We are sharing the below as a successful model of advocacy for increased behavioral health functionality in a major electronic health record (EHR) system. This example shows both an impressive level of flexibility and the ability to accommodate provider needs on the part of the EHR vendor, as well as a great example of how providers can be proactive to shape the available technology to meet their needs and to better serve the needs of their clients. This example also describes how to harness health IT to improve outcome-based evaluation capacities in behavioral health settings and how to leverage IT to facilitate enhanced integrated health care.
Overall, an area FQHC has advocated for:
Methods:
Successes:
Additional background:
Adapting to Other Practices:
Overall this example touches on three of the four Greater Houston Behavioral Health Affordable Care Act (BHACA) Initiative focus areas: (1) enhancing and increasing integrated health care, (2) outcome-based evaluation, and (3) electronic health record (EHR) systems.
Overall, an area FQHC has advocated for:
- Ask: To populate the clients’ medical charts with data from behavioral health, including results of behavioral health screens—such as the DAST, PHQ-9, AUDIT, GAD-7 and PCL-5.
Methods:
- Spoke consistently with the same IT contact at the EHR vendor, a senior analyst.
- Sent a help ticket, then went to this EHR vendor and explained the need, specifically re. IHC, in person after hours—provided education on IHC and solidified buy-in from senior analyst at the EHR vendor.
Successes:
- Added a “behavioral health” tab accessible through the main medical record interface.
- Clinician can, for example, select “PHQ-9” or select “AUDIT,” and it tabulates in the patient’s note, tracking data in a flow sheet in the EHR.
- Current capability: “If I gave the PHQ-9 today, and wanted to do it again 2-3 months from now, I would have the date and responses and overall score.”
- Helpful for reporting and research purposes to have this data available from within the EHR.
- Key: Data must be entered into the “flow sheet” option, which enables clinicians to later extract this data. (In contrast to the “questionnaire section,” which does not allow the same extraction of data.)
- Were able to upload three screening tools in 2-3 months: the PHQ-9, the AUDIT, and the DAST.
- Are able to use the results of the screens to provide staff education about the value of the BH screens and the value of tracking these outcomes over time. By using the technology to give feedback on client outcomes, our contact, a behavioral health consultant, provides a better understanding to fellow staff re. why this data is worth entering, thus cementing staff buy-in.
Additional background:
- This EHR apparently already had the PHQ-9 built in, but there was no BH built specifically into the charting system in the EHR.
- The PHQ-9, AUDIT, and DAST were in the Harris Health System previously, so this FQHC was able to pull them from there.
Adapting to Other Practices:
- Try searching for the PHQ-9, AUDIT, and DAST in the flowcharts section of your EHR.
- Submit a help ticket requesting the addition of the above capabilities to your EHR vendor.
Overall this example touches on three of the four Greater Houston Behavioral Health Affordable Care Act (BHACA) Initiative focus areas: (1) enhancing and increasing integrated health care, (2) outcome-based evaluation, and (3) electronic health record (EHR) systems.