Decision Support Is in Its Infancy: Some Obstacles Remain to Wider Adoption of This Technology in Behavioral Healthcare
Hagland, Mark, Behavioral Healthcare
The core function of electronic health records (EHRs) is to preserve data about patients and their care. To complement EHRs and maximize use of those data, healthcare organizations of all kinds are moving forward in the crucial area of developing and using clinical decision support (CDS) tools.
CDS is a loose term and covers a lot of ground. For behavioral healthcare professionals, the main areas of interest are CDS software programs that can help clinicians perform patient assessments and create treatment plans (thereby automating some functions); look up clinical information; prompt clinicians with alerts, warnings, and advice; document care; and manage medications. Thus, CDS tools have the potential to help busy clinicians improve the quality--and safety--of care.
Candace Cohen, MD, a psychiatrist at the Mendota Mental Health Institute, a state of Wisconsin facility in Madison, was involved in planning a clinical information system for the state of Wisconsin's behavioral healthcare facilities. Although the plans have not yet been implemented, Dr. Cohen's experience helped her crystallize what challenges behavioral health providers will face in developing and using CDS tools.
For example, she cites the need for clinicians to be able to electronically document progress notes but having the ability to limit the amount of "free text" in a record. Free text is unstructured narrative (descriptive writing) as opposed to, for example, electronic checkoff lists. Although free text is a large part of many paper and electronic behavioral health records, software designers would like to cut down on the amount of free text in EHRs in favor of drop-down menus with checkoff lists (such as those familiar to users of Microsoft Windows programs). This allows an electronic system to be structured to offer CDS tools, such as clinical alerts, access to clinical information (knowledge bases) for assistance with treatment planning, and analysis of EHRs on a meta level for quality improvement purposes.
Industry experts agree that only a small percentage of behavioral healthcare professionals are working with CDS tools, and many who do are in hospital-based integrated health systems, which have more experience with EHRs and other electronic applications. Factors for this include the relatively high cost of such tools and behavioral healthcare organizations' small budgets for information technology. Even large community mental health centers have small IT operations compared to the massive hospital-based health systems that typically have EHRs and extensive CDS tools for doctors and nurses. But some behavioral healthcare entities have taken the plunge into CDS technology, and their experiences offer their peers an idea of the challenges and opportunities involved.
Among the fraternity of behavioral healthcare professionals with hands-on experience in implementing CDS systems is Grady Wilkinson. Since 2002, Wilkinson has been president and CEO of Sacred Heart Rehabilitation Center, a behavioral healthcare provider based in Memphis, Michigan, which plans on rolling out a CDS system within the next few months. Previously, Wilkinson was the CEO at Decatur, Illinois-based Heritage Behavioral Health Center, which won the prestigious Davies Award in 2001 for its development of an electronic clinical record. …