Overview

Allina Health implemented an EHR-integrated psychiatric eConsult service in an effort to provide support for primary care providers (PCPs) in treating patients with mental illness.

Organization Name

Allina Health

Organization Type

• Integrated healthcare system/network

National/Policy Context

• In the U.S. healthcare system, primary care takes the lead in identifying and treating mental health disorders due to increased accessibility, lower stigma, and ease of treatment in the primary care setting.
• However, primary care providers (PCPs) often struggle to meet high demand for mental health services, as they are overburdened in the clinic, poorly equipped to deal with certain mental health disorders, and lack access to specialists for referral.
• PCPs increasingly rely on eConsult services, which allow PCPs to seek out specialists with specific expertise via a shared EHR or web-based platform.

Patient Population Served and Payor Information

• Allina serves geographically diverse patients: 20% of patients patients are from rural areas, 15% from urban areas, and 62% from suburban areas.
• 16% of patients are Medicaid beneficiaries, 19% are Medicare beneficiaries, 60% are commercially insured, and 5% are uninsured or covered by a different payer.
• The patient population is composed of 80% White patients, 7% Black patients, and 3% of Hispanic/Latino ethnicity.

Tech Involved

• eConsult/eReferral
• Electronic medical record

Team Members Involved

• NPs
• PAs
• Physicians

Workflow Steps

• When a PCP decides that a patient requires psychiatric consultation, the PCP can order an eConsult within the EHR on behalf of the patient.
• The EHR routes eConsult requests through the psychiatry pool from one of Allina’s service regions (Allina has seven service regions).
• Psychiatrists respond to the eConsults as they are received. They review the records and respond with treatment recommendations within one business day.
• The PCP implements the recommendation, taking into consideration the patient’s history, current clinical status, and preferences.
• Although designed as a one-time interprovider consultations, PCPs and psychiatrists can continue to communicate if necessary.

Budget Details

• Financial incentive for participating psychiatrists (~$50 per consult or 0.75 wRVUs)
• Note: patients are not billed for the service, so organizations must consider the cost of time of spent by both the PCP and psychiatrist for this service.

Where We Are

• The use of eConsults for psychiatric consultation started in August 2015 and is ongoing.

Outcomes

• PCP perceptions: Researchers evaluated PCP perceptions before and after eConsult intervention via survey evaluation. All PCPs were invited to participate in both surveys.
  • 17% improvement in perceived support for diagnosing mental health problems after intervention implementation.
  • 24% improvement in perceived ease of obtaining a consultation after intervention implementation.
  • There was no change in PCPs’ perceptions of skills for treating depression
    • PCPs at baseline reported high levels of confidence and skill at treating depression.
  • eConsults were viewed as an efficacious tool for managing chronic disorders and medication titration.

Future Outcomes

• Innovators plan to evaluate the ways that psychiatric eConsults affect patterns of mental health service use in general.

Benefits

• The use of psychiatric eConsults improved PCPs’ perceptions of support around diagnosing mental illness and ease of obtaining psychiatric consults, both of which are beneficial to patients with mental illness.

Unique Challenges

• Study limitations included:
  • There was difficulty assessing how quickly patients could access mental health services or the frequency of consultation with a mental health specialist.
  • There was a low survey response rate.
  • The study did not link survey responses to use of eConsults.

Sources

Golberstein E, Kolvenbach S, Carruthers H, Druss B, Goering P. Effects of electronic psychiatric consultations on primary care provider perceptions of mental health care: Survey results from a randomized evaluation. Healthc (Amst).  2018 Mar;6(1):17-22. doi: 10.1016/j.hjdsi.2017.01.002. Epub 2017 Feb 2. PubMed PMID: 28162990.