How a Behavioral Health Center Uses HIE to Drive Patient-Centered Care

Connecticut launched its statewide health information exchange (HIE) in 2021, United Services, a behavioral health center serving the eastern part of the state, was an inaugural member.

According to Zachary Dauphinais, MS, clinical informatics manager at United Services, connecting to the HIE was a no-brainer.

"Our philosophy has always been that mental health care is healthcare," Dauphinais told EHRIntelligence in an interview. "Mental health impacts physical health, and physical health impacts mental health."

For instance, depression increases the risk of many types of physical health problems, such as diabetes, and people with chronic conditions are at higher risk of depression. What's more, Dauphinais noted that many medications used to treat physical health conditions are also used to treat mental health conditions, underscoring the need for longitudinal patient records to support patient safety.

However, despite the link between physical and mental health, compiling a full view of a client's health history is challenging due to siloed data across the care continuum.

"A lot of our clients have comorbidities and see a lot of specialists, so when you're trying to get a complete picture of the client's health, there are so many places you have to reach out to," he explained. "It could take days, sometimes weeks, to get information."

Connecting to the statewide HIE has provided United Services with streamlined access to client information.

"It was such a need," Dauphinais said. "We were really excited about the idea of an easier path to getting that client information in one location. There's always been a separation between the two worlds, and we're seeing more of a combination which is really important to the total health of the patient."

United Services also receives real-time alerts from the HIE to drive care coordination. The system sends notifications when a client is admitted or discharged from an emergency department, inpatient unit, or certain long-term care facilities. These alerts allow United Services to swiftly inform the patient's care team, ensuring that all providers are up to date on the patient's status and needs.

When a client is discharged, the practice retrieves the discharge summary in the HIE. From there, a case manager follows up with the client on the phone or in person within 24 hours to ensure a bridge between the two levels of care, Dauphinais explained.

The practice is also using HIE alerts to track readmission patterns with certain clients.

"If we see a certain client with a certain issue going to the emergency department several times a month, we're able to work with the care team to develop an intervention and see if there is something that's missing with the client, or if there is something we can do outside of the emergency department to help them," Dauphinais said.

The real-time alerts have helped United Services flag client issues that the practice may not have otherwise known about, Dauphinais said.

For example, he described a situation where a client had missed several behavioral health appointments and hadn't responded to phone calls, letters, or in-person visits for several months.

As soon as the HIE alerts started, United Services received a notification that the client had gone to the emergency department for a medical issue. After receiving a discharge notification, United Services called to follow up with the individual. The client answered and explained that their physical health had been so bad that they hadn't been able to answer the phone or get to appointments.

"That day, we were able to get an appointment set up for a med visit, get her re-engaged with her therapist and case management, and help turn things around for that client," Dauphinais explained. "The big thing is really trying to help the patients who are falling through the cracks."

The HIE also empowers United Services with data for community health surveillance.

For instance, by analyzing client data, the practice has identified concerning trends such as an uptick in accidental overdoses.

"We maintain really solid relationships with other community providers in the area, and we all work together pretty well to identify these larger issues and advocate not only for the funding but the support from local, state, and federal governments and the community at large to work on these issues," Dauphinais noted.

As United Services delves deeper into data analysis, the organization is developing protocols for specific scenarios.

For instance, HIE data revealed that clients who had experienced a stroke were often admitted to the psychiatric inpatient unit within 30 days. This revelation led to the development of protocols aimed at providing better support and coordination for stroke patients with behavioral health issues.

"We're beginning to develop protocols where as soon as we're notified that a client has experienced a stroke, we're going to step up communications and support through our community case management team to work with the client to find the support that they need," Dauphinais said.

"It can be overwhelming," he emphasized. "A lot of times, strokes can be a life-changing event, and if you are already experiencing behavioral health issues, that life-changing event can really escalate mental health symptoms."