Designing health information technology tools for behavioural health clinicians integrated within US-based primary care teams

BACKGROUND: Electronic health records (EHRs) are a key tool for primary care practice. However, the EHR functionality is not keeping pace with the evolving informational and decision-support needs of behavioural health clinicians (BHCs) working on integrated teams. OBJECTIVE: Describe the workflows and tasks of integrated BHCs working with adult patients identify their health information technology (health IT) needs and develop EHR tools to address them. METHOD: A mixed-methods, comparative case study of six community health centres (CHCs) in Oregon, each with at least one BHC integrated into their primary care team. We observed clinical work and conducted interviews to understand workflows and clinical tasks, aiming to identify how effectively current EHRs supported integrated care delivery, including transitions, documentation, information sharing and decision-making. We analysed these data and employed a user-centred design process to develop EHR tools addressing the identified needs. RESULTS: BHCs used the primary care EHR for documentation and communication with other team members, but the EHR lacked the functionality to fully support integrated care. Needs include the ability to: (1) automate and track paper-based screening; (2) document behavioural health history; (3) access patient social and medical history relevant to behavioural health issues and (4) rapidly document and track progress on goals. To meet these needs, we engaged users and developed a set of EHR tools called the Behavioural Health e-Suite (BH e-Suite). CONCLUSION: US-based integrated primary care teams, and particularly BHCs working with adult populations, have unique information needs, workflows and tasks. These needs can be met and supported by the EHR with a moderate level of modification.