Technology can bridge gap between physical, mental health

Khalid Al-Maskari

It sounds trite to invoke the mind-body connection, but if the concept is so glaringly obvious, why are psychiatry and primary care still separate islands of health care?

Walk into any integrated health care facility and more likely than not there’s one reception area, floor, wing and staff for behavioral health and a separate location for primary care. That’s not integration. The dividing line is even starker at the information technology level. From the perspective of the electronic health record, a psychiatric patient may be an entirely different person to their primary care provider.

The records gap creates a high risk of miscommunication and fragmented care. Primary care providers in their fleeting patient encounters tend to know little or nothing about the behavioral health profile of their patient. And they have precious little time to get briefed. In addition to suboptimal care, the information deficit can have serious consequences like adverse drug interactions, substance abuse complications, misdiagnoses and off-target advice.

Psychological ailments can affect the body, and medical conditions can affect the mind. Maybe depression is causing a patient’s lack of energy or anxiety is what’s really robbing them of sleep. Conversely, primary care diagnoses can have big implications for the psyche. Chronic back pain can fuel substance abuse. New diagnoses can trigger panic attacks. The price of miscommunication and missed information is well-documented: One in 10 U.S. deaths are now due to medical error, according to a study by Johns Hopkins Medicine, and nearly two out of three of those errors are rooted in poor communication within a care team, according to the Institute for Healthcare Communication.

Sometimes communication blunders simply waste time and money, as when a PCP and psychiatrist order the same blood panel, and a cash-strapped patient is forced to pay for it twice. Social determinants of health are also relevant here: Social conditions like poverty clearly affect the mind, which also affects the body.

For years, policymakers have recommended and incentivized a fuller integration of behavioral health and primary care, but the health care culture has resisted it. If health care culture can’t change itself, perhaps technology should lead the transformation. That’s why I propose a new kind of EHR, one with these qualities:

A whole-patient view. Clinicians, case managers and support staff on both sides of the behavioral health/traditional medicine divide should see an encapsulated synopsis of the patient at the beginning of every patient encounter on whatever device they care to use. This synopsis would include relevant medical and psychiatric diagnoses, medications, lab results, providers, appointments, population categories and social determinants of health.

Filtering. No provider, case manager or staffer needs to see every data point, so the records system should be configurable to provide personalized views of the information each individual requires for his or her role. The same record should incorporate data from all relevant applications so that busy clinicians don’t have to waste time navigating different software (with different logins) for information on scheduling, treatment notes, prescriptions, referrals, etc. Clinicians already feel they’re burning out on administrative tasks and not spending enough time healing.

Mobile apps. Americans spend an average of 4 or more hours a day looking at their smartphone, and the device is close at hand during the remaining 19 or 20 hours. Health care professionals are no exception. According to a HIMSS Analytics study, 80% of C-suite executives, IT pros, clinicians and health care department heads already use tablets, and 43% use smartphones to provide and coordinate care.

That’s one place the data needs to be.

Social-style integration. Integrated patient records should work like social media apps, which ensure that the most pertinent content is front and center on any device a user is likely to employ, including smartphones, tablets, laptops and desktop computers. Social apps also ensure content is easily accessible through every communication app a person is likely to use, including email, instant messaging, EHRs, patient portals, internal video conferencing and telehealth.

Voice recognition. If you can vocally command your phone to call a friend or your smart speaker to forecast the weather, clinicians should be able to speak, rather than type, information into systems that manage appointments, orders, lab reports, treatment plan updates, prescriptions, visit verifications and more.

Artificial intelligence. The integrated EHR should continuously learn what you want it to do. Built-in artificial intelligence capabilities can anticipate what you’re about to say in your notes or structured data fields. It can offer increasingly accurate predictive text whether you’re using your keyboard or voice to update patient information.

Patient self-service. If a provider desires, it should be easy to invite patients into a tailored section of the shared EHR environment (with appropriate security), providing them with integrated access to scheduling, health records, prescription refills, lab results, notes, clinicians and educational materials. Even basic patient engagement can be cost-effective, reducing, for example, the need for administrative assistants to phone patients with appointment reminders.

Behavioral and physical health are integrated in every human being, so these two aspects of health care, including the technology underlying them, needs to be integrated as well. Although the culture won’t change itself, we’ve seen smart technology change the culture and our world. Let’s improve the EHR to reflect reality. That means affirming the mind-body connection in every respect for the sake of providers, payers, patients and society.

References:

Institute for Healthcare Communication. Impact of communication in health care. https://healthcarecomm.org/about-us/impact-of-communication-in-healthcare/. Published July 2011. Accessed Aug. 19, 2022.

Johns Hopkins Medicine. Study suggests medical errors now third leading cause of death in the U.S. https://www.hopkinsmedicine.org/news/media/releases/study_suggests_medical_errors_now_third_leading_cause_of_death_in_the_us. Published May 3, 2016. Accessed Aug. 19, 2022.

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Khalid Al-Maskari is founder and CEO of Health Information Management Systems, a Tucson, Ariz.-based company that designs EHR software to transform the integrated health care experience.