Here’s an interesting and useful analysis by the blog Nursing Informatics & Technology, in which the author outlines steps hospitals can take to put robust psychiatric feature in place in their EMR.
As blogger Nicole Mohiuddin notes, the need to support behavioral health services is acute. After all, many large hospitals offer behavioral health services. And more tellingly, one in eight or almost 12 million ED visits in the U.S. are due to mental health and/or substance abuse problems in adults, according to the Agency for Healthcare Research and Quality.
Currently, EMRs in use fail to address key characteristics of behavioral health care, she writes:
* Most providers are not MDs — they’re usually masters- or doctorate-prepared clinicians licensed to treat behavioral health disorders.
* The diagnostic process is different than other illness, as behavioral health is assessed solely on patient self-report. Tools needed by the clinicians include access to instruments such as the Beck Depression Inventory, Generalized Anxiety Disorder scale, and the DSM IV. These tools should be incorporated into the workflow of a behavioral health EMR, as well as the capacity to develop treatment plans with the patient’s participation.
* Even behavioral health-specific EMRs must be customized to meet state mandates, practitioner requirements and federal privacy rules applicable to behavioral health.
To address these problems, the author made the following suggestions:
- Create a small but specific implementation team that aligns with behavioral health leadership during the build and test period, so all build and testing work is completed in a collaborative manner.
- Build using the most commonly used diagnoses and their DSM IV criteria into the EMR to make it easy for providers and therapists to use drop-down lists to create the diagnostic picture of the patient.
- Build using ASAM criteria, so chemical dependency staffs can more easily complete treatment planning.
- Design within the ‘tighter than HIPAA’ federal constraints that govern confidentiality of patient information for patients receiving chemical dependency treatment (i.e., CFR 42).
- Involve trainers and testers in the workflow discussions
As my colleague John Lynn suggests, there’s good reasons for specialty EMRs to exist, and clearly, behavioral health EMRs are a particularly pointed example. In this case, the question will be whether hospitals are willing to allocate resources to buy, implement and customize departmental EMR instances. It may be a while before they feel they have the time, money and focus to make it happen.