Study finds EHRs can be behavioral health integration barrier

EHR systems present challenges to integrating behavioral health and primary care, according to a study published in the Journal of the American Board of Family Medicine.

The study detailed the EHR experience of eight primary care clinics and three community mental health centers that tried to integrate behavioral health and primary care in a clinical research setting from 2012 to 2014, as part of the Advancing Care Together (ACT) initiative funded by The Colorado Health Foundation. 

The primary care practices used a single EHR while the mental health centers used two different EHRs, one to document behavioral health and one to document primary care data.

The practices experienced common challenges with their EHRs’ capabilities, such as documenting and tracking relevant behavioral health and physical health information and supporting communication and coordination of care among integrated teams. The practices also had difficulty exchanging information between from one EHR to another and from EHR to tablet devices.

But, the practices developed workarounds. The study covered challenges such as double documentation and duplicate data entry, scanning and transporting documents as well as a reliance on patient or clinician recall for inaccessible EHR information and use of freestanding tracking systems.

“As practices gained experience with integration, they began to move beyond workarounds to more permanent HIT solutions, ranging in complexity from customized EHR templates, EHR upgrades and unified EHRs,” according to the authors.

“This work will require financial support and cooperative efforts among clinicians, EHR vendors, practice assistance organizations, regulators, standards setters and workforce educators,” the authors wrote. EHR vendors need to coordinate with clinicians to design EHR products that supported integrated care delivery functions with such tools as template-driven documentation for common behavioral conditions like depression and improved registry functionality and interoperability, they added.