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Why Electronic Health Records are Important to Behavioral Health Providers
Jon Glover, LCSW discusses electronic health records and why they are important.
Featuring:
Jon Glover, LCSW
Jon Glover is a Licensed Clinical Social Worker (LCSW) with a Substance Abuse Specialty Authorization. He practiced psychotherapy for both mental health and substance use populations in both outpatient and partial hospitalization treatment programs for 30 years prior to joining MetaStar in 2016. The last 17 years of his practice being with the University of Wisconsin Department of Psychiatry. He now works as a Behavioral Health Project Specialist at MetaStar to assist in projects that are focused on improving behavioral health across the state. Transcription:
Prakash Chandran: Metistar Health IT Radio is a podcast series that features consulting content experts and covers topics regarding the Wisconsin Medicaid EHR Incentive Program, promoting interoperability formerly meaningful use as well as behavioral health technical assistance initiative. Episodes covered will guide your practice clinic, hospital or hospital system through the complex Federal or State requirements of the promoting interoperability programs. Metistar has helped more than 2000 providers attest to promoting interoperability as Wisconsin's Regional Extension Center since 2010 and continues to provide attestation assistance and audit preparation. As a consulting service, we are joined by John Glover, a Licensed Clinical Social Worker and Behavioral Health Project Specialist at Metistar, where he assists with projects focused on improving behavioral health across Wisconsin. Today, he sharing with us information about why electronic health records are important for behavioral health providers. This is Health IT Radio, the podcast from Metistar. I'm Prakash Chandran. So first of all, John, who exactly are we talking about when we use the term behavioral health providers in this context?
John Glover: Yeah, well, behavioral health has traditionally sort of been broken down into two different categories, mental health and substance use. And to some extent these categories exist in the literature today, but there's an ongoing effort to transition those terminologies to one terminology, which is behavioral health. One of the reasons for the transition is that there's a lot of overlap that results in comorbidities between mental health and substance use conditions. And we really need to try to treat both at the same time. So behavioral health is an effort to recognize all of the clinicians that treat both of these types of issues. And they can include doctors, nurses, psychologists we have Masters prepared, therapists and counselors, there's bachelor's level and certificate level clinicians. And then we wouldn't want to forget the recovery coaches and community health workers that provide a lot of care for patients in between appointments.
Host: Absolutely. So why exactly is it so important for a behavioral health provider or a clinic to get involved in implementing an electronic health record? Especially right now?
John Glover: Yeah, this is important because for quite a while there's been a ongoing effort in the medical field be a meaningful use and now called promoting interoperability to use information technology, to improve patient care. One of the ways they do this is using EHR to facilitate the exchange of patient information between different providers providing care for the same patient. So when you do this, what happens is you get a much improved patient outcomes. Now at the same time in the behavioral health field, there've been efforts to integrate behavioral health into regular medical care. And we have decades of research that shows the impact of psychological and emotional states on our health and medical conditions. So for this integration of care to continue, our behavioral health providers are going to need EHRs that will help them coordinate care with other medical providers. And I might mention, you know, these efforts, aren't just about integrating with other providers. They also help behavioral health clinicians improve in their own work. A lot of times, things like measurement based care, tracking treatment progress, and how it comes or trying to improve the patient's engagement in their own care can all be helped through a good EHR.
Host: Got it. So you just mentioned measurement based care, and I'd love for you to tell us a little bit more about this and maybe give an example of how behavioral health providers might use it.
John Glover: Sure. Measurement based care involves the use of validated behavioral health tools, surveys, questionnaires. An example might be the PHQ9, which measures symptoms of depression or the GAD7, which helps us measure anxiety. Both of these can screen for the presence of symptoms and monitor treatment progress. So an EHR can actually be used to facilitate the use of these tools by capturing and monitoring the symptoms and then building those tools into the EHR, so that they can be used by the patient or the provider prior to sessions or during a session to get additional information about how treatment is going. EHR can also provide an alert for the provider to let them know that it's time to check on their condition and the symptoms to see how things are going. And then a really neat part of what an EHR can provide is, it can also provide a graph of the results over time so that you can see what's working, what's not working, that type of thing. And so this helps treatment remain really focused and it helps us adjust care more quickly based on what these graphs are showing us. So it helps both the provider and the patient better understand and focus on the treatment that they're trying to engage in.
Host: Yeah, it sounds incredible. And I think you may have just touched upon this a little bit, but you also said outcomes tracking could also benefit behavioral health providers. Maybe just talk a little bit more about this and how it can help improve patient care.
John Glover: Yeah. Outcomes tracking is really closely related to measurement based care because we're monitoring patients care, tracking the outcomes, and trying to identify effective and useful approaches to address symptoms. So one example that we were just talking about is using the EHR to graph the patient's progress and responses to care. So this is routinely done in medical situations, right? Blood pressures, A1C values, cholesterol, we'd actually be surprised if a medical provider didn't use some sort of measure like this to track how things were going. And then in behavioral health though, we don't have those kinds of objective measures. So we are relying on these surveys and questionnaires and tools, which involved the patients report to us. But when we track these symptoms, using these tools in the same way that a medical provider might track blood pressure or something like that, then we can create better clinical decision support tools for ourselves. And this is something specific to EHRs, that guide the provider and providing the best type of care. So when we create these tools and integrate them into the EHR, the provider can access them. We can update them, improve them over time. And ultimately the provider has access to the most up to date recommendations for the kind of treatment they're trying to provide to the patient.
Host: That makes so much sense to me, the ability to track those reported outcomes over time, and the ability to kind of obviously recognize patterns and improve the level of care. So obviously for this to work, it seems very important for the patient to be involved in the care. And I think you called this patient engagement. Can you talk a little bit more about, you know, health IT and how it can help patients become more involved in their own care?
John Glover: Sure. This is a really important area. We've been working on it for a long time, different ways, but the EHR is sort of a new way that we're exploring to improve patient engagement. And one of the ways, you know, that we can do this is just through what we were talking about with measurement based care. So there's actually some research that shows that when patients engage in the practice of measurement based care, responding to these surveys over time, they become more educated about their condition and their symptoms, and it improves their ability to identify any difficulties they're having or improvements they're experiencing. It also helps them communicate better with their provider about this information. So that's a huge piece and I think very important way that patients can become more engaged by getting better educated, but another important tool that EHR brings is the patient portal.
And this provides several different opportunities for patient engagement that are really great. Some organizations use it for the initial paperwork getting the patient to complete intake forms, consents of care releases of information. Even the clinical surveys we've been talking about. All of this can be managed electronically prior to the patient's visit, very helpful. It really helps reduce paperwork and provide a lot of information before the clinical care begins. The patient portal also, this is really important, can allow a patient to schedule or cancel an appointment so they don't have to call or wait on the phone for somebody else to handle it for them. They can just go into the portal. And so, you know, I'm not going to be able to make this appointment today and cancel that, and then they can look for another opportunity to go in and just change that appointment over to a different time.
One of the reasons this is so important is that it obviously helps the patient manage their care more effectively, but it also helps the provider to manage access to care and make sure that there are opportunities for other patients to get in. If someone can't show up for their appointment or needs to cancel it. So that's a really great win, win situation for both patients and providers. But one of my favorite uses, you know, it really is the ability for the patient to leave a secure message. This is something that I've really enjoyed as a clinician myself and it increased my use of patient portals. So a secure message allows the patient to log into the portal. They can either ask a question or provide some information about what's going on, and know that as a provider, I can look at it and respond to it without having to try to find them or wait to talk to them about it later. I can just put a response back into the portal and then together we can review the impact of, you know, that in our next visit together.
So a really powerful way of keeping the patient engaged in their care and moving care along in a real efficient manner. So, yeah, and there's one more thing I wouldn't want to leave out. And that's the recent implementation of telehealth in the behavioral health work. Some EHR portals are already able to provide telehealth services and others are in the process of upgrading to include it because it's been such an advantage for our behavioral health clinicians in the recent months. I think overall the patient portal allows both the patients and the providers to better manage their schedules, maintain consistent treatment, share information without having to wait for face to face encounters to do these things. You know, it's not uncommon for communication with patients to be a challenge in behavioral health. So I think whenever we can provide opportunities for them to interact with us that are easier and more comfortable, then everybody wins.
Host: Yeah, it's truly amazing to see how technology and electronic health records has just pushed the relationship closer between the provider and the patient. And you've mentioned so many wonderful benefits. You know, if our listeners are interested in getting more information, where can they go?
John Glover: Sure. You know, they can go to our website for more information about this topic and access similar resources. That's a Metastar.com/podcast. That's M E T A star.com/podcast.
Prakash Chandran: All right, John. Well, I truly appreciate your time today. That's John Glover, a licensed clinical social worker and behavioral health project specialist at Metistar. Thanks for checking out this episode of Metistar Health IT Radio. For more information on this topic and to access resources mentioned, please visit Metistar.com/podcast. That's M E T A star.com/podcast. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. Thanks. And we'll talk next time.
Prakash Chandran: Metistar Health IT Radio is a podcast series that features consulting content experts and covers topics regarding the Wisconsin Medicaid EHR Incentive Program, promoting interoperability formerly meaningful use as well as behavioral health technical assistance initiative. Episodes covered will guide your practice clinic, hospital or hospital system through the complex Federal or State requirements of the promoting interoperability programs. Metistar has helped more than 2000 providers attest to promoting interoperability as Wisconsin's Regional Extension Center since 2010 and continues to provide attestation assistance and audit preparation. As a consulting service, we are joined by John Glover, a Licensed Clinical Social Worker and Behavioral Health Project Specialist at Metistar, where he assists with projects focused on improving behavioral health across Wisconsin. Today, he sharing with us information about why electronic health records are important for behavioral health providers. This is Health IT Radio, the podcast from Metistar. I'm Prakash Chandran. So first of all, John, who exactly are we talking about when we use the term behavioral health providers in this context?
John Glover: Yeah, well, behavioral health has traditionally sort of been broken down into two different categories, mental health and substance use. And to some extent these categories exist in the literature today, but there's an ongoing effort to transition those terminologies to one terminology, which is behavioral health. One of the reasons for the transition is that there's a lot of overlap that results in comorbidities between mental health and substance use conditions. And we really need to try to treat both at the same time. So behavioral health is an effort to recognize all of the clinicians that treat both of these types of issues. And they can include doctors, nurses, psychologists we have Masters prepared, therapists and counselors, there's bachelor's level and certificate level clinicians. And then we wouldn't want to forget the recovery coaches and community health workers that provide a lot of care for patients in between appointments.
Host: Absolutely. So why exactly is it so important for a behavioral health provider or a clinic to get involved in implementing an electronic health record? Especially right now?
John Glover: Yeah, this is important because for quite a while there's been a ongoing effort in the medical field be a meaningful use and now called promoting interoperability to use information technology, to improve patient care. One of the ways they do this is using EHR to facilitate the exchange of patient information between different providers providing care for the same patient. So when you do this, what happens is you get a much improved patient outcomes. Now at the same time in the behavioral health field, there've been efforts to integrate behavioral health into regular medical care. And we have decades of research that shows the impact of psychological and emotional states on our health and medical conditions. So for this integration of care to continue, our behavioral health providers are going to need EHRs that will help them coordinate care with other medical providers. And I might mention, you know, these efforts, aren't just about integrating with other providers. They also help behavioral health clinicians improve in their own work. A lot of times, things like measurement based care, tracking treatment progress, and how it comes or trying to improve the patient's engagement in their own care can all be helped through a good EHR.
Host: Got it. So you just mentioned measurement based care, and I'd love for you to tell us a little bit more about this and maybe give an example of how behavioral health providers might use it.
John Glover: Sure. Measurement based care involves the use of validated behavioral health tools, surveys, questionnaires. An example might be the PHQ9, which measures symptoms of depression or the GAD7, which helps us measure anxiety. Both of these can screen for the presence of symptoms and monitor treatment progress. So an EHR can actually be used to facilitate the use of these tools by capturing and monitoring the symptoms and then building those tools into the EHR, so that they can be used by the patient or the provider prior to sessions or during a session to get additional information about how treatment is going. EHR can also provide an alert for the provider to let them know that it's time to check on their condition and the symptoms to see how things are going. And then a really neat part of what an EHR can provide is, it can also provide a graph of the results over time so that you can see what's working, what's not working, that type of thing. And so this helps treatment remain really focused and it helps us adjust care more quickly based on what these graphs are showing us. So it helps both the provider and the patient better understand and focus on the treatment that they're trying to engage in.
Host: Yeah, it sounds incredible. And I think you may have just touched upon this a little bit, but you also said outcomes tracking could also benefit behavioral health providers. Maybe just talk a little bit more about this and how it can help improve patient care.
John Glover: Yeah. Outcomes tracking is really closely related to measurement based care because we're monitoring patients care, tracking the outcomes, and trying to identify effective and useful approaches to address symptoms. So one example that we were just talking about is using the EHR to graph the patient's progress and responses to care. So this is routinely done in medical situations, right? Blood pressures, A1C values, cholesterol, we'd actually be surprised if a medical provider didn't use some sort of measure like this to track how things were going. And then in behavioral health though, we don't have those kinds of objective measures. So we are relying on these surveys and questionnaires and tools, which involved the patients report to us. But when we track these symptoms, using these tools in the same way that a medical provider might track blood pressure or something like that, then we can create better clinical decision support tools for ourselves. And this is something specific to EHRs, that guide the provider and providing the best type of care. So when we create these tools and integrate them into the EHR, the provider can access them. We can update them, improve them over time. And ultimately the provider has access to the most up to date recommendations for the kind of treatment they're trying to provide to the patient.
Host: That makes so much sense to me, the ability to track those reported outcomes over time, and the ability to kind of obviously recognize patterns and improve the level of care. So obviously for this to work, it seems very important for the patient to be involved in the care. And I think you called this patient engagement. Can you talk a little bit more about, you know, health IT and how it can help patients become more involved in their own care?
John Glover: Sure. This is a really important area. We've been working on it for a long time, different ways, but the EHR is sort of a new way that we're exploring to improve patient engagement. And one of the ways, you know, that we can do this is just through what we were talking about with measurement based care. So there's actually some research that shows that when patients engage in the practice of measurement based care, responding to these surveys over time, they become more educated about their condition and their symptoms, and it improves their ability to identify any difficulties they're having or improvements they're experiencing. It also helps them communicate better with their provider about this information. So that's a huge piece and I think very important way that patients can become more engaged by getting better educated, but another important tool that EHR brings is the patient portal.
And this provides several different opportunities for patient engagement that are really great. Some organizations use it for the initial paperwork getting the patient to complete intake forms, consents of care releases of information. Even the clinical surveys we've been talking about. All of this can be managed electronically prior to the patient's visit, very helpful. It really helps reduce paperwork and provide a lot of information before the clinical care begins. The patient portal also, this is really important, can allow a patient to schedule or cancel an appointment so they don't have to call or wait on the phone for somebody else to handle it for them. They can just go into the portal. And so, you know, I'm not going to be able to make this appointment today and cancel that, and then they can look for another opportunity to go in and just change that appointment over to a different time.
One of the reasons this is so important is that it obviously helps the patient manage their care more effectively, but it also helps the provider to manage access to care and make sure that there are opportunities for other patients to get in. If someone can't show up for their appointment or needs to cancel it. So that's a really great win, win situation for both patients and providers. But one of my favorite uses, you know, it really is the ability for the patient to leave a secure message. This is something that I've really enjoyed as a clinician myself and it increased my use of patient portals. So a secure message allows the patient to log into the portal. They can either ask a question or provide some information about what's going on, and know that as a provider, I can look at it and respond to it without having to try to find them or wait to talk to them about it later. I can just put a response back into the portal and then together we can review the impact of, you know, that in our next visit together.
So a really powerful way of keeping the patient engaged in their care and moving care along in a real efficient manner. So, yeah, and there's one more thing I wouldn't want to leave out. And that's the recent implementation of telehealth in the behavioral health work. Some EHR portals are already able to provide telehealth services and others are in the process of upgrading to include it because it's been such an advantage for our behavioral health clinicians in the recent months. I think overall the patient portal allows both the patients and the providers to better manage their schedules, maintain consistent treatment, share information without having to wait for face to face encounters to do these things. You know, it's not uncommon for communication with patients to be a challenge in behavioral health. So I think whenever we can provide opportunities for them to interact with us that are easier and more comfortable, then everybody wins.
Host: Yeah, it's truly amazing to see how technology and electronic health records has just pushed the relationship closer between the provider and the patient. And you've mentioned so many wonderful benefits. You know, if our listeners are interested in getting more information, where can they go?
John Glover: Sure. You know, they can go to our website for more information about this topic and access similar resources. That's a Metastar.com/podcast. That's M E T A star.com/podcast.
Prakash Chandran: All right, John. Well, I truly appreciate your time today. That's John Glover, a licensed clinical social worker and behavioral health project specialist at Metistar. Thanks for checking out this episode of Metistar Health IT Radio. For more information on this topic and to access resources mentioned, please visit Metistar.com/podcast. That's M E T A star.com/podcast. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. Thanks. And we'll talk next time.