Mar 22 2021

‘Care Should Be Integrated’: Best Practices for Linking Mental Health in EHRs

A recent report offers five recommendations on how to integrate behavioral health into primary care in electronic health record systems.

A successful integrated healthcare model requires the inclusion of both medical and behavioral health factors in determining a person’s overall health.

A report from the ECRI, a nonprofit organization dedicated to healthcare quality and safety, crafted in partnership with the Electronic Health Record Association, recommends five steps healthcare organizations should take to integrate behavioral health into primary care in electronic health record systems. Here’s what it lays out:

  1. Make sure behavioral health screening tools are integrated and accessible in the EHR.
  2. Put triggers in place that can set off medical support that integrates behavioral health and primary care.
  3. Make documentation better to help link behavioral health and primary care.
  4. Ensure secure and collaborative information sharing.
  5. Set up EHRs so that patient information sharing is consistent with regulations, policies and patient requests.

The first step calls for the integration and availability of validated, clinically accepted behavioral health screening tools in the EHR.

Tasneem Doctor, vice president of behavioral health at Equality Health, says these include the Patient Health Questionnaire-9 screening for depression and the General Anxiety Disorder-7 screening for anxiety, which are clinically validated screening tools that can be integrated into the EHR.

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“The EHR should notify staff members, including providers and support staff, when a mental health screening is due,” Doctor says. “It’s also important to identify key staff who will input results in the EHR.”

The Importance of Integration

The second recommendation concerns triggers for clinical decision support associated with behavioral health and primary care screening tools.

KLAS analyst Jon Christensen notes one best practice would be a “break-glass” feature within a health information exchange (HIE) or electronic medical record that allows for a physician or caregiver in a place such as the emergency department to access certain behavioral/mental health information in an emergency situation.

“For example, if a patient is admitted to the ED and is unconscious and clearly having a medical episode, the provider could see that there was mental health information available but walled off,” Christensen says.

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He notes that in order to implement such a program, a supporting IT team has to be able to track and audit who is accessing such information, how frequently and why.

In light of the third recommendation, which suggests that organizations optimize documentation to support integration of behavioral health and primary care, Doctor notes that it’s important that the EHR should alert providers when screening results indicate a positive result that necessitates further treatment or referral to a behavioral health specialist.

How to Make Collaboration Part of the Process

In order to enable information sharing across care environments and with patient portals, secure messaging and HIEs — the report’s fourth key recommendation — eVisit CTO and co-founder Miles Romney advises fluid integration between telehealth platforms and systems of record.

“It’s important to consider how both interact with ‘front door’ experiences and third-party services like lab ordering, coding and e-RX, as well as interfacing with HIEs and referral engines,” he says.

Most important, he adds, is that patients should be seeing providers who are connected to their long-term health and wellness and integrated with the holistic care teams.

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“They shouldn’t be seeking care from call centers a thousand miles away,” Romney says. “Care should be integrated, and it should be local.”

Finally, the ECRI/EHRA report also recommends enabling EHRs to segment patient information for exchange consistent with organizational policies, patient requests, and state and federal laws and regulations.

Best practices in this area, Doctor says, include making positive results of screenings available to the patient in the patient portal, similar to a lab result.

“The portal should also include referral details such as the name, number, location and appointment date of the behavioral health provider when a referral is made,” Doctor says.

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