Intermountain Healthcare in Salt Lake City, Utah, promotes consistent systematic behavioral health integration through its own in-house ambulatory and hospital-based information technology systems. Mental Health Integration (MHI) at Intermountain extends from primary care to specialty care clinics including sleep disorder clinics, diabetes care centers, spine clinics, cardiology clinics, and gynecological services.
Integrated Information Technology Workflow
The information technology systems at Intermountain, including the electronic medical record, health information exchange system, and population registries are all linked. The electronic medical record (EMR) contains a message log function through which the primary care physician, the behavioral health provider, and the care manager can communicate and exchange information easily. The patient can also use the patient portal in the EMR to communicate with care team members for follow up questions or any emergency need.
The workflow at Intermountain incorporates MHI as a standard quality of care. Each clinic has a standard scorecard and process for treating mental health as part of a normal routine visit. There are protocols and algorithms in place by which patients are screened with standardized tools for understanding the complexity of the patient’s concerns and acuity of symptoms. The data is then coded into the electronic medical record and a care plan is developed through provider discussions with the patient. The primary care physician provides about 80 percent of the mental healthcare using clinical protocols and decision aid supports. Care managers and mental health professionals are brought in as needed through either face-to-face communication or the message log of the electronic health record.
Patient responses can be printed from the electronic health record that contains an organized summary of the patient’s self-reported answers to an MHI packet containing over 160 mental physical health validated questions. Results to these questions are recorded into the EMR and used to determine course of treatment and follow up care with the mental health specialist. All information and communication that is stored in the electronic health record is merged into the a data warehouse and supplemented with information from other organization IT systems including patient hospitalizations, emergency visits, patient medications, and chronic disease registries. The registry information is stratified and organized in series of clinical and financial reports that are returned to the care team and clinic administrators creating a continuous information loop.
Achieving Triple Aim Outcomes
Intermountain Healthcare emphasizes five key institutional components that must work together to achieve the MHI Triple Aim Outcomes:
- Leadership and Culture
- Workflow Integration
- Information Systems
- Financing and Operations
- Community Resource Integration
Consistent with the Triple Aim, Intermountain uses information technology to facilitate behavioral health integration through population level data. Patient outcome data is tracked and reported to the providers through the information technology system. Intermountain maintains several chronic disease registries in its data warehouse including a depression registry of around 400,000 patients that is among the largest in the nation and has been used to develop risk assessment models. Intermountain recognizes that there is high comorbidity among patients suffering from chronic diseases and is working to make a more complex patient registry that would track all chronic conditions in one place.
The integrated information systems at Intermountain are also used to advance implementation of new medical and operational knowledge. In order to ensure providers are informed and patients are receiving the best treatment, tools have been developed including staffing models, clinical models, quality indicators, and methodologies for measuring cost and outcome longitudinally.
Intermountain strives to use their information technology system to support the Triple Aim by planning to incorporate population health, cost, satisfaction, and outcomes together in one integrated system. Presently, Intermountain is testing a pilot project of regrouping some of the Triple Aim information into one reporting tool for some of their clinics. For MHI this means defining the population through disease registries and administrative databases, gaining data on quality of care through use of protocols on follow up visits, antidepressant use, and talk therapy, and then tracking patient outcomes. Intermountain also tracks on a yearly basis the budget for MHI at some clinics to gain understanding of the overall costs of care delivery for patients with mental health concerns and link costs to quality metrics for established value added.
Shifting to a New System
Intermountain acknowledges that it is a constant challenge to develop a system that is the most user-friendly for clinicians to access and record information. Intermountain recently purchased a new electronic medical health record system through a private vendor in response to their growing population and ambulatory needs. The clinicians at Intermountain are working with a new system to replace both their hospital and ambulatory-based electronic health record systems. Intermountain is hopeful that directly involving clinicians in the system development process will help to ensure that the new system will meet provider needs.
The new system will incorporate alerts such as alerting providers if they need to do PHQ2 or PHQ9. Intermountain is also planning to add features that will enhance patient engagement such as tracking patient reported outcomes and patient engagement measures at the time of their visit.