The Behavioral Health Data Portal (BHDP) is a web application that allows for improved symptom assessment and clinical outcome tracking; put more simply, it lets clinics assess patients' symptoms in an efficient and accurate manner, also allowing them to easily track symptoms over time.
Since 2012, Army Behavioral Health departments have been using BHDP as part of their clinical assessment and have established its validity as a tool to gather patient symptom profiles. BHDP offers numerous advantages over "old-fashioned" paper forms, leading the U.S. Air Force and Navy Behavioral Health departments to start BHDP implementation in their clinics. As the Army Medical Home (AMH) is the main point of entry for beneficiaries serviced by the Military Health System (MHS), BHDP will be implemented at AMHs over the next few years.
Every adult patient with a scheduled appointment with their primary care manager (PCM) is required to be screened for symptoms of depression, anxiety, and substance abuse. Sixty seven percent of people with behavioral health disorders do not receive behavioral health treatment1 but 80 percent of patients with behavioral health disorders will visit primary care at least annually2. The goal of screening is to identify patients that may be suffering from these symptoms and provide early treatment, to prevent worsening symptoms and return patients to optimal functioning as quickly as possible.
Research has shown that many patients with medical disorders such as arthritis, hypertension, or asthma have co-morbid behavioral health symptoms3 that can affect their overall functioning and treating those symptoms can lead to improvement in their functioning. Hence, universal screening and appropriate treatment for behavioral health symptoms can benefit a wide variety of patients seen in the primary care environment, not just those with behavioral health disorders.
Identifying problems early and providing convenient and seamless treatment in primary care to improve the health of the entire primary care patient population was the impetus for the Primary Care Behavioral Health (PCBH) program and the integration of behavioral health providers into the AMH.
Current policy to screen all adult patients for behavioral health symptoms every time they see their PCM was due to the difficulty of tracking screening dates accurately with the current process via the electronic medical record (EMR). Screening during each encounter is seen as a nuisance by patients and providers alike due to the frequency and cumbersome nature of current screening methods. The current process involves paper and pencil forms that have to be hand scored, administration of secondary forms that are also hand scored, entry of numbers into the medical record, and scanning of the paper forms in the medical record.
Alternatively, patients are asked the questions verbally but may be too self-conscious to answer honestly, thus the screening is not an accurate representation of their symptom picture. A pilot study at Tripler Army Medical Center and Joint Base Lewis-McChord revealed that using BHDP to screen patients resulted in significantly higher positive response rates. People were more willing to acknowledge having symptoms when completing forms on a tablet versus on paper or when verbally asked questions. Therefore, implementation of BHDP in the medical homes will result in simpler and improved symptom screening.
BHDP has superior tracking ability, thus only requires quarterly screening. If a patient has been seen in the clinic less in than 90 days they will not have to be rescreened. Also, since many other clinics are now using BHDP, if a patient was recently screened in another clinic, BHDP will track this and that information will be available to all providers. A vital aspect of BHDP is optimizing direct patient care time.
The front desk personnel will check patients into BHDP and immediately identify whether screening is required. If needed, the patient will use a tablet/computer to access the portal and enter their responses, thus eliminating the need for hand scoring or administration of secondary forms, allowing AMH staff to focus on other aspects of the appointment. Since the transfer of BHDP data is accomplished by the licensed practical nurse (LPN) or licensed vocational nurse (LVN) through a simple cut/paste process in the EMR, it reduces the possibility of documentation errors and removes the time consuming process of scanning paper forms into the EMR. Once the data has been transferred by the nurse the PCM reviews the screening data in their note and applies the information to support comprehensive clinical decision making.
The screening process with BHDP takes approximately five minutes to complete from administration to entry into the EMR. A dedicated five minutes quarterly in the routine patient screening process can lead to enhanced assessment and the potential to improve health outcomes for a large group of patients.
As our health care delivery system continues to transition to a System for Health, the BHDP will expand its capabilities and be renamed the Health Data Portal (HDP). The expanded capabilities will provide additional support to AMHs with the inclusion or several other standard AMH screening questions to further streamline patient assessment. For example, required annual questions governed by the Joint Commission (TJC), questions about tobacco/nicotine use, medical screening questions could be asked automatically and tracked easily through this web portal. Like any new process, use of this health portal will require training and practice to optimize the work flow. However, over time using the electronic screening process will result in providers being able to better assess and treat their patients while affording the opportunity to spend additional time with them. The year 2016 has seen the beginning of electronic screening in some AMHs and by the end of 2017, I envision every Military Treatment Facility (MTF) in the Army to have at least one AMH using BHDP, complemented by the opportunity to expand this capability in support of the delivery of efficient, quality, and safe care across the Army Medical Department (AMEDD).
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