Chronic Mental Health: Improving Outcomes through Ambulatory Care Coordination

Without electronic communication, behavioral health providers cannot follow the full treatment path of their patients who have mental health issues as they move between various providers in urban and rural outpatient settings, mental health hospitals, protective custody, and crisis mental health facilities. This project demonstrated how health information exchange (HIE) between rural and urban providers improves ambulatory patient care coordination and safety across treatment settings. It developed and implemented the Electronic Behavioral Health Information Network (eBHIN), a regional HIE in southwest Nebraska, to decrease the time and effort it takes for providers to access comprehensive and accurate information about their patients.

The specific aims of this project were to:

• Identify provider barriers to technology acceptance. 
• Implement an HIE among three major behavioral health provider facilities. 
• Collect data on how timely access to accurate information relates to quality of care. 

eBHIN was implemented in the 16-county region of southeast Nebraska that comprises the Region V Behavioral Health Authority, and throughout the five counties of Region VI. These two regions are home to approximately 60 percent of Nebraska’s total population. Thirty organizations currently participate in eBHIN, with 77 percent of consumers having “opted-in” to share their health information.

The project used interviews and surveys to study two subject areas: 1) provider barriers and benefits to technology acceptance in the behavioral health setting; and 2) behavioral health care technology acceptance and adoption.

Among the barriers cited during interviews, all providers mentioned privacy and security concerns; nearly all providers mentioned delivery-of-services barriers; and more than half the providers cited quality-of-care barriers. For benefits, all providers mentioned quality-of-care benefits; two-thirds discussed delivery-of-services benefits; and fewer than one-in-ten discussed privacy and security benefits.

Thirty-three percent of respondents had negative beliefs of HIE, including a strong belief that HIE would add cost and time burdens. In addition, this group believed that the HIE would present access and vulnerability issues, would negatively impact workflow and control, and were skeptical that technology would improve care and communication. Sixty-seven percent of respondents had positive beliefs about HIE, including the belief that HIE would improve care and communication, and a belief that HIE would positively impact workflow and control. This group did not believe that the HIE would add cost and time burdens. Those who felt positively about HIE were younger, more confident about their computer skills, and had prior positive experience with electronic health records. Overall, the project found that behavioral health providers have positive attitudes toward sharing information electronically, but have concerns about privacy and cost.