Incorporating Behavioral Health in the EHR to Improve Care Insitute of Medicine | November 25, 2013...
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Incorporating Behavioral Health in the EHR to Improve Care Insitute of Medicine | November 25, 2013 Brigid McCaw, MD, MS, MPH, FACP Medical Director, Family
Incorporating Behavioral Health in the EHR to Improve Care
Insitute of Medicine | November 25, 2013 Brigid McCaw, MD, MS, MPH,
FACP Medical Director, Family Violence Prevention Program The
Permanente Medical Group
Slide 2
Health Risk Factors 2.0 Behavioral Health is essential to
health Prevention works People recover Treatment is effective
Substance Abuse and Mental Health Services Administration
(SAMHSA)
Slide 3
BIG FOUR for Primary Care Depression Anxiety Disorders
Substance Misuse Family Violence
Slide 4
Identifying Depression and Anxiety Symptoms of depression,
anxiety, and functioning problems combine to yield a Global
Distress Score Adult Outcomes Questionnaire (AOQ) includes PHQ-9,
GAD-2 and functioning items Serves as both screener and progress
monitor Available in paper, on-line, or by secure message Used in
adult medicine, womens health, specialty mental health, and health
education classes
Slide 5
Adult Outcomes Questionnaire (AOQ)
Slide 6
Transition in Quality Measures: From Process to Outcome
Slide 7
Screening, Brief Intervention, and Referral to Treatment
(SBIRT) Alcohol as a Vital Sign Began June 2013. All adult primary
care patients ( 18 y.o.) now screened annually with evidence-based
screener. Physicians provide brief advice or referral to Chemical
Dependency treatment as appropriate.
Slide 8
Alcohol Screening: prompt in EHR Logic: Will appear once a year
(or at six months if prior positive screening ). The first question
is gender & age specific.
Slide 9
Sensitivity/ Specificity at detecting Unhealthy Use: 82% / 79%
Smith, 2009, J Gen Intern Med NIAAA, 2005 Helping Patients Who
Drink Too Much Alcohol Screening Questions
Slide 10
Alcohol SBIRT Workflow *Vinson, 2007
Slide 11
BIG FOUR for Primary Care Depression Anxiety Disorders
Substance Misuse Family Violence
Slide 12
Comparison to Other Life-Threatening Conditions Affecting Women
New cases of breast cancer [2] 211,000 Number of women dying from
cardiovascular disease [3] 484,000 Women who are injured from IPV
[4] 2,000,000 In the US, each year
Slide 13
IPV screening and counseling should be core part of womens
health services Womens Preventive Health Care Services Committee
Universal screening for childbearing-age women recommended
Slide 14
The KP Systems-Model Approach Inquiry and Referral Supportive
Environment Leadership and Oversight On-site Services Community
Linkages Making the right thing easier to do
Slide 15
8-fold Increase in IPV Identification Largely in primary care
and mental health departments Members Diagnosed with Intimate
Partner Violence, 2000-2013 1022 8090 { { Emergency Dept. &
Urgent Care Mental Health Primary Care
Slide 16
Improving IPV Inquiry Reminders embedded in Progress Note
Slide 17
Improving IPV Documentation, Intervention & Referral Smart
phrases (clinic note with essential elements) Smart set (includes
note, orders, referral, followup) Danger/lethality assessment
questionnaire Care Pathway for ED, primary care and MH Facility
specific referral protocol Intranet resource site: abuse and
assault website
Slide 18
Abuse and Assault Site Connected to EHR
Slide 19
Online Training Tools for Clinicians
Slide 20
BH in Primary Care Must Address Clinician AND Patient Concerns
The doctor: How do I ask about BH issues? What do I do when the
answer is yes? The patient: If I disclose, what will happen ? How
will this benefit my health?
Slide 21
Documentation of BH Issues in EHR Concerns: safety, privacy,
stigma, visibility, discrimination Benefits: Facilitates
coordination of care Prompts for follow-up and ongoing intervention
Allows other clinicians to reinforce intervention Allows other
clinicians to better understand what may underlie current medical
conditions and adherence Safety Normalizing, removes stigma
Slide 22
What BH issues need to be next? What should that look like?
Integrated BH screening tool that has branched logic and is
interactive Provides information for clinician and to patient
Adverse Childhood Experiences Adult Abuse and Trauma
Slide 23
Contact Information Brigid McCaw, MD, MS, MPH, FACP Medical
Director, Family Violence Prevention Program The Permanente Medical
Group [email protected] 510-987-2035