Guest post by Edgar T. Wilson, writer, consultant and analyst.
It seems increasingly disingenuous to frame health IT as being “revolutionary.”
For one, digitization has already swept nearly every other industry. The iPhone was a revolution in communication, but after generations of iterations and imitations, smartphones are normal, and consumers have adjusted their expectations accordingly.
To bring electronic health records (EHRs) into American hospitals and clinics is less a revolution, and more a remediation. That arguments continue over whether this upgrade will prove practical, valuable, or beneficial to patient care and clinical outcomes at all reflects that this evolution has been a top-down endeavor, rather than a true bottom-up transformation.
Despite rhetoric–and plenty of earnest optimism–the EHR rollout has been incremental, administratively-guided, federally-mandated push toward adoption. It has been a crawl toward process improvement more in the mode of Six Sigma than a grassroots “reset” button on the fundamentals of healthcare.
The true revolution–the one that patients and caregivers alike desperately need–is not merely technological, although technology may be our next best hope for realizing it.
A Mental Problem
Healthcare needs to unify behavioral and physical health, treatment, and discourse.
While physical medicine is climbing the next hill with respect to primary care provider (PCP) shortages, interoperability quagmires, and meaningful use (MU), behavioral health is facing the same primary challenges it has since well before health IT became such a hot topic.
Namely, recognition as a legitimate and necessary component of whole-person wellness and medical treatment.
But on both the side of care providers, and patients, physical health has been rigidly siloed away from behavioral health. Even EHRs have been shoehorned through America’s hospitals while behavioral health clinics have been barred from accessing incentive money. Their exclusion from the development table means fewer solutions and platforms exist at all for those facilities and caregivers who want to embrace digitization, because developers have been preoccupied with MU compliance.
The problem is sociological as much as it is a practical matter of care delivery. Stigmas persist–even as the conversation about CTE in the NFL escalates, the knee-jerk reaction is to provide players with better helmets, rather than emphasize how physical injury manifests in behavioral ways.
The connection between mind and body is as important as the connection between impact and trauma, because while not everyone plays professional football, everyone is at risk of complications at the intersection of their physical and mental well-being.
The NFL is belatedly owning up to its role in America’s perception of mental health issues, and their connection to physical health. Having a major entertainment franchise and cultural mainstay become something of a symbol for the issue–and those currently suffering from systemic neglect–is important and valuable. But that same messaging needs to exist at every point of the patient journey through the continuum of care.
Owning the Continuum
Accountability with respect to re-admissions, patient satisfaction, and other metrics being forced into consideration by the new federal augmentation of meaningful use–MIPS–was necessitated only by their prolonged exclusion and the lack of broad uniformity. And as an idea, they are far from game-changing; the nuts and bolts hold adoption back, but there can be little disagreement that patient health matters in a care delivery setting, and that physicians want to be able to focus on quality, rather than compliance with federal programs, billing and coding regimens, or any of the other obstacles they must overcome to provide treatment.
But micromanaging documentation adds neither quality nor clarity; it complicates the process, and doesn’t add something that was truly missing.
What is missing, almost across the board, is a heightened focus on behavioral health. Making it as much a matter of routine in check-ups and patient records should be the top priority right now. Patient satisfaction — and actual, measurable outcomes — will not be diminish by acknowledging this long-neglected component of care. It isn’t just a matter of coercing PCPs into being more attentive — patients as well as caregivers need this conversation to become a dominant issue in health policy.
Physicians need to be rewarded for advancing this conversation. Patients need to feel empowered. The national dialogue needs to prioritize simple communication above gadgets and gizmos, payments and payers. This one thing will profoundly affect all others.
Time for Revolution
Inconsistent standards, compromises on coverage and funding, a lack of cultural awareness, and widespread patient confusion are all persistent challenges mental health care is still facing. There is a push in traditional, physical medicine to tackle every one of these; from the ACA to a renewed focus on patient engagement, and pioneering initiatives to create and implement new technology to support all these efforts.
Getting the tech to work may be the best way to align mental health on the same level — socially, culturally, and medically — with physical health. There is no question that the future of healthcare is digital; whether it is truly integrated remains to be seen.