Series 1: Meaningful Use for Behavioral Health Providers

1. Series 1: Meaningful Use for Behavioral Health Providers From the CIHS Video Series “Ten Minutes at a Time” Module 6: Using the EHR as an Effective Tool in Meaningful Use 9/2013

2. Outline • The certified EHR is a tool for achieving Meaningful Use – not the final goal • Patient engagement is central to successfully achieving Meaningful Use goals and objectives • Overview of 3 Core and 4 Menu Objectives that support patient engagement and better communication • How implementing Meaningful Use is likely to affect the way that clinicians use the EHR to engage patients and how the EHR can be effectively used in the treatment setting

3. Core Objectives - Patient Communication • Core Objective 12:Provide patients with an electronic copy of their health information (including diagnostic test results, problem list, medication lists, medication allergies) upon request. • http://www.healthit.gov/providers-professionals/achieve-meaningful-use/core-measures/electronic-copy-of-health-information • Core Objective 13: Provide clinical summaries [“after visit” summaries] for patients for each office visit • http://www.healthit.gov/providers-professionals/achieve-meaningful-use/core-measures/clinical-summaries • Core Objective 15: Protect electronic health information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities • http://www.healthit.gov/providers-professionals/achieve-meaningful-use/core-measures/protect-electronic-health-information

4. Menu Objectives - Patient Communication • Menu Objective 4: Send reminders to patients per patient preference for preventive/follow-up care (per HIPAA Privacy and Security 45 CFR 164.522(b) • http://www.healthit.gov/providers-professionals/achieve-meaningful-use/menu-measures/patient-reminders • Menu Objective 5:Provide patients with timely electronic access to their health information (including lab results, problem list, medication lists, and allergies) within 4 business days of the information being available to the EP. • http://www.healthit.gov/providers-professionals/achieve-meaningful-use/menu-measures/patient-electronic-access • Menu Objective 6:Use certified EHR technology to identify patient-specific education resources and provide those resources to the patient if appropriate. • http://www.healthit.gov/providers-professionals/achieve-meaningful-use/menu-measures/patient-education-resources

5. Using the EHRS During Patient Encounters • Clinicians already have varying communication styles independent of the EHR, that influence how the EHR is used • Information focus – position at the computer, use of computer guided questions, data orientation to problems • Interpersonal focus – led by patient’s narrative, positioned away from the computer • “Bridging style” - combination of both information and interpersonal focus • Reference – Ventres, et al., Family Medicine, 2005:37(4):276-281

6. Gaining Insight • Baseline communication skills, positive and negative, are amplified when the EHRS is in the room with the patient and care giver, and being used for concurrent documentation • Reference - Frankel et al., Journal of General Internal Medicine 2005;20:677-682 • Is the clinician aware of their current practice style? • Are they aware of how it impacts their use of the EHRS? • Amount of time looking at the screen • Impact on patient engagement • Do they go to the computer or to the patient first? • How much time is spent looking at the screen? Inversely proportional to patient engagement (average is 24% of encounter time) • Reference - Shackak, A., & Reis, J., Evaluation and Clinical Practice 2009;15:641-649)

7. Practice Considerations • Don’t let the EHRS set the agenda – engage patient before going to the computer in the room • Look at the patient (move away from the computer, take hands off keyboard and mouse) • Templates use close-ended questions, preventing communication of emotion as well as data. Don’t let them drive the entire information gathering process • Tell the patient what you are doing as you do it • Point to the screen • Involve patients in the documentation process • Know when to stop typing

8. Summary • Meaningful Use demands patient involvement in their own care. This is a critical piece in the evolution of health care • In fact, for Stage 1 Meaningful Use, there are 7 Core and Menu Objectives that drive this involvement • Communication tools in the EHR such as the Clinical Summary can be used to support patient involvement • The EHR itself can be enlisted to support better communication and to build trust • Providers should be aware of their style of communicating and how the EHR amplifies this style • The next step is to find a balance that supports the use of the EHR as an adjunct to treatment

9. We Have Solutions for Integrating Primary and Behavioral Healthcare Contact CIHS for all types of primary and behavioral health care integration technical assistance and training needs 1701 K Street NW, Ste 400 Washington DC 20006 Web: www.integration.samhsa.gov Email: integration@thenationalcouncil.org Phone: 202-684-7457 Prepared and presented by Colleen O’Donnell, MSW, PMP, CHTS-IM for the Center for Integrated Health Solutions