Connecting behavioral health and primary care requires going beyond simple collocation and collaboration. Integration often requires infrastructure change. Health care reforms in the past 5 years, including the Affordable Care Act of 2010, have called for increased use of electronic health records (EHRs)1. Central to the success of integrated efforts is the ability for providers to utilize EHRs and electronic Personal Health Records (ePHRs) in ways that are consistent with privacy and sharing regulations and health information exchange (HIE) guidelines.
- The EHR is a secure, HIPAA-compliant, point-of-care information resource for healthcare providers that serves to store patients’ healthcare data for direct clinical care and/or research and improve team-based care.
- Effective design and delivery of EHR can serve to improve provider communication and team-based care.
- The ePHR is a “universally accessible, layperson comprehensible, lifelong tool for managing relevant health information, promoting health maintenance and assisting with chronic disease management via an interactive, common data set of electronic health information and e-health tools2."
- An example of this may be a secure message center to facilitate electronic patient-provider communication.
- One goal of the ePHRs is to improve patient engagement in his or her health care in an effort to improve health outcomes3.
- Privacy and sharing regulations include HIPAA guidelines to protect patient rights regarding who has access to an individual's health care information.
- HIE guidelines represent a united effort to develop standardized names for elements related to the electronic exchange of health care information to reduce confusion among providers and consumers.
Combining these elements to develop effective Health IT systems within integrated primary care is a challenge and research efforts continue to find better ways to improve health care delivery and provider and patient communication and satisfaction.
Some of the primary current challenges include the following:
- EHR and ePHR systems continue to be costly;
- Concerns related to training and transitioning to new systems4; and
- Records of the respective fields are frequently kept in separate locations, which is promulgated by current training, education, and policymaking trends
While the literature suggests there is an inseparable relationship between behavioral health and physical health, this evidence has yet to translate into getting considerable support from within the larger health care policy, planning, and delivery systems. For the integration field to move forward, more research to support more effective health IT systems is needed.
 Glasgow RE, Kaplan RM, Ockene JK, et al. Patient-reported measures of psychosocial issues and health behavior should be added to electronic health records. Health Aff (Millwood) 2012;31(3):497-504.
 HIMSS Personal Health Records: Definition and Position Statement. Healthcare Information and Management Systems Society (HIMSS). http://himss.files.cms-plus.com/HIMSSorg/Content/files/PHRDefinition071707.pdf. Accessed August 20, 2013.