Evaluation of an Electronic Health Record (EHR) Tool for Integrated Behavioral Health in Primary Care

Background: Integrating behavioral health into primary care can improve care quality; however, most electronic health records are not designed to meet the needs of integrated teams. We worked with practices and behavioral health (BH) clinicians to design a suite of electronic health record tools to address these needs ("BH e-Suite"). The purpose of this article is to examine whether implementation of the BH e-Suite changes process of care, intermediate clinical outcomes, and patient experiences, and whether its use is acceptable to practice members and BH clinicians. Methods: We conducted a convergent mixed-methods proof-of-concept study, implementing the BH e-Suite across 6 Oregon federally qualified community health centers ("intervention clinics"). We matched intervention clinics to 6 control clinics, based on location and patient panel characteristics, to assess whether process of care (Patient Health Questionnaire-9 [PHQ-9] and Generalized Anxiety Disorder-7 screening) and intermediate outcomes (PHQ-9, Generalized Anxiety Disorder-7 scores) changed postimplementation. Prepost patient surveys were used to assess changes in patient experience. To elucidate factors influencing implementation, we merged quantitative findings with structured observations, surveys, and interviews with practice members. Results: Implementation improved process of care (PHQ-9 screening). During the course of the study, change in intermediate outcomes was not observed. Degree of BH e-Suite implementation varied: 2 clinics fully implemented, 2 partially implemented, and 2 practices did not implement at all. Initial practice conditions (eg, low resistance to change, higher capacity), process characteristics (eg, thoughtful planning), and individual characteristics (eg, high self-efficacy) were related to degree of implementation. Conclusions: Health information technology tools designed for behavioral health integration must fit the needs of clinics for the successful uptake and improvement in patient experiences. Research is needed to further assess the effectiveness of this tool in improving patient outcomes and to optimize broader dissemination of this tool among primary care clinics integrating behavioral health.