Arun Gupta
The proliferation of electronic medical records (EMRs) has left much to be desired. Though designed with care improvement and data exchange in mind, the necessary connective tissue layer is absent. Healthcare providers are still resorting to the phone and fax to communicate, and patients are still carrying their personal health information from one appointment to the next, or relying on memory.
But I’m optimistic that the next era of healthcare innovation is coming — the app layer that rides on top of EMRs. Despite the public perception that EMRs prefer to remain “closed,” some have shown that they can play well with third-party solutions. Athenahealth, for one, has been at the forefront of integrating with outside apps, even going so far as to build a marketplace of third-party solutions to offer provider partners.
In the same way that apps have transformed an iPhone into a taxi-summoning, heart-monitoring, grocery-delivering instrument, the app layer that sits on top of the EMR has the potential to give back providers control over their workflow, improve information sharing and create a more organized, seamless patient experience. But what is perhaps the most important benefit of this connected health technology? Medical collaboration.
Collaboration amongst providers is critical in all aspects of medicine, but nowhere is this more true than in behavioral health (mental health and substance use disorders), where the costs of poor collaboration are sky-high. The reason is that behavioral health conditions and physical health conditions very often go hand in hand.
A recent study found that people with asthma are nearly two and a half times more likely to screen positive for depression.¹ Another study found that individuals with type 1 or 2 diabetes were twice as likely to suffer from a major depressive disorder in their lifetime.²
There is a mountain of evidence to suggest that a bidirectional relationship exists between many behavioral and physical health conditions — medical disorders often lead to mental disorders, and mental health conditions may place someone at risk for medical disorders.
On average, chronically ill patients with a concomitant behavioral health condition hit the healthcare system significantly more, running up bills 50–175 percent higher than similarly ill patients without a behavioral health condition.³ That’s bad for patients, and bad for our healthcare system. Additionally, nearly half of the major cases of depression in our country go untreated today, and even when discovered and addressed — most often in the primary care setting — results are mixed, at best.
On the bright side, our analysis indicates that patients who receive treatment from a behavioral health provider actually end up with lower overall total cost of care.4 Additionally, Milliman estimates there is a $162 billion total annual value opportunity that stands to be realized through the integration of medical and behavioral health services in the commercial market.5 The key takeaway? As an industry, it’s time for a technology intervention that drives closed-loop collaboration.
Patients seeking care in the mental health arena have historically run into an expensive, cumbersome and stigmatized system, but new innovations in telemedicine are changing that dynamic. One telemedicine organization that is leading the charge with its browser-based telepsychiatry platform is 1DocWay.
Requiring only a webcam and Internet connection, patients are able to access the platform and connect with mental healthcare providers on their own terms, and in the setting most comfortable to them. And for those patients in underserved or rural communities, a lack of access to care is often the first barrier and blockade to receiving treatment.
Additionally, from the provider perspective, the payoff of technology integration is worth it. As Mark Binkley, general counsel at the South Carolina Department of Mental Health, recently detailed to US News, many patients in the ER will be admitted and held until an in-person psychiatric consultation can be delivered.
Ask any ER physician — this is a huge problem. To remedy this issue, South Carolina began deploying virtual psychiatry visits and consults in real-time, with promising results. To date, there have been 22,000 consults, and participating hospitals have yielded roughly $1,400 of savings per patient episode. And, often times, patient satisfaction with telemedicine is even higher than with in-person visits.
Another advancement in behavioral healthcare technology is the tools — smartphone apps, wearable devices and online support communities — a patient can use for self-managing behavioral health and chronic physical health conditions. Cognitive Behavioral Therapy (CBT) is one such treatment traditionally administered in face-to-face therapy sessions that has been successfully computerized in recent years by companies like myStrength.
CBT teaches techniques for recognizing and restructuring negative thoughts and behaviors, and is highly effective in combating depression, anxiety and insomnia. Many patients who are deterred from seeking traditional in-person treatment due to stigma or geography have been drawn to therapies like online CBT, and many insurance companies have begun to embrace the treatment.
Some companies have even figured out how to use the smartphone as a sensor to better detect behavior changes that can tell us a lot about one’s mental state. Ginger.io gathers information on movement, texting and call patterns — collected in the background on a patient’s phone — and has been able to recognize when certain behaviors might indicate risk of developing mental health disorders.
For example, if an individual is exhibiting more isolative interaction patterns and has stayed home from work for multiple days in a row, then the company might determine this patient is at risk for depression and trigger an intervention to determine the appropriate course of action for treatment.
Behavioral health providers are also finding technology relief with the advent of market-specific electronic health record (EHRs) systems. Because behavioral health institutions have very different workflows than those of their primary care counterparts, traditional EHR vendors have historically not been adept at meeting the needs of this subset of caregivers. This has driven companies like Qualifacts to develop behavioral health-specific EHR solutions, a game changer in mental health delivery and care coordination.
Simply put, the shift toward value-based care means healthcare stakeholders can no longer afford to not collaborate. From telehealth solutions to mobile apps to EHRs, behavioral health technologies are making those connections possible.
With core systems in place and incentives steadily changing, technology can be a potent catalyst to reorganizing how we work for patients. The time for collaborative behavioral health and chronic care management is now. The livelihood of our patients, and our organizations, literally depends on it.
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