The Promise of Health Information Technology in Behavioral Health PDF

The Promise of Health Information Technology in Behavioral Health and Informatics: An Overview  Behavioral health conditions are leading causes of disease burden around the world. Informatics innovations play a role in reducing that disease burden through accelerating neurobiological, ne...

The Promise of Health Information Technology in Behavioral Health and Informatics: An Overview  Behavioral health conditions are leading causes of disease burden around the world. Informatics innovations play a role in reducing that disease burden through accelerating neurobiological, neuroimaging, and health services, and epidemiological research efforts. Information technology itself is creating social connections and social experiences that promote well-being. Informatics efforts for clinical purposes are however adopted at a much slower rate than those that support research. If behavioral health clinicians do not adopt technology at a quick enough rate, translating knowledge into practice will be slower than in the past, and consumers who suffer from biopsychosocial impairments will again lag behind those with medical disorders. At the same time, the behavioral health field can lead on issues such as privacy, ethics, consumer adoption of technology itself, and intelligent use of quality and utilization data. Behavioral health can also lead in areas such as change management and the science of adoption of technology. Finally, behavioral health can define the standards of evaluating the success itself of systems that support care. This book is about the emerging issues, tools, and technologies that will shape behavioral healthcare in the twenty-first century. Technologies  The past decade has seen dramatic changes in hardware, applications, and communications technology. The Internet, since 1990, has grown at an exponential rate and web sites have grown at an exponential rate as well. Adoption of Internet technology has outpaced the adoption of previous technologies such as the telephone, VCRs, and even DVD systems. As chip capacity grows, application and software development capacity also grows. This creates a tremendous burden on both the purchaser and user of behavioral health information systems. The growth of communication tools and the capacity of existing hardware to be able to handle a tremendous amount of data traffic including full-screen video will be changing the way distance learning and “distance therapy” is conducted. Technologies  Technologies for interactive voice recognition systems will be able to detect subtle changes in voice patterns and determine the internal affectual state of the individual speaking and add both knowledge and confusion to the behavioral health landscape. Optical fiber and switch technology will make “terabyte” traffic possible.  There are, of course, tremendous risks in technology innovation. The problem with rapid advancement is that there is not enough time to study, to evaluate, and to ascertain whether a given technology is reliable and valid, and whether it is used in similar ways across patients and across treatment settings. Clinical Practice  In the clinical arena, multiple issues have either been addressed or identified with the advances and implantation of health information technology. In the past two decades, the traditional psychotherapies have also included computer-based psychotherapies. Computerized therapies for depression, anxiety, and stress management, and emerging computerized initiatives in manual-based addiction treatment and schizophrenia will surely come of age in the next 5 years. Clinical Practice  The field of behavioral health care has always emphasized, in both psychology and psychiatry, the need to codify and quantify diagnosis in severity of illness and need for treatment. A plethora of psychometric instruments exists to help clinicians evaluate and treat those consumers in distress seeking behavioral health services. These instruments are now available either in software packages or over the Internet. New measures such as the HSI developed by Bangara and colleagues will surely become the standard in Managed Care. Clinical Practice  Another recent trend in the clinical area has been the development of clinical prescription systems. Both physicians and consumer advocates have raised a number of concerns. The pharmaceutical industry and the pharmacists around the country are pushing for online prescriptions. The backdrop for this is a struggle for professional “turf”, where maintaining the “physician/patient relationship” and the human contact is seen as an essential part of treatment. The Internet and other information technologies – telephonic prescriptions, mail-order prescriptions – replace that human interface. The capacity of on- line prescriptions and distance prescription systems really pressures professionals into thinking “out of the box.” Utilizing technologies to complement and integrate into usual practice is the real behavioral health dilemma for the field. Organizing and Managing Care  One area that information technology and the rapid evolution of communications, hardware, and software capacity will greatly benefit behavioral healthcare is the ability to design and implement systems of care.  Another area where advances in technology can greatly benefit and improve the quality of health in healthcare for individuals suffering from mental illness is in the area of education and research. Standardized patient psychotherapies can greatly enhance problem solving skills and the learning of professionals. There will be a tremendous boom in the development of CNS medications in the next twenty years due to pharmaco-genetic research. The amount and quantity of information available will be exponentially greater than what has been available in at least the psychiatrist’s armamentarium in the past four decades. Organizing and Managing Care  This explosion in the new sciences and medication development will put increased stress on the knowledge demands of all professionals. The technologies, especially the Internet technologies that make knowledge available, are credible, easy to use, and must be frequently updated.  Traditional information systems have always been used for back office functions. Information technology, historically on a national scale, has evolved from defending national security, to financial and banking systems, and finally into entertainment. Now in healthcare, the same kinds of progression are evolving where technology is used for ensuring the security and financial survivability of an organization. However, due to the growing demand of quality accountability, coordination, and access to care issues that are prevalent in the twenty-first century, systems must be able to provide real time knowledge and decision support as well as on-going strategic decision support for both clinicians and administrators. Impact Issues  One of the biggest dilemmas in the behavioral healthcare arena, especially due to the recent policy mandates of integration with medical care, is the aspect of information privacy, specifically mental health privacy. While there may be a need for a primary care physician to understand the medical and some of the psychiatric aspects of the person being treated in behavioral healthcare, there is a resistance in practitioners to share. Unfortunately, this resistance to share contributes to the “distrust” and “lack of value” that behavioral healthcare practitioners are perceived. It will require a great deal of organizational group processes and organizational change strategies to implement these technological systems. Impact Issues  In summary, behavioral healthcare is unique. The communication that goes on between provider and patient forms a great part of the therapy or the cure of the illness. This is most unlike any other specialty in all of healthcare. The surgical approach by a therapist, to search, dissect, discover, and “suture” the pains of the past and present will surely be enhanced by the adoption of information technology in the new millennium.