Mind The Gaps: Closing the Digital Divide to Improve Behavioral Healthcare

An estimated one in four Americans suffers from a diagnosable mental health disorder every year. Though we’ve come a long way in destigmatizing behavioral healthcare, patients face many barriers to getting the treatment they need. 

The unfortunate truth is that often, behavioral health providers are not equipped with the digital tools they need to support their patients. Excluded from incentives that accompanied the HITECH act of 2009, such as Meaningful Use EHRs, these organizations commonly lack funding for the advanced interoperability framework that is becoming foundational to our country’s care continuum. 

The shortfalls that accompany this technology gap touch everything from continuity of care and outcomes to the patient experience. In this article, we demonstrate the far-reaching impact by following the journey of a hypothetical patient — Jeremy Smith. Through his struggles, we’ll identify three key areas where closing the digital divide between acute and behavioral health facilities can create a more favorable, value-based result. 

Referrals

As a pre-diabetic also diagnosed with chronic obstructive pulmonary disorder (COPD), Jeremy is seen regularly by his primary care physician (PCP). Through routine screenings, it becomes clear that he is having mental health challenges and needs immediate support. 

Based on Jeremy’s assessment for depression, substance abuse, and anxiety disorder, the PCP sends a referral to a behavioral health facility across town for psychiatric evaluation and treatment. The PCP then moves on to the next appointment.

Unfortunately, the behavioral health facility, located in an underserved area, does not have a strong referral intake interoperability system. Jeremy’s referral gets lost in the daily shuffle of paperwork and patient needs, and no one reaches out to schedule an appointment. Without treatment, Jeremy’s substance abuse, triggered by anxiety, will likely continue, and he will become more depressed. 

For many mental health patients, the story ends there. Depending on the care setting and where they are referred, patient completion for mental health referrals can range as low as 7% and up to 63%. Even in the best-case scenario, almost a third of patients will miss out on potentially life-saving care if the referral loop isn’t closed. But let’s assume that Jeremy follows up on his own, and the appointment is scheduled.

Intake, documentation and care

Once Jeremy reaches the behavioral health facility, another problem surfaces. Without a way to digitally transfer Jeremy’s patient records, the PCP is limited to faxing several hundreds of pages to an antiquated paper fax machine, leaving over-burdened providers with the painstaking task of combing through information to find what is relevant for Jeremy’s mental health needs. 

Lacking time and resources for this task, the provider is forced to rely mostly on Jeremy’s intake forms. Though he’s done his best, Jeremy failed to list the new medication his PCP prescribed in the past for his insomnia. The behavioral health provider orders another set of unnecessary screenings and then prescribes a selective serotonin reuptake inhibitor (SSRI) that, unbeknownst to the prescribing provider, is a duplicate therapy to the medication he is already taking for sleep.

Fortunately, his symptoms aren’t life-threatening, although over time it can be debilitating. Jeremy reports his symptoms to his behavioral health team. The provider changes his medication a few times until they find what works best. This facility, like other behavioral health organizations that historically lag in EHR adoption, still uses home-grown solutions and manual processes to capture patient information. The reaction is noted in his file, but not integrated into an EHR.

Care continuity

Soon, Jeremy moves to another state for a new job opportunity. His previous PCP successfully transfers his records to a new provider, who gains almost immediate access to Jeremy’s history and current physical health. Though Jeremy authorizes his information to be sent from the behavioral health facility, the unstructured information is not integrated into his electronic record, giving his provider an incomplete overview of his treatment.

When Jeremy mentions his mental health history and current SSRI (which needs to be refilled soon), his PCP refers him to another facility for screening and ongoing treatment. Once again, tests are duplicated, and a new, less-effective prescription is prescribed due to a missing medication history. Jeremy’s mental health declines, leading to a lapse in his activity and exercise, exacerbating his COPD and pre-diabetes. 

Even with the best providers working to improve his health, the current system fails due to lack of technology and interoperability. 

Closing the gaps — what the journey should look like 

The systemic lack of digital tools in behavioral health facilities results in massive gaps in care. If these organizations improved data sharing and interoperability, this story could go much differently:

Jeremy’s PCP uncovers a need for mental health care. The PCP sends a referral to a behavioral health facility, which receives it and reaches out to Jeremy immediately. Before Jeremy’s appointment, the mental health provider reviews his patient record, using tools that automatically pull the most critical information like medications, allergies, and test and screening results. Armed with more up-to-date information, the provider avoids duplicate testing and can more quickly prescribe the best treatment. 

When Jeremy moves, his behavioral health provider faxes his paper records to his new PCP. The PCP then utilizes AI to extract critical data from Jeremy’s faxed mental health records, transforming it into actionable insights that are automatically added to his patient record in the EHR. When Jeremy sees a new behavioral health provider, they are more informed, can continue optimal treatment, and Jeremy successfully manages his mental AND physical health symptoms.

Making this a reality

While there is work being done 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 advance existing tools.

Consider, for instance, if the behavioral health provider didn’t solely rely on paper-based fax. A cloud-based digital fax solution can digitize records and make them easier to review. New advancements in AI can read the fax and pull out the most important information, plugging it right into any EHR and dramatically improving interoperability. 

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

Photo: phototechno, Getty Images

Bevey Miner serves as Global Health IT Strategy/Chief Marketing Officer, Consensus Cloud Solutions, Inc. With over 20 years’ experience in healthcare technology and digital health, she has been instrumental in leading strategy, product management, business development, marketing and commercialization. Bevey has been influential leading innovation in care coordination, patient engagement, population health and interoperability as well as advocating for policy change with federal and state government.

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