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Achieving Parity in Healthcare: Integrating Psychiatry into

Kennedy . Ganti. , MD. Physician . Informaticist. - Cooper Medical Informatics and Care Delivery Innovation. Liezel. Granada, MSN. Nursing . Informaticist. - Cooper Medical Informatics and Care Delivery Innovation.

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Achieving Parity in Healthcare: Integrating Psychiatry into

Presentation on theme: "Achieving Parity in Healthcare: Integrating Psychiatry into"— Presentation transcript:


Achieving Parity in Healthcare: Integrating Psychiatry into the Healthcare Enterprise



, MD



- Cooper Medical Informatics and Care Delivery Innovation


Granada, MSN



- Cooper Medical Informatics and Care Delivery Innovation

Frank Aguilar, MD

Chief Resident – Department of Psychiatry

Cooper University Health CareSlide2


Learning Objectives

Identify the communication and coordination gaps between psychiatry and general medicine

Understand that behavioral health has not been incentivized like general medicine to adopt health IT tools

Learn how the Patient Protection and Affordable Care Act brings parity to behavioral health and medical care

Discover how psychiatry is learning the benefits from using a highly connected HER

Understand the implications of implementing the EHR in Psychiatry towards the goal of integrated behavioral health

Hear how one academic institution in New Jersey is integrating Psychiatry into general medical care under one EHR



History and Barriers of Mental Health Care

Implementation of the EHR in the Psychiatry department

Effects of Implementation through the eyes of a physician championSlide3

Historical Overview of Behavioral Healthcare from 1800- Present

United for Sight (2012) A Brief History of the US Mental Health System. Last Accessed October 1,2015


Video available by contacting presenters directly Slide4

Population Trends In Behavioral Health

Torrey, E Fuller;


, K et. At “The Shortage of Public Hospital Beds for Mentally Ill Persons” The Treatment Advocacy Center, 2008Slide5

Psychiatric Care in the USA: Institutionalization

Institutionalization of the mentally had been the norm from 1840-1955

Increasing reports of squalid conditions drove the deinstitutionalization movement from psychiatric hospitals to community care centers

The advent of Medicaid facilitated the outpatient treatment of the mentally ill starting from the inception of Medicaid in 1965

Deinstitutionalization drove the development of pharmacotherapies such at chlorpromazine (


) for schizophrenia in 1954 and imipramine (


) in 1958

United for Sight (2012) A Brief History of the US Mental Health System. Last Accessed October 1,2015Slide6

Barriers to CareFor ambulatory care, Medicaid recipients have had provisions for psychiatric care

Care for commercially insured patients has been largely lacking

Starting in 1996 did commercial insurers begin to receive mandates on covering psychiatric illness on par with medical illness

The Mental Health Parity and the Mental Health Parity and Addiction Equity Act both mandate increasing regulation on insurance plans to provide equal benefits IF mental health services are offered.



SAMHSA (2015, Jun) “Implementation of the Mental Health Parity

And Addiction Equity Act (MHPAEA





Last Accessed October 1,2015Slide7

Gaps in CarePrimary care physicians treat 2/3 of all patients with major depression and generalized anxiety disorder. Diagnoses like bipolar disorder, schizophrenia are generally handled by psychiatric providers (Psychiatrist and psychiatric Advanced Practice Nurses and Physician Assistants).

Payment for services have often been done as a “carve out”. For many insurers, there is an agreement with a psychiatric benefits manager (Magellan) who manages the benefits and payment of services.

Consequence- rise of Psychiatry as a “cash only” business

No need or obligation for Psychiatrists to communicate with Primary Care PhysiciansSlide8

Behavioral Health and Health ITThe Meaningful Use program has helped partially fund the Health IT revolution in the United States.

Notable areas of care absent are pediatric care and behavioral health care. These areas were not specified in the original HITECH (Health Information Technology for Economic and Clinical Health) provisions

From 2012 to 2014, the Office of the National Coordinator has held two separate roundtable discussions on how to extend Health IT to behavioral health

In 2015, Congressional legislation introduced on how to have “Meaningful Use for Behavioral Health”Slide9

Extending Health IT to Behavioral Health: The Cooper Experience

In order to provide the best care to our patients, we have embraced whole person care in terms of the



The Department of Psychiatric at Cooper University Health Care is a significantly grant funded department embracing progressive models of whole person care.

The Department requested and were strong participants in the EHR transformation process

This is the first step in developing integrated behavior health care.Slide10

Implementing the EHR: The power of Nursing InformaticsSlide11

Project GoalsImplement Epic Ambulatory EHR for Specialty in support of:

Meaningful use

Improved clinical outcomes

One patient chart across Cooper practices and hospital

Improve patient safety by maintaining current patient problem list, medications and allergies

100% electronic physician documentationSlide12

Project ObjectivesTransition from paper records to EHRCreation of Epic workflows to support the specialty’s processes

Install infrastructure

Provide training for all staff

Provide support for clinicians and staff during the change

Minimize Impact on patient care and office operationsSlide13

TeamProject Manager

– Manages the project processes to ensure achievement of expected outcome


Team Lead

– Schedule and facilitate clinical build work sessions, provides Epic technical leadership and expertise, develops Epic design solutions, oversees team work effort

Informatics Lead

– Liaison between the clinicians and Epic build team, schedules and facilitates current work flow and process improvement sessions, validates test scenarios

Epic Builder

– Experienced Epic builder 100% committed to project, documents workflows, completes build

FC Team

–TES Front desk implementation, schedule and charge interface planning, testing and activation

Infrastructure Lead

– Responsible for equipping sites for Epic

Training Lead

– Develop and deliver specialty specific training

Go-Live support

– on site at specialty during the initial implementation of Epic to help clinicians and staffSlide14

Pre-planningChoosing business owners, provider champions, and super usersConfirmation of scope

Abstraction criteria

Setting up weekly project meetings (core team meeting and physician champion meeting)Slide15

PlanningCurrent workflow analysis

Propose future workflow in epic


Testing (Epic Experience and Validation Lab)

Training (clinician/front desk training)Slide16

Project Plan Timeline (Start)Slide17

ExecutionUAT sign offRemind client to reduce schedule

Integrated testing

Technical and Dress Rehearsal

Go live trifold manualSlide18

Go-liveLive support – 10 touch pointsCommand center

Daily status report callsSlide19


Help Desk

Optimizations – monthly physician champion meetingSlide20

The Psychiatrist Is In.. The EHR !!Slide21

EHR Benefits in PsychiatryAbility to read and understand the context as to why a patient was referred to Psychiatry

Lab work and Imaging accessible

Direct communication with other providersSlide22

EHR Benefits in Psychiatry“Clean up” incorrect existing Psychiatric Diagnosis

Ability to closely monitor medication Rx

Find out other providers prescribing controlled substancesSlide23

EHR Benefits in PsychiatryUnderstanding patient’s struggles with their medical comorbidities

Obtaining additional Demographic information that can assist in



WorkflowCommunication with staff

Decreased phone time

Using EPIC with the addition of MA has been very helpful

Most challenging aspect of incorporating EHR in an ambulatory Psychiatry setting is transitioning Providers

Especially challenging in Psychiatry

Using a computer during Patient Encounters has not been common practice historically for Psychiatry compared to other specialties

Continues to be a work in progress in acclimating providers to new technologySlide25

EHR Integrated Behavioral HealthCollaborative CareAs the Mental Health Consultant

Provide PCP Brief formulation

Preferred diagnosis / diagnostic impression

Clear point by point treatment plan

Med ManagementSlide26

EHR Integrated Behavioral HealthThe use of Screening ToolsDevelopment and use of registries

Ability to provide complete care

Providing PCPs the further education

on psychopathology and psychopharmacologySlide27

EHR Slide28


Solicited Solutions


for attending our presentation!