Strong evidence shows that mental and physical co-morbidities are common and compound the risk for undesirable health outcomes. It is well established that service fragmentation is a significant barrier to effective care and a major drive of cost. Reorienting to an integrated care delivery model appears the most tenable solution for long-term sustainability and change. However, despite higher rates of EHR adoption and utilization, there is an abyss when it comes to health information technology (HIT) that is specifically designed to simultaneously support the individual work of mental health professionals and the new collaborations required for delivering integrated mental health and primary care services. OCHIN Inc., a Health Center Controlled Network comprising 60 health centers in 11 states nationally recognized for pioneering the use of HIT to improve the coordination and delivery of healthcare to safety net clinic populations, is at the vanguard of addressing the information and HIT needs of those practicing in new integrated care models. OCHIN's hosted Epic EHR includes a new suite of scalable integration functions ("BH Navigator") that, while initially created for use in mental health specialty centers, is being expanded to support integration in primary care settings. Informed by the Primary Care Change Model, the Technology Acceptance Model (TAM) and user-centered design best practices this study will examine how OCHIN's BH Navigator and primary care practices are co- evolving to support integration of mental health in primary care by accomplishing the following specific aims:
Aim 1 : Inform OCHIN's BH Navigator development to improve effective utilization in primary care practices;
Aim 2 : Demonstrate the feasibility of an intervention that includes concurrent implementation of the adapted BH Navigator, practice workflow redesign and provider behavior change in six primary care practices;
and Aim 3 : Design a practice-based randomized-controlled trial, for a subsequent R01, to test the effectiveness of the intervention we develop in improving clinical processes and outcome measures. A highly experienced, multidisciplinary team will carry out this study, and use an observational mixed method design to study use of the BH Navigator in order to support its continued evolution. We will conduct a pre-post feasibility test of an intervention that includes workflow redesign, provider behavior change and implementation of the refined BH Navigator in six practices and among a sample of patients with depression and depression and co-morbid chronic disease. The result will be thorough study of an innovative and novel technological solution in the Epic EHR, and the practice and provider changed needed to optimize use of this tool. The intervention we develop and test can be used as a model for documenting, sharing, and monitoring patients'mental and physical health needs and holds promise for integrating current information systems and supporting integrated clinical practice. This study will shed new light on how EHRs and practices must change to effectively transform how mental health and primary care providers work together to deliver higher quality and more comprehensive services.
In this study we thoroughly examine an innovative and novel technological solution in the Epic EHR that can be used as a model for documenting, sharing, and monitoring patients'mental and physical health needs and that holds promise for defragmenting current information systems and supporting integrated clinical practice.