August 26, 2022
4 minute read
Al-Maskari is founder and CEO of Health Information Management Systems.
It seems trivial to invoke the mind-body connection, but if the concept is so obvious, why are psychiatry and primary care still separate islands of health care?
Walk into any integrated health care facility and it is more likely to have one reception area, one floor, one behavioral health wing and staff, and a separate location for primary care. It’s not integration. The dividing line is even clearer at the level of information technology. From the perspective of the electronic health record, a psychiatric patient may be an entirely different person from their primary care provider.
Lack of records creates a high risk of miscommunication and fragmented care. Primary care providers, in their fleeting encounters with patients, tend to know little or nothing about their patient’s behavioral health profile. And they have very little time to be informed. In addition to suboptimal care, the information deficit can have serious consequences such as adverse drug interactions, addiction-related complications, misdiagnoses, and untargeted counseling.
Psychological conditions can affect the body and medical conditions can affect the mind. Maybe depression is to blame for a patient’s lack of energy, or anxiety is what’s really robbing them of sleep. Conversely, primary care diagnoses can have great implications for the psyche. Chronic back pain can fuel addiction. New diagnoses can trigger panic attacks. The price of miscommunication and missed information is well documented: One in 10 deaths in the United States is now due to medical error, according to a study by Johns Hopkins Medicine, and nearly two in three of those errors are rooted in poor communication within a health facility. team, according to the Institute for Healthcare Communication.
Sometimes miscommunications simply waste time and money, such as when a PCP and a psychiatrist order the same blood panel, and a cash-strapped patient is forced to pay for it twice. The social determinants of health are also relevant here: social conditions like poverty clearly affect the mind, which also affects the body.
For years, policy makers have recommended and encouraged a more comprehensive integration of behavioral health and primary care, but the culture of health care has resisted it. If the culture of healthcare cannot change on its own, perhaps technology should lead the transformation. This is why I propose a new type of DSE, with these qualities:
A holistic view of the patient. Clinicians, case managers, and support staff on both sides of the divide between behavioral health and traditional medicine should see an encapsulated patient summary at the start of every patient encounter, regardless of the device they want to use. This synopsis would include relevant medical and psychiatric diagnoses, medications, lab results, providers, appointments, population categories, and social determinants of health.
Filtration. No provider, case manager, or staff member needs to see every data point. The system of record must therefore be configurable to provide personalized views of the information that each individual needs for their role. The same folder should incorporate data from all relevant applications so that busy clinicians do not waste time navigating through different software (with different connections) for information on planning, treatment notes, prescriptions, referrals , etc. Clinicians already feel they are burning out on administrative tasks and not spending enough time healing.
Mobile app. Americans spend an average of 4 hours or more a day looking at their smartphone, and the device is within reach for the remaining 19 or 20 hours. Healthcare professionals are no exception. According to a HIMSS Analytics study, 80% of senior managers, IT professionals, clinicians and healthcare managers already use tablets, and 43% use smartphones to deliver and coordinate care.
It’s a place where the data should be.
Social style integration. Integrated patient records should work like social media apps, which ensure that the most relevant content is front and center on any device a user is likely to use, including smartphones, tablets, laptops and desktop computers. Social apps also ensure that content is easily accessible through all communication apps a person is likely to use, including email, instant messaging, EHRs, patient portals, internal video conferencing, and telehealth.
Speech Recognition. If you can voice command your phone to call a friend or your smart speaker to forecast the weather, clinicians should be able to speak, rather than type, information into systems that manage appointments, orders , lab reports, treatment plan updates, prescriptions, visits. checks and more.
Artificial Iintelligence. The embedded DSE must continually learn what you want it to do. Built-in artificial intelligence capabilities can anticipate what you’re about to say in your notes or structured data fields. It can offer increasingly accurate predictive text, whether you use your keyboard or your voice to update patient information.
Self-service for patients. If a provider wishes, it should be easy to invite patients into a personalized section of the shared EHR environment (with appropriate security), giving them integrated access to scheduling, health records, renewals prescriptions, lab results, notes, clinicians and educational materials. . Even basic patient engagement can be cost-effective, reducing, for example, the need for administrative assistants to phone patients with appointment reminders.
Behavioral and physical health are integrated in every human being, so these two aspects of healthcare, including the technology that underpins them, must also be integrated. Although culture will not change on its own, we have seen smart technology change culture and our world. Let’s improve the EHR to reflect reality. It means affirming the mind-body connection in all respects for the benefit of providers, payers, patients and society.
Institute for Health Communication. Impact of communication in health care. https://healthcarecomm.org/about-us/impact-of-communication-in-healthcare/. Published July 2011. Accessed August 19, 2022.
Johns Hopkins Medicine. Study suggests medical errors are now the third leading cause of death in the United States https://www.hopkinsmedicine.org/news/media/releases/study_suggests_medical_errors_now_third_leading_cause_of_death_in_the_us. Published May 3, 2016. Accessed August 19, 2022.
For more information:
Khalid Al-Maskari is founder and CEO of Health Information Management Systems, a Tucson, Arizona-based company that designs EHR software to transform the integrated healthcare experience.