Last week we discussed the importance of health information exchange (HIE) and the work being done in Maryland to help make sure that providers receive important updates about patients. This week we want to share with our readers how HIE entities and automated, real time alerts can be critical in mental health care coordination for patients.

Dr. Kishor Malavade, a psychiatrist at Maimonides Medical Center in Brooklyn, was talking with his colleagues when he felt his cell phone buzz in his pocket. What he found in his inbox was an automated alert from the Brooklyn Health Information Exchange (BHIX). Clicking the link within the email, he navigated to BHIX’s secure Clinical Messaging Center and saw that one of his patients had just been admitted to the emergency department at Lutheran Medical Center located a few miles away. In the next few hours, Dr. Malavade was able to proactively check in with his patient while she was still in the emergency department.

“Beyond the benefits of coordinating care between disparate systems and providers, as an individual physician, I now have a greater sense of where my patients are.  Having that information is incredibly powerful.”

-Dr. Kishor Malavade, Maimonides Medical Center

A Little Background on Maimonides Medical Center’s Work  with Coordinating Mental Healthcare

In 2009, Maimonides Medical Center scored a New York State Health Care Efficiency and Affordability Law (HEAL) grant to demonstrate enhanced care coordination among various caregivers across the community, enabling them to provide patient-centered medical care and home health services to their patients.

Recognizing that Brooklyn residents suffered from a high incidence of mental illness, Maimonides chose to focus its efforts on mental health care coordination for bi-polar and schizophrenic patients in Brooklyn through HIE.

Research has found that mental illness rarely occurs in isolation, and far too often coincides with general medical illnesses such as:

• heart disease,
• cancers,
• diabetes, and
• neurological illnesses.

Because of this, coordination of mental health care and general health care through HIE is vital to improving health outcomes.

Mental Health Care Coordination Among Bi-Polar and Schizophrenic Patients

As a partner of BHIX, Maimonides decided to use the HIE entities’ established infrastructure and assisted in developing additional functionality to send out real-time alerts for these select patients and to facilitate mental health care coordination  through a secure clinical message center.

To get started, BHIX and Maimonides selected a panel of patients using the diagnosis codes that indicate bi-polar and schizophrenia, as well as zip codes for the region they wanted to monitor.  In addition, the partners defined several events that would trigger an alert for their selected panel of patients, including:

• an inpatient admission/discharge,
• an emergency department admission/discharge,
• a psychiatric admission/discharge, or
• a death.

When BHIX, Maimonides and the six other participating hospital sites (including four teaching hospitals, a skilled nursing and long-term care facility, and a level one trauma center) were ready to launch, each site designated care coordinators to receive and monitor these alerts and to follow up with patients and clinicians as appropriate.

Through the original HEAL project, BHIX and Maimonides have enrolled more than 5,000 patients and generated more than 10,000 alerts.

Automated Alerts Are  Not a Replacement for Personal Communication

Dr. Malavade and other Maimonides providers are pleased with the BHIX alerting system’s benefits so far. Dr. Malavade pointed out that HIE is a tool that can help him target his face-to-face communication, not a replacement or substitute for personal communication and coordination.

“Just because I get a text message alert on my phone doesn’t replace the fact that I need to communicate with my colleagues and the patient.  These alerts are great, but they’ll never be as robust as in-person conversation,” Dr. Malavade said.

BHIX and Maimonides consider automated alerts a powerful HIE tool that must be meaningfully used to be truly impactful, and they look forward to future enhancements in the automated alerting system.

Expanding Beyond Mental Health Care Coordination

Maimonides and BHIX are using the initial alerting success as a springboard for additional mental health care coordination efforts, including patient education about BHIX consent. With infrastructure in place to support automated alerts, BHIX is expanding the service to other data trading partners, including some less traditional users like home health care.

One home health care organization is receiving BHIX alerts when their patients are admitted to the hospital or the emergency department. HIE is saving time and money for the agency, which now doesn’t have to send a home care nurse to a patient’s home when he or she is not there. Additionally, the alerts allow the home health care providers to better coordinate mental health care by following up with caregivers in the hospital or emergency department after a patient’s discharge.

“Now that we have the infrastructure in place, what we are doing with automated alerting is just the tip of the iceberg. As long we have the data and rules set up, we can do things like establish triggers for an entire practice’s patients…for things like abnormal labs…and even a trigger for the absence of data.  We are constantly working with our clinicians to determine how they want to use this functionality to improve care coordination.”

-Irene Koch, Brooklyn Health Information Exchange

Maimonides’ Future Focus on using HIT

Recently, Maimonides Medical Center won a contract from the Centers for Medicare & Medicaid Services’ Center for Medicare and Medicaid Innovation and plans to use part of the funding to expand their existing alerting program, adding many more chronically ill patients to their alerting system and care coordination program – possibly benefiting patients with diabetes and other conditions.

What efforts do you see in your state to coordinate mental health care using health information exchange or real-time alerts? We would love for you to share your comments below.