Mind the Gap: Closing the Digital Divide to Improve Behavioral Healthcare

It is estimated that one in four Americans suffers from a diagnosable mental health disorder each year. Although we have come a long way in eliminating behavioral healthcare, patients still face many barriers to getting the treatment they need.

The unfortunate truth is that behavioral health providers are often not equipped with the digital tools they need to support their patients. Beyond the incentives that came with the HITECH Act of 2009 (such as Meaningful Use EHRs), these organizations often lack the funding for the advanced interoperability framework that is becoming the foundation of our nation's care continuum.

The pitfalls created by this technology gap span everything from continuity of care and outcomes to patient experience. In this article, we demonstrate its profound impact by tracing the experiences of a hypothetical patient, Jeremy Smith. Through his struggle, we will identify three key areas where closing the digital divide between acute and behavioral health facilities can create more favorable, value-based outcomes.

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As a pre-diabetic who was also diagnosed with chronic obstructive pulmonary disease (COPD), Jeremy visited his primary care physician (PCP) regularly. Through routine check-ups, it became clear that he was facing mental health challenges and needed immediate support.

Based on Jeremy's assessment of depression, substance abuse, and anxiety, the PCP will make a referral to a behavioral health facility in town for psychiatric evaluation and treatment. The PCP then moves on to the next appointment.

Unfortunately, behavioral health agencies are located in underserved areas without strong referral intake interoperability systems. Jeremy's referrals were buried in the daily grind of paperwork and patient needs, with no one proactively scheduling appointments. Without treatment, Jeremy's anxiety-fueled substance abuse may continue and he may become more depressed.

For many mental health patients, that’s the end of the story. Depending on the care setting and referral location, the rate at which patients complete mental health referrals may be as low as 7% and as high as 63%. Even in the best-case scenario, nearly one-third of patients will miss out on potentially life-saving care if the referral loop is not closed. But let's assume Jeremy followed up on his own and the appointment was scheduled.

Intake, Record and Care

Once Jeremy arrived at the behavioral health facility, another problem arose. Unable to transmit Jeremy's patient records digitally, the PCP was forced to fax hundreds of pages to an outdated paper fax machine, leaving overburdened healthcare providers with the difficult task of combing through the information to find content relevant to Jeremy's mental health needs.

Lacking the time and resources to complete this task, the provider was forced to rely primarily on Jeremy's admission forms. Despite Jeremy's best efforts, he was unable to list new medications that his PCP had prescribed for his insomnia in the past. The behavioral health provider ordered another set of unnecessary screenings and then prescribed a selective serotonin reuptake inhibitor (SSRI) that, unbeknownst to the prescribing provider, was a duplication of therapy with the sleep medication he was already taking.

Fortunately, his symptoms are not life-threatening, although over time it can be debilitating. Jeremy reported his symptoms to his behavioral health team. The provider will change his medication several times until he finds the one that works best. Like other behavioral health organizations that have historically lagged behind in electronic medical record adoption, the agency still uses homegrown solutions and manual processes to capture patient information. The reaction was documented in his file but not included in the electronic medical record.

continuity of care

Soon, Jeremy moved to another state to pursue new job opportunities. His previous PCP successfully transferred his records to the new provider, who had almost immediate access to Jeremy's history and current physical health. Although Jeremy authorized his information to be sent from the behavioral health agency, the unstructured information was not integrated into his electronic record, leaving his providers without a complete picture of his treatment.

When Jeremy mentioned his mental health history and current SSRI (need to be added soon), his PCP referred him to another facility for screening and ongoing treatment. The test was repeated again and a new less effective prescription was given due to missing medication history. Jeremy's mental health declined, resulting in him becoming less active and exercising, exacerbating his COPD and pre-diabetes.

Even with the best providers dedicated to improving his health, the current system would fail due to a lack of technology and interoperability.

Bridging the gap – what the journey should look like

There is a widespread lack of digital tools in behavioral health facilities, resulting in huge gaps in care. If these organizations had improved data sharing and interoperability, the story might be very different:

Jeremy's primary care physician (PCP) identified a need for mental health care. The PCP sends the referral to the behavioral health agency, which contacts Jeremy immediately upon receipt of the referral. Before Jeremy's appointment, the mental health provider reviews his patient records using tools that automatically extract the most critical information, such as medications, allergies, and test and screening results. With more up-to-date information, providers can avoid repeat testing and prescribe the best treatment faster.

When Jeremy moves, his behavioral health provider will fax his paper records to his new PCP. The PCP then used artificial intelligence to extract key data from Jeremy's faxed mental health records, turn it into actionable insights, and automatically add it to the patient record in his EHR. When Jeremy saw his new behavioral health provider, they were more informed, could continue optimal treatment, and Jeremy successfully managed his mental and physical health symptoms.

make this a reality

While work is underway at the community and state levels to improve digital support for behavioral health facilities, the most obvious solution right now is to use current technology to improve existing tools.

For example, consider whether a behavioral health provider relies on more than just paper faxes. Cloud-based digital fax solutions can digitize records and make them easier to view. New advances in artificial intelligence can read faxes and extract the most important information, inserting it directly into any electronic medical record and significantly improving interoperability.

As our country continues to emphasize mental health and its role in value-based care, taking steps like this to close the digital divide is a critical step in advancing care coordination, outcomes, and value.

Photo: phototechno, Getty Images

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