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，精神和身体合并症是常见的，并加剧了不良健康结果的风险。众所周知，服务分散是有效护理的一个重大障碍，也是成本的主要驱动因素。重新定位到综合护理提供模式似乎是长期可持续性和变革的最站住脚的解决方案。然而，尽管电子病历的采用率和利用率较高，但在卫生信息技术（HIT）方面存在一个深渊，该技术专门用于同时支持精神卫生专业人员的个人工作和提供综合精神卫生和初级保健服务所需的新合作。OCHIN Inc.是一个由全国11个州的60个医疗中心组成的医疗中心控制网络，被公认为率先使用HIT来改善向安全网诊所人口提供医疗保健的协调和交付，是解决那些在新的综合护理模式中实践的信息和HIT需求的先锋。OCHIN托管的Epic EHR包括一套新的可扩展集成功能（“BH Navigator”），虽然最初是为精神卫生专业中心创建的，但正在扩展到支持初级保健机构的集成。根据初级保健变化模型、技术接受模型（TAM）和以用户为中心的设计最佳实践，本研究将通过实现以下具体目标，研究OCHIN的BH导航仪和初级保健实践如何共同发展，以支持初级保健中心理健康的整合：目标1：告知OCHIN的BH导航仪开发，以提高初级保健实践的有效利用；目标2：展示干预措施的可行性，包括在六个初级保健实践中同时实施改编的BH导航、实践工作流程重新设计和提供者行为改变；目标3：设计一项基于实践的随机对照试验，用于后续的R01，以测试我们开发的干预措施在改善临床过程和结果测量方面的有效性。一个经验丰富的多学科团队将进行这项研究，并使用观察混合方法设计来研究BH导航员的使用，以支持其持续发展。我们将对干预措施进行前后可行性测试，其中包括工作流程重新设计、提供者行为改变和在六个实践中实施改进的BH Navigator，并在患有抑郁症、抑郁症和合并慢性疾病的患者样本中实施。其结果将是对Epic EHR创新技术解决方案的深入研究，以及优化该工具使用所需的实践和供应商变化。我们开发和测试的干预措施可以用作记录、共享和监测患者精神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。这项研究将揭示电子病历和实践必须如何改变，以有效地改变精神卫生和初级保健提供者如何共同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.