There exists an opportunity to begin to leverage technology
in such a way that we can advance collaborative care in ways only imaginable
before. Just as the Collaborative Care
Research Network (CCRN) has started increasing the effectiveness research
for collaborative care practices, new and emerging technology allows for an
advancement of research with large data sets consisting of millions of patients
and hundreds of practices. This is a "game changer" that our field must take
advantage of to begin to make a stronger research case for collaborative care.
A tale of two cities
Technology has changed
everything. Never before have we had instant access to so much at one time. Need a new
sweater at 3am? Done. Need a new car? Done. We
are efficient and we are decisive. Technology means never having to say no to
instant access to information. Everything is accessible and on our timeframe.
Wait, did I say
everything? I meant everything but healthcare.
Healthcare remains the
single largest non-immediately accessible service through technology.
Interestingly enough, the last ten years have seen a push to integrate
technology and healthcare in new and novel ways. Case in point, to be a
patient-centered medical home (according to NCQA),
one has to meet certain technology requirements, which include such things as
the Availability of
Interactive Website, Electronic Patient Identification, and Electronic Care
Management Support. Bottom line, technology is important and everyone knows it,
including healthcare stakeholders. Primary care has integrated electronic
medical (or health) records (EMR) in a way that has changed the way medicine is
practiced (hang on to this for a minute). Plus, many like the electronic
medical records adoption as it saves money in the long run.
Now, consider the following. Primary care practices range in
size and scope. However, electronic medical records are becoming pretty common
in many medical settings. And, there is no shortage of
different electronic medical records.
Herein we find a small problem. If, different practices use different
electronic medical records, how can we look across practices for themes, etc.?
As many practice-based research networks do, common questions are asked to
different practices and data is aggregated to answer the research question.
This information was collected through chart reviews, card studies, etc. Does
this change when we begin discussing electronic medical records? Possibly not
if all practices used the same electronic medical record; however, practices
are as uniquely enrolled in electronic medical records as they are in patient
demographic. So, even if we wanted to examine across site research questions
using technology and EMRs could we?
Enter DARTNet. The Distributed Ambulatory Research
and Therapeutics Network or DARTNet is a federated network of different practice with different
EMRs. DARTNet combines data from different EMRs to create a large database
(think over 4 million patient lives) capable of answering almost any question
one could ask with data from an EMR. Did I mention this was a game changer?
Now, please click over to this cow and chicken picture as you visualize and think COLLABORATIVE
Yes, the connection I am attempting to make has to do with
mental health/primary care and EMRs. You see, anytime we talk about
collaborative care, there is the obligatory mention of the incompatibility of
mental health imbedded in primary care and using medical records. Not so real
life quote, but close: "The HIPAA police will arrest me". There does appear to
be some issues here, which can be written about on another post so I will leave
it at this: to truly examine collaborative care, our field is going to need to
find a way to evaluate many of our core field specific assumptions in tandem
It may be more helpful for this post if I use a metaphor:
When you are in an art gallery and see a unique piece of art, the last thing you likely want
someone to do is to come up to you and say: "this is what the artist meant when
he created this piece..." You don't necessarily need interpretation of a specific
piece as part of the beauty of art is your interpretation of the piece.
DARTNet, technology, collaborative care, research it is all the same thing. I
can tell you what could come from such relationships but would that really be
what is best for you and "the piece?" I would encourage each of you to read the
Pace, W. D., Cifuentes, M., Valuck, R. J.,
Staton, E. W., Brandt, E. C., & West, D. R. (2009). An Electronic
Practice-Based Network for Observational Comparative Effectiveness Research. Annals
of Internal Medicine, 151(5), 338-340.
For collaborative care to grow, technology is something we
must grasp. To this end, without taking advantage of technology and research
simultaneously are we relegated to the sidelines? I refuse to sit by and watch
while everyone else has fun and makes a difference along the way - you?