Deanne Clark, Senior Health Informatics Consultant at DSS, Inc., recently sat down with the Juno Health blog editorial team to share her insights around key electronic health record (EHR) and health IT trends.
In the following Q&A, Deanne shares her insights on current behavioral health challenges, how modern EHR systems can better support the continuum of care, and what the future might hold as the industry works toward a more holistic understanding of wellness.
The following has been edited for length and clarity.
Q: What are the challenges that the behavioral health arena faces today, especially when it comes to legacy EHRs?
Clark: That's a big question! I think that there are many challenges with legacy EHRs. When you get to behavioral health, it sort of adds another layer to that. To me they fall into three groups - capabilities, usability, and technical issues.
Capability-wise, they lack some functionality that's required for behavioral health, in particular anything that's different for behavioral health workflows. These can include treatment plans to group node charting, and being able to manage check-ins for things like seclusion and restraint. Also, for events, supporting programming like treatment models, being able to record those observations quickly, and move on through the day. Those types of capability gaps are not being dealt with.
Additionally, I think these systems fall down because they are designed for billing capture. In behavioral health there can be a billing component, but we're also looking for things like productivity, staff workload capture, being able to know how many people are being seen, and who's seeing whom and where. So being able to fill these gaps is something a next-generation EHR needs to be able to do for behavioral health.
That leads to usability issues, because this lack of capabilities results in the need for workarounds. So, we see people doing all sorts of creative things, trying to rework the system, putting time and resources into making the workflow support the system, rather than the system supporting the workflow, which is how it should be.
We see things like the lack of ability to cover client-specific programs, special checks for eligibility, your program enrollment lacking, being able to manage some of the referral process to see whether someone is able to join that program or not. So, usability suffers as a result of legacy EHR software capability gaps.
And then finally, there's a problem with managing equipment. Oftentimes legacy behavioral health EHRs are on-premises systems. They require lots of IT staff. The agencies depending on them may not have the expertise, or the ability to manage those systems. And EHR systems require equipment and hardware upgrades over time. And then that becomes a security problem as well. So hopefully we'll start to see next-generation EHRs in the cloud being more broadly adopted soon.
Q: Considering those challenges, how does Juno EHR meet behavioral health needs, especially when it comes to state agency?
Clark: One of the ambitions for Juno EHR was to treat the continuum of care, whether a patient or client is an outpatient, and then escalates to inpatient, or whether they're an inpatient initially as a crisis moment for intake, and then they come out and have outpatient care. State agencies often must span the gap between both inpatient and outpatient settings, and they need an EHR that covers all those areas of care without losing the client or the patient's story in the middle. In the industry we call this maintaining the “golden thread.”
So, you need to ensure that treatment plans are moving with the person -- whether they're escalating or de-escalating, whether they're stepping up or stepping down through transitions of care. The Joint Commission and other agencies often find that those are the areas that have patient care data fall through the gaps. We know that we can build those capabilities, or treatment plans for group therapy nodes, and for individual nodes, and maintain that golden thread throughout the care process.
The information moves along seamlessly, and the patient is always first and foremost. We've also built Juno EHR for interoperability. We're built on a framework that is FHIR and USCDI compliant, so we can help agencies communicate with external agencies. People don't exist in a vacuum.
Things happen before and after a patient’s initial touchpoint with a given agency, and that information needs to be available for medical decision-making and safety checks along the way.
This interoperability framework is coupled with Juno’s ability to provide a personalized, customizable solution that is locally managed, rather than going back to the vendor for every configuration change. We think this is a great way to move EHRs forward for behavioral health. It’s something new that people hadn't experienced before that solves many of these problems past and present.
Q: So, what does the future look like when it comes to HIT and behavioral health?
Clark: Well, I wish I had a crystal ball! But I hope the things that I see coming happen in a timeline that works for the people who need it, not only in the future but today.
Expanding the concept of wellness would be ideal. For example, people who are in a prison environment, maybe because they had untreated behavioral health issues, could also be helped by innovation.
To do that, we need data, and we need to provide outcome tracking. Care providers need to know not just billing information, but the types of programs that work, the types of interventions that have an impact. And EHR systems need to work with new data elements like social determinants of health, or SDOH. We need to be able to capture information about each client and put that into context.
No individual is independently formed or exists in a vacuum. We are all products of our environments. We're a product of where we live and socio-economic factors inevitably play a role. Once different kinds of data are available, I think we'll be able to use artificial intelligence and better decision support tools. Once we have the data that looks at someone holistically, we can look at behavioral health as a continuum and a spectrum - from someone who's in a severe crisis to someone who is able to maintain in a community and have the support they need to do so. Care needs to really focus on that wellness and support it with patient data, whether that's data that comes through the treatment plan, outcome tracking, being able to see what's working, and coupling that with new data that we know from demographics.
The industry needs a more holistic understanding of behavioral care. With the right data we can work even down to a zip code, and know things about someone, whether that's their economic outlook, or education background. We can take all that SDOH information and bring it together, and hopefully, bring new models of care into the market, and into our client services. Treatment shouldn’t be just for an acute episode. It should be something that bolsters a person in a customized and continuous way.
Click here to learn more about how Juno EHR for Behavioral Health is designed to support processes around patient safety and data sharing. In addition, please contact the Juno Health team here to learn more about our flexible behavioral health EHR solution.