SIM small grants fuel practice transformation part 2

By Meg Quiat, JD, SIM grants project manager


During a two-year period, 47 SIM cohort-1 practices will receive up to $40,000 each to support practice integration plan goals, such as:

  • Integrating licensed behavioral health providers into daily workflows.
  • Conducting digital behavioral health screenings on tablets
  • Renovations to make space for behavioral healthcare in practices
  • Training staff
  • Investing in technological solutions for reporting and analyzing data
  • Creating programs to foster patient and family engagement
  • Seeking methods to foster better coordination and referral to specialty mental health setting

The SIM office will feature one of these categories regularly to explore successes and challenges practices encounter as they incorporate these changes. Read last month’s column about how grantees are integrating behavioral health providers (BHPs) into their practices. This month’s piece explores electronic behavioral health screening as part of patient office visits.


Electronic behavioral health screening

Since implementation of the SIM small grants program in fall of 2016, 17 SIM practices have experimented with different ways to incorporate electronic behavioral health screening into their practices. Twelve of the 17 practices received small grants through the Colorado Health Foundation (CHF) and five received funding through the Center for Medicare and Medication Innovation (CMMI) funding stream.

Practices used CHF grants to purchase electronic tablets, some which had screening software, for use in behavioral health screenings. CMMI small grants funds were used to incorporate screening results in electronic health records (EHRs). Grant recipients range from small practices to large, complex practices that are independent and part of larger healthcare systems. Practice locations dot the map and include rural and urban areas, metro Denver and mountain towns.

Ideally the electronic processes enabled by grant funds will look something like this:

  1. Patients will complete behavioral health and other types of screenings and health history forms online prior to their appointments or on tablets while waiting to see providers.
  2. Screening results will go directly into a patient’s chart and EHR.
  3. The provider will see results immediately before or during a patient’s appointment and use this information to identify a need for further screening or treatment for behavioral health and other symptoms.
  4. Care teams will use screening results data to provide care and to follow up on prescribed treatments or recommendations from providers and to track patient outcomes.
  5. Screening data will be entered in searchable formats into EHRs for reporting purposes.

Practices have experienced significant successes using electronic screening.

Challenges

  1. Entering results into patient EHRs in real time: Practices continue to work with screening software and EHR vendors to make data flow electronically from screening tablets into electronic charts in real time. Work-around solutions used by SIM practices include:
  • Print screening results for providers to use in patient appointments and scan the results into charts and EHRs.
  • Print screening results for providers to use in the patients’ appointments and then manually enter the results into charts and EHRs.
  • Send screening results through an electronic “cloud” into a patient’s chart as a PDF file in real time.

Each workaround has its problems with administrative inefficiency, data that is not searchable and, therefore, not reportable.

  1. Integrating screening results into EHRs and reporting/analyzing Data: None of the behavioral health screening packages purchased by SIM small grantees “talk” directly to EHRs. Practices must manually enter behavioral health screening data into EHRs to make data searchable and reportable. Proposed solution: Continue to work with clinical health information technology advisors, report issues to the SIM office and talk with EHR and screening software vendors to find a solution.
  2. Language barriers: Some software packages only offer behavioral health and other screening forms in English. Many practices serve patients who do not have sufficient English language skills to properly use the screening tools. Some workarounds and solutions include:
  •  Have a bilingual practice employee use the screening tool with patients to help translate.
  • Demand multiple language screening tools from vendors.

One of the big takeaways from the initial phase of integrating electronic screening into practice workflows is that providers need to plan a significant amount of pre-purchase research time to fully understand the challenges of integrating these screening systems into patient charts and EHRs. 

Benefits:

  1. Provider supported: Practices found that tablet screening software benefits outweighed technical challenges. Feedback from practice teams:
  • “Using tablets and online screening tools (PHQ2 & PHQ9), we have begun routine depression screenings at annual wellness visits and for all new patients. We will train and spread to each medical team.”
  • “This project so far has been successful by improving workflow, moving screenings from paper to electronic media, improving accuracy of the patient demographic data, and improving the patient experience by offering online check-ins.”
  • “The notebooks and patient portal system has endless opportunities in providing our patients with any number of self-questionnaires and or testing to help identify patient needs. We are implementing reports that will aid in the identification of patients with mental health diagnosis for the clinical team to determine if behavioral health services are needed. Through our referral and hand-off process, we will be able to document if a patient followed-up with receiving counseling services.”
  1. Patient supported: “Generally patients have been very excited about using the tablets to check in and were also excited about being able to fill out patient forms from home at their own convenience. There have been several patients who verbally reflected this sentiment.”
  2. Improved workflow: Most practices report that using the tablets results in expedited health screenings, which increases process efficiency while providing patients and their families with comprehensive behavioral health assessment.
  3. More accurate information about patient behavioral health: Multiple providers say that patients are sharing information more openly through electronic screening on tablet devices compared with paper screenings. Particularly when patients use the tablets in private, patients report more openly about behavioral health issues. A story shared by one provider: “A patient’s family filled out the PSC-17 [screening] in the waiting room in three minutes (typically paper forms take much longer). Not only was the information collected completely, it was sent in real time for the medical assistant and provider to use in a conversation with the patient. That patient’s family did not [verbally] mention any concerns but the PSC-17 on the tablet revealed concerns. The provider spoke with the patient and family about those issues during the visit and made referrals for additional treatment.”
  4. Better conversations with patients: Some practices say electronic screening systems have helped improve the value of conversations with patients and their families and goes beyond demographic information or other administrative information. The tone of the patient-provider conversation has shifted more to patient care. Providers say that having screening results at their fingertips will enable further enhancements of care as they add screenings.

Learn more about the SIM small grants by reading part one of this series and stay tuned for more updates.