Behavioral health has generally lagged other healthcare sectors in the implementation of technology to aid care. For example, while acute care hospitals and specialty practices had very high EHR adoption rates (87-96% in 2019 and 70-96% in 2017, respectively), psychiatric hospitals and practitioners had only 49% and 61%, respectively. Initially, much of this had to do with limited reimbursement and the failure of legislation to include behavioral health – particularly community behavioral health centers – in the incentives for its use and funding for its purchase.
So, while the ROI was well documented, adoption remained slow due to the steep cost and disruption it created. Less attention was paid to the impact on clinical staff. They often argued that the use of an EHR “interfered” with their treatment. (Research says the opposite is true – once the clinician is trained on the technology and how to make it part of the clinical process.) Many continued to write paper notes for “later” entry into the EHR. Centers struggled with this dramatic shift in practice.
Telehealth was met with similar resistance, as centers saw the benefit of this delivery platform for rural and underserved communities where clinicians were in short supply. Clinicians argued that – like the EHR – the telehealth approach was not conducive to an effective therapeutic relationship. Again, despite the research to the contrary, resistance was high.
COVID changed that calculus in a way that is instructive to how we need to approach the implementation of technology in the behavioral health space. Much of the ROI discussion around these technologies has focused on their value to organizations – increased efficiency, ability to bill more accurately, the ability to receive reimbursement more quickly, decrease in needed facility space – and to their clients – easier access to their records, to appointments, less travel, and in some cases greater comfort by being at home rather than in an office. But what about the clinician? What’s in these implementations for them? What COVID showed us was how important that consideration is in an implementation.
As the shutdown took hold, clinicians found that having an EHR and telehealth capability meant they could remain employed and flex their hours to accommodate caregiver responsibilities. For a workforce that has many women (who bore the caregiving brunt of the pandemic), these were valuable benefits to the technology they had previously resisted, or at best previously just disliked. Clients continued to benefit from the technology, and many who had previously not used it now found it a lifeline. Its use soared. Centers continued to benefit from having revenue, and to better manage crisis patients and the surge in behavioral healthcare demand.
Looking ahead, organizations should capitalize on the new confidence that clinicians and clients have developed in the use of technology as they embrace new digital tools beyond telehealth. Also ahead is an increased demand for measurement-based care. This will mean that assessments will be more structured and result in metrics that will then measure progress; it will mean that treatment will include more digital aids, and outcomes will be tied to data. Clinical pathways, a staple in physical health, will gain greater traction in therapeutic modalities. Computer-assisted treatment will also increase. And there will be a greater number of apps for self-management of mental illness and addiction.
As these new digital tools can be of great benefit to organizations and to clients; they can also be of benefit to clinicians. Among the lessons of the pandemic is the shifting workforce expectations as work-life balance has taken on greater importance as a contributor to recruitment and retention. Data shows that the hybrid workplace is likely to remain a staple across industries. At the same time, workers want to feel that their work is meaningful. Frequently, clinicians highly rate pride in the good that they do at work when responding to engagement surveys. Linking the digital tools that we implement to that “good”, demonstrating how the effectiveness of their work is enhanced (as opposed to the digital tool replacing the value they bring) will be critical to their successful adoption.
The ability to show clinicians the impact of their work, and how the use of these digital tools has enhanced their effectiveness, builds engagement graphically and through metrics. Likewise, ensuring that the use of these tools creates efficiency that promotes better use of their time and better accommodates their other responsibilities (e.g., family and caregiver responsibilities) and interests will be critical to adoption of the tools but also to retaining staff and building satisfaction.
Organizations that successfully implement these tools will choose wisely among the growing array to ensure the tools they select add as much value to the staff as to the client. They will expend the time and resources to make sure staff understand the tools and how they enhance their role as experts in the field, and how to most efficiently use them to maximize their benefit. It has long been said that taking care of clients requires that we first take care of staff. We should keep that in mind as we implement new technology.
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