Turning EHRs into Assets for Mental Health and Uniting Practice (Team Up)

描述(由申请人提供)：强有力的证据表明，精神和身体并存是常见的，并增加了不良健康后果的风险。众所周知，服务分散是有效护理的一个重大障碍，也是成本的一个主要驱动因素。重新定位到综合护理提供模式似乎是实现长期可持续性和变革的最站得住脚的解决方案。然而，尽管电子健康记录的采用率和使用率较高，但在健康信息技术(HIT)方面仍存在深渊，该技术专门设计用于同时支持精神健康专业人员的个人工作以及提供综合精神健康和初级保健服务所需的新合作。OCHIN公司是一个由健康中心控制的网络，由11个州的60个健康中心组成，在全国范围内因率先使用HIT来改善向安全网临床人群提供医疗保健的协调和提供而受到认可，它是解决那些在新的综合保健模式中实践的人的信息和HIT需求的先锋。OCHIN托管的Epic EHR包括一套新的可扩展的整合功能(“BH导航器”)，虽然最初是为精神健康专业中心使用而创建的，但正在扩展以支持初级保健环境中的整合。受初级保健变化模型、技术接受模型()和以用户为中心的设计最佳实践的启发，这项研究将审查OCHIN的BH导航器和初级保健实践如何共同发展，通过实现以下具体目标支持初级保健中的精神健康整合：目标1：告知OCHIN的BH导航器开发，以提高初级保健实践的有效利用；目标2：论证干预措施的可行性，包括同时实施适应的BH导航器、实践工作流程重新设计和提供者在六个初级保健实践中的行为改变；目标3：为随后的R01设计一项以实践为基础的随机对照试验，以测试我们开发的干预措施在改善临床过程和结果衡量方面的有效性。一个经验丰富的多学科团队将进行这项研究，并使用观察性混合方法设计来研究BH导航器的使用，以支持其持续发展。我们将对干预措施进行事后可行性测试，其中包括工作流程重新设计、提供商行为改变以及在六个实践中以及在抑郁症和抑郁症患者以及合并慢性病的患者中实施改进的BH Navigator。其结果将是对Epic EHR中创新和新颖的技术解决方案进行彻底研究，并改变实践和供应商，以优化该工具的使用。我们开发和测试的干预措施可以作为记录、共享和监测患者心理和身体健康需求的模型，并有望整合当前的信息系统和支持综合临床实践。这项研究将阐明必须如何改变EHR和做法，以有效地改变精神卫生和初级保健提供者的合作方式，以提供更高质量和更全面的服务。

DESCRIPTION (provided by applicant): 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.