Kennedy Ganti MD Physician Informaticist Cooper Medical Informatics and Care Delivery Innovation Liezel Granada MSN Nursing Informaticist Cooper Medical Informatics and Care Delivery Innovation ID: 780545
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Slide1
Achieving Parity in Healthcare: Integrating Psychiatry into the Healthcare Enterprise
Kennedy
Ganti
, MD
Physician
Informaticist
- Cooper Medical Informatics and Care Delivery Innovation
Liezel
Granada, MSN
Nursing
Informaticist
- Cooper Medical Informatics and Care Delivery Innovation
Frank Aguilar, MD
Chief Resident – Department of Psychiatry
Cooper University Health Care
Slide2Overview
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
platrform
.
History and Barriers of Mental Health Care
Implementation of the EHR in the Psychiatry department
Effects of Implementation through the eyes of a physician champion
Slide3Historical 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
Slide4Population Trends In Behavioral Health
Torrey, E Fuller;
Entsminger
, K et. At “The Shortage of Public Hospital Beds for Mentally Ill Persons” The Treatment Advocacy Center, 2008
Slide5Psychiatric 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 (
Thorazine
) for schizophrenia in 1954 and imipramine (
Tofranil
) in 1958
United for Sight (2012) A Brief History of the US Mental Health System. Last Accessed October 1,2015
Slide6Barriers 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.
THEY
DO NOT MANDATE ALL PLANS TO COVER MENTAL ILLNESS CARE BENEFITS !!
SAMHSA (2015, Jun) “Implementation of the Mental Health Parity
And Addiction Equity Act (MHPAEA
)
http
://
www.samhsa.gov/health-financing/implementation-mental-health-parity-addiction-equity-act
Last Accessed October 1,2015
Slide7Gaps 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 Physicians
Slide8Behavioral 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”
Slide9Extending 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
biopsychosocial
model.
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.
Slide10Implementing the EHR: The power of Nursing Informatics
Slide11Project 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 documentation
Slide12Project 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 operations
Slide13TeamProject Manager
– Manages the project processes to ensure achievement of expected outcome
Epic
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 staff
Slide14Pre-planningChoosing business owners, provider champions, and super usersConfirmation of scope
Abstraction criteria
Setting up weekly project meetings (core team meeting and physician champion meeting)
Slide15PlanningCurrent workflow analysis
Propose future workflow in epic
Design/Development
Testing (Epic Experience and Validation Lab)
Training (clinician/front desk training)
Slide16Project Plan Timeline (Start)
Slide17ExecutionUAT sign offRemind client to reduce schedule
Integrated testing
Technical and Dress Rehearsal
Go live trifold manual
Slide18Go-liveLive support – 10 touch pointsCommand center
Daily status report calls
Slide19MaintenanceHelp Desk
Optimizations – monthly physician champion meeting
Slide20The Psychiatrist Is In.. The EHR !!
Slide21EHR 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 providers
Slide22EHR Benefits in Psychiatry“Clean up” incorrect existing Psychiatric Diagnosis
Ability to closely monitor medication Rx
Find out other providers prescribing controlled substances
Slide23EHR Benefits in PsychiatryUnderstanding patient’s struggles with their medical comorbidities
Obtaining additional Demographic information that can assist in
Biopsychosocial
formulation
Slide24WorkflowCommunication 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 technology
Slide25EHR Integrated Behavioral HealthCollaborative CareAs the Mental Health Consultant
Provide PCP Brief formulation
Preferred diagnosis / diagnostic impression
Clear point by point treatment plan
Med Management
Slide26EHR Integrated Behavioral HealthThe use of Screening ToolsDevelopment and use of registries
Ability to provide complete care
Providing PCPs the further education
on psychopathology and psychopharmacology
Slide27EHR
Slide28Questions/Discussion
Slide29Solicited Solutions
THANK YOU
for attending our presentation!