This article is sponsored by WellSky. This article is based on a Behavioral Health News Tech Talks virtual discussion with Lisa Lowery Deal, Director of Pharmacy at Sun Behavioral Delaware, and Carrie O’Connell, Senior Director of Clinical Strategy at WellSky. The discussion took place virtually on June 7, 2022. The article below has been edited for length and clarity.
Carrie O’Connell: Interoperability is something we’ve been talking about in the healthcare space for many years. The topic itself can seem intimidating and impersonable. We are going to talk about some real pertinent use cases to make interoperability more personable and patient specific.
I am the Senior Director of Clinical Strategy at WellSky. WellSky is a leading technology company with best of breed software, analytics, and services for the largest depth and breadth of end markets. We are lucky to work with Sun Behavioral, where Lisa Deal is the Director of Pharmacy for Sun Behavioral Delaware.
Lisa Deal: Sun Behavioral is a four-hospital health system specializing in behavioral health. I am currently at Sun Behavioral Delaware, which is a 99-bed inpatient facility servicing the needs of our community in Georgetown, Delaware. We have services ranging from adolescent to elderly care, as well as mental health and substance use. We also provide inpatient and outpatient services. I’m really excited to be here today to share the stage with WellSky and give you a little bit of information about what we do and how interoperability is such a big component of how we are improving patient care.
The learning objectives today are pretty simple, though we know interoperability can sound scary. Honestly, you’re already practicing interoperability every day. We’re going to show you how technology can improve not only patient care, but also actual outcomes. We’re going to talk a little bit about why interoperability is important, how we can streamline some of the technology to improve care from admission to discharge, and everything in between. Then we’re going to apply everything we discuss to a specific example.
The first question we have is: Does your organization currently function with interoperable technology that allows data sharing – whether it’s data sharing to your staff, which could be something as simple as Microsoft Teams, or something as complicated as a homegrown application that you use to submit sensitive data?
Do you share data through a portal to outside providers? Are you sharing data with your patients?
In behavioral health, it’s scary to be interoperable because we have such sensitive data. It’s really important for us to take that into consideration.
O’Connell: I keep telling people that I want to abandon the word interoperability altogether because it feels so sterile and so palpable and really outside of the day-to-day care that we give. I like just breaking it down to data sharing. Being able to get that data at that next level of care no matter where the patient is coming to your behavioral hospital from is so important. Being able to tap into that pharmacy network or other network so that you have that great list of important information while you’re caring for that person is invaluable.
Like I mentioned, interoperability is not new to any of us, but we really are at a pivotal point in health care with so many challenges, post-[public health emergency], hopefully, and staffing shortages. We really have to rethink how we work, and being able to get that person’s history to us is certainly going to be one of the keys for us to be successful in the future. I think many of us that have heard about interoperability are making a face because it was never done at the moments that we needed it. Getting information two days later actually feels like more work.
Now is a really exciting time to talk about this data sharing. I think we all know when we can’t get patient history or when we don’t know what’s going on with a patient, it makes for a much harder journey for all of us. One more thing I want to note before I hand it back over to Lisa is, in the behavioral health space we are challenged even more with 42 CFR Part 2. I hear the cool kids just call it “Part 2.”
We have all of these additional barriers that the rest of healthcare doesn’t always have. Sometimes, they’re getting someone from another location. In behavioral health, we often have somebody just walking in from the street and quite honestly, they’re not the best historians when they’re in that panic zone. Really taking a focused view on what we can do and how we can do things different in behavioral health is certainly really exciting. I’m going to pass it back over to Lisa now.
Deal: When we’re thinking about this, I want us to think about: Would you feel comfortable sharing some of your behavioral health episodes of care with an interoperable organization? As providers, I think a lot of us are apt to feel comfortable, given our knowledge of the space and the true intentions of what the data will be used for.
It’s the layperson and the general public who we’re hearing say, “I don’t want that information out in the community.” But really, we want the data because we want to do a better job of taking care of our patients. In behavioral health, sharing data psychiatry notes and other things has been taboo, and we don’t share; those records have to be subpoenaed. We’re really working hard these days to change that thought process.
As many of you are probably aware, behavioral health admissions are super complicated. These patients are commonly at a behavioral health facility for longer than an inpatient in an acute care hospital. [When you deliver a baby, for example], you’re typically able to be out of the hospital the next day. But in behavioral health our average length of stay is about five to seven days. If there’s an issue with data, if we get a wrong medication, if we get a wrong diagnosis, problems can be perpetuated throughout the admission. Then there are so many other issues in regards to where we are going to send this patient when they leave our organization and how we get them connected with the next episode of care.
We also have to understand that patients are coming from so many different places. Every single place of care has a different electronic medical record. They have a different mechanism for documenting data, whether it’s a group home, or the police, or another hospital. Even those places that have electronic medical records are still not doing the best job of sharing them. Sometimes facilities will end up printing that record and then sending it with the patient and printing another record, allowing documents to get lost and the process to get complicated. We also transfer a lot of our patients, making opportunity for things to get even more complicated.
A lot of people don’t understand that most behavioral health facilities are standalone hospitals. It’s not a place where they can get a lot of medical care. We have basic medical care to treat infection and things like that, but if they need an IV or a chest x-ray, for example, that’s not something that we can do. We sometimes even transfer our patients from our hospital to the community hospital and back again. Even within a short six-hour stay, data can be lost. If we can develop a mechanism that’s a little bit more connected, our patients are going to have a lot better care.
We also have patients who leave against medical advice. Most patients in our hospital are voluntary patients. Within reason, patients can leave before we are finished giving them care, but even then, we want to give them the best discharge plan possible, even if they’re leaving against medical advice. Being able to have something in place allows them to have a discharge plan that improves their care, and being able to send that to their next level of care is really important for us. When you take all of those factors into consideration, and then you throw in my favorite piece of the puzzle, which is medication, you can see how much more complicated it can get. One misstep out of any part of the process can lead to either a patient error, a core outcome, a disease state that’s not treated, side effect considerations or another ill outcome. There are so many different things that can happen. By having a system in place that allows for better discussion between providers and between caregivers, we can do a much better job of treating these patients and having better outcomes.
We really wanted to focus on meta-history and reconciliation. That’s something that’s near and dear to my heart. We want to get the best possible outcomes with the least amount of adverse events. In behavioral health, our medications have the potential to cause a lot of adverse outcomes. By having that patient’s medical history in our system, seeing what a patient has tried in the past and what hasn’t worked in the past, we can do a better job of managing their care.
We can also make sure that patients are receiving all the medications that they need and prevent duplications. I can’t tell you how many times I see patients getting Sun Behavioral health medications from their primary care physician, some from the psychiatrist, and then their pain doctor pops on a couple more and no one’s talking to one another. We also see duplications of therapy. All of this leads to increased risk of sedation or complications and drug levels being through the roof.
Then, finally, we want to have a process in place that allows patients to be able to reach their medication list at the tip of their fingers so that when they go to their PCP after they’re discharged, they can have that complete and accurate list. Then that PCP can edit the list of medications if need be and then the patient can carry it on. By having the ability to work together with all the episodes of care, how our patients see their medications, how medications are reconciled, and how medications are changed is improved.
O’Connell: Where does some of this patient medication information come from? Here’s just a partial list of where information may come from – the particular patient and/or caregiver, the primary care physician, the community pharmacy – just to name a few. When I start to go through this list, I get exhausted thinking about the detective skills you must use just to get some information about that person. Very often, we’re dependent on someone picking up the phone or somebody dropping something in the fax machine to get it to us.
That process has gotten us very far, but now that these national and regional data exchanges have more people participating, and the idea that you would query these networks before you even go in to meet that person, has to become part of how we deliver care. It doesn’t need to be that foreign thing that someone who might be in admissions does. Even myself as a nurse should be trained to do that data query. For example, if I as a nurse get information at five o’clock about this person and don’t know anything about it, instead of calling that patient’s cardiologist’s office, I can query care, quality, or CommonWell to get that person’s information back in real-time without needing another person to help with this.
When I talk about interoperability, I try to break it down to be really simple in the idea that we’re sending, receiving, finding, and using data. We often talk about alphabet soup when we start getting into Consolidated Clinical Document Architecture and United States Core Data for Interoperability, and all of those different formats that we must comply with in order to not be information blockers for the Office of National Coordinator for Health Information. On that clinical level, it’s about getting that medication list. It’s about querying for it. Maybe the host hospital is sending it. Maybe you’re querying that doctor’s office and you’re receiving it, you’re finding it, and you’re using it, thus starting to create those even better outcomes with less unnecessary demand on staff.
Deal: When we think about all of that, from a patient perspective, we hear a lot about transitions of care, or TOC. TOC is something that’s big for everyone, whether in acute care or behavioral health. What we see is that we need to make sure that at every discharge, and I’m talking about every discharge from every episode of care, and I know it’s important to me because I’m a pharmacist, are the medications still relevant? Were things changed because they were going to the operating room or because they had a decompensation in the behavioral health hospital? Were there things that were held that need to be restarted? Are these changes clearly documented? Why are we doing what we’re doing? I can’t tell you how many times, and you guys are probably aware of this, when I discharge a patient, I have this awesome medication plan for them. It’s going to be amazing. They’re going to do awesome. Then they get readmitted five days later because they went back to the same plan that they were on prior to the admission.
This excerpt has been edited for length and clarity. To watch the full discussion on video, please visit:
WellSky helps behavioral health providers across hospital inpatient and outpatient settings and ambulatory outpatient and residential facilities deliver safer, more effective care with behavioral-specific functionality. To find out how, visit: https://wellsky.com/behavioral-health-systems/
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