Implementation lessons: Adaptation of an electronic behavioral health record for integrated primary care

The American Recovery and Reinvestment Act of 2009 (ARRA) brought considerable attention to the adoption and use of electronic health records (EHR). Many physical and behavioral health care settings are implementing new systems or augmenting existing ones to meet the standards of “Meaningful Use” outlined in ARRA. In Colorado, the Mental Health Center of Denver (MHCD), the Department of Family Medicine at the University of Colorado Denver, and Colorado Access, with funding from the Colorado Health Foundation, are working together to provide integrated physical and mental health care at several MHCD clinics through the Promoting Resources for Integrated Care and Recovery (PRICARe) project. The PRICARe project provides integrated care by placing physical health care providers in a community mental health center. One aspect of the project was adapting MHCD's EHR to meet the needs of a primary care physician. The adaptation yielded a number of successful innovations for integrated care and also highlighted a number of pitfalls and obstacles for efficient integration of services. Issues encountered included: introducing a novel set of billing and documentation standards – those of primary care – to a behavioral healthcare record; and cultural differences between behavioral healthcare and primary care documentation practices. This session covers the approach taken by the PRICARe project in its adaptation, issues addressed and their resolutions, and implications for future integrated care projects.