ECRI Blog

Integrated behavioral health and primary care (integration) has been identified as a promising approach to enhancing patient care delivery, safety and quality. Technology tools, including electronic health records (EHRs), telehealth, clinical decision support (CDS), and standards-based interoperability, can enable integration among various disciplines and improve the delivery to more readily addresses patient needs. Reinforcing these opportunities, virtual care and telehealth have dramatically changed care availability and delivery, especially during the COVID-19 pandemic.

Patient safety remains, as it should, a priority for developers of and providers who use electronic health records (EHRs) and other health IT. For example, ECRI’s Partnership for Health IT Safety has worked with the HIMSS EHR Association on projects on opioids and behavioral health integration. More broadly, providers and developers continue active engagement in the Partnership and other patient safety initiatives.

A Continuing Inside Look into the Partnership Workgroup on Optimizing Health IT for Safe Integration of Behavioral Health and Primary Care

"Integration" of behavioral health and primary care is a promising approach to enhancing care, enabling patient safety and improving quality. Technology-enabled tools, including electronic health records (EHRs), clinical decision support, and standards-based interoperability, can enable integration to achieve these goals.

When technology entered healthcare, so too did alerts. Alerts acted as attention grabbers, reminders, notices of changes in a patient's condition, and warnings about malfunctions or improper functioning. As technology grew more prevalent with the advent of automated dispensing cabinets, computerized provider order entry (CPOE), digital point-of-care monitors and devices, and electronic health records (EHRs), the number of alerts grew exponentially. Clinicians were exposed not only to their own patients' alerts, but to all of the alerts or alarms sounding within a particular unit. The number of per-patient alerts can be astounding. One facility determined that in its critical care unit, "between 150 to 400 physiologic monitoring alarms" sounded per patient, per day.¹ This cacophony is compounded by alerts triggered by electronic records.

An Inside Look into the Current Partnership Workgroup

COVID-19 anxiety is increasingly part of our everyday lives. The resulting disruptions in daily routines can create or worsen anxiety and raise other mental and behavioral health concerns. In the best of times, behavioral health conditions are often underdiagnosed and undertreated. According to Jetelina et al., every year "26% of the United States population experiences an emotional, mental, or behavioral health problem."¹ In addition to the current events triggering these conditions, behavioral health issues can also be associated with chronic medical conditions such as diabetes,² cardiovascular disease, and substance use disorder (SUD).³

The seeds of an adverse drug interaction can be planted at any point in the care process, by any of the individuals involved. For instance, take a look at these common scenarios:

• A clinician, overwhelmed by meaningless alerts, overrides a warning and misses crucial information about a patient's drug allergy.
• A physician office's electronic health record (EHR) system enters the correct drug allergy information, but the pharmacist is unaware of the information.
• A young adult patient is allergic to an antibiotic, but doesn't know exactly what happened when he took the antibiotic as a child and he doesn't mention it when being treated for pneumonia.

The chances that any one of these situations may occur is increasing.