Online Program

HIT and the evolution of Primary Care and Behavioral Health Coordination: An organizational study of federally qualified community health centers in Massachusetts

Monday, November 2, 2015 : 10:50 a.m. - 11:10 a.m.

Jenna T. Sirkin, PhD, U.S. Health, Abt Associates, Cambridge, MA
Amity E. Quinn, MA, Heller School for Social Policy and Managment, Institute for Behavioral Health, Brandeis University, Waltham, MA
Deborah W. Garnick, ScD, Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, MA
John D. Halamka, MD, Information Systems, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
Danna Mauch, PhD, US Health, Abt Associates, Cambridge, MA
Cindy P. Thomas, PhD, Heller School for Social Policy and Management, Brandeis University, Waltham, MA
Background: Evidence suggests that coordinated primary care and behavioral health (BH) services improves outcomes. Electronic health records (EHRs) can facilitate coordination, patient management, and communication. Community health centers (CHCs) are at the forefront of EHR implementation and have a history of pioneering coordinated primary and BH care for underserved communities.

Objective: This study evaluated CHC approaches using EHR systems to coordinate primary care and BH services.

Methods: This is a comparative case analysis of four CHCs in Massachusetts, selected as the locus of study because of its advanced EHR implementation among CHCs and statewide health reform efforts. CHCs were purposively selected based on EHR adoption characteristics and on-site BH services. Interviews were conducted with CHC providers and administrators (n=38).

Results: Case study analysis revealed that CHCs with previously integrated BH departments and medical records implemented electronic coordinating systems such as “live” shared care plans, referral features, and internal tasking among providers and care managers.  In CHCs with historically separated BH departments and medical records, coordination challenges were magnified; CHC administrators delayed EHR implementation due to privacy concerns, strategic planning and training constraints, and lack of Meaningful Use financial incentives for BH. Providers at all sites noted significant limitations in usefulness of EHR system tools for documentation of screenings and assessments, patient management, clinical decision support, quality measurement, and external communication.

Discussion/Conclusions: The historical lack of capital investment, siloing of services, low reimbursement for safety-net BH providers, and limited utility of EHRs for managing BH clinical and quality tasks may be contributing to slow rates of diffusion and clinical integration. As most BH providers in CHCs are not eligible for Meaningful Use incentives, expanding the role and capacity of local technical assistance networks and Primary Care Associations will facilitate shared best practices, technical resources, and economies of scale in safety-net settings.

Learning Areas:

Chronic disease management and prevention
Communication and informatics
Social and behavioral sciences

Learning Objectives:
Identify electronic coordinating approaches that community health centers (CHCs) have successfully implemented and are piloting to facilitate behavioral health and primary care coordination. Discuss barriers to implementation and “Meaningful Use” of electronic health records for CHC behavioral health providers and departments. Evaluate policy recommendations for how CHC/regional HIT networks and vendors can facilitate best practices and technical assistance.

Keyword(s): Community Health Centers, Mental Health System

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I designed and implemented this study; I also collected and analyzed the findings that will be presented. My research has focused on the role of technology, delivery system reform, and payment models for improving care coordination in community health centers.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.