Individuals with serious mental illnesses are 2.6 times more likely than the general public to develop cancer and nearly twice as likely to end up in an emergency or inpatient department with a serious injury, according to recent studies conducted at Johns Hopkins.

For these patients, care coordination is necessary to support these acute care interventions, while providing basics such as preventive health screenings, risk factor modification, and medication safety across all health care settings. While electronic health information exchange is one tool that can help support care coordination, historically it has been challenging to launch across mental health and substance abuse care settings, due in part to the need for increased privacy protections. With a keen focus on supporting care coordination in these settings, Illinois is using the recent implementation of Direct secure messaging to enable electronic information sharing across primary care, acute care, and the broad behavioral health care community in the Chicago metro area.

ONC’s State HIE Program recently caught up with Margo Roethlisberger, VP of Program Operations in Behavioral Health and Clinical Services at Ada S. McKinley Community Services in Chicago to learn how her organization is using Illinois’s Direct secure messaging solution to increase care coordination, and reduce administrative costs.

Effects of Paper Overload During Care Transitions

Ada S. McKinley Community Services (Ada) is a comprehensive human and social services organization providing services to over 13,000 Chicagoans, and one of Ada’s largest programs is the outpatient mental health program. Every month, over 300 children and adolescents, primarily from low-income and underserved communities, walk through Ada’s doors in need of a range of mental health interventions. The large majority of these patients are referrals from primary care physicians or transfers from hospitals in the Chicago metro area, and with these referrals and transfers comes a lot of health care information. Margo commented that, “Ada receives about five discharges a day from area hospitals. Depending on the complexity of the patient, this can equate to hundreds of pages of paper documentation that need to be uploaded to our EHR system immediately.”

Although Ada has been using some form of an electronic health record (EHR) since 1995, the health center was still drowning in paper because referring physicians and hospitals did not have electronic systems. “Receiving paper discharge summaries and transition of care summaries via fax and mail were of little to no value,” Margo says. “By the time the paper was received, scanned, and placed in a patient’s EHR, the patient had already been seen by clinical staff. Absent this data, the clinician must rely on the family to bring in the child’s discharge papers and to inform him of the child’s past medical history, medications, etc.”

How Direct Secure Messaging is Helping

Ada has seen big benefits from using Direct secure messaging to exchange patient information during transitions of care since they initially signed up to use the tool in February 2012. The organization has cut the time it takes to get information into the patient’s EHR from months to minutes. Margo commented that “the documentation from Hartgrove [hospital] now comes electronically to Ada, so our staff can skip the scanning step and save it immediately to the EHR.” The timeliness of the data is making it more relevant, aiding in better patient care.

“The real value proposition is getting documents into the EHR,” Margo says. “Now clinical staff can review records prior to or at the time of care versus only having retroactive information.”

For mental health patients that have complicated medication plans with potentially dangerous side-effects and interactions, access to timely data is paramount. Ada staff are now able to discern – at the point of care – whether a patient required restraints or demonstrated other behavioral issues during hospitalization, which can significantly impact the approach they take in managing the patient’s care.

Going Mobile with Direct

Direct is also providing Margo’s staff with valuable mobility they often need when conducting mental health assessments in the field. Equipped with iPads, staff can now complete crisis assessments using a mobile application and send the assessments via Direct secure messaging to be immediately uploaded into the EHR at Ada. As more providers in the Chicago area adopt Direct, field staff will also be able to send these documents to area hospitals or primary care physicians via Direct – a much more expedient approach to sharing information than their previous process of printing assessments in triplicate and dispersing them via fax, mail, and hand-delivery.

Now an evangelist for Direct secure messaging, Margo is approaching other hospitals, community mental health agencies, and crisis centers about using the secure messaging tool, hoping to create a larger behavioral health network that securely exchanges timely information to support better patient care for Chicagoans.

To learn more about Illinois’s work with Direct secure messaging, visit the State HIE Bright Spots brief on them at http://statehieresources.org/bright-spots/ or the ILHIE Direct website at http://ilhiedirect.net .