Use of technology for care coordination initiatives for patients with mental health issues: a systematic literature review

Figures & data

Figure 1 Flow diagram of selected studies.

Table 1 Characteristics of studies that identified barriers to care coordination

Reference	Study objective/goal	Diagnosis	Type of center involved in care coordination	Technology used to facilitate care coordination/specific technology used	Findings
					Benefits	Barriers
Callahan et al^Citation18	Describe the experience in accomplishing a collaborative care program for dementia and late-life depression in a primary care setting	• Dementia • Depression	• Aging Brain Care Medical Home • Nurse practitioner with interdisciplinary team	• HIT • Laptop with wireless access to Internet and intranet, EHRs, Web-based tracking system, telephone/e-mail system	• Patients in intervention group more likely to rate their primary care as very good or excellent • Patients had far fewer neuropsychiatric symptoms at 12 months • Significant improvement in distress of caregivers	• Lack of financial resources, space constraints, patient flow, cultural barriers • Many times other chronic conditions among adults take priority over mental health
Cifuentes et al^Citation19	Focus on use and challenges of existing EHR systems to deliver integrated care and the HIT solutions that emerged in the process	Emotional/behavioral problems	• Primary care clinics • Community mental health centers	• HIT • EHRs	NA	• EHRs generally lack features essential to support key shared care plan templates for behavioral and primary care integration • Tablets not interoperable with EHRs • Two separate EHRs for primary care and behavioral health lead to duplicate documentation
Fortney et al^Citation20	Inform the design of future informatics systems that support the chronic care model	Depression	• Depression Chronic Care model • Depression care managers	• HIT • Web-based clinical decision support system (NetDSS)	• The NetDSS facilitates identification of new trials, treatment phases, and outcome milestones such as nonadherence, treatment response, remission, and relapse • Assists in patient registry, encounter scheduling, clinical decision support, and progress notes • Provides evidence-based depression care management	• NetDSS does not support multiple chronic illnesses • Patients with comorbid psychiatric conditions remain a challenge • Future clinical information systems need to be designed around the needs of patients instead of treatments for specific illnesses
Jones and Ku^Citation22	Understand to what extent integrated care is occurring for health center patients with behavioral health conditions	Mental health and substance abuse	• Community-based health center • Primary care centers	EHRs	Medical and behavioral health providers at most health centers shared access to patient information	• Restrictions on same-day billing for medical and behavioral health services • Staffing costs and health information technology implementation costs
Jones and Wittie^Citation21	Understand the interaction between community-based transformation efforts and federal- and state-level initiatives supporting HIT adoption to inform future policy	NA	Community health centers (Beacon vs non-Beacon)	• HIT • EHRs	• Health centers in Beacon communities were more likely to have an EHR system installed and in use compared with health centers not located in Beacon communities • Use of EHRs with basic quality and safety features, and use of advanced HIT functionalities to exchange health information grew faster in Beacon health centers	• Lack of infrastructure investment at the community level for interoperable HIT care coordination • Lack of reimbursement and IT technical support
Reitz et al^Citation23	Report the effects of EHRs in primary care settings with integrated behavior health services and physician satisfaction with these EHRs	NA	Collaborative Family Healthcare Association	EHR	• Long-term efficiency and a more complete record • High satisfaction with EHR billing, scheduling, interdisciplinary communication, documenting, and screening for mental health • EHRs brought more value to interdisciplinary communication	• Initial time consumption, steep learning curves, and difficult-to- navigate templated notes • Lack of chronic illness registries and confidentiality • Poor satisfaction with screening for mental illness
Wodarski and Green^Citation24	Use Internet-based interventions to provide substance abuse information with feedback on individual drug patterns, prevention, treatment intervention, and referrals	• Substance abuse • Mental health disorders	Regional mental health system	• HIT • Internet-based intervention	• Alcohol and drug use declined significantly • The number of participants on parole or probation fell significantly over the course of the program • Decrease in the number of days patients experienced serious depression	• Patients had limited access to technology (computers) • Poor internet connection in rural setting
Zeman et al^Citation25	Evaluate an automated behavioral health assessment instrument for feasibility, acceptability, utility, and longer-term sustainability in urban primary care settings from the perspectives of physicians and patients	NA	Primary care clinics	• Personal digital assistant • Web-based computerized behavioral health assessment	NA	• Uncertainty regarding what types of devices to use (computer vs tablet, etc) • Lack of patient engagement and willingness to take a psychiatric assessment in the primary care setting

Abbreviations: EHR, electronic health record; HIT, health information technology; IT, information technology; NA, not applicable; NetDSS, Net Decision Support System.

Table 2 Characteristics of studies not identifying barriers to care coordination

Reference	Study objective/goal	Diagnosis	Type of center involved in care coordination	Technology used to facilitate care coordination/specific technology used	Findings
Fortney et al^Citation26	Compare processes and outcomes among patients with depression treated at intervention and matched control sites and determine whether the intervention was cost-effective in routine practice	Depression	• VA health care system • Community-based outpatient clinic • PCPs, depression nurse care manager, an off-site psychiatrist, telepsychiatrist	Telemedicine (telephone, interactive video, EMRs, and Internet)	NA
Galambos et al^Citation27	Detection of early illness and clinical management of behavioral health issues using sensor systems	• Dementia • Depression	Independent living facility	Density-mapping technology (passive sensor system, passive infrared motion sensors to capture events as people move around their home)	Density map changes can help prompt health care providers to conduct mental health assessments and intervene to prevent or delay changes in mental health status
Gardner et al^Citation28	Use a computerized screening system for youth to detect suicidal thinking and coordinate care between a primary care center and a behavioral health network to help examine factors that might explain which at-risk youths received mental health services	• Depression • Suicide • Injury risk • Substance abuse	Primary care centers	• Screening technology • Wireless tablet computers	• Even when adolescents knew a physician would see their answers, they still disclosed suicidal thoughts when screened in a primary care setting • Web-based computerized suicide screening helps facilitate rapid contact with a social worker, triage the case, and then connect at-risk patients to a specialty mental health care system
Glowa-Kollisch et al^Citation29	Use EHRs to gather enough data to detect vulnerability among patients who can be subjected to abuse or neglect and promote human rights in the correctional health setting to help link cases of abuse and/or violence	Mental illness	Correctional health system	EHR with custom templates for injury, mental health encounters, drug and alcohol withdrawal, and mental health discharge	EHR allows the promotion of human rights by detecting vulnerable populations and reporting on adverse outcomes
Kalton et al^Citation16	Simulate real-world examples of coordinating care across larger systems for patients with serious mental illnesses	Serious and persistent mental illness	NA	Agent-based simulation model	• Simulation of coordinated care demonstrated improvement in patient transfer between providers (handoff success) • Improvement in patient medication adherence • The use of an agent-based simulation model helps represent complex ways in which patients engage with medical and social ecosystems
Pomerantz et al^Citation30	Use the open-access model (ie, all patients receive care on a walk-in rather than scheduled basis) to incorporate mental health care to primary care systems and provide full spectrum mental health advice at the first visit	Mental health	• VA medical center • Community primary care center	• EHR • Portable electronic touch pad	NA
Quanbeck et al^Citation31	Describe a protocol to evaluate the implementation of an e-Health integrated communication technology (Seva) within primary care centers	Substance abuse	• Community health centers • Primary care centers	• Mobile health technology • TES, a Web- and mobile- based curriculum for addiction treatment • Smart phone • EHR	• Using Seva in a manner that promotes integrative care will financially benefit federally qualified health centers • Mobile technology to support the treatment of substance use disorders provides a cost-effective means to improve the lives of patients with drug and alcohol problems
Ryan et al^Citation32	Improve care coordination with the use of technology as a tool to reduce health care use in a population of high-risk veterans with high-cost treatment	• Chronic conditions • PTSD • Schizophrenia • Mental health	Veterans integrated service network of hospitals and community primary care centers	Telemedicine (audio/video units, video phones, personal computers with Internet access, Polaroid cameras)	• High patient satisfaction and acceptance using technology without difficulty • Improved perception of physical and social functioning
Siddharthan^Citation33	Provide medical care coordination to veterans with war-related injuries distantly; help improve quality of care while reducing the use of the VA health system	• Traumatic brain injury • PTSD	• VA center • Advanced nurse practitioner	Telehealth rehabilitation	NA
Studies designed to compare collaborative care vs CAU
Fortney et al^Citation12	Adapt the collaborative care model for small primary care practices without on-site psychiatrists	Depression	• VA community–based outpatient clinics • PCPs • Consult telepsychiatrists • Depression nurse care manager • Off-site supervisor psychiatrist	Telemedicine technologies (eg, telephone, interactive video, electronic medical records, and Internet)	• Successful collaborative care models can be implemented using primary care clinics lacking on-site psychiatrists • Collaborative care provided significant improvements to medication adherence, depression severity, mental health status, and quality of life
Huijbregts et al^Citation9	Establish effectiveness of a target-driven collaborative care model for major depression using a Web-based decision aid and consultant psychiatrist to enhance the efforts of health care professionals in small-scale primary care practices	Depression	Primary care clinic	Web-based decision aid	• Target-driven collaborative care for major depression in small primary care practices can be very effective • Web-based tracking and decision aid algorithm with follow-up by psychiatrist is promising
Ma et al^Citation34	Test intervention effectiveness of the RAINBOW trial to evaluate the cost-effectiveness and implementation potential of an integrated, technology-enhanced, collaborative care model for treating adults with obesity and depression in primary care	• Obesity • Depression	Primary care clinic	Health information technology (Fitbit pedometer, Fitbit website, or mobile application and log using MyFitnessPal, which the coach can use to monitor progress and videos)	A video program for weight loss with collaborative depression care was successfully integrated while leveraging low-cost, wide-reaching health information technologies
Rollman et al^Citation35	Test the effectiveness of providing CCBT and ISG embedded within a collaborative care intervention	• Depression • Anxiety	• Primary care clinic • Care manager	CCBT via personal computer or smartphone	Significant increase in mood and anxiety symptoms for CCBT vs CAU

Abbreviations: CCBT, computer cognitive behavior therapy; EHR, electronic health record; EMR, electronic medical record; ISG, Internet support group; NA, not applicable; PCP, primary care physician; PTSD, posttraumatic stress disorder; RAINBOW, Research Aimed at Improving Both Mood and Weight; TES, therapeutic education system; VA, Veterans Affairs; CAU, care as usual.

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