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Leverage Technology for Integrated Behavioral Health

Digital health tools and technologies are revolutionizing healthcare, including integrated behavioral health settings.1 Digital health encompasses a range of categories, including health information technology (IT), telehealth and telemedicine, mobile health (mHealth), and wearable devices. Digital health tools and technology can support key functions of integrated behavioral health including, screening and assessment, treatment, patient management and monitoring, continuing care, patient education, provider collaboration, and patient engagement. A practice or system's digital health infrastructure serves as the foundational backbone for establishing and implementing the standardized and streamlined operational systems, efficient workflows, evidence-based protocols, and measurement-based care essential for effective integrated behavioral health.2-4 To promote the proper use of technology infrastructure, you will need to set aside resources for engaging and training staff, provider, and patients and address any technical issues or barriers to access.4

The practice has integrated digital health tools and technology to seamlessly support the daily functions of integrated behavioral health.

Integrated care is built upon the seamless exchange of information between primary care, mental health, and substance use providers and patients, so successful integration requires a strategic approach to leveraging health information technology (IT)—use of computer hardware, software, or infrastructure to record, store, protect, and retrieve clinical, administrative, or financial information. The ability of these different information systems to access, exchange, and use data in a coordinated manner (defined as interoperability) is essential.3

To get started:

  1. Assess interoperability and integration capabilities: Work with your IT staff or external provider to thoroughly assess the underlying architecture and current interoperability capabilities of your existing electronic health systems, telehealth platforms, and other relevant HIT systems. Clearly articulate the types of data sharing (e.g., assessment results, treatment plans, medication lists, progress notes) and workflow integration (e.g., shared care plans, referral tracking, co-visit documentation) you will need, so your IT staff can translate those requirements into technical specifications.
  2. Collaborate on vendor evaluation: When considering new systems or upgrades, involve your IT staff or external provider in the evaluation process. Their expertise is crucial for assessing vendors' adherence to interoperability standards and understanding the technical aspects of their integration capabilities, particularly behavioral health integration.
  3. Explore application programming interfaces (APIs): Your IT staff or external provider can help you investigate the availability and quality of APIs for both existing and potential systems. Their technical understanding is vital for determining the feasibility and security of data exchange between disparate systems, including electronic health records, screening tools, patient portals, and telehealth platforms. APIs can automate data transfer, minimizing the need for manual data entry and the potential for errors.
  4. Evaluate middleware options: Consult with your IT staff or external provider to determine if middleware or interface engines are necessary and feasible solutions for bridging gaps between less interoperable systems. They can assess the technical requirements, costs, and maintenance involved.
  5. Establish routine testing protocols: Work with your IT staff or external provider to establish routine testing procedures to proactively ensure that data exchange between different systems is functioning correctly and securely. This proactive approach allows for the early identification and resolution of interoperability issues before they can negatively impact patient care.

Health Information Exchanges (HIEs) are organizations or networks that facilitate the secure electronic exchange of clinical information among different healthcare providers and organizations. HIEs help allow primary care providers to access relevant information from emergency departments, inpatient hospitals, and behavioral health providers (with patient consent and adhering to privacy regulations) and vice versa. HIEs can facilitate the sharing of progress notes, medication changes, and other relevant information, allowing all members of the care team to stay informed and monitor the patient's status, progress, and outcomes effectively.5

To get started:

  1. Identify and actively participate in regional, state, or national HIEs that align with your patient population and care delivery partners.
  2. Be sure to understand the data sharing agreements, security protocols, and available services offered by these HIEs.

How Others Are Doing It

In the rural North Central Valley region of California, various providers, including primary care, specialists, hospitals, and county behavioral health services, worked with SacValley MedShare, a regional HIE, to securely and efficiently share patient health information. Membership in the HIE provided access to real-time data like medications, allergies, labs, and diagnoses across different settings. Its infrastructure enabled behavioral health providers to seamlessly access and contribute to a patient's comprehensive medical record, fostering a more integrated and informed approach to care. Learn more about SacValley MedShare's health information exchange.

Arkansas's Office of Health Information Technology (OHIT) is actively engaging behavioral health and primary care providers in their statewide HIE, the State Health Alliance for Records Exchange (SHARE) to improve healthcare delivery and outcomes. OHIT has onboarded behavioral health providers, particularly Medicaid providers, by increasing their access to SHARE's clinical portal and direct secure messaging. This participation allows behavioral health providers to access a more comprehensive view of their patients' medical history and securely exchange data, such as referral information and care summaries, with primary care providers. OHIT is working to develop integrated interfaces with popular behavioral health EHR vendors that will enable bidirectional exchange. OHIT field staff work closely with organizations joining SHARE to assess their workflows, develop use cases for exchange, and integrate SHARE services into their routine processes.

The EHR serves as the central nervous system for integrated behavioral health, housing critical patient information and facilitating essential workflows. Optimizing its functionality is paramount to achieving seamless care coordination and improved patient outcomes. This goes beyond simply digitizing paper charts; it involves strategically configuring and utilizing the EHR to specifically support the unique needs of integrated care delivery.

To get started:

  1. Standardize data fields and templates for behavioral health information: You can implement standardized data fields and templates within the EHR specifically designed for capturing key behavioral health information alongside physical health data. This includes structured fields for mental health or substance use assessments, treatment goals, progress notes, and shared care plans. Consistent data entry facilitates easier data retrieval, analysis, and sharing.
  2. Customize workflows to seamlessly support integrated care: You can embed screening tools for mental health, substance use, and health-related social needs; create specific encounter types for collaborative visits; develop shared care plan templates; and integrate referral management.
  3. Leverage secure messaging and communication tools for team-based care: These tools facilitate HIPAA-compliant direct communication between primary care and behavioral health providers within the same organization or connected through HIEs, enabling timely consultations, collaborative care planning, and efficient information sharing.
  4. Configure alerts and reminders to support integrated care protocols: You can configure clinical decision support rules to create reminders for behavioral health screenings during primary care visits, prompts for shared care plan reviews, or alerts regarding medication interactions between physical and behavioral health prescriptions.
  5. Utilize reporting capabilities to track key metrics related to integrated care: You can configure tailored, automated reports that can track screening, referrals, and patient visits to identify and follow up on gaps in care and the impact on patient outcomes. These reports are essential for informing quality improvement initiatives and optimizing your integrated care approach.

Patient portals provide patients with secure access to medical records, facilitate communication between patients and their primary care and behavioral health providers, and enable appointment scheduling and medication refills. Whether the portal is built into the EHR or a standalone application that interoperates with the EHR, you can optimize its functionality to support integrated behavioral health and patient-centered care.6

To get started:

  1. Expand appointment management to behavioral health providers: Allow patients to schedule, reschedule, and cancel appointments with both their primary care and behavioral health providers through the portal, improving access and reducing administrative burden.
  2. Integrate Patient-Reported Outcome Measures (PROMs): Administer standardized behavioral health assessments at regular intervals or before appointments. Where appropriate, provide patients with feedback on their scores and the ability to track their progress, thereby fostering greater engagement in their care. The care team can then regularly review PROMs, which facilitates measurement-based care and supports more informed treatment decisions.
  3. Provide access to behavioral health resources and social supports: You can integrate links and access to relevant psychoeducational materials, self-management tools, support groups, and community-based behavioral health resources within the portal.

Telehealth, the delivery of healthcare services remotely using technology, has become an increasingly vital component of integrated behavioral health. Telehealth technologies include hardware (e.g., telephones, smartphones, tablets, computers, kiosks, wearables, and patient monitoring and biometric and diagnostic testing devices) and software (e.g., short messaging service (SMS) texting programs, computer programs, online platforms, and mobile applications).7 Telehealth enables healthcare providers to collaborate and provide medical care without being physically present in the same location as patients, increasing access to behavioral health services and recovery supports, especially for patients who live in remote areas, have mobility issues, or are unable to travel to traditional healthcare settings.

Telehealth has generally demonstrated high feasibility and acceptability among providers, adult patients, and pediatric patients and their families,8-12 and produces patient outcomes are comparable to those achieved through in-person care for mental health disorders.13-17 Specifically, telehealth is comparable to in-person care for anxiety,18 depression,19 posttraumatic stress disorder,20 and other common mental health disorders21 in adult populations. In pediatric populations, telehealth is comparable to in-person care for anxiety (including obsessive-compulsive disorder and trauma),22 depression, and other common mental health conditions.15,18,23 For substance use among adolescent and adult populations, the evidence for feasibility, acceptability, and effectiveness of telehealth compared to in-person care is promising, particularly for alcohol and tobacco use, but requires additional research for tobacco/nicotine and other illicit drug use.17,24-27 There is a strong evidence base supporting the effectiveness of telehealth for remote monitoring, communication, and counseling for chronic conditions,28 as well as the delivery of psychotherapy,28 acute psychiatric care,29-32 and various types of medical consultations.33

Mobile health (mHealth) specifically focuses on the use of mobile-based solutions to deliver health services, including the burgeoning field of behavioral health apps for smartphones and tablets. These apps offer a diverse range of functionalities, supporting self-assessment, symptom tracking, psychoeducation, medication reminders, and even delivering evidence-based digital therapeutic interventions. However, the majority of the apps that are currently available lack clinically validated evidence of their efficacy.34

The available research suggests high feasibility and acceptability among behavioral health app users,35 and suggests promise for reducing symptoms of depression and anxiety,36-38 managing PTSD, and supporting adults with substance use disorders, especially smoking,36 among adolescents and adults. For substance use among adolescent and adult populations, the evidence for feasibility, acceptability, and effectiveness of behavioral health apps compared to in-person care is promising, but require further research.23,39,40 These apps may, but do not always,41 leverage evidence-based therapeutic interventions like Cognitive Behavioral Therapy, Acceptance and Commitment Therapy, and Behavioral Activation and deliver them in an accessible and convenient format.42 They also show promise as adjuncts to traditional therapy, enhancing engagement and providing ongoing support, and in some cases, as standalone interventions, particularly for milder forms of mental illness.43 Furthermore, the ability of these apps to facilitate self-monitoring, provide psychoeducation, and offer peer support networks contributes to improved patient outcomes and increased self-efficacy in managing their behavioral health.

How Others Are Doing It

Atrium Health successfully integrated behavioral health into 36 of its primary care and pediatric sites using a virtual platform. Their team-based model leverages video consultations and telephonic outreach to connect behavioral health professionals, including therapists, psychiatrists, and health coaches, with primary care physicians and their patients. This virtual integration aimed to improve early detection, initiate cost-effective treatment, and proactively reach patients. The outcomes demonstrated significant reductions in depression, anxiety, suicidal thoughts, avoidable inpatient care, and emergency department visits, alongside improved patient satisfaction and efficient use of behavioral health staff. Learn more about Atrium Health's virtual behavioral health integration program.

Located on a remote island in Washington State, PeaceHealth Peace Island Medical Center successfully implemented a telepsychiatry program to overcome the lack of local psychiatric services. By partnering with University of Washington psychiatrists, they established weekly virtual consultations accessible within their primary care clinic. This telehealth approach dramatically improved access for island residents, eliminating the need for lengthy and challenging travel to the mainland and reducing appointment wait times from months to days. The program integrates behavioral assessments by a social worker within the primary care setting, with collaborative care plans involving the primary care provider, social worker, psychiatrist, and patient, all documented in a shared EHR for care continuity. Read more about PeaceHealth Peace Island Medical Center's Telepsychiatry Program.

Useful Resource(s) for Expanding Use of Telehealth and mHealth

While EHRs provide a foundation for data reporting, you can enhance these capabilities with add-on modules or external tools to achieve more advanced analytics. With these more robust data analytics capabilities, your practice or system can identify trends in patient populations, measure the effectiveness of different treatment approaches, understand the impact of integrated care on key outcomes, and pinpoint areas for operational improvement.44

To get started, work with your IT staff or external provider to:

  1. Create a patient registry: Patient registries enable the systematic collection and organization of data for specific patient populations receiving integrated care (e.g., patients with co-occurring diabetes and depression). These registries facilitate proactive care management (identifying and addressing gaps in care), track progress against treatment goals, support quality improvement initiatives, and enable more effective follow-up.
  2. Design a dashboard: Dashboards can serve as a critical visual interface for understanding the complex data generated within an integrated behavioral health setting. These dynamic tools aggregate key performance indicators (KPIs) from your EHR and registry and present them in an easily digestible format, allowing behavioral health and primary care providers, administrators, and quality improvement teams to quickly assess the current state of the integration.

The wealth of data generated within an integrated care setting holds immense potential for continuous quality improvement and population health management. Implementing registries and dashboards is often an iterative process. You can start with simpler versions and then refine and expand them as your understanding of your data and your analytical needs grows.

How Others Are Doing It

Intermountain Healthcare in Salt Lake City, Utah established a linked system encompassing their EMR, health information exchange, and population registries. The EMR facilitates seamless communication between primary care physicians, behavioral health providers, and care managers via a message log, and patients can engage through a portal. Standardized screening tools are integrated into the workflow, with results coded into the EMR to inform care plans. Notably, the EHR allows for printing patient-reported outcome summaries and feeds into a data warehouse that combines clinical and financial data, generating reports for continuous quality improvement. Intermountain's new EHR system emphasizes user-friendliness and aims to incorporate alerts for screenings and enhanced patient engagement features, further optimizing the technology for integrated care delivery. Learn more about Intermountain's EHR optimization and advanced data analytics and reporting.

Artificial intelligence (AI) is increasingly integrated into existing digital health tools and technologies to enhance integrated behavioral health in pediatric and adult primary care settings. EHRs are incorporating AI for risk stratification and predictive analytics in identifying patients needing behavioral health support,45,46 while patient portals utilize AI-powered chatbots for patient support and resource navigation.47,48 AI-driven screening and assessment tools are also being embedded within these platforms.49 Additionally, standalone behavioral health apps and digital therapeutics leverage AI algorithms to personalize interventions, track user progress, and provide tailored support.50 While these advancements are promising and can impact physician decision-making,51 they can be accompanied ethical challenges, including potential breaches of privacy and bias.52,53

Integration is supported by documentation in a common medical record. Documentation by the behavioral health provider should be brief and focused on the information needed by the medical provider, such as:

  • What is the diagnosis, and is it different from what the medical provider thought?
  • What type of treatment will be provided?
  • Is the patient engaged in treatment? If not, what are the obstacles and what should the care team watch out for?
  • Is treatment helping? If not, what adjustments might be needed?
  • What, if any, treatment or coordination of care is needed from the medical provider?

Understanding privacy and confidentiality regulations related to behavioral health treatment in medical settings is an essential aspect of documentation. Behavioral health care involves specific restrictions on how patient information is handled. In general, however, if the patient understands and agrees to the sharing of information, it is okay to do so. Here are some tips on how to approach privacy and confidentiality in your integrated setting:

  • Revise general patient consent and authorization forms to incorporate information about the sharing of behavioral health information among providers and other members of the care team. This will make it clear that communication and information-sharing among members of the care team, including the behavioral health provider, are routine in the practice.
  • Psychotherapy process notes are a specific type of documentation that requires additional protection. These records rarely need to be shared with the rest of the team. File these notes separately, with special processes in place for team members to gain access.
  • Information about substance use disorder treatment also has special protection, but only when generated by substance abuse treatment facilities and programs that receive Federal assistance. Substance use disorder treatment information in primary care or other medical settings can be shared like other types of personal health information in the medical record.

Useful Resource(s) for documentation in an electronic health record system

Useful Resource(s) for privacy and confidentiality

Telehealth and Behavioral Health Integration

This Topic Brief aims to provide practical information and resources for using telehealth technologies to implement patient-centered integrated behavioral health care in primary and ambulatory care practices, including those related to substance use.
Format
Report/Paper/Issue Brief
Audience
Medical Providers
Behavioral Health Providers
Other Team Members
Source
Agency of Healthcare Quality and Research (AHRQ) Integration Academy
Year
Resource Type
Web Page

Potential Usefulness of Apps and Other Digital Technologies for Improving Access to Behavioral Health in Primary Care

This Topic Brief provides an overview of the state of the evidence for behavioral health apps and key considerations and concerns related to finding, evaluating, and selecting smartphone and Internet-based behavioral health apps to recommend or prescribe in primary care and integrated care settings.
Format
Report/Paper/Issue Brief
Audience
Medical Providers
Behavioral Health Providers
Other Team Members
Source
Agency of Healthcare Quality and Research (AHRQ) Integration Academy
Year
Resource Type
Web Page

AMA Telehealth Implementation Playbook

Outlines steps and best practices when implementing telehealth strategies to promote adoption of new technology by healthcare organizations

Format
Guide
Audience
Behavioral Health Providers
Medical Providers
Organizational Leadership
Other Team Members
Policymakers and Payers
Source
American Medical Association
Year
Resource Type
PDF
File Size
9.9 MB

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