how information technology may address them. The authors discuss their experiences implementing a computerized behavioral health assessment in four urban primary care clinics, the lessons they learned that warrant attention before successful implementation is possible, and how they addressed them. Lessons learned were grouped as technology, clinic, patient, and physician challenges. Lack of physician interest and motivation is a critical barrier even if technology offers a lowcost alternative, requires few additional resources, is easy to use, and provides evidence-based diagnostic and treatment information.

Use of technology for care coordination initiatives for patients with mental health issues: a systematic literature review

“…Overall, eight studies identified barriers to coordinated care 18 – 25 ( Table 1 ), and 13 studies 9 , 12 , 16 , 26 – 35 ( Table 2 ) did not specifically mention challenges facing care coordination, five of which 9 , 12 , 18 , 34 , 35 were specifically designed to compare the collaborative care model to CAU ( Table 2 ). Mental health illnesses addressed in the reviewed articles included dementia (n=2), 18 , 27 suicide (n=1), 28 substance abuse (n=4), 22 , 24 , 28 , 31 posttraumatic stress disorder (PTSD; n=2), 32 , 33 schizophrenia (n=1), 32 anxiety (n=1), 35 and depression, the most prevalent mental health condition assessed for collaborative care (n=9).…”

“…The majority of studies used health information technologies to coordinate care among patients and providers, including computer cognitive behavior therapy, 35 agent-based simulation modeling, 16 density mapping technology, 27 telemedicine, 12 , 26 , 32 , 33 and Internet Web-based communication. 9 , 18 , 20 , 24 , 25 EHRs were the most common health information technology used. 12 , 18 , 19 , 21 – 23 , 26 , 29 , 30 A single study used the Aging Brain Care Medical Home model to facilitate care coordination.…”

“…The implementation of coordinated care for mental health continues to face challenges, especially related to cost, usability, and integration of EHRs. Eight studies identified barriers to implementing care coordination ( Table 1 ); 18 – 25 these barriers were related to provider setting (n=7) 18 – 23 , 25 and patient engagement (n=3). 18 , 24 , 25 …”

“… 19 Zeman et al described similar experiences when implementing computerized behavioral health assessment in four primary clinics. 25 Challenges related to technology included determining what type of technology to use for assessments and software version issues between devices. 25 In an Assessment of Behavioral Health Services survey evaluating integrated care, of the 390 health center responses, only one in five (20%) reported joint conferences, and co-management of care between primary and behavioral health staff was reported in only 35% of institutions.…”

Technological adjuncts to enhance current psychotherapy practices: A review

“…Future research may benefit from assessing whether similar results can be achieved when substituting smartphones for PDAs. Researchers have also noted technical difficulties associated with PDA integration, such as PDA crashes, participants forgetting identification codes and passwords, and differing software systems between the devices and linked desktop computers (Yon, Johnson, Harvey-Berino, Gold, & Howard, 2007;Zeman, Johnson, Arfken, Smith, & Opoku, 2006), many of which may be overcome through using smartphones for similar functions.…”