EMRs bring all of healthcare together: confidentiality and care coordination issues affect how behavioral healthcare interfaces with primary care in an electronic medical record.(electronic medical records)

Behavioral healthcare documentation in electronic medical records (EMRs) poses both challenges as well as opportunities to integrate behavioral healthcare with the overall healthcare delivery system. EMRs offer the ability to provide timely behavioral healthcare information to primary and specialty care physicians that can enhance care coordination. Yet a primary concern is addressing the importance of confidentiality.

This article focuses on two areas. First, we examine the fundamental issues healthcare providers and leaders should consider in determining how behavioral healthcare documentation should be integrated into EMRs. Second, we consider potential strategies to address these issues. Our experience is based on Group Health Cooperative's two-year implementation of an EMR system. Group Health Cooperative is an integrated healthcare system serving nearly 550,000 people in Washington State and Idaho.

Fundamental Issues

The core issue in determining how behavioral healthcare documentation is integrated within the overall EMR is addressing the direction of a healthcare organization as it pertains to balancing the importance of care coordination and confidentiality. Key questions to consider are:

What has been your organization's experience with sharing behavioral healthcare documentation with primary care/specialty-care? How an organization historically has addressed confidentiality/care coordination issues within a paper record system will have a significant influence on how to address these issues within an EMR. Relevant issues include the number of patient complaints regarding specially protected healthcare information (e.g., mental healthcare and chemical dependency) being included in a medical chart, as well as any quality-of-care concerns that have been the result of primary/specialty care providers not being able to have access to behavioral healthcare information.

What is your organization's strategic direction regarding the integration of behavioral healthcare and your healthcare delivery system? If your organization has had a number of strategic initiatives focused on integrating behavioral healthcare into your healthcare delivery system (e.g., depression management in primary care), then it is important that your behavioral healthcare documentation in an EMR be relatively highly integrated within your healthcare system, and that the content is relevant to a broader audience than just behavioral healthcare clinicians.

What are key constituents' perspectives on confidentiality/care coordination regarding behavioral healthcare documentation within a healthcare system? Through either focus groups or surveys, determine the perspectives of primary/specialty healthcare providers, behavioral healthcare providers, and patients regarding the inclusion of behavioral healthcare ...