Four Strategies for Compassionate, Complete Behavioral Healthcare

1. Behavioral Healthcare
Four strategies for more
compassionate, complete
behavioral health care
Integrate behavioral and physical healthcare for better outcomes1
Bridge patient care gaps2
Treat 100% of your behavioral health patient needs3
Use an EHR to clear obstructions, capture robust data,
and deliver better care
4

2. More than a job—a healthcare mission.
Caring for behavioral health (BH) clients is more than a job — it’s a mission. It can be complex,
rewarding, heartbreaking, and life-affirming. All at the same time. After more than 17 years working
in healthcare, I’ve seen firsthand many of BH’s rewards and struggles.
To put it simply, you need the right tools, resources, and support to achieve your mission of
improving your clients’ care and outcomes.
That’s why I’ve made it my mission, as the dedicated Director of Behavioral Health at NextGen
Healthcare, to help you serve behavioral health clients the way you want to — more completely,
effectively, and compassionately.
NextGen Healthcare aims to help you keep your focus on clients and create positive client
outcomes, using our specialized BH services, customized software, personalized implementations,
tailored training methods, and ongoing support from dedicated BH experts.
In this eBook, I’ll share some of what I’ve learned while in the BH trenches. You’ve probably
seen firsthand how achieving better behavioral health outcomes starts with caring for the full
spectrum of your clients’ needs, including both behavioral and physical healthcare. I’ll talk
about how we can better integrate these disciplines through a single care record to create a
more holistic care environment.
I’ll show you how to accelerate and improve information sharing, and ways to overcome
information exchange barriers as a means to healthier, more successful BH outcomes. Finally,
I’ll show how you can deliver even more empathetic, comprehensive, and effective patient care
by using an electronic health record, health information exchange, and electronic pen to clear
care obstructions, capture robust data, share crucial information, and improve on the quality
time you spend with your BH clients.
I hope you find this eBook helpful. Please let me know what you think — or reach out if you
have questions.
Sincerely,
Gary Steiner
Director of Behavioral Health | NextGen Healthcare | gsteiner@nextgen.com

3. 1
CHAPTER
Integrate behavioral
and physical healthcare
for better outcomes

4. BH clients need more than quality care —they need
holistic, consistent care
Behavioral health clients need more than just high-quality care. They face
obstacles that call for a high level of holistic caring and help in overcoming
the challenges from fragmented, inconsistent, and episodic care.
They need treatment more frequently and it’s often difficult (or impossible) for
them to communicate their needs effectively, or care for themselves properly.
And the consequences can be life-threatening or deadly.
Physical health affects behavioral health, and vice versa
If you’re new to BH, or just want to reconfirm your experiences, let’s look
deeper at the clients you help each day.
For BH clients, attempts to self-medicate can lead to substance abuse and
addiction. Unfortunately, both sides of the care equation – physical and
behavioral health – don’t always communicate well on behalf of the patient.
Those suffering with behavioral health challenges are at risk for physical
health problems that lower their quality of life and can potentially lead to
early death. In fact, nearly 70 percent of adults with behavioral and mental
illnesses have co-occurring medical conditions, while 29 percent of adults
with physical health conditions have comorbid mental illness.* And the
risk is especially high for those with serious mental illnesses (SMI) such as
schizophrenia, bipolar disorder, and major depression.
*(Source: http://www.ihealthbeat.org/insight/2014/hie-helps-integrate-behavioral-and-physical-health
-care-but-hurdles-remain?view=print).

5. When compared to the general population, SMI clients:
Access emergency department care six times more often and primary
care one-half as often as the non-SMI population
(Source: Officials at Health Education Services Inc.)
Have high rates of co-occurring behavioral and medical disorders
— and are nearly three times more likely to have diabetes and three
times more likely to have chronic respiratory disease
(Source: http://www.corhio.org/for-providers/behavioral-health/research.aspx
Have higher rates of risk factors that put them in increased danger
of illness and death — including smoking, alcohol abuse, poor
nutrition, and unsafe sexual behavior
Face a higher incidence of metabolic disorders including obesity,
hypertension, cardiovascular disease, and stroke
SMI clients report they don’t seek care because, among other factors, they have
trouble making appointments, that crowded waiting rooms make them nervous,
that they feel uncomfortable disrobing in front of doctors, and that they feel
doctors didn’t really listen to them.
These clients die,
on average, 25
years earlier than
people in the general
population — and
many of these
deaths are
preventable.
(Source: National Association of State Mental Health
Program Directors, Report on mortality and morbidity
in the seriously mentally ill, 2006)

6. HOW DO
WE GET
THERE?
HOW DO
WE GET
THERE?
Collaborative care interventions can help
improve quality and outcomes
It may surprise some that more than half of adults in the
United States — 57 percent — will meet the diagnostic
criteria for a behavioral health condition at some point,
according to Rebecca B. Chickey, MPH, director of the
American Hospital Association’s Section for Psychiatric
and Substance Abuse Services. Chickey asserts that
these statistics underscore the importance of
integrating behavioral and physical healthcare.
Connecting physical and
behavioral care is essential to
advancing holistic patient care.

7. 2
CHAPTER
Bridge client care gaps

8. As caregivers, it’s our job to advocate for our BH clients
Unfortunately, as we’re all too aware, our fragmented healthcare system does not serve behavioral health clients well. Today, we’re still work-
ing to bridge the physical, policy, and cultural gaps that exist between primary and behavioral healthcare. A big part of the challenge
is that our healthcare system is problem-focused, not patient-focused. Many behavioral health caregivers believe that BH clients can get the
best care as part of a patient centered medical home (PCMH).
So, do we change for the better?
Caregivers can advocate to integrate behavioral health services
into the patient centered medical home so each patient has an
ongoing relationship with a primary care team. This way, the
care team can work collectively and collaboratively to meet
the patient’s healthcare needs in a way that’s accessible,
coordinated, and quality-driven.
For example, the Charles B. Wang Community Health Center
created a Mental Health Bridge Program, which allows patients
who come in for physical health services to access both mental
and behavioral health providers. In addition, patients who come
in for physical exams are screened for depression.
As program director, Teddy Chen, LCSW, PhD, suggests, “Offering
behavioral health services within the context of a primary health
center is especially important when serving people who are
immigrants. That’s because many immigrants are wary to admit
mental health problems and instead manifest them through
physical symptoms. People who are immigrants also face
cultural and linguistic barriers when attempting to access
mental health services.”*
*(Source: http://www.socialworktoday.com/archive/012610p14.shtml)

9. State-by-state BH improvements
With consensus growing around both the need for, and the benefits of, integrating services, some states have embraced a statewide
approach to assessing and supporting the integration of behavioral health services into primary care and community clinic settings.
The Integrated Behavioral Health Project (IBHP) in California, for example, has conducted numerous studies and funded over 30 initiatives
to identify and promote best practices that support integrated behavioral and physical healthcare delivery. These efforts have produced
a series of recommendations, including: the need to standardize data systems and utilization; improve bi-directional data sharing among
providers; and to offer a road map for broader implementation across the state.
“(Integration) is so logical that it should happen,” adds Jeffrey Borkan, MD,
PhD, a professor and the chair of the family medicine department at Brown
University’s Warren Alpert Medical School in Rhode Island. “There’s been a
change in thinking from the idea that the family doctor can do it all to the
idea that we need a team.”
Now, let’s talk more about the real-life tactics and tools we can use
to move toward better, more impactful healthcare integration.

10. 3
CHAPTER
Treat 100% of your
BH client needs

11. An integrated care record is vital to better BH outcomes
A single, holistic care record can help providers treat 100 percent of your behavioral health client needs. Without an integrated
care record, which includes the full patient care history, there’s a risk to the patient’s health, especially considering that primary
care practices are set up to address acute care problems.
“Primary care as traditionally practiced can’t achieve the triple aim of enhancing care, improving health populations, and
reducing costs,” says Frank V. deGruy, MD, who chairs the department of family medicine at the University of Colorado School
of Medicine. The patient centered medical home offers care that goes beyond traditional primary care, focusing on chronic
disease, care coordination, quality improvement initiatives, and disease registries to identify gaps in care.
Improve and accelerate information sharing and availability
Our current healthcare climate demands connectivity and interoperability. Plus, Meaningful Use Stage 2 requires higher
levels of data integration. A key prerequisite to care coordination for behavioral health clients is for both behavioral
and physical healthcare providers to exchange information about their shared patients’ care, including their treatment
plans, medications, and lab results.
In today’s healthcare system, we are becoming increasingly aware of the prevalence and cost of behavioral and physical
health conditions, and now recognize how addressing both conditions in a coordinated manner can improve outcomes and
reduce costs. In fact, today’s care leaders now embrace care delivery models that integrate behavioral and physical healthcare
and connect providers of such care to one another. So if you haven’t started down this path, you need to begin now.
Electronic health records and health information exchanges can improve
and accelerate information sharing and availability, while helping to
ensure confidentiality of patient information.

12. What the right technology can do for clients
ELECTRONIC HEALTH RECORD
The right EHR will empower you to
better focus on patient care and
improve outcomes
HEALTH INFORMATION EXCHANGE
The right HIE will facilitate easy, secure data
collection, organization, and exchange
Use your EHR to:
• Clear care obstructions
• Improve quality management
• Enable outcomes reporting
• Deliver evidence-based decision support
• Maintain an accurate patient care history
• Integrate behavioral health and medical workflows
• Automate data collection
Use your HIE to:
• See a community-wide view of your clients
• Simplify interoperability and ease communication
• Improve documentation and data sharing
• Use actionable data to enable clinical decision making,
care coordination, and population health reporting

13. Today’s information exchange barriers
Although data exchange is a core element of health reform, barriers exist today that impact the electronic exchange of
behavioral health information. These include state laws and regulations that impose special protections on such information
or that limit the types of healthcare that can be provided using that information.
Additionally, some providers interpret confidentiality laws as more restrictive than they actually are. For example, some
believe that HIPAA, which provides a federal baseline of privacy protection for patient health information (PHI), requires patient
authorization to disclose information for treatment purposes, when, in reality, no patient authorization is required. Another
common misconception is that HIPAA places tighter restrictions on the disclosure of behavioral health information than on
physical health information, which is generally not true either.
To remove barriers to data exchange at the state level, some states
have enacted legislation to replace their existing patchwork of privacy
laws with a single set of requirements governing the electronic
exchange of information. For example, North Carolina passed
legislation that supersedes other state privacy laws with respect to
information sharing within the state’s electronic health information
network, authorizing the exchange of all data within the net-
work in accordance with HIPAA standards.
(Source: http://www.ihealthbeat.org/insight/2014/hie-helps-integrate-
behavioral-and-physical-health-care-but-hurdles-remain?view=print)

14. Partner with NextGen Healthcare and Mirth to create your customized HIE solution
You can see how an HIE solution will help you better serve your behavioral health clients, but how can you choose
the right one? When choosing information exchange solutions, look for powerful HIE tools that can help you improve
patient safety by reducing medication and medical errors. These solutions can also help you increase efficiency (by
eliminating unnecessary paperwork) and improve outcomes by providing caregivers with clinical decision support tools
for more effective care and treatment. What’s more, they can eliminate redundant or unnecessary testing.
Finally, our solutions address confidentiality concerns by allowing clients to “opt out” of sharing their private
information,while still enabling providers to “break the glass” in order to view private data in emergencies
(all in accordance with state-by-state laws).

15. 4
CHAPTER
Use an EHR to clear
obstructions, capture
robust data, and
deliver better care

16. Collaborative, coordinated BH care is possible with the right EHR
Electronic Health Records (EHRs) have the potential to revolutionize the healthcare delivery system by clearing
care obstructions, improving quality management, and enabling outcomes reporting, so you can focus on
patient care. And if your EHR has behavioral health content, as NextGen®
Ambulatory EHR does, it can have an
impact right out of the box.
With EHR technology, you can be instrumental in the care of 100 percent of your client needs, not just the behavioral
piece. The right EHR can capture robust information on patient encounters, which can then be used for
evidence-based decision support. This is important because behavioral health clients are frequent users of
the healthcare system overall (especially those clients who are getting proper care), and all providers need to
be able to see what is happening on both the behavioral and physical side of the care equation.
Also, many clients return after years of “roughing it on their own,” and can’t adequately articulate their
conditions and treatment details, so providers need to be able to address their real issues with an accurate
patient care history. A good EHR can help provide that.
If your EHR has behavioral health content,
as NextGen Ambulatory EHR does, it can
have an impact right out of the box.

17. Concentrate on your client, not technology
NextGen Ambulatory EHR can help you relieve the pressures associated
with gathering, processing, and accessing data so you can spend more
time with and concentrate more on your client, not technology. For
example, it features the specific integrated behavioral health and
medical workflows which you need, and that other EHRs often lack. It
does the “heavy lifting” behind the scenes; with simplified workflow,
faster payments, and intuitive BH content that improves and automates
data collection. Just as important, it also helps you eliminate the
confidentiality risks associated with paper records and faxing, and
enables more secure data collection and sharing.
Give your clients more collaborative, coordinated care using solutions
that are interoperable with other systems. Gain continuity of care through
seamless integration of psychiatric history, primary care, lab orders,
medications, and more with the right EHR. Plus, use your EHR to better
manage care with built-in protocols for disease assessment and drug
treatment. Focus on your patient, not the technology.
Spend more time treating clients by spending less time on
documentation — The NextPen®
Solutions electronic pen speeds and
automates documentation so you can see clients faster, stay with
them longer, and see more of them. Collect demographic and clinical
information before an appointment so you can streamline intake, then
automatically transfer data directly into NextGen Ambulatory EHR.

18. The power and promise of technology
to help BH clients
We hope you’ve learned how the right EHR, HIE, productivity tools and better information sharing
can help you deliver more complete, compassionate care and better outcomes.
We covered the steps to delivering more compassionate and complete behavioral healthcare:
As a caregiver, advocate to integrate behavioral health and primary care.
Employ a single, holistic care record to treat 100 percent of your BH patient.
Harness the power of an EHR and HIE to improve and accelerate information sharing
and availability, while helping to ensure confidentiality.
Understand the true limits of confidentiality laws in your state so you can share data
appropriately and overcome information exchange barriers.
Leverage technology, including electronic pens, to stay with behavioral health clients
longer and see more of them.
1
2
3
4
5

19. EDU45 - 12/14
Take the Next Step.
Get empowered yourself to clear
care obstructions, capture robust
data, and share crucial information
to improve results and better serve
your behavioral health clients.
Contact us at 855-510-6398 or
results@nextgen.com.
NextGen Healthcare Information Systems, LLC, a wholly owned subsidiary of Quality
Systems, Inc., provides integrated clinical, financial and connectivity solutions for
ambulatory, inpatient, and dental provider organizations.
For more information, please visit nextgen.com and qsii.com.
Copyright © 2014 NextGen Healthcare Information Systems, LLC. All rights reserved.
NextGen is a registered trademark of QSI Management, LLC, an affiliate of NextGen
Healthcare Information Systems, LLC. All other names and marks are the property of
their respective owners.