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Technology Driving Better Mental Health Outcomes
By Wes Williams, Ph.D., VP and CIO, Mental Health Center of Denver
Colorado has two successful health information exchanges (HIEs): the Quality Health Network on the Western Slope, and CORHIO in the Front Range. Not all Coloradans, however, benefit from their health data flowing through these HIEs to help coordinate their treatment. In Denver, for example, where I am Chief Information Officer at the Mental Health Center of Denver, we cannot yet use CORHIO to exchange health information with our largest partner for primary care services. The Mental Health Center of Denver is a community mental health center providing lifespan clinical services by focusing on strengths and well-being. Denver Health, the nation’s largest federally qualified health clinic, provides primary care services to many of the patients receiving behavioral health services at the Mental Health Center of Denver. The Mental Health Center of Denver joined CORHIO years ago, but because of 42 CFR Part 2, the federal privacy law enacted to lower barriers to entering treatment for substance use disorders, has only been able to receive data from the HIE, not send any through it. Moreover, Denver Health is yet to join CORHIO.
Looking for alternatives to CORHIO for exchanging health information about our shared patients, Mental Health Center of Denver and Denver Health staff partnered with our electronic health record (EHR) vendors, Netsmart Technologies and Epic.
Determining out how to transmit the data between electronic health records was only the beginning of the implementation effort; clinical workflow needs also had to be addressed. When the Mental Health Center of Denver uses Carequality to query Denver Health about a patient, a C-CDA file is sent from Epic to Netsmart. A provider at the Mental Health Center of Denver next needs to review the information with the patient and decide what information, if any, should be imported into the Netsmart EHR. This process is called clinical reconciliation. Clinical reconciliation is one reason health information exchange can lead to better care coordination and clinical outcomes: by knowing what medications other doctors have prescribed, our psychiatrists can avoid prescribing medications that might have interactions with medications prescribed by the primary care physician.
Clinical reconciliation is one reason health information exchange can lead to better care coordination and clinical outcomes
The resistance was no longer the about software, but rather that technology had enabled a process that providers previously had not been able to perform, and therefore had not previously spent any time performing. Where would the extra time come from? Mental Health Center of Denver senior leadership convened with leadership from Netsmart to develop a change management strategy for adopting the new technology. To secure buy-in, we would first present the new clinical reconciliation process to our standards-of-care committee. Next, clinical champions would pilot the new workflow; other psychiatrists, rather than IT staff, would drive adoption.
Technology is a tool that can address many challenges, such as better care coordination in health care. The work of a CIO doesn’t stop with just delivering software. In this example, collaboration with our EHR vendor yielded elegant technology solution, and the partnership extended to the change management work that was necessary to adjust how psychiatrists spent time with patients to enable higher-quality care.